SUNDRY PAPERS ON MEDICAL EDUCATION, &C. BY CHARLES FISHBACK, M. D. 1859. INDIANAPOLIS: ELDER & HARKNESS, PRINTERS. 1859. SUNDRY PAPERS ON MEDICAL EDUCATION, &C. BY CHARLES FISHBACK, M. D. 1859. a,. PREFACE. Medical Education—or perhaps, more accurately, the education of phy- sicians and surgeons—has occupied greatly the attention o.f numbers in the profession for several years past; as has been clearly evinced by the dis- cussions in our Medical Associations—state and national—and in many of our medical periodicals. The feeling has become almost universal in the profession, that radical errors and defects attach to the prevalent system of preparing those who propose to practice the healing art, for assuming its responsibilities: and it is highly honorable to the profession that it is very generally pervaded by an earnest longing for essential reforms. At the same time, it is not to be disguised that there is in the profession a class, not inconsiderable in num- ber, and potent—frcm talent, learning, and position as public Teachers— in influence, who steadily resist all attempts at reform—not absolutely de- nying the existence of defects or errors in our system of instruction, but rather decrying efforts at reform as premature—impracticable now—and treating them as the suggestions of restless mal-contents, atrabilious grum- blers, visionary enthusiasts, pestilent agitators, and actual enemies—though perhaps, undesignedly so—to real improvement. They warn the advocates of reform that " It is easier to pull down than to build up," and point to the names of the renowned men of the past generation who developed the ex- isting system—to infer thence, either, the perfection of the system, or a captious spirit of detraction on the part of those asking for reforms towards the illustrious dead, whom these reformers, no less than their opponents, honor for their true greatness, and reverence for their professional and manly virtues—and, indeed, triumphantly claim their noble example in im- proving on the system which they found in vogue in their day, as a war- rant for manly effort to improve the existing system. The author of the following papers—who has borne his part in the dis- cussions of the subject in his limited sphere, has been induced by several considerations to publish them in the present form. 1 I 1. By the transcendent importance of the subjects discussed, to not only the medical profession, but also the entire community; who are—even more than the profession—interested in every effort to raise it to the high- est degree of perfection attainable. 2. By the belief that one great cause of the barrenness of practical re- sults from past individual and associated efforts on this behalf, is to be found in the limited and partial investigation—usual in the hurry of an- nual meetings of large bodies of professional men, absent from their homes and business, and anxious to return—of subjects having many difficulties intrinsic and extrinsic about them ; and, 3. By a desire to contribute his mite towards the general investigation and elucidation of the questions involved, prior to the meetings of the Con- vention of Delegates from Medical Schools—and of the American Medical Association, to occur in June next, at New Haven, at which this will be a prominent topic of discussion—which it is most earnestly to be hoped will result in great practical good. The author does not pretend to have exhausted the subject, but only to have glanced at the more prominent points. Nor does he claim infallibility for his views. He holds them from a profound conviction of their truth, after long and patient study, and with some experience as a student, and as a private teacher. He asks no one to adopt them on any other ground than a full persuasion of their correctness. His highest wish will have been attained should their publication be found to promote a thorough and candid examination of the subject, and an earnest purpose to pursue stead- ily the course which sound reason may indicate as most efficient for the speedy attainment of a standard of Medical Education in our country, commensurate with the just claims of our noble Profession, and the wants of suffering humanity. CHARLES FISHBACK. Shelbyville, Ind., July 12, 1859. REPORT OF 1857. The following Report on Medical Education—made to the Indiana State Medical Society in May, 1857—was written hurriedly on a steamer while journying unexpectedly, but imperatively, to a distant State, and was not received by the Secretary of the Society until after its adjournment. Con- sequently, no action was taken on the resolutions appended to the Report— and for tins reason also, they were not published iu the "Transactions" with the Report. The Committee of the Indiana State Medical Society, appointed at the annual meeting m 1856, on Medical Education, beg leave to report as fol- lows, viz: l While it is matter of sincere congratulation with every true and worthy member of our noble and beneficent profession that the proper education of its members, both as to the standard of general and of professional edu- cation, and the best means of securing it, has enlisted so powerfully the attention of so many of the best minds of our age and country ■ it is also matter of deep regret that the discussion has resulted, as yet,'in go'little tangible substantial improvement, in either elevating the standard or in 3 providing a more rational system of medical education. It is nevertheless true, that very much good has been done in the investigation and partial exposure of the defects of the one, and the errors of the other. And your Committee cannot forbear expressing the opinion, that one great reason that no more has been accomplished, is found in the controlling influence that prominent teachers in our profession have exercised in the discussion. For, it is believed that many considerations influence them to more partial views of the subject than others equally qualified to judge. Your committee, regarding the subject as one of vital importance to the profession, have given it much consideration ; and while it is impossible for them, in the limits of this Report, to discuss fully the entire subject in all its relations and