The Character and Qualifications of the Good Physician

Annual Oration 1844

By John Homans, M.D., M.M.S.S.

Gentlemen,

I should not have accepted the honor of addressing you on this occasion, had I not felt that I might rely with confidence upon your candor and kindness. I am entirely unaccustomed to public speaking. My pen is unskilled in all arts of composition, save the com-position of prescriptions (and perhaps has but little in that). I should despair, therefore, had I to rely solely on my own ability to discharge acceptably the duty which this day devolves upon me. I rely on the kind indulgence and friendly feeling which the Fellows of this Society cherish, and have ever been accustomed to manifest, towards each other.

I congratulate you on the return of another anniversary of the Massachusetts Medical Society,—on the pleasant reminiscences that gather around this occasion,—on the cheering prospects it opens to us in the harmony that prevails among its members, in the high and advancing standard of medical character and attainments which this Society has done so much to establish in our profession, and in the growing interest manifested in all those branches of study and science, which come within the scope of that profession, and aid in the accomplishment of its important object—the alleviation of human suffering, through the wise and right treatment of human diseases.

The direct purpose of our Society is strictly professional; yet social and moral influences necessarily flow from our associating together even for this purpose. Scattered as we are over a large extent of country, most of us having little or no opportunity for professional sympathy or counsel, engaged day after day throughout the year, in the duties of a laborious profession,—duties always arduous, and sometimes overwhelmingly painful in the extent of individual, solitary, unshared responsibility they involve,—it is pleasant for us, once a year, to behold each other’s faces, and, by the interchange of kind feelings and friendly salutations, to brighten, perpetuate and extend the chain of professional acquaintance, of personal friendship, and of high moral regard. And although the periods for this social intercourse are brief in their duration, and far between in their recurrence, yet they are not without their benefits and blessings. If they do not add much to our stores of wisdom and professional knowledge, they add largely to our stores of pleasant memories and agreeable thoughts. If they sometimes do little directly to make us better physicians, they always do much to make us better men; and, by enlarging our conceptions of the important character and noble purposes of our profession, quicken us to greater fidelity and industry, and thus indirectly, in the end, help to make us better physicians. For myself, I feel impelled to say that, in addition to the benefits derived from the rich results of professional study and investigation, which have sometimes been communicated to us on these occasions, I have never been present at an annual meeting of our Society, from which I have not received something of more value, I had almost said, than all professional learning; namely, quickened impulses to fidelity in the exercise and discharge of this profession. I have never returned from one of these meetings to my individual sphere of professional labor, without carrying with me a feeling of pride,—not a foolish and vain-glorious pride, but a just and manly pride, — a pride in the noble and benevolent purpose of our profession,—a pride in the high character and attainments of my professional brethren, a pride in being associated with such a body of learned, honorable, and high-minded men, in the prosecution of such a noble and benevolent purpose. And this is not a pride that puffs up with ridiculous vanity, but which, appealing to all the higher sentiments of our nature, prompts a man to such a course of effort and perseverance, as shall render him not unworthy of his associates and his profession. This is a benefit, I believe, we all derive from these occasions.

Although not universally the case, it has been common for the person charged with the preparation of the Annual Discourse to select some strictly professional subject in the department of medicine or surgery, and unfold its particular character and best modes of treatment. It is, undoubtedly, well that this should be the character of most of our Annual Discourses. I am prompted, however, to ask your attention to a somewhat broader and more general theme. I propose to speak to you of the character and qualifications of the good physician. What ought he to be, morally and intellectually, in order to attain, if not to distinguished eminence and a wide-spread fame, at least to an honorable usefulness and an unsullied name, in his profession?

