UNIVERSITY OF LONDON.

DR. CONOLLY'S

INTRODUCTORY LECTURE.

AN

INTRODUCTORY LECTURE

DELIVERED IN

THE UNIVERSITY OF LONDON,

On THURSDAY, OCTOBER 2, 1828. BY JOHN CONOLLY, M.D.

PROFESSOR OF THE NATURE AND TREATMENT OF DISEASES.

SECOND EDITION.

LONDON:

PRINTED FOR JOHN TAYLOR,

Bookseller and Publisher to the University of London, 30, UPPER GOWER STREET.

1828.

Printed by RICHARD TAYI.OK, Red Lion Court, Fleet Street,

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INTRODUCTORY LECTURE.

GENTLEMEN,

UNDER any circumstances, I should have felt considerable embarrassment in addressing so numerous an assembly, containing so many distinguished individuals as I see around me. But this feeling is very much increased by the circumstance of my accidentally following, in the order of succession, the very eminent gentleman * who yesterday ad- dressed you from this place ; a gentleman whose character as an accomplished, eloquent, and rarely-gifted teacher, and whose celebrity as one of the first physiologists of his time, have been so long and so generally acknowledged, that it is neither indelicate thus to allude to them, nor any dishonour to confess that I cannot hope to give much interest to a lecture intended for medical students, after the beautiful discourse we so lately heard from him.

The duty that I have undertaken in the Chair to which I have had the honour to be appointed in this University, is to teach the NATURE AND TREATMENT OF DISEASES.

The students who attend these lectures are supposed, generally, to have some previous acquaintance with certain branches of medical study ; not only with Anatomy and Physiology, the very foundations of all medical science, but with so much at least of Chemistry and Botany as relate to the Materia Medica.

But the Anatomy of the human body in a sound state, and Physiology, or the science of its healthy functions, having been previously explained to them, they are now to

* Professor Bell.

be taught the changes of structure and the interruptions of function, which constitute disease. Chemistry and Bo- tany, in connection with the history of the nature and pro- perties of the materials drawn from the mineral, vegetable, and animal kingdoms for medical purposes, having given them a general view of the powers of which physicians have availed themselves, in order to restore health when either structure or function was impaired ; they have now to study, by the help of this and of other practical Chairs, the application, combination, and adaptation of these powers, and whatever bears upon the management of every form of malady to which human beings are liable. This is the end to which all their former labours have been directed ; an end not to be attained without a previous devotion of time to the means just enumerated, and from a connection with which all their previous studies derive their principal value.

It is my business, therefore, to enter into the history of diseases ; to explain their causes, as far as they have been discovered ; to describe their varieties, as far as they have been observed ; to point out their symptoms, their distinc- tive features, their tendencies, their results : and then to instruct my pupils in what manner these evils are to be met ; how resources are to be used or devised against them ; how their causes are to be averted or destroyed ; how the effects are to be distinguished ; how their results are to be prevented or removed.

I should justly be suspected of taking a very imperfect view of my duties, if, on commencing such a task, so im- portant, so extensive, I did not feel and acknowledge a deep sense of the responsibility I have incurred ; — if I did not confess, that ever since I was elected to this office, I have been anxiously occupied in reflecting upon the best means of performing its duties so as to be useful to those who come to me for instruction.

In the introductory part of my Course, I shall so far de- part from custom as to say very little on the mere History

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of Medicine ; not from any particular love of novelty, but from a conviction that its details will be more advantage- ously introduced, because more readily and clearly com- prehended, if presented from time to time, when I have to speak of separate diseases. Even those who are now en- tering on the study of medicine, and for whom a slight re- trospect of the fluctuations it has undergone constitutes an essential introduction to the subject, as well as to any ex- position of my plan of treating it, would be wearied, far more than profited, if I were to dwell long on its past fluc- tuations, when they are naturally full of anxiety to know something of its present state.

It is, moreover, not easy to give a clear, orderly, con- nected view of the past history of medicine. Its progress from an acquaintance with a few remedies to its present ad- vanced state, has not been made by sure and regular steps ; it has neither been steady, nor, strictly speaking, gradual. There has often been, as a great authority* has remarked, " iteration, with small addition ; a circle, rather than pro- gression." In both medicine and surgery, (although the progress of the latter branch has been steadier, and at all times less mystified and pretending than that of physic,) we find so much anciently known, or supposed, which was afterwards forgotten, or lost, or accidentally obscured, and again, and even more than once, revived as new, that an attempt to disentangle the discoveries in either, and to place them in a true chronological series, would be one of the greatest difficulty. Such an attempt would be by no means uninteresting as a part of medical literature, but certainly not a proper employment of the time of those who attend here for the purpose of learning the Nature and Treatment of Diseases.

We have no distinct account of the origin of Medicine ; but it cannot be doubted that it began with simple and ac- cidental experience. Very soon it ceased to be a science

* Lord Bacon.

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of observation ; and its first corruption seems to have arisen from the fears and the ignorance of men, uncivilised, un- taught, exposed to various accidents, unable to account for any of the phaenomena of the natural world around them, and dependent on a superior power, of which they knew nothing.

In no long time, the dominion of error was extended by the pleasure arising from the indulgence of fancy compared with the labour of exercising the other faculties ; by vanity also, and the natural love of what is wonderful. Men were not wanting who boldly assumed a peculiar insight into the nature and influences of unknown powers ; and although, more than two thousand years ago, Hippocrates left the vain speculations of the philosophers who aspired to be pa- thologists without the lights of anatomy and physiology, and looked at the actual effects and progress of disease ; although he gathered up the scattered knowledge of his time, arranged it, and exceedingly enriched it by his own acute and exact observation ; his labours were repeatedly coun- teracted, and physic was again and again corrupted, and its very profession made contemptible in after ages, by the sophists of Greece, by the scholastic declaimers of Alex- andria, and by numerous speculative men in various coun- tries and of various periods, who found it easier and more agreeable to adopt the splendid reveries of men of genius, than to examine and judge for themselves. Thus we see that opinions were sometimes taken up upon trust, and that doubts and cavils were sometimes raised without reason or wisdom ; and in both cases facts disregarded, loose analo- gies pursued, the distinctions of diseases neglected, the effects of medicines confounded, imaginary qualities ascribed to various insignificant substances on the slightest grounds ; — and thus too we trace, from age to age, a long succession, interchange, and implication of ingenious theories, each raised on, or formed out of, the ruins of its predecessor, and each in turn thrown down to furnish materials, or form an unsound basis for the next.

