dtiM^^y aoom Ci)e Hibtatp otti}e Ditttston of ^tmh affairs (Ilnit)et0itp of I0ortii Carolina Iffifl:. iwr . m.m. Digitized by tine Internet Arclnive in 2009 witln funding from Nortln Carolina History of Health Digital Collection, an LSTA-funded NC ECHO digitization grant project http://www.archive.org/details/essayonpositiondOOjohn AIV ESSAY ON THE POSITION AND DUTIES OF THE MEDICAL PROFESSION IN THE MIDDLE OF THE NINETEENTH CENTURY. BY CHARLES E. JOHNSON, M. D. OF KALEIGH, N. C. RALEIGH: PRINTED AX THE OFFICE OF THE RALEIGH REGISIEK. 1858. PREFACE This Address was prepared to be delivered in Edenton last April, at the Annual Meeting of the State Medical Society ; but circumstances of a pressing nature prevented my atten- dance on that occasion. The above statement will account satisfactorily for the matter of the Address, and, to some degree at least, for the manner of it; while the following facts will, I trust, fully justify its appearing now in pamphlet form. Shortly after the adjournment of the Society in April last, at the solicitation of several friends who were pleased to insist that its publication would "5e of decided benefit both to the profession and the publie,'' I sent the Address to be published in the first number of the North Carolina Medical Journal, which was expected to make its appearance in a few months. For good and sufficient reasons, however, the first number of the Journal never was issued, and now I am again urged by these friends, and by some others, to bring this Essay before the public. Under these circumstances, I have concluded to publish it in pamphlet form, and in its original character of an Address from the retiring President of the State Medical Society. CHARLES E. JOHNSON. Raleigh, N. C, January, 1858. ADDRflSS. Gentlemen of the Medical Society of the State : It has been the custom for your retiring President, before leaving the chair, to address you upon some sub- ject connected with the interest and welfare of our beloved profession. I do not feel at liberty to depart from so honorable a precedent. Therefore, notwith- standing my time has been mainly engrossed by thoughts and efforts more eminently practical than theoretical, and notwithstanding, also, the very eloquent address, somewhat in connection with the subject of this dis- course, delivered before our Society twelve months ago, by my talented young friend. Dr. Edward Warren, I hope I shall not be considered presumptuous in commending to my professional brethren, especially to the younger ones among us, the following views for their consideration, for I, too, was brought up at the feet of Gamaliel. The middle of the nineteenth century. Gentlemen, finds us hurried along with that advancement of all the arts and sciences, and material improvement of mankind, so eminently characteristic of the age and country in which we live ; and the true disciple may contemplate, with pleasure amounting almost to delight, the wonderful progress and practical improvement that the medical sciences have made in the last fifty years in respect to the material welfare of suffering humanity. Nor need he shut his eyes to the fact that the moral and ethical relations of the profession have not been neglected amid the general movement. Under existing circumstances, it is impossible for them to have been overlooked. Constituting a most important part of the 6 seiences of morals and mental philosophy, in all their valuable relations with the pursuits and happiness of human life, they are, as objects of general interest, receiving their full share of the public consideration. Yet it cannot be denied that the bare fact of the sub- jects of metaphysical theology, religious doctrines, for- mulae and ceremonies, and ecclesiastical government and authority being found mingled with this current of events, is considered by some as an evidence of the sui- cidal progTess of civilization. This is worse than a mistake sim^ply; there is a degree of Vandalism in it; for as it is mischievous politics, because it is bad citi- zenship, to despair of the commonwealth, so is it both more unphilosophical and anti-christian to despair of the ultimate triumph of unfailing wisdom and eternal truth. There is no danger that " the wisdom of cen- turies will be overturned " universally. It is only the dust and rubbish that will be swept away ; while we shall advantageously become more and more enlightened as the mind advances to tlie attainment of higher and more comprehensive views of Nature and of Nature's God. Inaccurate and imperfect knowledge, handed down from one generation to another, constituting tra- ditional information, may be quite as pernicious in morals and religion as it is known to be injurious in physical philosophy; because, as in the latter case, it certainly perpetuates error with the obstinacy engen- dered by the evidence of ill-observed facts and popular prejudice, so in the former, being subjective to the pre- established opinions of others, it is eminently capable of hindering the mind in its efforts to comprehend and appreciate those great psycological principles and truths, which conclusively show that the theology of the Bible, being the word of God, and the theology of Nature, bemg the work of God, must be ulthnately one. It is as vain and foolish, if not wicked, therefore, to