(h :A - DISCOURSE Upon thjj Institution of MEDICAL SCHOOLS In AMERICA; Delivered at a Public Anniversary Commence- ment, held in the College of Philadelphia , May 30 and 31, ij6$. With a *" PREFACE Containing, amongft other things, The AUTHOR'S APOLOGY For attempting to introduce the regular mode of practifing PHYSIC in Philadelphia : By JOHN MORGAN m.d. Fellow of the Royal Society at London ; Corrc- fpondent of the Royal Academy of Surgery at Paris-, Member of the Arcadian Belles Lettres So- ciety at Rome ; Licentiate of the Royal Colleges of Phyficians in London and in Edinburgh ; and ProfefTor of the Theory and Practice of Medicine in the College of Philadelphia. /* 9 A*) *y *v- PHILADELP H^fA: Printed and fold by William Bradford, at the Corner of Market and Front-Streets. mdcc>lxv. T O Samuel Powel, Esquire, Of Philadelphia. SIR, ft-f^ff HE following; difcourfe was ^X' 1^ ><;|> written for the mod part at ^>< T X* tj • at a r #>< ^ X€* rans, and lerved as an agree- ||#$#ll able relaxation from the fe- verer ftudies in which I was, at that time, engaged. Our travelling together gave me an opportunity of fubmitting the performance to your critical eye, and it affords me a lingular fatisfadion to acknowlege, that, in feveral parti- culars, it has been greatly amended by your candid and judicious remarks. Upon [ •» ] Upon fuch an occaflon as this, I mould deem myfelf ungrateful indeed, was I to withold the little tribute I have in my power to pay to that genu- ine worth and difinterefted friendihip, which I have experienced in you. Sure 1 am that a perfon of your ami- able difpofition, whofe heart glows with the utmoft warmth of fecial affec- tion, whofe mind is enriched with the treafures of ancient and modern learn- ing, and whofe tafte has been improved and refined, by an acquaintance and converfation with men of the firft rank in life and of the greateft abilities in the learned world, muft be eminently ufe- ful to mankind, and particularly adorn and blefs the land wherein providence calls him to reiide. With great reafon, therefore, may we hope to fee you become a diftinguifhed ornament to fo- ciety. With great reafon may the place of your nativity claim the advantages which arife from fach abilities, and [ v. ] from a genius that was formed and nur- tured in her own bofom. Your coun- try has much to exped in waiting the return of a fon bleffed with fo many iifeful endowments; and I well know that, amongft your many other virtues, the love of your country prevails too much in your breaft to let her fuftain a difaDpointment. Opulence and generoiity feldom go hand in hand. The gifts of fortune are rarely accompanied with a fpirit to em- ploy them in deeds of charity and dif- interefted benevolence. It is yours, Sir, to foar above the fordid views of vulgar minds, and en- joy the fublime pleafures of a tender and fympathizing humanity, which al- ways carries its own reward, in the fa- tisfadion that fiWs from the exercife of fo precious a gift of divine bounty'. There are no connedions in life more honourable than thofe which we form with men of learning and virtue. I [ vi ] I cannot but congratulate myfelf, there- fore, on the ftncl intimacy with which you have fo long indulged me, and, at the fame time, be thankful to you for the advantages it has often procured me in foreign parts. During an abfence of five years from my country and friends, whihl I was engaged in fuch purfuits as were indif- penfably neceffary to fit me for more ex ten five ufefulnefs in my profeffion, the almofc uninterrupted enjoyment of your company, or correfpondence, con- tributed much to make fuch a fepara- tion more eafy and fupportable. It will always give me unfpeakable pleafure to refled upon the variety of fcenes through which we have paffed, and the enter- tainment and improvement we have met with, in vifiting. the principal cities and feats of fcience in Great-Britain, Holland, France and Italy ; places ce- lebrated for the birth or residence of men of the moll illuftrious genius in the world, [ vii ] world, and diftinguifhed for the culti- vation of manners, polite arts and li- terature. t These are the feveral confiderations that have induced me to prefent you with this performance. Happy fhould I have thought myfejf, if a little more leilure had enabled me to render it fome- what more worthy your notice. Such as it is, however, I requeft you to ac- cept it as a fmall teftimony of my perfonal regard and affedion for you. Whatever may be the merit or fuccefs of the work itfelf, I fhall always rejoice that it has given me an opportunity of telling the world, how much I refped your charader, and what an high va- lue I place upon your friendihip. I am, Dear Sir, Your moft affedionate friend and obliged humble fervant. JOHN MORGAN. PREFACE. "J:XX)JC¥; H E delay in publifhing my addrefs ori Q T $ tne institution of Medical fchools arofe >£ "Pl from the indifpenfable calls of bufmefs. . ,"\,-\,-,-, jt has given mc an opportunity, hqwever^ of hearing the opinion of many people upon the ad- drefs ; but more particularly upon what relates to my propofed method of practifing phyfic. My intention with regard to the latter, having, been made knov/n by general converfations only, I find has been often mifunderilood. No wonder then, if, in confequence thereof, it has been fometimes / greatly mifreprefented. This has determined me to commit to the prefs the plan of practice by which I defir. n to regulate myfelf as much as poftible ; and to deliver my fen- timents very briefly on the expediency of a regular and diftinfl practice in the feverai branches of Medi- cine. The public will then be able to jud^e more clearly [ » 3 clearly of the propriety of thole meafures, which, rrom a full perfuafion of their great utility, I ven- ture to recommend. Firft, I purpofe to confine myfelf, in practice, to thofe cafes which belong moft immediately to the office of a Phyficisn, that I may prefcribe for and attend fuch cafes to greater advantage. I fhall therefore avoid, all I can, interfering in the proper bufinefsof furgery viz. manual operation. I do not mean however to refufe to innoculate for the fmall-pox, where my patients or their friends object to employ another hand to make the incifion. This may frequently happen, although there is no more difficulty or art required in it, than in cutting an iflue and inferting a pea, or than in cupping and bleeding. Secondly, I propofe, in fuch cafes as fhall be re- quired, to attend in confutation with other Phyfi- cians, on the fame terms as thofe of character enter into confultation with one another. Thirdly, I fhall give my opinion in writing on the complaints of patients at a diftance from Philadel- phia, whenever the hiftory of the cafe is properly drawn up and tranfmitted to me for advice. Fourthly, [ in ] Fourthly, In fuch cafes of furgery as require coh- fultation, or the ufe of medicines, I am willing to attend, to prefcribe, confult, or advife •, but not to perform any operation myfelf, or drefs any wound. IN REGARD TO THE APOTHECARY AND SURGEON. ' It may be proper here to acquaint the public, that, for the better carrying of this plan into execu- tion, Mr. David Leighton, a gentleman of abilities ?.nd integrity, educated in Great-Britain both in phar- macy and furgery, has accompanied me hither. To him I fend to make up my prefcriptions. But patients are allowed to choofe any other apothecary to put up their medicines, or what furgeon they pleafe for the operative part. What I expect fro-n them is a proper compenfaticn for my advice ar..\ attendance as a phyfician. The medicines and ope- rations are to be considered as a diffmct and fepararf* charge. Mr.Le$btonh&s imported a large afibrtmer" of medicines, in which no expence has been fparen to have every thing of the beft in its kind. Th«. v have been prepared wiih particular care by MiH\-\ Silvanus and Timothf Bcvan, Druggiits in Louder., whofe knov/n (kill and reputation in that bufinefs a; ; too,well eltablifhed, both in Great-Britain and Ame- rica, to need further recommendation. [ * ] Mr. Leighton will oblige himfelf to put up fuch prefcriptions as are ordered, in the beft manner, and with the utmoft fidelity and care, as well as at the moft moderate rate. AS TO FEES. I always mean that thefe fhall be moderate, adap- ted to the circumftances of this place, of the patient and the attendance he may require, As a rule of conduct to fuch as are quite unac- quainted with the regular practice ot phyfic, let them inform themfelves what is the united expence for Medicines and attendance, as charged by the practitioners of eminence in this place. In fuch cafes as can be exactly afcertained, I fhall require no more from them, than they would be obliged to pay to others, as in the cafe of innoculation and attend- ance in the fmall pox j allowance being made for the Medicines. The fame rule, hj far as k can |?e obferv- ed in fevers and other ditbrders, might be applyed. Practitioners in many cafes make an advan- ced charge on their Medicines, fo as to include for attendance, This is done to make up for the patients deficiency in fees, than which, when it is will- ful and not the effect of ignorance in the patient, no- thing can be more equitable, or more expedient, ex- cept [ v ] ccpt charging for attendance under its proper name. For Practitioners muft be paid for their time and at- tendance, as well as for their Medicines, under what- ever name they make the charge. Indeed the molt cx- tenfive practice otherwife would be infufficient to lup- port a family in a becoming manner, as the greateft part of their time is employed in vifiting the fick. The paying of aphyfician for attendance and the apo- thecary for his Medicines apart is certainly the moft eligible mode of practice, both to patient and prac- titioner. The apothecary then, who is not obliged to fpend his time in vifiting patients, can afford to make up medicines at a reafonable price; and it is as defirable, as juft in itfclf, that patients mould al- low, fees for attendance, whatever it may be thought to deferve. They ought to know what it is they really pay for Medicines, and what for phyfical ad- vice and attendance. Nobody, I believe, will deny that the practice of rating Medicines, at fuch a price as to include the charge for Medicines and attendance, is liable togrofs impofirions on the part of ignorant medicafters, too many of whom fwarm in every city. Patients who are kept in ignorance of what price Medicines are, con- fidered feparateiy, and what is the value of phyfical (kill and attendance, naturally think the original coft of Medicines, which are comparatively cheap, to be very dear, and undervalue the (kill of a phyfician, [ vi ] his.toil of ftudy and his expence of time and money, in his education, which have often amounted to very large fums and to many years (pent abroad in queft of knowledge, as if they were of no confi- deration. The levelling of all kind of practitioners fo much with illiterate pretenders, who have art enough to gain employ, however ill qualified in that of healing difeafes, has a tendency to deter perfons, otherwifc of juft and liberal fentiments, from putting them- felves to a further expence to gain knowledge, than what is furficient to make money. This is to make a vile trade of phyfic, inflead of a noble profefiion, which as it certainly is, fo it ought to be efteemed. I have been told more than once, upon Teafoning on the fubject, that people here are ufed to this me- thod and dont love to change old cufloms. "What is it more than to fay, " Si populus vult decipi, decipiatur If people choofe to be deceived, even let us keep them in their deception." ? Instead of making a charge of fees, I willingly .leave to the patients themfelves to give what thcr [ vii ] they pleafe, upon my difmiflion from further atten- dance, or as foon after their recovery as fhall be thought convenient, without fpecifying any demand, unlefs where patients particularly require it, This I leek for to prevent the neceflity of making a book charge of fees, which is never done in any liberal profeffion. By thus leaving the fee in a great meafurc, or wholly, to the free will and circumftances of the patient, a phyfician may be employed by the mid- dling clafs of people as well as the rich. Many who have no adequate notion of the true value of attendance, or what rule is obferved by o- thers, may wifh rather to be directed what fee to pay for attendance, being defirous on one hand to avoid the appearance of being deficient in generofitv, and on the other hand willing to recompence the phyfician for his care, without unnecessary prodigalitv. Such perfons, upon intimation of their defires, it is to be hoped, will always find themfelves fully fatis- fied in this particular. As to attending poor patients gratis, and giving them my bed advice ; I (hall chearfully take my fhare of that kind of practice with my brethern of the faculty. For I fhall always efteem it a favourable cir- cumftanc;, f viii ] ftance, that puts it in my power to adminifter relief to perfons, whole indigence forbids them to expect it upon any other terms. These articles, I prefume, will effectually remove the objection which has been moft ftrongly urgedy viz. that my method of practice would only fuit the wealthy; and will prove that the expence to the patient is not greater, on the plan I have adopted, than in the common method of practice. It is true that, upon my firft arrival, I exprefled my defire of being paid for a certain number ofvi- flts, at a piftole the firft vifit, as a retaining fee, and a dollar for every vifit afterwards.