ANNUAL ORATION DELIVERED BEFORE THE PHILADELPHIA MEDICAL SOCIETY, BY APPOINTMENT, At the opening of its Session of 1844-5. BY D. FRANCIS CONDIE, M. D. HONORARY MEMBER OF THE SOCIETT. PUBLISHED BY ORDER OF THE SOCIETY. X°?s°J PHILADELPHIA: KIICG AWD BAIRD, PBI5TEBS, 9 GE.OBOI STBEKT. 1845. t fc 0R4TI0N. Among the various subjects adapted to an occasion like the present, which offer themselves for our selection, there is no one that would appear to be more replete with interest and instruction, than an examina- tion into the actual condition, and future prospects of the medical profes- sion in the United States. Our society, gentlemen, embraces among its members, the physician who has for a series of years been engaged in the active duties of his pro- fession, who has, perchance, grown gray in its service—and the aspirant for medical honours, who has not yet completed the period of his novitiate —the teacher and the pupil. To the first it cannot be devoid of interest and instruction to pause, for a short season, in his busy and engrossing career, that he may inquire whether the body to which he belongs, and by the prosperous or adverse fortunes of which his own are materially affected, continues still to hold that elevated rank in society, to which it is entitled ; and should he discover, that it has, in fact, lost much of its power and influence, to examine into the causes from which this has resulted. While to him who is preparing himself to become enrolled among its members, it will be profitable to know its present standing, and whether it is destined, in the future, to sink into a state of hopeless degradation, or to rise triumphanUy over the various evil influences by which it may be assailed. Unfortunately, however, even did your speaker possess the abilities requisite to a proper performance of the inquiry referred to, the time al- lotted him would be far too short for its successful execution. He may be permitted, nevertheless, to offer a few remarks in reference to some of the more prominent points connected with the subject—even though the time and talents be denied him for its complete examination. The imperfect hints which he shall present, may not be unproductive of good, by attract- ing to the subject the attention of some one better prepared to do it more ample justice. There is a strange fastidiousness exhibited by the leading members of the medical profession, in relation to the discussion of those means by I 4 which its interests, as a body, may be promoted, and its legitimate influ- ence with the public secured. They are willing that its success should rest solely upon the character and conduct of its members, and that all extraneous means of support and protection should be rejected ; in the full confidence, that the important benefits which the practitioner of the healing art, by the exercise of his skill, confers upon society—and the elevation of mind, and dignity of character, which should distinguish him as a mem- ber of a liberal, learned, and highly disinterested profession, will, of them- selves, be always sufficient to command the respect, esteem, and confidence of every class of the community, and to secure all the power and influence which physicians as a body, have any right to claim or to expect. However honourable such sentiments are to those who entertain and act up to them—however much we may desire the general recognition of their truth,—we nevertheless fear, that, in the present state of society, the at- tempt to carry them out in practice will fail to produce the desired results. We fear, that however legitimate the claim founded merely upon services rendered, or upon superior qualifications alone, it will not be so easily or invariably recognized, nor so readily admitted, as the high-minded members of our profession would fain believe. We have unfortunately to deal, not with what should be, but with what actually exists—without the power of commanding or controlling circumstances—and hence results the necessity of our resorting to every honourable means, that is calculated to maintain and further the true interests of the profession, and to erect a barrier, that all may recognize, for the separation of the qualified from the unqualified practitioner—the physician from the pretender—and thus prevent the ulti- mate degradation and destruction of the medical profession, from allowing its titles, its honours, and its emoluments to be usurped by the host of em- pirics who now, on every side, encompass it. However mortifying it may be to our pride, it must nevertheless be con- ceded, that the medical profession, in this country, does not hold that high and commanding position in society to which, from the moral worth, the scientific attainments, and professional skill of so large a portion of its mem- bers—it presents such just and powerful claims. The office of the physician is no longer held in that high estimation which its importance demands,—nor is the same degree of deference paid to advice emanating from the most distinguished members of the pro- fession—whether directed to the prevention or cure of disease—the alle- viation of suffering, or the preservation of life,—as was formerly the case. The influence of the physician in the community is, in a great measure, overlooked—his services meet, in but few instances, with an adequate re- ward—while the power he has acquired, from long years of deep and labo- 5 rious research into the secrets of the human frame and intellect, in their healthy as well as diseased conditions, is underrated or entirely disregarded. By his knowledge, he may foretel and stay the deadly pestilence—and enlarge the comforts, while he prolongs the lives of his fellow-citizens. By his skill, he may disarm the most potent poisons, by which the life of man is assailed, of their deadly influence, and be able to assuage the suf- fering, shorten the duration, and arrest the mortality of disease, and yet command neither public confidence, nor private gratitude. Scarcely is the hour of danger and of suffering past—scarcely is the shadow of fear dis- sipated, and the safety and blessings of health and enjoyment restored, than the important services of the physician—rendered often at the risk of his own life, and always at the sacrifice of his own comforts—are for- gotten, and his reward too generally—like that of virtue—confined to the performance of his own beneficent acts. There are, it is true, striking exceptions to this general disregard for the professors of the healing art. There are, unquestionably, to be found, in every community, many who duly appreciate the high office of the physician, and who are prepared amply to reward, while they cherish, with feelings of the deepest gratitude, the remembrance of those important services they have received from him in the hour of sickness and of suffering. It is nevertheless true, that with the multitude, the absurd pretensions, and bold assumptions of the veriest empiric will find more favour, and his worth- less services be more loudly lauded, and more freely and liberally repaid, than the most striking display of professional skill on the part of the scien- tific physician. And while the latter is tried by an ungenerous rule—the credit of his successful cases being withheld from him, and his failures, in too many instances punished by a withdrawal of confidence, if not by direct and unmeasured censure—the fatal errors of the empiric are over- looked. The confidence of the public would appear indeed to be accorded to the latter in direct proportion, not to the cures he effects, but to the num- ber of patients who die under his hand. Were this disregard to the claims of the