UNIVERSITY OF LONDON. 
 
 DR. CONOLLY'S 
 
 INTRODUCTORY LECTURE.
 
 AN 
 
 INTRODUCTORY LECTURE 
 
 DELIVERED IN 
 
 THE UNIVERSITY OF LONDON, 
 
 On THURSDAY, OCTOBER 2, 1828. 
 BY JOHN CONOLLY, M.D. 
 
 PROFESSOR OF THE NATURE AND TREATMENT OF DISEASES. 
 
 SECOND EDITION. 
 
 LONDON: 
 
 PRINTED FOR JOHN TAYLOR, 
 
 Bookseller and Publisher to the University of London, 
 30, UPPER GOWER STREET. 
 
 1828.
 
 Printed by RICHARD TAYI.OK, 
 Red Lion Court, Fleet Street,
 
 Stack 
 Annex 
 
 5 
 02% 
 
 INTRODUCTORY LECTURE. 
 
 GENTLEMEN, 
 
 UNDER any circumstances, I should have felt considerable 
 embarrassment in addressing so numerous an assembly, 
 containing so many distinguished individuals as I see 
 around me. But this feeling is very much increased by the 
 circumstance of my accidentally following, in the order of 
 succession, the very eminent gentleman * who yesterday ad- 
 dressed you from this place ; a gentleman whose character 
 as an accomplished, eloquent, and rarely-gifted teacher, and 
 whose celebrity as one of the first physiologists of his time, 
 have been so long and so generally acknowledged, that it is 
 neither indelicate thus to allude to them, nor any dishonour 
 to confess that I cannot hope to give much interest to a 
 lecture intended for medical students, after the beautiful 
 discourse we so lately heard from him. 
 
 The duty that I have undertaken in the Chair to which 
 I have had the honour to be appointed in this University, 
 is to teach the NATURE AND TREATMENT OF DISEASES. 
 
 The students who attend these lectures are supposed, 
 generally, to have some previous acquaintance with certain 
 branches of medical study ; not only with Anatomy and 
 Physiology, the very foundations of all medical science, but 
 with so much at least of Chemistry and Botany as relate 
 to the Materia Medica. 
 
 But the Anatomy of the human body in a sound state, 
 and Physiology, or the science of its healthy functions, 
 having been previously explained to them, they are now to 
 
 * Professor Bell.
 
 be taught the changes of structure and the interruptions 
 of function, which constitute disease. Chemistry and Bo- 
 tany, in connection with the history of the nature and pro- 
 perties of the materials drawn from the mineral, vegetable, 
 and animal kingdoms for medical purposes, having given 
 them a general view of the powers of which physicians have 
 availed themselves, in order to restore health when either 
 structure or function was impaired ; they have now to 
 study, by the help of this and of other practical Chairs, the 
 application, combination, and adaptation of these powers, 
 and whatever bears upon the management of every form of 
 malady to which human beings are liable. This is the end 
 to which all their former labours have been directed ; an 
 end not to be attained without a previous devotion of time 
 to the means just enumerated, and from a connection with 
 which all their previous studies derive their principal value. 
 
 It is my business, therefore, to enter into the history of 
 diseases ; to explain their causes, as far as they have been 
 discovered ; to describe their varieties, as far as they have 
 been observed ; to point out their symptoms, their distinc- 
 tive features, their tendencies, their results : and then to 
 instruct my pupils in what manner these evils are to be 
 met ; how resources are to be used or devised against 
 them ; how their causes are to be averted or destroyed ; 
 how the effects are to be distinguished ; how their results 
 are to be prevented or removed. 
 
 I should justly be suspected of taking a very imperfect 
 view of my duties, if, on commencing such a task, so im- 
 portant, so extensive, I did not feel and acknowledge a 
 deep sense of the responsibility I have incurred ; if I did 
 not confess, that ever since I was elected to this office, I 
 have been anxiously occupied in reflecting upon the best 
 means of performing its duties so as to be useful to those 
 who come to me for instruction. 
 
 In the introductory part of my Course, I shall so far de- 
 part from custom as to say very little on the mere History
 
 7 
 
 of Medicine ; not from any particular love of novelty, but 
 from a conviction that its details will be more advantage- 
 ously introduced, because more readily and clearly com- 
 prehended, if presented from time to time, when I have to 
 speak of separate diseases. Even those who are now en- 
 tering on the study of medicine, and for whom a slight re- 
 trospect of the fluctuations it has undergone constitutes an 
 essential introduction to the subject, as well as to any ex- 
 position of my plan of treating it, would be wearied, far 
 more than profited, if I were to dwell long on its past fluc- 
 tuations, when they are naturally full of anxiety to know 
 something of its present state. 
 
 It is, moreover, not easy to give a clear, orderly, con- 
 nected view of the past history of medicine. Its progress 
 from an acquaintance with a few remedies to its present ad- 
 vanced state, has not been made by sure and regular steps ; 
 it has neither been steady, nor, strictly speaking, gradual. 
 There has often been, as a great authority* has remarked, 
 " iteration, with small addition ; a circle, rather than pro- 
 gression." In both medicine and surgery, (although the 
 progress of the latter branch has been steadier, and at all 
 times less mystified and pretending than that of physic,) 
 we find so much anciently known, or supposed, which was 
 afterwards forgotten, or lost, or accidentally obscured, and 
 again, and even more than once, revived as new, that an 
 attempt to disentangle the discoveries in either, and to 
 place them in a true chronological series, would be one of 
 the greatest difficulty. Such an attempt would be by no 
 means uninteresting as a part of medical literature, but 
 certainly not a proper employment of the time of those 
 who attend here for the purpose of learning the Nature and 
 Treatment of Diseases. 
 
 We have no distinct account of the origin of Medicine ; 
 but it cannot be doubted that it began with simple and ac- 
 cidental experience. Very soon it ceased to be a science 
 
 * Lord Bacon.
 
 8 
 
 of observation ; and its first corruption seems to have arisen 
 from the fears and the ignorance of men, uncivilised, un- 
 taught, exposed to various accidents, unable to account for 
 any of the phaenomena of the natural world around them, 
 and dependent on a superior power, of which they knew 
 nothing. 
 
 In no long time, the dominion of error was extended by 
 the pleasure arising from the indulgence of fancy compared 
 with the labour of exercising the other faculties ; by vanity 
 also, and the natural love of what is wonderful. Men were 
 not wanting who boldly assumed a peculiar insight into the 
 nature and influences of unknown powers ; and although, 
 more than two thousand years ago, Hippocrates left the 
 vain speculations of the philosophers who aspired to be pa- 
 thologists without the lights of anatomy and physiology, 
 and looked at the actual effects and progress of disease ; 
 although he gathered up the scattered knowledge of his time, 
 arranged it, and exceedingly enriched it by his own acute 
 and exact observation ; his labours were repeatedly coun- 
 teracted, and physic was again and again corrupted, and its 
 very profession made contemptible in after ages, by the 
 sophists of Greece, by the scholastic declaimers of Alex- 
 andria, and by numerous speculative men in various coun- 
 tries and of various periods, who found it easier and more 
 agreeable to adopt the splendid reveries of men of genius, 
 than to examine and judge for themselves. Thus we see 
 that opinions were sometimes taken up upon trust, and that 
 doubts and cavils were sometimes raised without reason or 
 wisdom ; and in both cases facts disregarded, loose analo- 
 gies pursued, the distinctions of diseases neglected, the 
 effects of medicines confounded, imaginary qualities ascribed 
 to various insignificant substances on the slightest grounds ; 
 and thus too we trace, from age to age, a long succession, 
 interchange, and implication of ingenious theories, each 
 raised on, or formed out of, the ruins of its predecessor, 
 and each in turn thrown down to furnish materials, or form 
 an unsound basis for the next.
 