bearings, they propose to glance briefly at some of the considerations which, they think, call upon this Society to take an out- spoken and decided stand in favor of a high standard of medical education, and a rational system of means for its attainment. In doing this, they must necessarily bring under review the present prevailing standard and sys- tem. If in their progress they should seem to use any roughness, let it not be forgotten that the true surgeon is never deterred from a thorough explo- ration of an injury, however harsh to the unprofessional bystander, or even the patient, some of his most valuable means and methods of investigation may appear. The first consideration which they mention is, the auspicious circumstance that we have no organized, operative manufactory of medical diplomas in our State to contend with—and therefore can come to the consideration of the subject free from this most dangerous trammel to fairness—that we will have merely to construct, and not to reconstruct, a system of medical edu- cation. But it is mainly in the high claims of humanity upon our profes- sion, in the noble and beneficent position it assumes to occupy towards the afflicted, that we find the most weighty considerations for the adoption of a high standard and a rational mode of medical education. In order to bring these considerations to bear, we must view somewhat narrowly the present standard, in comparison with a proper one—and examine closely the pres- ent system in camparison with a rational one. We may safely assert that no other profession requires either so high or- der of talent or so great degree of cultivation of it, as the proper practice of medicine and surgery. Yet what multitudes enter the profession with but a very small amount of either! Your committee believe that the day cannot be remote, when reformation m medical teaching must and will be effected. The progressive spirit of the age has already done much for the improvement of our noble profession. But the love of money—the indis- position, so common, to labor for that which does not produce an immediate return in coin—the seemingly innate thirst of men for humbuggery—and the superlatively complex character of medical science, have conspired to prevent medical teaching from receiving that benefit from the advancing spirit of the age which has accrued to the literature and the art of the pro- fession. The difficulties in the way of reformation are certainly numerous and great—perhaps beyond our conception—yet every ennobling senti- ment of the profession demands that they be diligently sought out, encoun- tered with determination, and completely vanquished. The numerous isms, specialties, and even burlesques of systems of the profession are slowly and unintentionally, but certainly, preparing the way for reformation; and your committee are persuaded that many of the best minds of the profes- sion are sighing, " God speed the day !" Such will not always remain si- lent. Though oppressed with other more immediate, and therefore felt necessary labors, they will, after awhile, speak out in tones not to be disre- garded, demanding at least equal educational facilities with other profes- 4 sions. These should encourage and emulate each other in their efforts to discover and lay bare the causes of the existing state of things, and to point out and apply the appropriate remedies. In the further prosecution of the subject, your committee propose to con- sider: 1st, the present condition of Medical Education; 2d, the causes thereof; and 3d, the remedies therefor, including time and mode of appli- cation. . . 1. The present condition of Medical Education. Is it rational i Is it what we wish it were ? Is it not just what we permit it to be ? The first unsound point in the current system, to which your committee would direct attention, is one of fundamental importance, viz: The entire want of care in the selection of candidates for the study of the profession. The peculiarities of mental endowment, usually govern parents and guar- dians in the choice of the legal or clerical profession, or one of the numer- ous trades of life for their children or wards, but seldom is thought of with respect to our profession. In truth, there is too much foundation for the charge, that " Doctors are usually made of the refuse children," i. e., of such as are not likely to succeed in other professions, or even in agricultural or mechanical pursuits. No other profession or pursuit affords freer scope to the very highest powers of observation, of analysis, of reasoning, than ours. None demands a larger amount of common-sense, practical talent. Genius, in the ordinary sense of the term, will find here but little scope. Theoret- ical medicine may furnish fields for the display of genius, the creative powers of the imagination; but practical medicine, judiciously pursued, demands close, patient, persevering observation, and rigid, logical induction. The prevailing professional sentiment, as well as the popular opinion, must undergo a material change, before our profession can command the talent necessary to make professional education what it should be. In other words, we must have suitable timber. 2. This suitable timber must be thoroughly seasoned, before it is wrought into professional form, i. e., preliminary education must be thorough and complete. What multitudes enter the profession, without any adequate stock of general, or professional knowledge, or discipline of the mental powers! And it is probable that no other single defect operates more ex- tensively to the detriment of the profession, than want of mental discipline— unless it be want of conscientiousness. In the almost infinite variety and relations of the functions, physiological and pathological, of the human frame; ;n the frequently obscure, and often contradictory symptoms pres- ent, an . the large number and great diversity of the remedies from which to select, sharp powers of observation, and of reasoning, a sound, well- poised, self-reliant judgment, with familiar knowledge of anatomy, physiol- ogy, pathology, materia medica, and therapeutics, are indispensable to the well equiped physician and surgeon; and just here, it may not be out of place to intimate the belief, that it is because the people cannot detect and expose deficiencies of this kind, that so many incompetent men fill the ranks of our profession. These indispensable traits and equipments of the true physician, cannot be obtained without thorough, and previously ac- quired mental discipline. Yet, students are too often allowed to enter on the study of medicine with little or no more preliminary education, and of- ten with less than if about to enter a grocery store. And while your com- mittee rejoice in being able to refer to a resolution of this Society, amongst its very first acts, imposing on its members the " duty to discourage young men from the study of medicine, who have not the ability, tkc."