Yet there are few among the theories which have in turn flourished and decayed, in which you will not find that there was something reasonable and true, which was curi- ously perverted ; or something valuable, which was capri- ciously discarded. You will often detect the same theory under the disguise of new names; and sometimes see, that, except in name, contending sects differed little from each other. It is instructive to observe, and important to re- member, that physicians have approached, in a kind of suc- cession, near to almost every Physiological and Patholo- gical fact, long before its complete establishment ; and that, after catching a glimpse of truth, they have again and again given themselves up to imagination, which they should have kept in strict subservience, as a valuable auxi- liary ; and no longer having modest and faithful observa- tion for their guide, have wandered from the path of useful discovery, and been led irretrievably astray.

Throughout all these deviations and caprices, a more intimate acquaintance with the structure and functions of the body was promoted, and the effects of medicines be- came better understood. The pride of originality, the zeal of theory, the very fanaticism of hypothesis, stimulated the cultivators of medicine to greater exertions : the er- rors of one sect served as lessons to another; and the con- tentions of opposing parties often laid open the sources of truth.

At last, after repeated efforts to reduce the illimitable varieties of the human ceconomy to the rules by which other parts of nature were governed ; after many attempts to apply elementary, chemical, mathematical, mechanical, humoral, and other doctrines to the living body; physicians have become convinced, that in the functions of life, there is something more than mere elementary mixture ; some- thing more than a mere collection of vascular agents, of solids and fluids, and moving powers; and that, although to a certain extent the laws of many sciences are to be

found in force within the bodily fabric, there are vital ac- tions and laws of life independent of, and superior to them ; that there is a peculiar and a finer science of living and rational beings.

It can only be after you have become more fully ac- quainted with the present and past state of medicine, that you can form a just idea of the real improvement it has undergone within the last two centuries. You will then see how great a revolution has been effected ; how jargon and mystery have been gradually (I wish I could say en- tirely} banished ; how parade and confusion have given way to clearer views of disease, and the employment of plainer and more intelligible language ; how carefully, by the labours of many great men, some of whom yet survive to behold the effects of their honourable labours, the struc- ture of all the parts of the human frame have been in later times investigated ; its various and intricate functions how diligently inquired into : how cautiously the " footsteps and impressions" of maladies have been traced in the dead body ; how well the foundations of medicine have been cleared, what was unsound rejected, what was worthy to be retained placed in a better light, and the rubbish of the darker ages swept away. Then also you will find what valuable assistance has, during this time, been given to medicine by many other sciences which have been daily becoming more exact ; — and will acknowledge how justified we are in saying, that as a result of all this — a result in which mankind have a deep interest, — a more ra- tional Practice is pursued ; the character of many diseases is mitigated, others are entirely banished from among us ; and, notwithstanding the greater diffusion of some causes of disease, arising out of greater wealth, greater luxury, greater intellectual exertion, the value of human life is in every way increased.

These beneficial changes have not been brought about easily or readily, without much labour, many retrogres-

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sions, and some violent struggles. Even so retired a study as medicine, as it could not be preserved from the subtilties and wildness of the schoolmen, so it did not escape further interruption from the intemperateness and obstinacy of faction. Philosophy, no less than religion, has occasion- ally been deformed by idolatry, and degraded by bigotry ; and medicine has not escaped the like inconveniences.

There have also been, at all times, some physicians pro- fessedly opposed to the theories of all sects, whose boast it has been that they relied only on experience. The division of medical practitioners into Rational and Empirical, is of very ancient date. As science has advanced, the Rational physicians have continually gained more and more upon their opponents: because, without despising experience, they have always endeavoured to ascertain the causes of what they witnessed. The question between the two parties re- mains, in other respects, the same as it always was ; for as the annals of medicine teach us that to reason without being secure of facts is of all things the most sure to lead us into error, so it is self-evident that to found reasoning upon facts, to examine and compare them, to deduce from them certain principles for our direction, is the only way to make them useful. Without this employment of them, the hugest collection would be of little service, and the longest expe- rience unproductive of wisdom. The avowed despisers of theory and reasoning therefore, who appeared to be justified in former periods by the extravagance of the party opposed to them, have been always found in later times practically defective ; daily pursuing the same measures, and repeating the same faults ; relying upon the supposed infallibility of their own methods ; inobservant of the consequences of their own practice; shutting their ears to all information, and opposing a stubborn scepticism to all professional improve- ment.

The particulars on which the preceding remarks are founded will be brought before you hereafter. They have been thus alluded to because even so slight a survey of the

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revolutions, errors, and prejudices, which have attended the cultivation of the science upon which you are now entering, cannot but guard you in the outset against hasty con- clusions, and dispose you at once to examine thoroughly the theories now prevalent, and often to be alluded to, and to except truths by whomsoever you may find them offered. To record the progress of medicine would indeed be a mere waste of time, if it did not teach both you and me how to proceed, and reveal the method of avoiding faults which have misled so many who have gone before us ; if it did not dictate to 'me the plan I ought at this day to pursue, and if it did not convince you of the intricacy and difficulty of the study of medicine, of the propriety of humility, of the ne- cessity of patient labour, and of being animated in your own investigations by an ardent love of truth, and a proud desire to advance your science rather than yourselves.