——It was not my in- tention to require more than one fee per day, although I might wait on the patient oftner, nor yet every day that I vifited once, where a difeafe of a lingering nature, or requiring particular care, would render my attendance expenfive. A retaining fee I expected to receive from the rich, not from the poor ; and had firmly refolved in no cafe to receive more fees, than fufricient to pay me for the value of my time and trouble of attendance. But for want of fuitable opportunities of rendering this better known, I daily found that my good intention was in fome meafure fruftrated. This [ >x ] \ This, and the advice of fome judicious friends to endeavour to prevent the ill effects of prejudice, made me refolve to attempt fuch an alteration as might be better luited, at this time, to the cuftoms and circumftances of the people. The preceeding plan I have ever fince conftantly followed, to my entire fatisfaction, and I hope to that of my patients. Truth requires of me to acknow- ledge to the public, that I have always found, as far as my practice has hitherto given me an oppor- tunity of judging, that the infinuation,J which has been made to deter me from this mode of'practice, viz. that'people are too narrow minded here, and jhcix no generofity to a phyfician, only employing a doclor be- cause he is cheap or lives near to them, is utterly ground- lefs. In moft inftances I have found their generofity has much exceeded my expectations. One article more I have to mention under this head. It may frequently happen, in vifiting my friends and acquaintance who employ me in their fa- milies, that themfelve s, their children offervants, may have flight complaints, for which they would be glad to have advice, but do not think them of im- portance enough to call in a phyfician, who may ex- pect fees for little allnunLS. Su:'i perfons may always command my advice in thefe matters without a fee. b Thb r. * i THE NECESSITY OF REGULATING THE PRACTICE OF PHYSIC. It will be readily acknowledged by every one that allows himfelf to reflect upon it, that fome regulati- on in regard to a Phyficians attendance upon the fick is now become highly requifite. Formerly, when the city did not occupy much above half the extent, practice was much more manageable than it is at prefent. Living was then cheap. Within myowri memory, every article of expence was lefs by almoft one half. So that what fuited the circumftances of the place and people then does not fuit them now. Yet we may believe the knowledge of Phyfic has been cultivated all along with confiderable appli- cation. A medical education is at leaft become much more expenfive, and a man has little chance, if he keeps free from empiricifm, to get a to- lerable living by phyfic now, unlefs he has fpent fome years in an expenfive education in Europe. Is it not then more equitable to be paid for atten- dance, than to live by advancing the price of me- dicines ? I am not urging thefe as arguments for a more expenfive practice, but for an improvement of it, by feparating phyfic from furgery and pharmacy, which I [ » ] I think incompatible with them, at leaft according to the plan of education I have followed, by the ad- vice of fome of the moft eminent and fkillful judges of medical fcience of any in Great Britain. What reafonable objection can be then offered a- gainft an improvement in the prelent method of the practice of phyfic, which, to a man in great bufinefs, is by every one allowed to be the moft flavifh pro- feflion known in this part of the world. Every mechanic has a certain portion of time allot- ted to him for a relaxation from bufinefs, and for the enjoyment of focial happinefs. Phyficians have next to none, but they are obliged to be at the call of the fick, every hour in the nigra: as well as of the day. Were they born flaves to the public and not child- ren ? or, for fuch a voluntary furrender of their liberty and eafe as is neceflary to practife confcientioufly, are they to have no compenfation ? Is it thought an unreafonable demand to be paidfor a toilfome, but neceflary attendance, amidft objects of the moft mov- ing diftrefs, which deprives them much of the com- pany of their own family and of a number of gra- tifications, which every other profefllon allows of without detriment ? Where is the encouragement for a man to banifh himfelf from all the endearing tyes of friends and relations, to Ipend the prime of b2 lift r »i J life, and often the bulk of his fortune, to adminifter" more fkillful aid to the calamities of his diftrefTed fel- low mortals, if he is to be confidered as entitled only to the fame gratuity with thofe who employe all their time at home, in getting money, inftead of fpending it for the public good ? or is he to be al- lowed no more, than if, in acquiring this knowledge, he had been fupported at a public expence ? — let unbiaffed reafon and juftice determine. ~>~ '< I am forry that the objections, which have been made to my propofed method of practice, have laid me under thedifagreeable neceflity of mentioning the kind of education I have had to qualify me for my profeflion, and to afford me a reafonable expectation* of a living from my advke and attendance. i It is now more than fifteen years fince I began the ftudy of medicine in this city, which I have profecuted ever fince without interruption. During the firft fix years I fervcd an apprenticefhip with Dr. JOHN REDMAN, who then did, and ftills continues to enjoy a moft juftly scquired reputation in this city for fuperior knowledge and extenfive practice in phyfic. At the fame time I had an opportunity of being acquainted with the practice of other eminent phyficiarrs in this place, particularly of all the phy- ficians r. xi5i ] ficians to the hofpital, whofe prefcriptions I put up: there above the fpace of one year. The term of my apprenticefhip being expired, I devoted myfelf for four years to a military life, principally with a view to become more ikillful in my profeflion; being engaged, the whole of that time, in a very extenfive practice in the army, amongft difeafes of every kind. The laft five years I have fpent in Europe, under the moft celebrated matters in every branch of Medicine, and fpared no labour or expence to ftore my mind with an extenfive acquaintance in every fcierjce, that rela- ted any way to the duty of a phyfician j having in that time expended, in this purfuit, a fum of money, of which the very intereft would prove no contempti- ble income. WTith what fuccefs this has been done Others are to judge, and not myfelf. Thus I have arrived at the middle age of life, in en- deavouring to lay up treafures of ufeful knowledge, before 1 commence a fettled practice ; and yet I have been told, that to expect to gain a fupport here by my medical advice and attendance only, without be- coming a furgeon and apothecary too in order to help out, is to forget that I was born an American. 1 am very happy that my country has always difco- vered too much of a laudable ambition to excell in every branch of polite literature, and has taken too much pleafure in the reputation of her fons, to fill me [ xiv ] me with apprchenfion that an education in phyfic will be accounted too expenfive, fuch as I have thought neceflary to qualify myfelf for practifing my profeflion with eafe of mind to myfelf and with benefit to the community. As far as I can learn, every body approves of my plan for inftituting med'cal fchools, and I have the honour of being appointed a public profeflbr for teaching phyfic in the college here. Can any man, the lead acquainted with the nature of that arduous tafk, once imagine it poflible for me to acquit myfelf in that ftation, in an honourable or ufeful manner, and yet be engaged in one continued round of practice in furgery and pharmacy, as well as phyfic ? " To prepare for a courfe of lectures every year re- quires fome leifure, and a mind undifturbed with too great a variety of purfuits. So that my ufefulnefs as a profeflbr makes it abfolutely neceflary for me to follow that method of practice, which alone appears to be calculated to" anfwer that end. * ON * Quid caret alterna requie durabile non eft, Haec reparat vires, feflaquc membra novat. Ovi». [ ** ] ON THE ADVANTAGES OF A SEPARATE AND REGULAR PRACTICE OF PHYSIC, SURGERY AND PHARMACY. Tn the more laborious occupations of life, as in building a houfe or a fhip, a great variety as well as a ^reat number of artizans are employed, but all in iiFierent departments. In iiu. lefs laborious callings we obferve the like,, prudent regulations, thus in making a pipe, a button or a pin, a variety of hands, no lefs commonly than five, fix, or feven different artifts unite their induf-, try. By this means they finifh more work in a li- mited time, and can afford to fell it at a cheaper rate.^ than they could, if every individual was employed in all the fcparate branches. But each having a par- ticular province afligned to himfelf, while all confpirc in one uniform plan, they become more (killful and dextrous in their refpective parts, and all mere ufe- fullyfubfervient to one end. Are the good qualities of accuracy, difpatch and cheapnefs, not to fpeak of the greater perfection of the work, no recommenda- tion to the manner of doing it ? Why fhould the more difficult, but more ingeni- ous and liberal arts, fcorn to be taught wifdom from their example ? Is it eafier to underftand the intricate [ XVI j intricate'ftructure of the animal frame, the work of God, than to learn the conftruction of any machine, as a watch or clock, the work of human invention ? Or are the fprings and movements of the former, fo divinely adjufted, more eafily managed and put to rights when in diforder, than the wheels of the lat- ter? or does the prefervation of this in a found ftate require lefs ftudy, knowledge, and conduct ? The human body is certainly one of the moft com- pound machines in nature. Medicine is one of the nobleftand moft difficult of arts, made up of a number of fciences different from each other. The practice of phyfic requires deliberation, reafoning,, judge- ment, and experience. Surgery calls for different powers and qualifications rarely uniting in one man- Are thefe then all to be blended with the apothecary, the botanift, and chymift, which ought to be, and arc each of them feparate and diftinct in their very nature ? Whilft we labour amidft fuch a variety, of purfuits,all improvement muft be at a ftand. Where- as, let each cultivate his refpective branch apart, the phyfician, furgeon, apothecary &c. the knowledge of medicine will be then daily improved, and it may be practifed with greater accuracy and (kill as well as a lefs expence. % Prejudice may here afk, how can a phyfician practife with advantage, if he does not equally pur- fus [ xvii ] fuf every branch of his profeflion ? or how fhall he know that the Medicines are good, which he orders, if he does not prepare them himfelf? Answer, It is not only expedient, but neceflary that a phyfician fhould have a general and extenfive knowledge of the whole art, and be acquainted .with the principles of every bran:h of his profcGon. Thus the general of an army fnould be acquainted with every part of military fcience, and underftand the whole detail of military duty, from that of colo- nel down to a private centinel. But there is no ne d that he fhould act as a pioneer and dig in a trench. Where a proper fubordination is wanting, there is a perverfion of all practical knowledge No more then is a phyfician obliged, from his office, to handle a knife with a furgeon •, to cull herbs with the boa- nift ; to diftill fimples with the chymift ; or com- pound drugs with the apothecary. Can he be more fure however that his Medicines are genuine, if he does not collect his own herbs and roots as a botaniit, or diftill with the chymift, than he can, if, omitting thefe, he fhould ftick to the plaiftcr-p-:i and fpatula, or the peftle and mortar ? But practitioners in great bufinefs never do, or can do the ^bufinefs of an apoihecary in. this place, themfelves. They have apprentices for i the f xviii J the purpofe. After vifiting the fick, do not their a- prentices make up their prefcriptions ? I would afk, is not an apothecary thoroughly acquainted with trie rvt of compounding and making up Medicines 11 fkillful in it as an apprentice ? Is not a man educa- ted in the profeflion to be trufted in preference to one who is only learning that bufinefs ? or has the mafter, who na; be called from place to place to attend other cafes of furgery, or fee other patients, always time to wait for medicines to be made up under his eye ? These queries are eafy enough for every one to decide upon, without being brought up to the ftudy of phyfic. Will he not therefore do a worthy action, whoever mall fteadily apply himfelf to rernove the difficulties which are in the way of regular practice ? Will h not do real fervice to his country and man- kind, for the good effects of which pofterity may thaiik him ? Who then would hefitate to rank himfelf a.r.ongft the foremoft cLfs cf thofe who fhall bef con-" cer.ed in a work of fuch real benefit to the public ? Having thus fully explained the method I pro- pole for practiiing phyfic in this place, I appeal to the impartial jud gnentof the public to decide upon the queftion. Is it to be deemed an idle innova- vation, or is it not rather an improvement of practice in Philadelphia, to adopt a plan conformable to what isbbferved in great Britain and all po.ul.ua countries, as r afix ], as far as the circumftances of this place admit ? I pro- fefs myfelf open to conviction, and fhall allow due weight to every reafonable argument that may be op- pofed to my plan. When I am rationally convinced that I have been in an error, I fhall readily acknow- ledge and retract my fentiments, which I hope, till then, I may be allowed to continue, without being charged with an innovating fpirit. What remains yet to be done is to endeavour to elucidate a few paffages, which have been thought exceptionable in the diicourfe by particular perfons. ■ In fome paragraphs, the opinions and practice of the faculty of phyfic in this place have been thought. |o have been too indifcriminat.ely condemned. aw ktb ,. JFar be it from me to merit this charge, or to have entertained fentiments deroguory from a fet of gen- tlemen, many of whom I rank a.nongft rny principle friends in the city, and highly efteem for their inte- grity and abilities in their profeflion, to which they do great honour. To have ma e a nominal diftinc- tion was never my defign. It cr-nnot therefore-in juftice be imputed to me as a fault to have avoided, all I could, every thing which had the ieafl appear-; ance of particularity, and to have endeavoured to fuggeft an iuv-rovement of practice, without aiming at practitioners. :.».;.