—see page 9, of " Proceedings of the State Medical Convention of Indiana," for 1849— they cannot forbear expressing the fear, if not the conviction, that this res- olution is practically disregarded by some of those members of the Society, 5 whom, for their general devotion to the interests of the profession, your committee delight to honor, whose erroneous example will therefore prove the more pernicious. 3. Professional education, properly so called, is both defective and erro- neous in many particulars. The time appropriated to its attainment, is far too limited. The schools, or, more properly speaking, the money mak- ing machines, into which far too many of our medical schools have degen- erated, pretend to require' two years of study, prior to attendance upon their lectures and dissections; but who has heard of an inquiry on the sub- ject, of a candidate for matriculation, in the last ten years? And who is not aware that many commence the study (so called) of medicine, by atten- dance on a course of lectures ? But the time is too short, were it rigidly required, and even industriously and judiciously employed. No man can secure a good knowledge of anatomy, physiology, pathology, materia med- ica, and therapeutics, principles of diagnosis, obstetrics, medical chemistry, pharmacy, and medical jurisprudence in three years, how diligent soever he may be. And your committee do »ot hesitate to assert, that the more faithful the student, the more sensible will he be of the insufficiency of the time, even at the end of a four years course of study. But again, the mode of study, if mode that can be called which has no system whatever, is utterly irrational. With confessedly the most intricate, complex, and we may add, uncertain, of all the sciences, and the most dif- ficult of all the arts for his study and practice, the student usually enters a physician's oflice, has access to his books and a few medicines—is, perhaps, advised somewhat respecting his reading—occasionally sees a case of" disease or an operation, or more properly speaking, sees the subject of the disease or operation, for he has not the requisite knowledge to enable him to ob- serve the one or the other to any purpose; and in a majority of cases, this constitutes the sum total of instruction received in the office. Could there be a more palpable perversion of language than to call this instruction ? Are ministers, or lawyers, merchants or artizans of any kind made by such instruction? Not less objectionable, if not indeed more reprehensible, is the course of instruction, so called, in our medical schools. Here, from 100 to 500 stu- dents—as many as possible, for the greater the number the more money is made—are collected, and without regard or inquiry respecting their pre- paration for attendance upon lectures, and without classification according to the stage of study in each individual case, they are shown the way to the different lecture-rooms. If they choose, they may hear daily six lectures of about fifty minutes each, for a period of from six to twelve or fourteen weeks, on as many different topics, in crowded rooms, either too hot or too cold, and with but a single daily intermission of two hours. Is a knowledge of any other science obtained in such a manner ? And what are the lec- tures ? Instruction prepared by the lecturers and not elsewhere attain- able ? Why, no! Ninety-nine hundredths of it all can be found, equally as well expressed, if not better, in the various text-books of the profession. Not a single teacher has the time, in the four months term, to even gallop over the ground belonging to his department. Very much matter of equal importance to that exhibited to the class, is necessarily omitted, and much more is so hastily run over, that but feeble impressions of it are made upon the student's mind, and those feeble impressions are necessarily confused and often erroneous. Four of these lectures follow each other in succes- sion before the dinner recess of two hours. Wearied nature demands all of this recess for rest and refreshment, allowing no time for arranging the matter of the lectures, and still less for properly digesting it. The same may be said of the supper recess. Then follows three hours in the dissect- 6 in" rooms, usually in the midst of filth, surrounded by noise and confusion, each student is associated with several others in the order of matriculation, who may or may not—most generally the latter—care a groat for any ben- efit they may derive therefrom, save making the entrance to the green- room, to which it, or the $10 it costs, is the key. And a single demonstra- tor to half a dozen or more of such classes! Of these demonstrations m either the dead-room or the lecture-room, the most that can be said, is, that they are a clumsy'farce—of little or no advantage to either professors (ex- cept the dimes thev put in their pockets) or pupils, and bringing serious dis- advantages to the "latter, among which may be mentioned deceiving them into the supposition that they are acquiring a) knowledge of the_ science of medicine, the waste of their time and money, and the formation of bad habits of study and observation—all leading necessarily to superficiality ol attainments and to irrational routinism in subsequent practice. And, lest self-culture, under the guidance of common sense, might release the student from this slavish bondage, the chains must be riveted by the requirement of attendance upon a second course of