 Yet there are few among the theories which have in turn 
 flourished and decayed, in which you will not find that 
 there was something reasonable and true, which was curi- 
 ously perverted ; or something valuable, which was capri- 
 ciously discarded. You will often detect the same theory 
 under the disguise of new names; and sometimes see, that, 
 except in name, contending sects differed little from each 
 other. It is instructive to observe, and important to re- 
 member, that physicians have approached, in a kind of suc- 
 cession, near to almost every Physiological and Patholo- 
 gical fact, long before its complete establishment ; and that, 
 after catching a glimpse of truth, they have again and 
 again given themselves up to imagination, which they 
 should have kept in strict subservience, as a valuable auxi- 
 liary ; and no longer having modest and faithful observa- 
 tion for their guide, have wandered from the path of useful 
 discovery, and been led irretrievably astray. 
 
 Throughout all these deviations and caprices, a more 
 intimate acquaintance with the structure and functions of 
 the body was promoted, and the effects of medicines be- 
 came better understood. The pride of originality, the 
 zeal of theory, the very fanaticism of hypothesis, stimulated 
 the cultivators of medicine to greater exertions : the er- 
 rors of one sect served as lessons to another; and the con- 
 tentions of opposing parties often laid open the sources of 
 truth. 
 
 At last, after repeated efforts to reduce the illimitable 
 varieties of the human ceconomy to the rules by which 
 other parts of nature were governed ; after many attempts 
 to apply elementary, chemical, mathematical, mechanical, 
 humoral, and other doctrines to the living body; physicians 
 have become convinced, that in the functions of life, there 
 is something more than mere elementary mixture ; some- 
 thing more than a mere collection of vascular agents, of 
 solids and fluids, and moving powers; and that, although 
 to a certain extent the laws of many sciences are to be
 
 found in force within the bodily fabric, there are vital ac- 
 tions and laws of life independent of, and superior to them ; 
 that there is a peculiar and a finer science of living and 
 rational beings. 
 
 It can only be after you have become more fully ac- 
 quainted with the present and past state of medicine, that 
 you can form a just idea of the real improvement it has 
 undergone within the last two centuries. You will then 
 see how great a revolution has been effected ; how jargon 
 and mystery have been gradually (I wish I could say en- 
 tirely} banished ; how parade and confusion have given 
 way to clearer views of disease, and the employment of 
 plainer and more intelligible language ; how carefully, by 
 the labours of many great men, some of whom yet survive 
 to behold the effects of their honourable labours, the struc- 
 ture of all the parts of the human frame have been in later 
 times investigated ; its various and intricate functions how 
 diligently inquired into : how cautiously the " footsteps 
 and impressions" of maladies have been traced in the dead 
 body ; how well the foundations of medicine have been 
 cleared, what was unsound rejected, what was worthy to 
 be retained placed in a better light, and the rubbish of 
 the darker ages swept away. Then also you will find 
 what valuable assistance has, during this time, been given 
 to medicine by many other sciences which have been 
 daily becoming more exact ; and will acknowledge how 
 justified we are in saying, that as a result of all this a 
 result in which mankind have a deep interest, a more ra- 
 tional Practice is pursued ; the character of many diseases 
 is mitigated, others are entirely banished from among us ; 
 and, notwithstanding the greater diffusion of some causes 
 of disease, arising out of greater wealth, greater luxury, 
 greater intellectual exertion, the value of human life is in 
 every way increased. 
 
 These beneficial changes have not been brought about 
 easily or readily, without much labour, many retrogres-
 
 11 
 
 sions, and some violent struggles. Even so retired a study 
 as medicine, as it could not be preserved from the subtilties 
 and wildness of the schoolmen, so it did not escape further 
 interruption from the intemperateness and obstinacy of 
 faction. Philosophy, no less than religion, has occasion- 
 ally been deformed by idolatry, and degraded by bigotry ; 
 and medicine has not escaped the like inconveniences. 
 
 There have also been, at all times, some physicians pro- 
 fessedly opposed to the theories of all sects, whose boast it 
 has been that they relied only on experience. The division 
 of medical practitioners into Rational and Empirical, is of 
 very ancient date. As science has advanced, the Rational 
 physicians have continually gained more and more upon 
 their opponents: because, without despising experience, they 
 have always endeavoured to ascertain the causes of what 
 they witnessed. The question between the two parties re- 
 mains, in other respects, the same as it always was ; for as 
 the annals of medicine teach us that to reason without being 
 secure of facts is of all things the most sure to lead us into 
 error, so it is self-evident that to found reasoning upon facts, 
 to examine and compare them, to deduce from them certain 
 principles for our direction, is the only way to make them 
 useful. Without this employment of them, the hugest 
 collection would be of little service, and the longest expe- 
 rience unproductive of wisdom. The avowed despisers of 
 theory and reasoning therefore, who appeared to be justified 
 in former periods by the extravagance of the party opposed 
 to them, have been always found in later times practically 
 defective ; daily pursuing the same measures, and repeating 
 the same faults ; relying upon the supposed infallibility of 
 their own methods ; inobservant of the consequences of their 
 own practice; shutting their ears to all information, and 
 opposing a stubborn scepticism to all professional improve- 
 ment. 
 
 The particulars on which the preceding remarks are 
 founded will be brought before you hereafter. They have 
 been thus alluded to because even so slight a survey of the
 
 12 
 
 revolutions, errors, and prejudices, which have attended the 
 cultivation of the science upon which you are now entering, 
 cannot but guard you in the outset against hasty con- 
 clusions, and dispose you at once to examine thoroughly 
 the theories now prevalent, and often to be alluded to, and 
 to except truths by whomsoever you may find them offered. 
 To record the progress of medicine would indeed be a mere 
 waste of time, if it did not teach both you and me how to 
 proceed, and reveal the method of avoiding faults which 
 have misled so many who have gone before us ; if it did not 
 dictate to 'me the plan I ought at this day to pursue, and if 
 it did not convince you of the intricacy and difficulty of the 
 study of medicine, of the propriety of humility, of the ne- 
 cessity of patient labour, and of being animated in your 
 own investigations by an ardent love of truth, and a proud 
 desire to advance your science rather than yourselves. 
 
