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Pilgrimage, or, The sunshine and shadows of the physician / by Wm. Lane Lowder. Lowder, William Lane. 400dpi TIFF G4 page images University of Kentucky, Electronic Information Access & Management Center Lexington, Kentucky 2002 b92-45-26783847 Electronic reproduction. 2002. (Beyond the shelf, serving historic Kentuckiana through virtual access (IMLS LG-03-02-0012-02) ; These pages may be freely searched and displayed. Permission must be received for subsequent distribution in print or electronically. Pilgrimage, or, The sunshine and shadows of the physician / by Wm. Lane Lowder. Lowder, William Lane. R.H. Carothers, Louisville, Ky. :  vi, 190 p. : port. ; 16 cm. Coleman Microfilm. Atlanta, Ga. : SOLINET, 1992. 1 microfilm reel ; 35 mm. (SOLINET/ASERL Cooperative Microfilming Project (NEH PS-20317) ; SOL MN02107.02 KUK) Printing Master B92-45. IMLS This electronic text file was created by Optical Character Recognition (OCR). No corrections have been made to the OCR-ed text and no editing has been done to the content of the original document. Encoding has been done through an automated process using the recommendations for Level 1 of the TEI in Libraries Guidelines. Digital page images are linked to the text file. A PILGRIMAGE: OR THE SUNSHINE AND SHADOWS OF THE PHYSICIAN. BY WM. LANE LOWDER, B. S., M. D. TYPOGRAPHY AND PRESSWORK By R. H. CAROTHNRM., LOUISVILLK, KY. COPYRIGHTED, 1897, BY WM. LANE LOWDER. To THE STUDENTS AND PRACTITIONERS OF MEDICINE AND SURGERY. THIS VOLUME Is AFFECTIONATELY INSCRIBED. iv. V PR E FACE. The days of long prefaces are past; and it is also too near the close of the century to indulge in fulsome dedi- cations. I shall, therefore, only trouble the reader with a brief synopsis of that which I have attempted to say. This little volume is the outgrowth of a series of essays, or papers, read at different times before the following Medical Societies: Casey Co., Ky., Medical Society; Lincoln Co , Ky., Medical Society; Tri-Gounty, Ky., Medical Society; Russell Springs, Ky., Medical Society, and at the request of a number of the members, these papers have been collected, arranged and printed; and as a result the following pages are presented. The writer does not claim that this work is free from errors. It was not written beneath the still and quiet shadows of the University, nor in the cool and dusky silence of the College Chamber; but amid the active duties of a pro- fessional life. Many of its pages were written during the dark and silent hours of the night-hours stolen from sleep-hours usually allotted to the repose of body and mind. Consequently it is not offered as a classic to medical literature; and to avoid the poisoned darts of the critic, has not been the aim. The reader is requested, however, to observe that though the plan of this work is entirely that of the writer, he does not put it forth as altogether original in every respect, either in language or thought; but some- times worked up in his own language, and sometimes in that of others. Or in the language of M. Rollin, the Historian: "To adorn and enrich my own," says that celebrated writer, II I will be so ingenuous as to confess that I do not scruple, nor hesitate, to rifle wherever I come; and that I often do not cite the authors from whom I transcribe, because of the liberty I take to make some slight alterations " The wisdom of the present is but the accumulated knowledge of the past-a public treasure- wherein every man hath a share " In the preparation of this work, it has not been the object of the writer, to attempt to paint the lily or adorn the rose, or as Lowell says: " Plastering our swallowv-nests on the awful Past, And twittering around the work of larger men As we had builded, what we but deface." But to present the stern realities as they have appeared to him, has been the chief endeavor Should a perusal of its pages in any way inspire the "youth," sustain the "InIanhood," or console the "I aged " of the profession, this endeavor will not have been in vain. WM. LANE LOWDER. HUMPHREY, KY., Sept. 6th, 1897. Vi. PREFA E . A PILGRIMAGE: OR THE SUNSHINE AND SHADOWS OF THE PHYSICIAN. CONTE NTS. CHAPTER CHAPTER P I.-Introduction. 11.-Qualifications of the Physician. SECTION 1.-Mental ..... SECTION 11.-Moral ...... SECTION 111.-Literary. . SECTION IV.-Professional .... CHAPTER 111.-Duties of the Physician. SECTION 1.-To the Public SECTION 11.-To the Profession . SECTION 111.-To Himself . . . CHAPTER IV.-Influence of the Physician. SECTION I........ SECTION 11. ....... AGE. 3 13 22 37 47 60 68 77 .. 87 . .101 CHAPTER V.-Professional Friendship ... . . 116 CHAPTER VI.-Medical Ethics ........ . 127 CHAPTER VII.-Medical Societies .139 CHAPTER VIII.-Pilgrimage of the Physician. SECTION 1.-Youth . . . . . 152 SECTION 11.-Manhood .. . .165 SECTION 111.-Old Age. .. . . .178 CHAPTER I. INTRODUCTORY. The career of the Physician begins with his determination to study medicine and terminates with his death; or, as is so beautifully portrayed by the immortal Gray, in that matchless poem-"The Rude Forefathers of the Hamlet," when, " The breezy call of incense-breathing Morn, The swallows twittering from the straw-built shed, The cock's shrill clarion, or the echoing horn, No more shall rouse them from their lowly bed.". Then it is and not till then, that his labors cease and his trials are all ended. The morning of this life should be com- menced with aseptic hands and a ster- ilized heart, that the ambition to realize the ideal in a profession, " honored in all ages by all men" will not be infected by skep- ticism or greed. To do this he must cul- tivate agreeable relations with physicians whose precept will be a lesson, and whose life anl example, to inspire hinw i'th.a 1oft) 4 SUNSHINE AND SHADOWS conception and clear appreciation of the duties and responsibilities of a trust sub- mitted to his care, and sacred above all things else-a human life. In selecting for his life-work the profession of medicine the question of success will naturally be uppermost in the mind of the Physician. This, while largely affected by natural ap- titude, is like success in any other field of labor, more largely determined by the genius of hard work and the patience that has " learned to labor and to wait." If in statesmanship eternal vigilance is the price of liberty, in medicine eternal toil is the price of success. Great natural abilities, quickness of apprehension, a re- tentive memory, the logic that correlates and systematizes, powers of invention that create new wholes out of seemingly incon- gruous particles, equip one for the race in our profession and would appear to make success assured. Yet, he who is gifted with a German preseverance often wrenches from nature her secrets and is seen climb- ing far up the heights, whilst genius sleeps below. There are many things that enter into the toud ensemble of the physician's life OF THE PHYSICIAN. and career which may make or mar, though not so perceptibly as his scientific attainments and technical knowledge or the lack of what is necessary in respect to these. Life has been called a pilgrimage, and perhaps no term could be selected more expressive of its uncertainty, dangers and hopes. It is indeed a voyage through a region of varied aspects, beneath a check- ered sky of cloud and sunshine. Man is in- deed a pilgrim-one of a goodly company, as diverse in character and feeling as in language and complexion. Yet all unite in one common object, all pressing for- ward to one common goal-the ocean of eternity. As the strings of an instrument responding to the same touch but each vibrating with its own peculiar tone, pro- duce one harmonious melody, so all hearts respond to the touch of the same Divine Master, each with its own peculiar meas- ure, yet all uniting to perfect the great work for which they were created-the glory of the Creator. The life of the phy- sician is indeed a pilgrimage joyous to some, yet wearisome at times to all. 5 SUNSHINE AND SHADOWS "Yea, hope and despondency, pleasure and pain, We mingle together in sunshine and rain," in all its stages, youth, manhood and old age, changing and uncertain. Yet, on this journey, however dreary to each one, however desponding, there appear green spots as welcome as are the oases of the desert to the panting caravan where the sparkling waters and cool herbage invite to refreshment and repose. Here the weary spirit loves to linger and renew its vigor for the journey onward. Here, like the good old Patriarch, we erect a pillar of rememberance in token that God hath dealt kindly with us. Work and worry are ours from the time we begin the study of medicine until the winter of life has dusted our temples with the snowflakes of time. " So closely our whims on our miseries tread, That the laugh is awak'd ere the tear can be dried; And as fast as the rain-drop of Pity is shed, The goose-plumage of Folly can turn it aside." Yet the clouds that are seen as we hasten through a fruitful experience have many a brilliant lining, and the shield that may 6 OF THE PHYSICIAN. at times obstruct our vision has both a silver and a golden side. " But pledge me the cup-if existence would cloy, With hearts ever happy and heads ever wise, Be ours the light Grief that is sister to Joy, And the short brilliant Folly that flashes and dies." Life's pleasures and joys will blend themselves in a very large measure with its griefs and sorrows, and the eagles of victory will perch upon our banners more often than the vultures of defeat. On the long and lonesome ride, "when twilight dews are falling" and the "even- ing shades appear" as a token " of 'parting day," when houses by the wayside are dark and silent, " and all the air a solemn stillness holds," where the gloom and soli- tude of the forest are deepened by the shadows; along roads that wind by fields of waving grain, from which the ripening odor has filled the air with all its frag- rance; along dusty highways beneath the scorching rays of a torrid sun, when the din of the harvester is heard in the dis- tance and the carol of the lark recalls to the memory happier days gone by; amid falling snowflakes, that flutter down in 7 SUNSHINE AND SHADOWS soundless benediction on the dust beneath, when the earth is clothed in nature's wind- ing sheet, and the universal chill of the arctic clime penetrates the heart with a feeling of desolation, the ability to gener- alize from observation and experience, or to awaken the intellect with conceptions from the masters in literature, will keep the mind strong and the body erect. On many a dreary night and prolonged after- noon the paucity of country thought and the poverty of rustic knowledge will fill you with the enneui of solitude, and the gloomy reflection of thankless labor will mark you with the ingratitude of humanity. " The gay will laugh When thou art gone; the solemn brood of care Plod on, and each one, as before, will chase His favorite phantom: yet all these shall leave Their mirth and their employment, and shall come, And make their'bed with thee." Bleak and barren may be the prospect around us; the wood, the oak, the aspen and the willow may be leafless; and not a thrush may have as yet essayed to clear the furrowed brow of winter; but this we know shall pass away, give place, and be 8 OF THE PHYSICIAN. succeeded by the buds of spring and the blossoms of summer. Chill and cheerless may be the hope around us; but soon the wild flowers of joy and sunshine will spring, as it were, beneath our boyish tread; they will open in advancement, expand in ma- turity, and illumine our pathway with the richness of luxuriance. Poverty and dis- appointment will appear, at times, to hang frowning around us, and its apparition haunt our footsteps; but soothed and charmed by the fitful visits of the happy reflection of self-sacrificing deeds done for the good of suffering humanity, and crowned,as in a vision,with the holywreath, we will wanton in a fairy land and view the Elysian fields of Paradise. But the clouds of imagination are gath- ering, and the picture will soon be dark; but never, while memory lasts, can it fade out of the heart. What blessings would be ours, if only we could hold forever that exaltation of the spirit, that sweet resigned serenity, that pure freedom from all the passions of nature and all the cares of life which come upon. us amid such scenes and 10 SUNSHINE AND SHADOWS surroundings as these! "Alas, and again, alas." Even with the thought this golden mood begins to melt away; even with the thought comes our dismissal from its in- fluence. Nor will it avail us anything now to linger at the shrine. Fortunate is he, though in bereavment and regret, who parts from duty while yet her kiss is warm upon his lips-waiting not for the last farewell word, hearing not the last notes of the music, seeing not the last gleams of sunset as the light dies upon the sky. The labors and the discoveries of the physician have been the world's astonishment and delight. Men of talents and of taste, the most refined, have praised and hon- ored them; the lofty Prince in his gilded palace, and the lonely peasant in his squalid hovel have ever been grateful to them, and sang hyms of praise, in token of their appreciation, respect and admira- tion. The physician of the afflicted (rich or lowly) is the physician of MANKIND. He has had its confidences, he has known its weaknesses and its follies, its faults and its infirmities, and through all has been OF THE PHYSICIAN. the soul of honor. No trust betrayed, no confidence wronged nor duty violated. It is no wonder that men and women (and children, best judges of us all) do him homage, and in their hearts regard him with an abiding and loving tenderness, that years cannot deaden nor time destroy " To live in hearts we leave behind, Is not to die." The Physician, who for long years has visited suffering humanity amid storm and sleet, through sunshine and rain, who has stood at the bedside when the cry of the new-born broke the silence of the darkened chamber, who has cheered the lonely sufferer by his presence in the dark hour of sickness and gloom, who has stood by loved ones, when human skill availed not and death came, is the man of all men, to whom the human heart goes out in friendship close akin to love. The term LOVE is a strong one, and I thus choose it purposely, and with the intent to use it in all its strength. Though the ideal physi- cian fall, at home, among kindred and friends, or may wander for away from his 11 12 SUNSHINE AND SHADOWS natal spot, and far distant may be the scenes of his early labors, and a foreign soil "piously covers his remains within her bosom," mankind will always feel a deep and abiding thankfulness, that he lived and wrought, where he did, and as he did. "Oh, blest who in the battle dies, God will enshrine him in the skies." No lofty monument nor stately column may tower above his sacred ashes to im- plore " the passing tribute of a sigh," yet his silence speaks in solemn tones of a heritage left to posterity, which will be fondly cherished, long after polished stones have crumbled into their primitive dust. There will be no need of " storied urn or animated bust," his life-work will be his enduring monument, and his humane dis- coveries will be his immortal epitaph. " There scatter'd oft, the earliest of the year, By hands unseen, are showers of violets found; The redbreast loves to build and warble there, And little footsteps lightly print the ground." OF THE PHYSICIAN. CHAPTER II. QUALIFICATIONS OF THE PHYSICIAN-MENTAL, MORAL, LITERARY AND PROFESSIONAL. SECTION I. MENTAL QUALIFICATIONS. "Our brains are seventy-year clocks. The Angel of Life winds them up once for all, then closes the case, and gives the key into the hand of the Angel of the Resurrection. Tic-tac! tic-tac! go the wheels of thought; our will cannot stop them; they cannot stop themselves; sleep cannot stop them; madness only makes theni go laster; death alone can break into the case, and, seizing the ever- swinging pendulum, which we call the heart, silence at last the clicking of the terrible escapement we have carried so long beneath our wrinkled fore- heads."-OLIVER WENDELL HOLMES. One who presumes to practice medicine should possess the wisdom of Solomon, the patience of Job, the eloquence of David, the devotion of Ruth, and the faith of Elijah. A glance at any medical society- a little reflection upon the physicians of 13 14 SUNSHINE AND SHADOWS our own acquaintance, some honest self- communion as to our own motives and ability, are more than sufficient to convince the most sanguine that individuals em- bodying all the above-mentioned virtues are extremely rare. However widely writers upon mental science may differ in regard to the nature of the mind, all agree that the energy and the effectiveness of all our mental proces- ses are largely dependent upon the char- acter and condition of the brain. The brain is the physical organ of the mind. Scientists teach that every thought, feel- ing, or act of will is accompanied by a cer- tain expenditure of nervous energy, and a consequent destruction of a certain amount of brain tissue. As muscular action is performed at the expense of muscular tis- sue, so mental action is performed at the expense of brain tissue. The rapid de- struction of brain substance may be in- ferred from the enormous quantity of blood which flows to the brain to supply material to repair it. This organ, which weighs an average of 491 ounces in men and 44 ounces in women OF THE PHYSICIAN. -or about one-fiftieth as much as the en- tire body-receives one-fifth of the blood of the entire body. This fact indicates the dependence of healthy arnd vigorous brain activity upon the quantity and nutritive quality of the blood supplied to the brain. It is only when the entire body is in vigorous health that there can be the most effective action of the mind. The brain sympathizes with every other organ and is strong or weak as they are. This is true when brain action is normal. There is an abnormal condi- tion often experienced in certain states of disease in which there is an unnatural ac- tivity of brain, even when there is great weakness of the other organs. Also by an undue exercise of the brain, which is long continued, it comes to appropriate more than its share of the blood, and the other organs are thereby weakened to give strength to the brain. But these event- ually react upon the brain and a diminu- tion of its powers results. It is, therefore, when the body is in perfect health that there can be the most healthful and vigor- ous action of the mind. The old maxim, 15 16 SUNSHINE AND SHADOWS "A sound mind in a sound body," is all acknowledgment of the truth of this. Consequently, the physician who would be active and strong mentally must be heal- thy and strong physically. To be thus requires a strict observance of the rules and laws of hygiene on his part. The size and quality of the brain are not the same in all individuals. Mental power is de- pendent upon the size and quality of the organ which it employs to manifest itself, as well as upon the condition of the brain in respect to nutriment and vigor. The healthful or diseased condition of the body will determine theamountof energywhich the mind can put forth and the length of time it can sustain it; for the poet says " 'Mid pleasure or pain, in weal or in woe, 'Tis a law of our being, we reap as we sow." The brain must be fresh if the mind shall act vigorously. A tired brain will serve only for feeble thinking. How shall we rest the brain The only perfect rest is untroubled sleep. There are, however, changes of exercise that afford partial rest. Prof. Bain, of the University of OF THE PHYSICIAN. Aberdeen, Scotland, says that memorizing is an exercise which makes the greatest demands upon the nervous energies; that the use of ideas in the making of new com- binations,-in new constructions,-de- mands a less degree of brain vigor, and that writing, drawing, anyd searching ref- erence books for information, and noting what is found, make the least demands upon the nervous power. Partial rest is experienced by changing from one subject of study to another, provided the point of fatigue has not been reached. After this point has been passed, all labor is in- jurious. A vivid imagination i; a mental qual- ity that the physician should possess. It gives him influence and impresses person- ality, which are essential to his success. Personal magnetism has for its chief in- tellectual attribute a vivid imagination. Dr. Wayland says: " Imagination is that faculty by which, from materials already existing in the mind, we form complicated conceptions or mental images according to our own will." B 17 18 SUNSHINE AND SHADOWS The action of the mind in gaining knowl- edge differs much from its action when communicating. It is imagination which gives the power thus to go to the stand- point of another and work from his base. Says Bain in "Education as a Science:" " If the early training could be so directed as to enrich and invigorate the conceptive faculty [his term for imagination] a time would come when definite knowledge could be absorbed so rapidly as to dispense with the attempts to impart it prematurely." It is the imagination that gives spring and vivacity to the mind. Talmage is a mas- ter of imaginative speech. It is this, rather than his grotesque extravagance, which reaches the popular heart. When Bismarck said, " The cause of Germany is to be won by blood and iron, and not by parli- amentary speeches," it was by the heat of imagination that these thunderbolts of words were forged. The secret of eternal vouth lies in keep- ing the imagination fresh and active. " They are the lovely, they in whom unite Youth's fleeting charms with Virtue's lovely light." OF THE PHYSICIAN. The conception of the physician should be kept clear, strong, alert and active. And in no way can we do this but by ex- ercising it upon the imaginative products of others, or in creations of our own. Sir Joshua Reynolds says in one of his dis- courses: " It is by being conversant with the inventions of others that we learn to think. " The enquirer after new truth stands on the boundary of the known and peers into the unknown. His senses are alert, his memory retentive, his reason strong to prove the truth or falsity of every propo- sition presented; but if no propositions are presented his reason has nothing to operate upon. Imagination is the great asker of questions for the other powers to answer. It is not easy to learn to think; nor is it easy to think after learning how. The big-brained Carlyle says: "True effort, in fact, as of a captive struggling to free him- self: that is thought." We should teach by example as well as by precept. Pre- cepts are sometimes as worthless as a bank- rupt's unindorsed promise to pay; for, as 19 20 SUNSHINE AND SHADOWS Spurgeon, the great English divine truly says: "When you see a man with a great deal of religion displayed in his shop-window, you may depend upon it, he keeps a very small stock of it within." We, as physici- ans, should teach truth by adhering to it with the severest strictness. We should teach neatness by carefulness as regards our own person, work and surroundings. We should teach patience and amiability by keeping an unruffled front in the face of trying ordeals. The reflection forces itself in upon me that one who succeeds in all these hard tasks would be rather more of a saint than a " nineteenth-century- doctor," but it is a possible thing to be both, and we know the doctrine of a large and worthy body of people in regard to the perseverance of the saints. Permit me to say in this connection that it is a mistake for a man to be persuaded that it is not possible to mantain a Christian character in secular life. Paul made tents for his bread, but never failed to shine as a Christian; Newton mapped the stars to keep up his holy life; Wilberforce, in the heat and struggle and strife of public life, OF THE PHYSICIAN. always kept his flag floating as a child of God; and the Grand Old Man-Gladstone -never appears to finer advantage than when he reads the Sunday lesson in the little church at Hawarden. A good man is a glad man, and there are more doors open to such than to any other. It seemed to me a great sacrilege when I read that the largest steamship that was ever built-the "Great Eastern"-had to come down to be used as a common coaler on the sea; or for a splendid mill with its wonderful machinery, made for the finest work, the weaving of silks and satins, to be choked with shoddy and greasy rags, would be putting it to less-than its proper use. The human body is the greatest machine that was ever created, and it should not be divorced from the purpose of its crea- tion or debased to the meanest uses: "A sacred burden is this life ye bear; Look upon it, lift it, bear it solemnly; Stand up and work beneath it steadfastly; Falter not for sorrow, fail not for sin, But onward and upward till the goal you win." 21 SUNSHINE AND SHADOWS SECTION II. MORAL QUALIFICATIONS. "So live that when thy summons comes