lectures, which are yet not indeed another course, but merely a repetition of the first, after an interval 01 twelve months! The so-called quiz of second course students is little else than a farce, for it is notorious that the idle, if possessed of sufficient non- chalance and a certain pertness, succeed equally with the most studious. The same may be said of the green-room examinations, as also that the graduation fee of 625 or $30 blinds to many and great defects, and largely aids in imposing on the community a host of unqualified physicians and surgeons, who, though often conscious of their defects, have yet neither the moral courage to confess them, nor the mental vigor to remedy them; and following the example of not a few professors, they degenerate into respect- able quacks or undisguised mountebanks. Finally, our system of instruction in medical schools is based upon the idea of the " almighty dollar " as its chief corner-stone, and is, therefore, rotten in a vital point. Hence, the first object is to get a class, and the schools have vied with each other, not in giving the greatest possible amount of professional instruction in a given time, and at a given cost, but in enticing the largest number of students into their respective halls. Hence, a few weeks' attendance often passes for a full course, provided only the full course is paid for. Hence, also, almost every candadate for the degree is graduated. The examinations having degenerated into a mere form, each institution easily satisfying conscience with the plea that its examinations are as rigid as its neighbors', and cannot be more without driving students to other and no better schools ! Our code of Ethics beautifully says of practitioners—and the remark is equally applicable to teachers—"Medicine is a liberal profession, and those admitted into its ranks, should found their expectations of practice upon the extent of their qualifications, not on intrigue or artifice." What a dif- ferent state of things would soon exist were this precept faithfully observed by all our profession ! To be sure, they do occasionally, in each lecture term, denounce " quackery " and compliment orthodoxy; but expressions of this kind so evidently belong to the order of " soft soap," so lavishly used by dealers in small wares, that they have no weight whatever. Place distinctly and honestly before the students of our medical schools, the time nature of our profession and the proper objects and motives of its pursuits, and your committee hazard nothing in saying that three-fourths of them will confess to themselves, if not to their fellows, that such considerations never entered their minds. Hence, more than from all other sources, flows the almost resistless torrent of real empiricism (in the garb of true orthodoxy) and distrust of scientific medicine that is sweeping over our 7 land, and driving in disgust from the profession many of its brightest orna- ments—exalting not a few of the baser sort, and entailing debility of con- stitution, actual disease, and deformity or death upon multitudes, at a cost far greater than sufficient, if properly expended, to qualify and support a number of competent medical men equal to the wants of community. But we are admonished to pass on tothe consideration of the remedies for this confessedly deplorable state of medical education. The subject has been much discussed of late years; and although it is thus shown to be a matter of great interest, and though many good suggestions have been made in the course of the discussion, no satisfactory system of measures for the removal of the evils, has yet been devised. This result your committee regard as attributable mainly to two causes: 1. To the want of a rational, practical,-common-sense investigation of the whole subject, untrammeled by existing modes and means of education, and looking to fundamental reform rather than to mere patchwork; and 2. To the opposition of the existing medical schools, energized as it is—often, no doubt, unconsciously—by pe- cuniary and professorial interests, and supported as it is by the fast spirit of the age, to the adoption of a more rational system. " Young America " is not willing to plod along the slow and toilsome way marked out by sound reason, but is bent on rushing into the practical arena, regardless of the necessary (on their plan) absence of qualification for its responsibilities and duties; and we are sorry that we are compelled to say that profes- sional teachers yield far too much to this fast spirit of " Young America." What are the requisites for the proper discharge of the weighty respon- sibilities and arduous labors of the practice of medicine and surgery ? And how can these requisites be best attained in a reasonable degree ? Proper answers to these two inquiries will, your Committee think, indicate the kind of education demanded by the interests of the profession and of the people, and also of the best method of securing it. The first indispensable requisite in the physician is good mental endow- ments, combined with at least fair physical powers. In mental endow- ments we include intellectual faculties, both perceptive and reflective, and the moral sentiments; and by good mental endowments, something above mediocrity, and the more above, the better. Inattention to this point con- stitutes the first and one of the greatest defects in the current system of medical education. It is as if rotten limestone were used for the founda- tion of an immense granite superstructure. A few minutes consideration of the extensive range of scientific study required, and the superlatively intricate nature of the science of Life, Health, Disease, and Remedies, practically, and not abstractly, must satisfy any reflecting mind that a man of ordinary mental endowments can never attain respectability in the pro- fession, if the proper tests thereof are fairly applied. Fair physical powers means the ability to endure the irregular labor, repose, meals, exposure to vicissitudes of weather and temperature, and, above all, the severe intellec- tual and emotional efforts inseparable from the proper discharge of profes- sional duties. The second requisite is the thorough training of the mental