■; < ^ *:•- c 2 *&i [ XX, ] r I doubt not that every practitioner here of cdu-^ cation^ experience and integrity, has purfued the plan which, in his opinion, was beft fuited to the* place and people. But as circumftances alter, fo dees the propriety of particular eftablifhed cufloms,1 which gradually give way to others better fuited to thofe changes which happen in a eourfe of years. May I not hope to meet with the fame candour that I.fi-ow to others, and be admitted to act from the fame hontft principles, in recommending what I think an improvement of practice, that I allow thofe who have purfued a plan different from mine ? , ->iab f !,";* nV\~HEREVER there is the leaft appearance of being particular, or wherever I have fpoken exprefsly of the practitioners of this town, it has been in the rn-ii: becoming manner and without the leaft cenfure,^ ' well knowing how much I myfelf need the indulgence of others, "u • i n. " Mecum habito et novi quam fit mini curta fuppellex," In confirmation hereof, I fhall adduce a few inftan- ces to which- the reader may rerer. Thus I have faid,'p. iS. " and here we may congratulate our-' fe Ives)1, that an this, and fome of the large neighbour- ' ing towns, we have a number of fkillful phyficians^ ' jofii -moiJiJH ... rLi. ' and^ ^i'5li3 - [r **i ] and expertfurgeons, qualified by genius, education aad experience, to take charge of the health of their- fellow creatures." And p 30. " The city of Phila- delphia, adorned with a fet of eminent practitioners* draws to it a great number of pupils, from the neighbouring parts, to learn the arts of phyfic and furgery." Indeed the only part in which I have been particular, and there it was unavoidable, is in fpeak- ing of the phyficians of the hofpital, which I have done in terms of the higheft refpect. p. 31. It is true, I have endeavoured, as well as I was able, to defcribe the mifchievous effects that enfue from ignorance and prefumption, when young men enter upon the practice of Medicine before they are! duly inftructed in the important duties of the pro- feflion, See p. 23. 24. l* I have likewife urged the neceflity of joining ftudy with practice, and availing ourfelves of the medical difcoverles and improvements made by others. On the authority of a very learned fociety^ I have alfo dif- approved of the conduct of thofe, who, from preju- dice affecting a fimplicity, (which might often mif- lead them) difdain thofe perfons who divide their time between ftudy and practice. I have likewife ad- ded, on the fame authority, that novices enlightened by the difcoveries, which thefe practitioners fhut their I i »$" 3 their eyes agajnft, would in their turn with reafon defpife them, when grown old in their errors," fee p*. 42 and 47. But I have no where intentionally aimed the fhaft of cenfure at any one, or attempted the character of a particular man; much lefshave I dared to attack indif- criminately a whole body of men. As fir as 1 have en- gaged in painting the errors or faults of any, I have endeavoured to reprefent general actions of men, fuch as they are, and not the picture of individuals. Yet, as he Sage has juftly remarked, there are f ;.me perfons who cannot read, and I fay there are others who can-1 not hear, without making an application of thofe vici- ; ous or ridiculous characters Which they learn from ' an author. With him I decLre to all who have fuch.v a malicious propenfity, that they .re in the wrono to apply the portraits which they may find here exhibit ted j nor let any reader take for his own what may equally belong to another, otherwife he will foolilhly expofe himfelf, as Phaedrus fays, " Stulte nudabit animi confcientiam." The notice I have here given is, I hope, fuffidU ent therefore to exculpate me from the groundlefs charge of having unjuftly reflected upon, or cenfured the conduct of others,. ' ,j;d I -■ ~ 3i'fl Some [ xxiii } Some, it is faid, have thought, that I have de~ fcribed.the difficulties of attaining to the knowledge of phyfic in too ftrong terms, and have enumeratecf fo many qualifications as requifite to acquire any con- flderable knowledge of the medical art, that I rather deter ftudents, than encourage them in attempting to compleat their ftudics and to become fkillful in their profeflion. To thefe I reply, that I have been far from exag- gerating matters, and have left much unfaid, on purpofe to avoid difcour&ging their eager purfuit. Ir we cannot arrive at abfolute perfection in fcience, let us not abandon ourfelves to a criminal indolence, but ftrive to approach that degree of knowledge which is attainable by induflry, and we cannot fail of. being eminently fkiihul in the healing art and highly ufeiul to mankind. .Others, I am informed, as if they were afraid of engaging in top great an expence, have faid that I have in filled too much on the neceflity of ftudcnts attending lectures in every different branch of medi- cine. They ieem to imagine if they hear lectures upon Anatomy only, the branch which I have firft mentioned in my difcourfe, that they can eafiiy make themfelves mafters of all the other branches of medicine by reading. I blufh for thofe who thus expofe [ xxiv ] expofe either their' ignorance or their avarice. Why are rhey not equally contented with fuch a mare of knowledge in anatomy, as they can gain from books, fince this fcience can be better painted to the eye, than fome of the other branches of medicine, which are altogether as neceflary to be known by a phy- fician ? Are not anatomical plates and defcripti- ons as intelligible to a fludent, as the philofophical fludies of chymiftry, phyfiology, and pathology are, from a mere courfeof reading? or is it of lefs confe- quence to gain a fyftematic knowledge of the mate- ria medica, or practice of medicine, than of anatomy, which is of no other ufe to a phyfician than as it contributes its fhare towards explaining what difeafes are ? The others furnifh him with the means and manner of performing the cure, and require, at leaat, as much labour and explanation as anatomy iifelf demands. The worthy and learned Doctor Lewis is of opi- nion, " that the medicinal hiftory, or the know ledge of the powers and effects of medicine in the human body, though apparently a moft eflential branch of the healing art, has been far more incutioufly culti- vated, and flill perhaps continues lefs cleared from the errors of former ages than any other fcience." Another writer on the fame fubject fays, " it is an idle fuppofition to fet out upon, that there are the works [ xxv ] wdrks of good chymifts and good naturalifts extant; and that from thofe a fuffieient fyftem of information -on this important head may be compiled. To com- pile with judgement requires as much knowledge of the fubject as to write well upon it. No man is qua- il ded to execute this to advantage, who is not able to h^ve written what he borrows. Even the belt and moft authentic books on thefe fuhjects have their er- rors, moft of them too many •,' and while he who is himfelf deficient in the knowledge of the fubject^ can- hot but be liable to take in thefe with the reft, it is evident what fort of dependance ought to be placed On his collections;" Whatever anatomical fkill a man may boaft, yet if he is ignorant of the virtues of Medicines* or of their changes from differently compounding them. together, or knowG not what are the true indications in the cure, or relief of difeafes, he may value him- felf for expertnefs in difiection, but every fenfible man will hold him cheap as a phyfician. Nobody, who is anxious to be fkillful in the divine art of healing, will be a niggard of the neceflary trou- ble and expence of rendering himfelf intelligent in every thing his profeflion requires he fhould know. Whoever is fparing of thefe has no caufe of complaint, if he is rewarded only according to his merit, unlefs he K hewpuld inverj: fcr'ptureand the laws of reafon, and cafting his eyes on thofe who have fowed plentifully in knowledge and n aped but little pecuniary" adr vantage from thence, think, from fowing fpan- ingly, he has a better title to expect that his igno- rance fhould be rewarded with a bountiful harveit. «^fl» i . ? (J , - - *• .,., t\ c * 1 tt/ c ibid. II. its Definition and ; Ufe S ^ The Theory of Phyfic or Medical Inftittttions, ) What is meant by that Name $ Phyfiology* what, ibid. Its Importance, 12. Pathology, its Definition and Con-7 nection with the former, S *' Praxis or Practice of Medicine, its Definition, ibid. A general knowledge of all the preceedino; / neceflary in learning the Art of Phyfic, > ~* The Order recommended in the Study of them, 16. Pre-requifites to the Study of Medicine, 17—18, A general View of the State of Phyfic in "> ,o America and Obfb.cles to its Study $ ' 3* Effects ot ignorant and prefump- tious i.ra6hce, ^ 4' Argument Argument'; for inftituting Medical Schools* if; Tiie i cndcncy of luch an lnfhtution, 27—-8. CivcnmAances favourable to fuch an Undertaking, viz* Fn.in-'nt Practitioners in Philadelphia, 30; The Practice of the City Hofpital, 30—31. Flourishing State of Literature in the College* 32. Si'.u.ition and popuLus Ccnvii- > ., , tion of Philadelphia, p Incre fe of the Colonies, 334 Steps already taken towards inftituting } Midical Schools, C 24—281 And other Steps recorrimended to be taken* \ " & Objections Confidered. *--■........Infant State of the Colonies, 38. --------1 he mixt Practice of the uiffe- ~y rent Part of Medicine, 3 the regular Mode of Practifing ,; . Phyfic recommended, S *" Advantages to be expected frorrlthe propofedlnftitution *..............To Students of Medicine, 46—ro. .........-.....To the College, 51* *-.........—To the City of Philadelphia > __ and the Province $ & ""* *..............To the Neighbouring Colonies, 54. Addrefs to the Students of Medicine, *> _ g to animate them in their Studies. i o^ 0 * *■.....—To the Truflees of the College, -y recommending the Inftitution ot > 56—6p Medical Schools to their Patronage, J v,$ *$>.<■■'?■ ~^:^£ f£i''ti yi.\fy*)-S?$-$i p- 'H wd ;rw w www ?»,; TO THE TRUSTEES I 0/ACOLLEGE, AND THE CITIZENS Of PHILADELPHIA. Gentlemen, €4&-#£*&$$ H E cultivation of Science, and the ^y"'"""""'"y-J-i, progrefs of arts have juftly merited the "QK T X*3? regard of every age and country. I ^^';. ,yyj;l^ efteem myfelf happy, therefore, that I have an opportunity of delivering my fentiments before fo candid and learned an audi- ence, upon a fubject which refpects the advance- ment of the moft ufeful knowledge, and the grow- ing credit of this inftitution •,—a fubject as import- ant as can well be imagined to employ our ferious deliberation, or animate-our warmeft pufeuit. B What ^ [ * ] What I am to propofe is a fcheme for tranfplant- ing Medical Science into this feminary, and .for the improvement of every branch of the healing art. It rr.uft be confeffed that in a knowledge of the fupfeme Being, and of die duties which we owe to him, confifts the fublime of true philofophy. This is the mcfl interefting purfuit of rational matures, as it regards the foul and conftitutes the higheft happincfs. A knowledge of the duties which we owe to fo- cicty, refuhing from the relation in which we ftand to one another, is an object of the next importance. After this, whatever relates to the welfare of the bo- dy deferves our moft immediate concern.—Life, when burdened with difeafe, is but a complication of woes. Plealth is that choice feafoning which gives a ndim to all our enjoyments. As the end of medical fcience is to reftore and preferve health, the welfare of every individual, of whatever age or fex, h concetned in the improvement of it amongft them. M'.dicine is a fcience as important in its cbject, as it is difficult in the acquifition. It is very exten- five h its refearches, and prefuppofes the knowledge of many other fciences. The cultivation of it re* ; quires ■ . r 3 i quires no fmall abilities, and demands of thofe who engage in the arduous purfuit an enlarged and be- nevolent mind. But notwitftanding thefe difficulties, this fcience muft ftill be produdlive of very great ad- vantages and honour to aieminary of learning, to a city and to a country; where the wifdom of well con- certed laws, and the encouragement given to the pro- moters of it, are lufficient to procure it an effectual cftabifhment. A thirst of knowledge and a fpirit of inquiry are natural to man. It merits our endeavcuis to direct thefe to worthy objects. Whilft we are anxious to inform ourielves what were the cufloms of former ages, by what boundariei diftant kingd >ms are li- mited, what were the rites and cer; monies of bar- barous nations, or what flowers bloom in the remote Indies;—fhall we have no defire of ftudying what more immediately relates to ourielves? fhall we neg- lect to examine into the divinely curious and ama- zinp- ftructure of our own bodies? are we not con- cerned in applying our purfuits, tofind out the nature of thofe multiplied calamities to which the human frame is unavoidably expofed, and the means of removing or affwaging thofe calamities ? To hint at the means whereby we may accomplifh the inftitution of medical fchools in this city, and to B 2 point [ 4 J point out fome of the moft confiderable advantages it muft be attended with, is the talk in which I am here to engage. Upon a fubject fo new in this place, and fo pregnant with the moft intercftingconfequen- ces, I flatter myfelf you will hear candidly what I have to impart-, and let the goodncfs of my intention apologize for any inaccuracies in the execution. It may be proper, in the firft place, to give a gene- ral view of the boundaries of medicine, and the dif- ferent provinces of this extenfive icicnce; to fhow its prefent condition in America-, the difficulties which accompany its ftudy, and the impracticability of making any great progrefs therein, till it is put on a better footing. Thefe being explained, the means of effecting that end, and the benefits arifing from thence will be more eafily apprehended. According to the learned Gaubius, " Medicine " is the guardian of life and health, c.gainft death " and difeafe."