It is my earnest hope that the pupils of the Medical School of the University now first opened in this great capital, but destined, I trust, to flourish among the insti- tutions which adorn and benefit it, for many ages after those who first engage in its honourable duties shall be no more, will be no less distinguished by the laudable ambition which directs their labours, than by the zeal with which those la- bours are pursued : that they will despise the miserable vanity of announcing what is new, without a scrupulous re- gard to its being true ; that whilst they think boldly, they will examine their first thoughts carefully; and, remem- bering that observation is always difficult, and experience itself often fallacious, whilst they attempt to attain to causes through their effects, and the laws which regulate those ef- fects, will reason on what they observe with circumspection, feeling no anxiety except to discover what may be beneficial to their patients : that respecting, not blindly worshiping antiquity, combining the ardour of students with the mo- desty proper to men commencing an important study, they will not too hastily substitute their own authority for that of those whose experience was more extensive; or commit

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themselves prematurely to any theories, from which a false sense of shame may hereafter prevent their ever being dis- entangled; but will avail themselves of the opportunities which will here be afforded, of verifying their remarks by repetition, of discussing them with one another, of appealing to those whose opinions they regard, and who have found, as they will find, that many confident conclusions of youth require modification in future years; and, suppressing a restless fondness for what is new and strange, will still re- member that the science they cultivate is far from complete, and that they may possibly be able to advance it.

The profession to which you have devoted yourselves, Gentlemen, requires for its successful prosecution, not a suppression of the higher faculties of the mind, but an union of them, with a facility of applying the facts disco- vered in many sciences to a practical art of the utmost im- portance to your fellow-creatures. No profession calls for so accurate an observation, retention, and valuation of so great a variety of single facts; and to excell in it demands the most diligent exercise of your senses, a well-directed atten- tion, indefatigable and careful comparison, a faithful me- mory, an imagination suggesting all probabilities for scru- tiny, but disciplined and restrained. If medicine merely consisted of the application of a few known remedies to diseased states of the human frame, simple in their charac- ter and easily recognised, there would be little in it which occasional attention or a few months' study would not ena- ble you to master. But your task is far more extensive and delicate. As Nature does not abound in abrupt transitions, so slight deviations from health constitute incipient disease; slight aggravations modify it, alter its character, graduate its severity, induce or avert danger : and these changes are indicated by corresponding, and often very subtile varia- tions of external phenomena, as well as influenced by in- numerable remedial means. Thus the distinction of diseases is often difficult; the probable result in many cases not easily foretold ; and their treatment requires constant and

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serious attention : and supposing you all to be well ground- ed in Anatomy and Physiology, without which sciences all attempts to understand anything of physic must necessarily be vain ; the shades of difference by which, as practitioners, you will be distinguished from one another, will yet take their final colour from your superior discernment of states and stages of disease, and from the readiness, or I may say the felicity, with which, out of an immense variety of mate- rials, you select such as are exactly adapted to the combi- nation of symptoms and individual constitution of the pa- tient whom you have to treat.

I have now to speak of the mode in which it seems to me that students may be best conducted to this desirable end by those who are intrusted with their medical educa- tion ; or rather, of the plan and arrangement of my own lectures, and of the method of teaching which I myself pro- pose to adopt.

In determining on the plan I have laid down for myself, I have been governed by this feeling, — that my labours here were to be carried on for the benefit of others, rather than for any immediate return of praise to myself. Viewing, as deliberately as I could, the present state of medicine, and the present necessities of students, I have not thought it incumbent upon me, slavishly to copy even the most di- stinguished examples among past or living medical teachers; — to copy them is not to imitate them — but to consider, as no doubt they well considered, what is required in my own time, and in the actual state of our science, and to aim at supplying it.

A perfect order of the subjects to be treated of in a course of lectures on Medicine would be based on a knowledge of the Proximate Causes of all the diseases to be spoken of, or of those peculiar actions to which the term proximate cause has been, I think disadvantageously, yet very long and generally applied. Whatever may hereafter be in the power of a lecturer, our present knowledge of proximate causes

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(or, as I should say, of primary morbid effects or actions) is not sufficiently exact ; our acquaintance with the intimate structure and functions of the different parts of the body is too incomplete, to furnish him with a foundation sufficient to support a durable superstructure, and he must select one less exposed to movement and change. It is even ques- tionable whether such an arrangement would ever be the best for him to follow who has to combine the Art with the Science of medicine.

After considering, therefore, not without anxiety, what might be the best arrangement, one which would serve the purpose not of students only, but of men who are to prac- tise what they learn ; an arrangement by which external phenomena or symptoms would become readily, because habitually, associated with the system or set of organs af- fected in each case, and with the means to be adopted for relief, — for these, Gentlemen, are the objects of your study, and must be always the first objects of my teaching; — it seemed to me that no arrangement would better answer these ends, would less involve the lecturer in the pursuit of false reputation, or his hearers in useless disputes con- cerning classification ; none would approach more nearly to an arrangement by which all arbitrary associations and disjunctions of diseases would be avoided, and the first parts of the course would prepare for those which were to follow, — than one founded on Physiology.

It is therefore my design to speak of diseases in the order in which the functions are observed in the living body, from the first moment of life to the reproduction of a creature destined to perpetuate the species. First, consequently, I shall speak of diseases of the Circulating System, sangui- neous and lymphatic ; then of the diseases of the Respira- tory function and organs ; then of diseases of the Brain, Spinal Marrow, Nerves, organs of Sense and Motion ; then of diseases affecting Nutrition and Evacuation ; and lastly, of diseases of the Reproductive or Generative System. I do not insist on the exclusive value of this arrange-

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nient. It is impossible to begin anywhere without this in- convenience,— that things must sometimes be alluded to, which have not been explained. The connections of the different systems of the human body are so numerous, their reciprocal influences so incalculably many, that with no set of organs or class of functions can we commence, which, although primary in some points of view, are not secondary in others. We have to describe a circle, and may begin in any part of it. Other arrangements may have been preferable in other times, and a better may pos- sibly hereafter be practicable. I take medical science in its existing state, and adopt the arrangement of its subjects which seems to me best fitted to its present advancement.