endowments and physical powers to such degree as will fit their possessor for their prompt, skilful, and sustained exercise in any and all emergencies. The safety of life, of health, or of limb, often depends on the possession of this requisite. And, alas, how often is the one or the other sacrificed to the want of it in professional men! The considerations already referred to in proof of the radical necessity for good mental endowments, show still more conclusively, if possible, the importance of this second requisite. The third requisite is such full and thorough instruction in the science and practice of medicine and surgery, and the collateral sciences, as will 8 make the student complete master of the great principles of the science, and give him a degree of expertness in their practical application to the detaifs of the " ars medendi." Few, if any, respectable members of the profession will dispute the correctness of these views. But when we come to consider how these requisites can best be attained, considerable disagree- ment may be found to exist, and it becomes us, by a careful study of the whole subject, in the exercise of a spirit of liberality towards those who differ from us, to aim at the discovery of the truth, for its intrinsic value, and as a basis of greater unity of sentiment and concert of action amongst the members of the profession. The first of these requisites can be secured only by firmly rejecting from pupilage candidates of inferior mental endowments or physical powers. This will be found more difficult of accomplishment than would seem proba- ble at first glance. For you must first ascertain the want of this requisite by the candidate, and then convince him of the fact, not only in opposition to his self-esteem, but also in opposition to the fixed purpose of himself or his advisers that he shall and will be a doctor. The second requisite may be secured only by a long course of hard study. The length of time may vary in difierent cases, but several years, at the least, are necessary to the formation of fixed habits of close observation of facts and principles, and rigid logical induction. No other profession pre- sents subjects for investigation surrounded with like inherent difficulties, nor does any other afford so numerous or great opportunities or temptations for partial and defective observation and fallacious reasoning. The funda- mental principles of the science of theology and of law are plain and easily understood, and are uniform in their manifestations and application. Not so in our profession. The subtile principles of Life, in its endless variety of manifestations, influenced by innumerable surroundings—some obvious in their influence, but many more, obscure—and by the more mysterious action of mind and emotion, are the subjects of investigation, not only in their normal and regular, but also in their abnormal and irregular condi- tions. Thus, while the true physician is the fittest representative of the highest style of profound ratiocination, the poorest reasoner may pass amongst the unprofessional as respectable. The first resolution of the Committee on Preliminary Education in the American Medical Associa- tion of 1847, although looking in the right direction, evidently falls short of the mark. Mental and Moral Philosophy, Botany, Natural History, Inor- ganic Chemistry, Geology, Zoology, and ability to read freely the Latin and Greek classics, or, better still, some of the best scientific and profes- sional works in those languages, and speak the French and German lan- guages, ought to be added to their list, in order to afford the mental train- ing necessary to insure the promptness, skill, and perseverance in the use of the mental powers, and of the materies medendi, almost daily required of the true physician and surgeon. This requisite cannot be generally se- cured_ until a public and professional sentiment shall have been created de- manding it, which, we must confess, does not now exist; and if we act on the principle of " taking things as we find them," never will exist, unless we adopt that other principle, that we must constantly strive, with all our might, to make "things" what they should be. Let us exercise common sense, and the characteristic benevolence of our profession, in the thorough and repeated discussion of the matter, both in and out of the profession. Let us candidly acknowledge our deficiencies, and do all in our power to lessen those of our immediate successors, by straining the standard as hi«h as possible for every student coming within the reach of our direct or indi- rect influence. By pursuing such a course, we will induce the public to demand a higher standard of mental culture for medical men, and the de- 9 mand must precede the supply. Here we want education rather than in- struction; mental development primarily—instruction AS A means of mental development. The third requisite can be easily secured by a rational course of study, of three or four years' duration, by one who possesses the first and second requisites, and by none other, however long the period of professional study. When we consider the great number of organs in the human frame, the entirely concealed position of the most important of them, their numerous and complex relations and dependencies, their individual, relative, and combined functions, and the external agencies affecting them; the varia- tions, congenital and acquired, of the life-force in different individuals; he- reditary influences; the numerous subtile and latent causes of disease; the almost infinite variety of remedial forces and agents; the Protean forms and vague character of diseased manifestations, &c, &c, it must be obvious that we have not named too long a period of time for professional study. But this course of study must be a rational one ; and we proceed to indicate what we mean by that term. There should be a thorough study of but one or two subjects only, for some time, say Anatomy and Physiology as one, and Materia Medica, Med- ical Chemistry and Pharmacy as another. The student should carefully read the best text books; examine as much as possible the dead and the living subject; learn by actual inspection the