This inquiry will not, I trust, be deemed inappropriate to this occasion. In offering some brief hints upon it, I need dwell but for a moment upon the importance of that which is an essential element of success in every undertaking and profession, namely, a hearty interest in it. A physician must love and respect his profession, must have a deep conviction of its importance and usefulness, must regard it as an honorable and beneficent employment, as opening fields for thought, study and action, high enough and broad enough to satisfy the aspirations of a wise, just, and generous ambition. That there are reasons which justify all of us, the young who are just entering upon it, the old who have grown gray beneath its anxieties and its labors, in entertaining this high estimate of our profession, will not be disputed, I have no disposition to say any thing in disparagement of other employments or professions.

The great chain of mutual dependencies and reciprocal obligations which runs through all the various callings of life, forming them all into one great whole, one great body, of which the head cannot say to the hand, or the hand to the head, “I have no need of thee,” teaches us to respect all occupations that are conducted with integrity, and faithfully discharged. But inasmuch as none of these can be discharged without health, inasmuch even as that profession to which we commonly assign pre-eminence, because it aims to do a work upon the human soul that shall last for ever, and plant seeds whose issues shall go forth to eternity, inasmuch as this profession is dependent upon health, so that the preacher cannot preach with power, or the hearer receive and practically apply, unless each has, to some extent, a sound mind in a sound body, we may rightfully assign, if not an absolute pre-eminence, at least a high rank in the scale of usefulness and honor to the medical profession.

Whether we consider the themes with which, as a science, medicine occupies the mind, the field of knowledge it seeks to investigate and master, or the practical results it would produce, and, to a wide extent, does produce, by the application of this knowledge, we behold it alike clothed with the attributes of dignity and beneficence. We have high authority for the assertion, that we are “fearfully and wonderfully made.” With this fearful and wonderful work, this master-piece of the Almighty (so far as we are permitted to become acquainted with the creatures of his hand), the human frame, it is the purpose as well as the duty of the physician to make himself fully and thoroughly acquainted. He must understand its composition and construction; the various forms of matter that enter into it; the various modes in which they are combined, and put together, and all the laws that regulate their mutual action, and all the influences from within and without, that affect, for good or evil, that action. His studies, therefore, must take a wide range, and lead to the investigation of many profound and curious subjects. And when we look at the results he produces by the application of this knowledge; at the good it is sometimes in the power of his wisdom and skill to accomplish; at the happiness which not infrequently flows from his ministrations, we surely find enough to inspire us with professional enthusiasm and devotion; love and veneration for the healing art. There is this encouragement and satisfaction in our profession: its results, when successful, are distinct and palpable, and an unmixed good. The clergyman toils, but faith and hope are, in a great measure, his only stimulants. He plants and waters, but the year of the divine providence corresponds not with his wishes, and the harvest he effected is delayed. Even when most successful, that success is unseen but by the eye, unrecorded but by the hand of God. His work is like the dropping of water upon the jagged and uneven surface of the rock. No impression seems to be made. After a long course of time you can perceive that the surface is growing smooth and even; but you cannot at any given moment point to distinct and evident results, to encourage perseverance and stimulate to new efforts. And the lawyer, if he succeed, knows by that very success that a brother has failed; and that, if his client has won, his client's opponent has lost: and sometimes he may have a shadow of doubt, perhaps even a humiliating conviction, that, though the verdict is in his favor, right and justice are not on his side. But with the success of the physician, no alloy of this kind mingles. He is not and cannot always be successful. He does not hold, as its absolute master, the key to the gate of life. He cannot always stay the progress of disease, nor roll back the approaching shadows of death; and though the enthusiasm and the efforts of those who have sought to discover “the elixir of life” is a curious chapter in the world's history, yet those efforts have been, and of course ever must be, vain and foolish. The physician cannot exempt and deliver man from the great law of mortality to which God has made him subject. He cannot always be successful; but when he does succeed, that success is a pure, unmixed success. Its result is distinct, marked, palpable to his own and others’ observation; a result that brings gladness and gratitude to many hearts. When he checks a fever, gathering fierce and deadly upon the burning brow, or, by his skill and care, so moderates its violence and controls its action, that a fatal issue is prevented, and the enfeebled frame raised up to health and strength; or, when discovering the cause of intense and agonizing pain, he is enabled to apply a remedy, and bring relief and ease to a weary sufferer, he feels that he has done a distinct and decided good, and has conferred a benefit and blessing. He has bestowed that treasure, without which life itself becomes a burden. Sometimes it seems almost as if the gift of life were in his hands; and in all scenes, from the first joyful glances which the mother bestows upon her new-born child, to the agonized appeal with which in after life that child turns from that mother's sick bed, to ask if she cannot be restored, he feels that, next to God, and more than any other human being, he holds the balance between life and death. And when he brings back hope to the fainting spirit, when he succeeds in determining the preponderance in accordance with the wishes of loving hearts and fond affections, he sees, he feels, that it is a blessed result, well repaying all his efforts and his care. Anxious days and weary nights become light and gladness, when he can call back from the gates of death the weary and sinking spirit, and restore to the arms of affection those treasures which seem about to be snatched from their grasp. He can “count up the loved” restored,

