« C|e Mptians of tjje fast Centarg. A. LECTURE INTRODUCTORY TO THE COURSE AT THE j. PHILADELPHIA ASSOCIATION FOR MEDICAL INSTRUCTION, DELIVERED ON MONDAY, MARCH 23, 1857,, '^ J * J. DA COSTA, M. D., .ECTBRER ON THE PRINCIPLES AND PRACTICE OF MEDICINE, ETC. PUBLISHED BY THE CLASS. 0 PHILADELPHIA: HENRY B. ASHMEAD, BOOK AND JOB PRINTER, GEORGE STREET ABOVE ELEVENTH. 1857. I J Philadelphia, March 31, 1857. Sir:— At a Meeting of the Students of the " Philadelphia Association for Medical Instruction," it was resolved, that a committee be appointed to solicit of Dr. J. Da Costa, a copy of the very interesting and instructive Introductory Lecture to the Course, and obtain his permission for the publication of the same. In accordance with the above resolution, we respectfully request you will be so good as to furnish a copy of the Lecture for the purpose desired. We are respectfully, Your obedient servants, Wm. M. King, Pa., J. M. Moody, Tenn., E. C. King, Texas, L. W. Bickley, Pa. To Dr. J. Da Costa. Philadelphia, April 2, 1857. Gentlemen :—■ Your request for a copy of my Introductory Lecture for publication is so flattering, that it places it entirely out of my power to refuse to accede to it. I give into your hands the manuscript you desire : you will meet with a few remarks, appended as notes, which were placed there for my own use, and which I did not read when the Lecture Was delivered. Hoping that you may find these, and the imperfect sketches they accompany, of some use to you, and thanking you most sincerely for the honor you have conferred upon me, I beg of you to believe toe, Yours truly and faithfully, J. Da Costa. Messrs. William M. Kino, J. M. Moody, E. C. Kino, L. W. Bicklei. LECTURE. It has this morning, Gentlemen, fallen to my pleasant lot to greet you at this commencement of our Lectures. Let me then, in all our names, wish you a hearty, thrice-hearty, welcome! The Philadelphia Association for Medical Instruction has existed now for upwards of fourteen years, during which period it has been attended by many pupils. The larger proportion of these have received from us certificates of merit, granted only after a perfectly satisfactory exami- nation ; and it is a gratifying reflection, that not to one has this mark of our approbation been awarded, who has not subsequently been found qualified to receive a degree from any of the recognized Medical Colleges. The session in this Institution commences in March, and continues, with a recess in Midsummer, until the opening of the winter schools. Not more than three lectures are de- livered daily, thus enabling the student to avail himself of the benefits of clinical observation at the hospitals, and of the various private courses of instruction which a summer residence in Philadelphia so freely affords. Our prominent aim throughout the session will be to im- part useful, wholesome knowledge. We may not be able to place before you food as richly dressed, or as neatly served up, as you have been accustomed to during the winter; but G we shall take good care that it is as substantial and nutri- tive. Let us, then, to-day, at the commencement of our labors, join hands. We, as solicitous of your advancement as your- selves, ask from you for a regular and constant attendance; whilst you shall not find us wanting in a faithful discharge of our duties and in a conscientious interest in your im- provement. The selection of a subject for an occasion like the present, is not easy. Custom, it is true, permits a departure from the ordinary topics of medical lectures; but too wide a departure again, scarcely befits an introductory to a course, delivered at a Medical Institution. It has often occurred to me, that addresses at such times might not be disadvanta- geously employed, in inquiring into some special facts con- nected with the development of medicine, or into the labors and characters of individual medical men; and it is with this view that I beg leave this morning to spend the hour allotted to me, in a consideration of the lives of some of the physicians of former days. I might have selected for this purpose those of any epoch; the period which I prefer is the last century. It was an unusual century in the world's history. If you reflect that it witnessed within its bosom the reigns of the gorgeous Louis', and the tragic end of all their splendor in the bloody drama of the French Revolu- tion; that it saw the wars of Frederick of Prussia, and the battles of our own people successfully vindicating their rights against tyrannical oppression; that it was a century in which Pope and Addison wrote; in which Pitt and Franklin lived; and that it beheld the early deeds of that gifted Corsican, whose fiery nature set all Europe in a flame : it can surely not fail to be of interest to know what they were engaged in, who, in times of such moment, repre- sented the hereditary honors and dignity of the medical profession. 7 We medical men of the present day take too little interest in the lives and deeds of our brethren of previous times, even of those who by their talents and toil have enriched our science. We have always had in our profession gentlemen accom- plished and liberal, patriots illustrious, cultivators of science, great and indefatigable, benefactors of mankind unequalled. Where and when, if they belonged to by-gone days, do we instruct the public what they owe to them, and assert their right to the respect of the human race? When do we ourselves read their works, or endeavor to become acquainted with the circumstances connected with their histories ? We do not sufficiently reflect, that the study of Medical Biogra- phy is the study of the gradual growth of our science. For science is not an abstract. It is a substance which the minds of men have furnished, and which crystallizes around the names of its zealous cultivators. In our just pride in the rapid and unparalleled advancement of modem medicine, we are too apt to regard as old and useless anything of not very recent date. Granting the superiority of our know- ledge over that possessed by our forefathers, still who can doubt that an examination of their works, and surely of their lives, shows us, in the most striking manner, what talent and perseverance may accomplish; and on the other hand teaches us how our art is to be improved, and saves us from retreading paths that lead only to a barren wilder- ness. In treating, this morning, of the physicians of the last century, it is not, however, so much my intention to discuss their works or their contributions to science, as to speak of them as men. I would show you in what estimation they were held; what their views were; how they lived, studied and practised: I would exhibit them to you with all their virtues and wisdom, their quaint ideas and faults; so that you might compare their actions and modes of thought with 8 those of the medical men of the present day. If time per- mitted, the physicians of