 It is my earnest hope that the pupils of the Medical 
 School of the University now first opened in this great 
 capital, but destined, I trust, to flourish among the insti- 
 tutions which adorn and benefit it, for many ages after those 
 who first engage in its honourable duties shall be no more, 
 will be no less distinguished by the laudable ambition which 
 directs their labours, than by the zeal with which those la- 
 bours are pursued : that they will despise the miserable 
 vanity of announcing what is new, without a scrupulous re- 
 gard to its being true ; that whilst they think boldly, they 
 will examine their first thoughts carefully; and, remem- 
 bering that observation is always difficult, and experience 
 itself often fallacious, whilst they attempt to attain to causes 
 through their effects, and the laws which regulate those ef- 
 fects, will reason on what they observe with circumspection, 
 feeling no anxiety except to discover what may be beneficial 
 to their patients : that respecting, not blindly worshiping 
 antiquity, combining the ardour of students with the mo- 
 desty proper to men commencing an important study, they 
 will not too hastily substitute their own authority for that 
 of those whose experience was more extensive; or commit
 
 13 
 
 themselves prematurely to any theories, from which a false 
 sense of shame may hereafter prevent their ever being dis- 
 entangled; but will avail themselves of the opportunities 
 which will here be afforded, of verifying their remarks by 
 repetition, of discussing them with one another, of appealing 
 to those whose opinions they regard, and who have found, 
 as they will find, that many confident conclusions of youth 
 require modification in future years; and, suppressing a 
 restless fondness for what is new and strange, will still re- 
 member that the science they cultivate is far from complete, 
 and that they may possibly be able to advance it. 
 
 The profession to which you have devoted yourselves, 
 Gentlemen, requires for its successful prosecution, not a 
 suppression of the higher faculties of the mind, but an 
 union of them, with a facility of applying the facts disco- 
 vered in many sciences to a practical art of the utmost im- 
 portance to your fellow-creatures. No profession calls for 
 so accurate an observation, retention, and valuation of so 
 great a variety of single facts; and to excell in it demands the 
 most diligent exercise of your senses, a well-directed atten- 
 tion, indefatigable and careful comparison, a faithful me- 
 mory, an imagination suggesting all probabilities for scru- 
 tiny, but disciplined and restrained. If medicine merely 
 consisted of the application of a few known remedies to 
 diseased states of the human frame, simple in their charac- 
 ter and easily recognised, there would be little in it which 
 occasional attention or a few months' study would not ena- 
 ble you to master. But your task is far more extensive and 
 delicate. As Nature does not abound in abrupt transitions, 
 so slight deviations from health constitute incipient disease; 
 slight aggravations modify it, alter its character, graduate 
 its severity, induce or avert danger : and these changes are 
 indicated by corresponding, and often very subtile varia- 
 tions of external phenomena, as well as influenced by in- 
 numerable remedial means. Thus the distinction of diseases 
 is often difficult; the probable result in many cases not 
 easily foretold ; and their treatment requires constant and
 
 14 
 
 serious attention : and supposing you all to be well ground- 
 ed in Anatomy and Physiology, without which sciences all 
 attempts to understand anything of physic must necessarily 
 be vain ; the shades of difference by which, as practitioners, 
 you will be distinguished from one another, will yet take 
 their final colour from your superior discernment of states 
 and stages of disease, and from the readiness, or I may say 
 the felicity, with which, out of an immense variety of mate- 
 rials, you select such as are exactly adapted to the combi- 
 nation of symptoms and individual constitution of the pa- 
 tient whom you have to treat. 
 
 I have now to speak of the mode in which it seems to 
 me that students may be best conducted to this desirable 
 end by those who are intrusted with their medical educa- 
 tion ; or rather, of the plan and arrangement of my own 
 lectures, and of the method of teaching which I myself pro- 
 pose to adopt. 
 
 In determining on the plan I have laid down for myself, 
 I have been governed by this feeling, that my labours here 
 were to be carried on for the benefit of others, rather than 
 for any immediate return of praise to myself. Viewing, as 
 deliberately as I could, the present state of medicine, and 
 the present necessities of students, I have not thought it 
 incumbent upon me, slavishly to copy even the most di- 
 stinguished examples among past or living medical teachers; 
 to copy them is not to imitate them but to consider, as 
 no doubt they well considered, what is required in my own 
 time, and in the actual state of our science, and to aim at 
 supplying it. 
 
 A perfect order of the subjects to be treated of in a course 
 of lectures on Medicine would be based on a knowledge of 
 the Proximate Causes of all the diseases to be spoken of, 
 or of those peculiar actions to which the term proximate 
 cause has been, I think disadvantageously, yet very long and 
 generally applied. Whatever may hereafter be in the power 
 of a lecturer, our present knowledge of proximate causes
 
 15 
 
 (or, as I should say, of primary morbid effects or actions) is 
 not sufficiently exact ; our acquaintance with the intimate 
 structure and functions of the different parts of the body is 
 too incomplete, to furnish him with a foundation sufficient 
 to support a durable superstructure, and he must select one 
 less exposed to movement and change. It is even ques- 
 tionable whether such an arrangement would ever be the 
 best for him to follow who has to combine the Art with the 
 Science of medicine. 
 
 After considering, therefore, not without anxiety, what 
 might be the best arrangement, one which would serve the 
 purpose not of students only, but of men who are to prac- 
 tise what they learn ; an arrangement by which external 
 phenomena or symptoms would become readily, because 
 habitually, associated with the system or set of organs af- 
 fected in each case, and with the means to be adopted for 
 relief, for these, Gentlemen, are the objects of your study, 
 and must be always the first objects of my teaching; it 
 seemed to me that no arrangement would better answer 
 these ends, would less involve the lecturer in the pursuit 
 of false reputation, or his hearers in useless disputes con- 
 cerning classification ; none would approach more nearly 
 to an arrangement by which all arbitrary associations and 
 disjunctions of diseases would be avoided, and the first 
 parts of the course would prepare for those which were to 
 follow, than one founded on Physiology. 
 
 It is therefore my design to speak of diseases in the order 
 in which the functions are observed in the living body, from 
 the first moment of life to the reproduction of a creature 
 destined to perpetuate the species. First, consequently, I 
 shall speak of diseases of the Circulating System, sangui- 
 neous and lymphatic ; then of the diseases of the Respira- 
 tory function and organs ; then of diseases of the Brain, 
 Spinal Marrow, Nerves, organs of Sense and Motion ; then 
 of diseases affecting Nutrition and Evacuation ; and lastly, 
 of diseases of the Reproductive or Generative System. 
 I do not insist on the exclusive value of this arrange-
 
 16 
 
 nient. It is impossible to begin anywhere without this in- 
 convenience, that things must sometimes be alluded to, 
 which have not been explained. The connections of the 
 different systems of the human body are so numerous, 
 their reciprocal influences so incalculably many, that with 
 no set of organs or class of functions can we commence, 
 which, although primary in some points of view, are not 
 secondary in others. We have to describe a circle, and 
 may begin in any part of it. Other arrangements may 
 have been preferable in other times, and a better may pos- 
 sibly hereafter be practicable. I take medical science in 
 its existing state, and adopt the arrangement of its subjects 
 which seems to me best fitted to its present advancement. 
 
