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AN  ADDRESS
r rir. t'RtD bf.yony.
THE MEDICAL SOCIETY OF VIRGINIA.
;l &
TWENTT-H1STH AHN-UAL MEETING.   1
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HELD IX RICHMOND. APRIL lift!.
BY BEVERLEY R. WELLFORD, M. D r.T<
    Prfsident of thf. Society.
PUBI.TSHT-P r-T nRPEU OF THK
    R IV H M ONI):
I'^INTri) BY RITCHIE." *. DUNNAVAV
      18.V2. 
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AN  ADDRESS
DELIVERED BEFORE
THE MEDICAL SOCIETY OF YIRGI11.
TWEBTY-NINTH ANNUAL MEETING.
HELD IN RICHMOND, VA, APRIL 1852.
BY BEVERLEY R. WELLFORD, M. D. ETC.
    President of the Society.
I
PUBLISHED BY ORDER OF THE SOCIETY.
^
Liii;
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    RICHMOND:
PRINTED BY RITCHIE3 & DUNNAVANT.
       1852. 
( 
ADDRESS.
 Gentlemen,
                   The half of the nineteenth century which
 has just terminated is a remarkable^era.    Within that  brief
 space in the world's history, events have  occurred which will
 exert most momentous influences on the destinies of mankind
 throughout all coming  time.  Science  and art  and literature
 and enterprise have united in one  common cause,  and  have
 directed their energies, their attainments and their efforts to
 elevate the position and to augment  the comfort, prosperity
 and happiness of social life.  The researches of bygone  ages,
 which have been gradually approaching a truthful and perfect
 knowledge of the  rationale of natural  phenomena, appear in
 these our own times to have directed the results to the end
 and aim of all acquirement—a practical  and useful applica-
 tion to the business and necessities of man.   To this utilita-
 rian tendency, emphatically the character of the present age,
 everv art and every occupation is more or less  indebted.  In
 its  onward course it has touched every  employment of civi-
 lized  life, and it  has touched nothing which it has not im-
 proved.   To it agriculture  owes its cotton gin, its wheat ma-
 chines, its sugar apparatus and its other various appliances
 which have diminished the labor while  they have  increased
 the products of human industry:  commerce, its floating ware-
 houses, which successfully stem  the currents  of the boldest
 streams, invading even the dominions of the proud Niagara
 itself, or bear, with a celerity and precision formerly uncon-
ceived, the  treasures of the merchant to the uttermost parts
of the sea.  Machinery, so  skillfully prepared as to appear in- 
4
 vested with intellect, so perfectly does it perform functions to
 which in former days the human mind and human hands were
 supposed to be alone competent, converts the contributions of
 the three great kingdoms of nature into every variety-of fabric
 which is required to supply the wants or gratify the luxury of
 civilization and refinement.   Steam, in the  fearfulness of its
 power, has been made subservient to these and other purposes
 of equal utility, and curbed and controlled, like an  impetuous
 charger, obeys the wishes and performs the duties required by
 his conqueror.  In his bold and triumphant progress, the scien-
 tific utilitarian  has dared to seize on the material of lightning
 itself, and devote its powers to the dairy purposes of life.   By
 its agency he transmits his thoughts from one end of this vast
 continent to the other, and  annihilates both time and space by
 his knowledge of its properties, its powers and its laws.  The
 dazzling beauty of a theory or the  curious results of an ex-
 periment  are  no longer  sufficient incentives to the  scientific
 devotee; the cui bono is ever present in his  mind, and  until
 this, the impelling question of this matter-of-fact age is solved,
 all is regarded  as " weary, stale, flat and unprofitable ;" nor
 has the march of practical  improvement been more remarka-
 ble in any other art or science  than in that of medicine—a
 severe and accurate  process of investigation and of reasoning
 has superseded  the  construction of ingenious theories, based
 on brilliant conceptions rather than  on an  accumulation of
 well ascertained  facts.  The  imaginings of Brown  and  Cul-
 len and Darwin and Rush and Broussais  have withered be-
 neath the  stern process of inductive philosophy, and such of
 them as contained an alkaloid, have had it extracted, and the
 residuum has been cast " like a worthless weed away."   The
 modern medical  philosopher requires for his basis a  solid
 substratum of fact, or he knows that, like  the house built on
 the sand, the tempests of  demonstration will destroy his su-
 perstructure.   The doctrines of abstractions  and subtile es-
 sences can no longer survive the disclosures of the  knife and
 the microscope of the pathological anatomist,  and the day has
past when the medical world will tolerate  speculations where 
5
" nothing is, but what is not."  Nor has the practical improve-
ment of the age been limited to a more correct mode of rea-
soning.   New methods of diagnosis and of treatment have
been introduced,  and the eye and the ear now disclose, with
the certainty of perception, the  condition of internal organs
which was formerly surmised from vague and uncertain data.