The order I have chosen will have one very evident ad- vantage : it will embarrass the student with no hypotheses concerning either structure or function. When, in his first practical attempts, a disease is presented to his obser- vation, we all know, who have made those attempts, that he does not search his memory for a definition in order to understand such disease ; that he does not seek its place in any artificial classification ; but that he first inquires what functions or what organs are disordered: — the circulating, the respiratory, the digestive, the intellectual, the sensorial, the muscular, the generative; — and he will surely find his inquiry facilitated by having studied the disease, whatever it may be, in its natural place. He takes into his view many circumstances ; and by a comparison of them deter- mines the nature of the case : and it is surely desirable to avoid impeding him with imposing divisions, and names hostile to the recognition of disease in its effects, effects which he is to endeavour to remove. If, as commonly happens, two or more organs or functions are affected, he will be equally well prepared, by his previous study of dis- ease as fully described to him, to discover which affection was the first in order, whether that which was primary is yet in his power, or which demands his chief attention. Some disorders are of a nature to affect various structures,

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and consequently to appear in various organs, and to disturb various functions. These will be first treated of generally, and then as they affect particular parts. The general na- ture and treatment of Inflammation, for example, will be described in the First Division, as an affection of the Cir- culating System ; but inflammation will also be spoken of in each of the other divisions in which it forms distinct dis- eases. Morbid formations will be arranged among the dis- eases of the parts or structures in which they most com- monly appear, or which they most seriously affect.

Each of the Five divisions into which my Course is thus divided, will be commenced with a brief reference to such parts of what has been taught by the Professors of Anatomy and Physiology, as are inseparable from pathological con- siderations of a general character ; or which require, from their close connection with the diseases of the division, to be distinctly and constantly kept in mind. Having done this, the functional or physiological irregularities, and the morbid appearances or anatomical changes found in the system comprehended in that division, will be summarily viewed. This retrospect and survey will generally occupy one lecture. Afterwards, when speaking of the different disorders of the division separately and fully, it is my in- tention, whenever it is practicable, to show and describe, sometimes with the help of recent specimens, sometimes in morbid preparations, often by faithfully executed drawings, the effects of the disease which is under consideration, or its pathological anatomy, in the incipient state of the disorder, in its progress, and in its ultimate stage. My care will be to associate these appearances with the symptoms which they produce, and by which they are to be recognised during life ; and with this knowledge of effects and signs, it will not be difficult to connect rational views of medical treatment ; such as in the first and second stages may lead to measures calculated to prevent further progress or pro- duce a cure, and in the last to mitigate suffering and retard the approach of death.

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In some diseases I must speak of what cannot be recog- nised in the dead body by our senses, but of the existence of which we have reason to be certain from the effects which we see during life. Many disorders of the nervous system are of this kind ; and functional disturbance may continue long and leave no trace. The plan of illustration which I have mentioned will of course only be applicable to that aggravated state in which structural change super- venes on disorder of function.

In order to make the description of diseases available to the purposes of the student, it should not, 1 conceive, be merely systematic or historical, but should also represent them as they are most likely to be seen by the young prac- titioner. Thus, although the shivering, the bodily and mental languor, the wandering and unsettled pains which often precede the more marked symptoms of Fever, must not be omitted in the systematic description of that dis- ease; the student must be warned that his assistance will most likely be required when these symptoms have passed away, when the patient is not in a state to recall them, and the more prominent and alarming phenomena of fever are developed, complete prostration of bodily power, violent affections of the head, or chest, or bowels, and a bewildered mind. Pie will be told, that cases still more perplexing will be presented to him, in which no local symptoms are strongly marked, but all the functions labour and are op- pressed ; in which the causes and the origin of the com- plaint are obscure, and its progress has been inaccurately marked. He will be further warned, that fevers sometimes commence with the local symptoms of common inflamma- tory disorders, and sometimes with the suddenness and some of the appearances of apoplexy.

It is my intention to dwell somewhat more fully on Mental Disorders, or, to speak more correctly, of disorders affecting the manifestation of mind, than has I believe been usual in lectures on the practice of medicine; and for many reasons. There is a very general opinion gaining ground,

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that these dreadful disorders are more common than they formerly were. The consideration of them often involves the most important interests of families, and throws a heavy responsibility on the physician. I disapprove entirely of some parts of the usual management of lunatics. I also consider the distinction between Rationality and Insanity to be clearer and easier than it is generally represented, and look upon the singular and contradictory definitions which have on many occasions been publicly given, as so many proofs of the want of proper means of obtaining a practical acquaintance with insanity. In this important department, I trust I shall be enabled to afford opportunities to the student, for the first time in this country, of becoming fa- miliar with the diversified aspects of this alarming malady ; and I cannot but hope that a great impulse will thus be given to the study of them, and that great general improve- ment will in a few years arise in this department, to the advantage of the public, no less than to the honour of our medical school.

When detailing the modes of distinguishing one disease from another, I shall place before you those circumstances only which are the most surely established; mentioning perhaps, but not dwelling much upon, sometimes passing over, those less certain, which the pride of affected perspi- cacity has occasionally proclaimed. I conceive that my first object is to put you in possession of such facts as are so securely fixed as to be serviceable in the first steps of prac- tice. Thus, in speaking of the percussion of the chest by the fingers, or of the application of the ear to it, in order to ascertain the state of its contents, I shall in some affec- tions dwell on the value of these methods of exploration, in others pass lightly over them, — in all notice them only as auxiliaries ; for I should be with much reason appre- hensive of your doing great injury to the public, if, for- getting to acquaint you thoroughly with those symptoms which you can see and feel, I should trust your patients to

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your discrimination of those to be derived from the sense of hearing. I should expect you, and, what you will find to be of more consequence, your patients will expect you, to be able to distinguish a severe catarrh, or bronchitis, an inflammation of the mucous lining of the air-passages, from an inflammation of their parenchymatous substance, or from an inflammation of the pleura, or membrane by which the lungs are covered, in most cases, by the general sym- ptoms : but I should unquestionably wish you to be able to verify your diagnosis by the stethoscope and percussion, and thus, in cases apparently doubtful, acquire a certitude, I could almost say an infallibility of diagnosis unattainable by any other methods.

The same views will govern me in noticing the results of disease, or pathological anatomy. I shall take great pains to familiarize you with such as are the undoubted products of particular processes, more especially of such as are early indicated by particular symptoms, and which there is rea- son to think may be checked in their origin ; such as you have to expect when particular symptoms present them- selves, and such as you are to prevent or to cure. But I shall not dwell, lecture after lecture, on the infinite minutiae of morbid appearances ; for if I did, I should be forgetting the chief object of my lectures. I by no means would dis- courage any pupil, who is not very anxious to become en- gaged in practice, from applying himself to morbid ana- tomy even as a distinct science; but in these lectures it must always be spoken of as a science subservient to that of preventing the changes which it exhibits.

