INTRODUCTORY TO THE COURSE ON PATHOLOGY AND PRACTICE OF MEDICINE, IN THE UNIVERSITY OF VIRGINIA, FOR THE SESSION OF 1837-8. BY R. EGLESFELD GRIFFITH, M. D, > U- Published by the Members of the Class. CHARLOTTESVILLE, JAMES ALEXANDER, Printer. 1837. University of Va., Sept. 29, 1837. SIR, The members of the Medical Class being highly pleased with the Introductory Lecture delivered by you and conceiving its general diffusion calculated to increase the reputation of the School, have assigned us the pleasing task to request a copy of it for publication. With sentiments of great respect, C. Carter, ) D. H. Quirk, D-B. Bascombe, [committee. W. P. Whiting, f G. W. Rothwell, W. D. Willis. J To Dr. R. E. GRIFFITH. University of Va., Sept. 30, 1837. Gentlemen: I yesterday had the honour to receive through you, the highly flat- tering request, that I should furnish a copy ef my Introductory Ad- dress for publication. Although fully sensible how much the gentlemen of the Medical Class have overrated my humble efforts, their request is one that can not be denied, I therefore place the address at their disposal. I beg you to make known to the members of the class the grateful sentiments I entertain towards them, and accept individually the sincerest expression of my esteem. Your friend and ob't. servant, R. EGLESFELD GRIFFITH. To Messrs. C. Cartrr, D. H. Quirk, D. B. Bascombe, W. P. Whiting, G. W. Rothwell, W. D. Willis. Committee of the Medical Class. INTRODUCTORY ADDRESS. Gentlemen of the medical class : In assuming the duties incumbent on the Chair of Medicine in this Institution and in appearing as your in- structor in some of the most important branches of Medi- cal Science, those emotions of pride and gratification na- turally attendant on such an occasion, are subdued by sen- timents of a far deeper and more impressive character—by reflections of serious and heartfelt interest. Fully aware of the responsibility to be incurred and of the numerous difficulties to be encountered, I cannot look forward, with- out experiencing much anxious solicitude. The highly important trust confided to me, has been accepted with the firmest determination of devoting myself wholly and unreservedly to your service ; though I feel fully conscious that it will be impossible to accomplish the great aim and end of my aspirations or to attain the goal of my ambition. At the same time, I can truly say with an ardent zeal for the advancement of the Medical art, and the most anxious desire to justify the flattering opinions which have elevated me to the situation I occupy, I enter upon its duties with one sole and undivided purpose, that of aiding you to the best of my abilities in the attainment of the objects of your ambition, by acting as your guide and assistant in your ascent to the temple of vScience. In thus pledging myself to your service may I not hope that I shall be cheered and invigorated by your favorable wishes, and sti- mulated to increased exertion by your friendship and affec- tion ? I shall not rest satisfied with a mere approbation of 4 my labors ; I demand more of you—your confidence and es- teem—may I not feel assured that my hopes will not be disappointed, and that my duties as your preceptor may be exchanged for warmer and more enduring ties. My peculiar province in this University is to teach Patho- logy," Obstetrics and Medical Jurisprudence, or rather such portions of these branches as will be most practically use- ful to you, and best fit you for the successful performance of the high duties appertaining to the career you have cho- sen. It must be obvious, at the first glance, that it would be totally impossible to give a full exposition of all the facts and doctrines connected with these various depart- ments of the Medical art; the field is too vast to be explo- red in the time allotted to the task, nor could the rapid and hurried pace such a course would demand, be attended with any other results than those of exhaustion and fatigue, whilst the most important objects would be passed by, to- tally unheeded or superficially observed. I shall therefore restrict myself to much narrower limits, and endeavor to present you such a view of these sciences as I trust will fulfil all useful purposes, and to erect such land marks as may serve to indicate what is hereafter to be acquired by your own labor and assiduity. Before, however, entering upon a consideration of these topics, it may not be uninteresting or uninstructive to take a wider range and to investigate some subjects intimately connected with your pursuits, and which cannot be touch- ed upon at any time more appropriate than the present, when the portals of your tutelary divinity are about to be opened unto you. I shall therefore ask your attention to a few remarks on the duties and responsibilities of the profession under whose banners you are hereafter to be enrolled, and I cannot commence their consideration more appropriately than in the words of the Father of Medicine. " The healing art," says he, " is the most excellent and