medical profession exhibited, exclusively, by the uneducated and unreflecting classes of society, it would not excite so much surprise, and would claim our pity rather than our cen- sure :—but we find it exhibited, also, to an alarming extent even by those who make the highest pretensions to elevation of mind, to intellectual knowledge and refinement, and to purity of intention. By the clergyman and lawyer—the merchant and the man of leisure, equally with the me- chanic and the labourer. By him, whose profession should teach him habits of close investigation and deliberate judgment, and whom we should expect to distinguish, the most readily and accurately, between the claims of science and true skill* and the unfounded pretensions of ignorance and 1* 6 incompetence, as by uneducated minds, that choose without reflection, and decide without examination. In Philadelphia—whatever may be the case in the other cities of the Union —the empiric of the homreopaihic school, may not improperly be styled the physician of our fashionable and exclusive circles—and we know not but it may be considered as infallible a mark of gentility with us, to patron- ize an administrator of infinitesimal doses, as it was at one period, in Lon- don, to have the back burned by the notorious St. John Long—whose practice was almost exclusively confined to the Lords and Ladies of the higher circles. The question naturally suggests itself—from what has this state of things resulted ? Has it been the consequence of errors committed by the medical profession—or of the general want of knowledge and incapacity of its members—or, has it originated in causes altogether extrinsic to the pro- fession ? The question is one, however, much easier to propose than satisfactorily to answer. Not that the causes which act prejudicially upon our profession, are so hidden and obscure, as to prevent their detection ; but from their very complicated and diverse character. Some of these causes may no doubt be traced to the profession itself—the major part of them, nevertheless, depend upon circumstances foreign to it, and over which it has at best, only a very remote, indirect, and feeble control. The true value of the physician—his competency to fulfil the important duties required of him—and his faithfulness in their fulfilment, can, with difficulty, be correctly and fully estimated by any other than a member of his own profession. Medicine is, unquestionably, one of the most dif- ficult sciences properly to acquire—demanding not only the highest grade of natural ability, but long years of close and laborious study, and an acquaintance with many collateral branches of knowledge. It has, indeed, been correctly remarked, that there is scarcely any circle of human learning, upon the boundaries of which the scientific physician does not necessarily infringe, in some point or other of his extensive orbit. In fact, to acquire that extent of information, and that degree of practical skill necessary to constitute the physician, requires the close and devoted application of all the mind's best energies—under circumstances the most favourable to their full occupation and development. And yet almost every one in the community—whether learned or unlearned—assumes to himself the right to decide, not merely upon the competency of the individual members of the medical profession—which, within certain limits, is his right—but upon the relative value of different medical doctrines and modes of practice. The skill of a physician, and consequently the propriety of the reme- dial measures pursued by him may, unquestionably, be very fairly tested by the general result of his practice—but to do this requires opportunities 7 for observation, and an accuracy of judgment which the members of the community at large do not possess—their decision is consequently founded, in most instances, upon the result of single cases, the circumstances of which are often but imperfectly understood, or entirely misrepresented. It is this want of ability in the public, to decide correctly upon the value of remedial agents and the competency of medical practitioners—com- bined with that desire which all alike experience for speedy and certain relief, that renders it, more perhaps than any other cause, the ready dupe of bold pretension and unprincipled empiricism. The vaunted infallibility of any nostrum that promises an immediate restoration of health, becomes far more attractive than the slow and cautious measures pursued by the scientific physician. It is not, therefore, surprising, that the preposterous absurdities of homoeopathy—-the equally ridiculous and mischievous prac- tices of the Thompsonians, Botanists, and Hydropathists, or the more novel folly of the Crono-thermists, should become more popular than the curative skill exercised by the highest order of medical abilities, accompanied by the greatest natural and acquired advantages. In the United States, the membersof the community have, unfortunately, little else to direct them in their selection of a physician, than their own deceptive judgments, or the equally uncertain criterion of popular opinion. From the law, the medical profession receives neither encouragement nor protection. It is laid open alike to every one who may think proper to enter it—without question as to his competence for the faithful performance of his duties as a member. Whoever assumes to himself the title of doctor, belongs of right to the profession—there being no legal provision by which his claims to membership may be tested or denied. In fact, the individual upon whom the title of Doctor in Medicine has been conferred by the most distinguished University, to indicate that he has completed a regular pupilage, and is qualified to practise the art he has fully and faithfully studied, and he who but yesterday deserted the workshop of the mechanic or the counter of the tradesman, and without either natural abilities, or any preparatory study, announces himself as a doctor of the healing art, are both equally recognized and protected by the law. With the limits of the profession thus undefined, and the proper quali- fications of its members entirely disregarded by the state, it is in no de- gree surprising that the public should be deceived—and that in their selec- tion of a medical adviser, their choice should fall more frequently upon the charlatan—who ofiiciously obtrudes his pretensions upon their notice—and boasts loudly of his unerring skill, than upon the really meritorious, but mo- dest and unpretending physician. In most of the states, the tide of doctor, has become, in popular estima- 8 tion, synonymous with that of practitioner of medicine—without the slightest reference to the mode or place in which the individual who bears it, has qualified himself for the office it implies;—and, we are persuaded, that the title is assumed by many, in entire ignorance that such is not actually the case. We could point out more than one of the members, and even public teachers, of the most rigid of our religious sects, who practise medicine under the assumed title of doctor—nay, who even affix the initials of the degree to their names, in apparent unconsciousness of the falsehood and imposition upon the public they are thus perpetrating. Whether there are any provisions of the common law by which this species of fraud may be punished we know not. But we are persuaded, that, if there be any meaning in the act of assembly of this state, which purports to provide a remedy against cheating by false pretences, it will fall within its provisions. If, however, there really does exist no legal remedy for the evil, it is highly important that one be