imagine that the more we learn to comprehend and thoroughly understand the teachings of the Bible, the less we shall venerate, love and adore God, as it is ridiculously absurd to suppose that nature will by degrees lose a portion of the charm and magic of her power, as we learn more and more how to unveil her secrets, and to comprehend her laws. Each, in itself, but harmoni- ously with the other, is in fact, a perfect revelation of Almighty power, and wisdom, and goodness, and mercy ; and it is man's bounden duty, therefore, by dihgence and research, to learn, as far as he i^ capable of doing so, to comprehend and appreciate both of them, since God never designed to conceal Himself, either by word or deed, from any one of Eis creatures, nor to constitute only a few of them the sole recipients of that knowledge of his power, and wisdom, and goodness^ and mercy, which was intended equally for all. Then I shall not occupy your tune in discussing this question with such '^hopeless and helpless" speculators in the realms of thought and feeling and duty. They do not see that such inquiries are the natural consequences of that mighty upheaval in the moral and intellectual world, which is going on around them, and that it is on that account they are occu]3ying the thoughts and pens of a large and influential portion of every enlightened community. Nor have they learned that indiscrimi- nate reliance on authority no longer exists ; and that all blind followers of the blind must suffer the conse- quences of sapless stupidity, or self-confident bigotry. The present age being eminently distinguished by its 8 progressive tendency, there is not only a rapidly decreas- ing disposition to reliance upon jprescriiAioyi and au- thority, but so far as it remains, a,ccording to my obser- vation, it depends more on personal regard and confi- dence in the individual, than upon any general or special acknovvdedgement of prescriptive right. Every thing now is presumed to be capable of improvement ; and, in consequence, every thing is subjected to the most careful and searching scrutiny ; its foundations are examined, its truths tested ; and wherever a dispo- sition to oppos3 free inquiry, no matter by what name it may be called, or an inclination even to cling too closely to the past, is discovered to exist in regard to any subject, or fancied to exist, on the part of those connected with it, there will inevitably follow, general distrust and want of confidence. To assume the con- trary, and attempt to maintain confidence by authority only, would expose any man in this age, no matter what his position or calling, to both censure and ridi- cule; and rightly too, for both experience and right reason have abundantly proven that oppression, either physical or moral, is not the fixed fate of man. It is true that superior physical power may, for a time, give some the ascendancy, and superior intelligence may attain its destined eminence, although its possessors, for a time, exercise their power unjustly, oppressively, creating a state of things in which, by the aid of brute force, in the one instance, those of inferior condition have risen at the expense of those of superior intelligence, while in the other, superior intelligence, diverted from its legitimate purposes of wisdom ani usefulness, has degraded and afflicted those who rank below it, in an inferior condition. Bat neither of these conditions of 9 oppression constitutes the fixed and determined state of man In this world ; because eo.ch violates the eternal ]jimCiples of dath nnd jujtice, in being antaf^oniscic to the /floral i7hj_^roveme:it and material irelfare of ilie ma" jori'y. And so, OL.r present high a ^ advanced state of civiiisadon cler^'^y d^n-onstrates ttc there are demo- cratic Timciples a\ the arts and sciences, underlying the republic of letters, just as thre a^e aerno^ratic principles in politics, undeilv Lig the conmionwerlui of governments ; and that, as in the case of the latter, there '^ nc ^nst powers save those derived from the coi:sent of the governed, so in the case of the former, there is x :> proper authority or prescriptive right above and independent of those who support it. In other words, just as the safety and welfare of the citizen should be, as regards all gcveminents, a paramount consideration with the state, so should the safety and best interests of the patient, as regards the practice of medicine, be the chief concern of the medical profession. Now, I have a '' relfs^ sense " that too much reUance upon the Doctorate, without duly qualifying ourselves for the onerous labors and responsible duties of the medical scholar and practitioner, has scarcely left to the individual members of our profession, merely as such, the prestige even of that oracular air and magisterial au- thority, which gave them once a sort of dictatorial power over the minds of men in their peculiar vocation, resembling that possessed by the priest at the confes- sional. But we cannot complain of society for this ; Ave must blame ourselves ; for I shall pr^^ocntly show that the prc^^sing wants and necessities of every enlight- ened state and community actually require of the medi- cal man to take a more responsible and useful position 10 in society than formerly, just in proportion as civi- lization spreads, and