“And as their sum shall be
The riches of his spirit's treasury.”

But, even if he fail,—and when he fails, when his watchfulness and care are unavailing to preserve life,—they are not useless or insignificant in the good they do. They bring much alleviation; and when the door of hope is shut, and death has triumphed over human skill, and wounded human affections, the physician feels that his labor has not been utterly in vain,—abundant evidence of which is sometimes afforded him, in the gratitude and affection with which he is regarded. Sympathy in sorrow knits hearts together more closely than aught else on earth: and the true and kind physician, though his skill has sometimes failed, meets every where a grateful and confiding glance; receives from all a warm and heart-felt pressure of the hand, and lives ever in the consciousness that he is bound to those around him by no common ties of blood or kindred, but by the stronger ties of gratitude and affection. When we consider the dignity and beneficence that attach to our profession, the high subjects with which it occupies the mind, and the happy results it aims to produce, and, to a great extent, does produce, we are justified, we are called upon, to cherish a high respect, a hearty interest, an enthusiasm of devotion to it. We are unqualified for the profession, unless we so regard it.

Having thus spoken of that just estimate of his profession, that high respect, that hearty interest in it, which every physician ought to entertain and cherish, I may proceed to remark, that integrity is the great principle that should lie at the bottom of the medical character, to guide and command the physician, both in the preparation for and conduct of his profession. This principle should influence, and, when it exists, will influence him in respect to his qualifications; in the acquisition of that wide and various knowledge that justifies his assuming, and fits him to discharge, the duties of his profession.

The physician assumes important duties. He offers himself to the public for high and responsible trusts. He asks to have human life, amid the manifold perils to which accident and disease expose it, confided to his care. He calls upon the community to commit to his wisdom and skill those inestimable treasures, so highly prized by all, health and life. Integrity, therefore, demands that he be qualified for this trust; that he dare not to assume, that he offer himself not to assume it, without a consciousness of some honest and thorough preparation for it. And, perhaps, there is no department of human life and action, preparation for which requires such wide and thorough study as the medical profession. Indeed, it is hardly too much to say, that the acquirements that go to form the accomplished and thoroughly furnished physician, exceed in variety and profoundness those of any other profession. I have already alluded to the fact that the great concern of the physician is with that fearful and wonderful work of the Almighty, the human frame. But the human frame stands not apart by itself, disconnected with, and uninfluenced by other works and laws of God: and to be able to treat it aright, both in a diseased and healthy state, requires a knowledge of various arts and sciences, some of them seemingly little connected with each other or with the human body.

There are two great branches of knowledge that constitute the foundation of medicine as an art or science, viz., Anatomy and Physiology. A previous knowledge of the structure of the human frame is obviously necessary to the medical practitioner; and without it he is as a blind man, dealing his blows in the dark. If he proposes to be an operating surgeon, his knowledge of anatomy must be minute, accurate, thorough. He must be acquainted with the situation, structure, connexion and purpose of every, the minutest part and portion of the human frame, and the appearance it presents in a healthy and diseased state. And this knowledge must be so familiar that it will be constantly retained in his recollection.