speedily provided; for it is in vain to expect that any will be found willing to devote years of close study, and incur a heavy expenditure of money to acquire that which confers upon them neither honour nor profit—nor serves to distinguish them from the unqualified pretenders to medical science and skill. We are aware that, by several distinguished members of the profession, as well as by more than one of our medical institutions, every species of legal protection has been pronounced unnecessary and even mischievous. Empiricism, it is urged—and with great apparent truth—must be suppressed, not by legislation, but by enlightening the public in regard to its dangers. The dignity and influence of our profession are to be promoted, we are told, not by surrounding it with legal restrictions and privileges, but by an increase of individual zeal, and a more cordial co-operation among its members. The barrier which shall effectually separate the physician from the empiric is to be erected, not by penal enactments, but by the higher attainments, the greater skill, and the more honourable deportment of the former. Such a barrier it is within the power of the members of the pro- fession to make constantly higher and more strong—while it is one which empiricism cannot surmount, nor any legislative enactment ever weaken or destroy. All this would be very true, could the public mind become sufficiently en- lightened and discriminating to enable it to distinguish accurately between the claims and characteristics of truth, and the pretensions and disguises of error —and by this means to detect, without difficulty, the true line by which the qualified member of the medical profession is separated from the crowds of ignorant pretenders by whom he is surrounded. 9 Unacquainted with the vital laws of the human organism in health or disease; ignorant of the nature and operation of the various agents by which the regular action of its several parts is maintained or disturbed —and the means by which, when disordered action has been induced, it may, with the greatest promptitude and certainty, be quelled—and inca- pable of justly appreciating the skill of the practitioner—the exhibition of which is confined exclusively to the privacy of the sick chamber—it is in vain to expect that the public should not fall into error in judging between the qualified practitioner, and the ignorant pretender: or that the physician, however high and varied may be his attainments or perfect his skill, should be able to contend successfully against the encroachments of quackery—or to supersede in public estimation the professors of any popular system of medi- cal delusion. It is necessary that the title whether of Doctor or Physician should be made the certain indication of the qualifications in knowledge and in skill of the individuals who bear it. All who now assume the title—whether educated or uneducated, even though they may have evinced insufficient competency to acquire a knowledge of the rudest trade—are esteemed by the public generally, to be regularly qualified physicians—differing, per- chance, somewhat in experience and in skill, but all equally acquainted with the leading principles and resources of their art. And although some may command a greater degree of public favour, and a larger amount of patronage than others—this will be found to result less from superior qual- ifications than from the possession of more popular manners, family in- fluence, or the whims of fashion, or even from a system of puffing, and the other usual arts of the charlatan. The physician of the rarest talents, and the most matured experience, will often find himself, even in those families the members of which he has more than once been the instru- ment of snatching from the hand of death, and restoring to the enjoy- ments of health, superseded by the ignorant and vulgar, but bold and un- principled professor of the latest system of barefaced quackery, whose volunteer agents penetrate into every house, and pour his praises into every ear. And so infatuated are the public in the infallibility of their judgments of medical men and medical practice, that the most egregious blunders committed by the favourite charlatan of the day ; resulting often in the prolongation of disease, in the increase of suffering, and even in death, are seldom sufficient to shake their faith, or to cure them of their folly. It is aptly remarked, by a writer of the sixteenth century, that " mankind are ever ready to fall over the head and ears in love with bold pretension —the folly of which becometh in their eyes, wisdom—and its blunders, efforts of consummate skill. The more the object of their passion floun- 10 dereth in the mire of its incompetency, the more do they applaud—indeed the strikenest exhibitions of its ignorance seemeth to them to be strokes of genius, which it is envy alone that affecteth not to perceive." Now, we are persuaded, that the errors into which the public are most liable to be led in their estimate of medical men, medical opinions, and medical practice, may—to a certain extent at least—be remedied by judi- cious legal enactments. Were the qualifications necessary for admission into the medical profession, clearly and accurately defined, and all who lacked such qualifications excluded, the community could not be so readily deceived by the dangerous and protean impositions of ignorant and unprin- cipled charlatans—while, at the same time, the physician would receive new encouragement to enlarge the boundaries of his knowledge, and aug- ment his skill. The charlatan would no doubt find many still willing to patronize him—but their patronage would then be extended to him in his real character, and not under that of a pretended member of the medical profession. There cannot, certainly, be a more legitimate object of legislation, than the protection of the health and life of the citizen from ignorant pretenders to medical science, by whom they are as much, if not more endangered, than by any of those causes against which the existing sanatory laws are directed. And notwithstanding, all legal provisions and restrictions will, probably, ever fail in effecting the entire suppression of quackery—yet by drawing a broad and readily understood line of distinction between the qualified and unqualified practitioner, the dangerous popularity of the empiric must be greatly diminished, and his true character and calling made apparent to all; whilst the physician, being elevated to his proper position in society, will be able more effectually to secure his legitimate influence. The bold assumptions and cunning devices of imposture have always succeeded in securing, as its dupes and supporters, a large class in society —but never perhaps to a greater extent than at the present period. The boldest empiricism pervades now almost every pursuit in life, and nearly every department of human knowledge. With all our boasted advance in moral and intellectual improvement, it has been permitted to usurp the temple of religion, the hall of science, and the field of literature. Deluded by its pretended regard for human rights, and freedom of opinion, man has refused to bow the head or to bend the knee to any power on earth, or,we had almost added, in heaven either—and, at the same time, he has closed his mind and heart against the influence of every species of authority, whether exercised for good or for evil. Subjects the most sublime and intricate—questions of the greatest moment in reference to his present and future welfare—are approached with the utmost indifference, and discussed 11 with the same familiarity and flippancy as those of the most familiar and