* To be more particular. The Art of healing confifts in a thorough knowledge of the human ceconomy •, what conftitutes health •, what are the difeafes, as well internal as external, to which the body is expofed; their feat, caufes, and fymptoms-, and the means of applying with fkill, judgment, and addrefs, the various remedies adapt- ed to cure or mitigate them. From * Gaub. Inftitut. patholog. Medic. [ 5 1 From this view of medicine, we readilv percieve its great extent; we learn the principles on which is founded the divifi>~>n of it, into the Study of Phyfic, more properly fpeaking, t.nd into Surgery. The former is converfent about the cure of in- ward difeafes, and fuch complaints as require the ufe of medicines. The latter principally regards external diforders, and thofe in .vard maladies which need the manual affiftance of a dexterous operator to reiieve them. We likewife underftand the reafon of fo many diftinct branches of medical ftudy; the pre- vious knowledge of whkh, both in the Phyfician and Surgeon, are requifite in order to qualify them for fuccefsful practice. The neceflity of difcrim'nating between phyfic and furgery will more mam re Illy afyear when we confider, that they are diidnct in their nature, and that either of them is an art, fufficient of itfelf to en- gage the induftry of one man to cultivate. The various branches of knowledge which com- pofe the fcience of medicine, are Anatomy, Materia Medica, Botany, Chymiftry, the Theory of medi- cine, and the practice. These will be fully known by defining them fe- parately -, by fho wing what weight they bear in the ballance [ 6 ] ballance of healing arts; their relation to each other; and how far the knowledge of them refpectively con- tributes towards the cure of difeafes. ANATOMY, taken in a general fenfe, eonfifls in know- ing the ftrutture of the animal body; conjidered in parti- cular, it implies a knowledge of the frame and organization of the human body. It teaches of what kind of fub- ftance all the parts are compofed ; it fhews their fi- gure, texture, firmnefs, connection, and relation to each other. From this fource we derive our firft knowledge of the feat of difeafes -, of the proper or im- proper arangement of parts; of the danger or lafety of an operation; and learn the beft manner of perform- ing it with dexterity and fuccefs ; In fludying the art of healing we commonly begin with Anatomy, and very juftly, for, unacquainted with this, it is impofiible to learn the functions of the body in a healthy ftate, to know of what kind its difeafes are, or how to remedy them. It is Anatomy that guides the doubtful ftep of the young votary of medicine through an obfcure laby- rinth, where a variety of minute objects prefent themfelves in fuch a group as, at firft, to perplex his imagination. It is Anatomy which unravels the firft difficulties in his purfuit; it lays open to his Tiew the diverfity of parts, their combination, dif- pofition, [ 7 ] pofition, fubordination, and movements. Thefe, however intricate they may appear, all concur to eftablifh the moft perfect harmony in the human frame, which the attentive inquirer finds from Ana- tomy, to be created with the moft geometrical ex^ actnefs, according to laws prefcribed by unerring wifdom. In fhort, Anatomy is to be efteemed one of the principal pillars, on which we are to raife the fuper- flructure of medical fcience, as well phyfic as fur-' gery. Thofe who would engage in either cannot apply themfelves too early, or.with too much atten- tion, in order to become fkillful anatomifts. Can any one pretend to ftile himfelf a Surgeon, or to perform any operation with fafety, if he knows not the ftructure of the part he is to operate upon ? If he is ignorant of the mufcles which give it mo- tion, or of the nerves which give it fenfation, by cut- ting through the tendon of a mufcle, or by dividing fome principal nerve, hemay forever deprive th$ pati- ent of life, or movement inthe part. If he knows not the courfe and diftribution of its veffels, he may wound fome confiderable artery, and from the lofs of blood may occafion dangerous accidents. Perhaps fpeedy death will be the confequence of his rafh- nefs. With r s i With what propriety can any one arrogate to himfelf the title ct Phyf.cic.n, if he is ignorant of Ana- tomy ? how fhall he be able to dife^ver the feat of a difeafe, or what-chance lias he of being in a condi- tion to remedy it5' Nor is a fuperficial acquaint?nee with Aratcmy fuhicknt for ti'he'r i hyficfen cr Sur- geon. The latter, (that he may not rnhiake what is natural for a difeafe, and jn attempting to relieve an imaginary evil, bring or. a real one ; ) ought to know the ilr.alfeil hollow or protuberance of a bone ; which ferve in many inrlances to direct him, how far he may operate wl.h fafety, as the fituation of the nerves and blood vt fife Is are often to be referred to them. It is requifite for a phyfician to fearch out every the leaft particular in the ftructure of all the internal parts, that he may be in a condition to diftinguifh the nature of the ciforder with which it is affected. As a fkiilful Pilot informs himfelf of the leaft bank of fand cr fhoal where he is to avoid navigating his fhip -, fo every follower of medical purfuits fhculd be intelligent in the minutiae of Anatomy, if he wilhes to practice with eafe to himfelf, and to the benefit of his patient. The Mcteria Medica a;:d Botany may very properly be termed the natural hiflcry of medicine, as from thefe branches of fcience we derive our knowledge of that part of natural hiftory, which more immediately y relates [ 9 J relates to the health giving arts. How worthy of a Phyfician, a Philofopher or a Gentleman, is the knowledge of the different productions of na- ture taken in its full extent ? I cannot too earneftly recommend this ftudy to young men, to qualify them for every ufeful profeflion that is converfant about natural objects, and efpecially for the ftudy of medicine. But it behoves me to fpeak more parti- cularly of medical natural hiftory, if I may be allowed to adopt that term in the fenfe I have already ufed it; and firft of Materia Medica. MATERIA MEDICA treats of the natural hiftory, andmedical virtues, of all thofe bodies which are employed in diet, or in medicine. It confiders the changes they ' undergo when applied to the human body, either internally or externally; and the effects they pro- duce on the fyftem. It is beyond contradiction an object of great im- portance, to both Phyfician and Surgeon, to be well acquainted with the Materia Medica, as it belongs to this to confider the nature of aliments, the choice of medicines, and a knowledge of their action in the veffels, and how they prefervc or reftore health. Physiology, Pathology, Chymiftry, the Materi: Medica, and indeed the feveral branches of medi cine lend a mutual aid to one another, in a greater m lefs degree. C B0TAK7 [ io 1 B OTA NT is a kncwlege of the natural hiftory of vegetables. It may therefore be confidered as part cf the Materia Medica, as far at leaft-, as it is con- nected with the knowledge of medicine. By the Science of Botany we learn to methodize the vegetable part of the creation, and to range ve- getables in different claffes, fubdividing them, into a variety of orders, genera, and fpecies. Such afyfte- matic, or botanic arrangement, as it is called, has taught us this general obfervation, that all plants of fhe fame natural order have in a degree fome com- mon virtue. Botany thus leffens the difficulties wc muft otherwife have been at in difcovering their me- dical virtues. I need not therefore dwell on the im- portance of this ftudy to a Phyfician and a Philofopher. CHTMJSTRT is either Philofophic, or Pharma- ceutic The former confiders the particular pro- perties of bodies, and explains their effects. It is d'and that they fhould be taught a regular courfe of every diftinct branch of Medicine; the infant ftate of the co- lonies, and the want of profeffed teachers, have hi- therto cloged medical purfuits in America with in- numerable obftacles. Never yet has there offered a coalition of able men, v/ho v/ould undertake to give compleat and re- gular courfes of Lectures on the different branches of Medicine; and fuch an extenfive field it is, as re- quires the united eftbrts of feveral co-operating to- D 2 gether, r 20 ] gether, to cultivate it with fuccefs. As well might a parent take upon himfelf the private tuition of his fon, and to make him mafter of all the different lan- guages, ar-.r-, and fciences, which are generally deem- ed requifite, previous to his entering upon the high- er ftudies of Law, Phyfic and Divinity ; as that a " Phyfician, engaged in an extenfive practice, fhould undertake to deliver to his apprentices, in a regu- lar manner, the precepts of his art in all its branches. This is as impracticable as it is unreafonable to ex- pect. In fpite of himfelf and his inclination to qualify young men in the profeflion, they muft of necef- ficy be left, for the moft part, more to their own ingenuity, and precarious application, than a good man could wifh. Thefe are difficulties which he would rejoice to have removed ; but they are evils which have hitherto been without a remedy. The fatigue, the greatnefs of expence, and the want of leiiure time, which phyficians involved in bufinefs cannot command, are bars, which thofe moft willing to perfect ftudents cannot get over. Young men, who are limited to the prefent op- portunities of improvement in America, cannot en- ter upon the ita-e of action, but with unfavourable profpect-, and they muft unavoidably be in continual perplexities. For feldom can we hope to fee thofe who fro.n too great foo.vardnels, or too narrow cir- cumftances, engage untimely in the practice of their profeflion, ever become more than lervile imitators of r 21 ] of others. They blindly purfue an uncertain tract, in which they muft conftantly wander, fince it is fj often obfcured, and infufficient to conduct them any great length. A contracted view of Medicine naturally confines a man to a very narrow circle, and limits hi on to a few partial indications in the cure of difeafes. He foon gets through his little flock of knowledge*; he repeats over and over his round of preftnotions, the fame almoft in every cafe ; and, although he is conti- nually embarrafifed, has the vanity to believe that, from the few maxims which he has adopted, he has within himfelf all the principles of medical know- ledge, and that he has exhaufted all the refources of art. This is a notion fubverfive of all improvement. It flatters the imagination of the indolent, as it dif- penfes with thofe toilfome labours which are neceflary • to the production of truth; and chains him down to a dangerous rotine of practice,unworthy the nameofarc The induftry of many centuries have already- been employed to bring Phyfic to that degree of perfection at which it is now arrived. It will ftill require a long time to remove the cbfeurities which yet veil many parts of it. The application of many, amongft the greateft of men, has hitherto been in- infuffkient to clear up all our doubts in medicine. How then can it be fuppofed that any one, untutor- ed in this art. can by his own natural abilities ever reach- L *2 1 reach the bounds of what is already known in it ?■ The great multiplicity of difeafes, which befet the human race, prefent us with a field too vaft and unknown for individuals to cultivate by them- felves. Their caufes are frequently fo latent, and the ufual refources of art (o often fail the moft fkill- ful, as to compel them to feek out new paths in which they may proceed. For a man of the moft finifhed genius to enter upon practice, having only that flock of knowledge with which his own obfervation and experience could fupply him, unenlightened by thole difcoveries which others have made, would be an act of prefumption. Had this been fufneient to conduct us to the fummit of our art, it would have been in a ftate of perfection many ages ago. , Observation and phyfical experiments fhould blend their light to diflipate obfeurity from medicine. This is the more needful, as nature commonly offers herfelf to our notice under a cloud, and requires that we fhould follow her fteps with fcrupulous atten- tion, watch all her motions, and trace her through every meander fhe makes, in order to difcern clearly the tract fhe keeps in. * " In a courfe of obfervation, " the mind is but a mere fpectator, and only fees " external appearances. We muft aid thefe with the " light of Philofophy to unveil knowledge fully. We " muft dive into the bottom cf things by repeated and * Vid. _ Preface to the mcrr.c'.r; cf the royal Academy of Surge- ry at Paris. [ 23 ] *c and different experiments, and, as is were, force " nature to yield herfelf up to our inquiries." To accompli Hi this demands the brighteft talents, a liberal education and great experience. We can- not fuppofe then that a Student of ordinary part3 can, by any means of himfelf, acquire fufflcient fkill in medicine to take charge properly of the lives of mankind. The almoft infinite number of objects, to which he ought to be no ftranger, pafs before him fo very (lowly, that the longeft life would offer to his con- templation but a very inconfiderable fhare of thofe, with which he may be made acquainted, in the fe- veral branches of hi<; profeflion, by the inftruction of able mafters. Shall a novice then hope, merely by his own abilities, to raife a fuperftructure com- parable to that already built up to his hands, which has exhaufted the ingenuity and invention, and em- ployed the induftry of fome thoufand years ? Where will the moft extenfive practice be fufflcient; and how comparitively little will the moft enlarged fa- culties contribute, to furnifh him with a ten thou- fandth part of the materials? Should we for a moment turn our eyes upon the man, who dares to enter upon the practice of Phyfic, without being properly initiated in the fcience, or inftructed in the important duties of the profeflion, he would foon prefent us with a melancholy profpect; If not paft all feelings of humanity, what compuncti-' ons of confcience, what remorfe would not fill his [ * + ] breaft from practifing at random and in the darkj not knowing whet' cr his prefcription might prove a wholefome remedy, or a deftractive poifon. To difcover the nature of an uncommon difeafe, or to account for an unufual fymptom, puzzles his in- vention. — Ignorant of every true principle, from which, by a juft reafoning, he might be able to de- duce practical inrerrences, he knows not what prog- noftic to make, or what plan of treatment to ob- ferve......Unfleady and irrefolute, he attempts a va- riety of means; fuch as either avail not, or fuch as heighten the danger of the difeafe, already too vio- lent.