LECTURE ON THE EXPEDIENCY OF ESTABLISHING A AHD HOSPITAL IN THE CITY OF ALBANY /) ( ~A ■/ DELIVERED JANUARY 11th, 1830; INTRODUCTORY TO A COURSE ON V ^—-—-~ Anatomy and Operative Surgery. BY ALDEN MARCH, M. D. Professor of Anatomy and Physiology in the Vermont Academy of Medicine, he. , ,? f* *^ w. ■■., ( ^ ... ============================== <--, X.K'-r ' X ✓ ALBANY. Printed by L. G. Hoffman, 44 Dean-street, lean! Albanv, January 12th, 1830. SIR— A number of Gentlemen, who were present at the delivery of your in- troductory address, conceiving the objects contemplated by you, too im- portant to the cause of humanity and the interests of science, not to have your views made more public than the nature of the circumstances under which they were offered, could be supposed to admit, have conferred on us the honor of presenting to you their grateful acknowledgments, and re^ questing a copy of the address for publication. We are, Sir, with sentiments of respect, your obed't servants, L. WELLINGTON, ) A. F. LAWYER, } Committee. O. CROSBY Jun. ) To Professor Alden 3Iarch, M. D. Albany, January 12th, 1830. Gentlemen— In replying to your complimentary note received this morning, re- questing a copy of my introductory address for publication, permit me, through you. to tender my thanks to the gentlemen assembled, for this fa- vorable expression of their approbation. This familiar lecture was not designed for the public eye ; and al- though, owing to the multiplicity of my avocations, it affords but a hasty and imperfect sketch of my views upon this important theme, yet I cannot refuse complying with your polite request, hoping thereby to advance in some degree, the interests of the cause already auspiciously commenced. I have the honor to be, Gentlemen, Very respectfully, your obed't servant, ALDEN MARCH, L. Wellington, M. D. ) A. F. Lawver, M. D. \ Committee. Doct. O. Crosby Jun. ) LEOTTJUE. Gentlemen— The return of another season has called togeth- er the teacher and the pupil; and with this lauda- ble meeting are associated some of the strongest in- terests of the community. We are assembled for the purpose of communi- cating and receiving instruction in the science and the art of medicine,—the science and the art of restoring and preserving the health and the life of man. The value of our pursuits, therefore, can be estimated only by the value of life itself, and of that which alone endears it to its possessor,—health. The enlightened and judicious practitioner of medicine is justly ranked among the benefactors of mankind. In proportion as his time and talents are employed in acquiring an accurate and extended knowledge of his profession, in the same proportion will he become useful to his fellow citizens, and be entitled to their approbation and support. He should not be devoted to the mere sordid accumulation of wealth. A more noble, generous and humane mo- tive should hold the first place in his sentiments and actions. Prevent and relieve human misery, should be his motto, engraven in indelible characters on the tablet of his heart. No real benefit can result from the services, or acts of one man rendered to another who is lanquishing under pain and disease, unless the one has more knowledge of disease and of remedies than the other. The question then arises, how are we to become possessed of a proper 4 knowledge of the science of medicine, thereby to render an essential service to the sick. It is evi- dent that, as an incipient step, a preparatory educa- tion is required j a knowledge at least of the useful branches of general science, if not of the classical languages and literature. The means of obtaining this preliminary education are abundant, and brought within the reach of almost every student of medi- cine. Our country is supplied with numerous and well regulated colleges of arts, academies and schools for private instruction. In such institutions is to be laid the basis, upon which the superstruc- ture of a medical education is to be erected. Though I must here confess with much regret, that by far too many young men enter upon the study of our profession, without a due regard to a preparatory ed- ucation. True it is, that men have reached the highest eminence in our profession, without having been graduates in arts. John Hunter, Sir Astley Cooper and John Abernethy are striking examples of the eminence of character to which a man may arrive, by the force of native talent and genius. We might also specify with pride, individuals among our own countrymen. But is this any proof that the same men would not have shone more conspicuous- ly in the literary and scientific world, if they had enjoyed all the advantages of a good early educa- tion? Formerly the science of medicine was not taught as thoroughly and as systematically as it is at pres- ent. Within my recollection, the time was, when we had but few schools of medicine in this country, and when but a small proportion of the whole num- ber of young men who were studying medicine, at- tended lectures at any public medical school.