trivial character. All would now enter by force into the temple of science, cast forth its true votaries, and rifle with profane hands its treasures. The long and tedious roads to knowledge, pursued by our forefathers, are deserted—and every thing that requires time and labour for its acquisition is denounced as contributing nothing to the immediate good of the com- munity. All that concerns the human race, whether mentally, morally or physically, is attempted to be reduced to one level by the miserable test of a false utilitarianism; and in a professed opposition to the fictitious dis- tinctions of society, the reverence which is due to superior virtue, talents, knowledge, and skill, has become almost entirely extinct. Medical science—in common with every other monument of man's intellectual powers—has felt the influence of the spirit that is abroad, and upon its ruins empiricism has attempted to rear its more popular shrine. The present age has been pronounced, by a recent satirical, but at the same time truly philosophical writer, to be an age of transition—the inter- mediate period between that of the general ignorance and blind credulity of the mass, on the one hand, and of its intellectual and moral regeneration, on the other. The public mind has, it is true, been aroused from the dormant, passive state in which it had so long reposed—its powers have every where been set in motion, and the way opened for the universal diffusion of knowledge. They who for ages had been led solely by the force of authority, have been called upon to think and to act, to choose and to select for themselves. But, the progress of general education has not, as yet, become sufficiently advanced to teach the mass the proper exercise of their intellectual powers, nor to afford to these the appropriate materials to work upon. The field of knowledge has been, it is true, laid open alike to all—but it is still the favoured few alone who are able to cull and appro- priate its choicest fruits. Proud, however, of its newly awakened, but as yet imperfectly developed powers—and presumptuous, from its want of information and experience —the public mind believes itself fully able to judge and decide for itself in relation to every subject that presents itself, whether of the most com- plex or trivial character. The man of science and of literature, the member of a learned profession, is no longer viewed with that reverence in which he was held in times gone by. His laborious investigations, the slow and gradual steps, the days and nights of toil and watchfulness by which his knowledge has been obtained, and his judgment ripened, are overlooked— while to his opinions no greater authority is accorded than to those of the most superficial pretender of the day. The necessary consequence of this state of things is the predominance of empiricism in almost every 12 department of human knowledge—the senseless jargon and absurd theories of which are heard from the pulpit, at the bar, and from the bench; in our legislative halls, our popular assemblies, and, we were about to add, in our schools of medicine—but we recollect that in empirical medicine there is, in fact, nothing either to teach or to learn—its precepts are so simple that they may be acquired by the most illiterate, without the waste of time or study, and yet so profound as to be beyond the comprehension of the most erudite. Happily, in this country at least, our leading medical schools have escaped almost entirely the infection of the times. And though, unfor- tunately, more than one of our most distinguished professors have been guilty, from weak and indefensible compliance, of loaning their names and influence to subserve the purposes of one of the most successful of modern charlatans ; still, in the public courses of medical instruction, delivered in the most distinguished of our universities and colleges, the pre-eminent claims of scientific medicine are boldly asserted, and success- fully demonstrated. If our authorized medical teachers have not done all that was within their power to secure and extend the respectability and influence of the profession, they can rarely be accused of countenancing systematic quackery, even in the day of its greatest popular triumph. It may be asked—and the question is certainly a legitimate one—Have not the members of the medical profession generally—in the midst of all the difficulties and disadvantages under which they labour in this country —beeome careless and indifferent in the preparation of themselves for the responsible duties they are called upon to perform—Have they in no degree deteriorated in knowledge and in skill ? and by their own incompetence, forfeited in a great degree the confidence of the public ? Have they not failed to secure the esteem and gratitude of the sufferer, because he is no longer able to look up to them as his sole hope and sure reliance in the hour of need? The inquiry is one very readily answered. While we would desire in no degree to conceal or justify the wilful short-comings in duty of the medical men of our country, we feel proud in being able, with perfect truth, to declare, that so far from the medical profession—using the term in its proper and restricted sense—having in this country become deteriorated, it has, on the contrary, exhibited within the last twenty-five years a mani- fest improvement. Its members are now, generally speaking, far better educated than was formerly the case—they are more fully grounded in all the collateral branches of medical knowledge—more conversant with the writings of the master minds of the profession, and exhibit a greater zeal to become acquainted with every improvement and discovery in the heal- ing art—resulting from the labours of American or European investigators 13 ■^•as well as a greater degree of industry in the cultivation of the fields of observation placed within their own reach. Their opinions and practice are, at the same time, based more upon the results of cautious observation and experience than upon mere hypothesis. The authority of names and of sects has lost with them much of its influence, while the authority of facts is more fully recognized. It is true, that all the members of our profession may not possess equal talents and industry—there may be even some who can present but few claims to the character of an educated and skilful physician. When we consider the numbers of which the profession in the United States is composed, and the extent of country over which its members are scattered—when we take, also, into account, the difference in the natural abilities, in the acquired knowledge, and the amount of preparation gene- rally, of those who enter it: the very different fields in which they are called upon to exercise their professional duties—some affording but little, while others are replete with opportunities for the acquisition of personal experience and skill—some presenting the means of daily intercourse wilh the best informed and most distinguished members of the profession, and ready access to every species of scientific information, and to every new discovery and improvement in the healing art—while others, in the remote and newly settled portions of the country, are shut out from all extraneous sources of improvement. When we take all these circumstances, I say, into consideration, it is not in the least surprising that all the members of the profession should not be equally well informed, or that many should be deficient, to a very great extent, in the necessary qualifications of a skilful practitioner. It is indeed wonderful, on the contrary, when, to the foregoing circumstances, we add the very limited and