every country might thus be passed in review, as it is, I shall select mainly from those of Eng- land and Germany, which countries furnished during this period, the largest number of practitioners distinguished for their skill and attainments. At the commencement of the eighteenth century, London contained a famous set of physicians. One, whose name we find associated with those of nearly all his illustrious cotem- poraries, with some as a friend, with others as a physician, and with others again as a rival, is Radcliffe. Not very learned, for he used to make it his boast that he read but little; not a contributor to science, for no discoveries or books bear his name; Radcliffe is mentioned in all the cur- rent literature of that day as the eminent practitioner, and is referred to by his medical successors in popular favor as one of the greatest practical physicians England has ever pro- duced. His professional engagements must, indeed, have been extensive. When he started life, he was poor: when he died, he left a princely fortune. The year 1700 found him at the height of his reputation. He was consulting physician to nearly all London, and had been court physician. Much of his enormous success may be attributed to his keen appreciation of symptoms, and to the confidence with which his skill enabled him to pronounce on the termination of a disease; but to some extent, also, it was owing to his boldness and wit, and to the singular good fortune that, more than once, attended his daring prognosti- cations. As Radcliffe has left no writings behind him, it is not easy to determine his mode of practice. He does not seem to have been too fond of the violent sedative plans of treatment, then so much in vogue. He was more rational and simple in his prescriptions, than most of the other doc- tors of that day, and was one of the first to adopt in small- pox, the cooling plan of treatment, as recommended by 9 Sydenham. Following the fashion of the time, however, he was deeply imbued with the notions of humeral patholo- gy, and laid, therefore, especially in fevers, great stress on critical days; when to administer purgatives was considered by him as leading certainly to a fatal termination. Radcliffe's social position was even in that aristocratic age extremely high. He associated with all the eminent of the land; was elected member to Parliament; and it is recorded of him, that he entertained at his house the renowned Prince Eugene of Savoy, the rival in fame of Marlborough. The old doctor, of whom I am speaking, was very eccen- tric, and very fond of his amusements, for which he always found time, notwithstanding his extensive professional occu- pation. With his friends the Duke of Beaufort and my Lord Craven, he frequently resorted to a neighboring tavern, from which he was sometimes carried away by main force by the indignant messengers of his patients. He told his young friend Mead that the secret to fortune was to treat all mankind ill, and this precept he followed out most thoroughly himself. His wit, used to blaze forth regardless of time or person. Thus he gave extreme offence at Court by telling the King, wTho was suffering from dropsy in the legs, "that he would not have his two legs for his three kingdoms." To one person, who had carried him from his offerings to Bacchus to see a sick wife, he loudly remarked, "NowT you impudent dog, I'll be revenged of you, for I'll cure your wife"; a kind of joke which the crusty old bachelor was fond of, as he repeated it on more than one occasion. He was one of the very few who dared publicly to laugh at Dean Swift, who on that account hated him most cordially, and speaks of him as "that puppy Radcliffe." The redeeming point in Radcliffe's character was his liberality. He contributed during his lifetime to every 2 10 thing that tended to benefit the cause of science or religion; and at his death he left nearly the whole of his splendid estate to benevolent and scientific purposes. His will must forever remain a magnificent testimony of the generous spirit of a medical man. The sum bequeathed amounted to up- wards of £80,000 (nearly $400,000.) A large portion of which was to be appropriated to such charities as his executors deemed best. One legacy of £40,000 went to establish the library at Oxford, and £500 yearly to mend the diet of the patients of St. Bartholemew's Hospital. Many the scholars that shall owe their erudition; many the afflicted that have owed strength and a speedy recovery, to these gifts of this princely physician. Radcliffe may in several respects be taken as the type of a large class of the British physicians of the earlier and middle portion of the last century. They were kind-hearted and generous; but their manners and speech were disgust- ingly pompous, rude and coarse. Most of them were very able, some learned; all clear headed and possessed of a large amount of practical tact. Yet the prescriptions they wrote were, for the most part, complicated, and influenced by fanciful, preconceived notions of the cause of disease. Their social position was excellent, and their liberality has rarely been equalled. We find them patronizing arts, and sub- scribing to and founding charitable and scientific institutions. A physician of eminence, the celebrated Sir Hans Sloane, younger than Radcliffe, yet his rival as a practitioner, much his superior in learning, nearly his equal in generosity, left to his country his library, and an extensive collection of objects of Natural History, for a comparatively trifling sum, and thus became the originator of the British Museum. What a magnificent return this was to the Government that had conferred on him the first hereditary title of nobility given to any medical man. In the noble Institution, which has done so much for the advancement of science, good old Sir 11 Hans has left himself a monument well befitting his honors of President of the College of Physicians, and of the successor to the chair of Sir Isaac Newton at the Royal Society. The pomposity of some of these ancient doctors must have been prodigious, and was not a little set off by their dress, which always consisted of a full dress suit, coat of silk or velvet, of a sword, and, as signs of their medical dignity, of an enormous wig, a gold headed cane, and sometimes a. muff. The gold headed cane and wig were indispensable; to practise without them would have been considered as an insult to the profession. Some of the wigs of the last century acquired quite a celebrity. Dr. Brock- lesby's peruke was well known from the fact of its being daily carried through the exchange, the barber exclaiming, " Make way, make way for Dr. Brocklesby's wig!" The reputation of one of these professional ornaments, belonging to Dr. Dalmahoy, has been transmitted to us in song: "If you would see a noble wig And in that wig a man look big, To Ludgate Hill repair, my joy, And gaze on Doctor Dalmahoy." When the pomposity of medical men diminished, a circumstance to which the ridicule thrown on them by Moliere's plays contributed not a little, less stress was laid on the dress; so that now a days a physician is not to be recognized by his outer garments. We dress like other people. Canes are not usually carried by medical men; although they are still immensely popular with medical students. Wigs have given way to natural hair, and perhaps to a fondness for nicely trimmed mustaches: and muffs— fancy a doctor with a muff—have now no connection with the profession, excepting when in the hands of some of our modern female brethren. 