Practical chemistry too has come to the aid of practical me-
dicine, and presented it with chloroform and the alkaloids, by
which  results are now accomplished, which, if predicted  at
the commencement of  the present century, would  have been
scouted as  the day dreams of a wild and  undisciplined en-
thusiasm.
   But whatever,  gentlemen, may have been  the progress of
our science within the period to which  we  have alluded;
whatever additional resources may have been placed in our
hands, and  however cheering may be the prospect before  us
of farther professional advancement,  it must  be apparent to
the candid observer of medical events, that many and serious
defects exist .in our system, which must be corrected, if we
would  assume and maintain that position in the world-wide
commonwealth of medicine, which philanthropy and profes-
sional patriotism alike  urge us to attain.   The  practical utili-
tarianism of the age  is perhaps not more clearly exemplified
by any other incident, than by the fact that these defects are at
this moment occupying the attention of many of the best and
wisest members of the profession in the Union, who are devoting
their energies to reform our system and to place American me-
dicine on the  same platform with that of the  older and more
mature nations of the other hemisphere.  The interest which
is felt on  this subject  has now assumed a tangible form, and
the present occasion is itself evidence that the profession  in
our own  state is  alive  to the necessity for action, and appre-
ciates the importance of a systematic organization, if we would
contribute our due proportion to the great enterprise of medi-
cal reform.   To  estimate correctly our real position, and to
give a proper direction to our efforts, it is necessary that we
contemplate calmly and  impartially the actual condition  of 
6
 medical politics, without permitting our self-love or spirit of
 self-laudation to deceive us,  by exaggerating our excellencies
 or depreciating our errors.   Let us then compare our standard
 with that of others, and if defective, let us not be appalled by
 apparent difficulties, nor  underestimate our powers to cope
 with and subdue them.  But if any valuable consequence is
 to result from our  efforts, it can only be attained by  united
 and systematic action.  Unanimity, however desirable, is not
 to be anticipated.  Local and  individual interests will,  in
 some instances, conflict, and direct the opinions and wishes
 of the interested  parlies ; but in the large majority, higher and
 nobler impulses will prevail, and the claims  of science and
 humanity will induce them to aid in an enterprise which,  in
 accomplishing a work demanded alike by patriotism, philan-
 thropy and  the usefulness and dignity of our calling, will pos-
 sess all the  advantages of military organization and discipline
 over the irregular and inefficient action of guerilla warfare.
   Considerations and influences such  as these led to the for-
 mation of the American Medical Association, and to the revi-
 val  and  more expanded  organization of the Virginia Medical
 Society.   The American Medical Association has, at its seve-
 ral annual sessions, wisely and boldly investigated the condi-
 tion  of medicine  in  the United States, with a  view to ascer-
 tain  the causes which impede its progress, and to suggest the
 appropriate  remedies.   The  present occasion may perhaps
 be most  profitably employed  in a hasty glance at its history
 and  progress, in an examination of its  action and of the best
 method of aiding its efforts.
   So long ago as the year  1792, the justly  celebrated Dr.