—He may thus interrupt the falutary attempts of nature, or, not knowing how to fecond them, tamper with the life of his patient, and idiy waiting to fee what nature he felf is capable cf doing, neglect to fuccour her, till it is too late, and the fatal hand of .,i death is juftclofing the gloomy fcene......Wretched is * the cafe cf thofe whom chance, or mifinformed judg- ment, fhall throw into his hands, to fall victims ct his temerity.—Great is the h.tvoek which his ignorance fpreads en every fide, robbing the affectionate huf- band of his darling fpoufe, or rendering the ten- der wife a helplefs widow ;—increafing the number of orphans ;.....mercilefsly depriving them of their parent's fupport;—bereaving the afflicted parents of their only comfort and hope, by the untimely death of their beloved infants, and laying whole families defolate. Remorfelefs foe to mankind! actuated by more than favage cruelty 1 hold, hold thy extermi- nating hand— Glad [ 25 J . Glad fhould I be to moderate this too exact dc- fcription of the effects of ignorant aind prcfumptuous practice ; but what judgment can we pafs on thofe, who have been fcarcely inftructed in the firft elements of medical fcience, and yet force themfelves into prac- tice, as if they meant to fport themfelves with hu- man life, and human calamities? A very judicious perfon £ has remarked, that Medicine is the fcience concerning which people in common take upon them to reafon moft, without having the leaft notion.......Who, that has not made Mathematics his ftudy, will prefume to argue upon any of the difficult calculations of Algebra? But when medical fubjects are the topic, doub.tlefs we are mafters of them without ftudy. It muft be con- feffed indeed, if we know much about medicine without being educated in it, that our ideas of it are truly innate. Abstract truth is at all times but a Ample un- divided object, yet has ten thoufand counterfeits to impofe upon the unwary. No wonder that the impatient ardor of youth, who cannot brook delay, or always take the neceflary time to diftinguifh truth from falfehood, afpiring to reach the top of fcience by a rapid flight, hurries them on in a too unguarded manner, when left to themfelves, and thus E precipitates J Monf Sue, profeflbr of Anatomy. [ 26 ] precipitates them into the groffeft errors. In me- dicine, as in other lciences, if they do not let out On found principles, they pafs on from error to error and multiply miftakes, unable to diveft themfelves of their firft prejudices, which, being confirmed by habit, become a fecond nature. Eafy it is to fall into errors, hard to recover our- felves from them. Facilis defcenfus Averni : fed revoccre gradum, hoc opus, hie labor eft. -f- With greater eafe we may fow juft principles in the beginning, than clear away the rank weeds of popular prejudices, after having had time to take deep root, and fix themfelves firmly in the minds of (Indents. Let us now turn our views to the growing ftate of this and the neighbouring colonies ; let us reflect on the great number of inhabitants fcattered through fuch an extenfive tract of country, who are defti- ttite of all the aids, of medical fcience. Let us con- fider further, that in many large towns and villages, there are a number of perfons entruftfed with the practice of medicine and furgery, who, being de- ftitute of all means of acquiring the true principles of their profeflion, remain in a pitiful ftate of igno- rance in it, v/ithout any profpect or opportunity of correcting their errors, or greatly improving their knowledge. f Virgil; JEa. vi t V J knowledge. We cannot then remain untouched with fentiments of companion; we cannot avoid feeling part of their diftrefs, or forbear to wifh that a remedy were found for fo great a misfortune. Nor is this fo defirable an object quite beyond our reach. The inftitution of fchools for teaching the feveral branches of the healing arts muft have a very great tendency to cfifect our wifhes. To the full accompiifhment of thefe nothing can contri- bute more powerfully, than the relolution the truftees of this feminary have taken, to counte- nance this fcheme which I have had the honour of propofing; and their encouragement of fuch perfons as, upon due information, they fhall find qualified to take upon them the important offices of profeffors, in the various branches of Medicine. i Although we may not be in a condition to enter upon every part of this great undertaking immedi- ately, yet we may lay a foundation, which cannot fail of,being built upon fhortly by thofe who follow us. Time will perfect what is properly begun. What indeed is all fcience, but the accumulated ob- fervations and difcoveries of a fucceflion of many people, framed into a fyftem ? When this is pnce accomplished, every individual may them avail himfelf ©f the labours of others, and E 2 thvs [ 28 ] thus arrive, in a compendious manner, at a competent knowledge of any art. This is happy for us, fee- ing life is fhort, and the human mind neceffarily oc- cupied with a great number of purfuirs, very dif- ferent from our particular profeflions, v/hich would not allow us otherwife to go any great lengths. From the union of ingenious men the arts find refources, never to be met with in the la- bours of individuals, with whom the moft ufeful truths are frequently buried ; whilft focieties form a kind of magazine, v/hich collects together all the knowledge of the learned, and confecrates it to pub- lic utility. It eftablifhes a commerce for the com- munity, which neverperifhes, but from age to age is a fruitful fource of new acquifitions. -f What ra- pid progrefs have we not fometimes feen in fcience from a confpiration of counfel and induftry ? Thus inftitutions, which have appeared inconfiderable at firft, improve faft, and make hafty ftrides towards importance and grandure. This very Seminary, of late only a collection of private fchools, although of fo fhort a ftanding, has increafed its reputation and ufefulnefs, fo far as to attract the notice of our mo- ther country, and already begins to flourifh, beyond what could reafonably be expected in fo fhort a time. Of what confequence the united efforts of men learned in their profeflion are, the medical colleges of f Preface to memoirs of Royal Acad, of Surgery. [ *9 J of Edinburgh afford a remarkable inftance. With- in the fpace of little more than forty years, the pre- fent profefforfhips in Medicine were firft formed. A few gentlemen from Scotland, then profecuting their medical ftudies at Leyden, concerted a plan, and undertook, themfelves, the important charge of inftituting fchools for teaching the various branches of Medicine. They met with countenance and fup- port from the patrons of the univerfity, and by the great abilities, afliduity, and experience of thofe gentlemen, and fome few of their fucceffors, the re- putation of that place is raifed to fuch a height, that, to their immortal honour, it already rivals, if not furpaffcs that of every ether fchool of Phyfic in Europe. The names of Drummond, Dick, Clerk, Rutherford, Sinclair, Alfton, Plummer, Monroe, Whytt, Cullen, Hope, Black, and fome. others, are now known wherever the knowledge of Phyfic is cultivated; and they are revered at home as parents and guardians of the healing arts. There is a great refort of medical ftudents at the univerfity of Edinburgh, as well from Great-Britain, Ireland, and the Weft-Indies, as from the Continents of Eu- rope and America. Thefe bring to the univerfity- and city confiderable advantages, and, in return, car- ry the fame of their learning and their profeflbrs to every quarter of the globe. Were it neceflary I could eafily enumerate many fimiliar inftances of the improvement [ 3° ] improvement of fcience •, but thefe, I imagine, will fuffice for the prefent. Why fhould we be deterred from eftablifhing like inftitutions of Medicine in this feminary, efpecially as fo many circumftances confpire to invite and encourage fo important an undertaking. I fhall briefly enumerate the moft interefting of them. The city of Philadelphia, adorned with a fet of eminent practitioners, draws to it a great number of pupih, fronr the neighbouring parts, to learn the arts of Phyfic and Surgery. We may reafona- ably expect, that from the propofed inftitution, the number of ftudents, who fhall refort hither to par^ take of thefe advantages, will be gradually aug- mented. Besides men of great abilities and eminence, unr der whom they may fee private practice, the hofpitaj of this city is a great perfuafive to determine a concourfe of medical ftudents to this place. It would be doubly ufeful to them, and increafe their motive of repairing here, if they could be firft pro- perly initiated in the principles of their profeflion? by regular courfes of lectures duly delivered. This [ 3' ] This noble charity, maintained by the donations of the benevolent at no fmall expence, fupports a great number of fick of both fexes. As there arc fix phyficians of the moft unqueftionable {kill, inte- grity, and character, who, moved by the tender principles of humanity, have taken upon them the charge of attending the fick gratuitoufly ; pupils here meet with fuch a number of cafes, both chronic and acute, treated fo judicioufly, and fo agreeable to the rules of art, as cannot fail very much to facilitate the knowledge of their profeflion. It is a moft favourable circumftance to the un- dertaking which I have fuggefted, that of thefe fix phyficians, no lefs than five of them are truftccs of this college. We may from hence, I think, fafely infer, that every thing in their power may be hoped for, to fecond the medical inftitutions of the college, by uniting with them the advantages of the hofpital, and thus rendering the education of youth in the healing arts as compleat as poflible in this city -, to which nothing can contribute more than a courfe of clinical practice and clinical lectures, by phyfici- ans of knowledge and experience. * The' - * Befides thofe who are apprentices to, or under the immediate tu- ition of the hofpital phyficians, every fludent ot Medicine in town is admitted to fee their common practice in the hofpital, upon pay- ing a certain fum annually during his attendance there. It were to be wifhed that fome of thofe gentlemen, fo flcillful and experienced in the healing arts, enriched with ufeful obfervations, which only &mc, and an extenfive pra&jce can furnilh, would undertake to give [ 3* ] The flourifhing ftate of literature in this college, and the perfection in which the languages, mathema- tics, and polite arts are taught here, are ftrong in- ducements for fuch young men as propofe engaging in the ftudy of Medicine, to enter the college. * Be- caufe when medical lectures are given under the pa- tronage of the truftees and faculty, at the fame time that ftudents are profecuting other parts of learning, they will have greater advantages there than hitherto they have enjoyed. Thus the motives of repairing to Philadelphia for the ftudy of Medicine and Surge- ry will multiply in proportion. This city, fo large, in fuch a thriving ftate, and fo extremely beautiful and pleafant in its fituation, as well as fo nearly central to all the colonies on the continent, has peculiar advantages in refpect to the refort of ftudents ; which added to the advantage of the a courfe of clinical lectures, in order to explain the hofpital practice; the ftudents paying fuch reafonable fees to thofe clinical teachers as may be thought adequate to their trouble. This is a ltep of the greatelt and molt obvious utility to both hofpital and ftudent, con- sonant to reafon and the ufage of fome of the belt hofpitals in Europe. From my perfonal acquaintance with many of the managers when I attended the hofpital fome years ago, I am perfuaded they would readily encourage this plan. Their known benevolence and ardent defire of contributing all in their power towards the improvement of medical arts, as well as relief of the fick ; and thus uniting two of the molt valuable purpofes of fuch a foundation, lead me to think fo. When two fuch important inftitutions, as a medical college and a well regulated hofpual, contribute mutually to the advantage of each other, all ranks and conditions of people would no doubt moft chear- tully unite in fupport of a common interelt, fo beneficial to ufeful li- terature, aud lo advantageous to the province in i^iu-nd. [ S3 1 trie college, hofpital, and