the masses become enHghtened. But if Ave have neglected to improve the advantages which civilization offers, by failing to possess ourselves of that full amount of useful kno^yledge which the present advanced state of the medical sciences furnishes to every earnest student and diligent cultivator of the profession of medicine, whose fault is it ? Under such circumstances, can we reasonably expect of society to . tolerate our short-comings ? or shall we importunately seek of the body politic those ad\'^ntitious aids and helps which we should not need if all of us did our duty? Indeed, must we think it strange, while this is found to be the case among those who were once looked up to, on account of their profession only, as oracular and infallible, if distrust should creep in, and even the actual amount of our certain knowledge should come to be undervalued ? " There is no self-sustaining power," says an eminent writer, "in any form of social organi- zation. The only self-sustaining power is in individual virtue." Then, as the old claims of authority, to which we ourselves ha,ve clung much too long, longer in fact than many of us are fully aware of, are rapidly, and, as I believe, justly losing their influence, and passing away, we must attain to greater individual excellence, by increased acquirements, and by a more comprehen- sive and unselfish discharge of duty in the responsible position which the age assigns our profession, if we desire to establish a solid appreciation of our worth in the minds of those whose good opinion it is our interest, as it should be our happiness to obtain ; or, if we hope to escape becoming the victims of civilization. 11 That most remarkable man, the Emperor of the French, in his late speech opening the legislative assem- bly of France, said : " Civilization, though its object is the moral improvement and material welfare of the majority, advances, it must be admitted, like an army ; its victories are not gained without sacrifices or A\4thout victims." This is most true ; but while I am ready to admit that individuals, commerce, and even states are sometimes throAvn out of gear by the rapidity of this universal movement, I am also prepared to show that, under a wise employment of natural circumstances and the advantages which progress and improvement offer us, prosperity is not suicidal, but capable in an eminent degree of promoting ^'the moral improvement and material welfare of the majority." But, you will ask, how shall this be accomplished in regard to the profession of medicine ? Listen ; and I mil present you some hasty sketches of real life, or panoramic views, as it were, of the moving multitudes that compose this advancing army of civilization, and therefrom endeavor to draw lessons of "s^dsdom, that shall in their application, be a full answer to your inquiry. The electric wires, railways and steam navigation, those rapid means of communication between the ends of the earth ; machiner}', new currents of trade, the influx of gold, the indefinite expansion of credit, and other elements of unprecedented prosj^erity — in our own country especially, the incalculable benefits of civil and religious freedom, a free press and free schools — leave many unfortunates far behind, and aground, high and dry, demanding in vain that circumstances shall be adjusted to suit their characters of indecision and want of capacity. , Leave them alone. They are veritable 12 old fogies whom the current of events has thoroughly enasculated, so far as the practical pursuits and useful purposes of life are concerned. Again ; there are some who join in the forward move- ment of the armj^ of civilization, with objects of pleas- ure only, and who, by adventitious aids, keep time with lU progress for a while ; but, having led wastefully ex» travagant, idle and luxurious lives, without one single Self-sustaining mortal or intellectual principle for the propet* l^egulation of human conduct, their existence is an unnatural and feverish one, and they soon become laggards, from exhaustion of mind and body, and in their weakness are run over by the moving masses and trampled under foot as the very dung of the earth* Let them go too. They deserve their fate ; for in their lives they iiave only served to point a moral or adorn a tale, by throwing away blessings and opportunities which humbler and wiser men would have rejoiced in, as affording them the means of extended usefulness and beneficence. And again ; there is another class, the members of which make haste to get rich, or to obtain place at any Bacrifice of justice, truth, right, reason and humanity, fojr the purpose of having wealth or power that shall minister to their pride of heart and mere sensual grati- fications, forgetting that man is not placed in the world of sense alone, but that the essential root of his being is in God, and that whatever man does, so long as he does it for himself only, as a finite being, and through his own counsel for his own purposes, it is vain, and wicked, and foolish, and will sink to nothing. Yielding to one of the grossest, most debasing priticiples of human nature, and one which will be sure to reveal 13 itself in their outward lives^ tliey incur tli^ Inifailing tualediction of the Wise man, '' that he Who mahetli ha-^ie to he rich shall not he