THE MEDICAL PROFESSION IN MASSACHUSETTS…

THE MEDICAL PROFESSION IN MASSACHUSETTS

A Lecture of a Course by members of the Massachusetts Historical Society, delivered before the Lowell Institute, January 29, 1869.

The medical history of eight generations, told in an hour, must be in many parts a mere outline. The details I shall give will relate chiefly to the first century. I shall only indicate the leading occurrences, with the more prominent names of the two centuries which follow, and add some considerations suggested by the facts which have been passed in review.

A geographer who was asked to describe the tides of Massachusetts Bay, would have to recognize the circumstance that they are a limited manifestation of a great oceanic movement. To consider them apart from this, would be to localize a planetary phenomenon, and to provincialize a law of the universe. The art of healing in Massachusetts has shared more or less fully and readily the movement which, with its periods of ebb and flow, has been raising its level from age to age throughout the better part of Christendom. Its practitioners brought with them much of the knowledge and many of the errors of the Old World; they have always been in communication with its wisdom and its folly; it is not without interest to see how far the new conditions in which they found themselves have been favorable or unfavorable to the growth of sound medical knowledge and practice.

The state of medicine is an index of the civilization of an age and country,--one of the best, perhaps, by which it can be judged. Surgery invokes the aid of all the mechanical arts. From the rude violences of the age of stone,--a relic of which we may find in the practice of Zipporah, the wife of Moses,--to the delicate operations of to-day upon patients lulled into temporary insensibility, is a progress which presupposes a skill in metallurgy and in the labors of the workshop and the laboratory it has taken uncounted generations to accumulate. Before the morphia which deadens the pain of neuralgia, or the quinine which arrests the fit of an ague, can find their place in our pharmacies, commerce must have perfected its machinery, and science must have refined its processes, through periods only to be counted by the life of nations. Before the means which nature and art have put in the hands of the medical practitioner can be fairly brought into use, the prejudices of the vulgar must be overcome, the intrusions of false philosophy must be fenced out, and the partnership with the priesthood dissolved. All this implies that freedom and activity of thought which belong only to the most advanced conditions of society; and the progress towards this is by gradations as significant of wide-spread changes, as are the varying states of the barometer of far-extended conditions of the atmosphere.

Apart, then, from its special and technical interest, my subject has a meaning which gives a certain importance, and even dignity, to details in themselves trivial and almost unworthy of record. A medical entry in Governor Winthrop's journal may seem at first sight a mere curiosity; but, rightly interpreted, it is a key to his whole system of belief as to the order of the universe and the relations between man and his Maker. Nothing sheds such light on the superstitions of an age as the prevailing interpretation and treatment of disease. When the touch of a profligate monarch was a cure for one of the most inveterate of maladies, when the common symptoms of hysteria were prayed over as marks of demoniacal possession, we might well expect the spiritual realms of thought to be peopled with still stranger delusions.

Let us go before the Pilgrims of the Mayflower, and look at the shores on which they were soon to land. A wasting pestilence had so thinned the savage tribes that it was sometimes piously interpreted as having providentially prepared the way for the feeble band of exiles. Cotton Mather, who, next to the witches, hated the "tawnies," "wild beasts," "blood-hounds," "rattlesnakes," "infidels," as in different places he calls the unhappy Aborigines, describes the condition of things in his lively way, thus: "The Indians in these Parts had newly, even about a Year or Two before, been visited with such a prodigious Pestilence; as carried away not a Tenth, but Nine Parts of Ten (yea't is said Nineteen of Twenty) among them so that the Woods were almost cleared of those pernicious Creatures to make Room for a better Growth."

What this pestilence was has been much discussed. It is variously mentioned by different early writers as "the plague," "a great and grievous plague," "a sore consumption," as attended with spots which left unhealed places on those who recovered, as making the "whole surface yellow as with a garment." Perhaps no disease answers all these conditions so well as smallpox. We know from different sources what frightful havoc it made among the Indians in after years,--in 1631, for instance, when it swept away the aboriginal inhabitants of "whole towns," and in 1633. We have seen a whole tribe, the Mandans, extirpated by it in our own day. The word "plague" was used very vaguely, as in the description of the "great sickness" found among the Indians by the expedition of 1622. This same great sickness could hardly have been yellow fever, as it occurred in the month of November. I cannot think, therefore, that either the scourge of the East or our Southern malarial pestilence was the disease that wasted the Indians. As for the yellowness like a garment, that is too familiar to the eyes of all who have ever looked on the hideous mask of confluent variola.

Without the presence or the fear of these exotic maladies, the forlorn voyagers of the Mayflower had sickness enough to contend with. At their first landing at Cape Cod, gaunt and hungry and longing for fresh food, they found upon the sandy shore "great mussel's, and very fat and full of sea-pearl." Sailors and passengers indulged in the treacherous delicacy; which seems to have been the sea-clam; and found that these mollusks, like the shell the poet tells of, remembered their august abode, and treated the way-worn adventurers to a gastric reminiscence of the heaving billows. In the mean time it blew and snowed and froze. The water turned to ice on their clothes, and made them many times like coats of iron. Edward Tilley had like to have "sounded" with cold. The gunner, too, was sick unto death, but "hope of trucking" kept him on his feet,--a Yankee, it should seem, when he first touched the shore of New England. Most, if not all, got colds and coughs, which afterwards turned to scurvy, whereof many died.

How can we wonder that the crowded and tempest-tossed voyagers, many of them already suffering, should have fallen before the trials of the first winter in Plymouth? Their imperfect shelter, their insufficient supply of bread, their salted food, now in unwholesome condition, account too well for the diseases and the mortality that marked this first dreadful season; weakness, swelling of the limbs, and other signs of scurvy, betrayed the want of proper nourishment and protection from the elements. In December six of their number died, in January eight, in February, seventeen, in March thirteen. With the advance of spring the mortality diminished, the sick and lame began to recover, and the colonists, saddened but not disheartened, applied themselves to the labors of the opening year.

One of the most pressing needs of the early colonists must have been that of physicians and surgeons. In Mr. Savage's remarkable Genealogical Dictionary of the first settlers who came over before 1692 and their descendants to the third generation, I find scattered through the four crowded volumes the names of one hundred and thirty-four medical practitioners. Of these, twelve, and probably many more, practised surgery; three were barber-surgeons. A little incident throws a glimmer from the dark lantern of memory upon William Direly, one of these practitioners with the razor and the lancet. He was lost between Boston and Roxbury in a violent tempest of wind and snow; ten days afterwards a son was born to his widow, and with a touch of homely sentiment, I had almost said poetry, they called the little creature "Fathergone" Direly. Six or seven, probably a larger number, were ministers as well as physicians, one of whom, I am sorry to say, took to drink and tumbled into the Connecticut River, and so ended. One was not only doctor, but also schoolmaster and poet. One practised medicine and kept a tavern. One was a butcher, but calls himself a surgeon in his will, a union of callings which suggests an obvious pleasantry. One female practitioner, employed by her own sex,--Ann Moore,--was the precursor of that intrepid sisterhood whose cause it has long been my pleasure and privilege to advocate on all fitting occasions.

Outside of this list I must place the name of Thomas Wilkinson, who was complained of, is 1676, for practising contrary to law.

Many names in the catalogue of these early physicians have been associated, in later periods, with the practice of the profession, --among them, Boylston, Clark, Danforth, Homan, Jeffrey, Kittredge, Oliver, Peaslee, Randall, Shattuck, Thacher, Wellington, Williams, Woodward. Touton was a Huguenot, Burchsted a German from Silesia, Lunerus a German or a Pole; "Pighogg Churrergeon," I hope, for the honor of the profession, was only Peacock disguised under this alias, which would not, I fear, prove very attractive to patients.

What doctrines and practice were these colonists likely to bring, with them?

Two principal schools of medical practice prevailed in the Old World during the greater part of the seventeenth century. The first held to the old methods of Galen: its theory was that the body, the microcosm, like the macrocosm, was made up of the four elements--fire, air, water, earth; having respectively the qualities hot, dry, moist, cold. The body was to be preserved in health by keeping each of these qualities in its natural proportion; heat, by the proper temperature; moisture, by the due amount of fluid; and so as to the rest. Diseases which arose from excess of heat were to be attacked by cooling remedies; those from excess of cold, by heating ones; and so of the other derangements of balance. This was truly the principle of contraries contrariis, which ill-informed persons have attempted to make out to be the general doctrine of medicine, whereas there is no general dogma other than this: disease is to be treated by anything that is proved to cure it. The means the Galenist employed were chiefly diet and vegetable remedies, with the use of the lancet and other depleting agents. He attributed the four fundamental qualities to different vegetables, in four different degrees; thus chicory was cold in the fourth degree, pepper was hot in the fourth, endive was cold and dry in the second, and bitter almonds were hot in the first and dry in the second degree. When we say "cool as a cucumber," we are talking Galenism. The seeds of that vegetable ranked as one of "the four greater cold seeds" of this system.

Galenism prevailed mostly in the south of Europe and France. The readers of Moliere will have no difficulty in recalling some of its favorite modes of treatment, and the abundant mirth he extracted from them.

These Galenists were what we should call "herb-doctors" to-day. Their insignificant infusions lost credit after a time; their absurdly complicated mixtures excited contempt, and their nauseous prescriptions provoked loathing and disgust. A simpler and bolder practice found welcome in Germany, depending chiefly on mineral remedies, mercury, antimony, sulphur, arsenic, and the use, sometimes the secret use, of opium. Whatever we think of Paracelsus, the chief agent in the introduction of these remedies, and whatever limits we may assign to the use of these long-trusted mineral drugs, there can be no doubt that the chemical school, as it was called, did a great deal towards the expurgation of the old, overloaded, and repulsive pharmacopoeia. We shall find evidence in the practice of our New-England physicians of the first century, that they often employed chemical remedies, and that, by the early part of the following century, their chief trust was in the few simple, potent drugs of Paracelsus.

We have seen that many of the practitioners of medicine, during the first century of New England, were clergymen. This relation between medicine and theology has existed from a very early period; from the Egyptian priest to the Indian medicine-man, the alliance has been maintained in one form or another. The partnership was very common among our British ancestors. Mr. Ward, the Vicar of Stratford-on-Avon, himself a notable example of the union of the two characters, writing about 1660, says,

"The Saxons had their blood-letters, but under the Normans physicke, begunne in England; 300 years agoe itt was not a distinct profession by itself, but practised by men in orders, witness Nicholas de Ternham, the chief English physician and Bishop of Durham; Hugh of Evesham, a physician and cardinal; Grysant, physician and pope; John Chambers, Dr. of Physick, was the first Bishop of Peterborough; Paul Bush, a bachelor of divinitie in Oxford, was a man well read in physick as well as divinitie, he was the first bishop of Bristol."

"Again in King Richard the Second's time physicians and divines were not distinct professions; for one Tydeman, Bishop of Landaph and Worcester, was physician to King Richard the Second."

This alliance may have had its share in creating and keeping up the many superstitions which have figured so largely in the history of medicine. It is curious to see that a medical work left in manuscript by the Rev. Cotton Mather and hereafter to be referred to, is running over with follies and superstitious fancies; while his contemporary and fellow-townsman, William Douglass, relied on the same few simple remedies which, through Dr. Edward Holyoke and Dr. James Jackson, have come down to our own time, as the most important articles of the materia medica.

Let us now take a general glance at some of the conditions of the early settlers; and first, as to the healthfulness of the climate. The mortality of the season that followed the landing of the Pilgrims at Plymouth has been sufficiently accounted for. After this, the colonists seem to have found the new country agreeing very well with their English constitutions. Its clear air is the subject of eulogy. Its dainty springs of sweet water are praised not only by Higginson and Wood, but even the mischievous Morton says, that for its delicate waters "Canaan came not near this country." There is a tendency to dilate on these simple blessings, which reminds one a little of the Marchioness in Dickens's story, with her orange-peel-and-water beverage. Still more does one feel the warmth of coloring,--such as we expect from converts to a new faith, and settlers who want to entice others over to their clearings, when Winslow speaks, in 1621, of "abundance of roses, white, red, and damask; single, but very sweet indeed;" a most of all, however, when, in the same connection, he says, "Here are grapes white and red, and very sweet and strong also." This of our wild grape, a little vegetable Indian, which scalps a civilized man's mouth, as his animal representative scalps his cranium. But there is something quite charming in Winslow's picture of the luxury in which they are living. Lobsters, oysters, eels, mussels, fish and fowl, delicious fruit, including the grapes aforesaid,--if they only had "kine, horses, and sheep," he makes no question but men would live as contented here as in any part of the world. We cannot help admiring the way in which they took their trials, and made the most of their blessings.

"And how Content they were," says Cotton Mather, "when an Honest Man, as I have heard, inviting his Friends to a Dish of Clams, at the Table gave Thanks to Heaven, who had given them to suck the abundance of the Seas, and of the Treasures Aid in the Sands!"

Strangely enough, as it would seem, except for this buoyant determination to make the best of everything, they hardly appear to recognize the difference of the climate from that which they had left. After almost three years' experience, Winslow says, he can scarce distinguish New England from Old England, in respect of heat and cold, frost, snow, rain, winds, etc. The winter, he thinks (if there is a difference), is sharper and longer; but yet he may be deceived by the want of the comforts he enjoyed at home. He cannot conceive any climate to agree better with the constitution of the English, not being oppressed with extremity of heats, nor nipped by biting cold:

"By which means, blessed be God, we enjoy our health, notwithstanding those difficulties we have undergone, in such a measure as would have been admired, if we had lived in England with the like means."

Edward Johnson, after mentioning the shifts to which they were put for food, says,--

"And yet, methinks, our children are as cheerful, fat, and lusty, with feeding upon those mussels, clams, and other fish, as they were in England with their fill of bread."

Higginson, himself a dyspeptic, "continually in physic," as he says, and accustomed to dress in thick clothing, and to comfort his stomach with drink that was "both strong and stale,"--the "jolly good ale and old," I suppose, of free and easy Bishop Still's song,--found that he both could and did oftentimes drink New England water very well,--which he seems to look upon as a remarkable feat. He could go as lightclad as any, too, with only a light stuff cassock upon his shirt, and stuff breeches without linings. Two of his children were sickly: one,--little misshapen Mary,--died on the passage, and, in her father's words, "was the first in our ship that was buried in the bowels of the great Atlantic sea;" the other, who had been "most lamentably handled" by disease, recovered almost entirely "by the very wholesomeness of the air, altering, digesting, and drying up the cold and crude humors of the body." Wherefore, he thinks it a wise course for all cold complexions to come to take physic in New England, and ends with those often quoted words, that "a sup of New England's air is better than a whole draught of Old England's ale." Mr. Higginson died, however, "of a hectic fever," a little more than a year after his arrival.

The medical records which I shall cite show that the colonists were not exempt from the complaints of the Old World. Besides the common diseases to which their descendants are subject, there were two others, to say nothing of the dreaded small-pox, which later medical science has disarmed,--little known among us at the present day, but frequent among the first settlers. The first of these was the scurvy, already mentioned, of which Winthrop speaks in 1630, saying, that it proved fatal to those who fell into discontent, and lingered after their former conditions in England; the poor homesick creatures in fact, whom we so forget in our florid pictures of the early times of the little band in the wilderness. Many who were suffering from scurvy got well when the Lyon arrived from England, bringing store of juice of lemons. The Governor speaks of another case in 1644; and it seems probable that the disease was not of rare occurrence.

The other complaint from which they suffered, but which has nearly disappeared from among us, was intermittent fever, or fever and ague. I investigated the question as to the prevalence of this disease in New England, in a dissertation, which was published in a volume with other papers, in the year 1838. I can add little to the facts there recorded. One which escaped me was, that Joshua Scottow, in "Old Men's Tears," dated 1691, speaks of "shaking agues," as among the trials to which they had been subjected. The outline map of New England, accompanying the dissertation above referred to, indicates all the places where I had evidence that the disease had originated. It was plain enough that it used to be known in many localities where it has long ceased to be feared. Still it was and is remarkable to see what a clean bill of health in this particular respect our barren soil inherited with its sterility. There are some malarious spots on the edge of Lake Champlain, and there have been some temporary centres of malaria, within the memory of man, on one or more of our Massachusetts rivers, but these are harmless enough, for the most part, unless the millers dam them, when they are apt to retaliate with a whiff from their meadows, that sets the whole neighborhood shaking with fever and ague.

The Pilgrims of the Mayflower had with them a good physician, a man of standing, a deacon of their church, one whom they loved and trusted, Dr. Samuel Fuller. But no medical skill could keep cold and hunger and bad food, and, probably enough, desperate homesickness in some of the feebler sort, from doing their work. No detailed record remains of what they suffered or what was attempted for their relief during the first sad winter. The graves of those who died were levelled and sowed with grain that the losses of the little band might not be suspected by the savage tenants of the wilderness, and their story remains untold.

Of Dr. Fuller's practice, at a later period, we have an account in a letter of his to Governor Bradford, dated June, 1630. "I have been to Matapan" (now Dorchester), he says, "and let some twenty of those people blood." Such wholesale depletion as this, except with avowed homicidal intent, is quite unknown in these days; though I once saw the noted French surgeon, Lisfranc, in a fine phlebotomizing frenzy, order some ten or fifteen patients, taken almost indiscriminately, to be bled in a single morning.