to join The innumerable caravan that moves To the pale realms of shade, where each shall take His chamber in the silent halls of death, Thou go not, like the quary-slave at night, Scourged to his dungeon; but sustained and soothed By an unfaltering trust, approach thy grave Like one who wraps the drapery of his couch About him, and lies down to pleasant dreams." -WM. CULLEN BRYANT. Horace (Quintus), the Latin poet, de- scribes the physician in the twenty-second ode: "Integer vitae scelerisque purus." It declares that his morals must be fit, brains educated, motives beyond question, and his common sense apparent from the moment the bedside is reached; and, so- ciety having found these qualifications rewards him in two ways. As a first re- ward, it permits him from his own medi- cal income, to live well and die poor; but his second reward is quite a different com- pensation, sui generis. It cannot be esti- mated by any unit of commercial value. It is a reward of faith and belief, and when it is bestowed, it carries with it the seal of the divine commission, " Heal the sick, 22 OF THE PHYSICIAN. cleanse the lepers, raise the dead, cast out devils. Freely ye have received, freely give." The code of Ethics of the American Med- ical Association, Article I. Section 3, says: "There is no profession from the members of which greater purity of character and a higher standard of moral excellence are required than the medical, and to obtain such eminence is a duty every physician owes alike to his profession and to his patients. It is due to the latter, as with- out it he cannot command their respect and confidence, and to both because no scientific attainments can compensate for the want of correct moral principles. It is also incumbent upon the faculty to be temperate in all things, for the practice of physic requires the unremitting exer- cise of a clear and vigorous understand- ing; and on emergencies, for which no professional man should be unprepared, a steady hand, and an acute eye, an uncloud- ed head, may be essential to the well-being and even to the life of a fellow creature." The physician is the man, into whose care society intrusts the most valuable 23 24 SUNSHINE AND SHADOWS possession in existence-the lives of its individual members. There is nothing more beyond this. He is their custodian, the court of last human appeal. How essential it is, then, that we should ever be thoroughly pre- pared to discharge our professional duties. When the physician has done, the end has come; for "The leaves of the oak and the willow shall fade, Be scattered around, and together be laid; And theyoung and the old, aid thelow and the high Shall moulder to dust and together shall lie. " The hand of the king that the sceptre bath borne; The brow of the priest that the mitre hath worn; The eye of the sage and the heart of the brave, Are hidden and lost in the depth of the grave." It is no wonder, then, that as guardian of its highest interest, society declares be- forehand that the physician shall be only of the best. Dr. Holmes once said, in an after-dinner speech: " The medical pro- fession is so pure, that its writers of fic- tion are compelled to go outside its limits to get material for the villians of their stories." and this is but a reflection of the real truth, for only recently some uneasy genius who sought to fasten criminal pro- OF THE PHYSICIAN. pensity on the medical profession, could only find seven hundred who had suffered stautory penalty, among all the physici- ans who have practiced in the United States and Canada during the political history of these two countries. The physician should possess the " four cardinal virtues," viz.: Temperance, Pru- dence, Fortitude and Justice. Only the man who is strong in the strength of a lofty integrity and exalted honor is fitted for a profession demanding such high qualities and imposing such grave responsibilities as does that of medicine. The physician comes into the closest and most sacred re- lations of life. He sees men and women in their -hours of weakness, sees them when judgment and will are overthrown by dis- ease, sees them when the intellect is so shattered and enfeebled by disease that its mastery is lost and ignoble passions rule unchecked and unrestrained, and there is, therefore, an imperious necessity that he should be a man of sterling integ- rity and stainless purity, "chaste as un- sunned snow." The most delicate honor, the chastity of which is such that it feels 25 SUNSHINE AND SHADOWS " a stain like a wound" is as necessary to the true physician as sunshine to the flow- ers of the field. The physician's confessional is not always one where secrets are wittingly re- vealed, but is often one where the de- throned intellect or the disordered mind makes men and women reveal that which else no mortal ear had ever heard. Things are heard by him which the speaker would not have voluntarily given utterance to, though death were the penalty of silence. But not only does the physician hear what in health would have remained unspoken, for from many lips he hears voluntarily revealed secrets that the world should never know. He hears of infirmities that, if known, would bring his patient to infamy and shame, he hears that which, if re- vealed, would destroy the peace of families and wreck many lives. He holds the same power over his helpless patient as does the butcher over his innocent victim- " The lamb thy riot dooms to bleed to-day, Had he thy reason would he skip and play I Pleased to the last, he crops the flow'ry food, And licks the hand just raised to shed his blood." 26 OF THE PHYSICIAN. He holds often and often a greater power than that of death itself, for in his hands is the power to consign his patient to a fate a thousand fold worse than physical death. The physician in whose mind dwell coarse thoughts, not only dishonors a noble profession and shames the tradi- tiohs and history of a glorious past, but he also puts snares about his own feet, which sooner or later will be the means of casting him headlong " into a pit of de- struction." " 0, what a tangled web we wveave When first we practice to deceive." The life of a physician who is true to the ethical laws of his profession and to its traditions is a benediction, and he who lives it crowns himself and those to whom he ministers with unfading blessings. " He that has light within his own clear breast, May sit in the centre, and enjoy bright day; But he that hides a dark soul and foul thoughts, Benighted walks under the mid-day sun." The ethical principles woven into the mental and moral organization of men are like threads of gold woven into gross fab- 27 SUNSHINE AND SHADOWS ric, they remain bright and untarnished throughout all the years, while the base parts grow dark and moldy in decay. Men whose thoughts and actions are influenced by sound ethical principles are men whose virtues every one may see. The true phy- sician has little patience with those who talk slightingly of medical ethics. He be- lieves in them. He believes them sound in theory and beneficent in results. The more the physician knows of medi- cal ethics and the more closely he adheres to them, the better he will be fitted for the higher duties of his profession. A man who knows nothing of the ethics of the profession, or knowing them, gives them no heed, ought to be driven from the world of practical medicine, for he is unworthy of a place in it. The physician, of all the learned men in the professions of secular life, needs something to give strength and vigor to the better part of his nature, for his studies and his experiences incline him to gross materialism, and his opportuni- ties and duties subject him to peculiar temptations. Itwas said of old; "Where there are three physicians there are two 28 OF THE PHYSICIAN. atheists." If this is not the substance of truth, it is at least the shadow of truth. Some potent and ever present influence is, therefore, needed to overcome this ten- dency to materialism, and to arm the physician with strength to resist tempta- tion. This influence is in no small meas- ure supplied by the system of ethics con- structed by the physicians of this country, for that system declares principles of the soundest morality and purest honor. Ido not say that adherence to that system is all that is required-not that, by any means-but I do say, that it is a powerful and beneficent factor in the foundation of a physician's character. From the time when the first of woman born required assistance in the extraction of a thorn from the foot, even until now, the aid of the physician has been required by the unfortunate. So firmly was this necessity and the beneficence of succor impressed on the popular mind that it early became a prevalent belief that so great a boon must come direct from heaven. And to give expression to the obligation, divine honors have been paid 29 SUNSHINE AND SHADOWS to medical men. Does the proud skeptic reply, this is false " Of all the vices that conspire to blind Man's erring judgment, and misguide his mind, What the weak head with strongest bias rules, Is pride, the never-failing vice of fools." The diversity of opinions held by medi- cal men, and the opposing sects everywhere found, establish the objection that med- icine is uncertain and beneath the dignity of a science, and unworthy the confidence of an enlightened civilization. You will hear cavils like these. But the physician who has entered upon a life-long pursuit, should entertain the fullest faith in the utility and dignity of medicine. By such assurance only will he be inspired to pur- sue it with elevated devotion and persever- in-g efficiency. Therefore a suggestion upon this point is proper in this article at this place. The physician claims for medicine of to-day a recognition among the sciences, of utility equal to any. The objection to medicine based upon the diversity of opinions held by physicians upon medical subjects, may be briefly answered by comparison, which 30 OF THE PHYSICIAN. is not intended to be odious. Lass is said to be the perfection of human reason. Its axioms are written-its evidence duly and deliberatively weighed. Yet, in practice in the highest court in the land, in the most important issue that could come before it, the judges will be so equally divided in opinion, that four will differ from five, and so it is liable to be, all the way down to the lowest tribunal. And when a special commission is appointed to adjudicate upon a vital question to the State, by the highest authority, consisting of fifteen of the most eminent and disinterested men in the nation, seven will differ from eight. It still remains for publicists to give us a system of political economy which will be approved by the nations. In Divinity we might expect to have an illustration of har- mony and unanimity, especially when we recall the fact, that the doctrines are all drawn from, and are based upon the same authority. And furthermore, that this authority is described as being so plain, that he who runs may read, and the way- faring man need not err therein. What is the fact Sects innumerable exist, adher- 31 SUNSHINE AND SHADOWS ing with the greatest tenacity to tenets as opposite as Zenith from Nadir. The poet, Moore, in allusion to sects and differences, expresses himself as follows: "Come, send round the wine, and leave points of belief To simpleton sages, and reasoning fools; This moment's a flower too fair and brief, To be withered and stain'd by the dust of the schools. Your glass may be purple and mine may be blue, But, while they are filled from the same bright bowl, The fool who would quarrel for difference of hue, Deserves not the comfort they ,hed o'er the soul." Many other illustrations of diversity of opinion among men upon various subjects might be introduced, but I deem it unneces- sary. Granted, then, that diversity of opinion does exist upon medical subjects, medicine is therefore not peculiar. Medi- cine unworthy the present civilization! On the contrary, the obligations to medicine for benefits conferred, are greater than can be liquidated. Society and civilization will ever remain debtors to medicine. It ban- ishes pain. It shortens the duration of disease. Medicine has demonstrated the 32 OF THE PHYSICIAN. invisible causes of many diseases. It has made it possible to elude their effects. It has added innumerable comforts to daily life. It has prolonged the duration of human life at least one-third. The infant of today has a better expec- tation of life than ever before. Medicine is foremost in useful discoveries. It util- izes inventions. Hygiea is one of its dei- ties. It is perfecting sanitary science. It exacts tribute from every department of knowledge. Every branch of science con- tributes to practical medicine. Hence there is a propriety in asserting that the foundation of medicine is as broad as human experience. The physician should exemplify the type of the ideal. He should be raised above the petty jealousies and out of the narrow groove of the sects. The vast domain of nature is his field. All in this territority that is excellent, all that is useful, is his. It will not be difficult to justify this high claim for medicine. We might appeal to the experiences of the past in support of our position. More than one lesson may be learned from even a C 33 SUNSHINE AND SHADOWS brief retrospect. Confining our attention to the progress of medicine, we are war- ranted in drawing the following conclu- sions: 1. That sects have existed from the ear- liest times. 2. That the tenets of the sects have been characterized by partial views. 3. That partial views are always defec- tive. 4. That defective knowledge leads to error. 5. That sects are the legitimate product of error. 6. Hence sects ever have been, and always will be transitory. Bryant says: " Truth crushed to earth will rise again; The eternal years of God are hers; But error, wounded, writhes with pain, And dies among her worshipers." It does not militate against this position to reply that sects have appeared, and ex- ercised an influence continuously for years -for fifty years, it may be-or for a cen- tury. What is a century In the grand aggregate of the cycles, it is a mere point 34 OF THE PHYSICIAN. of time. It is as the passing cloud. When the cloud is dissipated, no vacuum remains. When the sect disappears, no item of use- ful knowledge is lost. The present age is too intensely practical to long foster that which is useless for its purposes-a fact which we commend to all chronic grum- blers. It "will not willingly let die" that which has a potency of life in it to accomplish, even in imperfect fashion, what is necessary to be accomplished, and what without this life would not be done. Success is the evidence of want. No man, or set of men, can build up a system or thing permanently, unless it is needed. "Ill weeds grow apace,"but they are speed- ily cut down. The shallow idea is that cunning is better than sagacity, that tact rises above talent, and genius succumbs to gumption. Accidental and temporary successes are mistaken for the rule, and a Mythical For- thne or Luek is pictured blindfold on a wheel. But neither the "Macrocosm " nor the "Microeosm " are the creatures of chance, or in anywise of the "fortuitous concurrence of atoms. " 35 36 SUNSHINE AND SHADOWS "For I doubt not through the ages one increasing ing Purpose runs, And the thoughts of men are widened with the pro- cess of the suns." To him that hath shall be given-hath ca- pacity and the will and the pou sto of Arch- imedes, it shall be given to move a part of the world at least; and he or they who have none of these things fail, however grievous their lamentations. The social law is as inexorable as that of gravitation; moving bodies produce the greatest changes, and the largest ones have the greatest at- tractive force. The counsel given by Longfellow in "A Psalm of Life" should be deeply im- presssed upon the mind, and indelibly en- graven upon the heart of the physician who would succeed in life's combat. " In the world's broad field of battle, In the bivouac of life, Be not like dumb, driven cattle! Be a hero in the strife! Trust no future, howe'er pleasant, Let the dead Past bury its dead, Act-act in the living Present, Heart within, and God o'erhead." -H. W. LONGFELLOW. OF THE PHYSICIAN. SECTION III. LITERARY QUALIFICATIONS. "Know something about everything and every- thing about something."--LoRD BROUGIIA M. Our Poet Physician once said: " The medical profession is the least learned of the professions, in this country at least. They have not the culture of the lawyers nor of the ministers, but they are more sensible." Dr. Holmes was a happy ex- ample of the combination of learning and common sense; for his stock of good sense was great and unfailing, and his learning wide and deep. There is, indeed, no con- ceivable reason why a learned man may not be a sensible one. On the contrary, there is every reason for affirming that the more of learning a man has the more sen- sible a man he is, provided always that the foundation of common sense is strong enough and broad enough to sustain the superstructure of learning. Book knowl- edge cannot, it is true, supply the place of that facultywe call common sense; but learning may widen and strengthen that faculty, and no man, however strong or vigorous his common sense, is qualified to 37 38 SUNSHINE AND SHADOWS enter the noble profession of medicine un- less his natural sense is enlightened by learning and his faculties disciplined by study. It matters not how much of com- mon sense a man may possess, there will always be some part of his mind in the shadow of ignorance unless the sunshine of learning is let in with such power as to dispel the dark shadows. Ignorance is the dominion of absurdity and the abode of superstition, unless disciplined common sense is strong enough to conquer absurd- ities or remove superstitions. The physicians of the middle ages were men of vigorous common sense, but never- theless, they were the most superstitious of mortals. The physician should by all means be an educated man. He should possess a good literary education. As a student, he should never be encouraged nor permitted to begin the study of medi- cine, without having first acquired good literary attainments. The imperious ne- cessity for this requirement is apparent to all. It has every argument in its favor, and none against it. All the leading medi- cal schools of this great country of ours OF THE PHYSICIAN. have discerned this prerequisite to be an absolute and indispensable qualification, before allowing their students to matricu- late upon their rolls. In consequence there- of, they require of the candidate prior to his admission within their walls, a degree in arts, science or letters, or in lieu of this he must pass an examination, the stand- ard of which shall equal that indicated by the bachelor's degree in arts, science or letters. "Better far pursue a frivolous trade by serious means, Than a sublime art frivolously." There was a period in the early history of this country, when such an exaction as this, from the prospective medical student would have appeared impractical and un- warranted; but "Tempora mnutantur, et vos mutamur in illis" [The times are changed and we are changed with them.] The pub- lic at large demands and rightfully expects more than ever before, and the spirit of the age never asked as much. While this applies with peculiar force to medicine, it is equally true of all the other professions. A thorough education in the line of the profession of the physician is an absolute 39 40 SUNSHINE AND SHADOWS necessity and an indispensable aid to his success in his daily practice. It would be difficult to grasp this special training with- out preliminary scholarship. Thorough and systematic learning in the line of the profession has a great advantage. It re- veals obstacles in the path of progress, that otherwise might be run against to the harm of both patient and physician. It affords inspiration amid dfficulties by the knowledge that others have borne the heat and burden of the day, and conquered. It lifts us into a higher plane of thought, and it relieves from much of that worry, worry, worry, that is grinding the life out of so many faithful but overly-anxious physicians. However, this professional training cannot be substituted for a gen- eral education. The physician should be a student of general literature and science, as well as that of medicine; or, as Shakespeare says, in "As You Like It:" "And this our life exempt from public haunt Finds tongues in trees, books in running brooks, Sermons in stones and good in everything." It is said that the lawyer and the minis- OF THE PHYSICIAN. ter qualify themselves for their work by study in special schools, and that in like manner the doctor should be specially in- structed in his own profession. But the successful -lawyer builds his professional education on top of a regular collegiate course; so does the minister, who would keep abreast with the times. So must the physician add his professional training to a good general education, for it can by no means take its place. The science of medicine is extremely difficult to compre- hend, with all the ordinary aids of learn- ing and education; though by its posses- sion, much time and a vast amount of labor may be saved. History records instances in the lives of men, who, in spite of defective education, by their native abilities and unconquera- ble energy, raised themselves not only to prominent positions during life, but to the highest pinnacle of professional fame. As an instance of this kind, there was John Hunter, the great English anatomist and surgeon. He was great because he could not help it, and without the ordinary aids of learning and education; but let not 41 SUNSHINE AND SHADOWS any who may chance to read this, foolishly conclude that they can dispense with them because he did. You are not Hunters, (only one of a kind of that class of men ever lived) and even he suffered much from his deficiencies in these respects. He had the mortification and useless toil of discovering many things that had been found out long before, only he did not know it, and his works are often so obscure and ill-written, that it is extremely diffi- cult to ascertain his real meaning. In looking over the history of medicine we find that every new truth and fact dis- covered was the natural result of some other truth or fact discovered before- oftentimes amid darkness and obscurity, toil and privation,- " Not a truth has to art or science been given, But brows have ached for it, and souls toiled and striven. "-LYTTON. Every advance in medicine has thrown additional burdens and responsibilities on the medical practitioner. The medical man of a half century ago was not called upon to make the careful and refined diag- nosis which modern science renders possi- 42 OF THE PHYSICIAN. ble, and which modern medicine demands. Then no thermometer, no ophthalmoscope, laryngoscope, stethoscope, microscope, sphygmograph or X-rays apparatus, de- manded his consideration. Yet now with all these the modern doctor has to work. In order to make a diagnosis he must spend more time with his patients than formerly, much more time in preparation than be- fore. The physician who would attain emin- ence among men, and distinction in his chosen profession, must of necessity have as his watchwords vigilance and activity. In these latter days it becomes more and more certain that a man must pass for what he really is. The physician of today has entered the profession at an auspicious period, at a time of great activity. The activity of this time is but the aggregate of the industry of individuals, and there- fore all who would retain a place in the onward movement, must of necessity exert their faculties to good effect, or lag behind and drop out of the line. 48 44 SUNSHINE AND SHADOWS " The heights by great men reached and kept, Were not attained by sudden flight; But they, while their companions slept, Were toiling upward in the night." Theories and opinions do not now influ- ence the thought of men, because they are venerable with antiquity. Theories, which in time passed, swayed and controlled the opinions of men for successive generations, have not infrequently, when tested in the crucible of independent experiment, crum- bled into dust. The lesson once learned in the older dispensation needed no revision. When in accord with the edict of the Master, the duty which it exacted was imitation merely. It therefore stimulated to no original thought or mental activity, but left abundant time for leisure. Venera- tion for authority like that, is a trait of the past. In our time the new must stand the test of experiment and experience. Hence the necessity of vigilance and ac- tivity. Activity is the condition of ani- mate nature. Stagnation implies death. By industry only do we live. Let none say that these actions are too severe. Do not regard the primeval decree, " In the OF THE PHYSICIAN. sweat of thy face shalt thou eat bread," as a curse. In the present state it is