 Rush, one of the earliest and most zealous teachers of sci-
 entific medicine in this country, attracted the attention of the
 profession to the  necessity of a high standard of preliminary
 education, and on various subsequent occasions urged the im-
 portance to  a physician of an acquaintance with the various
 subjects embraced, not only in the limits of mere professional
 acquirement, but  in  the  education  of an accomplished and
well  informed gentleman.  From that period  to the present, 
/
the most eminent  men of the profession have advocated the
same principles, and in frequent public addresses, have insisted
on the necessity of improvement in this respect, not merely to
prevent the deterioration of American medicine,  but  to ad-
vance  its dignity  and usefulness.   All such monitions were,
however, unconnected and isolated, and of course  ineffectual,
until it became so apparent that medicine,  if not actually
receding, was at least not, like its  sister sciences, improving in
conformity with the spirit of the age, that the New  York State
Medical Society in 1845  " earnestly recommended a national
convention  of delegates from  medical societies and colleges
in the whole Union to convene in the city of New York on the
first Tuesday of  May in the  year 1846, for  the  purpose of
adopting some concerted action."  In obedience  to this call,
and at the time  designated,  about  one hundred  members
assembled, comprising the  most  distinguished  physicians of
 New York, and representatives from  nineteen states of the
Union.  An effort was  made  to  arrest further progress, but
 signally failed, receiving only two votes in its favor, and the
 convention proceeded  unanimously  to resolve—" That it is
 expedient for  the  medical  profession of the United Stales to
 institute a National Medical Association, for the protection of
 their interests, for the maintenance of their honor  and respec-
 tability, for  the advancement of their knowledge, and  the
 extension of their usefulness."  Committees were  appointed
 to report a plan  of organization for such an  association  at a
 meeting  to be held in  Philadelphia  in the ensuing spring, to
 prepare  and  issue an  address  inviting the co-operation of
 medical  societies and  chartered  schools in the United States,
 and for other  purposes connected with the objects avowed by
 the convention.  Resolutions were also unanimously adopted,
 declaring it " desirable that a uniform and elevated standard
 of requirements for the degree of M. D. should be adopted by
 all the medical schools  in the United States.  That  it is de-
 sirable that young men, before being received as students of
 medicine, should have acquired a suitable preliminary educa-
 tion, and that it  is expedient that the medical profession in 
8
the United  Sates should be governed by the same code of
medical ethics."  Various other subjects of interest were pre-
sented to the convention, which were acted on or  referred to
committees, and  the convention adjourned to meet in Phila-
delphia in May 1847.
   At the appointed time, near two hundred and fifty delegates
from  schools and societies of twenty-three slates, assembled
in Philadelphia.  A plan of organization was reported and
adopted, which asserts that " an institution so conducted as to
give frequent, united and emphatic expression to the views
and aims of the medical profession in this country, must at all
times have  a beneficial influence, and supply  more efficient
means than  have hitherto been available here, for cultivating
and advancing medical knowledge, for elevating the standard
of medical education, for promoting the usefulness, honor and
interests of the medical profession, for enlightening and direct-
ing public opinion in regard  to  the duties,  responsibilities and
requirements of medical men,  for exciting and encouraging
emulation and concert of action in the profession, and for faci-
litating and  fostering friendly intercourse between those who
are engaged in it."   This, gentlemen, is ihe announcement  of
the motives  and intentions of the American Medical Associa-
tion—these are its avowed principles and declared  objects—it
is for you  to vindicate or repudiate them.  Your present and
future action will  evince to what extent you sanction and will
sustain them—to  what extent you  respect its labors and will
promote its  wishes.   As a large and influential portion of the
great medical community of the United States, your approba-
tion and assistance are essential to the success of an  institu-
tion intended to  exalt and  dignify a profession with which
your prosperity and honor are intimately associated.  At this
meeting in Philadelphia, an elaborate and admirable code  of
medical ethics was reported and adopted, and able reports on
the subjects  of preliminary education and the standard of re-
quirements for  the degree of M. D. were presented and re-
ceived with cordial approbation.  The report  on preliminary
education advises the establishment of a uniform standard for 
9
medical students, which shall be of such extent as will ensure
both the knowledge and mental discipline necessary to those
who would enter a profession full of labor and responsibility.
It earnestly  recommends  every medical preceptor to exact
this standard of every young man before he admits him as a
pupil, and requests all the medical colleges of the country to
require of each student, who applies for matriculation, a writ-
ten certificate from  his preceptor, that he possesses the preli-
minary  qualifications required,  specifying also  the  period of
admission into his office.