12 The manners of many of these by-gone practitioners to- wards the sick were extremely coarse. They delighted in insulting them, and in saying all kinds of cross and ill-natur- ed things, which the patients put up with, because, by long usage, they had been taught to regard rudeness as part of the character of a professional man. Radcliffe, as I told you, was distinguished for his uncouth speeches. Another physician, Sir Richard Jebb, who practised at a later pe- riod, was particularly irascible when asked about diet. An epitaph says of him, " Did you speak about diet, he wTould kick up a riot, and swear like a madman or trooper;" and such was literally the case. " What may I eat ?" asked a lady of him. " Boiled turnips," was the reply. " I beg you to recollect, Sir, that I cannot bear boiled turnips." " Then, madam, you must have a vitiated appetite;" prefix- ing to the word " vitiated," an adjective, which it would not be proper to mention to ears polite. Another lady touched on the same forbidden subject, by asking questions regarding her diet. "My directions," answered Sir Richard, "shall be simple, and easy of recollection. You must not eat the poker, shovel, or tongs, for they are hard of digestion; nor the bel- lows, because they are windy, but anything else you please." A practitioner of the last part of the century, being told by a lady, that her arm pained her when she lifted it, replied, " Why then what a fool you must be for doing so." With the author of this insolent speech (Abernethy) medical rude- ness departed, never again, let us hope, to stain our fair escutcheon. Shame on those who see in the distresses of humanity only food for displaying their wit, or fit occasions for venting their ill-temper. A soothing word, a sympathiz- ing glance, a cheering presence, has often effected cures, when all the articles of the Materia Medica would have been impotent. The medical consultations of the earlier part of the eighteenth century were mostly neither marked by much 13 professional courtesy, nor by a desire of doing good to the sick; being merely regarded as suitable occasions for the exhibition of learning. The humorous Garth,—the noble physician to whose exertions the body of Dryclen was in- debted for a befitting burial—portrays in his poem the " Dispensary" the consultations of his day : " The artist, too, expressed the solemn state Of grave Physicians at a consult met. About each symptom how they disagree, But how unanimous in case of fee, Whilst each assassin the learned Colleague tires With learned impertinence, the sick expires." Fortunately not all the consulting physicians were so careless of the lives of their patients. The advice of Dr. Mead and of Sir Hans Sloane was the most sought after, and was always conscientiously given. The latter was fre- quently written to from all parts of England. There is a curious letter extant from the immortal Locke, who was not only a graduate in Medicine, but even practised early in life our art, requesting his counsel in a case. The then young Mr. Locke has a patient about whom he is very anx- ious, and writes to Sir Hans to know " what ye fevers in town are, and what method ye find most successful in them," and states " that he will be obliged for a word or two by to- morrow's post." Doubtlessly this did bring a recipe for fever, and some high-wrought reflections upon peccant humours in general. When Radcliffe was old and tired of occupation, he re- commended his patients to Mead, who was then a rising young man, and whom we may take as a fine example of the learned physician of that period; for he was one of the most cultivated individuals that any age or country has pro- duced. Early in life one of the Physicians to St. Thomas' Hospital and Lecturer on Anatomy at Surgeons' Hall, his increased practice soon forced him to relinquish both ap- 14 pointments. His opinion was so much desired, that he had to repair to different coffee houses in the city, and give levees to the general practitioners, on wThose cases he decided from oral or written statements. The receipts from so extensive a practice amounted to upwards of £6000 a year. Never was a large income put to a better use. His motto was non sibi, sed toti, and all through his arduous life he proved true to it. Did any charitable institution need help, Mead was applied to, and his purse was as freely emptied as it had been quickly filled. Artists had access at all times to his fine collection of paintings; many he kept continually in his employ. His chariot, drawn by six superb horses, could frequently be seen before the door of some poor literary man, whom he was attending gratuitously, and to whom he had been giving money and encouragement. This generous spirit was duly appreciated. Not a few of the works then published, we find dedicated to him. Even that old Latin Dictionary of Ainsworth, the acquaintance of which we have all made in our youthful days, bears the in- scription " Doctissimo viro, Ricardo Mead." At the house of this Maecenas congregated all the distin- guished in politics, arts, and science. What sprightly sallies of wit; what erudition; what friendly arguments; what poetic thoughts; must that spacious library of his in Ormond street, have witnessed. See! there is Cheselden, the famous surgeon, listening with an air of great respect to a very venerable old man, of upwards of eighty years, whose spirit yet flashes out of his lively eye. They are looking at the busts of Shakspeare, and of Milton, and Sir Isaac Newton is comparing them with the celebrated bronze head of Homer, which stands off there in a corner. Here is Mead himself, showing to the learned Dr. Friend a manuscript in Arabic, which Boerhaave has sent him. But Friend's heart is too full to take any interest now in medicine. He has just been liberated from the Tower by Mead's perseve- 15 ranee, who refused to attend Sir Robert Walpole, the prime minister, until he had set the prisoner at hberty. And there is Sir Robert himself, speaking to the eccentric Dr. Mounsey; and there the jolly Sir Richard Steele and Knel- ler the artist, surveying the paintings; and that little, de- formed, sickly-looking man yonder, leaning on the arm of the polished Dr. Arbuthnot, one of the best physicians and scholars, and the greatest wit in all London—is Pope. He is looking up with his dark, lustrous eyes into the face of his beloved friend, who has on more than one occasion saved his life. He has been reciting some of his poetry, and now they are talking about the generous Garth, whose death they are still mourning; and about Dean Swift, who is absent; and about the continuation of the papers of the Scriblerus Club, of which they are the members; and Pope cannot resist telling Arbuthnot what Swift said of him: "that he was a man who could do everything but walk." The witty Arbuthnot retorts, but the laugh of the bystanders drowns the reply.