Dr. Fuller's two visits to Salem, at the request of Governor Endicott, seem to have been very satisfactory to that gentleman. Morton, the wild fellow of Merry Mount, gives a rather questionable reason for the Governor's being so well pleased with the physician's doings. The names under which he mentions the two personages, it will be seen, are not intended to be complimentary. "Dr. Noddy did a great cure for Captain Littleworth. He cured him of a disease called a wife." William Gager, who came out with Winthrop, is spoken of as "a right godly man and skilful chyrurgeon, but died of a malignant fever not very long after his arrival."

Two practitioners of the ancient town of Newbury are entitled to special notice, for different reasons. The first is Dr. John Clark, who is said by tradition to have been the first regularly educated physician who resided in New England. His portrait, in close-fitting skull-cap, with long locks and venerable flowing beard, is familiar to our eyes on the wall of our Society's antechamber. His left hand rests upon a skull, his right hand holds an instrument which deserves a passing comment. It is a trephine, a surgical implement for cutting round pieces out of broken skulls, so as to get at the fragments which have been driven in, and lift them up. It has a handle like that of a gimlet, with a claw like a hammer, to lift with, I suppose, which last contrivance I do not see figured in my books. But the point I refer to is this: the old instrument, the trepan, had a handle like a wimble, what we call a brace or bit-stock. The trephine is not mentioned at all in Peter Lowe's book, London, 1634; nor in Wiseman's great work on Surgery, London, 1676; nor in the translation of Dionis, published by Jacob Tonson, in 1710. In fact it was only brought into more general use by Cheselden and Sharpe so late as the beginning of the last century. As John Clark died in 1661, it is remarkable to see the last fashion in the way of skull-sawing contrivances in his hands,--to say nothing of the claw on the handle, and a Hey's saw, so called in England, lying on the table by him, and painted there more than a hundred years before Hey was born. This saw is an old invention, perhaps as old as Hippocrates, and may be seen figured in the "Armamentarium Chirurgicum" of Scultetus, or in the Works of Ambroise Pare.

Dr. Clark is said to have received a diploma before he came, for skill in lithotomy. He loved horses, as a good many doctors do, and left a good property, as they all ought to do. His grave and noble presence, with the few facts concerning him, told with more or less traditional authority, give us the feeling that the people of Newbury, and afterwards of Boston, had a wise and skilful medical adviser and surgeon in Dr. John Clark.

The venerable town of Newbury had another physician who was less fortunate. The following is a court record of 1652:

"This is to certify whom it may concern, that we the subscribers, being called upon to testify against doctor William Snelling for words by him uttered, affirm that being in way of merry discourse, a health being drank to all friends, he answered,

"I'll pledge my friends, And for my foes A plague for their heels And,'----

[a similar malediction on the other extremity of their feet.]

"Since when he hath affirmed that he only intended the proverb used in the west country, nor do we believe he intended otherwise.

"[Signed] "WILLIAM THOMAS. "THOMAS MILWARD.

"March 12th 1651, All which I acknowledge, and am sorry I did not expresse my intent, or that I was so weak as to use so foolish a proverb.

"[Signed] "GULIELMUS SNELLING."

Notwithstanding this confession and apology, the record tells us that "William Snelling in his presentment for cursing is fined ten shillings and the fees of court."

I will mention one other name among those of the Fathers of the medical profession in New England. The "apostle" Eliot says, writing in 1647, "We never had but one anatomy in the country, which Mr. Giles Firman, now in England, did make and read upon very well."

Giles Firmin, as the name is commonly spelled, practised physic in this country for a time. He seems to have found it a poor business; for, in a letter to Governor Winthrop, he says, "I am strongly sett upon to studye divinitie: my studyes else must be lost, for physick is but a meene helpe."

Giles Firmin's Lectures on Anatomy were the first scientific teachings of the New World. While the Fathers were enlightened enough to permit such instructions, they were severe in dealing with quackery; for, in 1631, our court records show that one Nicholas Knopp, or Knapp, was sentenced to be fined or whipped "for taking upon him to cure the scurvey by a water of noe worth nor value, which he solde att a very deare rate." Empty purses or sore backs would be common with us to-day if such a rule were enforced.

Besides the few worthies spoken of, and others whose names I have not space to record, we must remember that there were many clergymen who took charge of the bodies as well as the souls of their patients, among them two Presidents of Harvard College, Charles Chauncy and Leonard Hoar,--and Thomas Thacher, first minister of the "Old South," author of the earliest medical treatises printed in the country,[A Brief Rule to Guide the Common People in Small pox and Measles. 1674.] whose epitaph in Latin and Greek, said to have been written by Eleazer, an "Indian Youth" and a member of the Senior Class of Harvard College, may be found in the "Magnalia." I miss this noble savage's name in our triennial catalogue; and as there is many a slip between the cup and lip, one is tempted to guess that he may have lost his degree by some display of his native instinct,--possibly a flourish of the tomahawk or scalping-knife. However this may have been, the good man he celebrated was a notable instance of the Angelical Conjunction, as the author of the "Magnalia" calls it, of the offices of clergyman and medical practitioner.

Michael Wigglesworth, author of the "Day of Doom," attended the sick, "not only as a Pastor, but as a Physician too, and this, not only in his own town, but also in all those of the vicinity." Mather says of the sons of Charles Chauncy, "All of these did, while they had Opportunity, Preach the Gospel; and most, if not all of them, like their excellent Father before them, had an eminent skill in physick added unto their other accomplishments," etc. Roger Williams is said to have saved many in a kind of pestilence which swept away many Indians.

To these names must be added, as sustaining a certain relation to the healing art, that of the first Governor Winthrop, who is said by John Cotton to have been "Help for our Bodies by Physick [and] for our Estates by Law," and that of his son, the Governor of Connecticut, who, as we shall see, was as much physician as magistrate.

I had submitted to me for examination, in 1862, a manuscript found among the Winthrop Papers, marked with the superscription, "For my worthy friend Mr. Wintrop," dated in 1643, London, signed Edward Stafford, and containing medical directions and prescriptions. It may be remembered by some present that I wrote a report on this paper, which was published in the "Proceedings" of this Society. Whether the paper was written for Governor John Winthrop of Massachusetts, or for his son, Governor John of Connecticut, there is no positive evidence that I have been able to obtain. It is very interesting, however, as giving short and simple practical directions, such as would be most like to be wanted and most useful, in the opinion of a physician in repute of that day.

The diseases prescribed for are plague, small-pox, fevers, king's evil, insanity, falling-sickness, and the like; with such injuries as broken bones, dislocations, and burning with gunpowder. The remedies are of three kinds: simples, such as St. John's wort, Clown's all-heal, elder, parsley, maidenhair, mineral drugs, such as lime, saltpetre, Armenian bole, crocus metallorum, or sulphuret of antimony; and thaumaturgic or mystical, of which the chief is, "My black powder against the plague, small-pox; purples, all sorts of feavers; Poyson; either, by Way of Prevention or after Infection." This marvellous remedy was made by putting live toads into an earthen pot so as to half fill it, and baking and burning them "in the open ayre, not in an house,"--concerning which latter possibility I suspect Madam Winthrop would have had something to say,--until they could be reduced by pounding, first into a brown, and then into a black, powder. Blood-letting in some inflammations, fasting in the early stage of fevers, and some of those peremptory drugs with which most of us have been well acquainted in our time, the infragrant memories of which I will not pursue beyond this slight allusion, are among his remedies.

The Winthrops, to one of whom Dr. Stafford's directions were addressed, were the medical as well as the political advisers of their fellow-citizens for three or four successive generations. One of them, Governor John of Connecticut, practised so extensively, that, but for his more distinguished title in the State, he would have been remembered as the Doctor. The fact that he practised in another colony, for the most part, makes little difference in the value of the records we have of his medical experience, which have fortunately been preserved, and give a very fair idea, in all probability, of the way in which patients were treated in Massachusetts, when they fell into intelligent and somewhat educated hands, a little after the middle of the seventeenth century:

I have before me, while writing, a manuscript collection of the medical cases treated by him, and recorded at the time in his own hand, which has been intrusted to me by our President, his descendant.

They are generally marked Hartford, and extend from the year 1657 to 1669. From these, manuscripts, and from the letters printed in the Winthrop Papers published by our Society, I have endeavored to obtain some idea of the practice of Governor John Winthrop, Junior. The learned eye of Mr. Pulsifer would have helped me, no doubt, as it has done in other cases; but I have ventured this time to attempt finding my own way among the hieroglyphics of these old pages. By careful comparison of many prescriptions, and by the aid of Schroder, Salmon, Culpeper, and other old compilers, I have deciphered many of his difficult paragraphs with their mysterious recipes.

The Governor employed a number of the simples dear to ancient women, --elecampane and elder and wormwood and anise and the rest; but he also employed certain mineral remedies, which he almost always indicates by their ancient symbols, or by a name which should leave them a mystery to the vulgar. I am now prepared to reveal the mystic secrets of the Governor's beneficent art, which rendered so many good and great as well as so many poor and dependent people his debtors,--at least, in their simple belief,--for their health and their lives.

His great remedy, which he gave oftener than any other, was nitre; which he ordered in doses of twenty or thirty grains to adults, and of three grains to infants. Measles, colics, sciatica, headache, giddiness, and many other ailments, all found themselves treated, and I trust bettered, by nitre; a pretty safe medicine in moderate doses, and one not likely to keep the good Governor awake at night, thinking whether it might not kill, if it did not cure. We may say as much for spermaceti, which he seems to have considered "the sovereign'st thing on earth" for inward bruises, and often prescribes after falls and similar injuries.

One of the next remedies, in point of frequency, which he was in the habit of giving, was (probably diaphoretic) antimony; a mild form of that very active metal, and which, mild as it was, left his patients very commonly with a pretty strong conviction that they had been taking something that did not exactly agree with them. Now and then he gave a little iron or sulphur or calomel, but very rarely; occasionally, a good, honest dose of rhubarb or jalap; a taste of stinging horseradish, oftener of warming guiacum; sometimes an anodyne, in the shape of mithridate,--the famous old farrago, which owed its virtue to poppy juice; [This is the remedy which a Boston divine tried to simplify. See Electuarium Novum Alexipharmacum, by Rev. Thomas Harward, lecturer at the Royal Chappell. Boston, 1732. This tract is in our Society's library.] very often, a harmless powder of coral; less frequently, an inert prescription of pleasing amber; and (let me say it softly within possible hearing of his honored descendant), twice or oftener,--let us hope as a last resort,--an electuary of millipedes,--sowbugs, if we must give them their homely English name. One or two other prescriptions, of the many unmentionable ones which disgraced the pharmacopoeia of the seventeenth century, are to be found, but only in very rare instances, in the faded characters of the manuscript.

The excellent Governor's accounts of diseases are so brief, that we get only a very general notion of the complaints for which he prescribed. Measles and their consequences are at first more prominent than any other one affection, but the common infirmities of both sexes and of all ages seem to have come under his healing hand. Fever and ague appears to have been of frequent occurrence.

His published correspondence shows that many noted people were in communication with him as his patients. Roger Williams wants a little of his medicine for Mrs. Weekes's daughter; worshipful John Haynes is in receipt of his powders; troublesome Captain Underhill wants "a little white vitterall" for his wife, and something to cure his wife's friend's neuralgia, (I think his wife's friend's husband had a little rather have had it sent by the hands of Mrs. Underhill, than by those of the gallant and discursive captain); and pious John Davenport says, his wife "tooke but one halfe of one of the papers" (which probably contained the medicine he called rubila), "but could not beare the taste of it, and is discouraged from taking any more;" and honored William Leete asks for more powders for his "poore little daughter Graciana," though he found it "hard to make her take it," delicate, and of course sensitive, child as she was, languishing and dying before her time, in spite of all the bitter things she swallowed,--God help all little children in the hands of dosing doctors and howling dervishes! Restless Samuel Gorton, now tamed by the burden of fourscore and two years, writes so touching an account of his infirmities, and expresses such overflowing gratitude for the relief he has obtained from the Governor's prescriptions, wondering how "a thing so little in quantity, so little in sent, so little in taste, and so little to sence in operation, should beget and bring forth such efects," that we repent our hasty exclamation, and bless the memory of the good Governor, who gave relief to the worn-out frame of our long-departed brother, the sturdy old heretic of Rhode Island.

What was that medicine which so frequently occurs in the printed letters under the name of "rubila"? It is evidently a secret remedy, and, so far as I know, has not yet been made out. I had almost given it up in despair, when I found what appears to be a key to the mystery. In the vast multitude of prescriptions contained in the manuscripts, most of them written in symbols, I find one which I thus interpret:

"Four grains of (diaphoretic) antimony, with twenty grains of nitre, with a little salt of tin, making rubila." Perhaps something was added to redden the powder, as he constantly speaks of "rubifying" or "viridating" his prescriptions; a very common practice of prescribers, when their powders look a little too much like plain salt or sugar.

Waitstill Winthrop, the Governor's son, "was a skilful physician," says Mr. Sewall, in his funeral sermon; "and generously gave, not only his advice, but also his Medicines, for the healing of the Sick, which, by the Blessing of God, were made successful for the recovery of many." "His son John, a member of the Royal Society, speaks of himself as 'Dr. Winthrop,' and mentions one of his own prescriptions in a letter to Cotton Mather." Our President tells me that there was an heirloom of the ancient skill in his family, within his own remembrance, in the form of a certain precious eye-water, to which the late President John Quincy Adams ascribed rare virtue, and which he used to obtain from the possessor of the ancient recipe.

These inherited prescriptions are often treasured in families, I do not doubt, for many generations. When I was yet of trivial age, and suffering occasionally, as many children do, from what one of my Cambridgeport schoolmates used to call the "ager,"--meaning thereby toothache or face-ache,--I used to get relief from a certain plaster which never went by any other name in the family than "Dr. Oliver."

Dr. James Oliver was my great-great-grandfather, graduated in 1680, and died in 1703. This was, no doubt, one of his nostrums; for nostrum, as is well known, means nothing more than our own or my own particular medicine, or other possession or secret, and physicians in old times used to keep their choice recipes to themselves a good deal, as we have had occasion to see.

Some years ago I found among my old books a small manuscript marked "James Oliver. This Book Begun Aug. 12, 1685." It is a rough sort of account-book, containing among other things prescriptions for patients, and charges for the same, with counter-charges for the purchase of medicines and other matters. Dr. Oliver practised in Cambridge, where may be seen his tomb with inscriptions, and with sculptured figures that look more like Diana of the Ephesians, as given in Calmet's Dictionary, than like any angels admitted into good society here or elsewhere.

I do not find any particular record of what his patients suffered from, but I have carefully copied out the remedies he mentions, and find that they form a very respectable catalogue. Besides the usual simples, elder, parsley, fennel, saffron, snake-root, wormwood, I find the Elixir Proprietatis, with other elixire and cordials, as if he rather fancied warming medicines; but he called in the aid of some of the more energetic remedies, including iron, and probably mercury, as he bought two pounds of it at one time.

The most interesting item is his bill against the estate of Samuel Pason of Roxbury, for services during his last illness. He attended this gentleman,--for such he must have been, by the amount of physic which he took, and which his heirs paid for,--from June 4th, 1696, to September 3d of the same year, three months. I observe he charges for visits as well as for medicines, which is not the case in most of his bills. He opens the attack with a carminative appeal to the visceral conscience, and follows it up with good hard-hitting remedies for dropsy,--as I suppose the disease would have been called,--and finishes off with a rallying dose of hartshorn and iron.

It is a source of honest pride to his descendant that his bill, which was honestly paid, as it seems to have been honorably earned, amounted to the handsome total of seven pounds and two shillings. Let me add that he repeatedly prescribes plaster, one of which was very probably the "Dr. Oliver" that soothed my infant griefs, and for which I blush to say that my venerated ancestor received from Goodman Hancock the painfully exiguous sum of no pounds, no shillings, and sixpence.

I have illustrated the practice of the first century, from the two manuscripts I have examined, as giving an impartial idea of its every-day methods. The Governor, Johannes Secundus, it is fair to remember, was an amateur practitioner, while my ancestor was a professed physician. Comparing their modes of treatment with the many scientific follies still prevailing in the Old World, and still more with the extraordinary theological superstitions of the community in which they lived, we shall find reason, I think, to consider the art of healing as in a comparatively creditable state during the first century of New England.

In addition to the evidence as to methods of treatment furnished by the manuscripts I have cited, I subjoin the following document, to which my attention was called by Dr. Shurtleff, our present Mayor. This is a letter of which the original is to be found in vol. lxix. page 10 of the "Archives" preserved at the State House in Boston. It will be seen that what the surgeon wanted consisted chiefly of opiates, stimulants, cathartics, plasters, and materials for bandages. The complex and varied formulae have given place to simpler and often more effective forms of the same remedies; but the list and the manner in which it is made out are proofs of the good sense and schooling of the surgeon, who, it may be noted, was in such haste that he neglected all his stops. He might well be in a hurry, as on the very day upon which he wrote, a great body of Indians--supposed to be six or seven hundred--appeared before Hatfield; and twenty-five resolute young men of Hadley, from which town he wrote, crossed the river and drove them away.