defective means for professional education which our country affords, that it should not embrace a larger number of unqualified members. The distinguished individuals to whom we are indebted for the establish- ment of our medical schools, in fixing the term of pupilage, and the cha- racter and extent of the courses of instruction delivered in them, were evidently guided more by the condition and supposed wants of the country, in the earlier period of its settlement, than by a proper regard for the future interests and dignity of the medical profession. Hence, the amount of study demanded, and the degree of proficiency required by them for admission into the ranks of the profession, were, as much as possible cur- tailed; under the belief, no doubt, that, as the country became older and more densely settled, and its youth were better prepared to devote a longer period, and more intense application to the acquisition of professional knowledge, the scheme of medical instruction, in all our schools, would be, 2 14 from time to time, extended, and the qualifications for graduation propor- tionably increased—until finally, the means were provided for the com- plete professional education of all who would become practitioners of the art of healing. In thus doing, it is probable that our predecessors pursued the wisest course, and effected all that could reasonably be expected of them in the then existing state of the country. It must be evident, however, that the same amount of medical instruction, the same extent of qualification to constitute a physician, which, in consequence of the poverty and sparse population of the United States nearly a century ago, was considered suf- ficient, is far below what should now be demanded ; and yet, although many years have elapsed since the last of the founders of our oldest medical institutions has been numbered with the dead—notwithstanding the very great augmentation in the boundaries of the medical sciences, and, in consequence, the greater extent of knowledge requisite to constitute a physician than was formerly the case—notwithstanding the immense increase in the population and wealth of every portion of our country, and the greater amount of leisure which exists for study—and notwithstanding, finally, the necessity for a well educated body of physicians is becoming every where more apparent, but few, if any, important changes in, or additions to, the courses of professional instruction delivered in any of our medical schools have been made since the period of their first foundation, nor has any effectual movement been made to raise to a proper standard the qualifications of those who are sent forth from these schools to enter at once upon the active duties of their future profession. It would not, certainly, be strictly true to assert that the facilities for medical education have not been increased, especially in our larger cities, or that there is not exhibited on the part of a large body of medical stu- dents a laudable zeal to profit by them. The conirary is the case; and the beneficial influence of these increased facilities, and the extent to which they have been improved by the student are already very manifest. We owe them, however, not to the direct action—nor are they to be obtained within the halls—of our medical colleges and universities—they are the fruits solely of private enterprize, and the realization of their advantages is the result altogether of voluntary zeal on the part of the student. They have had, it is true, the necessary effect of increasing the qualifications, and elevating the character of our medical graduates generally; notwith- standing that admission to the full honors of the doctorate may still be obtained by individuals who present no other qualifications than such as can be acquired through the restricted and imperfect means of instruction afforded by those institutions that have alone the power granted to them of 15 conferring it. And so long as this remains the case, however much the facilities for medical instruction may be increased beyond the portals of our schools, it cannot fail to have a very powerful influence in depressing the character, and impairing the influence of the medical profession in this country, by enabling many to gain admission into it who are unqualified, in more respects than one, to fulfil its duties, to uphold its dignity, or to contribute in any manner whatever to its advancement. But, while we cannot with truth assert that the medical profession in the United States, as a body, has attained to that high standing of which it is capable, and to which it is destined speedily to arrive when the qualifica- tions of those who enter it shall be more carefully inquired into, and its just rights and privileges shall be better understood, and more effectually secured against the encroachments of every dishonest and ignorant pre- tender—we nevertheless can claim as its members very many whose classi- cal and scientific attainments, whose professional skill, and whose untiring industry to enlarge the boundaries of our knowledge, and increase our means for the prevention, detection, and cure of disease, should be suffi- cient to secure to it a full share of public confidence, and to remove much of the reproach cast upon it by its incompetent and unworthy members. We can proudly point, amid our contemporaries, to numbers fully com- petent to supply the places of our Rushes, Physicks, Bards and Shippens —our Wistars, Hosacks, Bartons and Mitchells—our Deweeses, Dorseys, Jameses, and the host of others of equal eminence, who have given a cha- racter to American medicine, and whose well earned fame is not confined to their own shores, nor to their immediate successors, but has extended to every country where medicine is cultivated as a science, and will survive so long as medical truth shall be recognized. Our profession includes, also, a large body of highly respectable, though less eminent, practitioners, whose professional competence and skill are becoming daily increased by the results of their own extensive experience. Let every unqualified and unworthy member be cast forth from it, and the Medical Profession of the United States will still retain a sufficient number to make good its claim to the character of an educated and scientific body, fully prepared to fulfil all that can be legitimately required of it. The plea that has been urged to justify the limited nature of the in- structions afforded by our medical schools—is, that any material increase in the period of study, or any demand for higher qualifications for admis- sion to the doctorate would exclude from the schools a large number of those who, from the present courses of instruction, are enabled to acquire, previously to entering upon the practice of their profession, a very respect- able and valuable amount of medical knowledge—and who, deprived of 16 the means of acquiring this, would commence their career as physicians altogether unqualified, and by their ignorance and incompetence, endanger the lives of those entrusted to their care. Hence, that it is far better to afford to all who enter the profession the means of obtaining even a limited medical education—which they may themselves subsequently enlarge and perfect—than, by aiming at too much, to confine the benefits of instruction to a few, while a host of uninstructed and mischievous practitioners are allowed to be turned aloose to prey upon society. The plea thus offered is, however, far more specious than valid. Were the medical profession properly protected by law, were no one permitted to gain admittance into its ranks unless he possessed the requisite