Again，thecomplaintisoftenheardthatthenativepopulationisnotincreasingsorapidlyasinformergenerations。ThebreedingandnursingperiodofAmericanwomenisoneofpeculiardelicacyandfrequentinfirmity。Manyofthemmustrequireaconsiderableintervalbetweenthereproductiveefforts，torepairdamagesaridregainstrength。Thismatterisnottobedecidedbyanappealtounschoolednature。Itisthesamequestionasthatofthedeformedpelvis，——oneofdegree。Thefactsofmal-vitalizationareasmuchtobeattendedtoasthoseofmal-formation。Ifthewomanwithatwistedpelvisistobeconsideredanexempt，thewomanwithadefectiveorganizationshouldberecognizedasbelongingtotheinvalidcorps。Weshuddertohearwhatisallegedastotheprevalenceofcriminalpractices；ifbackofthesetherecanbeshownorganicincapacityorovertaxingoftoolimitedpowers，thefactsbelongtotheprovinceofthepracticalphysician，aswellasofthemoralistandthelegislator，andrequirehisgravestconsideration。
Taketheimportantquestionofbleeding。Isvenesectiondonewithforever？SixyearsagoitwassaidhereinanintroductoryLecturethatitwoulddoubtlesscomebackagainsoonerorlater。AfortnightagoIfoundmyselfinthecarswithoneofthemostsensibleandesteemedpractitionersinNewEngland。Hetookouthiswalletandshowedmetwolancets，whichhecarriedwithhim；hehadnevergivenuptheiruse。Thisisapointyouwillhavetoconsider。
Or，tomentiononeoutofmanyquestionableremedies，shallyougiveVeratrumVirideinfeversandinflammations？Itmakesthepulseslowerintheseaffections。Thenthepresumptionwouldnaturallybethatitdoesharm。ThecautionwithreferencetoitonthisgroundwaslongagorecordedintheLectureabovereferredto。SeewhatDr。
JohnHughesBennettsaysofitintherecenteditionofhisworkonMedicine。Nothingbutthemostcarefulclinicalexperiencecansettlethisandsuchpointsoftreatment。
Theseareallpracticalquestions——questionsoflifeanddeath，andeverydaywillbefullofjustsuchquestions。Taketheproblemofclimate。Apatientcomestoyouwithasthmaandwantstoknowwherehecanbreathe；anothercomestoyouwithphthisisandwantstoknowwherehecanlive。Whatboy’splayisninetenthsofallthatistaughtinmanyapretentiouscourseoflectures，comparedwithwhatanaccurateandextensiveknowledgeoftheadvantagesanddisadvantagesofdifferentresidencesintheseandothercomplaintswouldbetoapractisingphysicianIsawtheotherdayagentlemanlivinginCanada，whohadspentsevensuccessivewintersinEgypt，withtheentirereliefofcertainobscurethoracicsymptomswhichtroubledhimwhileathome。Isaw，twomonthsago，anothergentlemanfromMinnesota，anobserverandamanofsense，whoconsideredthatStateasthegreatsanatoriumforallpulmonarycomplaints。Ifhalfourgrownpopulationareorwillbemoreorlesstuberculous，thequestionofcolonizingFloridaassumesanewaspect。EvenwithinthebordersofourownState，theveryinterestingresearchesofDr。Bowditchshowthatthereisagreatvariationintheamountoftuberculousdiseaseindifferenttowns，apparentlyconnectedwithlocalconditions。ThehygienicmapofaStateisquiteasvaluableasitsgeologicalmap，anditisthebusinessofeverypractisingphysiciantoknowitthoroughly。TheyunderstandthisinEngland，andsendapatientwithadryirritatingcoughtoTorquayorPenzance，whiletheysendanotherwithrelaxedbronchialmembranestoCliftonorBrighton。Hereisanothergreatfieldforpracticalstudy。
Soastotheall-importantquestionofdiet。“Ofallthemeansofcureatourcommand，“saysDr。Bennett，“aregulationofthequantityandqualityofthedietisbyfarthemostpowerful。“Dr。MacCormacwouldperhapsexcepttheairwebreathe，forhethinksthatimpureair，especiallyinsleepingrooms，isthegreatcauseoftubercle。
ItissufficientlyprovedthattheAmerican，——theNewEnglander，——theBostonian，canbreedstrongandsoundchildren，generationaftergeneration，——nay，Ihaveshownbytherecordofaparticularfamilythatvitallossesmayberetrieved，andafeebleracegrowtolustyvigorinthisveryclimateandlocality。Isnotthequestionwhyouryoungmenandwomensooftenbreakdown，andhowtheycanbekeptfrombreakingdown，farmoreimportantforphysicianstosettlethanwhetherthereisonecranialvertebra，orwhethertherearefour，ornone？——