* Such was the society in which Mead and the other emi- nent physicians of the day moved. It speaks well for our profession, that in this brilliant assembly, in point of bene- volence, learning, and wit, the balance was not against the medical men. As a practitioner, Mead was not given to polypharmacy, and insisted more upon a cooling plan of treatment in fevers, than was then usual. Our art is indebted to him for several * Swift, who was generally not very partial to physicians, was yet very fond of Arbuthnot. So was Pope, whose medical attendant he was: „, " Friend of my life, which did not you prolong The world had wanted many an idle song.—Pope." Swift, Pope, and Arbuthnot were members of the famous Scriblerus Club, designed to ridicule pedantic learning and prevalent abuses. During its brief existence it gave rise to " Gulliver's Travels," and to several most witty essays. Arbuthnot was universally considered as the most learned and humorous mem- ber of the club. 16 improvements. He introduced the principle of applying pressure to the abdomen, to relieve the sense of sinking ex- perienced after the withdrawal of fluid by tapping. He was the first physician in England or on the continent of Europe, who used the Eastern remedy of inoculation as a prophylac- tic against smallpox; an operation which he first practised on seven criminals in 1721, and of which he afterwards became the most distinguished advocate.* While some of the British physicians were thus laboring to improve their art, we find students from all countries flocking to Leyden, in Holland, attracted by the fame of Boerhaave. This illustrious man was, when young, a student of divinity, wTho, in his leisure hours, read medicine: the latter pursuit gained on him more and more, until he deter- mined to devote himself to it altogether. At first he met with but little encouragement. Patients w^ere few, and success seemed doubtful; but success came, and brought with it fame, wealth and honors unparalleled. In 1714 he was appointed physician to the hospital at Leyden, and shortly afterwards professor in the University; and from that period until his death, there was no man in all Europe, as a teacher more popular, or as a man more respected. His tall, majestic form was known to all the inhabitants of Leyden, who, when he passed in the streets, saluted him, and took off their hats to him. When, after a severe attack of gout, he resumed his duties, the whole University was illuminated to celebrate the event. His fame was such, that a letter from China, asking his advice about a case, reached him, simply directed, M. Boer- haave, Medecin, Europe. Numerous students attended his brilliant lectures, delivered, as the custom of the day re- quired, in Latin. Among them we find, Mynherr Van * Out of 100 inoculated, Mead states that he only lost one. Notwithstand- ing these favorable results, inoculation did not, in some countries, meet with much favor. In France it was late and then but rarely resorted to; on the other hand, we find it practised as early as 1722, in Boston. 17 Swieten and Gaubius; young Mr. Pringle; Mr. Alexander Monro from Scotland; and the charming Herr Albrecht von Haller, the descendant of a patrician family from Berne. It is said that the renowned professor showed to him much kindness: I wonder whether he had a presentiment that the gifted youth would afterwards more than rival his own fair fame. Boerhaave's practice was enormous. To it and his lectures he gave up the whole of the day; to his studies were allotted the early morning and late night. People travelled thousands of miles to consult him; and the fees he received enabled him to bequeath to his only daughter an immense fortune. Besides being a busy practitioner and lecturer, Boerhaave was a distinguished practical anatomist and chemist. He was also versed in the Latin, Greek, Hebrew, and other Oriental, and in modern languages, and was a most profound mathematician. Religion owned in him one of its most faithful supporters. At his death it was found that the honors heaped on the distinguished Leyden professor, had been frequently accom- panied by gifts of a very material kind; for the estate he left amounted to upwards of four million of francs, ($800, 000.) All medical men of the last century were better paid than they are now; while surgery, which was held in much lower repute, was not as well remunerated. In the year 1700 the law in England allowed to a surgeon for an am- putation of any limb £5; and 10 shillings a visit to a graduate in physic; although it states, " that he commonly expects or demands 20." Now, twenty he usually got, and frequently a great deal more. Dr. Radcliffe received re- peatedly several hundred pounds; once a fee of £1000, on another occasion one of £1200 ($6000); an enormous sum, if we take into account the much greater value money then possessed. Fothergilfs practice amounted to £8000 annually. Dr. Lettsom, at the end of the century, derived £12,000 a 3 18 year from his professional exertions, which is probably more than any physician now practising in England acquires. In France the largest medical practice of the present day does not, I believe, yield more than 200,000 francs, ($40,000); and I am sure that in the United States no general practioner, and but few surgeons, collects more than $16,000 yearly. Court physicians were especially well remunerated in the last century. The physician, whom Queen Caroline con- sulted, received £500. Dr. Willis, for his successful at- tendance on King George III., was rewarded by £1500 per annum for twenty years, and £650 to his son for life. Dimsdale was made a baron for inoculating the Empress of Russia and her son, obtained $60,000, and a pension of $2300. The largest sum with which I am acquainted, paid for any diagnosis, belongs, however, to antiquity. It was given to Erasistratus by Seleucus, King of Syria, for detect- ing the disorder of his son Antiochus, and amounted to 60,000 crowns, upwards of $74,000. The Chinese had the most unique plan of paying their medical men. They took as their common rule, "no cure no pay." The court physic- ians received regular salaries, which were stopped during the sickness of any of the Imperial family. Boerhaave's method of practice was founded on his theory of disease, which, on the whole, is eclectic, although it leans much to mechanical and