If he proposes to be, technically speaking, a physician, ascertaining diseases by the observation of symptoms, and seeking to cure them by the operation of medicinal agents, while it may not be necessary that he should constantly retain in his mind the accurate and minute knowledge that the surgeon needs, it is necessary that he should have, and have it at immediate command, a general and thorough knowledge of the structure of the human frame. And it is especially necessary that he should be well instructed in physiology, the science which teaches the functions of the different organs, the nature and composition of the fluids, their production, uses and discharges. But this science, to be thoroughly understood, requires at least some knowledge of many other departments of science. Indeed, there is hardly any branch of natural philosophy that does not enter into the explanation of the functions of the human body, and of which it is not important that the physician should have some knowledge. “When you inquire into this subject,” says Dr. Gregory, “you will find the human body a machine, constructed upon the most exact mechanical principles: in order, then, to understand its movements, you must be well acquainted with the principles of mechanics. Considering the human body in another view, you find fluids of different kinds circulating through tubes of various diameters: the laws of their motions, therefore, cannot be understood without a knowledge of the principles of hydraulics. The eye appears to be an admirable optical machine, and of course the phenomena of vision cannot be explained without a knowledge of the principles of optics. As the human body is surrounded with an elastic fluid, the air, subject to various changes in respect of gravity, heat, moisture and other qualities which have great influence on the constitution, it is proper to be acquainted with the nature and properties of this fluid, the knowledge of which constitutes the science of pneumatics. It were easy,” he continues, “to bring many more examples to show how necessary a knowledge of the various branches of natural philosophy is to the right understanding of the animal economy.”

We cannot but subscribe to these remarks of Dr. Gregory, and perceive that, even as he has stated the matter, a wide range of scientific knowledge must be embraced by the well instructed physician. But this is by no means its limit; nor does it present some of the most important and profound subjects of inquiry which the physician must investigate. Passing by, with a simple allusion to it, the absolute necessity of an extensive knowledge of chemistry to the elucidation of the changes that are induced in the fluids of the human body, in their combinations and properties, we are to consider that there are principles and phenomena connected with the human frame, inexplicable upon any or all the principles of natural philosophy, of mechanical or chemical science. Attempts have been made, indeed, to explain the phenomena of the human body upon mechanical and chemical principles. But these attempts have always failed. The human frame possesses something above and beyond these principles. It possesses an internal, self-sustaining, self-moving power or principle, which directs and influences, by laws peculiar to itself, its internal operations. What can be ascertained, and all that can be ascertained of this power or principle, and of the laws by which it acts, the physician must know. Hence it is necessary for him to study, by a series of minute observations, all those phenomena that are the result of life; to inquire into the laws of that faculty, which is called the vital principle, sensorial power, nervous energy, &c, and the almost infinite multitude of phenomena that are dependent on, or caused by that faculty, and the changes that are effected by its healthy or diseased action,—an inquiry necessarily rendered obscure and difficult from the circumstance that this power or faculty is not directly cognizable by the senses,—it is internal,—and these phenomena can only be ascertained by indirect inference, by external and obvious signs or symptoms.

But that he may not be misled, in judging of these signs or symptoms, it is necessary that the physician (and it is a very important part of his physiological knowledge), it is necessary that the physician should study and understand all those diversities of the human constitution that are caused by various circumstances, such as climate, age, sex, manner of living, original temperament and individual habits of body; because all these things modify both the nature and progress of disease, and the operation of remedies.

Again, though the physician need not be an acute metaphysician, and may certainly be excused for eschewing the labyrinths and subtleties of mental philosophy, he ought, certainly, to be acquainted with the faculties of the human mind, and the mutual influence of the mind and body upon each other. He ought to understand all the principles and phenomena connected with the power of habit, the effects of enthusiasm, the force of imagination, and the influence of the principle of imitation on the functions and diseases of the body: and for this purpose, what a wide, curious and interesting field of observation is it necessary for the physician to explore with profound and thoughtful study!