praise worthy, but from the ignorance of some of its disciples, and the rashness and want of judgment of others, has been degraded far below its proper rank. Whoever is desirous of devoting himself truly and conscientiously to the science of Medicine, should earnestly strive to fit himself for the study both in disposi- tion, learning and station, by early education, attention, in- dustry and time. The first requisite most indubitably is aptitude or disposition, for should this be wanting or defi- cient, the rest are useless, but when the proper disposition is present, every thing may be expected, and the most ex- 5 cellent rewards may be attained. It is necessary to che- rish this disposition prudently, so that it may be invigora- ted by early education, in a situation properly accommoda- ted for such an intent. But the utmost industry must be exercised, and persevered in for a long period, so that dis- cipline may be ingenerated and as it were naturalised, and thus produce an abundant harvest. In truth, we may ap- ply the same considerations to the study of Medicine, as to the art of the agriculturist. Our nature or disposition is the soil, the precepts and doctrines of instructors are the seed. In both cases the seed must be scattered at the proper and appropriate season, and on a duly prepared soil. Study is cultivation, and time strengthens the whole, that they may be perfectly matured. Were these circum- stances invariably observed in relation to Medicine, and properly attended to in its study, we should then possess physicians not in name only, but in truth. Unskilfulness is like a fortune founded on counterfeit coin, a visionary opu- lence, and those who are unfortunate in the possession or even the reputation of holding it, ought never to anticipate success, as being deprived of tranquility and self-confidence, they fall into the extremes of timidity or audacity. Tim- idity indicates weakness, and weakness ignorance of our art." Such are the precepts of the Coan sage, and although de- livered upwards of two thousand years since, are fully ap- plicable to the present state of Medical science. It is of the most vital importance that those about to enter upon the responsible duties of the profession, should be fully im- pressed with the weight of the task they have undertaken, and with correct ideas of the path they are to pursue.— Too many adopt it from accident or caprice and not from mature deliberation or natural bias, and hence set forth without duly inquiring to what point the road they have chosen will lead, what qualifications are requisite to follow it with success, or in what manner the difficulties that be- set it are to be overcome or removed. I do not advert to this, to deter you from entering upon such a career, or to dishearten your brightly formed expec- tations of success, but to warn and admonish you of what you must meet and conquer, and to facilitate your ad- vance by pointing out the best means of overcoming what you must attempt and perform. During the period of your noviciate, one great object is to be kept steadily in view, to fit yourselves to enter upon the arena of professional life, prepared for the endless sue- 6 cession of combats to which you will be called, and in which the stake at issue is reputation and public confi- dence You are to recollect that you must go forth ready to fulfil your duties as effective members of society, to an- swer for your actions at the bar of conscience in your own bosom, and at the high tribunal of honor and fame, both pre- sent and future. The illustrious founder of our science, has but too truly said '' that life is short, art is long, experience fallacious and judgment difficult." Such being the case, it behoves the student to permit nothing to entice him from the only road that has been traced for him, however rugged it may prove, or however wearying and oftentimes disheartening it may occasionally be found. It is his duty eagerly to grasp at every opportunity of acquiring know- ledge, and of augmenting his resources, never to loiter a- long the way as if the great business of life were a jest, or that intellectual and professional skill were to be acquired without exertion. Believe me there is no rail road to the shrine of Esculapius, the path is replete with obstacles, and must be traversed slowly and with unsparing toil, but it should also be remembered that every step is attended with satisfaction, and every difficulty that is removed, light- ens the burden of the task. Let the student then press onwards, diligently and unremittingly, under the cheering conviction, that at every advance he becomes better fitted to be permanently, and extensively useful. m Bear ever in mind that a diploma is not the ultimate goal of ambition, that your aim is so to prepare yourselves, that when called upon to grapple with disease and death, you may not be found wanting. A moderate, a very moderate portion of industry will enable you to obtain this highly valued prize, but the possession of this authorisation to dis- tribute