— Without the advantages of a public medical school, or the same advantages enjoyed by private instruc- tion, no man ever was, or can be well qualified to o practise in the various branches of our profession Without having an opportunity of being instructed in practical anatomy, and without founding upon this knowledge, correct principles of surgery, the sur- geon, at least, was constantly liable to mis-judge and to commit the grossest errors. To illustrate and to enforce this assertion, I shall here relate an anecdote of a surgical case that oc- curred in the western part of this state as recently as during the late war,—perhaps about fifteen years since. As the story was related to me, it appears that a man in the vicinity of Sackets-Harbour was affected with a tumor, situated in the ham. It had been of some months standing when a physician was called to attend the case. lie took the swelling to be a common phlegmonous abscess—accordingly ordered a succession of poultices, and to his great surprise, after persevering for a considerable length of time, he found no more symptoms of a spontane- ous discharge from the tumor than at first. Being at this time rather at a loss to know what the con- tents of the tumor were, he determined on thrusting his lancet into it at once; which, however, was no sooner done, than the surgeon and patient were both deluged in blood ! By this time we infer that the physician, or surgeon, if he is thought entitled to the latter appellation, was fully and awfully apprised of the dangerous nature of the disease. In this place we must do him the justice to say that he had suf- ficient presence of mind to command the hemorr- hage, by passing a fillet or ligature around the thigh, with which he succeeded in compressing the femo- ral artery. In this dilemma, it seemed to be the on- ly object of the physician, to save the life of the pa- tient if possible; though it is presumed from what followed, that he did not even as much as dream that the limb could also be preserved,a useful mem- ber to his patient. Accordingly a neighboring phy- 6 sician was sent for, to meet with him in consulta- tion, and to determine on the proper course of treat- ment. The result of the consultation was, to am- putate the limb above the situation of the diseased part. But neither the attending, nor the consult- ing physician had the necessary instruments for ope- rating. However, to turn necessity to the best ac- count, they sent to a house-joiner, and obtained a sash-saw, arid to a shoe-maker, and procured a shoe knife; and with these, together with a few oth- er domestic instruments, picked up, or prepared on the spur of the occasion, they proceeded to operate, and saved the life of the patient; though, we presume, the loss of the limb was entirely overlooked, when they reflected on the wonderful surgical feat they had performed. At the present day,a surgeon would be held respon- sible for a man's limb, thus unnecessarily sacrificed to sheer ignorance, as it inevitably appears that this must have been. Had they known that the femoral artery could be taken up, and that the hemorrhage could be thus arrested, and the limb preserved, in all probability the patient might have been a living and perfect monument to reflect honor upon their skill, instead of being a mutilated object, to reflect disgrace upon these individuals not oniy, but through them, upon the whole profession. Since the facilities for obtaining medical and sur- gical knowledge are diffused throughout the civili- zed world, mistakes of this kind very rarely occur to physicians of the present day. And if any one thing has contributed more than another, to disse- minate medical and surgical knowledge among the common ranks of our profession, it is the circum- stance that medical instruction is now within the reach, and is carried almost to the very doors of all who may seek it. Numerous as are our medical schools, and as 7 much rivalry as there appears to be among them, still I conceive no evil to the profession generally, nor to the community has thence arisen. It is al- ledged by some that we have medical schools enough, and more than enough, and that by establishing new ones, we incur the risk of impairing the value and utility of those that already exist. If this argument be true now, why was it not equally so, in applica- tion to the same subject, fifteen or twenty years a- go, when there were but about half the number of medical institutions in this country, that there are at the present time? And suppose, as most likely will be the case, the population of the United States to increase in the same geometrical ratio that it has for the last twenty years, should we then say the present number of colleges of arts, of academies, and of common schools, or even of medical colle- ges, are sufficient for the demands of this vast in- crease of population? Surely facilities for acqui- ring literary and scientific information must accu- mulate and extend in proportion to the increase and demands of the population. In connection with these sentiments, I propose to make a few remarks upon the subject of establish- ing a hospital and medical college in the city of Al- bany. Before I enter upon the subject, I trust my audi- ence will gratify me with their patience, while I briefly state the origin and progress of this private course of medical instruction. I came to this place in the autumn of 1820, and in November 1821,1 commenced a course of demon- strations and lectures in anatomy, to a class of 14 students; and from that time to the present, which is the commencement of my ninth course of lec- tures in this place, there has been a gradual increase in the number of the pupils, so that last year out- class exceeded thirty in