   On the subject of medical education, a brilliant report was
presented by the accomplished chairman of the committee,
Dr. R. W. Haxall of this city.   It presents a fair, comprehen-
sive and  accurate view of the whole topic, and its  facts and
arguments are alike entitled to the highest consideration, and
afford material  for the  grave reflection and action of all who
love their profession and would promote its prosperity and
usefulness.   The resolutions which are attached as deductions
from  the  facts set  forth in the report, recommend  to all the
colleges an extension of the period employed in lecturing, from
four to six months ;  an increase of the number of professors to
seven; to require of their pupils the devotion of three years to
the study of medicine before graduating;  the attendance on
two  full courses of lectures;  attention to dissections steadily
for three months; and other reforms, both important  and salu-
tary.  The report and resolutions were adopted, as expressive
of the views and opinions of the convention, and  still remain
as the recorded  judgment of the association.   In 1848, at the
meeting in Baltimore, these resolutions and those on prelimi-
nary education were reiterated, and their practical observance
strongly recommended.   In Boston, in 1849,  the association
again reiterated  their approval, after discussion and  reference
of the subject to a special committee.   In Cincinnati, in 1850,
it was resolved " That the recommendations of this association
at its former meetings, in regard to medical education, be re-
affirmed, and that private preceptors be still urged to receive
into their offices only those duly qualified by previous educa-
                     2 
10
tion to engage in the study of medicine ; and at the same meet-
ing the necessity of increasing the standard of preliminary and
professional education required of those who would enter the
medical profession is recognized, "for the purpose of encou-
raging and  maintaining a national  medical literature."  Fi-
nally, at  the meeting in Charleston  in  1851, it was  resolved,
that  the  recommendations of the association at its former
meetings in regard to education, both preliminary and medi-
cal, be reaffirmed, and that both the schools and private  pre-
ceptors be still  urged  so to do their duty as to secure to the
community a well educated  profession.  The report of this
ye&r was  from  the pen of Dr. Worthington Hooker of Con-
necticut,  and was considered  so remarkable for its  ability,
that the associalion recommended its republication by the se-
veral  state  medical societies, and  its general  distribution
among the profession.  In addition to  its reurging, as before
stated, the resolutions of Dr. Haxall in 1847, it asserts—that
the abuses which exist in the modes of medical education
pursued in this country demand the  serious consideration of
the profession ;  that they should be freely discussed as an im-
portant means of effecting their removal; that no effort  can
succeed that is not based on a reform in the public sentiment,
both of the  profession and the community; that reform is to
be effected mainly through professional organization, and  that
it is incumbent  upon every physician to give it character  and
efficiency  as far as it is in his power so to do; that the as-
sociation has confidence in  efforts  to  reform the sentiments
and practice of the community in relation to medicine and the
medical profession, and that  in  the work of medical reform,
while all precipitate movements should be avoided, we should
aim at a steady advance from  year  to year, until a thorough
system of education be established by the profession through-
out the country.   Let it be remembered, that such was The
action of the American Medical Association at its meeting the
last spring, and that the views expressed in  the  report,  and
condensed in the resolutions  of Dr. Hooker, of which  the
above is an abstract, must be  received as the recorded know- 
11
ledge and  opinions  on the subject of medical education, as
now existing, expressed by a large number of the physicians
of this country, whose opinions are derived from observation
and experience of evils existing in twenty-three states of this
Union, and who must be presumed to be well qualified to ar-
rive at just and correct conclusions.
   The enquiries instituted by the American Medical Associa-
tion appear then to have established the fact that the most in-
fluential impediments to the advance of our science in  the
United States are  defects  in our system  of education, both
preliminary and medical, and that such impediments have not
only existed  heretofore, but are  even now operating to a ca-
lamitous extent.  Nor is the evidence, that medical studies are
usually commenced without sufficient previous education, de-
rived only from members of the association.  Information, ob-
tained from private practitioners and teachers residing in every
part of the Union, sustain  its position on this  subject.  The
report of the committee of 1847  states, that full  and explicit
answers from thirty-nine  gentlemen  representing twenty-one
states of this Union, establishes the fact, not only that there is
no standard of preparatory education exacted of medical stu-
dents throughout the United States, but that there is no gene-
ral rule adopted in any particular state or district.  The whole
subject is left to private instructors, to the students themselves
or to their parents.  The evil of this state of things  is abun-
dantly sustained by testimony derived from the schools, which
are peculiarly qualified to appreciate every obstacle to the
acquisition of the medical education.   The dean of the faculty
of Castleton Medical College informs Dr. Campbell Stewart,
that above all other causes, the fact that little or no prepara1-
tory education is required of the  student, induces many to en-
ter the profession who are  by no  means qualified to do so, and
keeps many out of it from  the low  standard of professional
acquirement.  The faculty of Jefferson Medical College presses
on the attention of the committee the importance of a recom-
mendation, emanating from  the association, that its members*
should decline to receive, as private pupils, persons who do 
12
not possess the preliminary education necessary to fit them for
entering on the study of medicine ; and adds, that  such a re-
commendation, strictly complied with, would arrest a serious
evil at its inception, and save many young men from the mor-
tification of finding, after the waste of much time, that they
had mistaken their vocation.   The last report on this  subject,
after  alluding to  "the  deficient  preliminary education of a
large proportion of the medical students in this country," ex-
presses the opinion that  " the  laxness of practice which pre-
vails in regard to the preliminary training of medical students,
is one of the greatest  obstacles in the way of raising  the
standard of education and attainment in the profession."