chemical explanations of morbid actions. It embraces also some of the views of the humoral pathologists, and ascribes some symptoms to nervous agency. In this respect, Boerhaave's ideas were not as advanced as those of his cotemporary, Frederic Hoffmann, the renowned physician to the King of Prussia. Hoffmann was the first who distinctly recognized the great influence of the nervous system on the phenomena of health and disease. His friend Stahl, one of his colleagues at the Uni- versity of Halle, considered, also, it is true, the nervous 19 system, as an important agent, but not in the same way. He places the nerves, along with all other tissues and organs of the body, under a controlling vital principle, " anima," the soul, which presided somewhat as an autocrat, and directed whatever movements or actions it pleased. If its operations had become disordered, it had quite power enough, he thought, to set itself to rights again. On this theory his therapeutics were based, and, of course, as it attributed everything to the power of the soul—or what means here the same thing, to the " vis medicatrix naturae,"—consisted mostly of a grand do-nothing system. Now Hoffman's views differed from those of his friend Stahl. He was a solidist, and regarded nervous force as a power of a specific nature, operating by its own laws, and probably physical in its character. This view, which we more or less still adopt, he promulgated through those ponderous and diffuse writings of his, the mere enumeration of which, as given by Haller, extends through thirty-four pages quarto. I, for my part, cannot understand how these men could have written so much, and yet have found time for their other occupations. They must have been more industrious than we are; or have had a bodily and mental organization which never wearied. That they were not mere physicians, but skilled in languages and other sciences we have seen; and yet they published more, than any of the most prolific writers of our own times. A reason, perhaps, for the extreme length of their productions was, that the matter was not always as well digested, nor the style as concise and as clear, as that of our modern medical authors; and again, they had not so much to read, for never before has the profession, as a body, contributed as much to medical literature, as at the present day. Formerly, if a physician after having become acquainted during his collegiate course with the waitings of the ancients, read what Mead, or Boer- haa ve, or Stahl published, he could console himself with the 20 reflection that he was well acquainted with what was going on in the medical world. But now,—who does not shudder at the thought of the number of journals that are lying unperused on his table ? While the different theories mentioned, were dividing the attention of the medical world, there arose in the firmament of science a star, which illumined with its pure and bright fight, paths before enveloped in gloomy darkness. If Boer- haave was the glory of Leyden, Hoffman and Stahl that of Halle, the name of Haller will always be associated with the fame of Gb'ttingen. Haller was a Swiss by birth, and the recollection of the grand Alpine scenery never forsook him. When absent from home still his heart yearned towards it: all the honors and distinctions he gained during his glorious career, did not lessen his affection for those noble old mountains—the witnesses of his early genius, and of his first love. The boy Haller celebrated them in verse; Haller the man, at the zenith of his fame, declined the chancellorship of the University, with whose reputation his own was identified, to return to the snow-topped peaks and beauteous lakes of his native country. Some of Haller's poetry, written when quite a youth, descriptive of Swiss scenery and life, breathes an air of nature and of such pure morality, that it placed him at once at the head of the German poets of the day. It was nature and truth arrayed against stilted art and fiction. The literary world heard with surprise, that the author of these delightful poems was a physician, busily engaged in scientific research and in the practice of his profession. When he received the call to Gftttingen, he bade farewell to his muse, and devoted himself with untiring energy to the study of the branches he was called upon to teach. Poor Haller! How bitterly he must at one time have lamented that he ever left his native mountains; for he had no sooner arrived at his new home, than his young wife died from the injuries 21 she received by the overturning of her carriage. Deprived thus of the soothing influence of a family circle, he sought consolation in study. How he must have read and reflected! How many investigations he must have made, and encour- aged others to make ! He was blessed with a great genius, but he improved it by his enormous application. When the winter wind whistled around his old Gothic library windows, Haller warmed himself by study. When the rays of the summer sun annoyed him, he cooled himself by deep reflec- tion. When an accident to his right arm incapacitated him from using it, he commenced the same day to write with his left. Haller was always Haller. Always kind, always good, always pure; but always reading, always thinking, always investigating. Science was to him food, friend, wife. The cares and pleasures of life, bodily pain, were forgotten in the pursuit of those studies which made Albert Haller the greatest Physiologist of his century. Haller was a very pleasing lecturer. When he demonstrated his dissections, placed on the old wooden table, which stood up to the time of Langenbeck, a rude but venerable relic, the room was crowded to overflowing. Many students came to Gflttingen merely to hear him. It was customary in those days to travel to the different universities to attend the celebrated lecturers. Leyden, Padua, Paris and Gottin- gen were the most resorted to. After Boerhaave's death, and very shortly after Haller had retired from his academical life, (1753), Van Swieten and De Haen, pupils of Boerhaave, invited by the Empress Maria Theresa to Vienna, founded there a school for clinical instruction, which rapidly became one of the most popular in Europe. At the death of De Haen, his illustrious pupil Stoll succeded him, and discharged with still more ability the arduous task of a clinical teacher. This wTas the origin of that famous medical school, whose reputation is to this day kept up by the pathological researches of a Rokitansky, and the clinical lectures of the distinguished koda. 22 About the time that this school was established, a young Irish student came over from Edinburgh, where he had been attending the lectures of Monro, to perfect himself in the science of medicine by listening to some of the Conti- nental professors. He first directed his steps to Leyden, where Albinus was teaching anatomy and Gaubius chemis- try ; but in spite of all his affected