innocent,'' and that " lie that trusteth in his own heart is a fool!' These persons whom fVuition disappoints, complain even of success, and gen- eMly act out their part in life, by becoming giddy^ intoxicated, from the insane pursuit of, and thoughtless^ wicked devotion to, the god of their idolatry, and are piresently thro^vn reeling, tottering, tumbling headlong irom their course, to rise n'^ more, but to " die as the fool dieth." Let the dead bury their dead; we take care of the livino:. But, on the other hand, there afe those who are convinced that human nature was certainly made for greater things than the mere enjo}nilent of sense, since it is capable of nobler advancements by the constant exercise of wdsdom and virtue; and Vvdio believe that man shall he and do something in his temporal life, the remembrance and reality of which shcJl not only be left behind him as a monument of his usefulness, and as a beacon light to guide those who follow after him, but the genuine spirituality and Unselfish grandeur* of which shall fit his outward finite life, with gladden-- ing consciousness, to taste of the unspeakable joys and glories of the infinite. They believe that the Image of* God, the Diviiie Idea, which constitutes the chiefest element that lies in the essential nature of man, ren-* dering it capable of use filllless, grandeur and happiness^ must become with them a fxed idea, an unchangeable principle, pervading and determining all their inward thoughts and outward actions ; that throughout their* lives they must be accolnpanied by the indestructible consciousness that God's purposes are accomplished, and 14 his work acliievecl through the instrumentahty of men ; and therefore, that they shouht always look, in every pursuit and occupation of life, whether of the high- est or lowest, to an enlightened and properly cultiva- ted understanding and a genuine christian consciousness for proper counsel, and implicitly follow its guidance as the only true wisdom that can ensure them prosperity, power and peace. It is generally true, perhaps, and should be universally so, man being a rational creature, endowed with an imperishable soul, that human char- acter and conduct are formed and governed by fixed rules and precepts ; and so, it must be admitted, that just in the proportion that men are possessed with the conviction that in them and by them, God's work on earth shall be achieved, and his will accomplished, just to that same degree will they become immovably con- vinced that the whole material world, with all its adap- tations, and ends, and in particular the life of man in this world, are only so many means in themselves to be used by them for God's wise and merciful purposes in promoting "the moral improvement and the material welfare of the majority." And, as the consciousness of responsibilit}^ is more eminently a moral than an intel- lectual element of the human mind, it follows as a known result, that in proportion as responsibilities are felt, position will be appreciated ; and, therefore, that every true man will rise equal to emergencies, just iii4te proportion as he realizes the sense of responsibility and the sense of position. Then, no matter what their occupation in life, whether engaged in the cabinet or the field, in the laboratory or the workshop, whether hus- bandmen, artizans, or professional men, being possessed of all the necessary elements of successful enterprise, 15 important usefulness and distinguished merit, they will be instant in and out of season, laboring faithfully under the impulses of an enlightened self-interest, regu- lated by a well directed regard for the interest and welfare of others, and a conscientious observance of the revealed truths of eternal »\yisdom and justice. Then will the essential element of the nature of men, the Image of God, necessarily reveal itself in their outward lives, shine forth in all their thoughts, desires, and acts, and become their unvarying and unalteraljle character, which will be much .more respected and venerated than '=Tlie shadows Tliat Icccp the keys of all the creeds." Yes, these are the true representative men of the age, whose maxim is, '" Nmiquam non parafus^ lahoraregue est orare, ac forti et fideli nil difficile^' and who, when they are understood, will receive the full and perma- nent conMence of mankind, because they are capable of conferring the most desirable benefits upon them, as well in mitigating human suffering, as by multiplying their rational enjoyments. Now, gentlemen, look at these pictures, which are nothing more or less than sketches of leal life, presenting the only rational view of the movements of civilization, and tell me vdiich is Satyr, which Hyperion ; and then tell me also, with which class the members of the medical profession should always be found ; luider which stand- ard, with reasonable hopes, they may expect to be always able to march fcjrward in the discharge of the onerous and responsible, but invaluable duties of their high and benevolent calling. In the anticipation of a glorious future, can you hesitate under which banner you will enlist ? If you doubt, an attentive considcra- 16 tion of what society requires of every medical man who claims its confidence and support, will readily r oint out to you, not only that your proper place