the different courfes of lectures, could not fail of bringing a concourfe of ftrangers to this place. The eftablifhment of a medical library in this col- lege would prove another great benefit to ftudents, and tend likewife to influence their refort hither. Proper means may poflibly be fuggefted to accom- plifh this, without any great additional charge to the college. The pupils that attend lectures, for whofe advantage it is intended, may, upon being matricu- lated, afford each of them to contribute annually a fmall fum. This from a number of pupils, in a fuc- ceflion of fome years, would be of confiderable fer- vice towards procuring a medical library. Perhaps the phyficians of Philadelphia, touched with generous fentiments of regard for the riling generation, and the manifeft advantages accruing to the college thereby, would fpare fome ufeful books, or contribute fome- what as a foundation on which we might begin. The growth of this and the neighbouring colonies calls aloud for a medical inftitution. The increafing number of inhabitants demands an increafe of thofe who exercife the profeflion of Medicine and Surgery, and ought to be an argument with all of us, who re- gard either the prefent or future advantages of the country, to attend ferioufly to the importance of the fubject." F Ths t 34 J The fcheme of eftablifhing medical lectures, which: I now fubject with all deference to your confiderati- on, has been communicated to fome very competent and unbiafled judges in England, who not only deem it practicable, but a laudable and ufeful enter- prize. The great and well known Dr. Fothergill, the juftly celebrated Dr. Hunter, and the learned Dr. Watfon, men diftinguifhed for their fuperior know- ledge in literature, and particularly eminent in eve- ry thing which relates to medical fcience, have efteemed the improvement of fuch knowledge a* mongft us worthy of notice, and the inftitution of lectures in every branch of Medicine as deferving the patronage of all who wifh well to arts arid fci- ences. It would therefore argue great inattention in us to neglect the firft opportunity that offers, of giving effect and (lability to the defign. Nor can we defer the execution of it at this time, without rifquing the lofs of the noble profpect which it af- fords, net eafily to be retrieved. It is with the highefl fatisfaction I am informed from Dr. Shippen, junior, that in an addrefs to the pubic as introductory to his firft anatomical courfe, he propofed fome hints of a plan for giving medi- cal lectures amongft us. But I do not learn that he recommended at all a collegiate undertaking of this kind. What led me to it was the obvious- utility [ 35 3 utility that would attend it, and the defire I had of prefenting, as a tribute of gratitude to my al- ma mater, a full and enlarged plan for the inftitution of Medicine, in all its branches, in this feminary where I had part of my education, being a:nongft the firft fons who fhared in its public honours. I was further induced to it from a confideration, that pri- vate fchemes of propagating knowledge are inftable in their nature, and that th; cultivation of ufeful learning can only be effectually promoted under thofe who are patrons of fcience, and under the au- thority and direction of men incorporated for the improvement of literature. Should the truftees of the college think proper to found a profeflbrfhip in Anatomy, Dr. Shippen having been concerned already in teaching that branch of medical fcience is a circumftance favour- able to our wifhes. Few here can be ignorant of the great opportunities he has had abroad of qualify- ing himfelf in Anatomy, and that he has already gi- ven three courfes thereof in this city, and defigns to enter upon a fourth courfe next Winter. ' I propose in a few months to employ myfelf in giving a courfe of lectures on the Materia Medica, in which the pharmaceutic treatment of medicines, as well as their virtues, v/ill be defcribed, and the F 2 doctrines [ 3* ] doctrines of the chymical properties of bodies will be confidered, as far as is ufeful to give a general idea of Chymiftry, and as is confident with a courfe of the Materia Medica. Next year I defign to attempt a courfe of lectures upon the Inftitutes or Theory of Medicine, which will be illuftrated with practical obfervations. Poflibly in a few years more, perfons duly qualified may offer to undertake full and corn- pleat courfes of every branch of medicine-, and a plan may be adopted^ conformable to that which is followed in the, fojuftly celebrated, fchool of phyfic at Edinburgh. The regular diftribution of literary honours upon the deferving is a ftep, which is neglected in no in- ftitution that promifes fair to be extenfively ufeful. As it is fometimes prejudicial to attempt a fcheme entirely out of our reach, fo, on the other hand, a too contracted plan often mars the work altogether, or fruftrates the great utility which might be derived from a more finifhed model. Let us aim then i to diftinguifh wortn with adequate rewards, and confer due honours on real merit. This will, render the inftitution compleat, and give all poflible encouragement to pupils. As you have hitherto been fo careful not to pro- ftitute the honours of this feminary on any occafion by t 37 ] by conferring them on the undeferving $ and have made decrees in arts not an unmeaning title, but an honourable badge of diftinction, you have given folid reputation to thofe who have been educated here. You have thus conducted them with ecclat to the ftudy of the learned pirofeflions, or ufhered them into other ufeful fpheres of life with luftre and ad- vantage. The fame regard being had to the higher degrees of literature would increafe thefe good ef- fects. In a fhort time, every perfon would be afhamed to think of practifingphyfic, who had notindu;ri- oufly cultivated the beft opportunities of inftruction. He would otherwife be marked out by every in- telligent man, as one who had never been properly initiated in his profeflion, and, confequently, as un- equal to the talk which he had prefumptuoufly en- gaged in. If the feveral parts of the defign, which I have pointed out as practicable to execute, meet with that attention which they feem to merit, it is not to be doubted that, in a fhort time, medicine will pot on the form of a regular fcience, and be fuccefsiuliy cultivated in the College. And fuppofing we are not able to meet with gentlemen already in circuirir fiances to engage in every part of the work, we may however hope that a laudable ambition, fenti- ments of honour, and the intereft of the public weal will prompt fome of the rifing ftudertts, a- mong [ 3« J rfiong ourfelves, of more than ordinary talents, to cultivate with the utmoft application the particular' branches of medicine, to which they find their ge- nius more elpecially point. It is to be hoped that they will avail themfelves of every opportunity of improvement by going abroad, and on their re- turr, transplant hither, to the great emolument of the community, every different branch of knowledge relative to their profeflion. Is it not probable that fuch a plan as this laid before them w ill open the views, fpur on the ambition, and allure the induf- try of ftudents, fo that we may hope to fee, in fome years, a number of gentlemen, natives of America, qualified to fill the moft difficult and important parts ef their profeflion, with ufefulnefs and applaufe «? It may perhaps be objected, that the colonies are yet in fo intunt a ftate that any attempt to eftabhlh medical fchools is premature. It may be imagined, that it will prevent many from going abroad, to ob- tain a more complect education. Lei it be confider- ed, that every one, v*hofe circumftances allow of. this, will have a plan before them, and every incite- ment to renuer their education as perfect as pof- fible. Many who are not in a condition to fupport the expence of being educated abroad, by being inflruded here in the firft elements of their profeU fion, and informed what further remains to be done, have it in their power to finiih their ftudies abroad afterwards [ 39 ] afterwards with advantage. This clafs perhaps in* eludes the greateft part of medical ftudents. " The faving of money may be thought more necef- fary at this juncture, when the check which our comV merce has received makes it fo fcarce amongft us. Some there are indeed-, and not a few, who can« fiot by any means afford the expence of croffing the Atlantic, to profecute their fludies abroad. The propofed inftitution will therefore prove highly be- neficial to every clafs of ftudents in Medicine. There is a difficulty indeed in the way of the un- dertaking of great weight, which it were to be wiihei. could be furmounted ; I mean in cafe all the different branches of medicine fhould be blended in the prac- tice of any profeflbr. This evil would call aloud for a remedy. The love of humanity prompts every - ingenious man, engaged in that part of medical pur- fuits which he likes beft, to profecute it with aflidui* ty and conftancy. The bounds of. life are the only limits to his induftry. He devotes himfelf entirely to a toilfome ftudy, but which ceafes to appear fo to* him, when the intereffo of humanity are the fruits of his labours. There are men fo 'intent upon im- proving favourite fludies, that a labour of very many years is but a conftant exercife of the eyes and " hands, by which the fcience in general is greatly enriched [ 40 ] enriched, whilft they themfelves remain in a fhame- ful indigence and obfcurity, neglected by thofe .to whom their labours prove fo beneficial, -f Whilst Medicine from the greatnefs of its object, the prefervation of the fpecies, is one of the moft ufeful fubjects of knowledge to a ftate, and at the fame time One of the moft extenfive and difficult; we muft regret that the very different employment of a Phyfician, Surgeon, and Apothecary, fhould be promifcuoufly followed by any one man, however great his abilities. They certainly require very differ- ent talents. The infant ftate of a place, is fome- times ufed as an argument, not in fupport, but as an apology for fuch meafures. 1 he longer we follow any faulty cuftom, the more difficult we find the tafk to break through the (hackles of it, even when it "enflaves us to our greateft detriment. Every mechanic art, and almoft every employ- ment in life, ferve as inftructive leffons to the prac- ticioners of Medicine. The construction of a watch, the building of a houfe, nay the making of a pin, are ftriking examples of the truth of this affertion. In each of them a number of different artifts are employ- ed, who confining themfelves every one to his own branch of bufinefs j the whole work is more quickly finifhed, and more highly improved. The length to which human drill may arrive, when thus pro- f Memoirs of the Royal Academy of Surgery. perly r. 41 i perly directed is amazing. Why then fhould we continue to follow fuch a variety of different occu- pations as are generally crouded together in the prac- tice of the healing art ? The mutual intereft of pa- tient and practitioner feem to require a different pro- cedure. The chief argument alledged for it, viz. that it is lefs expenfive, is altogether fallacious, and, un- lefs I am much out in my conjectures, it will be found a very difficult talk to prove the affertjon. But granting it to be truely fo, yet when life is the object at flake, a notion of cheapening healthy and a difparagement of the practitioners fkill, argue a fordid mind, and will, in the end, always difcover a moft miftaken plan of oeconomy. If Phyfic, Surgery, and Pharmacy were in different hands, practitioners would then enjoy much more fatisfactiori in practice. They would commonly be lefs burdened with an over hurry of bufinefs, and have an opportunity of ftudying the cafes of the fick at more leifure. Would not this tend to the more fpeedy relief of difeafes and the perfection of medical fcience, as every Phyfician would have more time by ftudy, obferyation, and experience united, to cultivate that knowledge which is the only foun- dation of practice ? " This knowledge, fought out by Philofophy, drawn from nature and the opera- tion of Melicines, and founded upon the caufes of our complaints, upon obfervations of their figns and upon the laws of the animal ceconomy, form G the [ 42 J the true Theory, without which, there is neither art nor method in the treatment of difeafes. But how great is the force of prejudice, that prac- titioners, who affect a feducing kind of fim- plicity, fhould look upon thofe perfons with difdain, who divide their application between ftudy and prac- tice-, they infpire a contempt for Theory, where- by they impofe on the public who are no judges of its ufefulnefs. Thus the moft grofs igno- rance finds, incredulity, a too fure means of decry- ing that knowledge which can alone direct our fleps with certainty. Ought we then to endeavour to render the art compleat, by attending only to the progrefs of that experience which is acquired bv practice, which frequently begets fo much vanity and feduces the vulgar ?" * Let us rather commend thofe who would be afraid of making no further ad- vance in the healing arts, if they were compelled to abandon ftudy and to give themfelves up wholly to practice ; and who examine themfelves every year, to know what progrefs they have made in the know- ledge of difeafes. The great Boerhaave, whofe example * Mais telle eft la force de Prejugcs ; Ces Praticiens, dis je, qui fe parent d'une fmiplicite seduifante, regardent avec dedain ceux qui partagent leur application entre fetude et la pratique ; Us infpirent' du mepris pour la theorie, et en impofent au public, qui n'en icauroit connoitre l'utilite. Ceft ainfi que l'ignorance la plus groffiere tiouve dans la credulite un moyen toujours trop fur pour fiutrir le fjavoir, qui peut feul aflurer nos pas. Doit on en attendre les progres de cette experience qui s' acquiert