natural and physical proper- ties of the Materia Medica, and perform chemical experiments. On all his studies he should be fully and closely examined by the preceptor—daily, if practicable. After sufficient progress is made in these branches, add Pa- thology to the one and Therapeutics to the other. Still later, at appropri- ate periods, add Institutes of Medicine and Medical Jurisprudence, Prac- tice, including Obstetrics and Diseases of Women and Children, and the principles and practice of Surgery. Let the student have a preceptor to guide him in his studies, to examine him, aid in raveling intricacies as they arise, and instruct him in the details of practical diagnosis, dressings, and pharmacy, for the first year alone; and in conjunction with the lecturers during the last three years of study. Let us have a Medical School, entirely and amply supported by the State, and open to all her citizens, possessed of suitable preliminary qualifi- cations, free of charge. Let it be as fully manned with teachers as you please, but with only two, or, at most, three lectures daily, of one and a half hours each, preceded by half an hour's real examination of the students on the subjects of previous study, with the application and use, by both teach- ers and pupils together, of all the dressings and instruments used in surgery. Let the lecture term consist of not less than nine months in the year, and three terms constitute a course ; i. e., let each professor occupy nine months in each year, for three years, in going consecutively through his depart- ment, devoting, say one-third of the last term, to a review of the whole course. The time of the students out of the lecture room should be dili- gently employed in the study of the subject-matter of the lectures—prac- ticing the application on each other of the various bandages, splints, &c, &c, preparing medicines, and filling prescriptions. Clinical practice, either in hospital or private practice, or both, should be seen and participated in, during the last year at least. Then let us secure some such legislation as this, viz: Let the State Medical Society choose a Board of seven medical examiners, from men eminent in the profession, not residents of the State. Let the Board meet at the capital once or twice annually, for the public, oral examination of all candidates for the future practice of medicine and surgery. Let certificates be issued to those found to possess the necessary qualifications, authorizing them to practice the profession, and allow none 10 hereafter to enter upon the practice without such certificate, under heavy penalties. Such, your Committee regard as a rational course of preparation for the practice of a profession vastly more intimately related to all the earthly interests of the entire human family than any other. And they cannot believe it, in all its essential features, either unattainable, or attainable only at some remote period, unless the members of this Society, and other worthy members of the profession in this State, prove derelict of duty. Shall we go to work rationally and energetically, determined to attain so_ desirable and so glorious a result ? Or shall we sit down, fold our hands, sigh at the magnitude and glorious character of the object, wish it were attained, and put forth no rational, great-sustained efforts for its attainment ? The old system, irrational as it evidently is, will struggle hard for life. Many who live by the craft, will cry out as of old, under similar impulses, " Great is Diana of the Ephesians." And we may find some, who ought to be earnest coadjutors, wholly indifferent, if not actual opposers. But our noble pro- fession—noble in its nature, its origin, and its aims—degraded only by the unworthiness of its professed representatives—and poor, bleeding, suffering humanity call in trumpet-tones, and in agonizing wails, upon us to go for- ward, in the spirit of the " Great Physician," to the accomplishment of the glorious and beneficent work before us. Resolved, That in view of the immense importance of this subject, its thorough investigation be earnestly recommended to every member of this Society, and to all local medical societies in the State ; and to this end, Repaired, That an extra session of this Society be held in this city [In dianapolis], on the second Tuesday of January next [1858], and the two days following, for the discussion of this subject in connection with that of legislation—and that non-medical men of the State who feel interested, be cordially invited to participate in the discussion. Resolved, That a committee be appointed to address a circular to one or more physicians in each and every county in the State, urging the forma- tion of county or district societies—where such do not already exist—and the more perfect organization, and more efficient working of those already formed, and suggesting a closer union of all local societies with the State Society, in the hope thereby of more effectually " Maintaining union, harmony, and good government among the members of the professfon, and promoting its interests,-honor, and usefulness." Resolved, That it be earnestly recommended to all the members of this Society, to require of candidates for pupilage, good mental endowments, and preliminary education equal at least, to that recommended by the American Medical Association before cited—and also, more thorough pro- fessional qualification than merely sufficient to secure the diplomas of many of our medical schools. All of which is respectfully submitted on behalf of the committee CHARLES FISHBACK, Chairman. Steamer National, Red River, La., May 5, 1857. In the North American Medico-CMrurgical Review, edited by Drs Gross and Richardson, for July 1857, will be found an article on the " American System of Medical Education," coinciding remarkably with the views of this Report. At the same meeting of the same Society, in May 1857, " Dr. Jameson, 11 from special committee to memorialize our last Legislature, offered the Report of the Chairman, Dr. Fishback, and moved that it be referred with- out_ reading, to the Committee on Publication. Carried." See Transac- actions of 1857, page 8. This Report was not published in the