But all these branches of knowledge, numerous, comprehensive, and many of them profound, as they are, are only preliminary to the great practical duties of the physician, which consist in the diagnosis and cure of diseases. After he has made himself master, to some extent, of physiology, comes the great and appropriate work of his profession, which is built upon it, viz., pathology, or the general doctrine of the causes, symptoms and effects of disease, which, by wide observation and study, he must learn to detect and discover. But if he stop here, he is indeed a learned, but perfectly useless spectator of the sufferings consequent upon disease. His knowledge of causes and symptoms is worthless, if he have no knowledge of remedies,—if he be ignorant of all the means of controlling or modifying the action of diseases. Here comes in the crowning knowledge of his profession in which he must instruct himself,—its great and blessed purpose for which he must prepare himself. He must make himself master, as far as he can, of therapeutics.

Here, then, would seem to be no limit to the knowledge and experience which the physician may be and should be constantly acquiring—no boundaries to the field which his profession aims to explore. It embraces all nature. Every property of every substance in the animal, vegetable, and mineral kingdom may have some connexion, as cause or remedy, with human disease: and the more extensively and thoroughly these properties and this connexion are discovered, the farther is the science of medicine advanced. But what a field is here for study and investigation! What discoveries have been made in it! What discoveries yet remain doubtless to be made! It is not by the labors of an individual, nor yet by the united labors of an age, that the knowledge of the materia medica has been brought to its present comprehensive extent. It is the combined result of the experience and practice of all physicians of all ages, from the days of Hippocrates until now, aided by the researches of travellers and naturalists, and the discoveries and combinations of chemists.

I have thus given a brief and rapid glance at the various departments of knowledge, that are, to a greater or less extent, embraced in the medical profession, contribute to its usefulness, its progress and its honor,—and in view of these, I say that integrity demands of every man who offers himself to the public as a practitioner of medicine, that he have some acquaintance with all these various departments of knowledge. If he be ignorant of them, he is dishonest and unprincipled; and if he be grossly and notoriously ignorant of them, his dishonesty is only equalled by his impudence and his assurance. Yet this dishonesty prevails and always has prevailed. From the earliest ages to which the history of our profession carries us back, there have always appeared ignorant pretenders to panaceas and infallible and universal remedies. This has been one of the most successful forms of imposing upon the public, and acquiring a fortune, that human craft and selfishness have ever invented. And the extent to which quackery thrives at the present day, sanctioned and upheld by government in the protection it grants to all sorts of patent medicines, almost leads one to adopt the paradoxical conclusion, that human credulity, and a willingness or desire on the part of the community to be deceived, increases in a geometrical proportion with the intelligence of society.

If, however, the brief review I have given of the varied and comprehensive knowledge requisite to form the accomplished and thoroughly furnished physician be correct, it follows, of necessity, and may be laid down as an axiom in medical morals, that the quack or empiric, who, unqualified for, and negligent of, the task of pathological investigation, makes and administers any drug or compound as a universal remedy for any given disorder, without regard to the variations of that disorder, without consideration of its different stages or degrees of violence, or its occurrence in different constitutions, climates or seasons, in persons of different ages, sex, temperament, strength, etc., it may be laid down as an axiom that this person is dishonest. Quackery and dishonesty go together. Ignorance and selfishness are its chief ingredients.