 The order I have chosen will have one very evident ad- 
 vantage : it will embarrass the student with no hypotheses 
 concerning either structure or function. When, in his 
 first practical attempts, a disease is presented to his obser- 
 vation, we all know, who have made those attempts, that he 
 does not search his memory for a definition in order to 
 understand such disease ; that he does not seek its place in 
 any artificial classification ; but that he first inquires what 
 functions or what organs are disordered: the circulating, 
 the respiratory, the digestive, the intellectual, the sensorial, 
 the muscular, the generative; and he will surely find his 
 inquiry facilitated by having studied the disease, whatever 
 it may be, in its natural place. He takes into his view 
 many circumstances ; and by a comparison of them deter- 
 mines the nature of the case : and it is surely desirable to 
 avoid impeding him with imposing divisions, and names 
 hostile to the recognition of disease in its effects, effects 
 which he is to endeavour to remove. If, as commonly 
 happens, two or more organs or functions are affected, he 
 will be equally well prepared, by his previous study of dis- 
 ease as fully described to him, to discover which affection 
 was the first in order, whether that which was primary is 
 yet in his power, or which demands his chief attention. 
 Some disorders are of a nature to affect various structures,
 
 17 
 
 and consequently to appear in various organs, and to disturb 
 various functions. These will be first treated of generally, 
 and then as they affect particular parts. The general na- 
 ture and treatment of Inflammation, for example, will be 
 described in the First Division, as an affection of the Cir- 
 culating System ; but inflammation will also be spoken of 
 in each of the other divisions in which it forms distinct dis- 
 eases. Morbid formations will be arranged among the dis- 
 eases of the parts or structures in which they most com- 
 monly appear, or which they most seriously affect. 
 
 Each of the Five divisions into which my Course is thus 
 divided, will be commenced with a brief reference to such 
 parts of what has been taught by the Professors of Anatomy 
 and Physiology, as are inseparable from pathological con- 
 siderations of a general character ; or which require, from 
 their close connection with the diseases of the division, to 
 be distinctly and constantly kept in mind. Having done 
 this, the functional or physiological irregularities, and the 
 morbid appearances or anatomical changes found in the 
 system comprehended in that division, will be summarily 
 viewed. This retrospect and survey will generally occupy 
 one lecture. Afterwards, when speaking of the different 
 disorders of the division separately and fully, it is my in- 
 tention, whenever it is practicable, to show and describe, 
 sometimes with the help of recent specimens, sometimes in 
 morbid preparations, often by faithfully executed drawings, 
 the effects of the disease which is under consideration, or its 
 pathological anatomy, in the incipient state of the disorder, 
 in its progress, and in its ultimate stage. My care will be 
 to associate these appearances with the symptoms which 
 they produce, and by which they are to be recognised 
 during life ; and with this knowledge of effects and signs, 
 it will not be difficult to connect rational views of medical 
 treatment ; such as in the first and second stages may lead 
 to measures calculated to prevent further progress or pro- 
 duce a cure, and in the last to mitigate suffering and retard 
 the approach of death.
 
 18 
 
 In some diseases I must speak of what cannot be recog- 
 nised in the dead body by our senses, but of the existence 
 of which we have reason to be certain from the effects 
 which we see during life. Many disorders of the nervous 
 system are of this kind ; and functional disturbance may 
 continue long and leave no trace. The plan of illustration 
 which I have mentioned will of course only be applicable 
 to that aggravated state in which structural change super- 
 venes on disorder of function. 
 
 In order to make the description of diseases available to 
 the purposes of the student, it should not, 1 conceive, be 
 merely systematic or historical, but should also represent 
 them as they are most likely to be seen by the young prac- 
 titioner. Thus, although the shivering, the bodily and 
 mental languor, the wandering and unsettled pains which 
 often precede the more marked symptoms of Fever, must 
 not be omitted in the systematic description of that dis- 
 ease; the student must be warned that his assistance will 
 most likely be required when these symptoms have passed 
 away, when the patient is not in a state to recall them, and 
 the more prominent and alarming phenomena of fever are 
 developed, complete prostration of bodily power, violent 
 affections of the head, or chest, or bowels, and a bewildered 
 mind. Pie will be told, that cases still more perplexing 
 will be presented to him, in which no local symptoms are 
 strongly marked, but all the functions labour and are op- 
 pressed ; in which the causes and the origin of the com- 
 plaint are obscure, and its progress has been inaccurately 
 marked. He will be further warned, that fevers sometimes 
 commence with the local symptoms of common inflamma- 
 tory disorders, and sometimes with the suddenness and 
 some of the appearances of apoplexy. 
 
 It is my intention to dwell somewhat more fully on 
 Mental Disorders, or, to speak more correctly, of disorders 
 affecting the manifestation of mind, than has I believe been 
 usual in lectures on the practice of medicine; and for many 
 reasons. There is a very general opinion gaining ground,
 
 19 
 
 that these dreadful disorders are more common than they 
 formerly were. The consideration of them often involves 
 the most important interests of families, and throws a heavy 
 responsibility on the physician. I disapprove entirely of 
 some parts of the usual management of lunatics. I also 
 consider the distinction between Rationality and Insanity to 
 be clearer and easier than it is generally represented, and 
 look upon the singular and contradictory definitions which 
 have on many occasions been publicly given, as so many 
 proofs of the want of proper means of obtaining a practical 
 acquaintance with insanity. In this important department, 
 I trust I shall be enabled to afford opportunities to the 
 student, for the first time in this country, of becoming fa- 
 miliar with the diversified aspects of this alarming malady ; 
 and I cannot but hope that a great impulse will thus be 
 given to the study of them, and that great general improve- 
 ment will in a few years arise in this department, to the 
 advantage of the public, no less than to the honour of our 
 medical school. 
 
 When detailing the modes of distinguishing one disease 
 from another, I shall place before you those circumstances 
 only which are the most surely established; mentioning 
 perhaps, but not dwelling much upon, sometimes passing 
 over, those less certain, which the pride of affected perspi- 
 cacity has occasionally proclaimed. I conceive that my first 
 object is to put you in possession of such facts as are so 
 securely fixed as to be serviceable in the first steps of prac- 
 tice. Thus, in speaking of the percussion of the chest by 
 the fingers, or of the application of the ear to it, in order 
 to ascertain the state of its contents, I shall in some affec- 
 tions dwell on the value of these methods of exploration, 
 in others pass lightly over them, in all notice them only 
 as auxiliaries ; for I should be with much reason appre- 
 hensive of your doing great injury to the public, if, for- 
 getting to acquaint you thoroughly with those symptoms 
 which you can see and feel, I should trust your patients to 
 
 B 2
 
 20 
 
 your discrimination of those to be derived from the sense 
 of hearing. I should expect you, and, what you will find 
 to be of more consequence, your patients will expect you, 
 to be able to distinguish a severe catarrh, or bronchitis, an 
 inflammation of the mucous lining of the air-passages, from 
 an inflammation of their parenchymatous substance, or 
 from an inflammation of the pleura, or membrane by which 
 the lungs are covered, in most cases, by the general sym- 
 ptoms : but I should unquestionably wish you to be able 
 to verify your diagnosis by the stethoscope and percussion, 
 and thus, in cases apparently doubtful, acquire a certitude, 
 I could almost say an infallibility of diagnosis unattainable 
 by any other methods. 
 
 The same views will govern me in noticing the results of 
 disease, or pathological anatomy. I shall take great pains 
 to familiarize you with such as are the undoubted products 
 of particular processes, more especially of such as are early 
 indicated by particular symptoms, and which there is rea- 
 son to think may be checked in their origin ; such as you 
 have to expect when particular symptoms present them- 
 selves, and such as you are to prevent or to cure. But I 
 shall not dwell, lecture after lecture, on the infinite minutiae 
 of morbid appearances ; for if I did, I should be forgetting 
 the chief object of my lectures. I by no means would dis- 
 courage any pupil, who is not very anxious to become en- 
 gaged in practice, from applying himself to morbid ana- 
 tomy even as a distinct science; but in these lectures it 
 must always be spoken of as a science subservient to that 
 of preventing the changes which it exhibits. 
 