among your fellow men, happiness or misery, life or death, too often is found of little avail when its pos- sessor finds himself entering upon the sea of life, surroun- ded by innumerable perils that were not anticipated and destitute of those resources by which alone they are to be surmounted. Even to the most assiduous and best "prepared, the com- mencement of professional life is fraught with anxiety and the deepest feelings of responsibility, what then must be the sensations of those who are conscious of their incompe- tency, the consequence of wasted hours and neglect of the advantages they had once enjoyed. To use the language of a late writer, " the first step has been taken, and a re- gard for his own reputation forbids him to retreat. The 7 patient is before him, surrounded perhaps by his friends, all looking anxiously to the conduct of one to whose care and management they have confided their dearest treasure. He makes his enquiries, endeavors to collect his thoughts, and to put on the semblance of composure, but his mind is one chaos of confusion. The appearances of the case before him, vague recollections of what he has read or heard of similar complaints, fluctuating notions as to the proper plan of management, mingled with the appalling idea of risk to his patient's life, and danger to his own re- putation are tossed about in his bewildered thoughts like the fragments of a wreck in the sea." This is no ideal or highly wrought picture ; it is a faithful and even softened view of what has occurred but too often, and must conti- nue to occur as long as the graduates of our Medical schools, are merely solicitous, parrot like, to prepare them- selves with that small portion of learning which is consi- dered sufficient to entitle them to the honors of the docto- rate, and not with that fund of sterling coin, so absolute- ly requisite to their future success and respectability. It is not, it ought not to be expected that a student in the short time allotted to instruction in most of our Medi- cal colleges, should be able even by the most diligent at- tention and strenuous efforts to acquire all that is known in the various departments of the healing art, all that he can do, is to lay such a foundation as will permit him in after years to become a useful member of society, and a bene- factor to the human race. But to attain these proud dis- tinctions, he must not pause in his career, and rest con- tent with the exertions and labors of his youth, he must still press onward with unabated zeal and ardor—the mo- ment he halts in his course, or flags in his speed, he will be passed by some more active and vigilant competitor, and will never regain the vantage ground so ignobly lost. Let then your main attention be directed to the great principles of the science whose votaries you have become, principles which are immutable and irrefragable, however they may be disguised or obscured by the various theories that have in every age been the leading stars governing the opinions and actions of physicians. Each department of human learning has in turn exercised its influence over our science, and has modified its doctrines in a striking manner. As during the prevalence of an epidemic, every disease puts on the livery of the reigning malady, in like manner has the fashionable doctrine of the day subjected our art to its sway. This overweening preponderance of 8 one of the branches of the tree of knowledge, has always been seriously detrimental to the growth and vigor of the others, and it has been unfortunate that each has not been carefully restricted to its own sphere, where alone it can bring forth good fruit, and not suffered to encroach on the domains of others, where its only tendency must be to em- barrass and retard their due development. This has been peculiarly the case in Medicine; in every age its theories and doctrines have assumed different aspects according to the various lights they have received from other depart- ments of human enquiry, but these reflected rays have al- ways proved too weak to dispel the darkness, and have on- ly produced indistinct and oftentimes distorted images. He who refers to the annals of our art, will find ample proof in corroboration of what I have said. Thus, without attempting to trace its history in those early ages now in- volved by the misty veil of time, it may be sufficient to take a rapid glance at the various revolutions to which it has been subjected at more recent epochs. Soon after learning and science began to assume a prominent situa- tion, and to be eagerly cultivated, the metaphysical doc- trines and hypothetical subtleties of the school of Aristo- tle reigned triumphant—during their sway every thing was accounted for on logical principles; syllogisms usurped the place of observation, and the laws of nature were consi- dered unworthy of the most transient investigation. This sway of metaphysics was of long duration, and was exercised over every department of learning, owing to the speciousness of its doctrines, and the total