But that integrity, which, I contend, should be at the bottom of the medical character, will influence the physician not only in preparing and qualifying himself for his profession, but in discharging its difficult and responsible duties. These duties require that he be constantly under the control of this high principle, and sometimes place him in a position where it is a delicate and difficult matter to meet its just requirements. The physician is received and welcomed as a friend in every family that he visits professionally. No reserve, no concealments are practised with him. The doors are open to him at all hours; not even the clergyman is placed upon the familiar footing, that necessity requires that he be received. Sometimes from choice, often because circumstances demand it, he is made acquainted with the private, domestic history of the family, or its individual members. Integrity demands that he violate not the confidence reposed in him. He must resist all tendencies to a gossiping disposition. He must preserve locked up in his own breast, that knowledge of individual character and the domestic circle, with which his professional duties necessarily make him acquainted. He must show, by his caution, and prudence, and kindness, qualities which can have a stable foundation only in a high principle of integrity, that he may be trusted and relied upon as a friend, as well as confided in as a physician.

But the physician is constantly liable to be placed in a position, where the requirements of integrity will be of the most delicate and difficult character. He will be asked, either by the sufferer himself, or by the friends, that in anxiety and affection minister at his bedside, to give his opinion as to the condition of the patient,—to say frankly, what, in his judgment, will be the probable result of the disease;—and, to deter-mine what answer he shall make, or ought to make, may often be a nice and delicate question. His judgment and conviction as a physician, and his kindness of heart as a man, his unwillingness to extinguish the spark of hope, though there be in reality no justifiable ground on which to rest it, may be at issue, and tempt him to modify or withhold the opinion which integrity, the truth of the case, and, it may be, a just regard to the spiritual and immortal interests of the patient require that he should kindly, affectionately, but firmly and fully declare. Undoubtedly there is room here for a wide and wise discrimination; and an intelligent and benevolent physician will take into just consideration all the circumstances that attach to each particular case,—the constitution, temperament and character of the patient, the temporal and spiritual condition of the family and friends, that in mingled hope and fear, hang upon his words,—and be guided by these in the opinion he expresses,—in the communications he makes. Still, I think, it may be laid down as a general rule, that the great law of Christian morality, that we “speak the truth in love” holds here. Integrity demands, the highest kindness sanctions, its observance.

Another class of qualities essential to the success and usefulness of a physician may be ranked under the head of independence of mind. The physician must be a man of firmness, decision, self-reliance; able to meet emergencies, to think and act for himself as the case before him demands, and not as a servile imitation of the course of treatment described in a case somewhat similar would suggest. He must be superior to the inveterate prejudices of time-honored theories and the seducing novelties of caprice and fashion, neither adhering to the one, and opposing the other, nor abandoning the one, and adopting the other, with an obstinacy or a facility, alike to be condemned by a calm, clear, comprehensive judgment. He must not suppose all truth in the science of medicine to have been ascertained, nor accept with slight questioning every thing new as true, to be confided in and practised upon. With a mind open and active, with an observation extensive, accurate and discriminating, with the feelings that arise from association, habit, and long cherished opinion, under the control of the judgment, he must “prove all things, and hold fast that which is good.”

In every department of life, these qualities, which I have comprehended under the term independence of mind, are important. No man ever accomplished any thing valuable without them,—but to the physician, they are essential. It is not enough for him to possess knowledge, or even experience. Were the latter sufficient, an old hospital nurse, who, for years, had watched the daily and hourly progress of all sorts of diseases, would be the best physician; and were knowledge sufficient, the student, who is fresh from the lecture-room, the professor, who has all the learning of books and treatises at his command, would be the safest reliance of the sick in the hour of peril. The physician needs both knowledge and experience; but above and beyond these he needs an independent mind, that can at once bring in review all the principles embraced in his knowledge and experience, and act with decision and promptness in their application to the case in hand. A person may be familiar with all the principles of navigation, or, with but slight knowledge of these principles, he may have a practical acquaintance with the ordinary management of a ship, but unless this theoretical and practical knowledge be at the command of an independent, resolute, and ever active mind, that, when a storm, or any sudden emergency arises, shall be able to discern and decide with the requisite promptness what is best to be done, it does not qualify one to take command of a ship. The principle of the illustration is equally applicable to the physician. No other profession, perhaps, involves such an amount of unshared responsibility as ours; or makes such demands for a prompt, varied, yet wise, application of principles and knowledge. The physician cannot meet these demands, if he be a mere imitator, having little self-reliance, little independent action of his own mind in his own practice. Yet there is no profession, perhaps, in which there are stronger temptations to imitation, none in which men are more naturally and easily, and from high and pure motives also, led to yield to the authority of great names, and to adopt and follow the theories and modes of treatment which their authority sanctions; and undoubtedly here as in every thing else, deference is to be paid to the wisdom of the wise, and the observation of the experienced. But this deference should simply be an element to guide, not a power to control the judgment, and cripple the action of the individual in his practice; and when it becomes the latter, it exceeds its province, and mistakes and absurdities must mark the practice in which it prevails.