less a curse than a blessing. The labor of in- dustry is the source of man's highest hap- piness. " He that will not when he may, When he would, he shall have nay." The law of industry is most beneficent. It pervades all nature. It is the flowing water that remains sweet and potable. It is the atmosphere stirred by the winds that is most salubrious. It is the metal in constant use that corrodes the least. It is a great mistake to suppose that man's highest happiness consists in the enjoy- ment of listless ease. " Must I he carried to the skies, On flow'ry beds of ease; While others fought to win the prize And sailed through bloody seas" The physician who would keep abreast of the times must be a wide, general and thoughtful reader. Familiarity with the records of the past illuminates the page of current history. The daily newspaper or the monthly magazine is as necessary as daily food. The medical journals should 45 46 SUNSHINE AND SHADOWS be read, as is the secular press, after ex- perience-with a view of separating the true from the false-the oreide from the gold. There is a great amount of human nature in medical journals, and in medical books-cave canem! "Learn well to know how much need not be known, And what that knowledge which impairs your sense." There is vastly more in medical science than some believe, and possibly there is vastly less than some of its enthusiastic votaries claim. Let it ever be our aim to secure the central verity. The physician should be a constant student, and when he ceases to be a student he should cease to practice as a physician. Poetry and history should interest him; and the natural sciences should ever claim a close relationship with him. All books, whether great or small, are but attempts to translate that one great book which lies open before humanity, the star-and-flow- er-writ Book of Nature. There are many imperfect translations and poor commen- taries, and thrice happy is he who can OF THE PHYSICIAN. read the original without translation or commentaries. "And Nature, the old nurse, took The child upon her knee, Saying, ' Here is a story-book Thy Father hath written for thee.'" -LONGFELLOW'S " Tribute to Agassiz." SECTION IV. PROFESSIONAL QUALIFICATIONS. "He that attends to his interior self That has a heart, and keeps it-has a mind That hungers and supplies it, and who seeks A social, not a dissipated life, Has business," Every member of the medical profession should strive to be an exemplar-an ideal doctor, viz: robust, erect, of magnificent form, with strong countenance, and with "manhood's brow serenely high, and the fiery heart of youth "-exceedingly fair to look upon, gentle as a lady, strong as a lion, true as steel, swift as the roe, vigi- lant as the eagle, brave as Ceasar, a Ches- terfield in manners, and an Apollo in the sciences. In morals, benevolence, purity and intelligence he is the noblest work of the Creator, the highest type of man and 47 48 SUNSHINE AND SHADOWS human perfection, walking in the foot- steps of the Great Physician, of whom it is said, "Never man spake like this man." The index of a gentleman is politeness. Politeness is refinement of manners, con- nected with a desire to please others, by anticipating their wishes and wants and studiously avoiding whatever might give them pain. "Few to good breeding make a just pretence; Good breeding is the blossom of good sense; The last result of an accomplished mind, With outward grace, the body's virtue joined." From the most remote period in history we have some account of a rude system of medicine. It has always been and always will be one of the instincts of human na- ture to prevent and relieve the suffering of their fellow creatures. Even in the most barbarous states of society, there exists a rude species of medical and sur- gical practice. From some references made incidentally to some of the writings of the ancients respecting the practice of medi- cine among the Egyptian priests, it would appear that it consisted in a great measure in the employment of the magic arts, work- OF THE PHYSICIAN. ing upon the imagination, etc. In fact it was our modern Christian Science lacking both science and christianity, as it still does at the present time. These methods seem to have been the first steps in the art of medicine among the Egygtians. In the writings of Moses there are various allu- sions made to the practice of medicine among the Jews; the priests in these cases appear to have been the medical men. In the other countries of the Orient, at these remote periods, the art of medicine seemed to be even in a less advanced state than among the Egyptians. After this period the barber's pole of to-day constituted the sign of the phy- sic an and surgeon. The first charter granted to the incorporation of barber- surgeons in England was conferred by Ed- ward the Fourth in 1491. This absurd alliance continued in force for about three centuries, and at last came to include some men of eminence and abilities; even the great Ambrose Pare was one of the barber- surgeons. But as the light of civilization destroyed the guild of barber-surgeons, D 49 50 SUNSHINE AND SHADOWS and their more important functions dropped away from them, they still con- tiniued the practice of some of the minor operations, such as phlebotomy, as indeed the barbers still do in some parts of Eu- rope, and it may not be out of place to mention that the striped pole, used even now as a sign of barbers, is a relic of those times when the barber did the bleeding as well as the shaving, and it had a signifi- cance which indicated that fact, the white stripe represented the bandage placed around the arm, the blue stripe the vein, the red stripe the blood, and the pole it- self the staff which the patient grasped in his hand to facilitate the flow of blood. So long as this deplorable state of medi- cine and surgery existed, it is evident that any one could practice; there were no pro- fessional qualifications, and the physician was little more than a physical laborer, ignorant, socially underrated, and in her- aldry utterly repudiated. Observe the contrast to-day, if you please. He who was once scoffed at and repudiated, is now honored, trusted, a leader in science, the OF THE PHYSICIAN. recipient of national rewards and exalted honors. It needs no argument to prove that there is an imperious necessity for medical edu- cation and professional qualifications. Strong measures are required to protect the community from pretenders and char- latans. Humanity has suffered too much from ignorant pretenders, and it is high time to end their existence. There is but one safe course and that is for the law to sternly and imperatively exclude from the practice of medicine all except those who have studied in well organized colleges conducted by competent instructors. A guarantee of fitness and qualification the public weal requires, and this guarantee can only come from an Institution gov- erned and conducted by men of integrity and learning. The time for allowing men who have not given years of study to the science of medicine to tamper with such a delicate and complex organization as that of man has gone by. It is true that no man who is worthy to be a physician will enter the practice of the profession unless he feels 51 52 SUNSHINE AND SHADOWS that he has qualified himself profession- ally by years of study, but unfortunately, it is also true that there are men who would enter it fcr the greed of gain, though they were conscious that they could not discern a case of dysentery from phthisis pulmonalis. It is for such dishonorable men that strict laws unrelentingly en- forced are required. Education in the science of medicine, if rightly conducted, gives skill and pow- er. The object of all practical education is to create power, not simply to cram the memory with rules and precepts. "Examples may be heaped until they hide The rules that they were made to render plain." In no practical profession is there pow- er unless skill and learning are combined. A man may know how to bend the bow of Ulysses, but if he lacks the skill to do it, his knowledge is fruitless. A man may know how " Hector of the glancing helm," wielded his spear, but the knowledge with- out the skill would be a barren thing. A man may be taught the theory upon which a Sydenham or a Hunter diagnosed dis- OF THE PHYSICIAN. ease, but if he never gets beyond the mere theory, he will do but sorry work, when called to the bedside of the sick and suffer- ing. It is the man of power, who is of service at the bedside. The mere theorist is little better than a "Jobn-a-Dreams," who is ever "a muddy mettled rascal." If the power that comes from true educa- tion is wanting, he who assumes to enter upon the active practice, " will go sound- ing on a dim and perilous way," more perilous to his patients than himself. The basis of power in medicine is scien- tific learning of principles, and skill is the application of that learning or knowledge with judgment and wisdom. The knowl- edge that avails is scientific knowledge, and it is the only kind that makes a man strong when strength is needed, and gives him power to successfully grapple with disease. The man who possesses such knowledge is seldom at fault in diagnosing a case and his skill is not often baffled. The only knowledge that avails in the hour of disease is a philosophic one, for, as Bacon justly says: " Medicine not founded on philosophy is a weak thing." 53 54 SUNSHINE AND SHADOWS A medical education is neither complete nor valuable unless it gives the power to know what to do and how to do it. Medi- cine is a science as well as an art, and be- fore there can be proficiency in the art, there must be a mastery of the science. If medicine is a science, its principles are laws of universal sway in all of its do- main. Throughout all the universe law reigns and over all the sciences it holds dominion. Every science has its funda- mental laws which in the field of that particular science are universal. Medi- cine is no exception to this all-pervading rule. The laws of health are universal and where laws are universal there can be no distinct systems or schools, although there may be diversity of views as to the efficacy of remedies and modes of treatment. Fundamentally, however, there can be only one school, since every science is, in its primary element, a united aud indivisi- ble system of philosophical laws. In these laws and principles the man who deserves a place in the great profession of medicine must be deeply learned. The ideal phy- sician will be a sympathetic man, and a OF THE PHYSICIAN. firm man. He will be a man of few words in the sick-room. There is a better thing than the great man who is always speak- ing; and that is the great man who only speaks when he has a great word to say. Sickness is an awful and fatal thing often; and in this connection I cannot help quoting verbatim the following lan- guage used by Dr. Elisha Bartlett in his opening lecture at the old Louisville, (Ky.) City Hospital in 1849. He said: "Gen- tlemen, sickness is in one sense a very solemn thing. A hospital is a place where only dependent and homeless people come to seek succor at the hands of the phy- sician. If you are to make physicians worthy of the name, suffering will always command your sympathy. You will be shown here disease in all its phases and the manifold suffering which it entails. It is expected that you will study each individual case; studyits symptoms; study the practice advised; study the patholog- ical changes wrought by disease in various organs of the body. But in all your stud- ies here, I beg you, study to be quiet." Noble words of wisdom and counsel, al- 55 56 SUNSHINE AND SHADOWS beit uttered nearly fifty years ago. They may be applied with great propriety to us as physicians to-day in our daily practice at the bedside. Kindness is also a quali- fication that belongs to the profession of medicine. The physician can be kind and yet firm. He should ever remember the old though vulgar adage: " A good action is never thrown away, though done to a dog," or in the language of the poet- " I shot an arrow into the air, It fell to earth, I knew not where. "I breathed a song into the air, It fell to earth, I knew not where. "Long, long afterwards in an oak I found the arrow still unbroke; And the song, from beginning to end, I found again in the heart of a friend." Our professional attention to the needy and deserving poor, should never be slight- ed in our ambition for fame or wealth. The venerable Dr. Daniel Drake once said to a plysician, who was about to enter on the practice of his profession: "I have never seen a, great and permanent prac- tice, the foundations of which were not laid in the hearts of the poor. Therefore OF THE PHYSICIAN. cultivate the poor. If you need another though a sordid reason, the poor of to-day are the rich of tomorrow in this country. The poor will be the most grateful of your patients. Lend a willing ear to all their calls." When a man like Daniel Drake, whose whole life was devoted to the bene- fit of suffering humanity, whose heart and mind were always open and ready to give advice to the younger members of his cherished profession, utters words like these, they demand our respectful and thoughtful consideration, and we must give heed. Another qualification of the professional man is the art of talking well. This is more than a mere thinking world. A man owes it to his time to learn to talk well. While it is true we have two ears and but one mouth, and it means we must hear twice as much as we speak, yet that mouth is for use, and the man who is a good con- versationalist is a public benefactor-a tutor at large. I would not encourage the physician to get too near the danger line to which Benjamin Franklin referred when he said, "Do not fall in love with your 57 SUNSHINE AND SHADOWS own voice, " but I would urge him to study to talk well. It is not an uncom- mon thing for a man to spend a great deal of time on his dress; he studies his gait of walking, his pose in standing and his style in riding. Better, far, than be " an animated clothes-stand," or an actor in producing effects, that he study a style of conversation. How very few men there are who are able to state a fact! There is an art in talking well. "Some men scald their faces with luke-warm water," -so says an old Arabian proverb; so do they muddle and confuse everything they tell. There is an embellishing and ampli- fication in conversation to an extent of exaggeration that sometimes loses a char- acter for truthfulness. All men cannot sparkle like the late James G. Blaine, or some others that might be named, who have wonderful conversational powers; but their lost art may be recovered to a great extent by attention, practice and pains- taking. Almost any man may attain the accomplishment of being a good talker, if he will. Individuality should be a charitc- teristic trait or qualification of the pro- 58 OF THE PHYSICIAN. fessional man. The physician should be himself. To be little mocking-birds of some other men is a small ambition. Sturdy Oliver Cromwell once sat for his portrait to a famous painter who cared more to paint a king than a man. His palette turned kindly to royalty. He be- gan to soften and beautify the picture, wiping out its lines and seams. Cromwell, who always stood up for the truth on can- vas as well as everywhere else, said: "No, man, no; paint me as I am, wrinkles and all." So let us live, telling the truth to ourselves and of ourselves, and to every other man. Unearned praise and sudden popularity often soon fade away; they are like the dew of the morning, but it is the work of a full lifetime to make a good mark. It is possible, as has already been shown, for a man to make so deep an in- dentation on the world that his grave and his fame will never be forgotten. "No knights of old in fete or fight Have ever won a name so bright As thou may'st win and wear; It like the valiant ones of old Thy faith be high, thy heart be bold To do, as well as dare." 59 60 SUNSHINE AND SHADOWS CHAPTER III. DUTIES OF THE PHYSICIAN-TO THE PUBLIC, THE PROFESSION AND HIMSELF. SECTION I. TO THE PUBLIC. "In nothing (do men so near approach the gods, as in giving health to men."-CICERO. The physician should be a sentinel on the watch-tower of public opinion with reference to- all matters about which his superior special education and training make him best fitted to advise the people. He enjoys exceptional opportunities; and should use them with a wise forethought so that, when he has run his race, he may, in looking back over his career, see that the society in which he moved has been elevated and improved. a OF THE PHYSICIAN. " Such life as his can ne'er be lost; It blends with unborn blood, And through the ceaseless flow of years Moves with the mighty flood." Many of the noblest charities for the relief of suffering humanity owe their foundation to the influence of the physi- cian to whom a grateful patient gave an "attentive ear." Therefore, we may say that the doctor in society should be one o its active members, taking a prominent part in all its movements and interests; guiding, controlling, directing, molding opinion, correcting error, removing preju- dice, inspiring to right action and correct feeling, and establishing, by every right means, the good, the beautiful and the true. If it is the duty of the minister of the gospel to define moral or social evils, and to point out the way to avoid or forsake them, it is equally the duty of the physi- cian to sound a clear note of warning, when, through ignorance or false econ- omy, the authorities of his town or city fail to provide for the proper drainage of the streets and alleys, for the removal to 61 62 SUNSHINE AND SHADOWS safe places of all garbage, for measures giving to its citizens an abundance of pure water, for properly quarantining against all epidemics, for adequate and proper ventilation in public halls and school buildings. When the shadow of great epi- demics falls upon a frightened public, or the wail of private sorrow comes to his ears from those whose loved ones have been suddenly snatched away, he should be the first to find out the causes which make epidemics pestilential, and even iso- lated cases deadly. No effect is the result of a single cause. There is no fever poison so potent, or di- sease germ so malignant, but it may be robbed of the major part of its terrors by attention to the already discovered rules of enlightened hygiene. I would not bid the physician in the future, " When Jove Will o'er some high-viced city hang his poison In the sick air" Be fearless and present examples of brav- ery and self-sacrifice to the scared popu- lace-for I know he will not flinch-but I would ask him then to enforce the lesson OF THE PHYSICIAN. that, as "wise nations in time of peace prepare for war," so in time of health should individuals, families and the whole people so order their surroundings that what erstwhile were causes of disease and death may, thereafter, become the ser- vitors of heightened health and increased longevity. To thinking physicians, there are dis- closed evidences and greater advances in our science than any the world has yet seen. Those who are long past the merid- ian of life may not participate in them, as even Moses was not permitted more than a glimpse of the "Promised Land" -but many of us will, I fervently believe, have that magnificent privilege. The last half century is the most re- markable period of which history gives us record, but it is more than probable the next will wonderfully surpass it. And in no department is this more assured than in Medicine. Every considerable portion of the task before the physician, like that of the human body, is to eliminate. And medical science, again, like the same body, although it is constantly grasping for 63 64 SUNSHINE AND SHADOWS more, does not by any means become gi- gantic thereby. Medical science is not becoming more perfect by mere accretion, but mainly by excision, as the statue comes out of the marble by skillful use of the chisel and mallet. It is easier to elaborate than to concentrate. Of all the professions, the medical is the most chari- table. "There is no profession by the members of which eleemosynary services are more liberally dispensed than the med- ical, but justice requires that some limits should be placed to the performance of such good offices. Poverty, professional brotherhood and certain public duties here- tofore mentioned, should always be recog- nized as presenting valid claims for gratu- itous services; but neither institutions en- dowed by the public or by rich individuals, societies for mutual benefit, for the in- , surance of lives, or for analogous pur- poses, nor any profession or occupation can be admitted to possess such privilege. Nor can it be justly expected of physicians to furnish certificates of inability to serve on juries, to perform militia duty, or to testify to the state of health of persons OF THE PHYSICIAN. wishing to insure their lives, obtain pen- sions, or the like, without a pecuniary ac- knowledgement. " But to individuals in indigent circum- stances, such professional services should always be cheerfully and freely accorded. It is the duty of the physician, who is a frequent witness of the enormities com- mitted by quackery, and the injury to health and even the destruction of life caused by the use of quack medicine, to enlighten the public on the subjects, to expose the injuries sustained by the un- wary from the devices and pretensions of artful empirics and impostors. Physi- cians should use all the influence which they may possess as professors in colleges of pharmacy, and by exercising this op- tion in regard to the shops to which their prescriptions shall be sent, to discourage druggists and apothecaries from vending quack or secret medicines, or from being in any way engaged in their manufacture and sale." It is not only the duty of the physician to prescribe medicines and meas- ures to relieve present disease; but it be- E 65 66 SUNSHINE AND SHADOWS comes his duty to become educators of the individuals he treats, and the communi- ties where he resides, in the great princi- ples of health. This is wherein medicine has made its greatest advance and achieved its grandest triumphs. He should not be satisfied with being called upon, but seek a place among those who lead, and com- mand advance in tones not to be misun- derstood. Thorough education in hygienic and sanitary matters and training of the public mind to its principles should be- come a distinct branch of learning and culture, and its teachings accepted, and laws and regulations enacted to enforce its precepts- by both State and National governments. Sanitary education and san- itary reform must begin in the household. " Its foundation must be laid in the hearts of the mothers of the country and at the sacred shrine of infancy. Teach mothers to nurse their children-not too much nor too often; teach them that a child can be starved to death by too much food, and that frequently the more they are fed the faster they are starved; teach them that the overdistended stomach in infancy cre- OF THE PHYSICIAN. ates a morbid appetite which cannot be governed in after years, and that the mis- erable dyspeptic and drunkard is but the full fruition of what might have been pre- vented had a proper care been exercised at the cradle. " Teach them that fresh air, sunshine, and pure clean water, both internally and ex- ternally, are a part of God's best gifts to man, to be used and not wasted." Impress them thus, and sanitation will be given an impetus that will be far reaching in its effects. Physicians who succeed in doing their duty are great public benefactors, and gra- cious men, "and gracious men are public treasures and storehouses wherein every one hath a share." The lives of such men will never attract the deserved adulation of the historian. There is something pitiable in the ignor- ance of the press and public regardjng their work for suffering mankind. The camp, the battlefield, and the intrigues of state have ever charmed the poet and his- torian; but in the silent watches of the night, when the balance of life and death 68 SUNSHINE AND SHADOWS trembles in the hand of the physician, alike in the poverty-stricken hovel or in the palace of the rich, are wrought deeds of heroism unsung, inspired by the genius of these who now are dust. " Even in their ashes live our wonted fires." We believe with Hippocrates, that "the highest gift the gods have conferred upon men is the power to heal their fellow-creat- ures," and that these hands which have wrought so untiringly for science and hu- manity- " A richer meed of praise shall claim Than all that wait on wealth or fame." SECTION II. TO THE PROFESSION. "Ere you remark another's sin Bid thy own conscience look within." -GAY. Amidst all the innumerable branches of knowledge which solicit the attention of the human intellect, there can be none of so much importance, religion only excep- OF THE PHYSICIAN. ted, as that which constitutes the Healing Art. For the