fondness for the latter branch, and the high opinion he expressed in his letters to his friends at home of the ability of the professor, it does not appear that Oliver Goldsmith was ever an industrious frequenter of the lecture room. His nature did not permit him such work. He was too convivial, too frequently engaged in practical jokes; always lending the little money he had, and as often borrowing from his fellow-student Ellis. The Leyden air did not agree with him, and so he thought himself; for with only a trifling amount in his purse, a very slender wardrobe, and a flute, by playing on which he helped himself along, Oliver Goldsmith reached Paris. Here again he does not seem to have studied his profession very dili- gently. There were not many great physicians at Paris in those days. In fact, all through the eighteenth century, up to its close, France was poor in eminent physicians. She had many renowned soldiers and authors; her anato- mists and surgeons ranked high; in chemistry she produced a Lavoisier; in natural history a Buffon and Cuvier; but with the exception of Senac, the medical attendant of Louis XV, she gave birth to no great practitioners. How different was it near the commencement of this century, when the famous Corvisart was the clinical teacher of the faculty of medicine at the hospital " La Charite," practising and popu- larizing the then new art of percussion, and, by his brilliant example, fostering a love for the study of pathological anatomy, and for clinical research, in the minds of his pupils Bayle, Laennec, and Dupuytren. When Goldsmith returned to England, he endeavored to 23 establish himself in his profession. He bought a wig, a cane, and a suit of green and gold, which he afterwards exchanged for a more professional one of black. But in spite of his dress, and the intense look of dignity he at times assumed, not many came to profit by his medical knowledge. He had a few patients,—and who of us would not like to have been one of them, if only to have heard that kind voice of his, and to have seen the mock air of business the reckless poet assumed?—still they were very few who consulted him. It is said that one of his coats had a patch in it, that he assiduously covered with his hat; which singular attitude was much wondered at, and remained unexplained, until some very officious person insisted upon taking the hat out of his hand. He did not prosper as a practitioner, and when to add to his disappointment he was rejected by the College of Surgeons, he gave up the pur- suit of medicine. The world at large was a gainer : it lost a careless doctor, and obtained instead, the sweet author of the "Deserted Village," "The Traveller" and the "Vicar of Wakefield." Goldsmith was not the only literary man of that day in England, who could not succeed in medicine. There was the hapless Smollett, the author of that humorous tale of "Humphrey Clinker;" and Thomson's friend, Dr. Arm- strong, the writer of a poem " On the Art of Preserving Health," of which production he himself bitterly complains that it injured his professional advancement; and the satirical Dr. Walcot, better known as "Peter Pindar;" and Akenside, the composer of those delightful lines on the " Pleasures of the Imagination"—as a poet, sublime and inspired, at the bedside of the afflicted, an unfeeling, super- cilious tyrant.* * Of all the literary physicians Akenside succeeded best; but even his prac- tice was never very extensive, which is all the more to be wondered at, as he was a hospital physician, and much more ambitious about his medical than his 24 The physicians who at the time that these poet-doctors were but indifferently progressing, were taking rank in popular favor, were the charitable Fothergill; the accom- plished Warren; the religious Heberden; the clear-headed Pringle; that elegant scholar Sir George Baker; the clever, industrious William Hunter; and the dignified Pitcairn, the great enemy to quackery and quacks, of whom he used to say, "that there were not such liars in the world, except their patients." Yet gifted and learned as these men undoubtedly were,—much as they enriched the profes- sion by their studies and researches into the phenomena of health and disease,—their talents pale, and their in- vestigations seem insignificant, compared with those of that glory of surgery, John Hunter. " I am only the demonstrator of this discovery; it was my brother's," was a sentence constantly in William Hunter's mouth, and forsooth, the genius and determined industry of the rough, untaught country lad, made all the erudite scholars look like dwarfs at the side of him, who read simply in the book of nature. John Hunter's reputation in anatomy and surgery caused many students to resort to London, to learn these branches under his guidance. Among them we notice Fontana; Meckel and Soemmering from Germany; William Shippen and Physick from Philadelphia. Those desirous of studying practical medicine travelled to Edinburgh, to become the pupils of the celebrated Cullen. The medical department of this University, founded by the illustrious Monro, ob- tained still further renown, when Cullen commenced to deliver his clinical lectures. At one time a poor country poetical reputation. He even contributed to the literature of the profession. The Medical Transactions of 1768 contain some papers of his, one on cancers, and one on the use of ipecacuanha in asthma. He also read in 1775 the Gulstonian lectures before the College of Physicians. His want of success may be partly attributed to his uncouth ways, and partly to the prejudice the mass of the public entertain against any medical man who wooes the Muses successfully. 25 druggist associated with William Hunter, then a practitioner of medicine so disheartened, that he thought of giving up his profession, Cullen has left us another example of what determination and industry can effect, in spite of apparently overpowering obstacles. His lectures on clinical medicine wrere listened to with admiration, and rarely has there been a more popular professor. When he pronounced his sprightly discourses, his expressive countenance lighted up, and his tall, spare form showed by its animation the deep interest the lecturer was taking in his subject. Cullen's mind must have combined a strange mixture of powerful practical ability with an intense love of specu- lation. While we find in his "First Lines" descriptions of disease most graphic and true, and remarks on remedial agents which bespeak great sagacity and skill; we also see in some of his writings theories so incongruous, that we doubt if it be the same man who penned them. One of his main views was, that debility is the cause of disease, especially of fevers. This debility results from a sedative action on the brain or on the nervous system. It originates a spasm in the extreme vessels, which spasm he regards as a sign of violent reaction, calling for an antiphlo- gistic