The same views will influence me in what I say concern- ing the treatment of diseases, which will be exposed as clearly as may be practicable in relation to symptoms and results, and governed by such principles as seem to rest on the most fixed foundations, and to-be applicable to the many indescribable modifications of morbid actions. Doubtful measures, new remedies, empirical experiments,

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will not be despised ; but their success will not always be considered as a proof of their being fit for general applica- tion : they may be noticed as deserving of future attention, but not to the neglect of things more certain, plain, and familiar, of which you will have immediate and hourly need. Undecided questions, yet the subject of warm or intemperate controversy, will be stated, with the chief arguments of the contending parties ; but the student will be rather exhorted to examine than urged to decide. The lecturer can but give an outline, which the future industry of the student must fill up. His duty is not to repeat everything that has been said or written, but to analyse and simplify that which it is most important for you to learn ; to aid in the formation of opinions, rather than to dictate opinions ; and to furnish that information for which you will have instant necessity, in such a way as may induce you, and enable you, to add to it by your own subsequent industry. He is supposed to devote a great part of his time to the task of selecting, arranging, and condensing, from the voluminous records of physic, what it immediately or chiefly imports you to know, and to the more difficult labour of collecting out of the publications of his own time what is truly useful and really new; rejecting without scruple what is delusive or uncertain, or so minute as to be useless to the practitioner. Remembering that to many of his hearers the subjects of which he treats are new, solely anxious to inform and direct, lecturing to his pupils and not for the public, — it is desirable that he should not only be clear in his conceptions and accurate in his infor- mation, but plain and precise in his expressions ; dreading nothing so much as to mislead his hearers, above all in medicine ; since not their knowledge alone, not mere spe- culative opinions, but their practice, the fate of their pa- tients, may be influenced by what he says. Careless of the fame that may always be acquired by professing novel and ingenious doctrines, he must yet sometimes lead the way into the regions of speculation ; but he must know where

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to stop, and not be afraid to confess that there are many things which he cannot explain, and which are yet to be elucidated.

Still, beyond these lessons, something is required to make them useful. It is not learning alone, or extensive reading, or any familiarity with verbal descriptions, which can pre- pare the student to know disease when he sees it, or to cure it when it is recognised. The materials for discourses on medicine are open to all ; but it is the superiority of the modes of Clinical teaching, superadded to the ability of in- dividual lecturers, which has given celebrity to the most famous schools ; to those of Germany and of France, and I add with pleasure from my own experience, to the justly celebrated school of Edinburgh. In the Hospital and Dispensary attached to the University, constant, and I hope daily increasing, opportunities will be afforded of becoming practically acquainted with disease. TJiere the justness of what you hear in these lectures must be finally tried, the principles laid down be applied to practice, and the last attempt made to lead the student step by step to act for himself. You will there be enabled to compare the different ways of obtaining the same ends, and be a witness of those occurrences which in the course of a disease so often modify the best concerted plans of treatment; and become con- vinced that there are no practical aphorisms to be acquired in the halls of learning, which are to be confidently acted upon without any further exercise of the understanding at the bedside of the sick. You will see that no part of the system can be long in disorder, without affecting the tran- quillity of the rest; that complications beyond the power of any lecturer to enumerate are frequently met with ; and that when you come to be engaged in practice you will often have to deal with cases described in no lectures, compre- hended in no system of medicine, to which the most un- questionable principles of physic must be applied with cau- tion, and in which the blind application of eternal rules of practice will be fatal to the patient : — you will find, in short,

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that after obtaining a competent acquaintance with what is to be learnt from lectures, from books, and from an obser- vation of the practice of others, the chief requisite for prac- tising physic is what is commonly called good sense ; by which I mean the vigilant and ready exercise of the under- standing or judgment in all the accidents of practice, and a prompt adaptation of what you know, to what you have to do; — a possession consequently, which, though partly a gift of nature, is capable of great development by careful cul- tivation. In what relates to a practical art, industrious talent may acquire and arrange, genius may improve and adorn, but good sense must always direct.

Such is an outline of the principles and the manner ac- cording to which I conceive medicine requires to be taught in the present state of the science. The medical school of England, Gentlemen, has long stood honourably distinguish- ed above all or most of the European schools, by being free from the trammels and language of any exclusive theory. If, in our anxiety to attain and preserve valuable practical truths, we have been sometimes too negligent of what were considered to be mere refinements, we have at least avoided the disgrace of giving protection to imposture, or a solemn sanction to the absurd delusions by which visionary or dis- honest men have often, in other countries, found a way to fame. Our opportunities of anatomical investigation, and of observing the results of disease, have been limited, and unfortunately continue to be too much so, by the prejudice existing in this country against the examination of bodies after death : but at the same time, the diligence with which the opportunities we have enjoyed have been cultivated, the constant bearing which our pathological anatomy has had on the practical improvement of our profession, have left mu^i less to regret than is imagined by those who merely consider the opportunities of dissection afforded on the continent: — and let it not be forgotten, that causes which it is satisfactory to reflect upon, have in reality contributed

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to limit our opportunities — a greater regard even among our humble countrymen and women for those whom death has taken from their families, and a practice of medicine and surgery so zealous and direct as to prevent the exces- sive results of disease, and more powerfully to obviate what has been termed the " tendency to death." I would entreat those who have been led into what I cannot but consider an unjust and even an unsafe preference of the foreign me- dical schools, to reflect what kind of men have been pro- duced by the system followed in this country. I would beg them to observe the spirit and discernment, the union of zeal and judgment, with which medical investigations are carried on among us ; the general character of those who practise the different branches of the profession ; the esti- mation in which they are held in this country ; and above all — for this is the greatest consideration of all — the effects of their labours on the lives of their patients. In exchange for these benefits, we should ill-receive, in my opinion, all that is offered to us by systems of education from which, although I acknowledge the diligent ambition resulting from them, all noble views seem to be too much shut out; in which at least (for I have no wish to encourage prejudice or to exaggerate anything), exact and useful knowledge and good faith are not more conspicuous than in our own schools; but which call for more display, and for more ostentatious exhibitions, alien to the character of a serious study : — for as far as my own observation and experience have gone, I feel convinced, that it is not by public and formal efforts, by disputations, and competitions, and showy discourse, but by quiet observation long pursued, by care- ful, by repeated, by undisturbed reflection, and thought long unexpressed, that the medical student or practitioner works his arduous way to a knowledge of his profession.