soul in a diseased body, like the martyr in his dungeon, may retain its value, but has lost its usefulness. "The harp that once in Tara's halls The soul of music shed, Now hangs as mute on Tara's walls, As if that soul was fled." Thus " that Sweet Singer of the Emer- ald Isle" expresses the thought. Such is the nature of man under the strong pow- er of sense and sympathy; influenced by all the elements around him, and the en- ergies of thought within him-wearing out his mortal covering-sapping the founda- tions of his house of clay-while the pas- sions pour a continual storm upon the wheels of life. Thus circumstanced and impelled forward by the combined action of so many agents to that "bourne from whence no traveler returns," it is not as- tonishing if man, although the soul is so much superior to the body, should bestow upon the care of the latter the principal portion of his labors and his life. " Every individual on entering the pro- fession of medicine, as he becomes thereby 69 70 SUNSHINE AND SHADOWS entitled to all its privileges and immuni- ties, incurs an obligation to exert his best abilities to maintain its dignity and hon- or, to exalt its standing, and to extend the bounds of its usefulness. He should therefore observe strictly such laws as are instituted for the government of its mem- bers, should avoid all contumelious and sarcastic remarks relative to the faculty as a body; and while by unwearied dili- gence he resorts to every honorable means of enriching the science, he should enter- tain a due respect for his seniors, who have by their labors brought it to the ele- vated condition in which he finds it." It is the duty of the physician in his daily intercourse with his professional brethren to treat them with the utmost respect and courtesy. It matters not how humble or obscure may have been the birth or surroundings of your brother practitioner in early life; or what may have been his calling or trade, previous to his professional life; he has a just claim on your kind offerings-courtesy, favor and respect. Let us remember, in the language of an eloquent writer, that Pride OF THE PHYSICIAN. is unstable and seldom the same, that she feeds upon opinion, and is fickle as her food. She builds her lofty structures on a sandy foundation-the applause of beings every moment liable to change. But vir- tue is uniform and permanent; and fixed upon a rock are the towers of her habita- tion: for she looks for approbation only to Rim, who is the same, yesterday, to-day and forever. " Count life by virtues; these will last When life's lame, foiled race is o'er; And these, when earthly joys are past, Shall cheer us on a brighter shore." Physicians, remember when called upon in consultation, to share the burdens and responsibilities of your fellow-physician. When in the hour of his utmost extremity, he most needs your counsel, your admoni- tion and kindliest advice, then it is, a word, a look, a gesture, or a mere sign of disapproval may sink your poor confiding victim beneath a load of obloquy, censure and opprobrium that time cannot efface, merit obliterate, nor the apologies or re- gret of the offender repair the injury in- flicted. The physician's reputation is his 71 72 SUNSHINE AND SHADOWS capital. Destroy his reputation and he becomes a bankrupt professionally. How beautifully is this thought presented by the immortal "Bard of Avon," when in Othello he makes that serpentine charac- ter-Jago (the darkestcharacteranywhere found in his writings, whose very soul was black as night) say: " Good name in man and woman, dear my Lord, Is the immediate jewel of their souls: Who steals my purse steals trash; 'tis something nothing; 'Twas mine, 'tis his, and has been slave to thous- ands; But he that filches from me my good name Robs me of that which not enriches him And inakes me poor indeed." Then, brethren, it necessarily demands of us self-denial, self-control, it requires of us an honesty of purpose, a right in- tent, to be fully able at all times and un- der all circumstances, to render unto Caes- ar the things that are Caesar's; and to properly and equitably mete out to our professional brother that professional cour- tesy and favor that we expect and de- mand of him. Better by far be honored for the good within us than to receive the OF THE PHYSICIAN. plaudits and encomiums of the world for unmeritorious deeds and the wealth we may command. "Shall I ask the brave soldier, who fights by my side In the cause of mankind, if our creeds agree I Shall I give up the friend I have valued and tried, If he kneel not before the same altar with met From the heretic girl of my soul shall I fly, To seek somewhere else a more orthodox kiss No! perish the hearts, and the laws that try Truth, valour, or love by a standard like this!" The brightest star that shines out mid all the galaxy of glittering, glimmering jewels, that dazzles with its splendor and effulgence the heavenly cluster, that star, once unnamed and unknown, is now the peer of all that world of lights. So from the humblest walks in life, in the medical world, the brightest geniuses have sprung, who have secured the plaudits and good- will of mankind for their worth and ex- cellence in the profession. Let us there- fore have a care that we hinder not, by act, word or deed, one of the least of our number, lest we stay the dawning of the brightest star in the medical world in its course. 73 SUNSHINE AND SHADOWS "Who does the best his circumstance allows, Does well, acts nobly, angels could do no more. Our outward act indeed admits restraint; 'Tis not in things o'er thought to domineer. Guard well thy thought, our thoughts are heard in heaven." We may not all ascend to the highest pinnacle in the temple of medicinal fame, we may not all be able to delve down deep to the very stratum that lines the base of this grand structure of principle and science, we may not all etch our names on the very summit of its towering pinnacle, we may not all illumine the medical world with the light of our genius, wisdom, ac- quirements, or attainments in the profes- sion, but we may each of us, all of us, be honorable, honored and held in high es- teem by those around and about us mid the humbler walks of life in the medical world, for our reverence for, and our ad- herence to, the professional duties that bind us together. While our brother may not have been brought up in the schools and colleges of the learned, he may have been trained in one far superior for eliciting the powers of an original mind-that severe school of 74 OF THE PHYSICIAN. adversity-that perilous ordeal where the feeble minded perish; but the great of heart come out of the fires purified and resplendent in tenfold brightness. They rebound by the very impulse and pressure of the blow that was designed to crush them, and reach their elevation in the sky. The misfortunes of the virtuous often turn to their advantage. WAhen the world per- secutes them, they are generally driven into some illustrious career. Misfortunes are the road to great talents; or, at lea4, to great virtues, which are far preferable. The physician's life, like a kaleidoscope, is set in the mirror of time subject to the changes of the present and the reflections of the past. These may come at unsea- sonable hours and in unexpected places. Thus he knows not the time nor the place that he may need the good opinion and offices of his associates. He should there- fore carefully cultivate his eye and hand, his mind and heart, in professional morals as a part of his medical education, that the call for help will not go unheeded, and, if necessary, his honor and integrity 75 SUNSHINE AND SHADOWS defended from the conspiracy of slander and falsehood. " Whatsoever a man soweth, that shall he reap" is a divine injunction, and the thistles of unprofessional conduct will be blown by the whirlwind of resentment to the outermost edge of the everwidening circle of life, and the thorns of retaliation be thrust deeper when the occasion comes, which it is sure to do. While the cares and responsibilities of the profession rest heavily upon the phy- sician, there comes also a wealth of pleas- ure and a deep sense of gratitude in the discharge of its duties and obligations. He would, indeed, be recreant to his trust, and void of the higher feelings of human nature, within whose heart there did not dwell responsive chords of sympathy. To the true physician there is no greater pleasure than a consciousness of duty well done, and the heartfelt gratitude of suffering relieved of pain; for "He gave to mis'ry all he had-a tear; He gained from Heav'n ('twas all he wish'd) a friend." 76 OF THE PHYSICIAN. SECTION III. TO HIMSELF. "Think for thyself-one good idea, But known to be thine own Is better than a thousand gleaned From fields by others sown." -WILSON. To promote heal'th of body and tran- quility of mind, the sages of antiquity labored with the most severe and inces- sant toil. They studied the constitution of man, that they might find out the seat of his maladies, and the source of his mis- ery. The influence of the hope so feel- ingly expressed and deeply felt by every noble mind, that all diseases shall yet yield to the power of medicine in its per- fect state, ought to be abundantly sufficient to determine us to examine with candor every new discovery that is presented by the care and experience of man, whatever may be his station or condition in life. Great men are not always wise; and the very meanest is not beneath the care of a kind Providence, nor the influence of his holy spirit. " For thy kind heavenly father bends his eye, On the least wing that flits across the sky." 77 78 SUNSHINE AND SHADOWS And if, perchance, the grand Panacea shall be at last found-that Moly of the Egytians, and Elixir of the Greeks-who would not deem himself more honored by contributing the smallest item to the great discovery for relieving the wretchedness of the human race than if he had bes- towed upon him the Empire of the world " You have doubtless seen one fever rage, and prostrate its victim, over which the physician's skill had no influence. To have saved that life, to you 8o precious, you would have given the universe had you possessed it and would have considered it but as dust in the balance. No doubt oth- ers have felt as you did. And if the period shall arrive, when the heart strings shall no more be torn, lacerated, who would not exult in the joyful anticipations of that coming day And this dream of a universal medicine, which has pervaded the nations of the earth since the days of Isis and Osiris, is not all a dream-for the days shall come, saith the Lord, when there shall be noth- ing to hurt, or annoy, in my holy moun- tain. No pain to hurt nor sickness to an- OF THE PHYSICIAN. noy. But whether disease shall be ban- ished from the globe in the glorious pe- riod of the Millenium, or the grand cath- olicon be discovered to remove it, the data do not determine. But- "That very law that molds a tear, And bids it trickle from its source, That law preserves the earth a sphere, And guides the planets in their course." And the day will arrive when medical science and skill will have attained that apex of perfection, that it will be able to remove all the diseases of man; and leave not for life a single outlet, a single door of retreat, except old age. By means of sanitation and of serum- therapy (undoubtedly the therapy of the future), mankind will, at last, reach a point where (barring fortuitous accidents) the allotted span of life will be achieved, and the end of each human being will be Euthanasia. As a ship's crew is controlled by the captain, so the brain, bone and brawn of each human body constitute the crew of the "living vessel," and the soul is the 79 80 SUNSHINE AND SHADOWS captain in command. Each man must see to the sailing of his own bark. To be sure, he can be a log drifting with the tide, or he can float like a feather in the wind; but the wide-awake physician, properly equipped for the "life voyage," will not content himself to do less than use to the utmost the triple compound engines- knowledge, opportunity and ambition. Many a young man, like the oyster in whom energy is feeble, sticks in the mud, dreaming-idly dreaming, desiring a fu- ture, but doing nothing to make it. " Press on! surmount the rocky steeps, Climb boldly o'er the torrent's arch; He fails alone who feebly creeps; He wins who dares the hero's march." It has often been said that the (4) great powers of the world were Europe, Asia, the Rothschilds and the Barings; but things have changed, and it is nearer right to-day to say that the (4) great pollers of the world are, the United States, Eu- rope, Asia and an Education. In com- bining the first and the last-the United States and an education-there is no such other combine in existence in the world. OF THE PHYSICIAN. John Hickman, a Congressman from Pennsylvania, had written in Latin on his ring, "The best is nothing." And it is true, unless particular use is made of at- tainments and opportunities; but it is ten thousand times untrae in the lives of such men as S. D. Gross, D. H. Agnew, Austin Flint and J. Marion Sims. One of the Howards ordered a sun-dial put upon his tombstone to signify that life was only a shadow. Recalling the lives of Ephraim McDow- ell, Benjamin W. Dudley and Daniel Drake, and reonembering the splendid powers of Wm. E. Gladstone and Phillips Brooks, life is much more than a shadow. " Mount up the heights of wisdom, And crush each error low; Keep back no word of knowledge That human hearts should know." One of the most important duties of the physician to himself, is to see that he be properly remunerated for his services. It is a duty that he owes to himself and. family, to secure his pay for services ren- dered. He should early impress on the F 81 82 SUNSHINE AND SHADOWS minds of his patients the old maxim, that "the laborer is worthy of his hire," and he should not fail to ever cause them to keep the same verdant in their memories, by occasional allusions to its importance. By patients paying their physicians well for his time, labor and skill, they enable him to be a better man-a more skillful and scientific practitioner. It enables him to support his family, keep neat and clean, to buy new instruments, new books, med- ical journals, attend the medical societies, to visit the great hospitals occasion- ally, and to sit at the feet of the eminent surgeons and masters in the profession- as did the disciples of old at the feet of Gamaliel. Every physician should, besides being a good physician, be a good business matt. He should be as thorough in business mat- ters as in scientific ones. The ideal phy- sician can't afford to have any sympathy with all the sentimental talk about char- ity; after he has rendered an efficient service, he is justly entitled to proper re- muneration, and it is then not a subject for parley or discussion-there is no need OF THE PHYSICIAN. for any talk, sentimental or otherwise. After fees have once been charged they should be collected and not be allowed to remain on the books indefinitely. There are two most excellent reasons for this. Reason number one:-Just as long as a patient is owing his doctor he is the doc- tor's enemy. Reason number two:-It is unprofessional,, and the physician so do- ing is guilty of unprofessional conduct toward his fellow practitioners. Exempli pratia, suppose that a physician is finan- cially able (possibly one in a score is so cir- cumstanced) to carry his patients-their accounts from year to year, and not suffer for the necessaries of life; there are other physicians in his community, possibly, who are not so fortunate, and consequent- ly would be of necessity compelled to suf- fer for "the staff of life." To the physician there is nothing more deplorable after a life of earnest work and activity-looking upon the rays of life's descending sun-than to realize that he must of need work day and night for his own and the subsistence of a dependent family; therefore look to it, fellow phy- 83 SUNSHINE AND SHADOWS sicians, that you provide against the day when you will most, need the reward of labor prudently conserved, and that enough is left for enjoyment of reasonable rest and recreation. No other class of men do business in that loose, careless. unconcerned way as does the physician. It i8 not business. " Nothing succeeds like success " is a motto that I read somewhere not long since. I have heard also, that one of the largest banking houses in the world has made it a cardinal rule never to have any- thing to do with an unsuccessful man. Shakespeare, in " Hamlet " makes Polo- mius say: "Neither a borrower nor a lender be; For loan oft loses both itself and. friend, And borrowing dulls the edge of husbandry. This above all: to thine own self be true, And it must follow, as the night the day, Thb-m canst not then be false to any man." Perchance some of you have looked down from the gallery upon the Board of Trade during an exciting session, and perhaps imagined it a bewildering illus- tration of " chaos come again." The 84 OF THE PHYSICIAN. initiates know better. That man scream- ing at the top of his voice, and gesticula. ting so frantically, is not a lunatic, sur- rounded by fellow incurables. " There is a method in his madness," as the ware- houses, the banks and clearing house- sedate and cool-blooded parties enough, in their way-will tell you. Superficial observers think much in the same way of the larger floor upon which men compete for mere existence, for comfort, for wealth, position, fame and power. To them ' it is all a muddle," in which wrong is as likely to triumph as right; and chance and mo- mentary achievements are mistaken for the rule. But neither Fortune nor Luck are the creatures of chance. The physician owes it as a duty to him- self to occasionally take a much needed vacation. His social life is so circum- scribed by the exacting duties of his pro- fession, and the unnecessary demands made upon his time and talents, that he practically lives a life of seclusion, al- though in constant touch with the great stream of humanity in the outside world. The days, weeks, months and years of 8a 86 SUNSHINE AND SHADOWS the busy physician flit by as the mist of the morning, and the noontime of life is upon us ere we realize its magic flight. A little leisure, a little rest from the toil and care and worry of professional life is a good thing, and should not be deferred until gray hairs admonish us that the autumn of life is at hand. Then " Go forth unto the open sky, and list To nature's teachings, while from all around - Earth and her waters, and the depths of air- Comes a still voice:- Yet a few days, and thee The all-beholding sun shall see no more In all his course. Nor yet in the cold ground, Where thy pale form is laid with many tears, Nor in the embrace of ocean, shall exist Thy image. Earth, that nourished thee shall claim Thy growth, to be resolved to earth again." -BRYANT'S " THANATOPSIS." OF THE PHYSICIAN. CHAPTER IV. INFLUENCE OF THE PHYSICIAN. SECTION I. "'Tis not so much to press and plead, At every turn a friend and( foe, Because our creed they will not know; The rather let us well bestow Our precepts in the life we lead." The influence of the physician is power- ful and widesprea(l. There is not in all this broad land of ours. a household or a home in which the physician is not the most important visitor that crosses its threshold. He stands " upon the confines of existence, welcoming the new-comer and bidding farewell to the goer-away." Un- der Goa the issues of life and death are in his hands; disease and misery, or health and strength, often depend upon his knowl- 87 88 SUNSHINE AND SHADOWS edge, skill and judgment. An error on his part may cost life, or, if not productive of such serious consequences, may wreck the health of the patient, or send him out into the world infirm, lame or deformed. The Hon. Thos. F. Bayard, in an address to a medical class, not long since, made the following remarks: "I never knew a really great physician who was not great- er as a man-I mean whose greatness did not rest upon his personal and moral ba- sis, which elevated and strengthened his professional life, infused itself into the community in which he lived, and was, in fact, the underlying and pervading cause of his influence and consequent success in his profession. It has been my personal fortune to know such a man. It has been my privilege and delight to accompany him in visits where his only medicines were the personal presence and conversa- tiop of the man himself. He had shared and lessened their anxieties; counseled the wayward; had lead the sick back to health; cheered the weak-hearted; had rejoiced with them that did rejoice and wept with them that wept. And I have OF THE PHYSICIAN. seen such a man so surrounded by an at- mosphere of love and trust, holding as it were the heartstrings of a family in his hands, their guide, philosopher and friend, and then I realized what a moral force in society the profession, properly compre- hended and properly followed, was capa- ble of exerting, and how relatively small a part of its usefulness was the adminis- tration of medicine." The physician should be a man of edu- cation, of polished and refined manners, to the fullest extent. His profession should make him such, and the practice of that profession should make him a man of broad ideas. He is like the man who views the landscape from a broad emin- ence. The mainsprings of human conduct are not concealed from his view. He becomes familiar with the intereplay of those forces that control hunman actions. He, there- fore, should be a man not liable to be moved by prejudice or bigotry, two most banefur characteristics of a narrow mind. He should be keenly alive to the advance- ment of science. From his peculiar rela- SUNSHINE AND SHADOWS tions to people, he must be a man who wields an influence, the importance and force of which will be largely proportional to his breadth of information and his tact. Crises wil I a rise in every community when society will turn in its helplessness to him who knows. Let the physician be ever ready to resp)ond. L et the call find him qualified with that knowledge which will give him power. Through his influ- ence the physician becomes a leader in so- ciety, molding its opinions, removing its prejudice, directing its energies toward those human ends that will elevate and advance his fellow-beings. "The web of human life is wove Not with a single strand, But every grand and noble nman Holds one within his hand." The word Influence is the most incom- prehensible, the most vast and far reach- ing of all words. We seldom use it in any but a literal sense, but in every de- gree of its true meaning there is the shad- ow of infinity. Philosophers tell us, not in jest, but in the profoundest earnest, that every footfall on the pavement jars OF THE PHYSICIAN. the sun, and every pebble dropped into the ocean moves the continents with vibra- tions that never cease. The hand gives motion to a pendulum, and by that act an effect has been produced which shall endure through eternity. The vibration of the pendulum as a mass ceases, but only because its motion has been trans- formed from mass motion to molecular motion. Had it been suspended in a vacu- um and been made to swinig without. fric- tion at the point of suspension, it would have vibrated on forever, but the friction, which is inevitable, and the resistance of the air gradually bring it to rest, and we say the motion has ceased, but this is not true. The motion his only become in- visible. A moment ago the pendulum was swinging, but now infinitely small atoms are swinging in its stead, and the aggregate motion of all those atoms is just equal to the motion of the pendulum at first. These waves of atomic motion expand and radiate from points of origin, extend- ing on, and on, and on, past planets and stars, beating and dashing against their 91 92 SUNSHINE AND SHADOWS brazen bosoms as the waves of the ocean beat the rocky shore. This is not the language of fancy, it is the veritable phil- osophy, the demonstrated facts of science. The mind gave birth to motion com- municated along the nerve of the arm to the pendulum, and that motion has gone beyond its recall, on its eternal mission among the stars. What a solemn thought! "Man is the parent of the infinite !" And yet this illustration but faintly shadows the awfulness of human influence. If a simple motioin of the hand is fraught with eternal consequences, what shall we say of the influences of the mind They shall live- as long as the throne of the Infinite; ah, that the mind of the physician could be impressed with the awful truth, that an influence in its very nature is eternal. Not a word or thought or deed of all the myriad dead but live3 to-day in the char- acter of our words and deeds and thoughts. We are the outgrowth of all the past, the grand resultant of all the world's past forces. Only the Deity can measure the influence of a human thought. OF THE PHYSICIAN. "No stream from its source Flows seaward, how lonely soever