number. I shall not obtrude % upon my audience, a recital of the many difficulties that were constantly rising up at the commence- ment of my career in this place, as I advanced step by step. Suffice it to say that it was an undertaking which required nerve and sinew, (if I may be allow- ed the technical phraseology) to carry the project into effect. My efforts however, have been pretty uniformly crowned with success. I have had but little assistance in the line of instructing, except such as has been rendered by my distinguished col- league Dr. Tully. Our exertions were united in this infant establishment for the purpose of aiding the growth of a well established medical institution in the city of Albany. As it respects myself, I have no doubt but my humble merits have been duly ap- preciated; and it is with feelings of sincere regret, participated, I doubt not by my auditors, that I no- tice the absence of Dr. Tully, whose eminent at- tainments in literature and science, and unbounded qualifications in our profession, have caused his re- moval from this city to an honorable situation in an institution, where, from a longer acquaintance, his talents and acquirements are better known, and of course more highly valued. But however deserving the subject of these remarks may be, the present is not the time nor the place for eulogizing the living. I shall now proceed to notice the several circum- stances that require deliberate consideration, before we adopt any measures towards establishing a me- dical college in the city of Albany. Firstly—It will be necessary for us to show that the location of this city is good, possessing many advantages, and but few disadvantages. Secondly—That an institution of this kind is re- quired in this place, and that it will be useful to the public. Thirdly—That the object is practicable. We shall prove by a reference to other medical 9 institutions, both in the city and country, of the ma- nagement of the concerns of which, we claim to be familiar, that a place of this size, unites the advanta- ges of both a large city and the country; and that it commands some advantages that neither erj y individually. In the first place, this city is sufficiently large to afford ample employment in the practice of medi- cine, for the several professors in the intervals of the regular courses of lectures. Again, it is large enough to give us most, if not all the advantages of a hospital, including a suffi- ciency of subjects. I am well aware that the above points are strong- ly urged by the supporters of the schools of our large cities, as being all important, and I will readily al- low that the first has the highest claims for regard, in selecting a location for a medical school. No one can fully conceive the inconveniences of having a school located in a place too small to afford em- ployment to the professors in the intervals of the lectures, except those who have suffered from the evil. It is not confined to an individual, but its in- fluence is extended to the very vitals of the school. For what confidence can the public have in the sta- bility of an institution where there are frequent changes in its professors? If the question be asked, —cannot this be obviated and still keep up the repu- tation of the School? I answer, that it can in one way, and in one way only. I shall state it, though objections can be raised even to this. The only way of permanently retaining able professors, is to give them a salary that would support them and th^ir families handsomely, -without their attending to any other duties than those which are directly connec - ed with their professorship. But even though tiie institution had the means to nv-ot these heavy sala ries, yet a strong objection would very soon grow If I out of this plan. These professors, though able men, would soon become mere theorists, if not vis- ionary speculators. They could not be sound, prac- tical men, which seems to be at least important, if not absolutely necessary, in most of the branches of our profession. Men, that are capable of filling a place in a pub- lic medical school, can generally command a res- pectable business in private practice. This they could not, nor ought not to relinquish, unless the pay of the professorship was a sufficient induce- ment. We make the assertion then, that a mode- rate income from a school in this place, would be better for those practitioners who might be engaged in it, than twice the amount, and even much more, received from a country institution, where the prac- titioner would be under the necessity of abandoning his friends and practice, for the time being at least, to a very great disadvantage. There are other objections to being an itinerant lecturer; but as some of them, to say the least, relate to the affairs of domestic life, I shall not notice them in this place. With respect to the advantages of a hospital, it may be stated that we have a population of upwards of twenty thousand, as estimated by good judges, and of this number a pretty large proportion, in comparison with the population of many other pla- ces, are foreigners, destitute and friendless. A large number of this class of people too, are liable to all the diseases "which flesh is heir too;" and as they are dependent upon public charity for relief, there seems to be a kind of moral obligation on their part, to repay the public by affbrdingva (^SSJeal