is m tho foremost ranks, but it vfill likewise teach you that you must there struggle manfully, shoulder to shoulder, with the philanthropists and philosophers of the age ; for, among highly civilized nations, the medical man has become a necessary part of the social, moral and political condition of the people. This makes the science of medicine emphatically the science of human nature, and imposes upon the profession proper, a role of duties commensurate with the most comprehensive schemes for the promotion of the best interest and welfare of humanity. Consequently, medical men are expected to strengthen their minds by diligent, earnest cultivation ; to develope them in the widest range of practical and scientific attainments ; and more than all, to consecrate them in their strength and fullness to the loftiest aims and the most beneficent purposes of use- fulness. " 2 hen give jpiJace to the 'physician^'' for it may be asserted, without the fear of contradiction, that the medical man being the recognized cultivator and applier of the sciences of human nature, has a mighty future mission to fulfil towards sufiering humanity. But to enable him to fulfil this mission, he must not only be prepared with learning and wisdom to discharge the arduous labors of his calling, but he must be v,^ell-bred, kind, considerate, attentive, enduring, patient, forgiv- ing, firm ; in a word, he must think like a philosopher, feel like a woman, and act like a hero. Then he will be admitted to the fullest confidence, and be made the depository of secrets that bind together the whole fabric of society \ aye, the wise counselor, in its pux^poses of 17 usefulness and beneficence, of the stat(.^ itself. Indeed, is that not the case now with the deserving pliysician ? And does he not now occupy a position of singular inliu- ence and great moral power, such as the priest once held, with this advantage, that he is placed in that situation by society itself as a legitimate result of civili- zation, because, from the nature of his studies and the research of his art, he reads more deeply into the human heart, and wisely penetrates into its inmost recesses ; whereas, the priest, assuming to rule by Divine Rlght^ demands implicit obedience and an entire' surrender of our reasoning powers to what he asserts to be the mandate of Heaven, which he is especially delegated to proclaim. Yfhile ministering to the body the physician is exploring the mind; for io him alone do men speak without the least reserve, candidly, and jx^rhaps with even more than candour. Moreover, the phenomena presented by the human body, in health and disease, are most complicated in their character, being the o mbined result of every physical law, perhaps, which is found operating elsewhere in nature, and of two other pecu- liar elements of power, nerve force and mind, that are ^' mightier than all, overtopping, complicating all ; working now in harmony, now in discord, but always w^orking with them all," to elaborate the phenomena of humanity, which the medical man must study, as well in health, when all nature seems to smile upon us, as in disease, when known influences are at work against us, or when unknown ones, that " walk in darkness and waste at noonday," seem plotting our destruction. And, if the grosser agency of the body, reacting constantly on the complex and delicate operations of the mind, chances to 3 18 destroy its otherwise beautiful proportions and consen- taneous actions ; or if, on the other hand, the mind being disturbed in its healthy disposition and exercise, or de- formed, perhaps, in its original constitution, should be- come the disturber of the lawful and harmonious actions of our physical natures ; who will be expected above all others to make both mind and body equally the subjects of his most anxious study and careful exposition, but the conscientious and enlightened physician ? Tiie duty is a high and responsible one, and he who hopes to dis- charge it wisely, faithfully, must have a w^orld-wide philosophy, embracing within its comprehensive folds all races, ranks, conditions and intellects ; in a word, the wdiole phenomena of humanity. He must not only be able to expound and apply the laws of physics and physiology, pathology and therapeutics, but he must become a psychologist, a seeker and teacher of those great ethical truths and moral duties, which are fool- ishly thought by some to belong to the students of metaphysics and theology only, notwithstanding rea- son and the noral sense both proclaim that the sepa- ration of psychology and physiology is an unnatural divorce of those things which God has wisely and mercifully joined together. Hence it is the medical man's province to assuage human suffering in all its varieties and aggravations, whether of physical or moral disease, whether. as confined to individuals, com- munities, or as belonging to the state. He wages per- petual warfare with deadly disease, and fearlessly exerts himself to the utmost of body and mind, to stay the ravages of plague and pestilence ; and it is in his energy and j udgment, but above all in his honesty of purpose, that the people have to confide for immunity from 19 those fearful epidemical visitations which periodically thin their ranks. He is ever called upon, throughout his whole professional