HADLY May 30: 76

Mr RAWSON Sr

What we have recd by Tho: Houey the past month is not the cheifest of our wants as you have love for poor wounded I pray let us not want for these following medicines if you have not a speedy conveyance of them I pray send on purpose they are those things mentioned in my former letter but to prevent future mistakes I have wrote them att large wee have great want with the greatest halt and speed let us be supplyed. Sr Yr Sert WILL LOCHS

(Endorsed)

Mr. Lockes Letter Recd from the Governor 13 Jane & acquainted ye Council with it but could not obtaine any thing to be sent in answer thereto. 13 June 1676

I have given some idea of the chief remedies used by our earlier physicians, which were both Galenic and chemical; that is, vegetable and mineral. They, of course, employed the usual perturbing medicines which Montaigne says are the chief reliance of their craft. There were, doubtless, individual practitioners who employed special remedies with exceptional boldness and perhaps success. Mr. Eliot is spoken of, in a letter of William Leete to Winthrop, Junior, as being under Mr. Greenland's mercurial administrations. The latter was probably enough one of these specialists.

There is another class of remedies which appears to have been employed occasionally, but, on the whole, is so little prominent as to imply a good deal of common sense among the medical practitioners, as compared with the superstitions prevailing around them. I have said that I have caught the good Governor, now and then, prescribing the electuary of millipedes; but he is entirely excused by the almost incredible fact that they were retained in the materia medica so late as when Rees's Cyclopaedia was published, and we there find the directions formerly given by the College of Edinburgh for their preparation. Once or twice we have found him admitting still more objectionable articles into his materia medica; in doing which, I am sorry to say that he could plead grave and learned authority. But these instances are very rare exceptions in a medical practice of many years, which is, on the whole, very respectable, considering the time and circumstances.

Some remedies of questionable though not odious character appear occasionally to have been employed by the early practitioners, but they were such as still had the support of the medical profession. Governor John Winthrop, the first, sends for East Indian bezoar, with other commodities he is writing for. Governor Endicott sends him one he had of Mr. Humfrey. I hope it was genuine, for they cheated infamously in the matter of this concretion, which ought to come out of an animal's stomach, but the real history of which resembles what is sometimes told of modern sausages.

There is a famous law-case of James the First's time, in which a goldsmith sold a hundred pounds' worth of what he called bezoar, which was proved to be false, and the purchaser got a verdict against him. Governor Endicott also sends Winthrop a unicorn's horn, which was the property of a certain Mrs. Beggarly, who, in spite of her name, seems to have been rich in medical knowledge and possessions. The famous Thomas Bartholinus wrote a treatise on the virtues of this fabulous-sounding remedy, which was published in 1641, and republished in 1678.

The "antimonial cup," a drinking vessel made of that metal, which, like our quassia-wood cups, might be filled and emptied in saecula saeculorum without exhausting its virtues, is mentioned by Matthew Cradock, in a letter to the elder Winthrop, but in a doubtful way, as it was thought, he says, to have shortened the days of Sir Nathaniel Riche; and Winthrop himself, as I think, refers to its use, calling it simply "the cup." An antimonial cup is included in the inventory of Samuel Seabury, who died 1680, and is valued at five shillings. There is a treatise entitled "The Universall Remedy, or the Vertues of the Antimoniall Cup, By John Evans, Minister and Preacher of God's Word, London, 1634," in our own Society's library.

One other special remedy deserves notice, because of native growth. I do not know when Culver's root, Leptandra Virginica of our National Pharmacopoeia, became noted, but Cotton Mather, writing in 1716 to John Winthrop of New London, speaks of it as famous for the cure of consumptions, and wishes to get some of it, through his mediation, for Katharine, his eldest daughter. He gets it, and gives it to the "poor damsel," who is languishing, as he says, and who dies the next month,--all the sooner, I have little doubt, for this uncertain and violent drug, with which the meddlesome pedant tormented her in that spirit of well-meant but restless quackery, which could touch nothing without making mischief, not even a quotation, and yet proved at length the means of bringing a great blessing to our community, as we shall see by and by; so does Providence use our very vanities and infirmities for its wise purposes.

Externally, I find the practitioners on whom I have chiefly relied used the plasters of Paracelsus, of melilot, diachylon, and probably diaphoenicon, all well known to the old pharmacopoeias, and some of them to the modern ones,--to say nothing of "my yellow salve," of Governor John, the second, for the composition of which we must apply to his respected descendant.

The authors I find quoted are Barbette's Surgery, Camerarius on Gout, and Wecherus, of all whom notices may be found in the pages of Haller and Vanderlinden; also, Reed's Surgery, and Nicholas Culpeper's Practice of Physic and Anatomy, the last as belonging to Samuel Seabury, chirurgeon, before mentioned. Nicholas Culpeper was a shrewd charlatan, and as impudent a varlet as ever prescribed for a colic; but knew very well what he was about, and badgers the College with great vigor. A copy of Spigelius's famous Anatomy, in the Boston Athenaeum, has the names of Increase and Samuel Mather written in it, and was doubtless early overhauled by the youthful Cotton, who refers to the great anatomist's singular death, among his curious stories in the "Magnalia," and quotes him among nearly a hundred authors whom he cites in his manuscript "The Angel of Bethesda." Dr. John Clark's "books and instruments, with several chirurgery materials in the closet," a were valued in his inventory at sixty pounds; Dr. Matthew Fuller, who died in 1678, left a library valued at ten pounds; and a surgeon's chest and drugs valued at sixteen pounds.'

Here we leave the first century and all attempts at any further detailed accounts of medicine and its practitioners. It is necessary to show in a brief glance what had been going on in Europe during the latter part of that century, the first quarter of which had been made illustrious in the history of medical science by the discovery of the circulation.

Charles Barbeyrac, a Protestant in his religion, was a practitioner and teacher of medicine at Montpellier. His creed was in the way of his obtaining office; but the young men followed his instructions with enthusiasm. Religious and scientific freedom breed in and in, until it becomes hard to tell the family of one from that of the other. Barbeyrac threw overboard the old complex medical farragos of the pharmacopoeias, as his church had disburdened itself of the popish ceremonies.

Among the students who followed his instructions were two Englishmen: one of them, John Locke, afterwards author of an "Essay on the Human Understanding," three years younger than his teacher; the other, Thomas Sydenham, five years older. Both returned to England. Locke, whose medical knowledge is borne witness to by Sydenham, had the good fortune to form a correct opinion on a disease from which the Earl of Shaftesbury was suffering, which led to an operation that saved his life. Less felicitous was his experience with a certain ancilla culinaria virgo,--which I am afraid would in those days have been translated kitchen-wench, instead of lady of the culinary department,--who turned him off after she had got tired of him, and called in another practitioner. [Locke and Sydenham, p. 124. By John Brown, M. D. Edinburgh, 1866.] This helped, perhaps, to spoil a promising doctor, and make an immortal metaphysician. At any rate, Locke laid down the professional wig and cane, and took to other studies.

The name of Thomas Sydenham is as distinguished in the history of medicine as that of John Locke in philosophy. As Barbeyrac was found in opposition to the established religion, as Locke took the rational side against orthodox Bishop Stillingfleet, so Sydenham went with Parliament against Charles, and was never admitted a Fellow by the College of Physicians, which, after he was dead, placed his bust in their hall by the side of that of Harvey.

What Sydenham did for medicine was briefly this he studied the course of diseases carefully, and especially as affected by the particular season; to patients with fever he gave air and cooling drinks, instead of smothering and heating them, with the idea of sweating out their disease; he ordered horseback exercise to consumptives; he, like his teacher, used few and comparatively simple remedies; he did not give any drug at all, if he thought none was needed, but let well enough alone. He was a sensible man, in short, who applied his common sense to diseases which he had studied with the best light of science that he could obtain.

The influence of the reform he introduced must have been more or less felt in this country, but not much before the beginning of the eighteenth century, as his great work was not published until 1675, and then in Latin. I very strongly suspect that there was not so much to reform in the simple practice of the physicians of the new community, as there was in that of the learned big-wigs of the "College," who valued their remedies too much in proportion to their complexity, and the extravagant and fantastic ingredients which went to their making.

During the memorable century which bred and bore the Revolution, the medical profession gave great names to our history. But John Brooks belonged to the State, and Joseph Warren belongs to the country and mankind, and to speak of them would lead me beyond my limited--subject. There would be little pleasure in dwelling on the name of Benjamin Church; and as for the medical politicians, like Elisha Cooke in the early part of the century, or Charles Jarvis, the bald eagle of Boston, in its later years, whether their practice was heroic or not, their patients were, for he is a bold man who trusts one that is making speeches and coaxing voters, to meddle with the internal politics of his corporeal republic.

One great event stands out in the medical history of this eighteenth century; namely, the introduction of the practice of inoculation for small-pox. Six epidemics of this complaint had visited Boston in the course of a hundred years. Prayers had been asked in the churches for more than a hundred sick in a single day, and this many times. About a thousand persons had died in a twelvemonth, we are told, and, as we may infer, chiefly from this cause.

In 1721, this disease, after a respite of nineteen years, again appeared as an epidemic. In that year it was that Cotton Mather, browsing, as was his wont, on all the printed fodder that came within reach of his ever-grinding mandibles, came upon an account of inoculation as practised in Turkey, contained in the "Philosophical Transactions." He spoke of it to several physicians, who paid little heed to his story; for they knew his medical whims, and had probably been bored, as we say now-a-days, many of them, with listening to his "Angel of Bethesda," and satiated with his speculations on the Nishmath Chajim.

The Reverend Mather,--I use a mode of expression he often employed when speaking of his honored brethren,--the Reverend Mather was right this time, and the irreverent doctors who laughed at him were wrong. One only of their number disputes his claim to giving the first impulse to the practice, in Boston. This is what that person says: "The Small-Pox spread in Boston, New England, A.1721, and the Reverend Dr. Cotton Mather, having had the use of these Communications from Dr. William Douglass (that is, the writer of these words); surreptitiously, without the knowledge of his Informer, that he might have the honour of a New fangled notion, sets an Undaunted Operator to work, and in this Country about 290 were inoculated."

All this has not deprived Cotton Mather of the credit of suggesting, and a bold and intelligent physician of the honor of carrying out, the new practice. On the twenty-seventh day of June, 1721, Zabdiel Boylston of Boston inoculated his only son for smallpox,--the first person ever submitted to the operation in the New World. The story of the fierce resistance to the introduction of the practice; of how Boylston was mobbed, and Mather had a hand-grenade thrown in at his window; of how William Douglass, the Scotchman, "always positive, and sometimes accurate," as was neatly said of him, at once depreciated the practice and tried to get the credit of suggesting it, and how Lawrence Dalhonde, the Frenchman, testified to its destructive consequences; of how Edmund Massey, lecturer at St. Albans, preached against sinfully endeavoring to alter the course of nature by presumptuous interposition, which he would leave to the atheist and the scoffer, the heathen and unbeliever, while in the face of his sermon, afterwards reprinted in Boston, many of our New England clergy stood up boldly in defence of the practice,--all this has been told so well and so often that I spare you its details. Set this good hint of Cotton Mather against that letter of his to John Richards, recommending the search after witch-marks, and the application of the water-ordeal, which means throw your grandmother into the water, if she has a mole on her arm;--if she swims, she is a witch and must be hanged; if she sinks, the Lord have mercy on her soul!

Thus did America receive this great discovery, destined to save thousands of lives, via Boston, from the hands of one of our own Massachusetts physicians.

The year 1735 was rendered sadly memorable by the epidemic of the terrible disease known as "throat distemper," and regarded by many as the same as our "diphtheria." Dr. Holyoke thinks the more general use of mercurials in inflammatory complaints dates from the time of their employment in this disease, in which they were thought to have proved specially useful.

At some time in the course of this century medical practice had settled down on four remedies as its chief reliance. I must repeat an incident which I have related in another of these Essays. When Dr. Holyoke, nearly seventy years ago, received young Mr. James Jackson as his student, he showed him the formidable array of bottles, jars, and drawers around his office, and then named the four remedies referred to as being of more importance than all the rest put together. These were "Mercury, Antimony, Opium, and Peruvian Bark." I doubt if either of them remembered that, nearly seventy years before, in 1730, Dr. William Douglass, the disputatious Scotchman, mentioned those same four remedies, in the dedication of his quarrelsome essay on inoculation, as the most important ones in the hands of the physicians of his time.

In the "Proceedings" of this Society for the year 1863 is a very pleasant paper by the late Dr. Ephraim Eliot, giving an account of the leading physicians of Boston during the last quarter of the last century. The names of Lloyd, Gardiner, Welsh, Rand, Bulfinch, Danforth, John Warren, Jeffries, are all famous in local history, and are commemorated in our medical biographies. One of them, at least, appears to have been more widely known, not only as one of the first aerial voyagers, but as an explorer in the almost equally hazardous realm of medical theory. Dr. John Jeffries, the first of that name, is considered by Broussais as a leader of medical opinion in America, and so referred to in his famous "Examen des Doctrines Medicales."

Two great movements took place in this eighteenth century, the effect of which has been chiefly felt in our own time; namely, the establishment of the Massachusetts Medical Society, and the founding of the Medical School of Harvard University.

The third century of our medical history began with the introduction of the second great medical discovery of modern times,--of all time up to that date, I may say,--once more via Boston, if we count the University village as its suburb, and once more by one of our Massachusetts physicians. In the month of July, 1800, Dr. Benjamin Waterhouse of Cambridge submitted four of his own children to the new process of vaccination,--the first persons vaccinated, as Dr. Zabdiel Boylston's son had been the first person inoculated in the New World.

A little before the first half of this century was completed, in the autumn of 1846, the great discovery went forth from the Massachusetts General Hospital, which repaid the debt of America to the science of the Old World, and gave immortality to the place of its origin in the memory and the heart of mankind. The production of temporary insensibility at will--tuto, cito, jucunde, safely, quickly, pleasantly--is one of those triumphs over the infirmities of our mortal condition which change the aspect of life ever afterwards. Rhetoric can add nothing to its glory; gratitude, and the pride permitted to human weakness, that our Bethlehem should have been chosen as the birthplace of this new embodiment of the divine mercy, are all we can yet find room for.

The present century has seen the establishment of all those great charitable institutions for the cure of diseases of the body and of the mind, which our State and our city have a right to consider as among the chief ornaments of their civilization.

The last century had very little to show, in our State, in the way of medical literature. The worthies who took care of our grandfathers and great-grandfathers, like the Revolutionary heroes, fought (with disease) and bled (their patients) and died (in spite of their own remedies); but their names, once familiar, are heard only at rare intervals. Honored in their day, not unremembered by a few solitary students of the past, their memories are going sweetly to sleep in the arms of the patient old dry-nurse, whose "blackdrop" is the never-failing anodyne of the restless generations of men. Except the lively controversy on inoculation, and floating papers in journals, we have not much of value for that long period, in the shape of medical records.

But while the trouble with the last century is to find authors to mention, the trouble of this would be to name all that we find. Of these, a very few claim unquestioned preeminence.

Nathan Smith, born in Rehoboth, Mass., a graduate of the Medical School of our University, did a great work for the advancement of medicine and surgery in New England, by his labors as teacher and author, greater, it is claimed by some, than was ever done by any other man. The two Warrens, of our time, each left a large and permanent record of a most extended surgical practice. James Jackson not only educated a whole generation by his lessons of wisdom, but bequeathed some of the most valuable results of his experience to those who came after him, in a series of letters singularly pleasant and kindly as well as instructive. John Ware, keen and cautious, earnest and deliberate, wrote the two remarkable essays which have identified his name, for all time, with two important diseases, on which he has shed new light by his original observations.

I must do violence to the modesty of the living by referring to the many important contributions to medical science by Dr. Jacob Bigelow, and especially to his discourse on "Self-limited Diseases," an address which can be read in a single hour, but the influence of which will be felt for a century.

Nor would the profession forgive me if I forgot to mention the admirable museum of pathological anatomy, created almost entirely by the hands of Dr. John Barnard Swett Jackson, and illustrated by his own printed descriptive catalogue, justly spoken of by a distinguished professor in the University of Pennsylvania as the most important contribution which had ever been made in this country to the branch to which it relates.

When we look at the literature of mental disease, as seen in hospital reports and special treatises, we can mention the names of Wyman, Woodward, Brigham, Bell, and Ray, all either natives of Massachusetts or placed at the head of her institutions for the treatment of the insane.

We have a right to claim also one who is known all over the civilized world as a philanthropist, to us as a townsman and a graduate of our own Medical School, Dr. Samuel Gridley Howe, the guide and benefactor of a great multitude who were born to a world of inward or of outward darkness.

I cannot pass over in silence the part taken by our own physicians in those sanitary movements which are assuming every year greater importance. Two diseases especially have attracted attention, above all others, with reference to their causes and prevention; cholera, the "black death" of the nineteenth century, and consumption, the white plague of the North, both of which have been faithfully studied and reported on by physicians of our own State and city. The cultivation of medical and surgical specialties, which is fast becoming prevalent, is beginning to show its effects in the literature of the profession, which is every year growing richer in original observations and investigations.