school in medicine to the young and inexperienced part of the medical profession. Nor are the advantages of a hospital confi- ned to the young practitioner and medical student H alone. It affords an opportunity for the grey hea- ded practitioner to keep up with the improvements of the day, and in instructing others, to instruct him- self. It is universally conceded, that no man can qualify himself so well, in any branch of science or literature, as by teaching others. Here it is,that he is compelled to become master of his subject; and his talents, and strongest energies are called into action. Neither is the benefit confined to the teacher and the pupil. The physician,or physicians,who are in habits of intimacy with the the teacher are also be nefitted in a great degree, by a practical school of medicine, such as is afforded by a well regulated hospital. Nor does the advantage cease here.— The public comes in for its share of the benefit. It is to be distinctly understood then, that by get- ting up a public institution of this kind, its benefits are not to be confined to the poor, nor to the physi- cians and surgeons who might be employed in it. One of the advantages,that is expected to extend to the public by establishing a hospital and medical college in this place, is, the probability of elevating the character of the profession in this city, not only, but in a good degree its influence must extend to our neighboring physicians. We hope and trust, therefore, that our citizens will view the project under consideration, in a far more extended light, than that of a mere public cha- rity, designed solely for the relief of the poor.— And as far as the subject has been discussed among the friends of charitable institutions, and among those interested for the advancement of medical science, and also among those who take a deep in- terest in all general improvements in the city, it seems to have been uniformly favorably received. "he advantages, or perhaps I ought to say the on- ly advantage which a country institution has over 12 one located in a city, is, the extremely low rate at which students are enabled to attend the lectures, and which principally regards the price of board and tuition. Now both of these items can be made reasonable in the city of Albany.—And with respect to the first, I am prepared to say,that any number of medical students can procure good wholesome board and lodgings in this city, for two dollars a week, though they may go as much beyond this sum as they please. Upon this subject,I speak with the utmost confidence, as we have had for several years past, quite a number of students from our office,boar- ded and lodged for the sum that I have named.— Then again,our lecture fee need be but a trifle more than that of a respectable country school. So that the extra charges on these two items, ought not to exceed the sum of twenty or twenty-five dollars for each course of lectures. I shall, now, notice the sources from which it is expected that from eighty to one hundred students maybe collected,within two or three years at farthest. We can determine this point, with almost a cer- tainty, by referring to the following statistical table. Whole No. of students. No. from Whole No. of students No. from attending the Vermont the State attending at the Berkshire the State Academy of Medicine, of New- Medical Institution in the of New- in the years York. years York. 1823—126 41 1823— 84 18 1824—124 50 1824— 94 23 1825—101 42 1825—112 30 1826—103 34 1826—104 34 1827—100 33 1827—106 27 182*-- 94 38 1828—100 13 Toui No. iroin N. York—238.11 Total No. from N. York—145. It will be perceived by the above statement, that there has been an average annual number,for the last six years,of nearly sixty-four students from this state, who have attended at the schools in Vermont and Massachusetts. 13 We shall now refer to the catalogues of the Fair- field school, for the last two years, to ascertain how many students have attended from this and several of the counties in its immediate vicinity. On exam- ination, we find that the number of students from the counties of Albany, Saratoga, Rensselaer, Mont- gomery, Washington, Columbia, Schoharie, and Schenectady, in 1827-8, amount to twenty-four, and that from the same counties in 1828-9 amount to tw nty-three. Now, th se twenty three or four, ad- ded to the average number for the last six years, at- tending at the other two scools, as above stated, and also about twenty in Albany and in its immediate vi- cinity, who have been in the habit for a number of years of attending a private course in this place, and who have not attended a public course in the same season, will give us something more than one hundred. In making this statement,it will be perceived, that we have not calculated upon any that may now at- tend from year to year at the New-York, Philadel- phia, New-Haven, or Boston Schools, nor upon any that might be induced to come into the state from Connecticut, Massachusetts, or Vermont. I may here observe, that medical students cannot be induced, or coerced by legislative enactment, to attend medical lectures at any other institution, than that of their own choice. This assertion is proved, by the fact that there were but seven students who belonged north and west of the city of Hudson, who attended medical lectures in the State School in the city of New-York the last season. This