I commend not a presumptuous self-confidence, or the hasty judgment that is formed without a minute observation and a deliberate weighing of all the symptoms and circumstances that accompany each particular case of disease, or that threaten its progress. I commend not that rapidity of decision and action, which is often the offspring of ignorance; an ignorance that experiences no difficulty in deciding, because it anticipates no consequences, and knows not what consequences to anticipate.

Doubtless, the profession and the community suffer much from this source. Unquestionably injustice is often done the former in this respect. A physician is commonly expected and called upon to act with prompt decision in all cases, and if he hesitate, or doubt and delay, though the doubt proceed from superior knowledge, from a large and wide observation, and desire amid contending difficulties to choose the most eligible course of treatment, it is usually accounted proof positive of ignorance and insufficiency. It has been well observed in reference to our profession, that “a man must have merited the confidence of the world, before he can obtain time for consideration, and his reputation must be firmly established before he can own himself at a loss.” A bold, confident, decided, dogmatical air, that never hesitates, is never at a loss for an opinion as to the nature of the disease and the best mode of treatment, has ever been the capital of the quack, his great stock in trade. Its effect is like that of a rich and gorgeous display of goods at a shop window, seducing unwary customers to enter, but shutting out the light by which they may judge of the quality of what they purchase. I commend not, I approve not this. Even at the risk of a loss of professional reputation in the estimation of the weak-minded and inconsiderate, I would have a physician hesitate, and doubt, and delay, if the difficulties of the case and his thorough perception of them embarrass his judgment. Because, he is in doubt what to do, I would not have him do he knows not what.

By independence of mind in a physician, I mean not an independence alike of all principles of medical science and of sound morality. I mean simply that he should keep his mind open and active, superior to the littleness of theoretical prejudice, and the rashness of novel and capricious practice; that he should exercise his own judgment, consider that in the circumstances of every case, in the diagnosis of the disease, in the habits, constitution, idiosyncrasy of the patient, there is something peculiar to that case and patient, of which he is the sole observer, and must be the sole judge; and that, in the vigorous and energetic action of his own mind, he apply the principles and knowledge of his profession that he has acquired. It is only thus that he can fully develop his own abilities, or attain to eminence and usefulness in his profession.

But I find that the subject I have attempted to treat is altogether too extensive to be fully discussed in a single discourse, especially by one who, unaccustomed to, express them, has little power of condensing his thoughts, without making a larger demand upon your time and patience than I dare to be guilty of. I pass by some topics that had come up in mind to be remarked upon, such as punctuality in fulfilling his engagements with his professional brethren and with his patients, and that courtesy which should always mark professional intercourse; that charitable spirit which should actuate him in judging of the conduct of others; and will detain you only while I observe, in conclusion, that it deserves to be considered as one of the requisite qualifications of the physician, that he be a religious man. This, indeed, may be predicated of every human being. The physician is a man exposed to the discipline, trials and sorrows of life, and, in common with all, he needs and must desire the peace, safety and eternal happiness which religion alone secures and confers.