To these benefactors who have labored for us in their peaceful vocation, we must add the noble army of surgeons, who went with the soldiers who fought the battles of their country, sharing many of their dangers, not rarely falling victims to fatigue, disease, or the deadly volleys to which they often exposed themselves in the discharge of their duties.

The pleasant biographies of the venerable Dr. Thacher, and the worthy and kind-hearted gleaner, Dr. Stephen W. Williams, who came after him, are filled with the names of men who served their generation well, and rest from their labors, followed by the blessing of those for whom they endured the toils and fatigues inseparable from their calling. The hardworking, intelligent country physician more especially deserves the gratitude of his own generation, for he rarely leaves any permanent record in the literature of his profession. Books are hard to obtain; hospitals, which are always centres of intelligence, are remote; thoroughly educated and superior men are separated by wide intervals; and long rides, though favorable to reflection, take up much of the time which might otherwise be given to the labors of the study. So it is that men of ability and vast experience, like the late Dr. Twitchell, for instance, make a great and deserved reputation, become the oracles of large districts, and yet leave nothing, or next to nothing, by which their names shall be preserved from blank oblivion.

One or two other facts deserve mention, as showing the readiness of our medical community to receive and adopt any important idea or discovery. The new science of Histology, as it is now called, was first brought fully before the profession of this country by the translation of Bichat's great work, "Anatomie Generale," by the late Dr. George Hayward.

The first work printed in this country on Auscultation,--that wonderful art of discovering disease, which, as it were, puts a window in the breast, through which the vital organs can be seen, to all intents and purposes, was the manual published anonymously by "A Member of the Massachusetts Medical Society."

We are now in some slight measure prepared to weigh the record of the medical profession in Massachusetts, and pass our judgment upon it. But in-order to do justice to the first generation of practitioners, we must compare what we know of their treatment of disease with the state of the art in England, and the superstitions which they saw all around them in other departments of knowledge or belief.

English medical literature must have been at a pretty low ebb when Sydenham recommended Don Quixote to Sir Richard Blackmore for professional reading. The College Pharmacopoeia was loaded with the most absurd compound mixtures, one of the most complex of which (the same which the Reverend Mr. Harward, "Lecturer at the Royal Chappel in Boston," tried to simplify), was not dropped until the year 1801. Sir Kenelm Digby was playing his fantastic tricks with the Sympathetic powder, and teaching Governor Winthrop, the second, how to cure fever and ague, which some may like to know. "Pare the patient's nails; put the parings in a little bag, and hang the bag round the neck of a live eel, and put him in a tub of water. The eel will die, and the patient will recover."

Wiseman, the great surgeon, was discoursing eloquently on the efficacy of the royal touch in scrofula. The founder of the Ashmolean Museum at Oxford, consorting with alchemists and astrologers, was treasuring the manuscripts of the late pious Dr. Richard Napier, in which certain letters (Rx Ris) were understood to mean Responsum Raphaelis,--the answer of the angel Raphael to the good man's medical questions. The illustrious Robert Boyle was making his collection of choice and safe remedies, including the sole of an old shoe, the thigh bone of a hanged man, and things far worse than these, as articles of his materia medica. Dr. Stafford, whose paper of directions to his "friend, Mr. Wintrop," I cited, was probably a man of standing in London; yet toad-powder was his sovereign remedy.

See what was the state of belief in other matters among the most intelligent persons of the colonies, magistrates and clergymen. Jonathan Brewster, son of the church-elder, writes the wildest letters to John Winthrop about alchemy,--"mad for making gold as the Lynn rock-borers are for finding it."

Remember the theology and the diabology of the time. Mr. Cotton's Theocracy was a royal government, with the King of kings as its nominal head, but with an upper chamber of saints, and a tremendous opposition in the lower house; the leader of which may have been equalled, but cannot have been surpassed by any of our earth-born politicians. The demons were prowling round the houses every night, as the foxes were sneaking about the hen-roosts. The men of Gloucester fired whole flasks of gunpowder at devils disguised as Indians and Frenchmen.

How deeply the notion of miraculous interference with the course of nature was rooted, is shown by the tenacity of the superstition about earthquakes. We can hardly believe that our Professor Winthrop, father of the old judge and the "squire," whom many of us Cambridge people remember so well, had to defend himself against the learned and excellent Dr. Prince, of the Old South Church, for discussing their phenomena as if they belonged to the province of natural science:

Not for the sake of degrading the aspect of the noble men who founded our State, do I refer to their idle beliefs and painful delusions, but to show against what influences the common sense of the medical profession had to assert itself.

Think, then, of the blazing stars, that shook their horrid hair in the sky; the phantom ship, that brought its message direct from the other world; the story of the mouse and the snake at Watertown; of the mice and the prayer-book; of the snake in church; of the calf with two heads; and of the cabbage in the perfect form of a cutlash,--all which innocent occurrences were accepted or feared as alarming portents.

We can smile at these: but we cannot smile at the account of unhappy Mary Dyer's malformed offspring; or of Mrs. Hutchinson's domestic misfortune of similar character, in the story of which the physician, Dr. John Clark of Rhode Island, alone appears to advantage; or as we read the Rev. Samuel Willard's fifteen alarming pages about an unfortunate young woman suffering with hysteria. Or go a little deeper into tragedy, and see poor Dorothy Talby, mad as Ophelia, first admonished, then whipped; at last, taking her own little daughter's life; put on trial, and standing mute, threatened to be pressed to death, confessing, sentenced, praying to be beheaded; and none the less pitilessly swung from the fatal ladder.

The cooper's crazy wife--crazy in the belief that she has committed the unpardonable sin--tries to drown her child, to save it from misery; and the poor lunatic, who would be tenderly cared for to-day in a quiet asylum, is judged to be acting under the instigation of Satan himself. Yet, after all, what can we say, who put Bunyan's "Pilgrim's Progress," full of nightmare dreams of horror, into all our children's hands; a story in which the awful image of the man in the cage might well turn the nursery where it is read into a madhouse?

The miserable delusion of witchcraft illustrates, in a still more impressive way, the false ideas which governed the supposed relation of men with the spiritual world. I have no doubt many physicians shared in these superstitions. Mr. Upham says they--that is, some of them--were in the habit of attributing their want of success to the fact, that an "evil hand" was on their patient. The temptation was strong, no doubt, when magistrates and ministers and all that followed their lead were contented with such an explanation. But how was it in Salem, according to Mr. Upham's own statement? Dr. John Swinnerton was, he says, for many years the principal physician of Salem. And he says, also, "The Swinnerton family were all along opposed to Mr. Parris, and kept remarkably clear from the witchcraft delusion." Dr. John Swinnerton--the same, by the way, whose memory is illuminated by a ray from the genius of Hawthorne--died the very year before the great witchcraft explosion took place. But who can doubt that it was from him that the family had learned to despise and to resist the base superstition; or that Bridget Bishop, whose house he rented, as Mr. Upham tells me, the first person hanged in the time of the delusion, would have found an efficient protector in her tenant, had he been living, to head the opposition of his family to the misguided clergymen and magistrates?

I cannot doubt that our early physicians brought with them many Old-World medical superstitions, and I have no question that they were more or less involved in the prevailing errors of the community in which they lived. But, on the whole, their record is a clean one, so far as we can get at it; and where it is questionable we must remember that there must have been many little-educated persons among them; and that all must have felt, to some extent, the influence of those sincere and devoted but unsafe men, the physic-practising clergymen, who often used spiritual means as a substitute for temporal ones, who looked upon a hysteric patient as possessed by the devil, and treated a fractured skull by prayers and plasters, following the advice of a ruling elder in opposition to the "unanimous opinion of seven surgeons."

To what results the union of the two professions was liable to lead, may be seen by the example of a learned and famous person, who has left on record the product of his labors in the double capacity of clergyman and physician.

I have had the privilege of examining a manuscript of Cotton Mather's relating to medicine, by the kindness of the librarian of the American Antiquarian Society, to which society it belongs. A brief notice of this curious document may prove not uninteresting.

It is entitled "The Angel of Bethesda: an Essay upon the Common Maladies of Mankind, offering, first, the sentiments of Piety," etc., etc., and "a collection of plain but potent and Approved REMEDIES for the Maladies." There are sixty-six "Capsula's," as he calls them, or chapters, in his table of contents; of which, five--from the fifteenth to the nineteenth, inclusive--are missing. This is a most unfortunate loss, as the eighteenth capsula treated of agues, and we could have learned from it something of their degree of frequency in this part of New England. There is no date to the manuscript; which, however, refers to a case observed Nov. 14, 1724.

The divine takes precedence of the physician in this extraordinary production. He begins by preaching a sermon at his unfortunate patient. Having thrown him into a cold sweat by his spiritual sudorific, he attacks him with his material remedies, which are often quite as unpalatable. The simple and cleanly practice of Sydenham, with whose works he was acquainted, seems to have been thrown away upon him. Everything he could find mentioned in the seventy or eighty authors he cites, all that the old women of both sexes had ever told him of, gets into his text, or squeezes itself into his margin.

Evolving disease out of sin, he hates it, one would say, as he hates its cause, and would drive it out of the body with all noisome appliances. "Sickness is in Fact Flagellum Dei pro peccatis mundi." So saying, he encourages the young mother whose babe is wasting away upon her breast with these reflections:

"Think; oh the grievous Effects of Sin! This wretched Infant has not arrived unto years of sense enough, to sin after the similitude of the transgression committed by Adam. Nevertheless the Transgression of Adam, who had all mankind Foederally, yea, Naturally, in him, has involved this Infant in the guilt of it. And the poison of the old serpent, which infected Adam when he fell into his Transgression, by hearkening to the Tempter, has corrupted all mankind, and is a seed unto such diseases as this Infant is now laboring under. Lord, what are we, and what are our children, but a Generation of Vipers?"

Many of his remedies are at least harmless, but his pedantry and utter want of judgment betray themselves everywhere. He piles his prescriptions one upon another, without the least discrimination. He is run away with by all sorts of fancies and superstitions. He prescribes euphrasia, eye-bright, for disease of the eyes; appealing confidently to the strange old doctrine of signatures, which inferred its use from the resemblance of its flower to the organ of vision. For the scattering of wens, the efficacy of a Dead Hand has been out of measure wonderful. But when he once comes to the odious class of remedies, he revels in them like a scarabeus. This allusion will bring us quite near enough to the inconceivable abominations with which he proposed to outrage the sinful stomachs of the unhappy confederates and accomplices of Adam.

It is well that the treatise was never printed, yet there are passages in it worth preserving. He speaks of some remedies which have since become more universally known:

"Among the plants of our soyl, Sir William Temple singles out Five [Six] as being of the greatest virtue and most friendly to health: and his favorite plants, Sage, Rue, Saffron, Alehoof, Garlick, and Elder."

"But these Five [Six] plants may admitt of some competitors. The QUINQUINA--How celebrated: Immoderately, Hyperbolically celebrated!"

Of Ipecacuanha, he says,--"This is now in its reign; the most fashionable vomit."

"I am not sorry that antimonial emetics begin to be disused."

He quotes "Mr. Lock" as recommending red poppy-water and abstinence from flesh as often useful in children's diseases.

One of his "Capsula's" is devoted to the animalcular origin of diseases, at the end of which he says, speaking of remedies for this supposed source of our distempers:

"Mercury we know thee: But we are afraid thou wilt kill us too, if we employ thee to kill them that kill us.

"And yett, for the cleansing of the small Blood Vessels, and making way for the free circulation of the Blood and Lymph--there is nothing like Mercurial Deobstruents."

From this we learn that mercury was already in common use, and the subject of the same popular prejudice as in our own time.

His poetical turn shows itself here and there:

"O Nightingale, with a Thorn at thy Breast; Under the trouble of a Cough, what can be more proper than such thoughts as these?"...

If there is pathos in this, there is bathos in his apostrophe to the millipede, beginning "Poor sowbug!" and eulogizing the healing virtues of that odious little beast; of which he tells us to take "half a pound, putt 'em alive into a quart or two of wine," with saffron and other drugs, and take two ounces twice a day.

The "Capsula" entitled "Nishmath Chajim" was printed in 1722, at New London, and is in the possession of our own Society. He means, by these words, something like the Archxus of Van Helmont, of which he discourses in a style wonderfully resembling that of Mr. Jenkinson in the "Vicar of Wakefield." "Many of the Ancients thought there was much of a Real History in the Parable, and their Opinion was that there is, DIAPHORA KATA TAS MORPHAS, A Distinction (and so a Resemblance) of men as to their Shapes after Death." And so on, with Ireaeus, Tertullian, Thespesius, and "the TA TONE PSEUCONE CROMATA," in the place of "Sanconiathon, Manetho, Berosus," and "Anarchon ara kai ateleutaion to pan."

One other passage deserves notice, as it relates to the single medical suggestion which does honor to Cotton Mather's memory. It does not appear that he availed himself of the information which he says, he obtained from his slave, for such I suppose he was.

In his appendix to "Variolae Triumphatae," he says,--

"There has been a wonderful practice lately used in several parts of the world, which indeed is not yet become common in our nation.

"I was first informed of it by a Garamantee servant of my own, long before I knew that any Europeans or Asiaticks had the least acquaintance with it, and some years before I was enriched with the communications of the learned Foreigners, whose accounts I found agreeing with what I received of my servant, when he shewed me the Scar of the Wound made for the operation; and said, That no person ever died of the smallpox, in their countrey, that had the courage to use it.

"I have since met with a considerable Number of these Africans, who all agree in one story; That in their countrey grandy-many dy of the small-pox: But now they learn this way: people take juice of smallpox and cutty-skin and put in a Drop; then by'nd by a little sicky, sicky: then very few little things like small-pox; and nobody dy of it; and nobody have small-pox any more. Thus, in Africa, where the poor creatures dy of the smallpox like Rotten Sheep, a merciful God has taught them an Infallible preservative. 'T is a common practice, and is attended with a constant success."

What has come down to us of the first century of medical practice, in the hands of Winthrop and Oliver, is comparatively simple and reasonable. I suspect that the conditions of rude, stern life, in which the colonists found themselves in the wilderness, took the nonsense out of them, as the exigencies of a campaign did out of our physicians and surgeons in the late war. Good food and enough of it, pure air and water, cleanliness, good attendance, an anaesthetic, an opiate, a stimulant, quinine, and two or three common drugs, proved to be the marrow of medical treatment; and the fopperies of the pharmacopoeia went the way of embroidered shirts and white kid gloves and malacca joints, in their time of need. "Good wine is the best cordiall for her," said Governor John Winthrop, Junior, to Samuel Symonds, speaking of that gentleman's wife,--just as Sydenham, instead of physic, once ordered a roast chicken and a pint of canary for his patient in male hysterics.

But the profession of medicine never could reach its full development until it became entirely separated from that of divinity. The spiritual guide, the consoler in affliction, the confessor who is admitted into the secrets of our souls, has his own noble sphere of duties; but the healer of men must confine himself solely to the revelations of God in nature, as he sees their miracles with his own eyes. No doctrine of prayer or special providence is to be his excuse for not looking straight at secondary causes, and acting, exactly so far as experience justifies him, as if he were himself the divine agent which antiquity fabled him to be. While pious men were praying--humbly, sincerely, rightly, according to their knowledge--over the endless succession of little children dying of spasms in the great Dublin Hospital, a sagacious physician knocked some holes in the walls of the ward, let God's blessed air in on the little creatures, and so had already saved in that single hospital, as it was soberly calculated thirty years ago, more than sixteen thousand lives of these infant heirs of immortality. [Collins's Midwifery, p. 312. Published by order of the Massachusetts Medical Society. Boston, 1841.]

Let it be, if you will, that the wise inspiration of the physician was granted in virtue of the clergyman's supplications. Still, the habit of dealing with things seen generates another kind of knowledge, and another way of thought, from that of dealing with things unseen; which knowledge and way of thought are special means granted by Providence, and to be thankfully accepted.

The mediaeval ecclesiastics expressed a great truth in that saying, so often quoted, as carrying a reproach with it: "Ubi tres medici, duo athei,"--"Where there are three physicians, there are two atheists."

It was true then, it is true to-day, that the physician very commonly, if not very generally, denies and repudiates the deity of ecclesiastical commerce. The Being whom Ambroise Pare meant when he spoke those memorable words, which you may read over the professor's chair in the French School of Medicine, "Te le pensay, et Dieu le guarit," "I dressed his wound, and God healed it,"--is a different being from the God that scholastic theologians have projected from their consciousness, or shaped even from the sacred pages which have proved so plastic in their hands. He is a God who never leaves himself without witness, who repenteth him of the evil, who never allows a disease or an injury, compatible with the enjoyment of life, to take its course without establishing an effort, limited by certain fixed conditions, it is true, but an effort, always, to restore the broken body or the shattered mind. In the perpetual presence of this great Healing Agent, who stays the bleeding of wounds, who knits the fractured bone, who expels the splinter by a gentle natural process, who walls in the inflammation that might involve the vital organs, who draws a cordon to separate the dead part from the living, who sends his three natural anaesthetics to the over-tasked frame in due order, according to its need,--sleep, fainting, death; in this perpetual presence, it is doubtless hard for the physician to realize the theological fact of a vast and permanent sphere of the universe, where no organ finds itself in its natural medium, where no wound heals kindly, where the executive has abrogated the pardoning power, and mercy forgets its errand; where the omnipotent is unfelt save in malignant agencies, and the omnipresent is unseen and unrepresented; hard to accept the God of Dante's "Inferno," and of Bunyan's caged lunatic. If this is atheism, call three, instead of two of the trio, atheists, and it will probably come nearer the truth.