would seem to support the opinion of a distinguished individual, who has said, that," it should be borne in mind, that a monopoly of learning, or knowledge, cannot be cre- ated by legislative enactment." " The fostering care with which the arm of power confers and sus- tains exclusive privileges in science, neither stimu- J4 lates the exertions, increases the capacity, or elevates the views or character of those who may enjoy them." " A monopoly of the business of teaching, may in- deed be effected; but should it even be conceded, that this would produce higher attainments in litera- ture in the few, it cannot effect a more general dif- fusion of knowledge throughout the public mind, or, be productive of so much general benefit." As it respects the argument of some, who say there are two classes of medical Schools in this country, viz. the city, and the country institutions, and if one were to be located in this city, it would be ranked among the former, and that the expences of atten- ding a course of lectures in this place, would be a- bout the same that they are in the city of New-York or Philadelphia, we conceive it to be groundless.— One moment's reflection will set this matter in its true light. If it is, or has been an object for me, or for any other practitioner of this place to leave our business, and lecture in a country institution at the rate often dollars for each student, it must be obvi- ous that we could quite as well afford to lecture in this place for the same sum, and in the mean time at- tend to our regular and stated practice among our private patients. I, for one, would prefer giving a course of lectures in this place, and attending to my private practice during the time, for five hundred dollars, to going to a country institution and receiv- ing twice that sum for the same services :—and at the end of three years, I have no doubt that I should be the gainer in a pecuniary point of view, as well as in reputation. Let us suppose there were six professors, who should compose a faculty in a medical School at this place, with a fee often dollars each,—board and lod- ging to be obtained for two dollars a week, as it can be in this city,—and the course to consist of sixteen weeks:—the expence of board and lodging would be 15 thirty two dollars, and the fee for all the tickets sixty dollars, making a total of ninety two dollars. Ad- ding a few dollars for contingencies, might make the whole, in round numbers, about one hunred dollars. Certainly, this is far from being an exorbitant sum for a complete course of medical lectures. Perhaps it may not be entirely impertinent,here,to allude to the facilities which this city affords for trav- elling in all directions, and in every mode of convey- ance, and in which it probably is not surpassed by any place in the Union. A considerable number of medical students now pass annually through this city, on their way to their respective institutions; while on the other hand, in reaching some of the in- terior colleges, they often experience serious delays and inconveniences, and are sometimes, for a part of the distance,even obliged to resort to the expence of a private conveyance. We have,thus far,proceeded upon matters of fact; and if we may now be allowed the liberty of reason- ing exclusively upon the subject, I think it can be made out conclusively, that a medical institution is required in this place,—that it would be supported, and that it would be useful to the public. In enter- ing upon these points, it will be perceived that we embrace our aecond proposition. It evidently is the true policy of the state, to re- tain its circulating wealth, as far as is practicable, in its own territory. Money that is carried out of the state and expended, by medical students, rarely, if ever returns. The expences of a full course of lec- tures at the Castleton or Pittsfield Schools, cannot vary but little from eighty dollars, and this, multipli- ed by sixty-four, the average number of students go- ing from this state for the last six years, will give us the sum of five thousand, one hundred and twenty dollars annually. A medical institution is farther called for in this place, because it will best accom- 16 modate the students who now go to Vermont and Massachusetts for their education. B sides the benefits of a medical college, even with regard to the diffusion of useful knowledge, will by no means be exclusively confined to the pro- fession for which it is more particularly established. The science of medicine is so comprehensive that it might almost be defined the science of nature. An- atomy, Physiology, Zoology, Botany, Mineralogy, Chymistry, are interesting to every lover of know- ledge; and some of these branches cannot be tho- roughly studied at the present day, except in medi- cal schools. The science of medical jurisprudence also, is as important to the practitioner at the bar, as to the physician. These are matters in which the public is interes- ted; and if we wer<, novs, merely to allude ^o local interest, we should barely remark, that it requires not the least argument to convince any one of the im- portance of the acquisition of an institution like this to the city of Albany. If a professor is in pretty good practice, as there is no doubt but he might be, were he a practical man, it requires no enormous salary from the professor- ship, to induce him to engage in it. On hundred stu lents, or even seventy-five, at ten or twelve dol- lars each, would amount to a very considerable sum. We repeat therefore, that a school can be supported in this place, with as much certainty, as perhaps in a- ny other in the Union. In showing that the object,under consideration^ practicable, we shall be under the necessity of refer- ring to some of the argumeuts that have already been brought forward in support of other positions. If we were to consider this point in detail, it would be necessary for us to rake it up in the regular order in which we should proceed, were we now actually to engage in the undertaking. 