qualifica- tions, the student would be obliged to pursue that course of study, and submit to those regulations prescribed by the medical schools, or forfeit his right, not only to graduation, but to practice as a physician. And we main- tain, that the time has arrived when the true interests and proper dignity of the medical profession, and the real good of society, require that every one who offers himself as a claimant for public patronage, in the solemn and responsible character of a practitioner of the healing art, should be 'fully educated—that every incompetent person, no matter from what cause his want of competence may have resulted, should be prohibited, under severe penalties, rigidly enforced, from practising as a physician, or from engaging, under any pretext whatever, in the dispensing of remedies for the prevention and cure of disease. No private rights would be interfered with by such restrictions, for we are yet to learn that under any form of government, any one has the right to pretend to what he is not, when by such pretension the rights of others are invaded, and their lives jeoparded. Nor, on the other hand, need any fear be entertained that in consequence of the additional time and expense a proper and full course of medi- cal studies would require, a sufficient number of our youth would not be found to engage in and successfully complete it—or that the ranks of the profession would not be regularly and fully supplied. On the contrary, we are convinced, that by elevating the qualifications requisite for admission, and effectually closing the door against the indolent and the incompetent, an additional and very powerful inducement would be held out for young men of talents and industry to engage in the study of medicine. How many of our medical students do we, even now, find unsatisfied with the meagre qualifications which are demanded amongst us for admis- sion to the doctorate, and who, before they engage in the practice of the profession, exhibit an eagerness to prepare themselves, by every means within their reach, for the faithful performance of its duties, and who, after exhausting all the sources of instruction afforded them at home—avail 17 themselves with avidity of the additional advantages presented by the med- ical institutions of Europe. By such, neither the prolongation of their novitiate, nor the additional expense incurred, is put in competition, or forms the slightest impediment to the completion of their professional education. In no other way, we maintain, can the interests, the dignity, and the pro- per influence of the medical profession be so effectually promoted ; by no other means, can so effectual a barrier be erected against the increase and spread of empiricism, as by securing the complete education of all the mem- bers of that profession. By not only permitting no one to enter it, who is not prepared for the faithful performance of all its solemn and important duties, but also, by requiring of all who present themselves as candidates for the study of medicine the possession of a classical and liberal educa- tion. It was unfortunately maintained by the most popular teacher of one of the oldest and most influential of our medical schools, that a learned education is unnecessary as a preliminary to the study of medicine, and upon this erroneous principle, are the requirements of all our schools based : no further preliminary knowledge being required of candidates for the doctorate, than simply reading and writing and the rudiments of English grammar. Thousands have, in consequence, been induced to engage in the study of the healing art, who would be incapable, from defect of edu- cation, of profiting by even the most enlarged course of professional instruction, to as great an extent at least, as they would be, did they possess the advantages of a liberal education. It is well remarked by the elder Wallis, in the first book of his Praelec- tiones, that learning in the physician is not to be viewed as a mere accom- plishment, which, however much it ornaments, adds nothing to the perfection of his professional attainments, but as an indispensable requisite to fit him for the office he assumes. To him there is scarcely anything that can compensate for the want of it. Education, even in its broadest sense, will not, it is true, endow the mind with any new powers, but it sharpens, en- larges, expands, and renders much more efficient those powers which do exist. The possession of good natural abilities should be insisted upon as essential in all who would prepare themselves for the practice of the healing art; but he that would trust to them aloue, and supposes that the possession of them will enable him to dispense with all elementary instruc- tion, deceives himself, and will have frequent cause, in after life, to regret his want of it. Learning truly profiteth every one, but the physician more than almost any other. There is no species of acquired knowledge from which he cannot draw materials calculated to enhance his professional slull—there is scarce a language or science that wilfhot become to him a 2* 18 key to sources of useful information, from which the illiterate and un- learned are forever excluded. That of a mere linguist or belle-lettres scholar is not precisely the edu- cation we should require of the individual destined to the study of the medical profession. However important we consider a knowledge of lan- guages, and a cultivated taste as prerequisites for a physician, there are other branches of knowledge of the first importance to him, the foundation for which must be laid previously to his entering upon those studies which are of a more strictly professional character. The human body is so powerfully influenced by everything that sur- rounds it, and by every varying circumstance in which it may be placed, whether of a physical or moral character;—so numerous, indeed, and diversified are the set of causes necessary to support the healthy discharge of all its functions, or which tend to induce in it a state of disease, that the physician, not merely to make good his claim upon the respect of the learned—but also, that he may justly merit the confidence of the sufferer, and the gratitude of the public, is bound to store his mind with every fact which relates to the physical and moral being of man, and his relationship to the residue of his species, and to the phenomena of the natural world of whose surface he is an inhabitant. Without referring to those sciences—such as Chemistry and Botany, for example, which are very generally confessed to be indispensable to a com- plete medical eduoation, there remain other auxiliary branches of knowledge, much neglected, it is true, by medical students, a knowledge of which is not less important to constitute the judicious and successful practitioner. It is from an acquaintance with the difference in the character and changes of the season in any given situation; with the currents of air prevalent at particular periods of the year, as well as with the nature of the districts over which they pass. It is from a knowledge of the different qualities presented by the soil and water in the several portions of the globe—the nature of a country's surface, whether spread out in wide extended plains, undulated by a succession of hill and valley, or intersected by mountainous chains—whether parched by drought, or liberally supplied by moisture— whether abandoned to the spontaneous productions of nature, or carefully cultivated by the hand of man. It is from a knowledge of the food, occu- pations, and pursuits both public and private of the inhabitants, their clothing, the mode of construction and location