I am not disposed to deny the occasional injurious effect of the materializing influences to which the physician is subjected. A spiritual guild is absolutely necessary to keep him, to keep us all, from becoming the "fingering slaves" that Wordsworth treats with such shrivelling scorn. But it is well that the two callings have been separated, and it is fitting that they remain apart. In settling the affairs of the late concern, I am afraid our good friends remain a little in our debt. We lent them our physician Michael Servetus in fair condition, and they returned him so damaged by fire as to be quite useless for our purposes. Their Reverend Samuel Willard wrote us a not over-wise report of a case of hysteria; and our Jean Astruc gave them (if we may trust Dr. Smith's Dictionary of the Bible) the first discerning criticism on the authorship of the Pentateuch. Our John Locke enlightened them with his letters concerning toleration; and their Cotton Mather obscured our twilight with his "Nishmath Chajim."

Yet we must remember that the name of Basil Valentine, the monk, is associated with whatever good and harm we can ascribe to antimony; and that the most remarkable of our specifics long bore the name of "Jesuit's Bark," from an old legend connected with its introduction. "Frere Jacques," who taught the lithotomists of Paris, owes his ecclesiastical title to courtesy, as he did not belong to a religious order.

Medical science, and especially the study of mental disease, is destined, I believe, to react to much greater advantage on the theology of the future than theology has acted on medicine in the past. The liberal spirit very generally prevailing in both professions, and the good understanding between their most enlightened members, promise well for the future of both in a community which holds every point of human belief, every institution in human hands, and every word written in a human dialect, open to free discussion today, to-morrow, and to the end of time. Whether the world at large will ever be cured of trusting to specifics as a substitute for observing the laws of health, and to mechanical or intellectual formula as a substitute for character, may admit of question. Quackery and idolatry are all but immortal.

We can find most of the old beliefs alive amongst us to-day, only having changed their dresses and the social spheres in which they thrive. We think the quarrels of Galenists and chemists belong to the past, forgetting that Thomsonism has its numerous apostles in our community; that it is common to see remedies vaunted as purely vegetable, and that the prejudice against "mineral poisons," especially mercury, is as strong in many quarters now as it was at the beginning of the seventeenth century. Names are only air, and blow away with a change of wind; but beliefs are rooted in human wants and weakness, and die hard. The oaks of Dodona are prostrate, and the shrine of Delphi is desolate; but the Pythoness and the Sibyl may be consulted in Lowell Street for a very moderate compensation. Nostradamus and Lilly seem impossible in our time; but we have seen the advertisements of an astrologer in our Boston papers year after year, which seems to imply that he found believers and patrons. You smiled when I related Sir Kenelm Digby's prescription with the live eel in it; but if each of you were to empty his or her pockets, would there not roll out, from more than one of them, a horse-chestnut, carried about as a cure for rheumatism? The brazen head of Roger Bacon is mute; but is not "Planchette" uttering her responses in a hundred houses of this city? We think of palmistry or chiromancy as belonging to the days of Albertus Magnus, or, if existing in our time, as given over to the gypsies; but a very distinguished person has recently shown me the line of life, and the line of fortune, on the palm of his hand, with a seeming confidence in the sanguine predictions of his career which had been drawn from them. What shall we say of the plausible and well-dressed charlatans of our own time, who trade in false pretences, like Nicholas Knapp of old, but without any fear of being fined or whipped; or of the many follies and inanities, imposing on the credulous part of the community, each of them gaping with eager, open mouth for a gratuitous advertisement by the mention of its foolish name in any respectable connection?

I turn from this less pleasing aspect of the common intelligence which renders such follies possible, to close the honorable record of the medical profession in this, our ancient Commonwealth.

We have seen it in the first century divided among clergymen, magistrates, and regular practitioners; yet, on the whole, for the time, and under the circumstances, respectable, except where it invoked supernatural agencies to account for natural phenomena.

In the second century it simplified its practice, educated many intelligent practitioners, and began the work of organizing for concerted action, and for medical teaching.

In this, our own century, it has built hospitals, perfected and multiplied its associations and educational institutions, enlarged and created museums, and challenged a place in the world of science by its literature.

In reviewing the whole course of its history we read a long list of honored names, and a precious record written in private memories, in public charities, in permanent contributions to medical science, in generous sacrifices for the country. We can point to our capital as the port of entry for the New World of the great medical discoveries of two successive centuries, and we can claim for it the triumph over the most dreaded foe that assails the human body,--a triumph which the annals of the race can hardly match in three thousand years of medical history.

Spotted a typo or a problem in this chapter? Tell us

THE YOUNG PRACTITIONER

[A Valedictory Address delivered to the Graduating Class of the Bellevue Hospital College, March 2, 1871.]

The occasion which calls us together reminds us not a little of that other ceremony which unites a man and woman for life. The banns have already been pronounced which have wedded our young friends to the profession of their choice. It remains only to address to them some friendly words of cheering counsel, and to bestow upon them the parting benediction.

This is not the time for rhetorical display or ambitious eloquence. We must forget ourselves, and think only of them. To us it is an occasion; to them it is an epoch. The spectators at the wedding look curiously at the bride and bridegroom; at the bridal veil, the orange-flower garland, the giving and receiving of the ring; they listen for the tremulous "I will," and wonder what are the mysterious syllables the clergyman whispers in the ear of the married maiden. But to the newly-wedded pair what meaning in those words, "for better, for worse," "in sickness and in health," "till death us do part!" To the father, to the mother, who know too well how often the deadly nightshade is interwoven with the wreath of orange-blossoms, how empty the pageant, how momentous the reality!

You will not wonder that I address myself chiefly to those who are just leaving academic life for the sterner struggle and the larger tasks of matured and instructed manhood. The hour belongs to them; if others find patience to listen, they will kindly remember that, after all, they are but as the spectators at the wedding, and that the priest is thinking less of them than of their friends who are kneeling at the altar.

I speak more directly to you, then, gentlemen of the graduating class. The days of your education, as pupils of trained instructors, are over. Your first harvest is all garnered. Henceforth you are to be sowers as well as reapers, and your field is the world. How does your knowledge stand to-day? What have you gained as a permanent possession? What must you expect to forget? What remains for you yet to learn? These are questions which it may interest you to consider.

There is another question which must force itself on the thoughts of many among you: "How am I to obtain patients and to keep their confidence?" You have chosen a laborious calling, and made many sacrifices to fit yourselves for its successful pursuit. You wish to be employed that you may be useful, and that you may receive the reward of your industry. I would take advantage of these most receptive moments to give you some hints which may help you to realize your hopes and expectations. Such is the outline of the familiar talk I shall offer you.

Your acquaintance with some of the accessory branches is probably greater now than it will be in a year from now,--much greater than it will by ten years from now. The progress of knowledge, it may be feared, or hoped, will have outrun the text-books in which you studied these branches. Chemistry, for instance, is very apt to spoil on one's hands. "Nous avons change tout cela" might serve as the standing motto of many of our manuals. Science is a great traveller, and wears her shoes out pretty fast, as might be expected.

You are now fresh from the lecture-room and the laboratory. You can pass an examination in anatomy, physiology, chemistry, materia medica, which the men in large practice all around you would find a more potent sudorific than any in the Pharmacopceia. These masters of the art of healing were once as ready with their answers as you are now, but they have got rid of a great deal of the less immediately practical part of their acquisitions, and you must undergo the same depleting process. Hard work will train it off, as sharp exercise trains off the fat of a prize-fighter.

Yet, pause a moment before you infer that your teachers must have been in fault when they furnished you with mental stores not directly convertible to practical purposes, and likely in a few years to lose their place in your memory. All systematic knowledge involves much that is not practical, yet it is the only kind of knowledge which satisfies the mind, and systematic study proves, in the long-run, the easiest way of acquiring and retaining facts which are practical. There are many things which we can afford to forget, which yet it was well to learn. Your mental condition is not the same as if you had never known what you now try in vain to recall. There is a perpetual metempsychosis of thought, and the knowledge of to-day finds a soil in the forgotten facts of yesterday. You cannot see anything in the new season of the guano you placed last year about the roots of your climbing plants, but it is blushing and breathing fragrance in your trellised roses; it has scaled your porch in the bee-haunted honey-suckle; it has found its way where the ivy is green; it is gone where the woodbine expands its luxuriant foliage.

Your diploma seems very broad to-day with your list of accomplishments, but it begins to shrink from this hour like the Peau de Chagrin of Balzac's story. Do not worry about it, for all the while there will be making out for you an ampler and fairer parchment, signed by old Father Time himself as President of that great University in which experience is the one perpetual and all-sufficient professor.

Your present plethora of acquirements will soon cure itself. Knowledge that is not wanted dies out like the eyes of the fishes of the Mammoth Cave. When you come to handle life and death as your daily business, your memory will of itself bid good-by to such inmates as the well-known foramina of the sphenoid bone and the familiar oxides of methyl-ethylamyl-phenyl-ammonium. Be thankful that you have once known them, and remember that even the learned ignorance of a nomenclature is something to have mastered, and may furnish pegs to hang facts upon which would otherwise have strewed the floor of memory in loose disorder.

But your education has, after all, been very largely practical. You have studied medicine and surgery, not chiefly in books, but at the bedside and in the operating amphitheatre. It is the special advantage of large cities that they afford the opportunity of seeing a great deal of disease in a short space of time, and of seeing many cases of the same kind of disease brought together. Let us not be unjust to the claims of the schools remote from the larger centres of population. Who among us has taught better than Nathan Smith, better than Elisha Bartlett? who teaches better than some of our living contemporaries who divide their time between city and country schools? I am afraid we do not always do justice to our country brethren, whose merits are less conspicuously exhibited than those of the great city physicians and surgeons, such especially as have charge of large hospitals. There are modest practitioners living in remote rural districts who are gifted by nature with such sagacity and wisdom, trained so well in what is most essential to the practice of their art, taught so thoroughly by varied experience, forced to such manly self-reliance by their comparative isolation, that, from converse with them alone, from riding with them on their long rounds as they pass from village to village, from talking over cases with them, putting up their prescriptions, watching their expedients, listening to their cautions, marking the event of their predictions, hearing them tell of their mistakes, and now and then glory a little in the detection of another's blunder, a young man would find himself better fitted for his real work than many who have followed long courses of lectures and passed a showy examination. But the young man is exceptionally fortunate who enjoys the intimacy of such a teacher. And it must be confessed that the great hospitals, infirmaries, and dispensaries of large cities, where men of well-sifted reputations are in constant attendance, are the true centres of medical education. No students, I believe, are more thoroughly aware of this than those who have graduated at this institution. Here, as in all our larger city schools, the greatest pains are taken to teach things as well as names. You have entered into the inheritance of a vast amount of transmitted skill and wisdom, which you have taken, warm, as it were, with the life of your well-schooled instructors. You have not learned all that art has to teach you, but you are safer practitioners to-day than were many of those whose names we hardly mention without a genuflection. I had rather be cared for in a fever by the best-taught among you than by the renowned Fernelius or the illustrious Boerhaave, could they come back to us from that better world where there are no physicians needed, and, if the old adage can be trusted, not many within call. I had rather have one of you exercise his surgical skill upon me than find myself in the hands of a resuscitated Fabricius Hildanus, or even of a wise Ambroise Pare, revisiting earth in the light of the nineteenth century.

You will not accuse me of underrating your accomplishments. You know what to do for a child in a fit, for an alderman in an apoplexy, for a girl that has fainted, for a woman in hysterics, for a leg that is broken, for an arm that is out of joint, for fevers of every color, for the sailor's rheumatism, and the tailor's cachexy. In fact you do really know so much at this very hour, that nothing but the searching test of time can fully teach you the limitations of your knowledge.

Of some of these you will permit me to remind you. You will never have outgrown the possibility of new acquisitions, for Nature is endless in her variety. But even the knowledge which you may be said to possess will be a different thing after long habit has made it a part of your existence. The tactus eruditus extends to the mind as well as to the finger-ends. Experience means the knowledge gained by habitual trial, and an expert is one who has been in the habit of trying. This is the kind of knowledge that made Ulysses wise in the ways of men. Many cities had he seen, and known the minds of those who dwelt in them. This knowledge it was that Chaucer's Shipman brought home with him from the sea--

"In many a tempest had his berd be shake."

This is the knowledge we place most confidence in, in the practical affairs of life.

Our training has two stages. The first stage deals with our intelligence, which takes the idea of what is to be done with the most charming ease and readiness. Let it be a game of billiards, for instance, which the marker is going to teach us. We have nothing to do but to make this ball glance from that ball and hit that other ball, and to knock that ball with this ball into a certain caecal sacculus or diverticulum which our professional friend calls a pocket. Nothing can be clearer; it is as easy as "playing upon this pipe," for which Hamlet gives Guildenstern such lucid directions. But this intelligent Me, who steps forward as the senior partner in our dual personality, turns out to be a terrible bungler. He misses those glancing hits which the hard-featured young professional person calls "carroms," and insists on pocketing his own ball instead of the other one.

It is the unintelligent Me, stupid as an idiot, that has to try a thing a thousand times before he can do it, and then never knows how he does it, that at last does it well. We have to educate ourselves through the pretentious claims of intellect, into the humble accuracy of instinct, and we end at last by acquiring the dexterity, the perfection, the certainty, which those masters of arts, the bee and the spider, inherit from Nature.

Book-knowledge, lecture-knowledge, examination-knowledge, are all in the brain. But work-knowledge is not only in the brain, it is in the senses, in the muscles, in the ganglia of the sympathetic nerves,--all over the man, as one may say, as instinct seems diffused through every part of those lower animals that have no such distinct organ as a brain. See a skilful surgeon handle a broken limb; see a wise old physician smile away a case that looks to a novice as if the sexton would soon be sent for; mark what a large experience has done for those who were fitted to profit by it, and you will feel convinced that, much as you know, something is still left for you to learn.

May I venture to contrast youth and experience in medical practice, something in the way the man painted the lion, that is, the lion under?

The young man knows the rules, but the old man knows-the exceptions. The young man knows his patient, but the old man knows also his patient's family, dead and alive, up and down for generations. He can tell beforehand what diseases their unborn children will be subject to, what they will die of if they live long enough, and whether they had better live at all, or remain unrealized possibilities, as belonging to a stock not worth being perpetuated. The young man feels uneasy if he is not continually doing something to stir up his patient's internal arrangements. The old man takes things more quietly, and is much more willing to let well enough alone: All these superiorities, if such they are,'you must wait for time to bring you. In the meanwhile (if we will let the lion be uppermost for a moment), the young man's senses are quicker than those of his older rival. His education in all the accessory branches is more recent, and therefore nearer the existing condition of knowledge. He finds it easier than his seniors to accept the improvements which every year is bringing forward. New ideas build their nests in young men's brains. "Revolutions are not made by men in spectacles," as I once heard it remarked, and the first whispers of a new truth are not caught by those who begin to feel the need of an ear-trumpet. Granting all these advantages to the young man, he ought, nevertheless, to go on improving, on the whole, as a medical practitioner, with every year, until he has ripened into a well-mellowed maturity. But, to improve, he must be good for something at the start. If you ship a poor cask of wine to India and back, if you keep it a half a century, it only grows thinner and sharper.

You are soon to enter into relations with the public, to expend your skill and knowledge for its benefit, and find your support in the rewards of your labor. What kind of a constituency is this which is to look to you as its authorized champions in the struggle of life against its numerous enemies?

In the first place, the persons who seek the aid of the physician are very honest and sincere in their wish to get rid of their complaints, and, generally speaking, to live as long as they can. However attractively the future is painted to them, they are attached to the planet with which they are already acquainted. They are addicted to the daily use of this empirical and unchemical mixture which we call air; and would hold on to it as a tippler does to his alcoholic drinks. There is nothing men will not do, there is nothing they have not done, to recover their health and save their lives. They have submitted to be half-drowned in water, and half-choked with gases, to be buried up to their chins in earth, to be seared with hot irons like galley-slaves, to be crimped with knives, like cod-fish, to have needles thrust into their flesh, and bonfires kindled on their skin, to swallow all sorts of abominations, and to pay for all this, as if to be singed and scalded were a costly privilege, as if blisters were a blessing, and leeches were a luxury. What more can be asked to prove their honesty and sincerity?

This same community is very intelligent with respect to a great many subjects-commerce, mechanics, manufactures, politics. But with regard to medicine it is hopelessly ignorant and never finds it out. I do not know that it is any worse in this country than in Great Britain, where Mr. Huxley speaks very freely of "the utter ignorance of the simplest laws of their own animal life, which prevails among even the most highly educated persons." And Cullen said before him "Neither the acutest genius nor the soundest judgment will avail in judging of a particular science, in regard to which they have not been exercised. I have been obliged to please my patients sometimes with reasons, and I have found that any will pass, even with able divines and acute lawyers; the same will pass with the husbands as with the wives." If the community could only be made aware of its own utter ignorance, and incompetence to form opinions on medical subjects, difficult enough to those who give their lives to the study of them, the practitioner would have an easier task. But it will form opinions of its own, it cannot help it, and we cannot blame it, even though we know how slight and deceptive are their foundations.