17 And, in the first place, it is necessary that the sub- ject should be well digested, and a kind of plan stretched out by some one who is familiar with it in all its bearings. The first step, then, will be for us to make a judicious selection of a number of gentle- men for a board of trustees or corporation. In the next place, it devolves upon those more immediately concerned, whether of the number se- lected for the corporation, or others, to make all the interest possible with the medical public, particular- ly in this vicinity. Nor should it be confined to me- dical men only. Every liberal and enlightened ci- tizen should be well informed upon the subject, and his influence brought to bear and co-operate with the physicians. It is preposterous to suppose, that all the learning and talent of the immense population of this country, is, or can be concentrated in one or two setts of me- dical teachers, as has been argued by the friends of a monopoly. After it is made out that we have selected a good location for our medical institution, that it possesses all the advantages heretofore enumerated, that the wants of the public now call for it, and that all pre- liminary measures respecting its organization have been completed, the important question remains, can we obtain a charter, that will secure to us, all the rights, privileges, and immunities, usually enjoyed by similar institutions? The brief answer to this question is, that the entire success of the measure, depends upon the zeal and assiduity with which the subject is pursued by those who are interested. If any one is doubtful as to the practicability of effecting so great an undertaking as that before us, we would call his attention to what has been accom- plished by individual enterprise and perseverance. If it should be desired, we can confine our notice of the success of"*"*^""1 "~™*i<*r\ tn rnenin our owo_ 18 If we cast our eyes upon the historic page of me- dical science in Europe, we shall there notice the brilliant achievements of individual effort. The el- der Monro by his splendid talents and industry, hap- pily established the celebrated medical school of Edinburgh: the success, if not the origin of the Lon- don school of medicine, is to be attributed to the zeal and perseverance of the Hunters: and Boer- haave may be considered the father of the great uni- versity of Leyden. More might be said concerning the vast achieve- ments of men abroad. But leaving Trans-Atlantic talent and enterprise, let us examine the origin of some of the medical institutions in our own country. Dr. John Warren of Boston, conceived and furnish- ed a plan for a medical school connected with Har- vard college, and owing to his talents and exertions, the several professorships were filled, and the insti- tution soon put into successful operation. We may also notice the amazing labours of the late Dr. Na- than Smith, in founding, and actually representing in his own person the whole corps of professorships, for twelve successive years in the medical depart- ment of Dartmouth college. He was also eminent- ly instrumental in raising the character of several other medical institutions in New-England. Again, Dr. Wm. Shippen of Philadelphia, is entitled to the honor of founding the most distinguished medical institution in America. He gave his first course Of lectures on Anatomy and Midwifery, to a class of ten students. We might carry this subject still farther, and no- tice the more modern medical institutions, and their living founders; but I trust enough has already been shown, to prove what has been, and what can be ac- complished by the exertions of individuals. If in reply to this statement it is said that these men, or most of them,were possessed of pre-eminent talents, 19 learning, and genius, and that their ability to accom- plish great undertakings Was far above that of ordi- nary men, we will cheerfully grant it to be true.— But let the efforts of twelve or §fteen men of medi- um talents and acquirements be concentrated,__let there be a perfect co-operation in thfcn- power and influence, and we will see how much the sum of their forces will exceed that of any individual, however distinguished. Gentlemen:—I cannot conclude, without expres- sing the (I trust well-grounded) hope, that the ef- forts now making by the friends of knowledge and benevolence, will be continued, and rewarded with success,—that ere long, our city will be able to boast of a well conducted Medical College and Hospital, institutions favorable alike to the interests of Sci- ence and of Humanity. It has been suggested that it might be expedient to connect with the Hos- pital, an Asylum for the Insane, which seems at present to be quite a desi deratum in this part of the state. ■/ -V*! // /f 30 *i 4