par la feule pratique, qui inlpire fi fouvent tant de vanite et qui feduit le vuigairc? &c. &c. "Vid. mem. de TAcad; royal; de Chirurg : de Paris. t 43 I example is worthy of imitation, laid it down to him- felf, as an inviolable law, to divide his time between ftudy and practice. Where abilities and the love of a profeflion unite, there is the fureft prefage offuccefs. But unhappy is the Phyfician, who has a foul turned to phiiofophi- cal inquiries, who loves to fearch into the caufes, and inveftigate the phcenomena of difeafes •, and yet is at the fame time diverted from thefe ufeful refearches, by other occupations to which hejias an averfion. How difagreeable ! how cruel a cafe is it to be forced, in compliance with cuftom, to ftifle the tender feelings of humanity ; to take the knife into his unfteady hand •, and in fpite of reluctant nature within him, to be obliged to perform fome painful and tedious operation on the fuffering pa- tient! better configned to one whofe inclination, experience, and addrefs, qualify him for the irkfome, but needful talk! On the other hand, a fpirit of intrepidity and a particular turn of mind carry many beyond the horrors which get the better of others. Fired at the fame time with a like love of humanity, and filled with defires of relieving the calamities to which external violence, and innumerable ac- cidents both from within and from without fub^ jeer, our lot, they apply themfelves with the moft laudable zeal and afiiduity, to improve that effential G 2 part [ 44 3 part of the healing art which is capable of giving effectual aid by the painful, but wholefome feverity of manual operation. To render any perfon dextrous in the operations of Surgery, however intrepid he may naturally be, it is neceflary that he fhould practife them often, and devote himfelf to them. This is inconfiftent with the occupation of a Phyfician involved in a multi- plicity of bufinefs, and requiring leifure to ftudy the cafes ef his patients, who linger under a complica- tion of evils widely different. It is to lovers of humanity like thefe, fo different- ly occupied, that fome owe the movement of their limbs, others the mitigation of obftinate difeafes, and others the prolongation and pleafure of their lives. The bufinefs of Pharmacy is entirely different from either. Free from the cares of both, the Apothecary is to prepare and compound medicines as the Phyfici- an (hall direct. Altogether engaged in this, by length of time he attains to that nicety of (kill therein, which he never could have arrived at, were his at: tention diffracted by a great variety of other fubjects. The wifdom of ages approved by experience, the moft certain teft of knowledge, has taught us the neceflity and utility of appointing different perfons for thefe fo different employments, and accordingly, we find them profecuted feparately in every wife and polifhed [ 45 3 podimed country, to the great advantage of each, and to the unfpeakable emolument of the community s Indeed the benefits which thefe prefervers of the human race, improving each his profeflion apart, have fhed abroad in the world, fomewhat refemble the great bleflings of nature, the light and air •, they are fo common we all enjoy them, and, for the moft part, without appearing fenfible of their unfpeak- able value. I appeal to the common fenfe of mankind. The common fenfe of mankind, duly informed, gives its verdict againft a promifcuous profeflion of different occupations. When a country has made fome advances in other arts, and begins to flourifn in knowledge, perhaps not without fome luxury* it is high time that medical fcience fhould be; practifed with regularity. It would be unpardonar ble in the profeffors to let it remain at a ftand, as if they had already attained the fummit of human wifdom. This would curb every laudable attempt to improve polite literature amongft the rifing o-eneration. In general, languid is the profecution of ftudy, when there is but little profpect of feeing our labour crowned with fuccefs. Let us now confider in a brief manner the ad- vantages we may hope for from the execution of our defign. Thefe are greater, and more in number, than flrike our notice at once. We fhall firft con* fidcr [ 46 ] fider the benefits which the Students of Medi- cine will derive from it. In a place fo remote as Philadelphia from every fchool of Phyfic, we cannot expect a very early in- intelligence of all the medical difcoveries and im- provements which are made in Europe. In efta- blifhing medical colleges, the profeffors of each branch will find it incumbent on them to keep up a correfpondence with the learned abroad. They will thus getfpeedy accounts of every thing new which may relate to their particular provinces. By improv- ing this knowledge, they can diffufe it amongft their pupils, and, by their means, more readily propagate it through every part of the country. That this will be of the greatelt utility is manifeft, if we rely on the authority of the moft celebrated academicians. They ftrongly recommend " to let none of thofe difcoveries efcape us, which are daily brought to light by the labours of mafters in the art. Without this care, fay they, the moft cdnfummate practitioner, within the fpace of twenty years, will be ignorant of thofe truths which are then familiar to novices: the labours of others will thus become a fource of labours to himfelf, and, without new ftudy, his knowledge will decay into ignorance. Thus the celebrated practitioners in the time of Harvey, content with the knowledge which they had acquired from [ 47 1 from their predeceffors, fhut their eyes againft the light which this great man prefented to them. They had made a long career in the exercife of their art, without knowing the circulation of the blood, which expofed fo many errors in the books of the ancients, and fo many falfe fleps in their proceedings. •, whilft Novices, enlightned by this difcovery, with reafon defpifed thefe haughty practitioners who grew old in their errors." * Students are apt to be difgufted with any art, when, at their firft entrance upon it, they find it be- fet with difficulties which to them appear unfur- mountable •, but when thefe begin to clear up, their eager purfuit of knowledge increafes daily with growing pleafure. A regular courfe of inftruction prompts them to an eager purfuit of learning: it fheds forth conviction upon the mind, and improves the confidence of the diligent ; a confidence founded on * II faudroit encore ne laiffer echapper aucune des decouvertes qui naiffent tous les jours des travaux des mattres de Tart: fans cette etude, le Praticien le plus confomme ignorera dans Pefpace de vingt annees des verites qui feront familieres a. des novices : les travaux des autres font done une fource de travaux pour lui; et fans une iiouvelle etude, fon f^avoir meme feroit fletri par fon ignorance.. Tels etoient des Praticiens cele'ores conteinporains d 'Harvce. Contens des connoiflances qu'ils avoient puisees dans les Ecrits de leurs predecefl'euis, ils fermercnt les yeux a la lumiere que leur pre- fer.toit ce grand homme 5 ils parcoururent une longue carriere dans Pexercife de leur art, fans connoitre la circulation du fang, qui devoile tant d'erreurs dans les livres des anciens, et tant de faux pas duns leur marche. Des Novices, eclaires par cette decouverte, meprifoient avec railbn ces praticiens dedaigneux qui vieilliffoient dans leurs erreurs. Vid mem. de 1,'Acad: royal: de Chirurg: de Paris, t 48 ] on thejuft principles of demonftration and reafon. it is very certain that oral inftructions and ocular illuftra- tions render fcience eafier, are more convincing, and make a more durable impreflion than the beft wrote treatifes. A courfe of reading and obfervation is not fuf- ficient, without other inftruction, to qualify young men for practice •, fince many of the books of me- dicine are full of obfcurity, or crouded with ab- furdities, which puzzle the unexperienced reader, and often lead young minds aftray. As the moft precious metals in a ftate of ore are mixed with drofs, fo the choice truths of Medicine are frequently blended with aheap of rubbifh. How va- luable and neceflary is an experienced profeflbr who knows how to clear this away •, to prefent thofe truths fimple and pure from mixture •, to trace them out under the various appearances they put on at differ- ent times, and to difcover to ftudents the clue of rea- foning which they ought to purfue* in winding through a labyrinth of obfcurity, before they can ar- rive at a clear knowledge of the more difficult parts of their profeflion 1 That is to teach them how to philoibphize juftly in medicine. The greateft genius left to kfelf is like the earth, when deftitute of the fun, incapable of bringing its productions to a perfect maturity. A courfe of re- gular [ 49 ] gular inftrudtion is to the mind like the rays of light darting through the obfcurity of Chaos. It dif- pells the clouds that envelope the understanding, and enables the diligent ftudent to penetrate into the fecret receffes of nature. Thus prepared, he is in a fituation to enrich himfelf with thofe treafures of knowledge which the obfervers of nature have heaped together for many ages. He has a torch put into his hand to light him to the true fcience of curing difeafes. As the practice of teaching is requifite, in or- der to be able to explain the difficulties of any fcience, and render the communication of its pre- cepts familiar to others, it is neceflary that perfons fhould devote their time very much to it. This can only be done to good purpofe, fo that ftu- dents may reap ample advantages therefrom, by means of inftituting public profefforfhips. The bufinefs of a Profeflbr is to place before ftudents in a full light, at their firft entrance upon any ftudy, the true object of that ftudy, and to afcertain their proper purfuit. In performing this, he firft ex- plains to them the terms of art, and renders the lan- guage and ideas thereof familiar. He afterwards di- rects them to what is the moft proper courfe of ftudy, and to the beft authors to pe'confulted 0n the fubjects of which he treats. He points out the miftakes which anv of them may have run into,, and putsuhern upon H ° their [ 5<> ] their guard againft fuch errors as are apt to miflead ftudents. He fupplies the defects of thofe authors, and mentions what new light the lateft difquifiti- ons and difcoveries have thrown upon every fubject. He thus points out the road which leads to fcience, and prevents the young votary from running into a maze of doubts. He confirms his fteps, fmooths the rugged path he has to tread, aflifts him in climbing the fteep afcent, and, before difmiflion,, informs him how he is to conduct himfelf, in order to reach at length to the fummit of his profeflion. Having a plan before him, a fixed end in view, and the means of attaining it within his reach, the ftudent, impell- ed on with irrefutable ardor, preffes forward, ea°-er to reach the goal of knowledge and the height of all medical attainments •, and fince he is fo well inftruct- ed in his career, has the apparent profpect of wifhed for fuccefs. Another manifecl advantage of public lectures- is, that they bring together a number of ftu- dents of the fame clafs of knowledge. If the profeflbr is a man who labours to improve the growing mind, he has it in his power to kindle an ambition in the bread of his pupils. An opportunity is put into his hands of examining the progrefs they make. They become acquainted, and fometimes form fo- cieties under the eye and direction of their teachers and mafters. They converfer and write difcourfes [ 5i ] on fuch literary and medical debates as tend greatly to their mutual improvement. As to what regards ftudents themfelves, thefe fe- veral particulars I am perfuaded are fufficient to convince every judicious perfon of the neceflity of inftituting, in this feminary, profeflbrfhips in all the branches of the healing arts. The great advantage which may be expected to accrue to the Seminary itfelf, from the eftablifhment of medical fchools, is the advancement of the grand defign of fuch a feminary in general, and the im- provement of fome of the moft ufeful branches of literature, that can embellifh any feat of learning. If wifdom and profitable fcience are the glory, the ornament, the higheft attainment of humane nature, and give the ftrongeft evidence of a people being enriched with generous and refined fentiments, by which all poliftied nations are ambitious of being diftinguifhed; then, moft certainly, it becomes an object of the firft confideration with us to determine, whether the cultivation and patronage of this fcience are worthy our moft ardent purfuits, and whether we fhall improve this opportunity which is now put into our hands for that purpofe. It is needlefs to in- form you of what confequence it is to take the lead in a defign fo interefting, fo noble and important. H 2 Ths t 5* I The reputation ot every fort of ufeful learning muft be of great benefit to a City, as it will draw, from all parts, perfons that have a relifh for litera- ture, who will always prefer a place of education, in which the greateft number of advantages coincide. The refort of ftrangcrs to any city* for the cultiva^ tion of fcience muft give it proportionably a preemi- nence over others. An education in any place begets that place an intereft, and as it were naturalizes flran- gers to it. In return for a difpenfation of knowr ledge, it collects a tribute of riches as well as of affec- tion from all quarters. Amongst the benefits to be derived to the Pro- vince from the eftablifhment of medical fchools, I cannot pafs over a particular one, which ought to fire the ambition, and animate the induftry of every ftudent who has chofen to devote himfelf to the cul- tivation of the healing arts. We live on a wide extended continent of which but the fmalleft portion, even of the inhabited part, has yet been