ButIhaveatasteforthehomologies，Iwanttogodeeplyintothesubjectofembryology，Iwanttoanalyzetheprotonihilatesprecipitatedfrompigeon’smilkbytheactionofthelunarspectrum，-
shallInotfollowmystar，——shallInotobeymyinstinct，——shallI
notgivemyselftotheloftypursuitsofscienceforitsownsake？
Certainlyyoumay，ifyoulike。Buttakedownyoursign，orneverputitup。ThatisthewayDr。OwenandDr。Huxley，Dr。AgassizandDr。JeffriesWyman，Dr。GrayandDr。CharlesT。Jacksonsettledthedifficulty。Wealladmiretheachievementsofthisbandofdistinguisheddoctorswhodonotpractise。Butwesayoftheirworkandofallpurescience，astheFrenchofficersaidofthechargeofthesixhundredatBalaclava，“C’estmagnifique，maiscen’estpaslaguerre，“——itisverysplendid，butitisnotapractisingdoctor’sbusiness。Hispatienthasarighttothecreamofhislifeandnotmerelytothethinmilkthatisleftafter“science“hasskimmeditoff。Thebestaphysiciancangiveisnevertoogoodforthepatient。
Itisoftenadisadvantagetoayoungpractitionertobeknownforanyaccomplishmentoutsideofhisprofession。HallerlosthiselectionasPhysiciantotheHospitalinhisnativecityofBerne，principallyonthegroundthathewasapoet。Inhislateryearsthephysicianmayventuremoreboldly。Astrucwassixty-nineyearsoldwhenhepublishedhis“Conjectures，“thefirstattempt，wearetold，todecidetheauthorshipofthePentateuchshowinganythinglikeadiscerningcriticism。SirBenjaminBrodiewasseventyyearsoldbeforehelefthisphysiologicalandsurgicalstudiestoindulgeinpsychologicalspeculations。Theperiodofpupilagewillbebusyenoughinacquiringtheknowledgeneeded，andtheseasonofactivepracticewillleavelittleleisureforanybutprofessionalstudies。
Dr。GravesofDublin，oneofthefirstclinicalteachersofourtime，alwaysinsistedonhisstudents’beginningatoncetovisitthehospital。Atthebedsidethestudentmustlearntotreatdisease，andjustascertainlyaswespinoutandmultiplyouracademicprelectionsweshallworkinmoreandmorestuffing，moreandmorerubbish，moreandmoreirrelevant，uselessdetailwhichthestudentwillgetridofjustassoonasheleavesus。Thenthenextthingwillbeaneworganization，withanexaminingboardoffirst-ratepracticalmen，whowillaskthecandidatequestionsthatmeanbusiness，——whowillmakehimoperateifheistobeasurgeon，andtryhimatthebedsideifheistobeaphysician，——andnotpuzzlehimwithscientificconundrumswhichnotmorethanoneofthequestionerscouldanswerhimselforeverheardofsincehegraduated。
Orthesewomenwhoarehammeringatthegatesonwhichiswritten“Noadmittanceforthemothersofmankind，“willbyandbyorganizeaninstitution，whichstartingfromthatskilfulkindofnursingwhichFlorenceNightingaletaughtsowell，willworkbackwardsthroughanodynes，palliatives，curatives，preventives，untilwithlittleshowofscienceitimpartsmostofwhatismostvaluableinthosebranchesofthehealingartitprofessestoteach。Whenthattimecomes，thefitnessofwomenforcertainmedicalduties，whichHecquetadvocatedin1708，whichDouglasmaintainedin1736，whichDr。JohnWare，longthehonoredProfessorofTheoryandPracticeinthisInstitution，upheldwithinourownrecollectioninthefaceofhisownrecordedopiniontothecontrary，willverypossiblyberecognized。
Myadvicetoeveryteacherlessexperiencedthanmyselfwouldbe，therefore：Donotfretoverthedetailsyouhavetoomit；youprobablyteachaltogethertoomanyasitis。Individualsmaylearnathingwithoncehearingit，buttheonlywayofteachingawholeclassisbyenormousrepetition，representation，andillustrationinallpossibleforms。NowandthenyouwillhaveayoungmanonyourbencheslikethelateWaldoBurnett，——notveryoften，ifyoulecturehalfacentury。Youcannotpretendtolecturechieflyformenlikethat，——aMississippiraftmightaswelltakeanocean-steamerintow。
Tomeethiswantsyouwouldhavetoleavetherestofyourclassbehindandthatyoumustnotdo。PresidentAllenofJeffersonCollegesaysthathisinstructionhasbeensuccessfulinproportionasithasbeenelementary。Itmaybeahumiliatingstatement，butitisonewhichIhavefoundtrueinmyownexperience。
TothestudentIwouldsay，thathoweverplainandsimplemaybeourteaching，hemustexpecttoforgetmuchwhichhefollowsintelligentlyinthelecture-room。Butitisnotthesameasifhehadneverlearnedit。Amanmustgetathingbeforehecanforgetit。Thereisagreatworldofideaswecannotvoluntarilyrecall，——