Transactions, but is inserted here, on account of its bearings on the subject of Medical Education. REPORT ON LEGISLATION. The Committee of the Indiana State Medical Society, appointed at the annual meeting in May, 1856, "to urge upon the next legislature, the en- actment of such laws as may be requisite for the protection of the commu- nity from incompetency and recklessness on the part of practitioners of Medicine and Surgery, and the Apothecary's art," would report as fol- lows, viz: About the 1st of December, 1856, the Chairman of the Committee vis- ited Indianapolis, to confer with the other members of the committee, about the matter assigned to them. The result was, that several hundred copies of the following petition to the legislature and circular to physicians, were printed: PETITION. The undersigned, citizens of the State of Indiana, feeling assured that many persons utterly incompetent, are recklessly engaged in the practice of Medicine and Surgery, and the Apothecary's art, in this State, to the great injury of the good people thereof, hereby respectfully ask the Legis- lature to take the matter into consideration, and pass such laws as may be requisite for the protection of the community in this regard. December, 1856. CIRCULAR. Dear Sir :—The undersigned, a Committee of the Indiana State Med- ical Society, to urge upon the next Legislature, suitable legal enactments for the protection of the community from incompetency or recklessness in Physicians, Surgeons, and Apothecaries, respectfully ask your aid and cc^ operation, as follows, viz: 1. Place the accompanying petitions in the hands of some efficient per- sons, physicians or not, as you may deem best, in different sections of your count}-, with the request that they will have them presented to all the vo- ters in their several districts for signature, without delay. 2. Return the petitions by mail, with names of subscribers, to your Rep- resentative at Indianapolis, on or before the Tuesday next following the meeting of the next Legislature. 3. Secure the presence of as many of the educated physicians of your county as practicable, at a meeting at J. W. Gordon's Office, in Indiana- polis, on the evening of Tuesday, the 13th of Jan., 1857, for conference in reference to the details of this subject. CHARLES FISHBACK,) P. H. JAMESON, V Committee. G. W. MEARS. ) \ 12 A copy of each was sent to every member of the Society whose address could be obtained, and to some regular practitioner, in each and every county in the State. The chairman of your committee went to Indianap- olis at the time appointed, and met a, few friends of the cause. A special committee of each House of the Legislature had already been appointed, and to them the petitions numerously signed, had been referred. Your committee had frequent conferences with members of the legislative com- mittees, and two meetings with the committees of the two Houses—Hon. Wm. Grose, of Henry county, and Dr. Freeland, of Knox county, being their respective chairmen. Those committees were large, and contained a number of medical men, amongst the most earnest and laborious of whom should be mentioned, Drs. Freeland, of the Senate, and Todd, of the House, who cordially aided your committee. These conferences resulted in the development of two facts: 1. That a very general feeling prevails, both in and out of the profession, in favor of the expediency and necessity of some legislstive action for the protec- tion of the people in this regard. And 2. That no positive legislation could be expected at that session, on account of pre-occupancy of the minds and the time of the people's representatives with more engrossing and exciting topics of discussion and action. Your committee was less anxious for completed legislation at this time, than for a consideration of the subject, by the special committee of the Legislature, such as would lay the foundation for its discussion, both in and out of the profession—with a view to the development of a matured and correct public sentiment, professional and non-professional, before the meeting of another Legislature. Your committee was therefore entirely satisfied with the decision of the Legislative Committee—made, indeed, in accordance with the wishes and at the suggestion of your committee—to present a report, arguing, " That it is not merely expedient, but obligatory, under our Constitution, to provide for the safety and well being of the people in their limbs, their health, and their lives, against the ignorance of pretendedPhysicians, Surgeons, and Apothecaries, by legislation;" and to ask the printing, by legislative authority, of a large number of the Re- port for general circulation. A copy of it (1200 were printed by the two Houses) is appended to and made part of this Report. Neither jour committee nor the legislative committee could agree upon the details of legislation for the attainment of the object in view. The chairman of your committee presented a plan, the general principles of which he regards as just, philosophical, and ultimately practicable, if adop- ted after mature consideration, as he believes it will be by most reflecting men who will give it their full attention. It is appended hereto, and made part of this Report.^ The bill accompanying the Report of the Legislative Committee, and which was approved by a majority of your committee, dif- fers essentially from the plan named, and a copy of it will be appended hereto, if it can be procured. Your committee regret that it was not print- ed with the Legislative Report. Your committee would respectfully suggest that the Society adopt such measures as m its wisdom may seem best, to secure thorough consideration and discussion of the whole subject, by the members of the profession all over the State, and especially before the people. Your committee are fully persuaded that much of the necessity—confessedly urgent—for legislative action m this behalf, grows out of a failure, to a greater or less extent, in past time, on the part of members of the profession, individually, to en- deavor to enlighten the public mind respecting the mutual relations and dimes of medical men, real and pretended, and society at large; and, the best means of differential diagnosis of the two classes/by the Jublic; and, 13 also, to cultivate more highly than is generally done, an esprit du corps of the most elevated order—one having reference to the profession, as such, and not as a trade—nor to themselves as tradesmen. They therefore recommend the adoption of the following resolutions, viz : 1. Resolved, That the foregoing Report and accompanying papers, be printed with the " Transactions," and that one thousand extra copies of said Report, &c., be printed, separately, in cheap form, for circulation amongst the people. 