This is the way it happens: Every grown-up person has either been ill himself or had a friend suffer from illness, from which he has recovered. Every sick person has done something or other by somebody's advice, or of his own accord, a little before getting better. There is an irresistible tendency to associate the thing done, and the improvement which followed it, as cause and effect. This is the great source of fallacy in medical practice. But the physician has some chance of correcting his hasty inference. He thinks his prescription cured a single case of a particular complaint; he tries it in twenty similar cases without effect, and sets down the first as probably nothing more than a coincidence. The unprofessional experimenter or observer has no large experience to correct his hasty generalization. He wants to believe that the means he employed effected his cure. He feels grateful to the person who advised it, he loves to praise the pill or potion which helped him, and he has a kind of monumental pride in himself as a living testimony to its efficacy. So it is that you will find the community in which you live, be it in town or country, full of brands plucked from the burning, as they believe, by some agency which, with your better training, you feel reasonably confident had nothing to do with it. Their disease went out of itself, and the stream from the medical fire-annihilator had never even touched it.

You cannot and need not expect to disturb the public in the possession of its medical superstitions. A man's ignorance is as much his private property, and as precious in his own eyes, as his family Bible. You have only to open your own Bible at the ninth chapter of St. John's Gospel, and you will find that the logic of a restored patient was very simple then, as it is now, and very hard to deal with. My clerical friends will forgive me for poaching on their sacred territory, in return for an occasional raid upon the medical domain of which they have now and then been accused.

A blind man was said to have been restored to sight by a young person whom the learned doctors of the Jewish law considered a sinner, and, as such, very unlikely to have been endowed with a divine gift of healing. They visited the patient repeatedly, and evidently teased him with their questions about the treatment, and their insinuations about the young man, until he lost his temper. At last he turned sharply upon them: "Whether he be a sinner or no, I know not: one thing I know, that, whereas I was blind, now I see."

This is the answer that always has been and always will be given by most persons when they find themselves getting well after doing anything, no matter what,--recommended by anybody, no matter whom. Lord Bacon, Robert Boyle, Bishop Berkeley, all put their faith in panaceas which we should laugh to scorn. They had seen people get well after using them. Are we any wiser than those great men? Two years ago, in a lecture before the Massachusetts Historical Society, I mentioned this recipe of Sir Kenelm Digby for fever and ague: Pare the patient's nails; put the parings in a little bag, and hang the bag round the neck of a live eel, and place him in a tub of water. The eel will die, and the patient will recover.

Referring to this prescription in the course of the same lecture, I said: "You smiled when I related Sir Kenehn Digby's prescription, with the live eel in it; but if each of you were to empty his or her pockets, would there not roll out, from more than one of them, a horse-chestnut, carried about as a cure for rheumatism?" Nobody saw fit to empty his or her pockets, and my question brought no response. But two months ago I was in a company of educated persons, college graduates every one of them, when a gentleman, well known in our community, a man of superior ability and strong common-sense, on the occasion of some talk arising about rheumatism, took a couple of very shiny horse-chestnuts from his breeches-pocket, and laid them on the table, telling us how, having suffered from the complaint in question, he had, by the advice of a friend, procured these two horse-chestnuts on a certain time a year or more ago, and carried them about him ever since; from which very day he had been entirely free from rheumatism.

This argument, from what looks like cause and effect, whether it be so or not, is what you will have to meet wherever you go, and you need not think you can answer it. In the natural course of things some thousands of persons must be getting well or better of slight attacks of colds, of rheumatic pains, every week, in this city alone. Hundreds of them do something or other in the way of remedy, by medical or other advice, or of their own motion, and the last thing they do gets the credit of the recovery. Think what a crop of remedies this must furnish, if it were all harvested!

Experience has taught, or will teach you, that most of the wonderful stories patients and others tell of sudden and signal cures are like Owen Glendower's story of the portents that announced his birth. The earth shook at your nativity, did it? Very likely, and

"So it would have done, At the same season, if your mother's cat Had kittened, though yourself had ne'er been born."

You must listen more meekly than Hotspur did to the babbling Welshman, for ignorance is a solemn and sacred fact, and, like infancy, which it resembles, should be respected. Once in a while you will have a patient of sense, born with the gift of observation, from whom you may learn something. When you find yourself in the presence of one who is fertile of medical opinions, and affluent in stories of marvellous cures,--of a member of Congress whose name figures in certificates to the value of patent medicines, of a voluble dame who discourses on the miracles she has wrought or seen wrought with the little jokers of the sugar-of-milk globule-box, take out your watch and count the pulse; also note the time of day, and charge the price of a visit for every extra fifteen, or, if you are not very busy, every twenty minutes. In this way you will turn what seems a serious dispensation into a double blessing, for this class of patients loves dearly to talk, and it does them a deal of good, and you feel as if you had earned your money by the dose you have taken, quite as honestly as by any dose you may have ordered.

You must take the community just as it is, and make the best of it. You wish to obtain its confidence; there is a short rule for doing this which you will find useful,--deserve it. But, to deserve it in full measure, you must unite many excellences, natural and acquired.

As the basis of all the rest, you must have all those traits of character which fit you to enter into the most intimate and confidential relations with the families of which you are the privileged friend and counsellor. Medical Christianity, if I may use such a term, is of very early date. By the oath of Hippocrates, the practitioner of ancient times bound himself to enter his patient's house with the sole purpose of doing him good, and so to conduct himself as to avoid the very appearance of evil. Let the physician of to-day begin by coming up to this standard, and add to it all the more recently discovered virtues and graces.

A certain amount of natural ability is requisite to make you a good physician, but by no means that disproportionate development of some special faculty which goes by the name of genius. A just balance of the mental powers is a great deal more likely to be useful than any single talent, even were it the power of observation; in excess. For a mere observer is liable to be too fond of facts for their own sake, so that, if he told the real truth, he would confess that he takes more pleasure in a post-mortem examination which shows him what was the matter with a patient, than in a case which insists on getting well and leaving him in the dark as to its nature. Far more likely to interfere with the sound practical balance of the mind is that speculative, theoretical tendency which has made so many men noted in their day, whose fame has passed away with their dissolving theories. Read Dr. Bartlett's comparison of the famous Benjamin Rush with his modest fellow-townsman Dr. William Currie, and see the dangers into which a passion for grandiose generalizations betrayed a man of many admirable qualities.

I warn you against all ambitious aspirations outside of your profession. Medicine is the most difficult of sciences and the most laborious of arts. It will task all your powers of body and mind if you are faithful to it. Do not dabble in the muddy sewer of politics, nor linger by the enchanted streams of literature, nor dig in far-off fields for the hidden waters of alien sciences. The great practitioners are generally those who concentrate all their powers on their business. If there are here and there brilliant exceptions, it is only in virtue of extraordinary gifts, and industry to which very few are equal.

To get business a man mast really want it; and do you suppose that when you are in the middle of a heated caucus, or half-way through a delicate analysis, or in the spasm of an unfinished ode, your eyes rolling in the fine frenzy of poetical composition, you want to be called to a teething infant, or an ancient person groaning under the griefs of a lumbago? I think I have known more than one young man whose doctor's sign proclaimed his readiness to serve mankind in that capacity, but who hated the sound of a patient's knock, and as he sat with his book or his microscope, felt exactly as the old party expressed himself in my friend Mr. Brownell's poem--

"All I axes is, let me alone."

The community soon finds out whether you are in earnest, and really mean business, or whether you are one of those diplomaed dilettanti who like the amusement of quasi medical studies, but have no idea of wasting their precious time in putting their knowledge in practice for the benefit of their suffering fellow-creatures.

The public is a very incompetent judge of your skill and knowledge, but it gives its confidence most readily to those who stand well with their professional brethren, whom they call upon when they themselves or their families are sick, whom they choose to honorable offices, whose writings and teachings they hold in esteem. A man may be much valued by the profession and yet have defects which prevent his becoming a favorite practitioner, but no popularity can be depended upon as permanent which is not sanctioned by the judgment of professional experts, and with these you will always stand on your substantial merits.

What shall I say of the personal habits you must form if you wish for success? Temperance is first upon the list. Intemperance in a physician partakes of the guilt of homicide, for the muddled brain may easily make a fatal blunder in a prescription and the unsteady hand transfix an artery in an operation. Tippling doctors have been too common in the history of medicine. Paracelsus was a sot, Radcliffe was much too fond of his glass, and Dr. James Hurlbut of Wethersfield, Connecticut, a famous man in his time, used to drink a square bottle of rum a day, with a corresponding allowance of opium to help steady his nerves. We commonly speak of a man as being the worse for liquor, but I was asking an Irish laborer one day about his doctor, who, as he said, was somewhat given to drink. "I like him best when he's a little that way," he said; "then I can spake to him." I pitied the poor patient who could not venture to allude to his colic or his pleurisy until his physician was tipsy.

There are personal habits of less gravity than the one I have mentioned which it is well to guard against, or, if they are formed, to relinquish. A man who may be called at a moment's warning into the fragrant boudoir of suffering loveliness should not unsweeten its atmosphere with reminiscences of extinguished meerschaums. He should remember that the sick are sensitive and fastidious, that they love the sweet odors and the pure tints of flowers, and if his presence is not like the breath of the rose, if his hands are not like the leaf of the lily, his visit may be unwelcome, and if he looks behind him he may see a window thrown open after he has left the sick-chamber. I remember too well the old doctor who sometimes came to help me through those inward griefs to which childhood is liable. "Far off his coming "--shall I say "shone," and finish the Miltonic phrase, or leave the verb to the happy conjectures of my audience? Before him came a soul-subduing whiff of ipecacuanha, and after him lingered a shuddering consciousness of rhubarb. He had lived so much among his medicaments that he had at last become himself a drug, and to have him pass through a sick-chamber was a stronger dose than a conscientious disciple of Hahnemann would think it safe to administer.

Need I remind you of the importance of punctuality in your engagements, and of the worry and distress to patients and their friends which the want of it occasions? One of my old teachers always carried two watches, to make quite sure of being exact, and not only kept his appointments with the regularity of a chronometer, but took great pains to be at his patient's house at the time when he had reason to believe he was expected, even if no express appointment was made. It is a good rule; if you call too early, my lady's hair may not be so smooth as could be wished, and, if you keep her waiting too long, her hair may be smooth, but her temper otherwise.

You will remember, of course, always to get the weather-gage of your patient. I mean, to place him so that the light falls on his face and not on yours. It is a kind of, ocular duel that is about to take place between you; you are going to look through his features into his pulmonary and hepatic and other internal machinery, and he is going to look into yours quite as sharply to see what you think about his probabilities for time or eternity.

No matter how hard he stares at your countenance, he should never be able to read his fate in it. It should be cheerful as long as there is hope, and serene in its gravity when nothing is left but resignation. The face of a physician, like that of a diplomatist, should be impenetrable. Nature is a benevolent old hypocrite; she cheats the sick and the dying with illusions better than any anodynes. If there are cogent reasons why a patient should be undeceived, do it deliberately and advisedly, but do not betray your apprehensions through your tell-tale features.

We had a physician in our city whose smile was commonly reckoned as being worth five thousand dollars a year to him, in the days, too, of moderate incomes. You cannot put on such a smile as that any more than you can get sunshine without sun; there was a tranquil and kindly nature under it that irradiated the pleasant face it made one happier to meet on his daily rounds. But you can cultivate the disposition, and it will work its way through to the surface, nay, more,--you can try to wear a quiet and encouraging look, and it will react on your disposition and make you like what you seem to be, or at least bring you nearer to its own likeness.

Your patient has no more right to all the truth you know than he has to all the medicine in your saddlebags, if you carry that kind of cartridge-box for the ammunition that slays disease. He should get only just so much as is good for him. I have seen a physician examining a patient's chest stop all at once, as he brought out a particular sound with a tap on the collarbone, in the attitude of a pointer who has just come on the scent or sight of a woodcock. You remember the Spartan boy, who, with unmoved countenance, hid the fox that was tearing his vitals beneath his mantle. What he could do in his own suffering you must learn to do for others on whose vital organs disease has fastened its devouring teeth. It is a terrible thing to take away hope, even earthly hope, from a fellow-creature. Be very careful what names you let fall before your patient. He knows what it means when you tell him he has tubercles or Bright's disease, and, if he hears the word carcinoma, he will certainly look it out in a medical dictionary, if he does not interpret its dread significance on the instant. Tell him he has asthmatic symptoms, or a tendency to the gouty diathesis, and he will at once think of all the asthmatic and gouty old patriarchs he has ever heard of, and be comforted. You need not be so cautious in speaking of the health of rich and remote relatives, if he is in the line of succession.

Some shrewd old doctors have a few phrases always on hand for patients that will insist on knowing the pathology of their complaints without the slightest capacity of understanding the scientific explanation. I have known the term "spinal irritation" serve well on such occasions, but I think nothing on the whole has covered so much ground, and meant so little, and given such profound satisfaction to all parties, as the magnificent phrase "congestion of the portal system."

Once more, let me recommend you, as far as possible, to keep your doubts to yourself, and give the patient the benefit of your decision. Firmness, gentle firmness, is absolutely necessary in this and certain other relations. Mr. Rarey with Cruiser, Richard with Lady Ann, Pinel with his crazy people, show what steady nerves can do with the most intractable of animals, the most irresistible of despots, and the most unmanageable of invalids.

If you cannot acquire and keep the confidence of your patient, it is time for you to give place to some other practitioner who can. If you are wise and diligent, you can establish relations with the best of them which they will find it very hard to break. But, if they wish to employ another person, who, as they think, knows more than you do, do not take it as a personal wrong. A patient believes another man can save his life, can restore him to health, which, as he thinks, you have not the skill to do. No matter whether the patient is right or wrong, it is a great impertinence to think you have any property in him. Your estimate of your own ability is not the question, it is what the patient thinks of it. All your wisdom is to him like the lady's virtue in Raleigh's song:

"If she seem not chaste to me, What care I how chaste she be?"

What I call a good patient is one who, having found a good physician, sticks to him till he dies. But there are many very good people who are not what I call good patients. I was once requested to call on a lady suffering from nervous and other symptoms. It came out in the preliminary conversational skirmish, half medical, half social, that I was the twenty-sixth member of the faculty into whose arms, professionally speaking, she had successively thrown herself. Not being a believer in such a rapid rotation of scientific crops, I gently deposited the burden, commending it to the care of number twenty-seven, and, him, whoever he might be, to the care of Heaven.

If there happened to be among my audience any person who wished to know on what principles the patient should choose his physician, I should give him these few precepts to think over:

Choose a man who is personally agreeable, for a daily visit from an intelligent, amiable, pleasant, sympathetic person will cost you no more than one from a sloven or a boor, and his presence will do more for you than any prescription the other will order.

Let him be a man of recognized good sense in other matters, and the chance is that he will be sensible as a practitioner.

Let him be a man who stands well with his professional brethren, whom they approve as honest, able, courteous.

Let him be one whose patients are willing to die in his hands, not one whom they go to for trifles, and leave as soon as they are in danger, and who can say, therefore, that he never loses a patient.

Do not leave the ranks of what is called the regular profession, unless you wish to go farther and fare worse, for you may be assured that its members recognize no principle which hinders their accepting any remedial agent proved to be useful, no matter from what quarter it comes. The difficulty is that the stragglers, organized under fantastic names in pretentious associations, or lurking in solitary dens behind doors left ajar, make no real contributions to the art of healing. When they bring forward a remedial agent like chloral, like the bromide of potassium, like ether, used as an anesthetic, they will find no difficulty in procuring its recognition.

Some of you will probably be more or less troubled by the pretensions of that parody of mediaeval theology which finds its dogma of hereditary depravity in the doctrine of psora, its miracle of transubstantiation in the mystery of its triturations and dilutions, its church in the people who have mistaken their century, and its priests in those who have mistaken their calling. You can do little with persons who are disposed to accept these curious medical superstitions. The saturation-point of individual minds with reference to evidence, and especially medical evidence, differs, and must always continue to differ, very widely. There are those whose minds are satisfied with the decillionth dilution of a scientific proof. No wonder they believe in the efficacy of a similar attenuation of bryony or pulsatilla. You have no fulcrum you can rest upon to lift an error out of such minds as these, often highly endowed with knowledge and talent, sometimes with genius, but commonly richer in the imaginative than the observing and reasoning faculties.