plan of treatment. Singular as were these views, from them sprang the still more eccentric doctrines of Brown, which created almost a revolution in the medical world. I cannot here enter into a consideration of them; I will only say that Brown believed all diseases to arise from an augmentation or diminution of Excitement. The first he calls sthenic, the latter asthenic. To these morbid actions he opposes, without regard to symptoms, only two systems of therapeutics. Remedies against sthenia were the Anti- sthenics; and those for asthenia the Sthenics or Excitants. In asthenia he recommends animal diet, and as the most energetic excitant, opium. This system was well calculated by its simplicity to 4 26 charm, and to deceive. We who live now, know little of the disturbance it created. The battle has been fought, and is simply recorded in history. We read of it coolly; but few of us have any idea how many fives were sacrificed, and what inveterate hatred and animosity it gave rise to. At Edinburgh the students' discussions were carried to such a pitch of violence, that a law was enacted, if any person should challenge another for remarks passed in debates, he should be expelled.* At Gottingen the arguments of the disputants were maintained by force of arms, and a detachment of military had to quell the insurrection; and even in the distant plains of Catania, on the eastern coast of Sicily, could be seen written on the outside of a wine house, "Non sedat opium." " Viva il celeberrimo Brown." There is yet another theory, that belongs to the last cen- tury, which, with all respect to its framer be it spoken, was even more atrocious, than the one last mentioned. It was the view of the unity of morbid action, by the celebrated Philadelphia physician, Dr. Rush, the favorite pupil of Cul- len.f All diseases, he asserts, are one; although they show themselves as spasm, convulsion, itching, aura dolorifica, or suffocated excitement. They may be transformed; thus, pulmonary consumption may be changed into a headache, rheumatism, diarrhoea, or mania; local inflammations are but the results and symptoms of general fever. No man ever carried the depletory practice further than he. He bled profusely, and gave calomel, or as he termed it, " the Samson," in larger doses than had ever before been done. But if we cannot consider Dr. Rush's theories as abounding much to his credit,—perhaps on the principle with which he himself closes one of his numerous productions, * Beddoe on the character of Dr. Brown. f Rush was personally much attached to Cullen. He takes leave of him in his inaugural dissertation " Vale egregia academiae decus, nomen mecum sem- per durabit, et laudes et honores tui in aeternum manebunt." 27 " We think our fatherB fools, so wise we grow, Our wiser sons, I hope, will think us so," —there is another field on which he shines and has gathered fame. It is as a physician, in his faithful account of the frightful epidemics he witnessed; as a lecturer, in the ardent love of the profession he fostered in the minds of his young hearers; as a citizen, in his noble exertions in the cause of humanity, science, and philanthropy. To him the poor of our city are indebted for the Dispensary. The State owes to him Dickerson College at Carlisle. He was one of the main agents in having solitary confinement substituted for corporal punishment. He served nobly his struggling coun- try in the capacity of Physician General, and ever afterwards, by deed, and by the wisdom of his word. And, gentlemen, in those days when that fearful contest was raging, he was not the only physician, who linked his fate to that of his bleeding country. There was Shippen, and Thacher, and a host of others connected with the medical department of the army; and Brooks, one of the heroes of Saratoga; William Bradford, and Lee; and one, whose burning patriotism equals whatever Grecian poem sings, Joseph Warren, one of the martyrs of Bunker Hill. This love of country and of humanity, thank Heaven! still glows as warmly as ever in the bosom of our profession. Who was he, for whom the nation is still grieving, who braved the rigors of an Arctic winter, in quest of those who had on him no other claim, but that God had given to them the same form—was he not a physician ? Did he not be- long to us, who forsook a loving family and dear friends, to grope in sunless days, amongst ice-bound fields, in search of lost human beings—did not he belong to us, the bold, the chivalric Kane ? And when but a short time since a neighboring town was afflicted with that dire pestilence, saw you not how kindred, interest, all was forsaken, to go to the relief of suffering 28 brethren in that plague-stricken city? All honor be to those heroes, who, for naught but the love of their race, flew thus into the jaws of death. From Maryland went Morris, Fliess and Booth; from Pennsylvania, McFadden, Worl, Smith and Meirson; from New York, Fredericks, Freer, Schell and Robinson; Virginia sent her Carter, Gelbardt, Blow and Gooch; Louisiana her Stone, Fenniston and Jen- ner; South Carolina her Skrine, Holmes, Rich and Wil- liams ; Georgia her Godfrey, Bignon, Nunn and Donaldson. And in those frightful scenes how they labored, how they soothed, how they comforted! In the forlorn and almost desolate streets of Norfolk and Portsmouth, from which every human being that could, had fled; in mansions and in the dreary wards of hospitals, filled with parching forms and fiery eyes looking up to them for relief; at the grave, where bodies were hastily hurled or heaped in layers, and to which no relatives came to perform the last sad rites: we see them encouraging and directing dispirited friends; nursing and relieving those whom fever heat was consuming:—we see fathers looking to them to restore their children; infants clinging to them as if in search of their lost mothers. Was there ever truer valor ? Was there ever greater contempt of death ? We speak of a Hollan in admiration, the intrepid youth, who, at his captain's bid, stood to his post, firing the death-knell of his own and his noble vessels fate:* the whole world, not long since, rang with applause at the sight of squadrons plunging with cheers into the mouth of flaming batteries. Who doubts their courage ? Who will refuse to shed a tear over the watery grave or the cold sod that covers their gallant forms! Yet was theirs a heroism greater? Which requires higher courage, to do a bold act in the enthusiasm of a moment, or to stand, by your own choice, for days exposed, cool and collected, when death, with a ruthless hand, is striking down at your side your brethren * The Arctic's. 29 and comrades ? Friends, let us not murmur that so many of them fell victims to the pestilence; a higher power had determined that, but let us treasure their virtue, and their manly self-devotion. In that lone graveyard at Portsmouth they lie buried. A few small sticks planted irregularly, with names