2. Resolved, That every member of the profession in the State, be re- spectfully urged to give the subject earnest attention, and to lose no oppor- tunity to bring it to the notice of the people amongst whom they reside. 3. Resolved, That an extra meeting of this Society be held at the capital on the second Tuesday of January next, (and two following days) for the discussion of this subject, and that medical men of surrounding states, and non-medical men of Indiana, who may feel interested, are cordially invited to be present and participate in the discussion. 4. Resolved, That the newspaper press of Indiana be requested to devote a small space to this important topic, and that a committee of three be ap- pointed to prepare suitable matter for the press. 5. Resolved, That a committee of three be appointed to urge this matter upon the attention of the next Legislature. REPORT OF SPECIAL COMMITTEE OF INDI- ANA LEGISLATURE. In the House of Representatives of the Indiana Legislature, Feb. 27, 1857, " Mr. Grose, from the select committee on the practice of Medicine and Surgery, made the following Report: Mr. Speaker :—The select committee to whom was referred the many petitions, numerously signed, from various parts of the State, praying for the protection of the community, by legislation, against the ignorance, in- competency, and recklessness of Physicians, Surgeons, and Apothecaries, having maturely considered the subject, beg leave to report as follows, viz: They suppose it will be very generally conceded that no other interests reiatinf to the present life, can claim greater importance than those con- nected with health, whether considered in relation to individuals or com- munities; and whether the happiness, or the pecuniary interests of either the individual or community, are regarded. Infirm health, or distortion, or impairment of limbs, not only entails pos- itive evil upon the individual possessor thereof, and his immediate family— as every one well knows—but also diminishes his productive energies, con- sumes in his care the time and strength of his family and friends, and ab- sorbs in expenditure for medical and surgical aid, medicines, &c, much of the actual products of his own and his family's diminished energies; but, in addition to all this, contributes largely to fill our alms houses, prisons, and institutions for the deaf, dumb, blind, and the insane; thus at once les- sening the revenue of the State, which is derived from and proportioned to the°actively engaged productive energies of all the individuals constitut- ing the community, and increasing the expenditures of the State in mak- ing provision for those thus rendered unable to provide for themselves. 14 These positions need no demonstration, for they are patent to all observ- ant and reflecting minds; but they may be illustrated by individual cases, by our county poor houses, and hospital for the insane: e. g. G. II. and wife are persons of average physical power and industry. They com- menced life poor in worldly goods, and a rapidly increasing family, with not more than an ordinary amount of sickness, has kept them so. The spring has come—H. has rented a farm, and has well prepared the ground and planted his corn. While ministering to the wants of a neighbor, of the nature of whose illness he is not aware, and misled by an ignorant Doc- tor, he contracts small-pox, and before he is aware of it, has communicated it to his children. Being himself the first attacked, and having the disease in a mild form, through the influence of vaccination in early life, he does not become aware of its true nature until shown in his unprotected (by vaccination) family. Their cases occurring successively, require his con- stant care, until the season for cultivating his crop is passed : and, while he his rent to pay, he has no crop with which to pay it, or to sustain his fam- ily until another is made. This is no fictitious case, for it has actually oc- curred within thirty miles of this capital in the past year. Every entrance to the Insane Hospital is the result of disease or injury—and so, also, is al- most every admission to our Poor-Houses. Kqually palpable and undeniable is the proposition, that to qualify any man for performing beneficially to the community, the offices of Physicians. Surgeons, and Apothecaries, the possession of much and varied knowledge specially pertaining to these callings, is indispensably requisite. The bla-ksmith must serve a considerable apprenticeship before he can properly shoe a horse; the engineer a more protracted one, before he is allowed to run a train over our railroads; and the falls and river pilots must receive license to practice their respective callings, from those who are qualified to judge of their fitness. By our statutes, no one can teach in our common schools, uless he has first been examined by an officer appointed for that purpose, and received from him a certificate of qualification; and the min- imum of such qualification—" a knowledge of orthography, reading writ- ing, arithmetic, and English grammar"—is fixed by the statutes f nor is this minimum too great by any means. Now let us glance at some of the branches of knowledge indispensably necessary for the practice of Medicine, Surgery, and the Apothecary's art, in such a manner as will promote the good of community—in addition to any measure of general classical and scientific knowledge that is attain- able. 1. Anatomy, or the number, shape, situation, structure, and connection of all parts or organs of our frame, in which are more than two hundred bones, and four hundred muscles, besides nerves, blood-vessels,