But there are considerations arising out of his profession, its duties, exposures and opportunities, which make religious faith, hopes and affections, important qualifications for the right discharge of that profession. I can only throw out a few hints upon this topic, without stopping to unfold them. In the first place, his profession exposes the physician to great and peculiar temptations, which religious principle will alone enable him successfully to withstand. It subjects him, also, to peculiar and severe trials, which only religious faith will give him strength to bear with patience and humility. There are hard trials often in the early part of the profession. Here is a young man of varied and profound acquirements; of good, perhaps high endowments; conscious of a capacity for usefulness, and eager for employment; but the hours hang heavily upon his hands. Few seem disposed to trust his youthful wisdom, or test his unestablished skill. The doors of professional success seem shut and barred against him; and, when they begin to open, they turn slowly and heavily upon their hinges, and threaten often to swing back upon him, and close more firmly than before. Few of the paths of life are encompassed, in the outset, by severer trials than those of our profession. How shall the young man bear them with patience? How shall he keep up a good heart, and “bide his time” with cheerfulness and hope, unless he have a holy trust in that over-ruling Providence, that appointeth the lot of all, and ultimately smiles upon every honest purpose, and honorable endeavor. And when these early obstacles are surmounted, and full employment and professional fame are attained, there are different, yet severer trials, perhaps, to be borne.

In the early part of my discourse, I spoke of the gratification accompanying the successful application of skill and knowledge in our profession. But when this application is not successful, and the physician finds himself baffled and powerless, and a life of incomparable worth in its sphere,—a father, whose designing head and executing arm were the stay and support of his family,—a mother, whose holy influence and blessed presence were the light of her dwelling,—passes away, and he witnesses the scene of bereavement and sorrow, which his utmost skill and care have been impotent to prevent,—if he is a man of any sensibility, what can relieve or sustain him but a religious trust in that Being in whose hand is the breath of every living thing?

But again, the physician has opportunities of usefulness; of quietly, indirectly, unostentatiously exerting a blessed and benevolent influence, which only a mind illumined by religion—a cultivated religious faith and hope—can enable him rightly to improve. If his character be worthy of his profession, he will be received and treated as an intimate friend, as well as a medical adviser. He will be made acquainted with the secrets of life and character; he will be present at scenes when these will develop and manifest themselves; and at scenes and under circumstances which soften the heart, make the mind impressible, and lay bare the conscience to be touched and quickened by the hand of gentle and affectionate friendship. Indirectly, without obtrusion, or the professional air of the clergyman, he has opportunity, at such times, by a few kind, gentle and affectionate words,—words of sympathy, counsel, encouragement or admonition,—of leaving lasting impressions; of rendering incalculable service.

Amid the scenes, and in the exercise of the skill by which he raises up the physical frame from weakness or disease, he may, by the direct or indirect influence of his character, manners and conversation raise up the soul to the liberty and joy, the moral health of virtue. I stop not to make the qualifications; to point out the prudence and caution to be observed here, that we sink not the physician in the priest. You will make those yourselves. I only say, that the physician cannot meet the peculiar opportunities for moral influence which his profession opens to him, unless he be a religious man.

And, in conclusion, I observe, that unless his mind be cultivated and imbued with the spirit of religion, he cannot resist the tendencies of his profession to make his heart callous and insensible. Our profession has these tendencies. I need not to illustrate them. It makes us familiar with human suffering in all its forms, from the simplest to the most aggravated; and the effect of familiarity is to beget indifference. Our path is one by the side of death. Accustomed to contend with him, and often successfully, we are in danger of becoming insensible of his power,—forgetful that we ourselves are subject to him,—forgetful, it maybe, of the scenes which await us when that power has been exercised upon us. Let the events which almost every anniversary of our Society calls us to notice, recall us from our professional to moral responsibility. During the past year an unusual number of our profession,—seventeen members of the Society,—have departed this life, many of them in the midst of their usefulness and activity. I need not name them, or eulogize them. They have reared their own monuments in their honored and useful lives. While we cherish their memories, let us be cheered by their example, and instructed by their death.

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