neglect of all experimental enquiry. When however, the genius of Bacon detected the fallacies attendant on this mode of investiga- ting the mysteries of science, and pointed out to mankind the only true and legitimate course, that of experiments and analytical research, the whole fabric, beautiful and fanciful as it was, fell to the ground, for like the tower in the parable, it was founded on premises that yielded to the first shock. As is almost invariably the case, it was succeeded by a system diametrically opposite,—the mathematical or me- chanical,—this accounted for every action of the body on mechanical principles, and our science was' then deluged with diagrams and calculations tending to establish conclu- sions as erroneous and theories as delusive as those ema- nating from the metaphysical. The celebrated Borelli car- ried his enthusiasm to such a height as to assert, that he acknowledged no other powers in nature, and was fully 9 persuaded that a thorough knowledge of the wonderful laws that govern the human frame was to be acquired through the medium of the geometric calculation. When the great and important discoveries in chemistry attracted universal attention, they were immediately grasp- ed at as affording a solution of all that was mysterious and obscure, and the chemical notions of Paracelsus divi- ded the empire with the Archaeus of Van Helmont. Du- ring the prevalence of this doctrine, we find every writer speaking of lentor and thinness of the blood, fermentations, acidity, alkalescence, cacochymia of the fluids, and the in- troduction of the irritating particles of saline substances into the circulation. This inundation of vague and un- founded ideas and phrases could not long maintain its ground though supported either in part or in whole by the names ofBoerhaave, Sydenham and others of almost equal weight. Of late years the knife of the anatomist has been thought all sufficient to explain every function and action of the bo- dy, but this implicit reliance on pecularities of organiza- tion is fraught with full as much evil as the last mentioned. In fact there need be no hesitation in admitting as an axiom, that the most accurate acquaintance with Anatomy and with the laws of Mechanics and Chemistry are insufficient to explain the phenomena of vitality. As is observed by Dr. Gregory, there is an internal principle cognisable only by its effects, which directs and influences most of the opera- tions of the body, and that by a code of laws wholly dis- tinct from, and independent of all others. Now this prin- ciple whether dependant upon or only allied to organiza- tion, necessarily eludes the keenest scrutiny, and although we are obliged to admit, that without it, organization would be in vain, and all the resources of our art fruitless, yet we cannot, and in all probability will never be enabled to disco- ver its essence. But if we are not permitted to taste of the fruit of the tree of knowledge we are invited to shelter our- selves beneath its widely spreading branches, and are am- ply rewarded for our exertions in reaching it by the beauty of the multitude of objects we discover on our way. Let us be satisfied that it is not allotted to mortals to lift the last veil of nature's sanctuary, and that a bound has been fixed to our aspirations. Besides the influences just spoken of, a host of minor consequence might be adduced, but it would be superflu- ous to advert to them at the present time. In thus alluding to the baneful effect caused by an undue 10 preponderance of one or more of the sciences on the pro- gress of the Medical art, I am far from denying their utility or even their absolute necessity as auxiliaries in elucidating its doctrines or explaining its phenomena, on the contrary I would most earnestly impress upon you, the value of gen- eral information. Medicine is one of the most liberal of the learned professions and to excel in it requires a greater compass of knowledge than is needed in any other, for it may be truly said that there is scarcely any branch of hu- man learning with which it is not more or less connected, and in a manner that cannot be severed with impunity. The sciences like the graces walk hand in hand, and no- thing would be more vain than to pursue either of them separately. They may in truth be compared to a beauti- ful piece of mechanism, from which it is impossible to ab- stract any of the parts without destroying the order and usefulness of the whole, and however perfect our frame may be in itself, it makes but one integer in the general system of nature, and is subjected to the action anfl influ- ence of all the powers by which it is surrounded. Hence although no one function of our organs, or the effects of remedial agents upon these organs can be explained by the laws which govern inanimate bodies, or on mere mechani- cal or chemical principles, it does not necessarily follow that these very laws and principles are wholly without their effect upon the system, for all actions and operations of the body are the result of a