life, to fight that never ending battle of poverty against the proud man's contumely and the greedy man's avarice; while sometimes, he has to throw the whole weight of his intellectual and moral force between the strong arm of the law, and some unfortunate member of society, against whom it is uplifted, in the sacred name of justice, and with all its dread formalities, to inflict, not punishment, but ven- geance. How often, too, is the medical man called upon to mourn over that antagonism between the ermine on the bench, and the rags at the bar, which he sees and feels to be too unnatural to be right, because the true moral dignity of human nature is outraged not miuch more in the culprit than in the judge. With the good physician, then, it is a subject of hon- orable boast, that science and learning are merely the necessary means to an important end ; that all his knowl- edge is eminently practical, and its greatest purpose be- nevolence. Therefore, it is devoutly to be hoped, that the punishment and reforma,tion of criminals, as is now almost universally the case in regard to the insane, will ultimately come within the pale and under the dominion of medical science. A sound philosophy and a genuine christian consciousness ought, and must, plead against all blind vengeance, and unmeaning, useless cruelty ; and I believe they must and will appeal at last, to medi- cal science for the means and mode whereby mercy and justice may be linked together. Who, so well as we, are entitled to open the door to moral and intellectual sources of improvement ? We have unequalled oppor- tunities for observation and reflection ; are called upon 20 ' daily to watcli the secret workings of liimian passions and to trace the progress of mankind in virtue and hi vice ; and, as a consequence, I will boldly ask, where will you find so little bigotry, so little prejudice ? We consider the subjects of health and recovery frolii dis- ease, whether physical or moral, as objects of paramtjunt importance ; and should seek to establish and apply tliB principles and practice of our profession without regard to other considerations than the discovery and declaration of the truth, and the safety and welfare of all. In devising, and in superintending all sanitary refor- mations and plans of medical police, we are expected to co-operate understandingly, and as advisers, with the leg- islature and with the civil authorities, with parents and guardians, and with the architect and engineer. Then we must call to our aid all the knowledge which the state of civilization in the arts mid sciences furnishes, and endeavor to give it proper direction and availability for "the moral improvement and material welfare of the majority, ' by means of the statutory acts of enlight- ened governments, the efficient administration of the civil authority, and the systematized efforts of practical philanthropists ; while we should always be ready in person to superintend the execution of what we may theoretically recommend. In fact, practitioners of medi- cine will always be compelled from their honorable and responsible position in society, even if they should not feel bound by the sacred principles of natural and revealed religion, to exeri themselves for the improve^ ment of the physical and moral conditions of mankind. All those legislative measures and pUilantliropic efforts, therefo' ^, which have this object in view, will not only receive tlieir cordial support, but will likewise be found^ 21 Vtpon inquiry, in most instances, actually to kdve received their original impulse or riglit direction from medical men. And particularly, in those more directly practical labors which contribute to the alleviation of human suffering, where will you find more earnest or more faithful ministers of Providence, than those whom no toil or danger restrains from attending to the simple call of professional duty, alike in the hovel as in the palace, in the squalid haljitations of penury as in the abodes where wealth contribu^:es its utmost to mitigate the discomforts of the suiferer-; for thev know that oftentimes '• PiiUida ^Hiors aeqtih ^uhrfi pede P(iupei'it)>i tabenias regwnque furres." "He (the practitioner) is a social reformer in the highest sense of the word," says an accomplished writer. "Everywhere he comes in contact with misery and vice, with degraded habits and injurious customs, with the numerous families of the poor, and the sterile panv pered homes of the rich. To tdl, he can give advice with benefit, and in every sphere of labor diffuse a, kno^'ledge of hygiene." Medical men have been mainly instrumental in providing due space for ventilation, and in other respects securing the highest salubrity attaina^ ble by architectural arrangements and thorough drain- ing ; and to them, also, may all our additional comforts and meliorations, in cleanliness and warmth, clothing and food, physical aaid moral training, be chiefly attrib^ * uted. Those wretched states, sickness and poverty and criivr, which are so often linked together by the tongues of men, but of which they actually i:now so little, we see m our daily rounds, walk really hand in hand*. We Jcnmv that where there is much poverty and sickness 22 there is much ctime, and that whei'e there is much crime and poverty there will be much sickness ; and with all, from public neglect and "man's inhumanity to man/' a helplessness of degradation, a clouding of the faculties, a dullness of the moral sense, a prostra- tion, in a word, of the God-liive powers of humanity, that leave little to hope for the position of beings in the next world, so degraded, so debased in this. Now, relief of poverty from the public purse, as a social right, is one of the characteristics of modern civi- lization ; and this principle should be further extended so as to include relief of sickness. Then we should not only have a lessened amount of poverty and sickness and crime, but a class of intelligent and useful citizens, the practitioners of medicine, would be relieved from a burdensome tax, for the imposition of which no good reason can be given, and for which, they receive no return whatever from the body politic, either in the way of actual remuneration or fostering care. On the subject of education, believing that, as man is nearer to the diety in wisdom and knowledge, as well as in grace and goodness, in that same proportion will he be nearer to the deity in the future state, the happi- ness of which depends upon the soul's knowledge as well as its love of God, the diffusion of useful knowledge among tlie masses will be to him a question of trans- cendent importance, and, therefore, he will insist that it be conducted on the soundest scientific and christian principles. In his estimation, it is not " sufficient that the mere organs of mental action be developed, but it is also required, that they be developed with a reference to the motives from wliich they will act, and to the final cause of their action ; otlierwise, the training, so 2 o far from being a good to man, may be an evil, by afford- ing him greater power for the commission of evil and of departure from God." Now, the intelligent practi- tioner knows that " this better state of knowledge " can only be attained by a proper training and development of all the faculties, physical, moral and intellectual, and that these are best to be attained by a thorough knowl- edge of physiological laws. Hence there is an obvi- ous propriety in the medical man's being connected with all comprehensive schemes or educational plans for the useful development of man's faculties. But our duties are not confined to home or a circle of selected friends and acquaintainces. We are especially called upon, as scientific and practically useful men, to go abroad in the service of our country ; to be present with all expeditions and emigrations, by land and by water ; always as conservators of the lives and health of others, or as companions, and frequently as leaders, for no expedition that is of the least importance to human life or interests, not even Christian missions, can move without us. Thus, everywhere, in every region of the globe, in every pursuit of life, and in every stage of intellectual culture, we must be present to contribute a most important part toward "the moral improvement and material welfare of the majority?" Such, gentlemen, is the position we occupy ; and such is the nature of our vocation, the usefulness and impor- tance of which cannot be exaggerated. Have we quali- fied ourselves to fill this station, to discharge these duties ? If we have not, whatever estimate we may form of our own merits, wc must not expect society at large to view them in the same light ; and, as there is no appeal to Csesar, its judgment will be final, and generally 24 sjjeakiiig, just. The truth is, the common sense of every cultivated people is rapidly coming up to the point, at which even the most profound Doctor, whether of medicine, law or divinit}^, may stand, and in contem-, plating the range of his intellect, confess that all men have an equal right to the hoon of knowledge ; where^ fore, let us endeavor to secure submission to our pro-, fessional advice by convincing mankind of the value and safety of our counsel, rather than by striving to enforce obedience by an acknovvdedged supremacy of professional authority. By our fruits must vie ask and desire to be judged. If they are like the apples of Sodom, we deserve no better than a Sodom's fate. But, if they are pleasant to the sight, agreeable to taste, and wholesome to body and mind, we have a right to expect of our fellow citizens ample remuneration for our services, and that they will cheer us on, in our arduous labors, with their approb.ation and their smiles. But, gentlemen, if we hope to bring forth fruits meet for the rewards, the approbation, the smiles of mankind, there is a consic era- tion of paramount importance, which I have not touched upon yet, but which should not be overlooked, viz : we must ever remember that no professional man can pre- serve the public favor unless he possesses the respect of his own profession ; that if he would effectually guard his own interest, he must be mindful to attend to the interest of others ; and, therefore, that he must be stu- diously pareful liberally to construe that part of medical ethics, which regulates the conduct of physicians towards each other, and towards their patients. For, after all, medical etiquette, which is considered by some persons as a sort of raw-head and bloody bones, is nothing more or less than gentleman-lilve deportment, on the part of li> mc(Uc