 The same views will influence me in what I say concern- 
 ing the treatment of diseases, which will be exposed as 
 clearly as may be practicable in relation to symptoms and 
 results, and governed by such principles as seem to rest 
 on the most fixed foundations, and to-be applicable to 
 the many indescribable modifications of morbid actions. 
 Doubtful measures, new remedies, empirical experiments,
 
 21 
 
 will not be despised ; but their success will not always be 
 considered as a proof of their being fit for general applica- 
 tion : they may be noticed as deserving of future attention, 
 but not to the neglect of things more certain, plain, and 
 familiar, of which you will have immediate and hourly 
 need. Undecided questions, yet the subject of warm or 
 intemperate controversy, will be stated, with the chief 
 arguments of the contending parties ; but the student will 
 be rather exhorted to examine than urged to decide. The 
 lecturer can but give an outline, which the future industry 
 of the student must fill up. His duty is not to repeat 
 everything that has been said or written, but to analyse and 
 simplify that which it is most important for you to learn ; 
 to aid in the formation of opinions, rather than to dictate 
 opinions ; and to furnish that information for which you 
 will have instant necessity, in such a way as may induce 
 you, and enable you, to add to it by your own subsequent 
 industry. He is supposed to devote a great part of his 
 time to the task of selecting, arranging, and condensing, 
 from the voluminous records of physic, what it immediately 
 or chiefly imports you to know, and to the more difficult 
 labour of collecting out of the publications of his own time 
 what is truly useful and really new; rejecting without 
 scruple what is delusive or uncertain, or so minute as to 
 be useless to the practitioner. Remembering that to many 
 of his hearers the subjects of which he treats are new, 
 solely anxious to inform and direct, lecturing to his pupils 
 and not for the public, it is desirable that he should not 
 only be clear in his conceptions and accurate in his infor- 
 mation, but plain and precise in his expressions ; dreading 
 nothing so much as to mislead his hearers, above all in 
 medicine ; since not their knowledge alone, not mere spe- 
 culative opinions, but their practice, the fate of their pa- 
 tients, may be influenced by what he says. Careless of the 
 fame that may always be acquired by professing novel and 
 ingenious doctrines, he must yet sometimes lead the way 
 into the regions of speculation ; but he must know where
 
 22 
 
 to stop, and not be afraid to confess that there are many 
 things which he cannot explain, and which are yet to be 
 elucidated. 
 
 Still, beyond these lessons, something is required to make 
 them useful. It is not learning alone, or extensive reading, 
 or any familiarity with verbal descriptions, which can pre- 
 pare the student to know disease when he sees it, or to cure 
 it when it is recognised. The materials for discourses on 
 medicine are open to all ; but it is the superiority of the 
 modes of Clinical teaching, superadded to the ability of in- 
 dividual lecturers, which has given celebrity to the most 
 famous schools ; to those of Germany and of France, and 
 I add with pleasure from my own experience, to the justly 
 celebrated school of Edinburgh. In the Hospital and 
 Dispensary attached to the University, constant, and I hope 
 daily increasing, opportunities will be afforded of becoming 
 practically acquainted with disease. TJiere the justness 
 of what you hear in these lectures must be finally tried, 
 the principles laid down be applied to practice, and the last 
 attempt made to lead the student step by step to act for 
 himself. You will there be enabled to compare the different 
 ways of obtaining the same ends, and be a witness of those 
 occurrences which in the course of a disease so often modify 
 the best concerted plans of treatment; and become con- 
 vinced that there are no practical aphorisms to be acquired 
 in the halls of learning, which are to be confidently acted 
 upon without any further exercise of the understanding at 
 the bedside of the sick. You will see that no part of the 
 system can be long in disorder, without affecting the tran- 
 quillity of the rest; that complications beyond the power 
 of any lecturer to enumerate are frequently met with ; and 
 that when you come to be engaged in practice you will often 
 have to deal with cases described in no lectures, compre- 
 hended in no system of medicine, to which the most un- 
 questionable principles of physic must be applied with cau- 
 tion, and in which the blind application of eternal rules of 
 practice will be fatal to the patient : you will find, in short,
 
 23 
 
 that after obtaining a competent acquaintance with what is 
 to be learnt from lectures, from books, and from an obser- 
 vation of the practice of others, the chief requisite for prac- 
 tising physic is what is commonly called good sense ; by 
 which I mean the vigilant and ready exercise of the under- 
 standing or judgment in all the accidents of practice, and a 
 prompt adaptation of what you know, to what you have to 
 do; a possession consequently, which, though partly a gift 
 of nature, is capable of great development by careful cul- 
 tivation. In what relates to a practical art, industrious 
 talent may acquire and arrange, genius may improve and 
 adorn, but good sense must always direct. 
 
 Such is an outline of the principles and the manner ac- 
 cording to which I conceive medicine requires to be taught 
 in the present state of the science. The medical school of 
 England, Gentlemen, has long stood honourably distinguish- 
 ed above all or most of the European schools, by being free 
 from the trammels and language of any exclusive theory. 
 If, in our anxiety to attain and preserve valuable practical 
 truths, we have been sometimes too negligent of what were 
 considered to be mere refinements, we have at least avoided 
 the disgrace of giving protection to imposture, or a solemn 
 sanction to the absurd delusions by which visionary or dis- 
 honest men have often, in other countries, found a way to 
 fame. Our opportunities of anatomical investigation, and 
 of observing the results of disease, have been limited, and 
 unfortunately continue to be too much so, by the prejudice 
 existing in this country against the examination of bodies 
 after death : but at the same time, the diligence with which 
 the opportunities we have enjoyed have been cultivated, 
 the constant bearing which our pathological anatomy has 
 had on the practical improvement of our profession, have 
 left mu^i less to regret than is imagined by those who 
 merely consider the opportunities of dissection afforded on 
 the continent: and let it not be forgotten, that causes which 
 it is satisfactory to reflect upon, have in reality contributed
 
 24- 
 
 to limit our opportunities a greater regard even among 
 our humble countrymen and women for those whom death 
 has taken from their families, and a practice of medicine 
 and surgery so zealous and direct as to prevent the exces- 
 sive results of disease, and more powerfully to obviate what 
 has been termed the " tendency to death." I would entreat 
 those who have been led into what I cannot but consider 
 an unjust and even an unsafe preference of the foreign me- 
 dical schools, to reflect what kind of men have been pro- 
 duced by the system followed in this country. I would beg 
 them to observe the spirit and discernment, the union of 
 zeal and judgment, with which medical investigations are 
 carried on among us ; the general character of those who 
 practise the different branches of the profession ; the esti- 
 mation in which they are held in this country ; and above 
 all for this is the greatest consideration of all the effects 
 of their labours on the lives of their patients. In exchange 
 for these benefits, we should ill-receive, in my opinion, all 
 that is offered to us by systems of education from which, 
 although I acknowledge the diligent ambition resulting from 
 them, all noble views seem to be too much shut out; in 
 which at least (for I have no wish to encourage prejudice 
 or to exaggerate anything), exact and useful knowledge 
 and good faith are not more conspicuous than in our own 
 schools; but which call for more display, and for more 
 ostentatious exhibitions, alien to the character of a serious 
 study : for as far as my own observation and experience 
 have gone, I feel convinced, that it is not by public and 
 formal efforts, by disputations, and competitions, and showy 
 discourse, but by quiet observation long pursued, by care- 
 ful, by repeated, by undisturbed reflection, and thought 
 long unexpressed, that the medical student or practitioner 
 works his arduous way to a knowledge of his profession. 
 