Knowing myself to address many students who are commencing their studies in this metropolis, I shall not be departing from the proper limits of my duty if I de-

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vote the remainder of the present lecture to observations of a general kind, chiefly connected with the habits and education proper or desirable for those who mean to study any of the branches of our profession.

The first habit to be recommended to all students is diligence, and to a medical student a diligent devotion of his mind to his proper profession. Whoever means here- after to practise physic with comfort or credit; whoever would be consoled under the depressions incidental, I ima- gine, to the most judicious practice ; must never forget that the sciences connected with it, and to which he is conse- quently introduced, are only valuable to him as the auxilia- ries of his profession, — that they do not make, but only assist a physician. With this caution, the medical student can- not be too diligent. To him no mistake will be more de- trimental than to underrate the homely virtue of industry ; without which, in our profession, perhaps in any profes- sion, no man ever attained to eminence. If some indivi- duals, by the help of a brilliant imagination and certain powers of acquirement, have gained celebrity in spite of their notorious indolence, such men have done little for their profession, their country, or mankind, and have ac- quired no permanent or valuable fame; but the greatest men of all nations and times have been men of industrious or even of laborious habits. I have watched with much interest the fate and conduct of many of those who were pur- suing their studies at the same time with myself. Of these, some were of course idle, and despised the secluded pursuits of the studious : — of such, I do not know one whose pro- gress has been satisfactory : many of them, after trying various methods of dazzling the public, have sunk, already, into merited degradation. But I do not know one among those who were industrious, who has not attained a fair prospect of success : many of them have already acquired reputation ; and some of them will doubtless be the im- provers of their science in our own day, and remembered with honour when they are dead.

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It would doubtless be most desirable that the general education of a student should end when his professional education commences. This, I fear, can seldom be the case with medical students. But the more carefully and liberally a youth has been educated, the more advan- tageously will he enter on his medical studies. I leel it in- cumbent upon me to express myself very unreservedly on the subject of Classical learning, because I know that it has often been represented as incompatible with professional ability, and a depreciation of it has, even within our own time, and in our own profession, been regarded as an ex- pression of liberality ; as the indication of a mind which, bowing to no authority, dared to assert its own freedom. These opinions, originating perhaps in the too evident waste of time when a knowledge of the dead languages is considered the principal object of a man's life, are yet erro- neous and prejudicial. — Certainly, of all delusions, that of a man who, without any classical taste, any elegance of mind, any habits of literary life, affects to look down upon others because he had in his youth what is called a classi- cal education, is the most ridiculous and the most unfortu- nate ; for such a delusion keeps him in a state of profound and vulgar ignorance, and at the same time in a state of the most perfect satisfaction with himself. Far be it from me to be accessary to the continuance of such a pompous and useless prejudice. — But, Gentlemen, you cannot be fa- miliar with the languages of Greece and Rome, without at the same time becoming familiar with the characters of some of the greatest men who ever lived, and the most exalted sentiments which the human mind ever conceived : nor can you be intimately acquainted with the beauty and accuracy of expression which characterize the best Greek and Roman writers, without becoming at the same time accustomed to the most admirable order and precision of thought.

Both languages were spoken and written in their greatest purity by nations which, though inferior in many points of private morals to the modern, were yet distinguished in

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their time far above all the other people of the earth. When those languages became corrupt, public spirit had lamentably declined ; and when they ceased to be heard, a moral darkness overspread the fairest parts of the world ; the sciences, and medicine very remarkably, were neglected; the voice of wisdom and the splendours of poetry were either restrained or prostituted to the meanest purposes ; and liberty was altogether extinguished. But when, after this dreary period, the barbarous models of the middle ages were put aside, and the noble languages of antiquity re- vived ; not learning only, not only poetry and eloquence, but sciences and arts revived ; the human mind seemed to receive an accession of strength ; the moral and political condition of men improved ; manners began to be purified and refined ; the modern languages were polished into elegance ; and, lastly, medicine was rescued from the sla- very of imitation, and all those researches made, and all those reforms effected in it, which I have already said have marked the last two centuries. Since that revival, the most distinguished men in all countries have drank the deepest at these pure fountains ; and even at present, an acquaintance with classical learning, an habitual inter- course with the orators, poets, philosophers, and physicians of past ages, is most conspicuous in those who are the first poets, orators, physicians and philosophers of our own.

To depreciate languages ever associated and cotempo- raneous with advantages like these, is surely then a, false liberality, and a mere affectation of practical wisdom ; and instead of being likely to cherish feelings of true liberty, mental or political, has a direct tendency to make you view all institutions and all parts of learning with a narrow and prejudiced mind.

Seek then, I would say, or continue to keep up, an ac- quaintance with the languages of Greece and Rome. The latter is at least within your attainment, and a knowledge of it of the greatest utility to a medical student. If you have neglected it, let me persuade you to devote one hour

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a day to it during the whole period of your medical study ; such an occupation will form an agreeable relief after your other duties, and at the end of a few years you will be sur- prised to find how much that little sacrifice of time has enabled you to accomplish.

Very great advantage will attend your being acquainted with some of the modern Europaean languages, particularly with French and German ; and the number may easily be increased when one or two are well learnt. Nor should I omit to mention an attention to the correct use of your own, of which many men proud of their classical attainments, and many medical writers, have been but too negligent. A man may assuredly be a very good physician, or a very good surgeon, without any knowledge of Greek and Latin, of French or German ; but if he cannot write his own clearly, or speak it correctly, his writings and language will cast perpetual ridicule on what is considered a learned pro- fession. And let the British student remember, that the English tongue yields to none in copiousness, in strength, and in variety ; that it is spoken more extensively than any other ever was, and has been employed to express the thoughts and deeds of men who will bear a comparison with the foremost men of all antiquity.