Let me return once more to the young graduate. Your relations to your professional brethren may be a source of lifelong happiness and growth in knowledge and character, or they may make you wretched and end by leaving you isolated from those who should be your friends and counsellors. The life of a physician becomes ignoble when he suffers himself to feed on petty jealousies and sours his temper in perpetual quarrels. You will be liable to meet an uncomfortable man here and there in the profession,--one who is so fond of being in hot water that it is a wonder all the albumen in his body is not coagulated. There are common barrators among doctors as there are among lawyers,--stirrers up of strife under one pretext and another, but in reality because they like it. They are their own worst enemies, and do themselves a mischief each time they assail their neighbors. In my student days I remember a good deal of this Donnybrook-Fair style of quarrelling, more especially in Paris, where some of the noted surgeons were always at loggerheads, and in one of our lively Western cities. Soon after I had set up an office, I had a trifling experience which may serve to point a moral in this direction. I had placed a lamp behind the glass in the entry to indicate to the passer-by where relief from all curable infirmities was to be sought and found. Its brilliancy attracted the attention of a devious youth, who dashed his fist through the glass and upset my modest luminary. All he got by his vivacious assault was that he left portions of integument from his knuckles upon the glass, had a lame hand, was very easily identified, and had to pay the glazier's bill. The moral is that, if the brilliancy of another's reputation excites your belligerent instincts, it is not worth your while to strike at it, without calculating which of you is likely to suffer most, if you do.

You may be assured that when an ill-conditioned neighbor is always complaining of a bad taste in his mouth and an evil atmosphere about him, there is something wrong about his own secretions. In such cases there is an alterative regimen of remarkable efficacy: it is a starvation-diet of letting alone. The great majority of the profession are peacefully inclined. Their pursuits are eminently humanizing, and they look with disgust on the personalities which intrude themselves into the placid domain of an art whose province it is to heal and not to wound.

The intercourse of teacher and student in a large school is necessarily limited, but it should be, and, so far as my experience goes, it is, eminently cordial and kindly. You will leave with regret, and hold in tender remembrance, those who have taken you by the hand at your entrance on your chosen path, and led you patiently and faithfully, until the great gates at its end have swung upon their hinges, and the world lies open before you. That venerable oath to which I have before referred bound the student to regard his instructor in the light of a parent, to treat his children like brothers, to succor him in his day of need. I trust the spirit of the oath of Hippocrates is not dead in the hearts of the students of to-day. They will remember with gratitude every earnest effort, every encouraging word, which has helped them in their difficult and laborious career of study. The names they read on their diplomas will recall faces that are like family-portraits in their memory, and the echo of voices they have listened to so long will linger in their memories far into the still evening of their lives.

One voice will be heard no more which has been familiar to many among you. It is not for me, a stranger to these scenes, to speak his eulogy. I have no right to sadden this hour by dwelling on the deep regrets of friendship, or to bid the bitter tears of sorrow flow afresh. Yet I cannot help remembering what a void the death of such a practitioner as your late instructor must leave in the wide circle of those who leaned upon his counsel and assistance in their hour of need, in a community where he was so widely known and esteemed, in a school where he bore so important a part. There is no exemption from the common doom for him who holds the shield to protect others. The student is called from his bench, the professor from his chair, the practitioner in his busiest period hears a knock more peremptory than any patient's midnight summons, and goes on that unreturning visit which admits of no excuse, and suffers no delay. The call of such a man away from us is the bereavement of a great family. Nor can we help regretting the loss for him of a bright and cheerful earthly future; for the old age of a physician is one of the happiest periods of his life. He is loved and cherished for what he has been, and even in the decline of his faculties there are occasions when his experience is still appealed to, and his trembling hands are looked to with renewing hope and trust, as being yet able to stay the arm of the destroyer.

But if there is so much left for age, how beautiful, how inspiring is the hope of youth! I see among those whom I count as listeners one by whose side I have sat as a fellow-teacher, and by whose instructions I have felt myself not too old to profit. As we borrowed him from your city, I must take this opportunity of telling you that his zeal, intelligence, and admirable faculty as an instructor were heartily and universally recognized among us. We return him, as we trust, uninjured, to the fellow-citizens who have the privilege of claiming him as their own.

And now, gentlemen of the graduating class, nothing remains but for me to bid you, in the name of those for whom I am commissioned and privileged to speak, farewell as students, and welcome as practitioners. I pronounce the two benedictions in the same breath, as the late king's demise and the new king's accession are proclaimed by the same voice at the same moment. You would hardly excuse me if I stooped to any meaner dialect than the classical and familiar language of your prescriptions, the same in which your title to the name of physician is, if, like our own institution, you follow the ancient usage, engraved upon your diplomas.

Valete, JUVENES, artis medicae studiosi; valete, discipuli, valete, filii!

Salvete, VIRI, artis medicae magister; Salvete amici; salvete fratres!

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MEDICAL LIBRARIES

[Dedicatory Address at the opening of the Medical Library in Boston, December 3, 1878.]

It is my appointed task, my honorable privilege, this evening, to speak of what has been done by others. No one can bring his tribute of words into the presence of great deeds, or try with them to embellish the memory of any inspiring achievement, without feeling and leaving with others a sense of their insufficiency. So felt Alexander when he compared even his adored Homer with the hero the poet had sung. So felt Webster when he contrasted the phrases of rhetoric with the eloquence of patriotism and of self-devotion. So felt Lincoln when on the field of Gettysburg he spoke those immortal words which Pericles could not have bettered, which Aristotle could not have criticised. So felt he who wrote the epitaph of the builder of the dome which looks down on the crosses and weathercocks that glitter over London.

We are not met upon a battle-field, except so far as every laborious achievement means a victory over opposition, indifference, selfishness, faintheartedness, and that great property of mind as well as matter,--inertia. We are not met in a cathedral, except so far as every building whose walls are lined with the products of useful and ennobling thought is a temple of the Almighty, whose inspiration has given us understanding. But we have gathered within walls which bear testimony to the self-sacrificing, persevering efforts of a few young men, to whom we owe the origin and development of all that excites our admiration in this completed enterprise; and I might consider my task as finished if I contented myself with borrowing the last word of the architect's epitaph and only saying, Look around you!

The reports of the librarian have told or will tell you, in some detail, what has been accomplished since the 21st of December, 1874, when six gentlemen met at the house of Dr. Henry Ingersoll Bowditch to discuss different projects for a medical library. In less than four years from that time, by the liberality of associations and of individuals, this collection of nearly ten thousand volumes, of five thousand pamphlets, and of one hundred and twenty-five journals, regularly received,--all worthily sheltered beneath this lofty roof,--has come into being under our eyes. It has sprung up, as it were; in the night like a mushroom; it stands before us in full daylight as lusty as an oak, and promising to grow and flourish in the perennial freshness of an evergreen.

To whom does our profession owe this already large collection of books, exceeded in numbers only by four or five of the most extensive medical libraries in the country, and lodged in a building so well adapted to its present needs? We will not point out individually all those younger members of the profession who have accomplished what their fathers and elder brethren had attempted and partially achieved. We need not write their names on these walls, after the fashion of those civic dignitaries who immortalize themselves on tablets of marble and gates of iron. But their contemporaries know them well, and their descendants will not forget them,--the men who first met together, the men who have given their time and their money, the faithful workers, worthy associates of the strenuous agitator who gave no sleep to his eyes, no slumber to his eyelids, until he had gained his ends; the untiring, imperturbable, tenacious, irrepressible, all-subduing agitator who neither rested nor let others rest until the success of the project was assured. If, against his injunctions, I name Dr. James Read Chadwick, it is only my revenge for his having kept me awake so often and so long while he was urging on the undertaking in which he has been preeminently active and triumphantly successful.

We must not forget the various medical libraries which preceded this: that of an earlier period, when Boston contained about seventy regular practitioners, the collection afterwards transferred to the Boston Athenaeum; the two collections belonging to the University; the Treadwell Library at the Massachusetts General Hospital; the collections of the two societies, that for Medical Improvement and that for Medical Observation; and more especially the ten thousand volumes relating to medicine belonging to our noble public city library,--too many blossoms on the tree of knowledge, perhaps, for the best fruit to ripen. But the Massachusetts Medical Society now numbers nearly four hundred members in the city of Boston. The time had arrived for a new and larger movement. There was needed a place to which every respectable member of the medical profession could obtain easy access; where, under one roof, all might find the special information they were seeking; where the latest medical intelligence should be spread out daily as the shipping news is posted on the bulletins of the exchange; where men engaged in a common pursuit could meet, surrounded by the mute oracles of science and art; where the whole atmosphere should be as full of professional knowledge as the apothecary's shop is of the odor of his medicaments. This was what the old men longed for,--the prophets and kings of the profession, who

"Desired it long, But died without the sight."

This is what the young men and those who worked under their guidance undertook to give us. And now such a library, such a reading-room, such an exchange, such an intellectual and social meeting place, we be hold a fact, plain before us. The medical profession of our city, and, let us add, of all those neighboring places which it can reach with its iron arms, is united as never before by the commune vinculum, the common bond of a large, enduring, ennobling, unselfish interest. It breathes a new air of awakened intelligence. It marches abreast of the other learned professions, which have long had their extensive and valuable centralized libraries; abreast of them, but not promising to be content with that position. What glorifies a town like a cathedral? What dignifies a province like a university? What illuminates a country like its scholarship, and what is the nest that hatches scholars but a library?

The physician, some may say, is a practical man and has little use for all this book-learning. Every student has heard Sydenham's reply to Sir Richard Blackmore's question as to what books he should read,--meaning medical books. "Read Don Quixote," was his famous answer. But Sydenham himself made medical books and may be presumed to have thought those at least worth reading. Descartes was asked where was his library, and in reply held up the dissected body of an animal. But Descartes made books, great books, and a great many of them. A physician of common sense without erudition is better than a learned one without common sense, but the thorough master of his profession must have learning added to his natural gifts.

It is not necessary to maintain the direct practical utility of all kinds of learning. Our shelves contain many books which only a certain class of medical scholars will be likely to consult. There is a dead medical literature, and there is a live one. The dead is not all ancient, the live is not all modern. There is none, modern or ancient, which, if it has no living value for the student, will not teach him something by its autopsy. But it is with the live literature of his profession that the medical practitioner is first of all concerned.

Now there has come a great change in our time over the form in which living thought presents itself. The first printed books,--the incunabula,--were inclosed in boards of solid oak, with brazen clasps and corners; the boards by and by were replaced by pasteboard covered with calf or sheepskin; then cloth came in and took the place of leather; then the pasteboard was covered with paper instead of cloth; and at this day the quarterly, the monthly, the weekly periodical in its flimsy unsupported dress of paper, and the daily journal, naked as it came from the womb of the press, hold the larger part of the fresh reading we live upon. We must have the latest thought in its latest expression; the page must be newly turned like the morning bannock; the pamphlet must be newly opened like the ante-prandial oyster.

Thus a library, to meet the need of our time, must take, and must spread out in a convenient form, a great array of periodicals. Our active practitioners read these by preference over almost everything else. Our specialists, more particularly, depend on the month's product, on the yearly crop of new facts, new suggestions, new contrivances, as much as the farmer on the annual yield of his acres. One of the first wants, then, of the profession is supplied by our library in its great array of periodicals from many lands, in many languages. Such a number of medical periodicals no private library would have room for, no private person would pay for, or flood his tables with if they were sent him for nothing. These, I think, with the reports of medical societies and the papers contributed to them, will form the most attractive part of our accumulated medical treasures. They will be also one of our chief expenses, for these journals must be bound in volumes and they require a great amount of shelf-room; all this, in addition to the cost of subscription for those which are not furnished us gratuitously.

It is true that the value of old scientific periodicals is, other things being equal, in the inverse ratio of their age, for the obvious reason that what is most valuable in the earlier volumes of a series is drained off into the standard works with which the intelligent practitioner is supposed to be familiar. But no extended record of facts grows too old to be useful, provided only that we have a ready and sure way of getting at the particular fact or facts we are in search of.

And this leads me to speak of what I conceive to be one of the principal tasks to be performed by the present and the coming generation of scholars, not only in the medical, but in every department of knowledge. I mean the formation of indexes, and more especially of indexes to periodical literature.

This idea has long been working in the minds of scholars, and all who have had occasion to follow out any special subject. I have a right to speak of it, for I long ago attempted to supply the want of indexes in some small measure for my own need. I had a very complete set of the "American Journal of the Medical Sciences;" an entire set of the "North American Review," and many volumes of the reprints of the three leading British quarterlies. Of what use were they to me without general indexes? I looked them all through carefully and made classified lists of all the articles I thought I should most care to read. But they soon outgrew my lists. The "North American Review" kept filling up shelf after shelf, rich in articles which I often wanted to consult, but what a labor to find them, until the index of Mr. Gushing, published a few months since, made the contents of these hundred and twenty volumes as easily accessible as the words in a dictionary! I had a, copy of good Dr. Abraham Rees's Cyclopaedia, a treasure-house to my boyhood which has not lost its value for me in later years. But where to look for what I wanted? I wished to know, for instance, what Dr. Burney had to say about singing. Who would have looked for it under the Italian word cantare? I was curious to learn something of the etchings of Rembrandt, and where should I find it but under the head "Low Countries, Engravers of the,"--an elaborate and most valuable article of a hundred double-columned close-printed quarto pages, to which no reference, even, is made under the title Rembrandt.

There was nothing to be done, if I wanted to know where that which I specially cared for was to be found in my Rees's Cyclopaedia, but to look over every page of its forty-one quarto volumes and make out a brief list of matters of interest which I could not find by their titles, and this I did, at no small expense of time and trouble.

Nothing, therefore, could be more pleasing to me than to see the attention which has been given of late years to the great work of indexing. It is a quarter of a century since Mr. Poole published his "Index to Periodical Literature," which it is much to be hoped is soon to appear in a new edition, grown as it must be to formidable dimensions by the additions of so long a period. The "British and Foreign Medical Review," edited by the late Sir John Forties, contributed to by Huxley, Carpenter, Laycock, and others of the most distinguished scientific men of Great Britain, has an index to its twenty-four volumes, and by its aid I find this valuable series as manageable as a lexicon. The last edition of the "Encyclopaedia Britannica" had a complete index in a separate volume, and the publishers of Appletons' "American Cyclopaedia" have recently issued an index to their useful work, which must greatly add to its value. I have already referred to the index to the "North American Review," which to an American, and especially to a New Englander, is the most interesting and most valuable addition of its kind to our literary apparatus since the publication of Mr. Allibone's "Dictionary of Authors." I might almost dare to parody Mr. Webster's words in speaking of Hamilton, to describe what Mr. Gushing did for the solemn rows of back volumes of our honored old Review which had been long fossilizing on our shelves: "He touched the dead corpse of the 'North American,' and it sprang to its feet." A library of the best thought of the best American scholars during the greater portion of the century was brought to light by the work of the indexmaker as truly as were the Assyrian tablets by the labors of Layard.

A great portion of the best writing and reading literary, scientific, professional, miscellaneous--comes to us now, at stated intervals, in paper covers. The writer appears, as it were, in his shirt-sleeves. As soon as he has delivered his message the book-binder puts a coat on his back, and he joins the forlorn brotherhood of "back volumes," than which, so long as they are unindexed, nothing can be more exasperating. Who wants a lock without a key, a ship without a rudder, a binnacle without a compass, a check without a signature, a greenback without a goldback behind it?

I have referred chiefly to the medical journals, but I would include with these the reports of medical associations, and those separate publications which, coming in the form of pamphlets, heap themselves into chaotic piles and bundles which are worse than useless, taking up a great deal of room, and frightening everything away but mice and mousing antiquarians, or possibly at long intervals some terebrating specialist.

Arranged, bound, indexed, all these at once become accessible and valuable. I will take the first instance which happens to suggest itself. How many who know all about osteoblasts and the experiments of Ollier, and all that has grown out of them, know where to go for a paper by the late Dr. A. L. Peirson of Salem, published in the year 1840, under the modest title, Remarks on Fractures? And if any practitioner who has to deal with broken bones does not know that most excellent and practical essay, it is a great pity, for it answers very numerous questions which will be sure to suggest themselves to the surgeon and the patient as no one of the recent treatises, on my own shelves, at least, can do.

But if indexing is the special need of our time in medical literature, as in every department of knowledge, it must be remembered that it is not only an immense labor, but one that never ends. It requires, therefore, the cooperation of a large number of individuals to do the work, and a large amount of money to pay for making its results public through the press. When it is remembered that the catalogue of the library of the British Museum is contained in nearly three thousand large folios of manuscript, and not all its books are yet included, the task of indexing any considerable branch of science or literature looks as if it were well nigh impossible. But many hands make light work. An "Index Society" has been formed in England, already numbering about one hundred and seventy members. It aims at "supplying thorough indexes to valuable works and collections which have hitherto lacked them; at issuing indexes to the literature of special subjects; and at gathering materials for a general reference index." This society has published a little treatise setting forth the history and the art of indexing, which I trust is in the hands of some of our members, if not upon our shelves.