explored. The woods, the mountains, the rivers and bowels of the earth afford ample fcopc for the refearches of the ingenious. In this refpect an American ftudent has fome confidcrable advantages over thofe of Europe, viz. The moft ample field lies before us for the improvement of natural hiftory. The countries of Europe have been repeatedly traverfcd by t 53 ] by numerous perfons of the higheft genius and learn- ing, intent upon making theftricteftfearch into every thing which thofe countries afford -, whence there is lefs hopes or chance for the ftudents who come after them to make new difcoveries. This part of the world may' be looked upon as offering the richeft mines of natural knowledge yet unriffled, furficient to gratify the laudable thirft of glory in young in- quirers into nature. The difcovery muft greatly en- rich medical fcience, and perpetuate the glory of the authors to lateft time, How many plants are there, natives of this foil, poffeffed of peculiar virtues ? how many foflils to enrich the cabinets of the curious ? how many na- tural fubftances, objects of new trade and commerce to fupply materials for various arts, as well as to en- large the bounds of Medicince ? what means are fo likely to bring them to our knowledge as medical refearches and careful experiments, profecuted b^ thofe inftructed how to make them, and how to pro- fit themfelves of the difcovery ? A fpirit of inquiry into thefe things would be put on foot as the natu- ral tendency of fuch an inftitution, and prove the moft likely means of bringing to light the know- ledge of many ufeful things, of which we yet remain ignorant, the more readily, as natural hiftory is one of the moft effential fludies to prepare a perfon tor . [ 54 ] for profecuting medicine with fuccefs, and one of the moft diftinguilhed ornaments of a phyfician and man of letters. From all thefe different views, I prefume none will deny the expediency, and neceflity if I may fo fay, as well as the exceeding great benefits of the propofed inftitution to this feminary, city and pro- vince. Nor does the utility of it flop here. We may not only hope to profit ourfelves, but, in very many inftances, contribute hereby to the advantage of the Colonies, the vicinity and connections of which with ours might encourage many ftudents to refort hither. Thus the reputation and influence of this in- ftitution, becoming at length more univerfal, might extend themfelves as from a center, and include diftant places within the circle of its ufefulnefs. FOR a few moments, fuffer me here to befpeak the attention of The STUDENTS of MEDICINE. Having now laid before you an object worthy of your moft earned regard ; the nature of the fludies in which you are to engage •, their extent, difficulty, importance and dignity being now pointed out, and a plan fuggefted to you, whereby your labours may meet [ 55 ] meet with a more certain fuccefs •, confider well, Gentlemen, how much depends upon your own di- ligence----Think how neceflary it is to employ all your attention in order to accompliih fo valuable an end.---To this end place before your eyes the illu- ' flrious examples of great men, who, by pufhing their refearches into the bofom of nature, have extended the bounds of ufeful fcience. Tread in their fteps, become indefatigable in the cultivation of medical literature, and be earned to bring it to perfection. The rewards of the rich, the countenance of the great, and rhe juftly merited efteem of the good and the vir- tuous, which outlafts the fleeting years of humane date, will not be wan ting for your encouragement. You will be in a condition to practife the healing arts with fkill and reputation, and to tranfmityour knowledge* and the benefits thereof, to a fucccflion of others. What is a moft pleafing refleftion, thofe who have been diftreffed by irkfome difeafes, and relieved by your fkill, will own themfelves indebted to you for the life you have prolonged •,—-You will be ever remembered as the ornament and boaft of your pro- feflion, and be juftly ftiled guardians of the health of mankind. These confiderations ought to animate you in the noble purfuit, and determine you to perfeverc therein with unfhaken firmnefs and conftancy. Be not [ 5* 1 not difpirited at the difficulties which prefent, or the obftacles you are to encounter. Let them ferve ra- ther as a fpur to your induftry. They will not ftand in the way of men who are determined to furmount all oppofition in their courfe. Regard them as left by others for you to matter. Was there no dif- ficulty remaining, you would have lefs fcope for a genius of inveftigation •, lefs honour in being barely followers of others. Both fcience and honour offer one fate to their votaries. They reward the cour- age of the brave and of the fleady, and repell the faint hearted and irrefblute. You have an ample field before you to cultivate. Infpired by a love of fcience, your diligent inquiry into natural caufes and effects mult produce difcoveries •, and thefe difcove- ries prompt you with frelh alacrity to new refearches; an employment as delightful and honourable as it is advantageous. O'adzr requires that I fhould now addrefs myfelf In particular TO THE TRUSTEES OF THE" COLLEGE. To you Honoured Sir, * and you Gentlemen who are truftees of this feminary, the refpected patrons of literature, who alone can give force and {lability to undertakings of fuch moment a? this, I beg leave to return my wanneft acknow- ledgements * The governor of Pennjylvanb, who is president of the trances. L 57 ] acknowledgements for the difpofition you have (hewn of encouraging every attempt to promote fcience in this place ; for your ready concurrence with my propofal of inftituting medical fchools in this femi- nary, and for the honour you have conferred on me, in appointing me a profeflbr of the Theory and Prac- tice of medicine. My gratitude cannot be manifefted in a better manner, than in fhewing the moft feru- pulous regard to the improvement of medical learn- ing, and diligently profecuting every meafure which may be thought conducive to that end. I .flatter myfelf nothing in my power fhall be wanting to an- fwer the great purpofes of the inftitution. The learned Provoft, vice Provoftand faculty of the college have employed their unwearied care in cultivating every branch of academical knowledge •, and thus,- with a fuccefs anfwerable to their wii'dom and perfeverance, have carried this feminary to a ve- ry high pitch of reputation. Their induftry I fhall fet before me as an example worthy of imitation, and fhall confult with them, in framing fuch rules as may be thought expedient for the better regulating of phyfical exerc.lcs, and fixing the medical fchools on the moft refpectable footing. From their experi- enced judgement, and warm attachment to the intereft of the college, I have rgom to hope for all the affiftance they can yield me in carrying the de- fkm into execution. 5« J Being afiured of this, it is yours to perfect the plan which I have briefly fketched out. Under your patronage we may hope that Medicine will put on the form of a regular fcience, and be cultivated with ardor and fuccefs •, and that your influence will be employed to promote the feveral branches of it; to the cftablifhment and perfection of which are annex- ed confequences, of the higheft concern to the Ame- rican colonies in general, to this province, this city, and this feminary in particular. It belongs to you to collect the fcattered powers that are neceflary to be united, in an attempt fo important; and to tranfplant hither fome of the moft noble and bene- ficial feiences that mankind are bleffed with, the feeds of which, fo opportunely fown, will certainly produce a luxuriant growth of the moft profitable knowledge. Perhaps this Medical inftitution, the firft of its kind in America, though fmall in its beginning, may receive a conftant increafe of ftrength, and an- nually exert new vigour. It may collect a number of young perfons, of more than ordinary abilities. :.nd fo improve their knowledge as to fpread its reputation to difeint parts. By fending thefe a- broad duly qualified, or by exciting an emula- tion amongft men of parts and literature, it may rive birth to other ufeful inftitutions of a fimilar na- ture, or occafional rife, by its example, to nu- merous. L 59 J merous focieties of different kinds, calculated to fpread the light of knowledge through the whole American continent, wherever inhabited. ''Sure I am that you regard the rifing youth as the growing hopes of the country. You ardently wim that they may become eminent, in every qualification which can render them an ornament, or a bleffing to their fellow creatures. You are, no doubt, anxious to encourage a fpirit of literature amongft them, and are attentive to procure them every advantage that may enable them to fill the higher offices of life, and efpecially the learned profeflions, with ability and dio-nity. Nor do 1 imagine you will neglect any occafion, fuch as this which now offers, to anfwer thefe falutary purpofes. Deftitute of culture, the imagination of youth fhoots wild and unprofitable-, but, directed by art and improved by fcience, a na- tural genius is like a rich foil, the fruitful fource of many benefits to a country. sfe Whilst the fludies of youth are profecuted un- der the encouragement and patronage of men dif- tincruifhed by their literature and worth, they have the higheft motives that can animate the purfuits of a generous mind. They confider.themfelves as un- der the notice of the public, to which every ingeni- ous perfon labours to approve himfelf. I 2 A [ 6© ] A love of fame and a laudable ambition allure him with the moft powerful charms. Thefe paflions have, in all ages, fired the fouls of heroes, of patri- ots, of lovers of fcience, have made them renowned in war, eminent in government and peace, juftly celebrated for the improvement of polite and ufeful knowledge. They have powerfully influenced the perfection of arts, the advancement of commerce and the profperity of cities. They have heightened the character of particular.people to fuch a degree, as to make them regarded by other countries with*;* admiration and efteem. Such I hope will be the confequence of your patronizing Medical fcience in this pk.ee. The difficulties of executing the propofed plan are inferior, far inferior to the glory of being firft in fuch an undertaking. What grand enterprize w.r, ever accomplifhed without any difiiculties? If we have but revolution to mafter thofe which ob-' flruct our defign, they will only ferve to heighten the luftre of its achievement. Seize then the op- portunity of executing a fcheme fo glc-'ous in itfelf, and of fuch importance to this place: as you have given a beginning to the talk, I doubt not to fee it' fully perfe'etedin due time. As the intereft of literature and the intereft of this province are concerned in it, the undertaking v/ill meet with affiftance and fupport from every lover of fcience r «i ] fcience and every worthy citizen. They will unite their mutual aids to render the foundation of itfolid and permanent. The good of the community, the. welfare of our fellow creatures, and the common ties of humanity will fugged: the moft powerful ar- guments in favour of it, with every perfon of a pa- triotic generous difpofition. When, by an early and. well placed affiftance, every one of us may contribute to fave the lives of thoufands; of thoufands yet un- born •, and, in fome fenfe, give being to thoufands more who fhall fpring from them; who doe3 not feel himfelf warmly engaged in a defign of fuch public utility ? The confcious reflection of contributing to in- ftruct the rifing generation, and to form them for public fervice, of cultivating the healing arts a* mongft us, and thus afwaging the calamities of di- feai'cyand relieving manymiferable objects who labour under a load of poverty and ficknefs, cannot fail of giving an exalted pleafure to a benevolent mind. They experience it in the higheft degree, who arc moft bleffed with the refined fentiments of a tender and feeling humanity. The prefent iEra will be ever memorable in the annals of hiftory, for the reputation of Britifii valour, and the fuccefs and glory of the Britifh arms, as well as diftinguifhed by the reign of a King, the boa{£ and t to J and joy of his people. Under his aufpices, letters are cultivated, the arts flourifh, and the fciences are pfrote&ed with a paternal care. His regard for li- terature has been particularly extended to this femi- nary. Let us unite every power within us to ren- der ourfelves worthy of fuch royal bounty, and multiply, all we can, the benefits which our gracious fovereign has intended we fhould reap from it, by the moft diligent culture of every fpecies of ufeful knowledge. This will be a proof of the veneration we have for our monarch, who delights in the happinefs and welfare of his fubjects, the moft diftant of whom arc near to him; and will teftify how anxioufiy we defire to become, under his government, benefactors of mankind. The improvement of a fcience, ufeful as that of Medicine, adds luftre to a throne, and will perpetuate, to the lateft pofterity, the names of thofe who (hall patronize and improve it. Oh! let it never be faid in this city, or in this province, fo happy in its climate, and its foil, where commerce has long flourifhed and plenty fmiled, that fcience, the amiable daughter of liberty and filter of opulence, droops her languid head, or follows behind with a flow unequal pace. I pro- nounce with confidence this fhall not be the cafe; but, under your protection, every ufeful kind of learning fhall here fix a favourite feat, and fhinc forth r 63 i forth in meridian fplendor. To accomplifti which may every heart and every hand be firmly united. Hoc opus, hoc ftudium parvi properemus et ampli9 Si patriae volumus, ft nobis vivere cari. Q^ Horat. Flac. Epift. 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