its course, But what some land is gladdened. No starever rose Andl set without influence somewhere. Who knows What earth needs from earth's lowest creature No life Can be pure in its purpose and strong in its strife, And all life not be purer and stronger thlereby." The physician knows that pathology is the ever-shadowing Nemesis of histology; that disease, health, pleasure and pain go hand in hand; that it is but a step across the border line from sanity to insanity; that virtue and vice, law and anarchy, poverty and riches, touch elbows; that rust and decay go with inactivity, while growth and increase follow activity. Above all, he knows that environment is one of the most powerful of influences, and often the only one strong enough to overcome hered- itary tendences. All these and many other contending forces in the daily equa- tion lead the physician away from " Al- truria," into the vision of society, the field of post-graduate activity. There is nothing more evident than the law of com- pulsion. Everything is obliged to bend to it. Summer's heat and winter's storm 93 SUNSHINE AND SHADOWS are compulsion. Law, society, customs and religion are compulsion. Commerce, so fittingly called "the hymn of prosper- ity," the dirge of famine, vespers of the dark ages, is compulsioi. There is no place where the individual is let alone. Everywhere influences of contending for- ces limit physiological as well as social life. The beautiful scenery of our country- the landscape of cultivated farms, villa- ges, factories, rivers and railroads stands for the collective compulsory labor of so- ciety. It represents community, its ad- vancement represents civilization, and while it is all compulsion it is still thus beautiful because of individual influences directing its developement. The poet, Keats, says: "A thing of beauty is a joy forever; Its loveliness increases; it will never Pass into nothingness." Let us see what place the physician has in this developement, for he is one of three principal, positive, forming influences in society. He shares alike in this respon- 94 OF -THE PHYSICIAN. sibility with the press and the pulpit. "The mantle of prophecy no longer de- scends on a successor, and the divine pur- pose is not revealed to mortals." There exists, however, in every age, mast erful classes of men, whose environments per- mit them to shape the destinies of society and direct its quiet, but powerful forces. In this silent, quiet work of directing for- ces, the two things necessary are always at hand in the physician's daily life, viz.: education and opportunity. He finds out early, in his daily rounds, as one lately said, "It is not station, nor riches, nor power, but knowledge and wisdom and personal worth, that most really and sure- ly command the final homage of men." By no author has this ever been so beauti- fully portrayed in story as by Ian Mac- laren, a physician of the old school, in " Stories of the Bonny Briar Bush." The germinative influence of Dr. MacLure in "Dromtochty " has been a revelation to the reading world, who have all too little appreciated the influence of the physician in society. Ian Maclaren, in answer to a direct question at a banquet in his hon- 95 SUNSHINE AND SHADOWS or at Glasgow, stated that he had known four practitioners of medicine in Scotland, from any one of whom he could reproduce the character of Dr. MacLure, while doubt- less we ourselves have known one or two physicians, from whom the same charac-- ter could be drawn. Such men lead the inner life of the community with them, The inspirations of their daily life to the boys and girls of their clientage and their words of advice are among the forming or incentive influences by which our schools and colleges are filled with students, and our country with useful men and women. Dr. Chauncey Depew says, that the physi- cian, in his daily rounds, preaches, from a perambulating pulpit, lessons, principles, maxims, doctrines, proverbs, which in time form a large part of the ethics and virtue of his constituency. " Words of love from hearts sincere, In this world of care and woe, Are like springs in deserts drear, Giving life where'er they flow." This quiet, every day creative influenced of the physician is a great factor in the developement of great intellectual move- OF THE PHYSICIAN. ments. Broad ideas are the products of isolated germination, planted among the few who are able to grasp their meaning. They grow slowly, taking hold only here and there at first. These movements may be educational or social or revolutionary; but, whatever they are, they are discussed over and over again with the family phy- sician, who tarries to talk awhile after his professional call is ended. He observes the birth of a broad idea in this way, and disseminates it in his dailv rounds among those whose minds arc tit to seize it. Af- ter a time these ideas group, and the groups mass, then the public announces a common cause under some leader who is competent to organize it and direct its purpose. In this way grand schemes or- iginate and complex influences are direct- ed to harmonious execution. This is the influence of contact, of line on line, and precept on precept, of day by day, and year by year, close personal associa- tions. It is a part of the physician's life and of his real field of usefulness, but is by no G 97 98 SUNSHINE AND SHADOWS means the whole of it, for his influence extends to more extensive fields. Literature, poetry, fiction, history, the sciences and discovery have all drawn dis- tinguished followers from the ranks of medicine. Apollo was the god of poetry, music, science and medicine. The Greeks, who were the closest observers of associa- ted virtues, brought these attributes to- gether as their ideal of what ought to be found in the character of a Greek physi- cian. Poetry and music; the charm of strophe, and the harmony of sound, to mellow the daily toil of the medical sani- tarian, who so often is compelled to make bricks without straw. What an exponent of poetry and medicine our own Dr. Oliv- er Wendell Holmes has been. In his " Poet at the Breakfast Table " he has embalmed the best part of his poetical nature. Ver- satile, stirring, witty, tender poems, that live with us and become a part of us, are "Old Ironsides," "The Wonderful One- horse Shay," and "The Chambered Nau- tilus." Where can there be found in the Eng- lish language a more humorous, witty and OF THE PHYSICIAN. ludicrous poem, than " Rip Van Winkle, M. D."-An after-dinner prescription writ- ten by Dr. Holmes and taken by the Mass- achusetts Medical Society, at their meet- ing held May 25, 1870. I cannot refrain from quoting verbatim, a portion of CANTO FIRST. Months grew to years; at last he counted three, And Rip Van Winkle found himself M. D. Illustrious title! in a golden frame He set the sheepskin with his Latin name, RipuM VAN WINKLUM, QUEEM we-scImus-know IDONEUM ESSE-to do so and so. He hired an office; soon its walls displayed His new diploma and his stock in trade, A mighty arsenal to subdue disease Of various names, whereof I mention these: Lancets and bougies, great atnd little squirt, Rhubarb and Senna, Snakeroot, Thoroughwort, Ant. Tart., Vin. Colch., Pil. Cochive, and Black Drop, Tinctures of Opium, Gentian, Henbane, Hop, Pulv. Ipecacuanhae, which for lack Of breath to utter men call Ipecac, Camphor and Kino, Turpentine, Tolu, Cubebs, " Copeevy," Vitriol-white and blue, Fennel and Flaxseed, Slippery Elm and Squill, And roots of Sessafras and " Sarsaf'rill," Brandy-for colics, Pinkroot-death on worms, Valerian, calmer of hysterical squirms, Musk, Asaftetida, the resinous gum 99 100 SUNSHINE AND SHADOWS Named from its odor-well, it does smell- Jalap, that works not wisely but too well, Ten pounds of Bark and six of Calomel. For outward griefs he had an ample store, Some twenty jars and gallipots, or more; Ceras'umu simnplex-housewives oft compile The same at home, and call it " wax and ile," Unguent/un Resinosutm-change its name- The "drawing salve" of many an ancient dame; Argenli Ni/ras, also Spanish flies, Whose virtue makes the water bladders rise- (Some say that, spread upon a toper's skin, They draw no water, only rum or gin)- Leeches, sweet vermin! don't they charm the sick And Sticking-plaster-how it hates to stick! Emplastrum Ferri-ditto Picis, Pitch, Washes and Powders, Brimstone for the-which, Scabies or Psora is thy chosen name Since Hahnemann's goosequill scratched thee into fame, Proved thee the source of every nameless ill, Whose sole specific is a moonshine pill, Till saucy Science, with a quiet grin, Held up the Acarns, crawling on a pin Mountains have labored and have brought forth mice: The Dutchman's story hatched a brood of twice. I've well nigh said them-words unfitting quite For these fair precincts and for ears polite. OF THE PHYSICIAN. SECTION II. There are others, too, who once took the oath of Hippocrates, whose influence and poetry lives after them. So long as books are written "Endymion " and " Lamia " will he read, and Dr. John Keats will live in the memory of men, while "Bitter Sweet", and its author, Dr. J. G. Holland, will be studied and cherished by women whose hearts are wounded and feet weary. The poetry of Marchelli, Haller, Gold- smith and Erasmus Darwin, is a part of the standard literature of the tongue in which they wrote. Mathematics and As- tronomy, Surveying and Navigation, have drawn eminent disciples from the ranks of medicine; and the name of Joseph Ray, M. D., and his series of mathematical text- books, are as household words in every state and county in the Union. The first grammar of the English language placed in our puerile hands, was written by T. S. Pinneo, A. M., M. D. In many other de- partments of life, medical men have ex- tended lasting influences. A portion of our boyhood's literature in our early school-days, was the arctic 101 102 SUNSHINE AND SHADOWS expeditions of Dr. Kane and Dr. Franklin, and we are thrilled no less again, in man- hood, by the North-pole voyages of Dr. Nansen. From the earliest period in our nation's history, our profession has always stood firm in the defense of our country's cause; and the names of Drs. Joseph Warren, Hugh Mercer and Benjamin Rush, are in- delibly written in the annals of the Revo- lution; and their deeds recorded show that they were not idle spectators of the fray. And the Juggernaut of war never stained its wheels with nobler blood, nor left grander spirits in ruins, than those among our noble surgeons, during our last sad internecine conflict. "A common citizenship holds sacred in the urn of memory the exalted manhood and imperishable fame of an ancestry who command their own tribute of affection and the admiration of the world." These noble men responded to the summons of Providence for a glorious work, and, like the chosen of old, many closed their work with the blood of martyrdom. Greater heroism was never displayed by man or OF THE PHYSICIAN. woman. Martyrs burned at the stake could not escape the death if they would; but these personifications and crystallizations of heroism would not abandon their posts of duty and escape the dangers if they could; but their labors are finished-all honor to them-their mission is enlded. The world will not soon look upon their like again. "Rest on, embalmed and sainted dead! Dear as'the blood ye gave; No impious foot-steps here shall tread The herbiage of your grave; Nor shall your glory be forgot While Fame her record keeps, Or honor points to the hallowed spot Where Valor proudly sleeps." -O'HARA. In philosophy there are few books of greater interest than Dr. Draper's " Intel- lectual Developement of Europe," and what might be said about the works of Dr. Chas. Darwin can be omitted, for you are all doubtless familiar with his labors, from his journey on the "Beagle" until the establishment of the new philosophy, which at first brought ignominy and abuse as reward, and at last canonized his name 103 SUNSHINE AND SHADOWS in science and earned for his remains a final resting-place in Westminster Abbey, alongside of archbishops and cardinals, whose doctrines he opposed. "Unveil thy bosom. faithful tomb, Take this new treasure to thy trust, And give these sacred relics room To slumber in the silent dust." In discoveries for the benefit of suffer- ing humanity, the physician's labors have always been active, ceaseless and unre- lenting. The names of the immortal Har- vey, the illustrious Jenner, the imnperish- able Morton, and the sainted McDowell, are known and revered in every land and clime upon which the great Luminary sheds his brilliant rays. Sir Edwin Arnold says, in his tribute to the discover of Anws- thesia, " Let me take permission to tell you what fills my own heart most with thank- fulness, and causes me chiefly to congrat- ulate you on these new days of therau- peutic science is the benign, the blessed discovery, and the now almost universal employment of anuesthetics. If you look into the history of that happy revolution, you will be warned against depreciating OF THE PHYSICIAN. fresh ideas by noticing how sadly slow men are to take hints which nature gives to them of her very choicest treasures of resource. " Why did not any one act upon what Sir Humphrey Davy so long before learned and imparted about the properties of nitrous oxide " The key was already there, but not until many years afterward did an almost casu- al hand (that of an American dentist) fit it into the golden door, behind which sat waiting an angel of pity, kinder and more powerful than any Arabian fairy sudden- ly revealed in her divine beauty and boun- tifulness to any prince or magician of the Thousand ant One 'iykhts Is there any- thing in human history which more stern- ly teaches that man must win every boon of Nature by his own ceaseless striving than that this simple chemical and phy- siological secret of anesthesia should have lurked so sadly long in its easy formula, undeciphered through all those waiting generations, when p iin was an omnipres- ent tyrant whom science could not con- trol, and the operating room a torture 105 106 SUNSHINE AND SHADOWS chamber dreaded almost as much by the surgeon as by the sufferer " " Lips that blanch not in the reeling strife Tnrn silent andl white from the surgeon's knife." Thus a poet sang, prior to the discovery of anwsthetics. "Think of those gallant sailors of Nelson at Trafalgar, whose bleed- ing stumps, in the gloom of the orlop deck, were plunged into hot pitch to stay the hemorrhage! One would almost expect that pity for such brave men, and for the countless tender women and children who, age after age, so hopelessly endured, Tel- esphorus, the God of Healing, or Nature herself, would have burst the iron law of her impassive silence; and as Helen did in the Odyssey for the sorely tried Greeks, have poured this nepenthe into the bitter cup of mortal life." Dr. Holmes says: "The man to whom the world owes this priceless gift is Dr. Wm. Thomas Green Morton." Imagine, if you please, the conflicting emotions which stirred within the heroic breast of this immortal man, when his discovery was first subjected to public trial. If the OF THE PHYSICIAN. experiment proved successful, his name would be rendered immortal and the op- erating room robbed of its greatest terror; if it should fail, only ridicule awaited him. It was successful. What this has done for the amelioration of the horrors of pre-anoesthetic sur-gery, very few now living can appreciate. Instead of shrieks, cries and groans of the patient, everything now proceeds with that quiet and leisure which is so essential to the performance of many, if not most, of our modern elab- orate and prolonged operations. The au- thor of the wigqht of Asia says again: " I have myself known what it is to pass, fearless of the keen steel, into that w orld of black velvet tranquility, of which your magic drugs now keep the gate; and to awake as good as healed, grateful beyond words for the soft spell of enchanted peace. and the sure and faithful skill." Who could possibly endure the torture of an operation lasting for one, two, or it may be even three hours, when every minute seems an eternity of anguish But happily now " the fierce extremity of suffering has been steeped in the waters of oblivion SUNSHINE AND SHADOWS and the deepest furrow in the knotted brow of agony has been smoothed away forever. " A great surgeon lately remarked: "I would rather be the discoverer of anes- thesia, than have won an Austerlitz or a Waterloo." Who can measure the im- portance of this signal event to humanity! It remained for America to confer this priceless boon on suffering mankind. Many gilded monuments have towered heaven- ward to perpetuate the names and com- memorate the prowess of martial heroes, who have tarnished the earth with the blood of slaughtered men, or, in the lan- guage of the "Elegy in a Country Church- yard "- "To wade through slaughter to a throne And shut the gates of mercy on mankind" have sent a wail of sorrow over entire continents! But such "frail memorials " pale into insignificance, as the native-born or alien, "who, mindful of th' unhonored (not dishonored) dead " listens to the "artless tale " of two humble dentists OF THE PHYSICIAN. whom God enabled to discover a slumber that antidotes every pain. "Such names as Warren, Jackson, Morton, Wells, Will live as long as suffering manhood dwells Within this weary world of death and funeral knells." Thus a poet sweetly sings of the discov- erers of antesthesia. Their work is done. Their duties performed. Their lives were an inspiration. They are at rest; where " No chilling winds or poisonous breath Can reach that healthful shore- Sickness and sorrow, pain and death, Are felt and feared no more." They at last reached the pure Empyrean and, to use Shelley's words, robed in daz- zling immortality, sit on thrones "Built beyond mortal thought, Far in the Unapparent." In a hallowed spot, a typical American home, in Rockbridge County, Va., Nov. 11, 1771, the "Father of Ovariotomy" first saw the light. It has been said that great men, like great mountains, stand alone, with the valley of ancestry on the one side and the gulf of posterity on the other. But 109 110 SUNSHINE AND SHADOWS history tells us, however, that this tower- ing character did not stand alone, for the foothills of his ancestry were of decided magnitude, prophetic of a genius destined to lay the foundation for a great revolu- tion in the ars chirurgiea, and to become one of the greatest benefactors of the hu- man race. After obtaining his literary education at Georgetown, Ky., our hero in 1793-4 at- tended lectures at the University of Edin- burgh. In 1795 he returned to America and began the practice of his profession at Danville, an aristocratic little colony not far from Lexington, Ky. He faced dangers from storm and flood, in clouds and dark- ness at night, at times lost in the dense forest. He was actuated by the higher principles of his profession. He feared neither man nor devil; he knew no fear ex- cept the fear of God, and that of doing wrong. The degree of his happiness was determined by the magnitude of his under- taking. In December, 1809, he was called to see a lady suffering from an ovarian tu- mor, and at once suggested its removal. But he stated to her that, so far as he OF THE PHYSICIAN. knew, the operation had never been done -that it would be an experiment; conse- quently he could make no promise as to the outcome. By his manly presence and honest words he planted a new hope in the heart of despair. Thus, "lhe unlocked the bosom of confidence with the key of personal magnetism." The patient gave her assent to the operation; whichl was performed at his home in Danville. When it became known what he was about to undertake he found a mob gathered about his house. He also learned that if the patient recovered, it would be well with him, but if she died from the operation, he would be at the mercy of a merciless mob. He offered up a prayer and pro- ceeded with his work. This prayer, in fervency and literary merit, it is claimed by scholars, has never been surpassed and seldom equaled by mortal man. What an example of true courage and resolute de- votion was exhibited by this heroic, good, kind, gracious, loving and lovable man! He no doubt felt the force of the lamenta- tion of the poet:- ill SUNSHINE AND SHADOWS " Truths would you teach, to save a sinking land, All shun, none aid you, and few understand." No truer heroism has been, or ever will be, recorded on the immortal pages of never- ending history. True courage must be deliberate, must be premeditated, must be actuated by a high, a holy and a bene- ficent motive. It was not a maddening pseudo-heroism stirred up by the rattle of the drum and shriek of fife on battlefields, where man seeks to slay his fellow-being. The heroism of Hannibal, Alexander, Xer- xes, or Napoleon, can never be compared to that of this cool, calculating, thinking man. The operation was completed, and the torch lighted by Ephraim McDowell in the midnight darkness has shone forth with resplendent glory in this brilliant noonday of abdominal surgery. The cen- tury, which, in a year or two, will have rolled on to the eternal past, has placed in the magnificent temple of medicine many pillars of surpassing beauty and grandeur, while its surgical columns have risen high towards Heaven, where as gild- ed towers they fain would vie with the 12 OF THE PHYSICIAN. God-given sunshine in dispelling the chill and gloom of human agony. "Chirurgia's tower, thy li ghts resplendent blaze, Dries woman's tears and lengthens out her days. McDowell and Sims, ot our Columbia's clime, Began the work, moved onward, nigh sublime. To woman, then, these blessings shall be given, Queen of the home, and home the type of Heaven." In 1817, "Three Cases of Extirpation of Diseased Ovaria "-the first publication of ovariotomy-was made to the world. It was long before Europe could believe that such a brilliant, original and magnificent improvement could originate in what was then known as the back-woods of America; but she has been apprised many times since of the genius of America's Physicians and Surgeons. My dear reader, should every other source of pride in your Amer- ican citizenship fail, you have only to point to the recorded triumphs of Amer- ican medicine and surgery to have it res- tored. In 1827, Dr. Johnson, Editor of the London Medico Chirurgical Review, after announcing the results of five cases of H 113 SUNSHINE AND SHADOWS ovariotomy, four of whom had recovered, says: "There were circumstances in the narrative of some of the first cases that raised misgivings in our minds, for which uncharitableness we ask pardon of God and of Dr. Ephraim McDowell, of Dan- uille." What a noble confession! Virginia is justly proud of her orators, statesmen and soldiers, " but shall not the achievements of her statesmen suc- cumb, at last, to the pitiless logic of events Shall not the voice of her orators grow fainter with coming ages Shall not the victories of her soldiers be found at last only in the libraries of students of military campaigns, whilst the fame of this village surgeon, like the ever-widen- ing waves of the inviolent sea, shall be wafted to the utmost shores of time, hailed alike by all nations in all ages for having lessened the burden and prolonged the span of human life " He was a handsome man. His was a beautiful life. "Beautiful lives are those that bless Some silent river of happiness Whose secret fountains none can gaess." 114 OF THE PHYSICIAN. 