It is hardly necessary for me to observe, that a gentleman practising the higher branches of a liberal profession is ex- pected to have a general acquaintance with modern litera- ture, and some knowledge of what are called the Fine Arts. But it will also prove highly serviceable to him to have studied such parts of Natural Philosophy as explain some of the properties, functions, and capacities of the living body ; he will sometimes find it necessary to direct his thoughts to the Philosophy of the Human Mind; his in- formation will be much increased by an acquaintance with the very interesting studies of Comparative Anatomy and Zoology : neither should he be ignorant of Mathematics ; and he will often be materially assisted by possessing the accomplishment of Drawing. These acquirements, if they

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do not all constitute indispensable parts of a complete me- dical education, may at least precede it with great benefit to the student. The habits of attention which such studies favour, and the store of ideas with which they furnish the student, strengthen, by exercising, his mind ; and enable him to enter upon with less difficulty, and to comprehend more readily, the anatomy and physiology of the human body, and whatever relates to the practice of physic and surgery.

The studies which I have enumerated (for I have omitted many which have sometimes been insisted on) are not at all beyond your reach, provided your early years have been well spent, and you have learned to " pick up the fragments of your time ;" nay, they may be graced and set off with many accomplishments, provided you have no attachment to low and debasing pursuits ; provided that your ambition is a well regulated and steady principle, arising from your desire to do what is useful and good ; and that your asso- ciates and even your amusements are well chosen.

I need not, I am sure, dwell on the advantage, now first known in London, of an University in which will be pre- sented opportunities for the cultivation of any or of all the parts of knowledge which I have mentioned ; situated too, in the midst of an intellectual capital, in which the student can never be driven, by the proscription of elegant and rational amusements, or the want of agreeable and virtuous society, to throw away his early life in low debauchery or vice ; — an institution in which the mere parade of learning, or the most laborious perversion of talent, will be far less considered than the attainment of useful knowledge ; — an institution in which it is professed, as I solemnly believe, without reserve or equivocation, that no sect, no party, no persuasion, no difference of rank, or fortune, or opinion, will be a bar to all the academical honours which a pupil may merit, or which can here be bestowed. You must be very inattentive to what is passing around you, if you are not convinced that the careful culture of the mind was never

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more necessary than it now is, for the preservation of the rank in which you are placed, or for the attainment of a higher. Nor will you ever find that your acquisitions are barely equal to the expectations with which your efforts were commenced. Menial industry is always abundantly rewarded. New rays of intelligence, and clearer views of your duty, will be communicated to you from every side ; and you will experience, I trust, that the cultivation of true knowledge has not only informed your understanding, but exalted your whole character.

Whatever may have been your past advantages or dis- advantages, whatever may be the present state of your in- formation— again I say, keep in your memory at all times that it is the Practice of your profession with which you have to do. Neglect nothing that may enrich your minds, or give you consideration, or improve your real happiness ; but remember that the great business of your lives is " to learn what you can, and to do what you can, for the good and the comfort of the sick and the miserable."* Let every day therefore be well employed ; for though the time you have to spend in study now seems long, it will pass away quickly, and cannot return. Excuses are too often admit- ted by the student when he is conscious of his own indolence, and he promises himself that on another occasion that fault will be avoided ; but days, and weeks, and months follow one another, and at last his opportunities are gone. Attend daily therefore, and regularly, both lectures and hospital practice ; a day's neglect breaks the chain, and makes many lectures unintelligible, and many cases uninstructive. Keep accurate and copious records of the cases you have time to attend to ; review these records at stated periods, and make memorandums of what seems worthy of observation, pre- serving such notes arranged in alphabetical order, without which, or some such precaution, the more your manuscripts

* Life of Dr. Bateman. — An account of this interesting piece of Medical Biography was given by me in the London Medical Repository for December 1826, to which T beg to refer the medical Student.

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increase, the greater will be their confusion. Do not at- tempt to read many volumes, or distract yourselves with numerous authorities, or the countless cases related in me- dical writings. With a few of the ancient authors and some of the moderns I should wish you to be familiar, and these I will take opportunities of pointing out to you. But in general I would say, read little, observe carefully, and think much. Accustom yourselves also to write such re- marks as seem to you to be new or otherwise worth pre- serving, never deferring doing so beyond the earliest mo- ment of leisure you can command after the observation has been made. All men are accountable for their time, but none more than you. You will be hereafter liable to be called upon to act unassisted, or to assist others, in cases of sudden and great danger ; and on your previous prepa- ration, and on the state and temper of your mind, it must often depend whether the result be life or death. The sa- crifices and exertions which these considerations render necessary, are surely more than compensated by the real importance, interest, and dignity of your art; by the value of which you may be to your fellow-creatures : for there is no pursuit which engages its followers in such a variety of delightful studies, for ends more directly useful to man- kind. The ample page of all knowledge is thrown open to you, from whence to learn how to relieve the sufferings, restore or prolong the activity, and thus bless the existence of those about you.

Let me exhort you never to take less worthy views of the profession in which you have engaged, or at any time to become unduly sceptical of its powers. Those powers are indeed limited, but by no means visionary. Although there may be great difficulty in finding out the principles of the science, we may be assured they are no less exact than any by which other sciences are regulated. The leading cha- racters of all the most serious diseases have been the same from the earliest aera of which we have any medical re-