of their dwellings, nay, even from an acquaintance with the nature of their governments, their so- cial and domestic habits, and their religious opinions, rites and ceremonies, that the physician is to derive much of that light in regard to the causes, and nature of diseases, and the modes of their prevention—if not of their' 19 cure—which is essential to fit him for the duties of his profession, and which it would be impossible for him to derive from any other sources. It is all-important, therefore, that every one who would prepare himself for assuming the responsible office of a physician, should have pursued, with diligence, the study of the natural sciences—of history and geography__ in fact of all those correlative branches of knowledge capable of placing at his command the important facts of which we have hastily sketched the leading groups. He who is destined for the medical profession, should, in fact, be educated with a special view to his future calling, from his earliest years. If the best portion of his youth has been passed in indolence or dissipation—or has been devoted to pursuits that have little influence in developing and enriching his mind, he will seldom have time and opportunities to acquire that extent of information, and readiness of application, which the prac- tice of the art of healing so eminently demands. The subject of a proper medical education in all its details, is one of vital importance to the interests of our profession. The views entertained in regard to it are, it is true, in the main, correct, but there is exhibited no little indecision in fully carrying out those views in practice, and an almost criminal facility in conceding professional rank to those who, in their educational qualifications, fall far short of that standard which, in theory, all admit to be the proper one. Upon this branch of our inquiry we might extend our remarks to a much greater length did time permit us. The space we have already occupied, will prevent us, also, from notic- ing the serious injury inflicted upon the interests and dignity of the pro- fession, by the repeated, and occasionally gross violations of the recognized code of medical ethics, evinced in the intercourse of physicians among themselves and with their patients. It must be evident that no profession can command the respect, and secure the confidence of the public, the members of which evince a disregard for the rights and feelings of each other, or of those on whose behalf their professional services are to be exercised. We must be allowed, however, before we close, to direct your attention to one other serious evil under which the medical profession labours in this country, and which, until it is effectually remedied, must, in a great mea sure, render unavailing every effort to enlarge and extend our courses of medical instruction, and elevate to a sufficient grade the qualifications for admission into our profession. We refer to the rapid and unlimited extent to which medical schools, all legally empowered to grant the degree of Doctor in Medicine, are multiplied. Between these institutions, often 20 located in the immediate vicinity of each other, there must ever exist a very powerful competition and rivalry. Every means will be resorted to, to secure by each the greatest number of students, and to graduate the largest classes annually. Were the competition and rivalry between our medical schools always evinced in the proper manner—did the means employed by them to attract students always consist in affording every increased facility for the acqui- sition of medical knowledge, and in giving to the degree, conferred upon those who shall honourably and faithfully complete their pupilage, an increased value, by demanding higher qualifications for its reception—the multiplication of medical schools would prove beneficial rather than pre- judicial to the best interests of our profession. Each would stimulate the others lo renewed exertions to secure, by every legitimate means, an increased share of public favor and patronage. But, unfortunately, many of our schools would seem to be organized solely with the view of enabling men of inferior talents and contracted cir- cumstances, to obtain a support from the income of their lectureships. In too many, indeed, the means by which the size of the classes may be increased would appear to occupy the minds of the lecturers far more than the means by which the pupils may be best prepared for an honorable and faithful discharge of their duties as physicians. From these causes, as well as from the usual incentives of pride and ambition, a very powerful temptation is created to reduce the amount and expense of instruction, and increase the facilities for graduation, as a means of attracting the attendance of students. And there is a danger that, by this unworthy species of com- petition, a number of imperfectly educated physicians—clothed with the doctorate—may be sent forth annually, into every section of our country, who will not only bring disgrace upon the profession by their ignorance, but, being unable to secure public confidence, and obtain a sufficient income from the regular practice of their profession, will be prompted lo resort to the arts of the charlatan to escape starvation. Even now, in consequence of the ranks of our profession having become overcrowded, and the number of incompetent members who have obtained admission into it, we are presented almost daily with the humiliating spec- tacle of those upon whom the degree of Doctor of Medicine has been con- ferred by one or other of our medical schools—in direct violation of those principles in which their diplomas certify to the world that they have been thoroughly instructed—practising for a living some one of the popular forms of empiricism. Perfectly indifferent—so long as they can obtain, through its means, an income adequate to their wants—how decidedly it may be condemned by common sense, and be repudiated by every established truth 21 in physiology, pathology, and therapeutics, and reckless as to its influence upon the health and lives of those who, in the confidence of blind credu- lity, submit themselves to their care. Many of the graduates of our medical schools have sunk into even a still lower state of degradation. Without pretending to any settled medi- cal principles or plan of practice, whether true or false, regular or empirical, they are willing, for a bare subsistence, to become all things to all men. They exhibit not the least hesitation to pander to the ignorance, the caprice, and the delusion of the different classes of the community, and, as the whims or prejudices of their patients dictate, to prescribe for the ailments of one according to a system of quackery, the very opposite of that which they adopt for those of another—thus running through, in the same day, all the phases of empiricism—while, at the same time, they assure the more enlightened and reflecting portion of the community that their confidence in the regular rules of practice is unshaken, and that according to these they are prepared to prescribe whenever it shall accord with the wishes of their patients. It is the conduct of these medical freebooters—who unfurl whatever flag, whether lawful or piratical, that suits, for the occasion, their predatory intentions, while they exhibit no real fealty to any—which has, more per- haps than any other cause, sullied the character and lowered the standing of the profession of which they claim to be members, and to a very great extent alienated from it the respect and confidence of the public. Rierson, a sensible Prussian writer, who visited Turkey towards the close