115 Should a student of medicine, in cen- turies hence, ask who first performed ov- ariotomy, the answer will be ready and unequivocal. As a result of this self- sacrificing life and wonderful result, there goes forth a benediction to every home in the known world; from every hearthstone in Christendom there returns a blessing to the memory and the resting place of Ephraim McDowell. " Hark! how the sacred calm, that breathes around, Bids every fierce, tumultuous passion cease; In still small accents whispering from the ground A grateful earnest of eternal peace." SUNSHINE AND SHADOWS CHAPTER V. PROFESSIONAL FRIENDSHIP. " When true hearts lie withered, And fond ones are flown, Oh! who would inhabit This bleak world alone" Sophocles says: " What good man is not his own friend" Young states that a foe to God was ne'er true friend to man. Some sinister intent taints all he does. Dryden says: " Want gives us to know the flatterer from the friend." Shakespeare makes Cassius say: " A friend should bear his friend's infirmities." Webster's defin- ition of a friend is one who entertains for another such sentiments of esteem, respect and affection that he seeks his society and welfare-a well-wisher. Egotism, hatred, 116 OF THE PHYSICIAN. avarice, intemperance, immorality and in- fidelity are at enmity with professional friendship; any member must purge him- self of these evil genii before he knocks at the door of professional friendship for recognition and admittance. To have pro- fessional friends we must be worthy of them-promoters of each others' welfare, success and happiness-all gentlemen who are members of our noble profession will be friends Friendship is founded on con- fidence, confidence on integrity, and with- out integrity there can be no friendship. The duties incumbent upon the physi- cian are not those alone that afflicted hu- manity requires at his hands; but the principle of justice, right, and a " script- ural injunction," demands of him a far nobler, higher, loftier, grander and more generous and kindred feeling; one that should actuate him in all his professional intercourse with his fellows; a spirit of professional duty, of conciliation, of mu- tual fellowship, so inculcated in the heart, mind and memory, that naught but a wide departure from every obligation that binds him to the common brotherhood should 117 SUNSHINE AND SHADOWS sever the tie that binds him. We, as pro- fessional men, men loving justice, should unbiasedly, unselfishly and unreservedly help to bear the burdens of each other- " to feel a brother's care," as it were. To be true to the trust confided and the con- fidence imposed requires of us often- many times, self-denial and self-sacrifice, but, "When otir cause, it is just, Conquer we must. This be our motto, In God is our trust." How endearing is the title of friend; what a charm in the very name of friend- ship! How the mind turns at once to the circle at the fireside, for it is here that friendship is seen in all its beauty and in- tensity. The mother's devotion has ever been the theme of the poet's song and the minstrel's strain, and filial love has been promised in its fulfillment. Desolate in- deed must be that heart which cannot look back to the early quiet joys of home. The remembrance of a parent's love hath oft- en come back to the lone wanderer like a long-forgotten strain, to cheer him in 118 OF THE PHYSICIAN. his solitude and calm his weary spirit; and feelings of hatred at the world's in- gratitude have given way to kindlier emo- tions, as he thought of his earliest, his truest friend-his mother. "A mother's love! the sacred thought Unseals the hidden fount of tears, As if the frozen xlaters caught The purple light of early years." It causes his memory to revert to the old home, with all its familiar surroundings, with its moss-grown roof, that in turn " lets in the sunshine and the rain," to his pious father and his sainted mother, who have long since "crossed the dark river" and are resting "under the shade of the trees "-that silent depository of the low- ly dead; to the bright-eyed brother and the golden-haired sister of long ago, and the cov little maiden, who in turn kept house for him one day, his brother the next; and a little grassy mound on the hillside, across the meadow, near the green wood rises to view, and a few "pious drops" gather in the eyes, as "he thinks of her he loved so well, and those early broken ties." How fond recollection calls 119 120 SUNSHINE AND SHADOWS to mind his dumb-playmates: his faithful dog, his gentle cow and his playful colt- all " have quietly mingled their bones in the dust." Throughout all animal nature is this principle recognized. The humble ant shows attachment to his fellow-worker, and the busy bee will permit no intruder in its hive, and so up through the scale of created beings is this ruling principle evident, increasing gradually in power, until in man, under the guidance of rea- son, it is displayed in its full development. It is the basis of patriotism-that love of country which nerves -the arm and fires the heart to protect our native soil from the step of the invader-our hearth-stone from the finger of the oppressor. It im- parts hope to the exile when sweet strains of some home-melody strikes his ear, with all its hallowed associations. High and low, rich and poor, acknowledge its power. It heightens the joys of wealth in the pal- ace, and alleviates the misery of squalid poverty in the hovel. Even the wicked, whose hearts have been worn away by the constant drippings of evil, yield to its in- fluence. OF THE PHYSICIAN. What noble instances of heroism has it produced! It has comforted the "de- parting soul " of the martyr in its celes- tial flight. It was seen at the cross on Calvary, when Rome, proud Rome, was in her pristine vigor, when, amid revelings and reproaches, that ever faithful band of followers stood by and witnessed the last agony. It guided the lone woman "at the peep of dawn " to the " narrow cell " to see where they had laid her Friend and Saviour. History has given us a beautiful account of the ties of friendship that ex- isted between Damon and Pythias. The former having been condemned to death, obtained permission from Dionysius, to visit his home and bid farewell to his family, kindred and friends, the latter gives himself, as a ransom in prison, to suffer the punishment in his stead in case he did not return at the appointed time. Damon was punctual; and this striking instance of friendship so affected the king that he at once pardoned Damon and re- quested to become his friend. 121 SUNSHINE AND SHADOWS " But whether on the scaffold high, Or in the battle's van, The fittest place where man can die Is where he dies for man." What a noble instance of true friendship is represented in the death of Christ. This is the kind of friendship that is of value. A friendship that is not willing to give and do more than it receives is base in- deed. To the man whose mind is indeed aright, there is no pleasure so great as the consciousness of having done a good ac- tiOn. The incense of prayer and praise is doubly fragrant when performed by deeds of benevolence and kindness. 0 how much we all need a brother's helping hand! We start on life's voyage down the stream of time-the banks are strewn with flowers- we do not see the hidden thorns-, -e do not inhale the lurking poison-we glide on gently, the distant mountains bright with hope, and all beyond an expected Paradise. But will the stream be always smooth Shall we not feel the thorns Shall we not inhale the poison How cross the mountains The pilgrim's staff may break in ascending the rugged heights. 122 OF THE PHYSICIAN. How welcome then a brother's hand to ease us a little of our burden. " Teach me to feel another's woe, To hide the fault I see; That mercy I to others show, That mercy show to me." How sacred should be that tie of friend- ship which binds the physician to his fel- low, no one can know or feel until ex- perience has taught the lesson and left its impress indelibly engraven upon the heart and memory by a lifetime of toil, of care, of privation, of want, of anxiety, of per- plexity and a hundred other ills conse- quent upon, and the attendants of, his professional life. Unhonored and unsung must he commence the struggle for recog- nition and maintenance, for conquest, de- feat or victory. Years of poverty, years of severest toil, years of study, onward must he go midst heat and cold, midst storms of adversity, with but an occa- sional gleam of sunshine to cheer him along life's rugged thorn-strewn pathway; uncompensated, unappreciated, a mendi- cant, a slave, to obey the behests, com- 123 124 SUNSHINE AND SHADOWS mands, dictates and calls of every one, however ungenerous, unappreciative, or ignoble, and life itself may prove the sac- rifice in the discharge of his professional duties. To whom then must we look, aye, from whom expect condolence, sympathy and a just regard, if not from those who travel the same rugged, thorn-strewn path- way; if not from our own brotherhood, who by sad experience have been taught these terrible truths As to the duties and obli- gations, no man, least of all a member of the medical profession, who should be en- dowed with ordinary intelligence, need be misguided or misdirected; neither need he misinterpret or misunderstand his profes- sional duties to his brethren. It may all be summed up in one scriptural injunc- tion: "Do ye unto others as ye would that others should do unto you." Charles Kingsley says: "Do noble tbhings, not dream them all day long,- And thus make life, death, and the vast hereafter, One grand, sweet song." The dissensions, the animosities, the pro- fessional jealousies, the bickerings, the OF THE PHYSICIAN. distrust and disfavor among us, lead the public to question our sincerity, capacity and integrity, conserve to our own hurt and injury, lessen us in the public confi- dence and esteem, weaken our cause, and bring reproach and obloquy upon the science we should love, honor and cherish. They bring unkindly and ungenerous feel- ings, pervert our judgment, warp and dis- tort our sense of justice, deaden the kind- lier and finer feelings of the soul, and burden us with a load of prejudice, avar- ice, greed and professional distrust that will oppress us, and lower our chosen profession. Let us suffer ignominy and contumely ourselves and forever remain unrecognized by the world rather than betray the confidenice imposed in us by a professional brother. Let a spirit of fair- ness, of justice, of right prevail; let it actuate us in all our professional inter- course with each other. Rather suffer wrong ourselves than to inflict it on those who call upon us to share their burdens and responsibilities. Then will the shadows of discontent flee a-way, and the cheering sunlight of pro- 125 126 SUNSHINE AND SHADOWS fessional peace and prosperity dawn upon us, to light our pathway, lighten our burd- ens and gladden our lives; and smiles will come oftener than tears, joy oftener than grief, and many a cheerful ray of glad sunshine will burst through the clouds of a stormy sky, and hope itself will find the unknown quantities of time in the equa- tions of eternity. " There are green isles in each ocean, O'er which affection glides; And a haven on each shore, When love's the star that guides." OF THE PHYSICIAN. CHAPTER VI. MEDICAL ETHICS. "The noblest lesson taught by life To every great, heroic soul, Who seeks to conquer in the strife, Is self-control." Webster defines Ethi-,s-the science of morals, manners, conduct and deport- ment. There are many pretty, engaging little manners which every person may "put on," without the risk of being deemed either affected or foppish. The sweet smile, the quiet, cordial bow, the earnest move- ment in addressing a friend, or more es- pecially a stranger, whom one may recom- mend to our good regards, the inquiring glance, the graceful attention, which is 127 128 SUNSHINE AND SHADOWS captivating when united with self-posses- sion-these will insure us the good regards of even a churl. Above all, there is a cer- tain softness of manner which should be cultivated, and which, in either man or woman, adds a charm that almost entirely compensates for lack of beauty. The voice may be modulated so to intonate that it will speak directly to the heart, and from that elicit an answer; and politeness may be made essential to our nature. Neither is time thrown away in attending to such things, insignificant as they may seem to those who engage in weightier matters. Such things enter largely into the make up of a gentleman-an ideal physician- Let us ever bear in mind that the real gentleman is not be who displays the la- test fashion, dresses in extravagance, with gold rings and chains to display; not he who talks the loudest, and makes constant use of profane language and vulgar words; not he who is proud and overbearing, who oppresses the poor, and looks with con- tempt on honest industry; nor he who cannot control his passions, and humble himself as a child; but it is he who is kind OF THE PHYSICIAN. and obliging-who is ready to do you a favor with no hope of reward; who visits the poor, and assists those who are in need; who is more careful of his heart than of the dress of his person; who is humble and sociable-not irascible or re- vengeful; who can always speak the truth without resorting to profane or indecent words. Such a man is a true gentleman wherever he may be found. Rich or poor, high or low, he is entitled to the appella- tion. "What's a tine person, or a beauteous face, Unless deportment gives it ease and grace With every other requisite to please, Some want the striking elegance of ease." By medical Ethics, we inea l medical manners-professional conduct and de- portment among those engaged in the pro- fession of medicine. " Sincerity and plain- dealing" (sincerity of heart and honesty of purpose) should ever distinguish us. Medical ethics should be taught in all Medical Colleges, especially during the sen- ior year of the student. We will notice first the Ethics of Consultation. 129 SUNSHINE AND SHADOWS Consultations are held (1) at the re- quest of the friends to satisfy them that everything possible is being done for the patient; or (2) at the request of the phy- sician for his help and guidance and to protect himself, if necessary. Every reg- ular physician ought to be willing to con- sult with another regular physician, when asked to do so by the friends. There can be nothing to lose by it, if the consultant is a gentleman, and if he is not, it is bet- ter to know it. If the family physician asks for consul- tation he should take care that his con- sultant be properly rewarded for his work. and since the physician in charge of the case would have to make a definite ap- pointment, he will be justified in doubling his usual fee for calling. The physician having the case should first tell his con- sultant or consultants all he knows about the case that will help them; he ought to know more than they could learn from one examination, and will doubtless be possessed of information they will not be likely to glean. The attending physician should be the first to propose the neces- 130 OF THE PHYSICIAN. sary questions to the patient, after which the consulting physician should have the opportunity to make such further in- quiries of the patient as may be necessary to satisfy him of the true character of the case. After this the patient should be examined by the attending physician and consulting physician or physicians. They should then retire to a private place to calmly and deliberately discuss the case; and the physician's privilege of secrecy should be strictly adhered to in this dis- cussion. The friends have a right to know the result, but they have no right to pry into the discussion of the case. If neces- sary, the patient should be re-examined before a decision is made. "In consultations no rivalship or jeal- ousy should be indulged; candor, probity, and all due respect should be exercised toward the physician having charge of the case." (Code of Ethics Article IV. Sec- tion 2). Differences of opinion should be freely discussed at this time, and not on meeting the friends. It is not courtesy for either the attending physician, or the consultant, to hold private interviews with 131 SUNSHINE AND SHADOWS the friends or relatives of the patient. "In consultations, theoretical discus- sions should be avoided, as occasioning perplexity and loss of time. For there may be much diversity of opinion con- cerning speculative points, with perfect agreement in those modes of practice which are founded not on hypothesis, but on experience and observation." (Code of Ethics Article IV. Section 6). The consulting physician should ever observe the greatest caution in his manner and conduct during consultation. " We may try to evade it, May do what we will, But our acts, like our shallows, Will follow us still." He should not by word, look or gesture, show a sign of disapproval in the treat- ment pursued; but, on the other hand, should consider himself bound by duty and honor to share equally in the respon- sibility-in the credit of success or in the censure of failure. The result of the con- sultation should be communicated to the family through the attending physician, 132 OF THE PHYSICIAN. and the consultant or consultants should express their confidence in the physician's ability to manage the case, collect their fees, and depart. The physician should be very careful in making the so called friendly visits to a pa- tient in charge of another physician; but, in the case of a relative, or a near friend, or neighbor, where common courtesy, ci- vility and good citizenship, require visits of this kind, he should never converse on the subject of the patient's disease, or on its treatment. The reason for this is ob- vious, as an observation or remark may be made without any intention of interfe- rence, which may destroy or shake the confidence in the course he is pursuing, and cause him to neglect the directions prescribed. The physician occasionally meets with the self-constituted doctor or doctress- Romo sapiens-there is scarcely any com- munity, but is infested with one or more of these evil genii, who always pretend to possess infallible remedies for every dis- ease. Don't enter into a quarrel with them about the merits of these great death 133 184 SUNSHINE AND SHADOWS robbers, pain annihilators, etc., you can't afford it; but let them enjoy that peace- ful state of mind that is so congenial to man's happiness. " When ignorance is bliss, Tis folly to be wise." But never allow your patients to be per- suaded to take any medicine or any rem- edy prescribed by this class of persons. However simple their preparations may appear to be, it often occurs that they are the cause of much mischief, and in all ca- ses they are harmful by being an obstruc- tion, and an opposition to the plan of treatment adopted by the physician. The physician should always make it his duty to instruct his patients along the line of ethics. Teach them never to send for a consulting physician without the express consent of their own medical attendant. And no physician should respond to such a call, unless he knows it is perfectly agreeable to the attending physician. Should a physician be discharged by his patient, he has a perfect right to demand the cause or reason of his dismissal, and OF THE PHYSICIAN. also should demand a settlement-either by cash or note. The physician should impress his pa- tients with the fact that they are as badly in need of his services as he is of their money. No physician should ever visit the patient of another physician in his absence, except it be at the request of the attending physician, or in case of emer- gency. Professional enmity of the most bitter nature has been caused between physicians, that lasted through life, from the failure to exercise due caution and respect in regard to this matter. " He that is respectless in his courses, Oft sells his reputation at cheap market." The physician should never allow him- self to be engaged in too many things at the same time. The study and practice of his profession should claim the greater portion of his time. It would not be ad- visable for him to devote more of his time to the politics and religion of his com- munity than to his profession. Should he desire to engage actively in politics, and to become a " political hustler " or a 135 SUNSHINE AND SHADOWS " ward-heeler," he should lay aside the cap and gown of Hippocrates and don po- litical costume, that he may enter the arena, "properly clothed." The true phy- sician practices christianity every day of his life; although he may not be one of the brethren in the church sense, he stands higher than those who make empty pro- fession. Whether you regard him as a man or a physician-the servant of the people-you will say of him, ' well done; thou hast served thy fellow-men well," and to say that, in this our passing day, is to pass a high encomium upon worth and character. While it is the duty of the physician (and every other good citizen) to study the Holy Word, and attend church when convenient, it would not be prudent for him to lay aside his medical studies, and engage in the endless discuns-in of innu- merable sects, creeds, denominations, dog- mas and heresies of men, which have done, and are now doing the cause of true chris- tianity more harm than all the writings and teachings of Tom Payne and Bob In- gersoll combined. However, should the 136 OF THE PHYSICIAN. physician find that he has made a mistake in life, by getting into the wrong profes- sion, and prefer that of the clergy, he should at once abandon that of medicine and turn minister. It has been said that a man cannot serve two masters at the same time; that he will love the one and hate the other. Remember, that " the more reserved, the more observed," and that ''true worth is in being, not seeming." It has been said that the physician be- ,comes so accustomed to suffering and death that he looks upon them only as a necessary result of the process and end of physical organization. So far as the ma- terial body is concerned, his knowledge of the laws regulating its mechanism teaches him the necessity and certainty of its de- cay, but his knowledge of the mechanism of that body also teaches him that life is something more than a mere manifesta- tion of forces on a physical organization, and that death is more than the decay of matter. His constant association with suffering and death teaches the physician to appreciate sorrow and bereavement, and his sympathies go out to the bereaved 137 138 SUNSHINE AND SHADOWS ones when his ministration to the sick is at an end. When the fear of death enters the household, it may be for the occupant of the cradle, or for that of the easy chair by the window, an appeal is made to stay its relentless grasp. None know the force of the appeal so well as the physician, as he realizes the responsibility of the confi- dence imposed. The knowledge of duty well done is the whispering approval of an aspiring conscience which is the vision of the touch of God with the hidden treas- ures of the soul. Then let us abide in the work, do the right as it is given us to know the right, that an approving conscience may be ours when life's work is ended, and as we ap- proach the twilight of existence may we not be melancholy and dejected, but joy- ous in contemplation and satisfied in re- flection;- " And leave behind us, freed from grief and fears, Far nobler things than tears, The love of friends, without a single foe- Unequaled lot below." OF THE PHYSICIAN. 