 Knowing myself to address many students who are 
 commencing their studies in this metropolis, I shall not 
 be departing from the proper limits of my duty if I de-
 
 .25 
 
 vote the remainder of the present lecture to observations 
 of a general kind, chiefly connected with the habits and 
 education proper or desirable for those who mean to study 
 any of the branches of our profession. 
 
 The first habit to be recommended to all students is 
 diligence, and to a medical student a diligent devotion of 
 his mind to his proper profession. Whoever means here- 
 after to practise physic with comfort or credit; whoever 
 would be consoled under the depressions incidental, I ima- 
 gine, to the most judicious practice ; must never forget that 
 the sciences connected with it, and to which he is conse- 
 quently introduced, are only valuable to him as the auxilia- 
 ries of his profession, that they do not make, but only assist 
 a physician. With this caution, the medical student can- 
 not be too diligent. To him no mistake will be more de- 
 trimental than to underrate the homely virtue of industry ; 
 without which, in our profession, perhaps in any profes- 
 sion, no man ever attained to eminence. If some indivi- 
 duals, by the help of a brilliant imagination and certain 
 powers of acquirement, have gained celebrity in spite of 
 their notorious indolence, such men have done little for 
 their profession, their country, or mankind, and have ac- 
 quired no permanent or valuable fame; but the greatest 
 men of all nations and times have been men of industrious 
 or even of laborious habits. I have watched with much 
 interest the fate and conduct of many of those who were pur- 
 suing their studies at the same time with myself. Of these, 
 some were of course idle, and despised the secluded pursuits 
 of the studious : of such, I do not know one whose pro- 
 gress has been satisfactory : many of them, after trying 
 various methods of dazzling the public, have sunk, already, 
 into merited degradation. But I do not know one among 
 those who were industrious, who has not attained a fair 
 prospect of success : many of them have already acquired 
 reputation ; and some of them will doubtless be the im- 
 provers of their science in our own day, and remembered 
 with honour when they are dead.
 
 26 
 
 It would doubtless be most desirable that the general 
 education of a student should end when his professional 
 education commences. This, I fear, can seldom be the 
 case with medical students. But the more carefully and 
 liberally a youth has been educated, the more advan- 
 tageously will he enter on his medical studies. I leel it in- 
 cumbent upon me to express myself very unreservedly on 
 the subject of Classical learning, because I know that it has 
 often been represented as incompatible with professional 
 ability, and a depreciation of it has, even within our own 
 time, and in our own profession, been regarded as an ex- 
 pression of liberality ; as the indication of a mind which, 
 bowing to no authority, dared to assert its own freedom. 
 These opinions, originating perhaps in the too evident 
 waste of time when a knowledge of the dead languages is 
 considered the principal object of a man's life, are yet erro- 
 neous and prejudicial. Certainly, of all delusions, that of 
 a man who, without any classical taste, any elegance of 
 mind, any habits of literary life, affects to look down upon 
 others because he had in his youth what is called a classi- 
 cal education, is the most ridiculous and the most unfortu- 
 nate ; for such a delusion keeps him in a state of profound 
 and vulgar ignorance, and at the same time in a state of 
 the most perfect satisfaction with himself. Far be it from 
 me to be accessary to the continuance of such a pompous 
 and useless prejudice. But, Gentlemen, you cannot be fa- 
 miliar with the languages of Greece and Rome, without at 
 the same time becoming familiar with the characters of some 
 of the greatest men who ever lived, and the most exalted 
 sentiments which the human mind ever conceived : nor can 
 you be intimately acquainted with the beauty and accuracy 
 of expression which characterize the best Greek and Roman 
 writers, without becoming at the same time accustomed to 
 the most admirable order and precision of thought. 
 
 Both languages were spoken and written in their greatest 
 purity by nations which, though inferior in many points of 
 private morals to the modern, were yet distinguished in
 
 27 
 
 their time far above all the other people of the earth. 
 When those languages became corrupt, public spirit had 
 lamentably declined ; and when they ceased to be heard, 
 a moral darkness overspread the fairest parts of the world ; 
 the sciences, and medicine very remarkably, were neglected; 
 the voice of wisdom and the splendours of poetry were 
 either restrained or prostituted to the meanest purposes ; 
 and liberty was altogether extinguished. But when, after 
 this dreary period, the barbarous models of the middle ages 
 were put aside, and the noble languages of antiquity re- 
 vived ; not learning only, not only poetry and eloquence, 
 but sciences and arts revived ; the human mind seemed to 
 receive an accession of strength ; the moral and political 
 condition of men improved ; manners began to be purified 
 and refined ; the modern languages were polished into 
 elegance ; and, lastly, medicine was rescued from the sla- 
 very of imitation, and all those researches made, and all 
 those reforms effected in it, which I have already said have 
 marked the last two centuries. Since that revival, the 
 most distinguished men in all countries have drank the 
 deepest at these pure fountains ; and even at present, an 
 acquaintance with classical learning, an habitual inter- 
 course with the orators, poets, philosophers, and physicians 
 of past ages, is most conspicuous in those who are the first 
 poets, orators, physicians and philosophers of our own. 
 
 To depreciate languages ever associated and cotempo- 
 raneous with advantages like these, is surely then a, false 
 liberality, and a mere affectation of practical wisdom ; and 
 instead of being likely to cherish feelings of true liberty, 
 mental or political, has a direct tendency to make you view 
 all institutions and all parts of learning with a narrow and 
 prejudiced mind. 
 
 Seek then, I would say, or continue to keep up, an ac- 
 quaintance with the languages of Greece and Rome. The 
 latter is at least within your attainment, and a knowledge 
 of it of the greatest utility to a medical student. If you 
 have neglected it, let me persuade you to devote one hour
 
 28 
 
 a day to it during the whole period of your medical study ; 
 such an occupation will form an agreeable relief after your 
 other duties, and at the end of a few years you will be sur- 
 prised to find how much that little sacrifice of time has 
 enabled you to accomplish. 
 
 Very great advantage will attend your being acquainted 
 with some of the modern Europaean languages, particularly 
 with French and German ; and the number may easily be 
 increased when one or two are well learnt. Nor should I 
 omit to mention an attention to the correct use of your own, 
 of which many men proud of their classical attainments, 
 and many medical writers, have been but too negligent. A 
 man may assuredly be a very good physician, or a very good 
 surgeon, without any knowledge of Greek and Latin, of 
 French or German ; but if he cannot write his own clearly, 
 or speak it correctly, his writings and language will cast 
 perpetual ridicule on what is considered a learned pro- 
 fession. And let the British student remember, that the 
 English tongue yields to none in copiousness, in strength, 
 and in variety ; that it is spoken more extensively than any 
 other ever was, and has been employed to express the 
 thoughts and deeds of men who will bear a comparison 
 with the foremost men of all antiquity. 
 