of the seventeenth century, and has published a very entertaining account of a three months residence at Constantinople, states, that he fell in with several European physicians in the capital and some of the villages of the Turkish empire, who, to enable them to practice their profession in safety—from which they were deriving a considerable income—had for- mally renounced Christianity, and bowed their turbaned heads to the cres- cent of the false prophet, with all the apparent devotion of the true mos- lem; and he expresses in the strongest terms the disgust with which the degradation of these apostates inspired him. On reproving some of them for the baseness of their conduct, they assured him, most solemnly, that their apparent proselytism to-the moslem faith was merely outward, and assumed solely to ensure their safety, and enable them to do much good, while they obtained a decent living for themselves, by the practice of medi- cine, among a people by whom the Christian name was contemned and cruelly persecuted. If my disgust was great, remarks our author, when I believed these men had in truth renounced the cross of the Redeemer, it was redoubled when I learned, from their own mouths, that they had become 22 not only false to it, but were equally so to the infidel faith, the external forms of which they had assumed : and I could have spat upon, and spurned with my foot these double traitors, equally treacherous to truth and to error. Now, in the estimation of every high and honourable mind, the conduct of the physician who basely deserts the ranks of his profession, and, for a living, assumes the character of a charlatan, must sink to precisely the same level, and excite the same feelings of condemnation and disgust, as the degraded beings referred to by the author just quoted. There are, indeed, between the conduct of the two, many striking points of resem- blance. In what, in fact, does the moral character and conduct of the pretended christian, who assumes solely for gain the cloak of a false reli- gion, differ from that of the Doctor of Medicine, who, for the same un- worthy object, pursues the practice of homoeopathy—Thompsonianism— hydropathy—or the so called botanic system? Who, if it will but fill his pocket, is equally ready to prescribe infinitesimal doses and "the freed spirits of remedial agents" with the first—to reduce, with the second, all therapeutical means to the vapour bath, lobelia, and number six—or still further to simplify the materia medica, by excluding, with the third, all remedies but cold water, or, with the fourth, to denounce every mineral substance as invariably pernicious, and trust the cure of diseases entirely to vegetable substances, as those devoid of all deleterious effects, and under every form, and in every dose, innocent and eminently efficacious. Such conduct—and there are numbers who pursue it in every city in the Union, —can excite no other sentiments than those of supreme disgust. They who exhibit it, denounce themselves, by their own acts, as double traitors —traitors to the profession of which they claim to be members, and trai- tors even to the empiric crew with which they consort. We are convinced that we have, in no degree, exaggerated the delete- rious consequences which are liable to result, nay which have already resulted to a very great extent, from the too rapid and incautious multipli- cation, in different portions of the United States, of medical schools, invested with the power of granting degrees. The proper remedy for the evil is not, however, the exclusion of any one, or any number of persons, who can obtain a class, from teaching any or all of the branches of medical science—but the requiring, of all candidates for admission into the profes- sion, conclusive evidence that they possess the proper qualifications, with- out regard to the place where or the mode in which those qualifications have been* acquired ; the rendering the qualifications for admission uniform throughout every portion of the country ; the submitting the examination into the qualifications of candidates to, and the requiring the certification of their possession from, a board of physicians, selected by the profession 23 itself, from among those of its members who are neither directly nor indi- rectly interested in any medical school or lectureship. In other words, the evil is to be remedied by defining accurately the qualifications necessary to constitute a practitioner of the healing art, by allowing no one to practice medicine who is not thus qualified, and by excluding all medical teachers from the jury by whose verdict the posses- sion of the requisite qualifications is to be determined. Under this regu- lation, while the title of Doctor in Medicine would possess a positive and definite value, medical schools and lectureships might be multiplied to any extent without the fear of any injurious consequences. The merits of each school would be effectually tested by the proficiency of its pupils, and the size of its classes would be in proportion to the abilities and devotion of its teachers, and the real advantages afforded by them for the acquisi- tion of that amount of professional knowledge essential to graduation. The physicians of Great Britian have, very recently, petitioned parlia- ment for the establishment by law, throughout the kingdom, of regulations somewhat similar to those, the outlines of which we have sketched—and we feel persuaded, that the period is not far distant when the propriety of their legalization in the United States will be acknowledged by the mem- bers of our profession, as well as by the public generally. They certainly cannot be objected to by any one who has the true interests of either at heart, and who has carefully and candidly examined the present condition of the medical profession in this country, and the evils under which it now labours. While the adoption of regulations, such as we have proposed, can interfere with the legitimate rights of no individual or body of indi- viduals, it would be calculated gradually, but very certainly, to elevate the character, and beneficial influence of the medical profession, by increasing the talents, knowledge, and efficiency of all its members. That some efficient means are necessary to secure the rights and inter- ests of the medical profession from invasion by the hordes of charlatans by which they are now threatened, and have been already to some extent invaded, is now very generally confessed ; no little discrepancy of opinion, however, slill exists in regard to the exact nature of the means best adapted to effect this important end. Much may be done towards securing unanimity of sentiment and action, by a free expression and interchange of opinions. In the attainment of this object the Philadelphia Medical Society is able to afford very efficient aid. The efforts it has already made to elevate the character, and promote the true interests of the profession—the boldness it has on more than one occasion exhibited in stripping empiricism of its mask, and exposing to public view its unfounded pretensions and dangerous tampering with human 24 life, have not been unproductive of beneficial results. Let its members keep steadily in view the important objects for which the society was instituted—let them but continue true to the ennobling principles for which they have heretofore so ably contended, and its influence upon all that concerns the permanent welfare of the profession cannot fail to be felt, and its voice in favour of whatever may be deemed necessary to extend and secure its interests will be heard and responded to, throughout the length and breadth of the land.