139 CHAPTER VII. MEDICAL SOCIETIES. "But Knowledge to their eyes her ample page, Rich with the spoils of Time, did ne'er unroll; Chill penury repressed their noble rage, And froze the genial current of the soul." -GRAY. [Paraphrase-But they had no school or college privileges. Poverty and want prevented them from carrying out their exalted aspirations-lofty ambitions, and chilled and restrained the flow of their activities, as frost checks the current of a stream by freezing it.] At the time the above stanza was writ- ten, and to whom the allusion was made (The Rude Forefathers of the Hamlet) it was no doubt true, but a century and a half of time has rolled into the eternal past, and we now stand upon a plane of existence where poverty and want no long- Should this explanation seem unnecessary, or excessively elementary-even puerile-to certain readers, they must remember that the poem from which this stanza is taken is so full of artistic perfection as to be utterly beyond the reach of most people when they read it first, and of a great many when they read it last. W. L. L. SUNSHINE AND SHADOWS er repress our noble rage-crush out our noble desires. Good books are cheap, and schools are within the reach of everyone, no matter how indigent his circumstances. Channing says: " In the best books great men talk to us, give us their most precious thoughts, and pour their souls into ours. They are the voices of the dis- tant and the dead, and make us heirs of the spiritual life of past ages. Books are the true levelers. They give to all who will faithfully use them the society, the spiritual presence, of the best and greatest of our race." It matters not how poor you are-it matters not, though the prosperous of your own time will not enter vour obscure dwelling-if the sacred writers will enter your humble dwelling and take up their abode under its roof, if Burns will cross your threshold to sing to you the songs of his native land-of the Doon, the classic Doon, or Hermit Ayr, and Alloway Kirk, and Moore to soothe and cheer you with his Irish Melodies, and Milton to sing to you of Paradise (Lost and Regained), and Shakespeare to open up to you the worlds 140 OF THE PHYSICIAN. of imagination, and the workings of the human heart, and Franklin to enrich you with his practical wisdom-you will not pine for want of intellectual company, and may become an educated man, though shut out from what is termed the best so- ciety in the community in which you re- side. "From every lowly cottage roof, However poor and brown, From every dusty hovel points A hand at glory's crown." There was a period in the history of this country when the stanza cited above, from " Gray's Elegy," could have been applied with equal force and propriety to the phy- sicians of the day, as to the rustic, unpol- ished Forefathers of the Hamlet. But since that time there have been wonderful changes-mirabile visu [wonderful to be- hold]. There were then few books, fewer medical schools, and medical societies were unknown. But at this our passing moment, books are within the easy reach of all, medical colleges abound on every hand, and there is scarcely a county in any State in the Union, but that has its 141 142 SUNSHINE AND SHADOWS medical society. There has never been a time when facilities were greater, oppor- tunities more convenient, or circumstances more favorable, for acquiring a thorough scientific training in the healing art than at the present. The physician should immediately after his graduation become a member of some medical society. He should pursue his studies continuously, and in no way can this be done better than by associating himself with his brethren in a medical so- ciety. Earnestness in the pursuit of knowl- edge is the key-stone to its acquisition. The public judge us by the interest we take in our own business, and the profession judges us by the results achieved. We should try and make ourselves worthy the good opinion of both. If to our earnest- ness of purpose to increase the interest in the work of the society, we add the laud- able ambition of attaining success in our profession and to assist in the advance- ment of medical science, surely our efforts will not fail of approbation, and we will be honored and respected by all those OF THE PHYSICIAN. around and about US, for the good within US. " Oft 'mid the forest's deepest glooms, A bird sings from some blighted tree; And in the dreariest desert blooms A never dying rose for thee." To the physician the medical society has a theoretical, a scientific, and a prac- tical interest. Theories in medicine as in law, politics and religion, may bge said to have governed the ultimate progress of the science since the days of Hippocrates. Many of them were conceived in ignorance and born in superstition, which the light of centuries has not obliterated. Some have been heralded forth as great discov- eries, and believed in Lintil displaced by others apparently more rational, while a few have been followed to a logical con- clusion by pains-taking study and experi- ment, and produced the grandest results in the world's history. The science of medicine relates chiefly to the work of reducing knowledge of its various branch- es to principles, that it may be applied to practice. This knowledge depends largely upon 143 SUNSHINE AND SHADOWS observation and experience in the practice of the art. The practice of medicine is the art of healing the sick, and upon its successful application depends the fame and fortune of the physician. The well regulated medical society is the place where all these topics may be discussed and men studied as well as med- icine; there we find the theorist, who al- ways has a reason for the faith that is in him; there we find the scientific man with- out practical methods, and the practical man without scientific methods. There we study the methods and character of the successful man, as success is measured, and perhaps gain an insight that will en- able us to apply the results to our own lives. Not only does a medical society benefit and improve its members, but it secures public appreciation and gives tone to the entire profession. It stimulates to personal investigation and in many other ways contributes to the advancement of medical science. The physician should not only associate himself in a medical society, with his professional brethren, but he should labor earnestly in its inter- 144 OF THE PHYSICIAN. est. The only way to make a society of interest is to get interested in the society. And the only way to accomplish this is to do that which is of interest to the mem- bers and to the profession at large. " No endeavor is in vain; the reward is in the doing, And the prize the vanquished gain, is the rapture of pursuing." When God walked with man in the Garden of Eden, then and there he was taught unbounded love for all things cre- ated, and holy reverence for the Being who created them. Purity and holiness were attributes of the mind. As the blood coursed through his veins, untainted by disease, so thought traversed the mind and moved the soul, unpoisoned by the touch of evil. As the earth poured forth her treasures unbidden, for his corporeal na- ture, so Heaven, through ministering an- gels, supplied, direct, his spiritual aliment. Man walked forth in the image of his Maker-perfect in form, in feature and in mind. There was harmony in all things -the carol of the bird, the plash of the waterfall, the roar of the lion, the bleat of 145 SUNSHINE AND SHADOWS the lamb. The softest zephyrs stirred the forest leaves, and the moonbeam was un- broken as it rested on the streamlet. Beauteous and gladsome was the face of nature-all things were subjected to the dominion of man's will-all made subser- vient to his interests and enjoyment. He felt no physical pain-he suffered no men- tal anguish; the burning heat and the biting cold-the excitement of hope and the bitterness of despair, were alike un- known to him. A created being, he held converse with his God. Yet he felt a void within-a want unsupplied. Humanity yearned after human sympathy. "It is not good for man to be alone!" So a helpmeet was provided-the family rela- tions were established, and thus was fore- shadowed what, to the end of time, is to be a necessity of humanity. " A law of strange attractive force, That holds the feelings in their course; It is a presence undefined, O'ershadowing the conscious mind, Where love and duty sweetly blend To consecrate the name of friend." The world grew older and sons and 146 OF THE-PHYSICIAN. daughters became its denizens. The wing of the evil one had overshadowed the pure and perfect one. The carol of the bird is hushed by the snare of the fowler. The lion no longer crouches at the feet of his master. The thunder of God's wrath had been heard crushing amid the forest trees, and the lightning of his eye had withered the tall cedars. The heart of man had become a volcano of passions, which ever and anon burst forth in devastating fury. Ambition looked for a field to play her part in, and the hand of man had been raised against his brother. How changed -how changed the face of nature, once so beauteous and gladsome! The trail of the serpent has left its mark upon all things created; yet still men cling together, as those who have a community of interest and feeling. Patriarch and people, chief- tain and tribe, are one and undivided. They feel pressing upon them, as with an iron hand a necessity of humanity,- "A love for sickness and for health, For rapture and for tears; That will live for us, and bear with us Through all our mortal years." 147 SUNSHINE AND SHADOWS Man feels pressing upon him a necessity of humanity; and thus associations are formed of those who can harmonize in pursuits and feelings. They unite for mutual support and encouragement-for intellectual improvement and for social enjoyment. This principle is coeval with the creation of man, and was instituted ill the Garden of Eden. To this principle of nature we trace the origin of all our or- ganizations and societies. Yet a large portion of mankind are ever wont to decry the good in them. But such is the frailty of man. " To err is human, to forgive divine. " The most colossal form of human con- ceit, probably, is that of the individual who thinks all other creatures inferior who happen to be unlike himself. We all know and feel the influence of associations-how productive they are of either good or evil. In our professional gatherings, the habit is acquired of think- ing well of our neighbor, and this is the first step toward seeking to do him good. We learn to look upon our fellow-worker, not as one who can be used to advantage, 148 OF THE PHYSICIAN. but as one who has claims upon our sym- pathy and kind offerings. In our pilgrimage we should ever teach humility; and there is no better way of teaching it than by its daily practice. If nature has endowed one with superior gifts, he should use them for the benefit of his fellow-laborers; but not by unnec- essary display to excite jealousy and envy. True merit is never obtrusive, nor does it ever go without reward. The lowliest flow- er often exhales the sweetest perfume, and is the especial object of the naturalist's care. At our medical societies we meet at the fountains of Truth and Brotherly Love, and for a brief period, muse beside the still waters. How refreshing thus to come together and interchange friendly greet- ing, and exchange friendly ideas; renew our faith, add hope to hope, strengthen our friendship and unity; how pleasing to feel that when the tocsin is sounded for the procession to move onward, we are to march together, hand in hand, through the remaining portion of our pilgrimage, lessening each other's hardships and shar- 149 150 SUNSHINE AND SHADOWS ing each others' responsibilities; or, in the language of the poet Schiller; "Have love. Not love alone for one, But man as man thy brother call, And scatter like the circling sun, Thy charities on all." Though we do not hold the key to the Book of Life, we can bring the sunshine of hope and comfort to the home of the sick and suffering, smooth many of the wrin- kles of care and lessen its sorrow. There are two hours in life's history in which the physician is appealed to as one bearing a sacred mission-the hour of travail and of death. In the agonizing wail of labor anticipating motherhood we rec- ognize the voice which gave to the world and humanity that priceless treasure-a mother's love, the love which impels her to scold and then take to her bosom and kiss the small tot in the nursery and wel- come to her home, her arms and her heart, the wayward son of manhood's years, though his hands are colored with the crimson of murder. It is in this hour the physician may have the responsibility of OF THE PHYSICIAN. holding two lives in his hand-one bear- ing the fruits of maturity and love, the other cast helpless upon the ocean of life, as a jeweled petal blown from the rosary of God, an unblossomed bud of humanity. The grandeur of motherhood, the com- plete fulfillment of law in the design of Nature, the beauty of helpless innocence of the child-that immaculate seal upon the altar of love-all conspire to unite in an impressive appeal to the duties of the occasion. To be instrumental in the sav- ing of life at this moment, is a trust wor- thy the greatest of human efforts. Surely a life of unselfish devotion to the cause of humanity would make him a fit companion for the gods. "To such a life there is no death; What seems so, but transition. His life, his mortal breAith Was but a suburb of the life elysian Whose portals we call death." 151 152 SUNSHINE AND SHADOWS CHAPTER VIII. PILGRIMAGE OF THE PHYSICIAN. STAGES: YOUTH, MANHOOD AND OLD AGE. SECTION I. YOUTH. "Man's life's a book of history; The leaves thereof are d(ays; The letters, mercies closely joined, The title is God's praise." -MASON. In Youth, as Medical Students, we should industriously occupy our minds in the acquisition of useful knowvledge; in Man- hood, as Physicians, we should apply our knowledge to the discharge of our respec- tive duties to God, our patients and our- selves; so that in Old Age, as Retired Physicians, " we may enjoy the happy re- OF THE PHYSICIAN. flection consequent on a well-spent life, and die in the hope of a glorious immor- tality. " A Pilgrimage has been defined by Web- ster as "A journey to a place deemed sacred." Life has been termed by some a pilgrimage, and perchance no term could be chosen more expressive of its uncertain- ty, dangers and hopes. It bears us on like the current of a mighty river. Our boat at first glides down the narrow channel through the playful murmurings of the little brook and the windings of its grassy borders. The trees shed their blossoms over our young heads; the flowers on the brink seem to offer themselves to our young hands; we are happy in hope, and we grasp eagerly at the beauties around us; but the stream hurries us on, and still our hands are empty. Our course in Ydnth and Manhood is along a wider and deeper flood, amid objects more striking and mag- nificent. We are animated by the moving pictures of enjoyment and industry pass- ing before us; we are excited by some short-lived success, or depressed and made miserable by some equally short-lived dis- 153 SUNSHINE AND SHADOWS appointment. But our energy and our de- pression are both in vain. The stream bears us on, and our joys and griefs are alike left behind us. We may be ship- wrecked-we cannot be delayed; whether rough or smooth the river hastens to its home, till the roar of the ocean is in our ears and the tossing of the waves is be- neath our feet; and the land lessens from our eyes, and the floods are lifted up around us, and we take our leave of earth and its inhabitants, until of our further voyage there is no witness save the Infinite and the Eternal. "Thus mnan, the sport of bliss aid care, Rises on Time's eventful sea; And having swe]Fd a moment there, Thus mnelts into eternity." Marcus Aurelius once said to a friend, who was exhausting his breath upon the unequal distribution of the favors of the gods-" It is not in your power to become a great natural philosopher, a poet, a mathematician, an orator, or an historian; but it is in your power to be an honest and virtuous man, which is far superior to them 154 OF THE PHYSICIAN. all. Use well the gifts the gods have given thee, and leave off repining at the good they have denied. For the very talents thou sighest after are far from conferring happiness on their possessors." Inter silvas academi quwerere verum-as the poet says: to search out truth through academic groves may be a very pleasing, but often is a very unprofitable occupa- tion. The splendor derived from success- ful studies seldom repays the occupant for the lassitude and exhaustion of the mind- the feverish debility and throb of nervous excitement which thrill through all his frame. The peasant in his cot perhaps has more real enjoyment, and certainly has more peace and calm contentedness than the philosopher, crushed to an un- timely grave by the very magnitude of his studies. You may behold the scholar pale over his midnight lamp, and far distant the golden dreams of honor and applause, which he is never destined to realize. How disconsolate is the condition of an intel- lectual being, who thus suspends his hap- piness on the praise and glory of the world 155 SUNSHINE AND SHADOWS "If every one's eternal care Were written on his brow, How many would our pity share, Who share our envy now." The good Aurelius gave an advice wor- thy of being inscribed in letters of gold. He who places his heart on material ob- jects, or expects to draw the streams of consolation from the resources of the world, must be exposed, in every vicissi- tude, to the keen pangs of anguish. The slightest calamities will disquiet and trou- ble his soul. In adversity he is cast down, and every stay on which he leaned for succor, like the infidelity of Egypt-as a broken reed-will pierce him to the heart. From the gay and lofty summit of his pride and presumptive daring, he sinks to the deplorable level of his own weak and worthless presumption. Qt nntum mutatus ab illo-is that sunken hopeless condition. The glory of the world, uncertain as it is, is not within the grasp of many minds. And even those who are able to seize the gay and gilded prize, it stings in the very embrace, and perishes in the enjoyment. 15B OF THE PHYSICIAN. "The thoughtless world to majesty may bo w, Exalt the brave and idolize success; But more to innocence their safety owe, Than power or genius e'er conspir'd to bless." But the path of virtue that leads to happiness on high lies open to every traveler; and he can neither be mistaken in his course, nor disappointed in his ac- quisition. He has with him, and around him, in the darkest hour, in the lone desert or the crowded city, a Being who knows his pain, and hears every sigh of his com- plaints. He made the soul and is able to delight and ravish its inmost faculties, with the communication of joys unspeak- able. How noble was the sentiment expressed by Sir Isaac Newton. Speaking of infinite space he said " It was the sensorium of the Deity;" as if a fibre touched, in the most minute, remote, or worthless of all his creatures, could move the spirit of the eternal Godhead. This view of his power and his providence inspires the heart with a holy hope and high dependence, far above the influence of a troubled and a fleeting world. 157 SUNSHINE AND SHADOWS Queen Elizabeth, when her triumphant fleet had swept from the briny deep the invincible Armada of Spain, had medals struck, with this most beautiful and ap- propriate motto: Afflavit Deus, et dissipan- fur, "God blew with his wind, and they were scattered." How exalted the thought I The belief of a divine and superintending Providence taking care of us and our con- cerns, elevates and ennobles the mind. It transports a mortal creature to the high and holy meditations of angelic beings, and fills the soul with the purity and peace of heaven. " There is a home for weary souls, By sin and sorrow driven; When tossed on life's tempestuous shoals, Where storms arise and ocean rolls, And all is drear-'tis heaven." The young physician, starting out in the morning of his professional pilgrimage, finds many, many things that try his pa- tience and trouble his soul. It would re- quire a volume to enumerate all of them. He has to deal with the whims and fan- cies, not alone of the patient, but of many of his or her friends, who perhaps mean 158 OF THE PHYSICIAN. well in all things, but lack materially in discretion and judgment. He has been a close student, has improved his oppor- tunities, and is well posted-really knows a good deal, possibly more than he will a few years hence. His daily work will bring him in con- tact with empty heads and emptier hearts. Business and social exactions will present themselves and demand attention. Men there are who, not appreciating their own time, will not hesitate to rob him of his. He is often compelled to give an unwilling ear to the endless tale of woe of some one who has a grievance-fancied or real. Happy will it then be for him whom a habit of self-reliant introspection enables to find food for thought in a mental store- house of facts, or whose imagination, cul- tivated by a close acquaintance with the poets, endows him with power to draw from natural sounds and sights melodies that soothe, pictures that please, and in- struction. that adds both strength and skill, to acquirements already filled with power. 159 160 SUNSHINE AND SHADOWS " The wisdom of the present hour Makes up for follies past and gone; To weakness strength succeeds, and power From frailty springs;-Press on! Press on!" He has the vigor and enthusiasm of youth about him, and his sheepskin, beau- tifully mounted within a gilded frame, adorns the office wall. He feels that " The cock's shrill clarion, or the echoing horn " of fame is waiting for him just around the corner to sing for him her triumphant songs of praise and glory; and as he muses on the morning of his life, his imagination is wrought up to a point where he believes the songs sung are iden- tical withl those that will be produced by the gentle zephyrs from the Elysian fields, playing through the tops of the trees of Paradise. He has to come in contact occasionally with the veteran doctor whose degree was given in the year 1, and whose diploma was attested by the names of Hippocrates. Galen and Sydenham. He has occasion- ally to come in contact with the quack, and the unprofessional-the sneak-thief. He is unavoidably thrown in consultation OF THE PHYSICIAN. with him, and often has to witness and bear many things that are both humilia- ting and shocking to true professional dig- nity. For instance, in diseases of the chest, this evil genits will percuss at once, to make the patient believe that he is re- ceiving his share of the grand tabiuluun of human knowledge, of which he imnagines that he possesses a very large am-ioutnt. He demonstrates that a body filled with air will make a louder and clearer sound than a solid one. Having duly impressed this fact upon the patient, he proceeds to be- labor hiuma with his fingers, and then comes auscultation. The glory of this procedure is enhanced, if the entire family and neighbors of the patient sit near by. Hav- ing spent the requisite time in listening to the sonorous rales, he straightens up, carefully removes the instrument from his ear, waves it in the air a few times, and then proceeds to give the patient, friends and neighbors, a lecture on the crepitant and suberepitant rales, metallic tinkles, friction sounds, winding up with " am- phoric resonance," for the sake of its K 161 SUNSHINE AND SHADOWS sweetly rolling sound. But it knocks the rales, ronchi and bruits all "sky high" when the head of the house, the patient's spokesman, says to the young physician; " Doctor, I ask you to take charge of the patient." The young physician of this day and time will never be a dude, for- " A dandy is a thing that would Be a young lady, if he could; But as he can't, does all he can To show the world he's not a man." He can't afford to countenance this sil- ly affectation in himself or in any one else. But he is going to do some good in this world, mitigate its pain and sorrows, and help the sunshine to linger a little longer. All honor to him. We who have grown gray in the harness will give him the right hand of fellowship wherever we find him, and cordially welcome him to the ranks of the profession. In his rosy fancy a fortune, oftentimes, is awaiting him. A few fees already collec- ted assure him of that, and the bills come in and pile up very high in his imagina- tion. Honor will be bestowed upon him, 162 OF THE 'PHYSICIAN. for is it not far better to be a professional man, than an overworked mechanic or clerk like his relatives before him Thus to-day he puts forth the tender leaves of hope; to-morrow may they bloom; and may he bear his blushing honors thick up- on him, is our fervent wish. For the pro- fession at large, I bid him God Speed! To many, no doubt, love's gentle dal- liance has already given power to see a rainbow in an Oriental or an Occidental, or a Northern or a Southern sky, and painted all sunrises with the golden efful- gence of hope and promise. Those who have yet in store what has been aptly termed " the enchantment of human life " can doubtless draw, without assistance, pictures of what is to be, when some fond face lingers at the cottage window and awaits your gentle step; when, in a home made by your intellect and builded by your hands, you have coined your heart into currency of happiness, and with the extravagance of a spendthrift reck neither of yesterday nor to-morrow; when with the sweets of domestic life you live over again the home life of early youth, and 163 164 SUNSHINE AND SHADOWS fond memory, with its enchanted scroll, "Rich with the spoils of Time," gives form and color to a thousand joys of the past, while hope fills the future with con- tentment, love and plenty, and all other rewards of honest industry and exalted aspiration, and like the humble dweller of the cottage, whom the poet, Burns, so graphically pictures in The Cotter's Satur- day Night, when- "At length his lowly cot appears in view, Beneath the shelter of an aged tree; Th' expectant wee things, toddlin ', 'stacher through To meet their dad, wi' 'flichterin' noise and glee. His wee bit single, blinking bonnily, His clean hearthstone, his thriftie wifie's smile, The lisping infant prattling on his knee, Does a' his weary 'kiaugh and care beguile, And makes him quite forget his labor and his toil." 'stagger. 'fluttering. 'fire-place. 