Something has been done in the same direction by individuals in our own country, as we have already seen. The need of it in the department of medicine is beginning to be clearly felt. Our library has already an admirable catalogue with cross references, the work of a number of its younger members cooperating in the task. A very intelligent medical student, Mr. William D. Chapin, whose excellent project is indorsed by well-known New York physicians and professors, proposes to publish a yearly index to original communications in the medical journals of the United States, classified by authors and subjects. But it is from the National Medical Library at Washington that we have the best promise and the largest expectations. That great and growing collection of fifty thousand volumes is under the eye and hand of a librarian who knows books and how to manage them. For libraries are the standing armies of civilization, and an army is but a mob without a general who can organize and marshal it so as to make it effective. The "Specimen Fasciculus of a Catalogue of the National Medical Library," prepared under the direction of Dr. Billings, the librarian, would have excited the admiration of Haller, the master scholar in medical science of the last century, or rather of the profession in all centuries, and if carried out as it is begun will be to the nineteenth all and more than all that the three Bibliothecae--Anatomica, Chirurgica, and Medicinae-Practicae--were to the eighteenth century. I cannot forget the story that Agassiz was so fond of telling of the king of Prussia and Fichte. It was after the humiliation and spoliation of the kingdom by Napoleon that the monarch asked the philosopher what could be done to regain the lost position of the nation. "Found a great university, Sire," was the answer, and so it was that in the year 1810 the world-renowned University of Berlin came into being. I believe that we in this country can do better than found a national university, whose professors shall be nominated in caucuses, go in and out, perhaps, like postmasters, with every change of administration, and deal with science in the face of their constituency as the courtier did with time when his sovereign asked him what o'clock it was: "Whatever hour your majesty pleases." But when we have a noble library like that at Washington, and a librarian of exceptional qualifications like the gentleman who now holds that office, I believe that a liberal appropriation by Congress to carry out a conscientious work for the advancement of sound knowledge and the bettering of human conditions, like this which Dr. Billings has so well begun, would redound greatly to the honor of the nation. It ought to be willing to be at some charge to make its treasures useful to its citizens, and, for its own sake, especially to that class which has charge of health, public and private. This country abounds in what are called "self-made men," and is justly proud of many whom it thus designates. In one sense no man is self-made who breathes the air of a civilized community. In another sense every man who is anything other than a phonograph on legs is self-made. But if we award his just praise to the man who has attained any kind of excellence without having had the same advantages as others whom, nevertheless, he has equalled or surpassed, let us not be betrayed into undervaluing the mechanic's careful training to his business, the thorough and laborious education of the scholar and the professional man.

Our American atmosphere is vocal with the flippant loquacity of half knowledge. We must accept whatever good can be got out of it, and keep it under as we do sorrel and mullein and witchgrass, by enriching the soil, and sowing good seed in plenty; by good teaching and good books, rather than by wasting our time in talking against it. Half knowledge dreads nothing but whole knowledge.

I have spoken of the importance and the predominance of periodical literature, and have attempted to do justice to its value. But the almost exclusive reading of it is not without its dangers. The journals contain much that is crude and unsound; the presumption; it might be maintained, is against their novelties, unless they come from observers of established credit. Yet I have known a practitioner,--perhaps more than one,--who was as much under the dominant influence of the last article he had read in his favorite medical journal as a milliner under the sway of the last fashion-plate. The difference between green and seasoned knowledge is very great, and such practitioners never hold long enough to any of their knowledge to have it get seasoned.

It is needless to say, then, that all the substantial and permanent literature of the profession should be represented upon our shelves. Much of it is there already, and as one private library after another falls into this by the natural law of gravitation, it will gradually acquire all that is most valuable almost without effort. A scholar should not be in a hurry to part with his books. They are probably more valuable to him than they can be to any other individual. What Swedenborg called "correspondence" has established itself between his intelligence and the volumes which wall him within their sacred inclosure. Napoleon said that his mind was as if furnished with drawers,--he drew out each as he wanted its contents, and closed it at will when done with them. The scholar's mind, to use a similar comparison, is furnished with shelves, like his library. Each book knows its place in the brain as well as against the wall or in the alcove. His consciousness is doubled by the books which encircle him, as the trees that surround a lake repeat themselves in its unruffled waters. Men talk of the nerve that runs to the pocket, but one who loves his books, and has lived long with them, has a nervous filament which runs from his sensorium to every one of them. Or, if I may still let my fancy draw its pictures, a scholar's library is to him what a temple is to the worshipper who frequents it. There is the altar sacred to his holiest experiences. There is the font where his new-born thought was baptized and first had a name in his consciousness. There is the monumental tablet of a dead belief, sacred still in the memory of what it was while yet alive. No visitor can read all this on the lettered backs of the books that have gathered around the scholar, but for him, from the Aldus on the lowest shelf to the Elzevir on the highest, every volume has a language which none but he can interpret. Be patient with the book-collector who loves his companions too well to let them go. Books are not buried with their owners, and the veriest book-miser that ever lived was probably doing far more for his successors than his more liberal neighbor who despised his learned or unlearned avarice. Let the fruit fall with the leaves still clinging round it. Who would have stripped Southey's walls of the books that filled them, when, his mind no longer capable of taking in their meaning, he would still pat and fondle them with the vague loving sense of what they had once been to him,--to him, the great scholar, now like a little child among his playthings?

We need in this country not only the scholar, but the virtuoso, who hoards the treasures which he loves, it may be chiefly for their rarity and because others who know more than he does of their value set a high price upon them. As the wine of old vintages is gently decanted out of its cobwebbed bottles with their rotten corks into clean new receptacles, so the wealth of the New World is quietly emptying many of the libraries and galleries of the Old World into its newly formed collections and newly raised edifices. And this process must go on in an accelerating ratio. No Englishman will be offended if I say that before the New Zealander takes his stand on a broken arch of London Bridge to sketch the ruins of St. Paul's in the midst of a vast solitude, the treasures of the British Museum will have found a new shelter in the halls of New York or Boston. No Catholic will think hardly of my saying that before the Coliseum falls, and with it the imperial city, whose doom prophecy has linked with that of the almost eternal amphitheatre, the marbles, the bronzes, the paintings, the manuscripts of the Vatican will have left the shores of the Tiber for those of the Potomac, the Hudson, the Mississippi, or the Sacramento. And what a delight in the pursuit of the rarities which the eager book-hunter follows with the scent of a beagle!

Shall I ever forget that rainy day in Lyons, that dingy bookshop, where I found the Aetius, long missing from my Artis bledicae Principes, and where I bought for a small pecuniary consideration, though it was marked rare, and was really tres rare, the Aphorisms of Hippocrates, edited by and with a preface from the hand of Francis Rabelais? And the vellum-bound Tulpius, which I came upon in Venice, afterwards my only reading when imprisoned in quarantine at Marseilles, so that the two hundred and twenty-eight cases he has recorded are, many of them, to this day still fresh in my memory. And the Schenckius,--the folio filled with casus rariores, which had strayed in among the rubbish of the bookstall on the boulevard,--and the noble old Vesalius with its grand frontispiece not unworthy of Titian, and the fine old Ambroise Pare, long waited for even in Paris and long ago, and the colossal Spigelius with his eviscerated beauties, and Dutch Bidloo with its miracles of fine engraving and bad dissection, and Italian Mascagni, the despair of all would-be imitators, and pre-Adamite John de Ketam, and antediluvian Berengarius Carpensis,--but why multiply names, every one of which brings back the accession of a book which was an event almost like the birth of an infant?

A library like ours must exercise the largest hospitality. A great many books may be found in every large collection which remind us of those apostolic looking old men who figure on the platform at our political and other assemblages. Some of them have spoken words of wisdom in their day, but they have ceased to be oracles; some of them never had any particularly important message for humanity, but they add dignity to the meeting by their presence; they look wise, whether they are so or not, and no one grudges them their places of honor. Venerable figure-heads, what would our platforms be without you?

Just so with our libraries. Without their rows of folios in creamy vellum, or showing their black backs with antique lettering of tarnished gold, our shelves would look as insufficient and unbalanced as a column without its base, as a statue without its pedestal. And do not think they are kept only to be spanked and dusted during that dreadful period when their owner is but too thankful to become an exile and a wanderer from the scene of single combats between dead authors and living housemaids. Men were not all cowards before Agamemnon or all fools before the days of Virchow and Billroth. And apart from any practical use to be derived from the older medical authors, is there not a true pleasure in reading the accounts of great discoverers in their own words? I do not pretend to hoist up the Bibliotheca Anatomica of Mangetus and spread it on my table every day. I do not get out my great Albinus before every lecture on the muscles, nor disturb the majestic repose of Vesalius every time I speak of the bones he has so admirably described and figured. But it does please me to read the first descriptions of parts to which the names of their discoverers or those who have first described them have become so joined that not even modern science can part them; to listen to the talk of my old volume as Willis describes his circle and Fallopius his aqueduct and Varolius his bridge and Eustachius his tube and Monro his foramen,--all so well known to us in the human body; it does please me to know the very words in which Winslow described the opening which bears his name, and Glisson his capsule and De Graaf his vesicle; I am not content until I know in what language Harvey announced his discovery of the circulation, and how Spigelius made the liver his perpetual memorial, and Malpighi found a monument more enduring than brass in the corpuscles of the spleen and the kidney.

But after all, the readers who care most for the early records of medical science and art are the specialists who are dividing up the practice of medicine and surgery as they were parcelled out, according to Herodotus, by the Egyptians. For them nothing is too old, nothing is too new, for to their books of all others is applicable the saying of D'Alembert that the author kills himself in lengthening out what the reader kills himself in trying to shorten.

There are practical books among these ancient volumes which can never grow old. Would you know how to recognize "male hysteria" and to treat it, take down your Sydenham; would you read the experience of a physician who was himself the subject of asthma, and who, notwithstanding that, in the words of Dr. Johnson, "panted on till ninety," you will find it in the venerable treatise of Sir John Floyer; would you listen to the story of the King's Evil cured by the royal touch, as told by a famous chirurgeon who fully believed in it, go to Wiseman; would you get at first hand the description of the spinal disease which long bore his name, do not be startled if I tell you to go to Pott,--to Percival Pott, the great surgeon of the last century.

There comes a time for every book in a library when it is wanted by somebody. It is but a few weeks since one of the most celebrated physicians in the country wrote to me from a great centre of medical education to know if I had the works of Sanctorius, which he had tried in vain to find. I could have lent him the "Medicina Statica," with its frontispiece showing Sanctorius with his dinner on the table before him, in his balanced chair which sunk with him below the level of his banquet-board when he had swallowed a certain number of ounces,--an early foreshadowing of Pettenkofer's chamber and quantitative physiology,--but the "Opera Omnia" of Sanctorius I had never met with, and I fear he had to do without it.

I would extend the hospitality of these shelves to a class of works which we are in the habit of considering as being outside of the pale of medical science, properly so called, and sometimes of coupling with a disrespectful name. Such has always been my own practice. I have welcomed Culpeper and Salmon to my bookcase as willingly as Dioscorides or Quincy, or Paris or Wood and Bache. I have found a place for St. John Long, and read the story of his trial for manslaughter with as much interest as the laurel-water case in which John Hunter figured as a witness. I would give Samuel Hahnemann a place by the side of Samuel Thomson. Am I not afraid that some student of imaginative turn and not provided with the needful cerebral strainers without which all the refuse of gimcrack intelligences gets into the mental drains and chokes them up,--am I not afraid that some such student will get hold of the "Organon" or the "Maladies Chroniques" and be won over by their delusions, and so be lost to those that love him as a man of common sense and a brother in their high calling? Not in the least. If he showed any symptoms of infection I would for once have recourse to the principle of similia similibus. To cure him of Hahnemann I would prescribe my favorite homoeopathic antidote, Okie's Bonninghausen. If that failed, I would order Grauvogl as a heroic remedy, and if he survived that uncured, I would give him my blessing, if I thought him honest, and bid him depart in peace. For me he is no longer an individual. He belongs to a class of minds which we are bound to be patient with if their Maker sees fit to indulge them with existence. We must accept the conjuring ultra-ritualist, the dreamy second adventist, the erratic spiritualist, the fantastic homoeopathist, as not unworthy of philosophic study; not more unworthy of it than the squarers of the circle and the inventors of perpetual motion, and the other whimsical visionaries to whom De Morgan has devoted his most instructive and entertaining "Budget of Paradoxes." I hope, therefore, that our library will admit the works of the so-called Eclectics, of the Thomsonians, if any are in existence, of the Clairvoyants, if they have a literature, and especially of the Homoeopathists. This country seems to be the place for such a collection, which will by and by be curious and of more value than at present, for Homoeopathy seems to be following the pathological law of erysipelas, fading out where it originated as it spreads to new regions. At least I judge so by the following translated extract from a criticism of an American work in the "Homoeopatische Rundschau" of Leipzig for October, 1878, which I find in the "Homoeopathic Bulletin" for the month of November just passed: "While we feel proud of the spread and rise of Homoeopathy across the ocean, and while the Homoeopathic works reaching us from there, and published in a style such as is unknown in Germany, bear eloquent testimony to the eminent activity of our transatlantic colleagues, we are overcome by sorrowful regrets at the position Homoeopathy occupies in Germany. Such a work [as the American one referred to] with us would be impossible; it would lack the necessary support."

By all means let our library secure a good representation of the literature of Homoeopathy before it leaves us its "sorrowful regrets" and migrates with its sugar of milk pellets, which have taken the place of the old pilulae micae panis, to Alaska, to "Nova Zembla, or the Lord knows where."

What shall I say in this presence of the duties of a Librarian? Where have they ever been better performed than in our own public city library, where the late Mr. Jewett and the living Mr. Winsor have shown us what a librarian ought to be,--the organizing head, the vigilant guardian, the seeker's index, the scholar's counsellor? His work is not merely that of administration, manifold and laborious as its duties are. He must have a quick intelligence and a retentive memory. He is a public carrier of knowledge in its germs. His office is like that which naturalists attribute to the bumble-bee,--he lays up little honey for himself, but he conveys the fertilizing pollen from flower to flower.

Our undertaking, just completed,--and just begun--has come at the right time, not a day too soon. Our practitioners need a library like this, for with all their skill and devotion there is too little genuine erudition, such as a liberal profession ought to be able to claim for many of its members. In reading the recent obituary notices of the late Dr. Geddings of South Carolina, I recalled what our lamented friend Dr. Coale used to tell me of his learning and accomplishments, and I could not help reflecting how few such medical scholars we had to show in Boston or New England. We must clear up this unilluminated atmosphere, and here,--here is the true electric light which will irradiate its darkness.

The public will catch the rays reflected from the same source of light, and it needs instruction on the great subjects of health and disease,--needs it sadly. It is preyed upon by every kind of imposition almost without hindrance. Its ignorance and prejudices react upon the profession to the great injury of both. The jealous feeling, for instance, with regard to such provisions for the study of anatomy as are sanctioned by the laws in this State and carried out with strict regard to those laws, threatens the welfare, if not the existence of institutions for medical instruction wherever it is not held in check by enlightened intelligence. And on the other hand the profession has just been startled by a verdict against a physician, ruinous in its amount,--enough to drive many a hard-working young practitioner out of house and home,--a verdict which leads to the fear that suits for malpractice may take the place of the panel game and child-stealing as a means of extorting money. If the profession in this State, which claims a high standard of civilization, is to be crushed and ground beneath the upper millstone of the dearth of educational advantages and the lower millstone of ruinous penalties for what the ignorant ignorantly shall decide to be ignorance, all I can say is

God save the Commonhealth of Massachusetts!

Once more, we cannot fail to see that just as astrology has given place to astronomy, so theology, the science of Him whom by searching no man can find out, is fast being replaced by what we may not improperly call theonomy, or the science of the laws according to which the Creator acts. And since these laws find their fullest manifestations for us, at least, in rational human natures, the study of anthropology is largely replacing that of scholastic divinity. We must contemplate our Maker indirectly in human attributes as we talk of Him in human parts of speech. And this gives a sacredness to the study of man in his physical, mental, moral, social, and religious nature which elevates the faithful students of anthropology to the dignity of a priesthood, and sheds a holy light on the recorded results of their labors, brought together as they are in such a collection as this which is now spread out before us.

Thus, then, our library is a temple as truly as the dome-crowned cathedral hallowed by the breath of prayer and praise, where the dead repose and the living worship. May it, with all its treasures, be consecrated like that to the glory of God, through the contributions it shall make to the advancement of sound knowledge, to the relief of human suffering, to the promotion of harmonious relations between the members of the two noble professions which deal with the diseases of the soul and with those of the body, and to the common cause in which all good men are working, the furtherance of the well-being of their fellow-creatures!

NOTE.--As an illustration of the statement in the last paragraph but one, I take the following notice from the "Boston Daily Advertiser," of December 4th, the day after the delivery of the address: "Prince Lucien Bonaparte is now living in London, and is devoting himself to the work of collecting the creeds of all religions and sects, with a view to their classification,--his object being simply scientific or anthropological."

Since delivering the address, also, I find a leading article in the "Cincinnati Lancet and Clinic" of November 30th, headed "The Decadence of Homoeopathy," abundantly illustrated by extracts from the "Homoeopathic Times," the leading American organ of that sect.

In the New York "Medical Record" of the same date, which I had not seen before the delivery of my address, is an account of the action of the Homoeopathic Medical Society of Northern New York, in which Hahnemann's theory of "dynamization" is characterized in a formal resolve as "unworthy the confidence of the Homoeopathic profession."

It will be a disappointment to the German Homoeopathists to read in the "Homoeopathic Times" such a statement as the following: "Whatever the influences have been which have checked the outward development of Homoeopathy, it is plainly evident that the Homoeopathic school, as regards the number of its openly avowed representatives, has attained its majority, and has begun to decline both in this country and in England."

All which is an additional reason for making a collection of the incredibly curious literature of Homoeopathy before that pseudological inanity has faded out like so many other delusions.

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