32

cords : the susceptibilities and the functions of the body, the properties of medicinal substances, the state of the earth and of the air, have undergone no change ; the fa- culties of the human mind, the springs of human affection and passion (with all which enlightened medicine has to do), have ever been the same. The treatment therefore of disease ought not to be wavering or uncertain ; ought not to present a broad and unnatural contrast to this great uniformity and constancy of nature. Nor will you find that it does so, if you confine your views to such treatment as can alone be accounted rational, and meet the varieties of disease by means which, though equally varied, are not adopted capriciously or incautiously, but suggested by such knowledge of the nature of diseases as you can acquire. Be assured, Gentlemen, that exercised with judgment, medi- cine will enable you to exert more controul over disease than you sometimes dare to hope. Many acute affections may be overcome and destroyed with what may almost be called certainty ; the progress of morbid formations of the most serious kind may be suspended, if not wholly pre- vented ; and in some cases effectually and wholly checked ; whilst in almost every case sufferings may be lessened, life rendered comfortable, and death delayed. Such, even at present, is the power of medicine ; and if we look at the apparent intention of the most fatal morbid processes, and consider the exhaustless stores of nature, and the daily productions of scientific pharmacy, we shall see much rea- son to believe that the powers of medicine may yet "be greatly amplified ; that some diseases now considered the most intractable may hereafter become curable by art. The justifiable hope of being able to add to the resources of the physician or surgeon ; of being able to cure diseases now invariably fatal ; to relieve sufferings which now pro- ceed uncontrouled ; and thus to become signal benefactors to your nation and to the world, is surely sufficient to pre- vent your becoming desponding during your studies, or

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inert in your daily practice. If there be any truth in these observations, you cannot be desponding without folly, or negligent without criminality.

It is, I hope, almost superfluous for me to explain that in making the observations I have done on the diligent employment of a medical student's time, and on the devo- tion of all his faculties to his profession, I have not meant to encourage or excuse the total neglect of more serious thoughts and occupations. God forbid, Gentlemen, that I should be supposed for a moment capable of joining in any hypocritical and odious cry, in which the sacred name of religion is employed to promote political ends and worldly interests, to justify persecution, and to excite the worst passions of men ! But there is a religion which makes men better ; and so much of your employment will be among the works of the Almighty hand, and you will have so many opportunities of rightly estimating at the bed of the sick and the dying the true value of all mere worldly con- siderations, that I trust I may without impropriety beseech you in the midst of your busy engagements, not to let your feelings be interested by these occupations in vain. Habi- tually engaged, as you will be, in doing good, I should wish you to be supported and directed in your exertions by an exalted sense of duty. This is the state of mind by which all the brightest characters in our profession were distinguished, and I pray that it may be yours.

As the rules of the University leave you one day in the week (Saturday) for the revision and arrangement of your notes, and for proper relaxation, you will not be under the necessity of employing any part of Sunday in that manner. On that day therefore, let all your medical occupations be put aside — your Hospital attendance, or visits to any poor patients under your care, excepted. Attend the services of religion. Examine how you are passing your time. Re- view and regulate your thoughts ; and clear your minds of any animosities or discomposures which may have arisen during the week. Let the remainder of the day be passed

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in the perusal of esteemed authors, or in the society of wise and good associates. You will then not only not lose a day, but will actually gain time, by the refreshment of your minds ; and by the acquisition of that serenity, the want of which is most unfavourable to mental exertion, and which is never enjoyed except when we are quite at peace with ourselves.

Gentlemen, I have but one word more to say on the present occasion. You commence your studies when our professional body is agitated by many matters of great in- terest. Some of you may perhaps be persuaded, before your studies are completed, to take a part in proceedings or distussions having for their object certain changes in the medical constitution. On the propriety of these changes it would be unbecoming in me to offer any opinion in this place. But let me advise you to approach these subjects calmly, and not to give way to any feeling but a desire to do good to and to protect the whole body of the profession, and to benefit the public, of which that profession forms a part.

Beware how you allow your passions to be influenced by any, who, on the just ground that old establishments need occasional alterations, would really engage you in the de- struction of what is useful as well as venerable. Hear the opinions of the old as well as of the young ; compare one with another; and judge for yourselves. Leave, for the present, to others, the care of changes demanding time, which you have not to spare ; experience, which you cannot be supposed to possess ; patience, which does not belong to your age. Do not waste valuable hours, and neglect your present opportunities, in endeavouring to effect what only your seniors can effect, — hours which you can never recall, and opportunities which will never present themselves again ; but will be looked back upon, if lost, with pain and regret as long as you live.

And, Gentlemen, above all things, when you are urged

to any particular line of conduct, let your first inquiry be concerning the character of those who are most active in it, and who are to be your associates. Ask yourselves if they be truly honest men. If they are not, have nothing to do with them in any cause, for they will corrupt the best. In all countries pretending to civilization and morality, people have long been convinced that the end, however laudable, does not justify unholy means. It may be your duty to endeavour to reform, but only if you can reform by honourable efforts. An ancient edifice may require repair, and repair might conduce to its safety ; but if the few skil- ful workmen who alone could undertake this experiment of preservation be surrounded by a passionate and unscrupu- lous multitude, their wise efforts will be overborne, and no good end effected.

If you forget these truths, and become committed to the cause of injudicious, or selfish, or reckless men, be assured you will find, even in your own profession, a spirit which will not tolerate you ; and by the public sense of this country you will be opposed and defeated in every step of your pro- ceedings. The time has gone by, when in the comparative ignorance of the community at large, want of principle was occasionally tolerated because connected with highly cul- tivated talent. You live in days when not knowledge alone, but character is power ; when knowledge without character can procure no more than temporary and very transient preeminence; and cannot save from final exposure and disgrace. Unjust suspicions may attach to an innocent man ; the general consistency and integrity of his life will wipe them away; the imprudencies of youth may be re- paired by the circumspection of middle age : but if you justly lose your reputation for probity and honour, you may struggle, and resist the great decree of public opinion; but you will find, whatever your attainments, whatever en- gaging qualities or natural endowments you possess, that yqur influence in society is gone, and that you are in all respects lost and ruined men.

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We have reason to congratulate ourselves, Gentlemen, that we do live in a country and in times so favourable to the exercise of virtue. Let it be your constant ambition, then, to be esteemed and distinguished when esteem and distinction are not conferred even upon intellectual great- ness, except when combined with, and elevated by, some approach towards moral excellence ; — when not the mere possession of talent is a title to admiration, but that just employment of it, which, whilst it is truly useful to your fellow-creatures, and satisfactory to yourselves, can alone be pleasing to the Great and Good Being by whom so glorious a gift was imparted.

THE END.

Printed by RICHARD TATLOR, Red Lion Court, Fleet Street.

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