'anxiety. OF THE PHYSICIAN. PILGRIMAGE OF THE PHYSICIAN. SECTION II. MANHOOD. "I saw from the beach, when the morning was shining, A bark o'er the waters move gloriously on; I came, when the sun o'er that beach was decli- ning,- The bark was still there, but the waters were gone! Ah! such is the fate of our life's early promise, So passing the spring-tide of joy we have known; Each wave, that we danced on at morning, ebbs from us, And leaves us, at eve, on the bleak shore alone." -MOORE. Our next view is that of the middle- aged physician, who has been in active practice a score of years. We gently alarm the outer door and quietly enter his office. We find him in a deep reverie; he is mu- sing on his life. Many of his youthful dreams have failed to materialize. Things are not so rosy as when he first set out on his pilgrimage. His memory reverts to the evening of the commencement; when proud and hopeful he stood, for the last time, with the boys of his old class, and 165 166 SUNSHINE AND SHADOWS received his degree. He hears the sweet strains of music, and sees the beautiful flowers that enlivened and adorned the hallowed occasion.; and perceives the feel- ings of delight with which he received the beautiful wreath, woven by fair hands, unseen; and "The sweet song died, and vague unrest, And a nameless longing filled his breast." The wreath of flowers is faded and gone; its holy dust was scattered long ago; " 'twas dying sure but slow, just as she died" who gave the wreath, "some twenty years ago." As he muses, he stands again in the cool and dusky silence of the old college building-venerated Alma Ma/er, with its air of stately age and its familiar odor, while the light of the occidental sun, broken into rays of gold and ruby, streams through the great painted windows, and softly falls upon the old museum, filled with pictures and bones, quaint-looking jars, and unspeakable effigies; and look- ing forth through the great arched door, he sees the dark and melancholy boughs of the dreaming cypress tree, and nearer, OF THE PHYSICIAN. in a shadow of rippling leaves in the clear sunshine of the door-way path arise before him the phantom forms of the departed- his beloved teachers-and he feels a strange desire to meet them there again and talk to each, face to face, "as a man talketh to his friend." But alas! how futile is this. Yet, perchance, ere long we shall meet in a distant realm, where, " The crooked shall become straight, and the rough ways smooth." Where: " When the mists have cleared away, We shall know as we are known." Thus, as he continues to muse on these hallowed associations, amid this mourn ful beauty, the picture of the college building is photographed in his memory, wihile every tree that waves its branches around it, and every vine that clambers on its surface, seems to clasp it in the arms of love. Nothing breaks the silence but the sighing of the wind in the great Yew tree, near the door-way, beneath which often was his favorite seat, and where the brown needles, falling through many an autumn, have made a dense carpet on the turf. 167 SUNSHINE AND SHADOWS Now and then there is a faint rustle in the ivy, a fitful bird-note serves but to deepen the stillness; from a rose tree close by a few leaves flutter down in soundless bene- diction on the dust beneath. He hears again the fond farewells and tender vows of parting classmates; but it avails him nothing now to linger longer at the shrine. It was a sad parting, but never, while memory lasts, can it fade out of the heart; and the memory of the place, with its hallowed associations, can never be des- poiled of its loveliness; and as he awakes from his reverie, the following beautiful lines of Lord L.ytton, come uncalled across his mind: " There is no death! the leaves may fall, And flowers may fade and pass away; They only wait through wintry hours, The coming of the May." ihe physician belongs to that calling which bears more responsibility than all others combined. He thinks a little dif- ferently now of the mechanic or clerk, whose day's work ends with the setting of the sun. He realizes that he has chosen 168 OF THE PHYSICIAN. the most exacting of all vocations. There is scarcely a moment that he can call his own. Night and day he is at the beck and call of his constituency-a slave, to obey the behests, commands, dictates and calls of all-regardless of age, sex, race or color, " or previous condition of servitude." He is made to feel the force of the query expressed by the poet Burns: " If I'm design'd yon lord]ing's slave- By nature's law designed- Why was an independent wish E'er planted in my mind " The lawyer has months in which to pre- pare his briefs; the parson abundant time for his sermons, but the physician must be ready ini an instant for any and all emergencies. He is a teacher of hygiene by precept only; for his life-broken rest- irregular meals, exposure to storm, infec- tioIl and accident-necessarily render it impossible for him to observe or to prac- tice that which he teaches. During his years of practice, his former library, which possibly numbered only half a dozen volumes, has grown into a full 169 SUNSHINE AND SHADOWS case, many of them with time faded backs, and here and there a new work on some special subject shox ing itself. His sign is fast becoming a victim of rust and time, and his sheepskin with its gilded frame now reposes in the garret. There are some old batteries and a surgical apparatus or two up there also, that worked well once; especially, in the hands of the gentleman- ly instrument dealer, who sold them to hi m. His account-books-day-book and led- ger, are near at hand, and ever ready to sing to him the names of a multitude of " promising men "-young and old, who surround him, and with whom he has had the honor of associating. They serve as a biography of men, wherein are recorded the faith, promptness, honesty, and, to a marked extent, the religion of the respec- tive individuals. The physician would like to take a post- graduate course occasionally; and he is aware that he should take a much needed vacation, but it would be difficult to spare the money or the time, and worst of all, if he goes, his patients might possibly 170) OF THE PHYSICIAN. stray away after strange gods, fabled he- roes, etc. He would like to visit the old Alma Mater, the scene of his early labors, and strike glad hands with his classmates that will be gathering there again. But alas! many of the gallant boys of that noble class he could not see if he went- the long grass waves over them, and some of the stones that mark them are entirely shrouded with ivy-for the average life of a physician is only forty-five years, and half the number have passed off the stage of action into " The undiscovered country, from whose bourne No traveler ever returns." I cannot feel content to close this ar- ticle without paying a grateful tribute to the memory of a departed physician, who fell in the prime of manhood's years. One under whose guidance, and in whose office, it was my fortune to begin the study of medicine. We are doing nothing out of the ordinary when we pay a tribute to the memory of a deceased brother. The an- cient Greeks and Romans were wont to gather about their fallen heroes, and re- 171 SUNSHINE AND SHADOWS count their virtues and the trophies they had won. Memorials in brass and marble, in undying verse and imperishable utter- ances, have come down through all ages to inspire the ambition of youth and stir the pulse of manhood. It is fitting that we should pause a brief moment, amid the absorbing cares of daily life, and mark the footprints of those who have attained a worthy prominence among men; and while we weave a garland of flowers to deck the grave of our friends who have gone from among us, the lesson of our mortality and the duties we owe to each other and our families. It has been truly said that peace bath her victories not less than war. Of all these victories, those of the phy- sician and surgeon are the most marked, because the most conspicuous. This noble genius was a conquerer, not of his fellow- m9n, but of the dangers which beset them. Nor are his conquests finished yet. Long years after the bodily form of this beloved preceptor has passed away, the precepts he impressed so clearly, the result of his experience, will remain to mitigate pain and sorrow, and to soothe many otherwise 172 OF THE PHYSICIAN. hopeless pillows. The history of his life, now that the volume is closed, will live in the memories of men and go on indefinite- ly. It has been often my good fortune to be associated with him professionally. In time of need he would adhere to his friends, " closer than a brother." Prominent, among his characteristics were tireless energy and patience to stand against the tide. In all cases where will was required he was al- ways in the van. He was a born leader. Whatever enterprise he chose to engage in, he rapidly rose to the leader's posi- tion. He was in every respect my ideal of what a physician should be; he knew no sham, he could not respect quacks, he could not act the professional sneak thief. He never would do anything to take a pa- tient from another doctor. His dress, which was plain, neat, uiisoiled; his man- ner, his social and professional intercourse, were in perfect harmony. He stood al- most alone with convictions of the powers and capabilities of his profession ; moral calculus fails to grasp the sum of his bene- ficence. He was a man of many superior quali- 173 174 SUNSHINE AND SHADOWS ties of head and heart-a man of more than ordinary abilities and qualities- good, just and genial. Although dignified, he was full of good humor and jollity, and was apt at telling stories. I prized his friendship dearly. He, like the rest of us, met with many "ups and downs," but met them with the fortitude of a martyr. He was true to his ideals of what he thought was right. It is well to note in passing that we are more than doctors, we are men! How many kind acts have we done to the dead! Of how little importance, after all, are life's successes or failures! " The host of heraldry, the pomp of pow'r, And all that beauty, all that wealth e'er gave, Await alike the inevitable hour: The paths of glory lead but to the grave." There is a lesson to learn-be a little truer to our profession as men to each oth- er, and do a few more kindly acts, which are about the only things worth remem- bering at the end of life's voyage. The professional life of this skillful man was such as to command all honors to his mem- ory. I owe as much to him as to any pro- OF THE PHYSICIAN. fessional man, living or dead. In loving remembrance and with heartfelt gratitude, I refer to the life and memory of the la- rnented Dr. A. B. Pitzer, of Tipton, Ind. Dr. Pitzer was a man of rare executive abilities and prescience. He was polite and kind to every one. No man in the profession was better equipped in manners. Before his illness came upon him he was notably modest, seldom spoke of himself, or of his own achievements. I think yet, as I thought when I first saw him, that he was superior to almost any man of his age that I had ever met. " Still o'er these scenes our memory wakes, And fondly broods with miser care, Time but the impression deeper makes, As streams their channels deeper wear." Regarding him, as I have already said, with the deepest interest, and under cir- cumstanices favorable for observation, I describe him as he impressed himself upon me. The great characteristic of his mind was strength, and his predominant faculty was reason. He possessed the power of impression-deep, lasting impression-of 175 SUNSHINE AND SHADOWS interesting you, not only in what he said, but in himself, of stamping upon the mem- ory his own image in the most eminent degree and the most extraordinary man- ner, of any person whom it has been my fortune to encounter. The late Dr. Holmes said: "Nature is in earnest when she makes a woman." She undoubtedly was in earnest when she endowed Dr. Pitzer with these rare pro- fessional gifts which Nature alone can bestow. He entered upon his professional career armed at all points, and practice flowed in upon him, in a full and wealthy tide. Public sympathy rallied around to cheer a-i support him in a manner seldom k')wn before. Every step of advance- ment but deepened the interest and vin- dicated more triumphantly the opinion held of him. His counsel was sought far and near. " He encountered hostility in his upward flight, [when did soaring ge- nius fail to do it] and meaner birds would have barred him from his pathway to the skies. With crimson beak and bloody talons, he rent his way through 176 OF THE PHYSICIAN. the carrion crew, and moved majestically up to bathe his plumage in the sun." Rarely indeed did ever a career more dazzingly splendid awaken the eye of young ambition than burst upon Dr. Pit- zer. The people sang his praise, and the community was full of his name, though he wore his honors with the ease of a familiar shoe " He trod the new and dizzy path with a steady eye, and with that same veteran step which was so eminently his characteristic." All difficulties had apparently vanished before him; and he at last reached the consummation of his earliest wishes, the ambition of his child- hood's prayer. Dr. Pitzer's health failea gradually for a year or two before his death, but his waning life sank, not the spirit of the man. And at last when the summons came, like the martyrs of old, he manned himself to die with dignity. Thus perished in the forty-ninth year of his life, Dr. Andrew 13. Pitzer, a man de- signed by nature and himself for inevita- ble fame. A man whose natural abilities L 177 SUNSHINE AND SHADOWS were as faultless as his intellectual con- stitution was vigorous and brilliant. A man to whose advancing eminence there would scarcely have been a limit, had not the powers of his mind proved too great for the element of clay which enclosed them. "His life was an inspiration; His memory is precious; He sleeps well." PILGRIMAGE OF THE PHYSICIAN. SECTION III. OLD AGE. "Look not alone on youthful prime, Or manhood's active might; Man then is useful to his kind, Supported is his right. But see him on the edge of life, With cares and sorrows worn; Then age and want, 0, ill-matched pair! Show Man was made to mourn." -BURNS. Finally, we see the venerable physician, as he walks slowly with his aged compan- 178 OF THE PHYSICIAN. ion through the evening of life. He has seen "you weary winter-sun twice forty times return." He stands the last of his old class; for only one physician in twen- ty reaches the age so graphically described by the Psalmist. He has seen many theories put forth the tender leaves of hope, bloom and blos- som, as it were, for a day, then a biting frost would nip the shoot, and they would pass away like blades of grass-into noth- ingness. For, since the time that Hippo- crates transcribed the votive tablets that he found in the temples (having found that most likely it was the things the patients had taken and inscribed there, rather than the action of the gods, that led to their recovery) even until now, there has been no end to the making of theories and books. Each generation has assumed that it possessed all the wisdom that had yet come into the world on medical subjects, and aimed to consign to oblivion all the works of its predecessors, with the same spirit which actuated Paracelsus, when, with great solemnity, he burned the works of Hippocrates and Galen. When he be- 179 SUNSHINE AND SHADOWS gan the study of medicine, four-fifths of the practitioners of the country were non- graduates. All at once everybody turned to the medical colleges, and the hoary- headed practitioner and the beardless boy met on the level in the class-rooms. This developed an age of discussion, and hence, in medical societies, in clubs and in class- rooms, were discussed all the theories that were advanced by the teachers of that day. While they had not the germ theory (or germ fact) as understood to-day, there were followers of De Sault, agreeing with the English poet, Pope, in part at least; while they did not entirely agree that all humankind were worms, as Pope wrote to, Moore, they were perfectly willing to con- cede the fact that all humankind were destroyed by worms, not intestinal, but infinitesimal. While we do know that the germ theory, (or fact, because it is no longer a theory) has developed a great improvement in the practice of medicine; we are also willing to believe that Mason Good, in 1828, and the doctor who planned the cleaning of the city of New Orleans for General BuLtler, understood clearly the ISO OF -THE PHYSICIAN. value of cleanliness, and of pure air, and of sunlight; and knew the danger of dirt and filth, as men do to-day; although they might not have recognized the germ and known the size of its head or the curl of its tail. Although there have been won- derful strides made in the practice of medicine and surgery during the last fifty years, I fully believe that the generation of men who entered the arena fifty years ago did well; they proved themselves full of character and progress, both in war and peace; they rest in the Silences, but their work abides. Some were gathered like shocks of corn fully ripe; some were taken when in their prime; others were called away "while the dew of youth was still fresh upon them;" and in the language of O'Hara: " Yon marble minstrel's voiceless stone, In deathless song shall tell, When many a vanished year hath flown, The story how ye fell; Nor wreck, nor change, nor winter's blight Nor time's remorseless doom, Can dim one ray of holy light That gilds your glorious tomb." SUNSHINE AND SHADOWS And, we your successors, have caught none of your grace, nor inherited aught of your glory; but, standing upon your shoul- ders, it may be permitted us to believe that we do see farther than you saw; just as those who shall succeed us will see farther than we now see. I fervently hope and trust that the young men of to-day (who sometimes imagine that we have done great things, when we have really had but little time to do anything, and actually know but little, except what we have learned from the older men, who have been our predecessors in the busi- ness), from the vantage ground now pos- sessed, will march bravely on, and accom- plish as much in the next fifty years, as has been accomplished during the last. There was a period in the world's history, when to advance a new idea or theory along the line of progress for the benefit of humanity, was to court a familiar ac- quaintance with a public executioner. For- tunately, these gracious men lived in an age when it was not considered a crime to be a public benefactor; and many of them lived to see the matured fruits of their 182 OF THE PHYSICIAN. well-aimed efforts; while there are others, whose spirits are looking down from the realms above upon the present scene, who are rejoicing with joys unspeakable at the happy achievements. They, living, be- lieved the day not far distant when the idol of their life and labors would be achieved-that the hour would come when atonement would be made for the injustice done them. Thev died in this faith. It had supported them through many a long day of worry and trial, when the heart was almost ready to sink beneath the bur- den of bitter disappointment and despai r, and beneath the load of obloquy and re- proach, which their persecutors-some in ignorance, but more inl malice-had heaped upon them. They no doubt felt, at times, as did the noble (though ill-fated) Emmet, when in his last words, he says: " Let me repose in obscurity, and my tomb remain unin- scribed, until other times and other men can do justice to my character.", And in allusion to this last request-the " charity of the world's silence," how tenderly can we join with the poet Moore, who, thus 183 SUNSHINE AND SHADOWS beautifully mourns his fate, in the follow- ing matchless linies: " 0! breathe not his name-let it sleep in the shade, Where cold and unhonored his relics are laid- Sad, silent, and dark be the tears that we shed As the night-dew that falls on the grass o'er his head! But the night-dew that falls, though in silence it weeps, Shall brighten with verdure the grave where he sleeps, And the tear that we shed, though in secret it rolls, Shall long keep his memiory green in ouir souls." But the time has come, and their epi- taphs have been written, and their charac- ter vindicated. We now stand before the public and the world with a swelling and grateful heart, but with a tongue and pen too feeble to do justice to the subject or the occasion. Nor would we mar its beauties or pleasures by narrating bygone difficulties-difficulties which, we trust, are forever buried in oblivion. Their achieve- ments and the edifice which they began, shall stand as a proud and lasting testi- mony of the world's admiration. This monument rises like the piled cairn over our warriors of old-each man casts his 184 OF THE PHYSICIAN. stone; and in sacred memory of those fel- low-workers in the cause of suffering hu- manity, with the true feelings of great- ness, pays tribute at the shrine of genius. May the good work prosper, and when happily completed, then may it tell to fu- ture generations, that the age that could produce a McDowell. a Sims, a Gross, a Flint, or an Agnew, and a host of others, was rich also in those who could appre- ciate their talents and their labors. It, perchance, ill-becomes us to speak thus of our science and her heroes, lest it be thought that cool judgment has given way to excited feeling. Yet who are bet- ter fitted to speak her praises than those who have been taught her principles-who have realized their power We would not, however, be the mere eulogist of medicine and her illustrious sons, for she needs no eulogy of words. Circumspice: look around, is the best eulogy of medicine. Look at her institutions, bright with the fires of truth in every clime-look at her sons, their name is legion, humbly ministering daily to suffering mankind. Medicine is venerated for her blessings-gracious gifts. 185 186 SUNSHINE AND SHADOWS The mosses of antiquity have gathered around her stately columns. The wisdom of the ancient sages is treasured within her archives. Her principles and materials are coeval with the origin of man. In a moment of time, as it were, by a single step, we come from the distant lands of the Orient, and from those shadowy times of the long, long past, to this our own country, and this our passing day. In this rapid transit we have passed through the period of highest art and refinement of Greek civilization, through the prowess of Roman aggression. We have traversed all the intervening centuries. Our way has been overcast by the shadow of the " Dark Ages." We may have seen the re- vival of literature, of science and of art. And to-day we have an illustration that medicine remains a power in the world. It is sleeplessly and constantly watching and laboring for man's good; it never ceases to devise new plans and put forth new efforts for his deliverance from his ancient foes: pain, disease and death. At last we enter the office of the aged physi- cian. There are now several cases of OF THE PHYSICIAN. books, well filled. His sign, the prey of rust and time, has scarcely a letter left, to indicate its former grandeur. Being a constant student from the day of his graduation, not only of medicine, but of collateral literature as well, he is an ele- gant conversationalist, the best generally informed man in the community, and has a social standing second to none in society. Devoid of shams and' superstitions in all its forms himself, he sees through the thin cloak of deception in others. Humanity is the same to him, whether in the palace of the prince or millionaire, or in the low- est depths of squalid poverty. He sees oftener than any one else the grandeur and elevation that hide in the cabin or lowly cottage, as well as the vices and evil passions of the great, and like the Parson in Goldsmith's Deserted Village " Beside the bed where parting life was laid, And sorrow, guilt and pain, by turns dismay'd, The reverend champion stood. At his control, Despair and anguish fled the struggling soul, Comfort came down the trembling wretch to raise, And his last faltering accents whisper'd praise." 187 SUNSHINE AND SHADOWS With nature his God, duty his watch- word, and an approving conscience his guide, he has faced the King of Terrors in every form and escaped more pitfalls than anyone else not in the profession. Or in the language of the soldier, he has been under fire since the date of his diploma. And what is his reward Wealth, did you say Bias, one of the seven sages of Greece, once said: Omnia mea niecumporto-I car- ry with me all my possessions. This ad- mirable saying of that "Prince of Wise Men " is as true of many of us to-day as it was of that humble dweller of Priene, in the days of ancient Greece. Fully one- third of his time and earnings have gone to charity. If he has been a great busi- ness man, he may have a competence. If not, he may share the melancholy fate of. Homer: " Seven rival towns contend for Homer dead, Through which tbeliving Homer begged his bread." One may say Public Favor But alas! the ways of the politician are not his. Another Fame Let us see, if you please. Worldly fame is uncertain, and not within 188 OF THE PHYSICIAN. the grasp of many minds. And even those who are able to seize the gay and gilded prize. it stings in the very embrace, and perishes in the enjoyment. Let us ask the old gentleman his reward. "The discovery of the antitoxins for diptheria and tetanus, the discovery of anesthesia and vaccinnation, aseptic med- icine and surgery, the banishment of ty- phus fever and that scourge of maternity -puerperal fever-and the limitation of cholera have lengthened the life of man ten years within my memory; and by means of sanitation and serum-therapy (undoubtly the therapy of the future) mankind will at last reach a point, where (barring fortuitous accidents) the allotted span of life will be achieved. and the end of each human being will be Euthanasia." This is the reply that is wafted back on "fleeting breath " and failing voice, as he stands an instant, his white head bowed in the twilight of existence and vanishes in the gathering night; and a quiet voice is whispering in the chambers of thougit- 189 190 SUNSHINE AND SHADOWS "No farther seek his merits to disclose, Or draw his frailties from their dread abode, (There they alike in trembling hope repose,) The bosom of his Father and his God." FINIS.