 It is hardly necessary for me to observe, that a gentleman 
 practising the higher branches of a liberal profession is ex- 
 pected to have a general acquaintance with modern litera- 
 ture, and some knowledge of what are called the Fine Arts. 
 But it will also prove highly serviceable to him to have 
 studied such parts of Natural Philosophy as explain some 
 of the properties, functions, and capacities of the living 
 body ; he will sometimes find it necessary to direct his 
 thoughts to the Philosophy of the Human Mind; his in- 
 formation will be much increased by an acquaintance with 
 the very interesting studies of Comparative Anatomy and 
 Zoology : neither should he be ignorant of Mathematics ; 
 and he will often be materially assisted by possessing the 
 accomplishment of Drawing. These acquirements, if they
 
 29 
 
 do not all constitute indispensable parts of a complete me- 
 dical education, may at least precede it with great benefit 
 to the student. The habits of attention which such studies 
 favour, and the store of ideas with which they furnish the 
 student, strengthen, by exercising, his mind ; and enable 
 him to enter upon with less difficulty, and to comprehend 
 more readily, the anatomy and physiology of the human 
 body, and whatever relates to the practice of physic and 
 surgery. 
 
 The studies which I have enumerated (for I have omitted 
 many which have sometimes been insisted on) are not at all 
 beyond your reach, provided your early years have been 
 well spent, and you have learned to " pick up the fragments 
 of your time ;" nay, they may be graced and set off with 
 many accomplishments, provided you have no attachment 
 to low and debasing pursuits ; provided that your ambition 
 is a well regulated and steady principle, arising from your 
 desire to do what is useful and good ; and that your asso- 
 ciates and even your amusements are well chosen. 
 
 I need not, I am sure, dwell on the advantage, now first 
 known in London, of an University in which will be pre- 
 sented opportunities for the cultivation of any or of all the 
 parts of knowledge which I have mentioned ; situated too, 
 in the midst of an intellectual capital, in which the student 
 can never be driven, by the proscription of elegant and 
 rational amusements, or the want of agreeable and virtuous 
 society, to throw away his early life in low debauchery or 
 vice ; an institution in which the mere parade of learning, 
 or the most laborious perversion of talent, will be far less 
 considered than the attainment of useful knowledge ; an 
 institution in which it is professed, as I solemnly believe, 
 without reserve or equivocation, that no sect, no party, no 
 persuasion, no difference of rank, or fortune, or opinion, 
 will be a bar to all the academical honours which a pupil 
 may merit, or which can here be bestowed. You must be 
 very inattentive to what is passing around you, if you are 
 not convinced that the careful culture of the mind was never
 
 30 
 
 more necessary than it now is, for the preservation of the 
 rank in which you are placed, or for the attainment of 
 a higher. Nor will you ever find that your acquisitions are 
 barely equal to the expectations with which your efforts 
 were commenced. Menial industry is always abundantly 
 rewarded. New rays of intelligence, and clearer views of 
 your duty, will be communicated to you from every side ; 
 and you will experience, I trust, that the cultivation of true 
 knowledge has not only informed your understanding, but 
 exalted your whole character. 
 
 Whatever may have been your past advantages or dis- 
 advantages, whatever may be the present state of your in- 
 formation again I say, keep in your memory at all times 
 that it is the Practice of your profession with which you 
 have to do. Neglect nothing that may enrich your minds, 
 or give you consideration, or improve your real happiness ; 
 but remember that the great business of your lives is " to 
 learn what you can, and to do what you can, for the good 
 and the comfort of the sick and the miserable."* Let every 
 day therefore be well employed ; for though the time you 
 have to spend in study now seems long, it will pass away 
 quickly, and cannot return. Excuses are too often admit- 
 ted by the student when he is conscious of his own indolence, 
 and he promises himself that on another occasion that fault 
 will be avoided ; but days, and weeks, and months follow 
 one another, and at last his opportunities are gone. Attend 
 daily therefore, and regularly, both lectures and hospital 
 practice ; a day's neglect breaks the chain, and makes many 
 lectures unintelligible, and many cases uninstructive. Keep 
 accurate and copious records of the cases you have time to 
 attend to ; review these records at stated periods, and make 
 memorandums of what seems worthy of observation, pre- 
 serving such notes arranged in alphabetical order, without 
 which, or some such precaution, the more your manuscripts 
 
 * Life of Dr. Bateman. An account of this interesting piece of 
 Medical Biography was given by me in the London Medical Repository 
 for December 1826, to which T beg to refer the medical Student.
 
 31 
 
 increase, the greater will be their confusion. Do not at- 
 tempt to read many volumes, or distract yourselves with 
 numerous authorities, or the countless cases related in me- 
 dical writings. With a few of the ancient authors and 
 some of the moderns I should wish you to be familiar, and 
 these I will take opportunities of pointing out to you. But 
 in general I would say, read little, observe carefully, and 
 think much. Accustom yourselves also to write such re- 
 marks as seem to you to be new or otherwise worth pre- 
 serving, never deferring doing so beyond the earliest mo- 
 ment of leisure you can command after the observation has 
 been made. All men are accountable for their time, but 
 none more than you. You will be hereafter liable to be 
 called upon to act unassisted, or to assist others, in cases of 
 sudden and great danger ; and on your previous prepa- 
 ration, and on the state and temper of your mind, it must 
 often depend whether the result be life or death. The sa- 
 crifices and exertions which these considerations render 
 necessary, are surely more than compensated by the real 
 importance, interest, and dignity of your art; by the value 
 of which you may be to your fellow-creatures : for there is 
 no pursuit which engages its followers in such a variety of 
 delightful studies, for ends more directly useful to man- 
 kind. The ample page of all knowledge is thrown open to 
 you, from whence to learn how to relieve the sufferings, 
 restore or prolong the activity, and thus bless the existence 
 of those about you. 
 
 Let me exhort you never to take less worthy views of the 
 profession in which you have engaged, or at any time to 
 become unduly sceptical of its powers. Those powers are 
 indeed limited, but by no means visionary. Although there 
 may be great difficulty in finding out the principles of the 
 science, we may be assured they are no less exact than any 
 by which other sciences are regulated. The leading cha- 
 racters of all the most serious diseases have been the same 
 from the earliest aera of which we have any medical re-
 
 32 
 
 cords : the susceptibilities and the functions of the body, 
 the properties of medicinal substances, the state of the 
 earth and of the air, have undergone no change ; the fa- 
 culties of the human mind, the springs of human affection 
 and passion (with all which enlightened medicine has to 
 do), have ever been the same. The treatment therefore of 
 disease ought not to be wavering or uncertain ; ought not 
 to present a broad and unnatural contrast to this great 
 uniformity and constancy of nature. Nor will you find 
 that it does so, if you confine your views to such treatment 
 as can alone be accounted rational, and meet the varieties 
 of disease by means which, though equally varied, are not 
 adopted capriciously or incautiously, but suggested by such 
 knowledge of the nature of diseases as you can acquire. Be 
 assured, Gentlemen, that exercised with judgment, medi- 
 cine will enable you to exert more controul over disease 
 than you sometimes dare to hope. Many acute affections 
 may be overcome and destroyed with what may almost be 
 called certainty ; the progress of morbid formations of the 
 most serious kind may be suspended, if not wholly pre- 
 vented ; and in some cases effectually and wholly checked ; 
 whilst in almost every case sufferings may be lessened, life 
 rendered comfortable, and death delayed. Such, even at 
 present, is the power of medicine ; and if we look at the 
 apparent intention of the most fatal morbid processes, and 
 consider the exhaustless stores of nature, and the daily 
 productions of scientific pharmacy, we shall see much rea- 
 son to believe that the powers of medicine may yet "be 
 greatly amplified ; that some diseases now considered the 
 most intractable may hereafter become curable by art. 
 The justifiable hope of being able to add to the resources 
 of the physician or surgeon ; of being able to cure diseases 
 now invariably fatal ; to relieve sufferings which now pro- 
 ceed uncontrouled ; and thus to become signal benefactors 
 to your nation and to the world, is surely sufficient to pre- 
 vent your becoming desponding during your studies, or
 
 33 
 
 inert in your daily practice. If there be any truth in these 
 observations, you cannot be desponding without folly, or 
 negligent without criminality. 
 