variety of powers, some of which are well known and appreciated, whilst others are recognisable only by the phenomena that result. In fact to institute a well qualified physician, much more is requisite than an acquaintance with those branches which strictly speaking, constitute the science of Medicine, as man the object of his care is connected with every thing in na- ture. I am fully aware that many writers of no slight in- fluence in the profession, have asserted that general infor- mation is not useless but even prejudicial to the student, as tending to withdraw his attention from those subjects to which alone he should direct his views. Nothing howe- ver, is more untrue or more calculated to degrade the pro- fession. The real, the legitimate influence should be, that the man who was acquainted with any thing beyond the mere conventional details of his calling is unfit to pursue even that with credit to himself and advantage to others. It is the duty of all to grasp at the acquisition of g<_ neral knowledge as the best instrument of action during life, and to strengthen by the best cultivation of their reasoning 11 faculties, all those principles of moral rectitude which form at once the basis and cement of all social prosperity, and happiness. The flimsy garniture required for the mere business of life, like the net of the retiarius can be em- ployed but seldom and always subjects its bearer to incon- venience and danger whilst the substantial panoply that qualifies for every emergency, like the arms of the soldier gives a form and energy to the limbs that command respect and insure success. It is true that such an extended course of education is impossible during the few years required for your noviciate, but ample time will be afforded to most of you at the com- mencement of your professional career, and this period which is too often spent by the young practitioner in idle repinings or listless inactivity, should be improved to the utmost, as when once actively engaged in the laborious du- ties which await your maturer years, but little time will be found for study and reflection. This is peculiarly impor- tant at the present day, for the great characteristic feature of Medicine, distinguishing it from what it was in former times, is the spirit of investigation displaying itself through- out the profession, the determined search for truth that has manifested itself, and the ardor and zeal for the advance- ment of the art observable in its followers. The time was, when a moderate degree of knowledge, was amply sufficient to ensure to its possessor a large mea- sure of emolument and reputation, though it is evident that in a vast majority of instances such reputation was but the halo created by the mists of ignorance. In the early settlement of this country and indeed until within a few years past, comparatively speaking, it was not expected that much time would or could be devoted to any studies which were not absolutely required, when the demand for professional services was so urgent and inces- sant. But a new condition of things has commenced, the ranks of the profession have been rapidly filled and those who enrol themselves are obliged to use every endeavor not to be pass- ed in the march. Owing to the rapid diffusion of know- ledge, the characters and attainments of Medical men are now measured by accurate standards and precisely in pro- portion to the facility by which these may be estimated, will these standards be elevated. Talents and learning are appreciated according to their real amount, and neither ignorance nor prejudice are per- mitted to magnify or lessen their true proportions, and al- 12 though in times past a reputation for skill and proficiency may have been readily acquired, it can now be only obtain- ed and kept up by long and close application to study and industrious habits of observation, and those who neglect either, or who content themselves with the attainments of their earlier years, betray not only a neglect of the progres- sive improvements of the age, but also a contempt for the intelligence of the public, which will not fail to award a true verdict whenever claims to favor and support are brought before its high tribunal. It must be admitted that some peculiarly gifted minds on whom nature appears to have lavished her choicest gifts, have risen to the highest honors of the profession, shedding a brilliant light on every object they approached, and whose intrinsic talent and genius supplied in some measure the place of application and study, but they can only be con- sidered as rare exceptions to the general rule—and even in their case, whatever might have been the lustre of their career, and however astonishing their success, a proper course of mental discipline would have enabled them to have passed through their destined orbit with additional glory to themselves and increased utility to their fellow citizens. But it is not enough that a physician should thus prepare himself, talents of another kind are requisite, for although the improvement