theyareoutsidethelimitsofthewill。Buttheyswayourconsciousthoughtastheunseenplanetsinfluencethemovementsofthosewithinthesphereofvision。Nomanknowshowmuchheknows，——howmanyideashehas，——anymorethanheknowshowmanyblood-globulesrollinhisveins。Sometimesaccidentbringsbackhereandthereone，butthemindisfullofirrevocableremembrancesandunthinkablethoughts，whichtakeapartinallitsjudgmentsasindestructibleforces。Someofyoumustfeelyourscientificdeficienciespainfullyafteryourbestefforts。Buteveryonecanacquirewhatismostessential。Amanofverymoderateabilitymaybeagoodphysician，ifhedevoteshimselffaithfullytothework。Morethanthis，apositivelydullman，intheordinaryacceptationoftheterm，sometimesmakesasaferpractitionerthanonewhohas，wewillsay，fivepercent。morebrainsthanhisaverageneighbor，butwhothinksitisfiftypercent。more。Skullsbelongingtothislastvarietyofthehumanracearemorecommon，Imayremark，thanspecimensliketheNeanderthalcranium，acastofwhichyouwillfindonthetableintheMuseum。
Whethertheaveragetalentbehighorlow，theCollegesofthelandmustmakethebestcommoditytheycanoutofsuchmaterialasthecountryandthecitiesfurnishthem。ThecommunitymusthaveDoctorsasitmusthavebread。ItusesupitsDoctorsjustasitwearsoutitsshoes，andrequiresnewones。AllthebreadneednotbeFrenchrolls，alltheshoesneednotbepatentleatherones；butthebreadmustbesomethingthatcanbeeaten，andtheshoesmustbesomethingthatcanbeworn。Lifemustsomehowfindfoodforthetwoforcesthatrubeverythingtopieces，orburnittoashes，——frictionandoxygen。Doctorsareoxydableproducts，andtheschoolsmustkeepfurnishingnewonesastheoldonesturnintooxyds；someoffirst-
ratequalitythatburnwithagreatlight，someofalowergradeofbrilliancy，somehonestly，unmistakably，bythegraceofGod，ofmoderategifts，orinsimplerphrase，dull。
Thepublicwillgiveeveryhonestandreasonablycompetentworkerinthehealingartaheartywelcome。ItisonthewholeveryloyaltotheMedicalProfession。ThreesuccessiveyearshavebornewitnesstothefeelingwithwhichthisInstitution，representingitinitseducationalaspect，isregardedbythosewhoarethemselvesmosthonoredandesteemed。ThegreatMasterofNaturalSciencebadethelastyear’sclassfarewellinourbehalf，inthoseaccentswhichdelighteveryaudience。TheHeadofourancientUniversityhonoredusinthesamewayintheprecedingseason。AndhowcanweforgetthatotheroccasionwhentheChiefMagistrateoftheCommonwealth，thatnoblecitizenwhomwehavejustlost，large-souled，sweet-
natured，alwaysreadyforeverykindoffice，cameamongusatourbidding，andtalkedtousofourdutiesinwordsasfullofwisdomashisheartwasofgoodness？
Youhavenotmuchtofear，Ithink，fromthefancypractitioners。
Thevulgarquackeriesdropoff，atrophied，oneafteranother。
Homoeopathyhaslongbeenencysted，andiscarriedonthebodymedicalasquietlyasanoldwen。Everyyeargivesyouamorereasoningandreasonablepeopletodealwith。SeehowitisinLiterature。ThedynastyofBritishdogmatists，afterlastingahundredyearsandmore，isonitslastlegs。ThomasCarlyle，thirdinthelineofdescent，findsanaudienceverydifferentfromthosewhichlistenedtothesilverspeechofSamuelTaylorColeridgeandthesonorousphrasesofSamuelJohnson。Wereadhim，wesmileathisclottedEnglish，his“swarmery“andotherpicturesqueexpressions，butwelaydownhistiradeaswedooneofDr。Cumming’sinterpretationsofprophecy，whichtellsusthattheworldiscomingtoanendnextweekornextmonth，iftheweatherpermits，——nototherwise，——feelingverysurethattheweatherwillbeunfavorable。
Itisthesamecommon-sensepublicyouwillappealto。Thelesspretensionyoumake，thebettertheywilllikeyouinthelongrun。
Ihopeweshallmakeeverythingasplainandassimpletoyouaswecan。Iwouldneverusealongword，even，whereashortonewouldanswerthepurpose。Iknowthereareprofessorsinthiscountrywho“ligate“arteries。Othersurgeonsonlytiethem，anditstopsthebleedingjustaswell。Itisthefamiliarityandsimplicityofbedsideinstructionwhichmakesitsopleasantaswellassoprofitable。AgoodclinicalteacherishimselfaMedicalSchool。WeneednotwonderthatouryoungmenarebeginningtoannouncethemselvesnotonlyasgraduatesofthisorthatCollege，butalsoaspupilsofsomeonedistinguishedmaster。