 It is, I hope, almost superfluous for me to explain that 
 in making the observations I have done on the diligent 
 employment of a medical student's time, and on the devo- 
 tion of all his faculties to his profession, I have not meant 
 to encourage or excuse the total neglect of more serious 
 thoughts and occupations. God forbid, Gentlemen, that I 
 should be supposed for a moment capable of joining in any 
 hypocritical and odious cry, in which the sacred name of 
 religion is employed to promote political ends and worldly 
 interests, to justify persecution, and to excite the worst 
 passions of men ! But there is a religion which makes men 
 better ; and so much of your employment will be among 
 the works of the Almighty hand, and you will have so 
 many opportunities of rightly estimating at the bed of the 
 sick and the dying the true value of all mere worldly con- 
 siderations, that I trust I may without impropriety beseech 
 you in the midst of your busy engagements, not to let your 
 feelings be interested by these occupations in vain. Habi- 
 tually engaged, as you will be, in doing good, I should 
 wish you to be supported and directed in your exertions 
 by an exalted sense of duty. This is the state of mind by 
 which all the brightest characters in our profession were 
 distinguished, and I pray that it may be yours. 
 
 As the rules of the University leave you one day in the 
 week (Saturday) for the revision and arrangement of your 
 notes, and for proper relaxation, you will not be under the 
 necessity of employing any part of Sunday in that manner. 
 On that day therefore, let all your medical occupations be 
 put aside your Hospital attendance, or visits to any poor 
 patients under your care, excepted. Attend the services of 
 religion. Examine how you are passing your time. Re- 
 view and regulate your thoughts ; and clear your minds of 
 any animosities or discomposures which may have arisen 
 during the week. Let the remainder of the day be passed
 
 34 
 
 in the perusal of esteemed authors, or in the society of wise 
 and good associates. You will then not only not lose a 
 day, but will actually gain time, by the refreshment of your 
 minds ; and by the acquisition of that serenity, the want of 
 which is most unfavourable to mental exertion, and which is 
 never enjoyed except when we are quite at peace with 
 ourselves. 
 
 Gentlemen, I have but one word more to say on the 
 present occasion. You commence your studies when our 
 professional body is agitated by many matters of great in- 
 terest. Some of you may perhaps be persuaded, before 
 your studies are completed, to take a part in proceedings 
 or distussions having for their object certain changes in the 
 medical constitution. On the propriety of these changes 
 it would be unbecoming in me to offer any opinion in this 
 place. But let me advise you to approach these subjects 
 calmly, and not to give way to any feeling but a desire to 
 do good to and to protect the whole body of the profession, 
 and to benefit the public, of which that profession forms a 
 part. 
 
 Beware how you allow your passions to be influenced by 
 any, who, on the just ground that old establishments need 
 occasional alterations, would really engage you in the de- 
 struction of what is useful as well as venerable. Hear the 
 opinions of the old as well as of the young ; compare one 
 with another; and judge for yourselves. Leave, for the 
 present, to others, the care of changes demanding time, 
 which you have not to spare ; experience, which you 
 cannot be supposed to possess ; patience, which does not 
 belong to your age. Do not waste valuable hours, and 
 neglect your present opportunities, in endeavouring to 
 effect what only your seniors can effect, hours which you 
 can never recall, and opportunities which will never present 
 themselves again ; but will be looked back upon, if lost, 
 with pain and regret as long as you live. 
 
 And, Gentlemen, above all things, when you are urged
 
 to any particular line of conduct, let your first inquiry be 
 concerning the character of those who are most active in 
 it, and who are to be your associates. Ask yourselves if 
 they be truly honest men. If they are not, have nothing to 
 do with them in any cause, for they will corrupt the best. 
 In all countries pretending to civilization and morality, 
 people have long been convinced that the end, however 
 laudable, does not justify unholy means. It may be your 
 duty to endeavour to reform, but only if you can reform by 
 honourable efforts. An ancient edifice may require repair, 
 and repair might conduce to its safety ; but if the few skil- 
 ful workmen who alone could undertake this experiment of 
 preservation be surrounded by a passionate and unscrupu- 
 lous multitude, their wise efforts will be overborne, and no 
 good end effected. 
 
 If you forget these truths, and become committed to the 
 cause of injudicious, or selfish, or reckless men, be assured 
 you will find, even in your own profession, a spirit which 
 will not tolerate you ; and by the public sense of this country 
 you will be opposed and defeated in every step of your pro- 
 ceedings. The time has gone by, when in the comparative 
 ignorance of the community at large, want of principle was 
 occasionally tolerated because connected with highly cul- 
 tivated talent. You live in days when not knowledge alone, 
 but character is power ; when knowledge without character 
 can procure no more than temporary and very transient 
 preeminence; and cannot save from final exposure and 
 disgrace. Unjust suspicions may attach to an innocent 
 man ; the general consistency and integrity of his life will 
 wipe them away; the imprudencies of youth may be re- 
 paired by the circumspection of middle age : but if you 
 justly lose your reputation for probity and honour, you may 
 struggle, and resist the great decree of public opinion; 
 but you will find, whatever your attainments, whatever en- 
 gaging qualities or natural endowments you possess, that 
 yqur influence in society is gone, and that you are in all 
 respects lost and ruined men.
 
 36 
 
 We have reason to congratulate ourselves, Gentlemen, 
 that we do live in a country and in times so favourable to 
 the exercise of virtue. Let it be your constant ambition, 
 then, to be esteemed and distinguished when esteem and 
 distinction are not conferred even upon intellectual great- 
 ness, except when combined with, and elevated by, some 
 approach towards moral excellence ; when not the mere 
 possession of talent is a title to admiration, but that just 
 employment of it, which, whilst it is truly useful to your 
 fellow-creatures, and satisfactory to yourselves, can alone 
 be pleasing to the Great and Good Being by whom so 
 glorious a gift was imparted. 
 
 THE END. 
 
 Printed by RICHARD TATLOR, 
 Red Lion Court, Fleet Street.
 
 n 
 
 University of California 
 
 SOUTHERN REGIONAL LIBRARY FACILITY 
 
 405 Hilgard Avenue, Los Angeles, CA 90024-1388 
 
 Return this material to the library 
 
 1991 
 
 RECEIVED 
 
 SUIBRARY-0/r 
 ' 
 
 
 s
 
 HERN REGIONAL LIBRARY FACILITY 
 
 A 000 096 794 3