of his mind should claim the first place, it must be kept in view that much of his future success will depend on circumstances of a widely different cha- racter. When he once launches his bark on the troubled sea of life, he must learn so to steer it, as to avail himself of the most favorable currents, and to avoid the rocks and quicksands by which he will be perpetually surrounded. It needs but little observation to perceive that the posses- sion of talents and learning is not always a certain criterion of success, though when joined to good sense and a know- ledge of the world, ultimate prosperity must be the result. The moral qualities should never be overlooked, they are in the great majority of cases, the only data by which the public appreciate the members of our profession ; how many practitioners have attained the highest honours and the richest rewards, whose chief recommendation has been, the urbanity of their manners and the kindliness of their conduct. In fact without that sensibility of heart which makes us feel for the distresses of our fellow creatures, and anxious to relieve them, the profession of Medicine would never advance in usefulness ; were we merely to barter a given portion of time and advice for a certain pecuniary 13 remuneration, and wholly regardless of the sufferings we witness, to graduate our attentions by the reward that is to await them, how degraded would be the name of physi- cian. But such is not the case. Our art arose from the finest feelings implanted by nature in our organization, from that sympathetic benevolence which induces us to compassionate the sufferings of others and to endeavour to assuage them; and it has been the peculiar study of Medicine that its followers have always been found in the foremost ranks in every enterprise of benevolence and hu- manity. The appearance of sympathy even where it does not in reality exist, naturally attracts the confidence and affection of a patient, and in no small proportion of cases tends in an astonishing manner, to his recovery. Where a physician displays a gentle and soothing deportment to- wards those under his care, they hail his approach with pleasure and gratitude, whilst where the reverse is the case, whatever may be the opinion the sick may entertain of his skill and talents, they shrink from him with disgust and even terror. This sympathy and compassionate feeling has however been supposed to unfit a Medical man for the due performance of his duties and the proper exercise of his judgment, but experience has shown that such is not the case, nor is it to be considered as an indication of a feeble mind. The physician may feel deeply without per- mitting it to enervate or unman him. That an unreal and sickly sympathy is often assumed, there can be no doubt, but this should be as sedulously guarded against, as the op- posite extreme. There is one duty which cannot be too strongly enforc- ed on the members of the Medical profession, that of se- crecy as respects the maladies or concerns of those by whom he is employed. One of the most despicable crea- tures on earth, is the physician who is in the habit of tat- tling and gossiping what he may have seen or heard. In undertaking the practice of the Medical art we are tacitly bound to an observance of the strictest silence as it regards the character and affairs of our patients and their families. From the very nature of our office we are admitted to the unreserved confidence of those we attend, not only in re- spect to their diseases but also to their opinions and ac- tions. We are thus under an implied oath of secrecy, ad- mitted as it were behind the scenes and enabled to view characters divested of their disguises and tinsel, and hence it constantly happens that the standing of individu- als and the happiness and credit of families depends solely 14 on our honour and discretion. There is but one excuse for divulging what we thus learn, and that is, when we are called upon in the capacity of a witness by the laws of our country. In such a case, whatever may be our scru- ples or however unpleasant the task, they must be sacri- ficed at the altar of public good. But even under such circumstances it is our duty to detail nothing beyond what is absolutely necessary, and to suffer it rather to be extorted from us than to step voluntarily forward. I am perfectly conscious in expressing these opinions and in recommend- ing such a course, that I am taking high ground,—but so highly do I estimate the absolute necessity of secrecy that I cannot avoid inculcating them upon you even at the ha- zard of subjecting you to some personal inconvenience should you adopt them. I know in truth of no more un- enviable situation, than that of a Medical man of deep feelings, and fully embued with the duties of his profes- sion, undergoing an examination before a legal tribunal, as to circumstances which have come to his knowledge in his professional capacity. He is sensible that he may be obliged to reveal many things which he would never have learnt, had