roughly carved on them, is all that marks their graves. Noble trees spread out their boughs to shield their remains, a silvery stream whispers its quiet requiems over their dust; but no monument erected by man, tells of their courage, of their devotion, of their heroism, of their death. If those for whom they sacrificed their lives, have been so unmindful of the honors due them, let us, their brethren, throw laurels on their memory, for they have deserved it of their profes- sion, of their country. Humanity is indebted to a physician of the last century for the mitigation of that scourge, small-pox, by the discov- ery of the protective powers of vaccination. When Jenner was twenty-one years of age, we find him studying with John Hunter; a master well worthy of such a pupil. The genius and exalted nature of Hunter made so lasting an impression on the mind of the young student, that to the day of his death he never mentioned his name with- out emotion. He used to call him the " dear man," and let no opportunity pass to speak of his honesty and warmth of heart. The biographies of Jenner contains quite a lengthy correspondence between him and Hunter, which well ex- hibits their traits of character and pursuits. Most of the letters are on subjects of natural history; at times, Jenner writes to him about his cares and troubles. Yet I do not think he did this often. Lofty as wTas the soul of Hunter, he was too absorbed in his scientific investigations, to think much of the ordinary pleasures or disappointments of life. When Jenner was unfortunate in a matrimonial engagement, into which he had entered, Hunter writes to him—" I own I was glad when I heard you were to have been married to 30 a woman of fortune; but let her go, never mind her," and then immediately continues, " I shall employ you with hedgehogs, for I do not know how far I may trust mine." But Jenner's nature was not such that he could console him- self for every grief, by the study of hedgehogs, or of any other subject. He was not cast in so stern a mould as his friend John Hunter. A shade of pensiveness and sorrow was at times in his noble face, which bespoke a delicacy and depth of feeling, more than common. He was a man with a woman's heart; who commanded love by his tenderness and kindness, and respect by his benevolence, talents and accom- plishments. At times, as all men of such fine feelings are, depressed and gloomy, he was at others one of the liveliest of companions. It is said that his conversation was so charming, that people would accompany the delightful coun- try practitioner for twenty or thirty miles in a morning, to hear him talk. Occasionally Jenner composed poetry, partly for his own amusement, and partly for that of his patients. Some of his serious pieces show the poet-naturalist, who paints perhaps too faithfully in verse, the objects he observes in his daily rounds. Of his fugitives productions the following may serve as a specimen. It was sent with a present of a couple of ducks to a convalescing patient: " I've despatched, my dear madam, this scrap of a letter, To say that Miss------is very much better. A regular doctor no longer she lacks, And therefore, I've sent her a couple of quacks." It is not, however, as a poet that Jenner's name will descend to posterity. His brilliant mind seized hold, when young, of the traditions amongst the country people about the shielding agency of cow-pox; and he remained faithful through life to the determination he formed, to ascertain their truth. He commenced his inquiries, when yet a stu- 31 dent of medicine, but it was only after many, many years of arduous study and experiment, that he passed the vaccine virus from one human being to the other, and ascertained clearly its protective properties. On the 14th of May, 1796, was the birthday, as a modern writer happily expresses it, of Vaccination. The discovery met with strenuous opposition. Clergymen and physicians alike denounced it. His friends, fearful it mght ruin his reputation as a man of science, advised him not to publish his observations: his enemies caricatured him as riding on a cow. Notwithstanding all ridicule, vaccination found its way, and with its introduction came a reaction of feeling in favor of Jenner. Parliament voted him the sum of £30,000. Addresses of thanks were showered on him. Among them we find one from the Chief of the Five Nations, containing this elevated passage : " We shall not fail to teach our chil- dren to speak the name of Jenner, and to thank the Great Spirit for bestowing upon him .so much wisdom and so much benevolence." All the praises and just rewards Jenner received, did not in the slightest way affect his lovely, modest character. To the day of his death he was the same kind, generous being, as had been the country practitioner at Berkeley. We admire the student Haller; wre may esteem the gifted Cullen; but we must love the pure, the noble William Jenner. The discovery of vaccination was the glorious finish to the additions made to medicine by its faithful followers dur- ing the last century. Gone, long gone now, are all those eminent cultivators of our science.—If in the course of these imperfect sketches of the lives of a few, I have not failed in showing you with what kind and benevolent feelings their hearts throbbed; if I have succeeded in pointing out the industry and glowing love of science that animated them; if the esteem in which the distinguished of all nations have 32 held these departe* representatives of our art, has become clear to you; happy indeed shall I be ; for the dignity and responsibility of the calling you have chosen, must then be- come deeply engraved on your mind. If, further, we have witnessed how the onward course of medicine has been at times checked by too great a love of theorizing, and how invariably progress has followed persevering experimental inquiries; ought not that to determine us to keep clear of those quick-sands on which more than once our science has almost foundered ! And, gentlemen, in this respect, we are decidedly in advance of our forefathers. The spirit -of Modern Medicine is not one that dreams of facts, or loves wild visions of their significance. It needs not a prophet's eye to see that we are living in the dawn of a day, when medicine is approaching in its exactness other branches of natural science. The morning rays of the same sun that shone on Galileo and Newton, are now dispelling for us the mist of previous ages. All. recent researches are charac- terized by an accuracy and a seeking into nature, which was in former days only exceptional. Men speculate less, and observe more. And if there be even now, some disposed to resort to unwarrantable generalizing on facts, accumu- lated with so much toil and care, let us pray, that Modern Medicine may, like the infant Hercules in its cradle, stretch out its baby arms, and crush the serpents that would poison and destroy its young existence. ■