they not been confided to him with the idea that they would never be divulged, and yet these, although they may have no important bearing on the point at issue, he must proclaim in open court at the bidding of the law- yer. In the case of females especially, as has been obser- ved by Dr. Gregory, this is peculiarly distressing, for there are certain states of health which though in no respect connected with their reputation, every woman, from the natural delicacy of her sex, is anxious to conceal, and in some cases this may be of the utmost consequence to her health, to her interest and to her happiness. One of the most recent writers on Medical Jurispru- dence, M. Trebuchet, goes even further, and contends, that such is the validity of the implied bond of secrecy en- tered into by physicians, that they have no right to dis- close circumstances which have come to their knowledge during their professional attendance, even where such a disclosure would prevent crime, or protect the interests of their dearest friend. Although I a:n not prepared to adopt or inculcate such a doctrine, still T can conceive of cases where a Medical man would be justified in even resisting the requisitions of the law, and thus of subjecting himself to its penalties. It is true, that these can occur but seldom, but that they have taken place, the criminal records of all countries give ample proof. 15 I need scarcely observe that among the duties peculiarly incumbent upon a physician, those of temperance and sobriety hold a high rank. From the nature of our occu- pations we must be always prepared for the exercise of the fullest powers of our judgment and memory, and hence should pursue such a line of conduct as will enable us to have the most complete command of all our faculties. There are many minor points which will hereafter be adverted to, as the time allotted by custom to a discourse like the present will not permit me to touch upon them now. Before concluding, however, there is one other subject on which I would say a few words, namely our legal responsibilities. These of course differ in various States according to the respective enactments regulating the practice of physic, but the great point of " whether physicians are responsible to the laws for what is term- ed mala praxis," rests I believe in the domain of com- mon law throughout the country. That a physician should be amenable to justice for flagrant inattention or wilful malpractice is consonant with every principle of right, but that he should be punishable for unfortunate re- sults where he had exerted his utmost skill, appears emi- nently unjust and oppressive. But at the same time the law has decided otherwise, and we are bound to bow to its behests. From a survey of the cases which have been re- ported in this country, the great difficulty appears to have been, what was the degree of skill that was to be consider- ed sufficient to shield the unfortunate practitioner from the penalties attendant on his want of success. One of the latest trials of any importance occurred a few years since in one of the Eastern States. On this occasion, the judge in his charge, stated that there was no other criterion except that of the skill of physicians in the same section of the country, this which is perhaps as definite as the subject admits, is however liable to many objections, as the immu- nity of a practitioner would in such a case depend on the fact of all his brethren being as unskilful as himself, or what is of more importance, on their entertaining precise- ly the same views, and hence it might happen that a sur- geon of eminent abilities, might be subjected to much in- convenience, from pursuing a plan of treatment of a novel character and which the physicians of his neighborhood were incapable of appreciating. In fact, viewed in every light, the subject presents many difficulties and requires a thorough examination from competent hands. During that part of the course devoted to Medical Jurisprudence, I shall again advert to it at greater length. 16 In conclusion permit me to add that in the course of lectures, I shall have the honor to deliver to you in this School it will be my principal aim to give such a direction to your studies as will I trust embue you with such philo- sophical principles, as will give you confidence in your own resources and will enable you to comprehend and ex- plain the phenomena you may hereafter witness. With such information, you will know, when you are to act, how you are to act, and which is of equal importance, when you are to permit nature to pursue her own course. With what success my endeavours will be crowned, time only can de- velope, but with the firmest determination of devoting my- self to your service, and of identifying as far as possible my feelings and hopes with yours ; whatever defects or omissions you may perceive or imagine, believe me there is no one who will experience a deeper interest in your prosperity and welfare, or will hail with greater pleasure your advancement in knowledge and fame.