   If we compare  this utter neglect of preliminary  education
in the United  States with the requirements of Europe, we  are
driven to the admission  that  a knowledge of medicine  de-
mands as little mental culture for its acquisition as the simplest
mechanical trade, or concede that the mass of European prac-
titioners are more  competent to the performance of their pro-
fessional duties than those of the United States.  Of course,
I do not  refer to the exceptions—I merely point to the rule.
The Anglo Saxon  mind  especially, as developed amid  the free
institutions and magnificent scenery of our own country, has
proved itself at least not inferior to that of any other people on
the face of the globe ; and I defer to none in my admiration for
the illustrious examples  of distinguished medical merit which
we now have among us, and have always had since  the scien-
tific cultivation  of medicine originated within our borders.
But, however vigorous and acute the intellect may be,  without
early and judicious cultivation, it is as powerless to compre-
hend  the varied and recondite  mysteries  of science, as  the
most fertile soil would be to produce in perfection the  fruits of
the earth without the wisely directed labor of the agriculturist.
In the United  States alone has this subject failed to  receive
from the guardians of the public  health the attention its im-
portance demands.  In  Prussia, at the University  of Berlin,
every candidate for admission into the medical  department
must  undergo a  satisfactory preliminary examination  on 
13
Physics, Chemistry,  Botany, Natural  Sciences, the Classics,
Mathematics, History, and the Rudiments of Philosophy, or
else  present  certificates  of acquirement  in  each of  these
branches from some recognized academy or  university.  In
Austria the study of medicine  must be premised by an at-
tendance on the  primary schools of four years, in the gram-
mar schools of six years, and in the study of Greek, Latin,
Mathematics, Astronomy, History and Modern Languages two
years more.  A certificate of proficiency in all these branches
is also required.   At the University of Munich, in Bavaria, the
first two years are devoted to Logic, Metaphysics, Moral and
Juridical Philosophy, Philology, History,  Mathematics, Geo-
graphy,  Natural History,  Ethnography,   Physics,  Organic
Chemistry,  Botany, Mineralogy and Zoology.  A  satisfac-
tory examination at the end  of two  years gives admission
to the courses of the medical  faculty.  In Italy, at ihe Uni-
versity of Pavia, students  must produce certificates of ac-
quirement in all  the branches of elementary education, or un-
dergo an examination on History, Latin and Greek Composi-
tion, Mathematics, Botany, General Chemistry, Mineralogy
and Geology before they can matriculate.   In Paris, before a
young man can commence his  medical  studies, he must  have
graduated  in the arts and  sciences, excepting such as are
taught in the medical course.  In Russia,  ample evidences of
elementary education are  invariably insisted on as prerequi-
sites to admission into the medical classes.   In the British
army,  a lib?l||}  education  and  a competent knowledge of the
Greek and  Latin languages are indispensably requisite in
every candidate.  In the British navy, previously to the ad-
mission of assistant  surgeons, it is required that they produce
proof of having  received  a preliminary classical education,
and  that they possess in particular a competent knowledge of
Latin.  Even in our own army, insufficient  preparatory educa-
tion is  enumerated among the  most striking causes of failure
on the part  of the candidates.  They  are examined on the
branches usually taught in  our medical schools, and  also on
their literary and scientific attainments,  embracing a gramma-
tical knowledge  of  the English language,  Latin, and Natural 
14
Philosophy, all of which are deemed important branches  to
those entering on the study of a liberal profession.
  The remarkable  discrepance  between  the  European and
American plan with reference to preliminary education, must
at once be apparent to the most superficial observer.  It is ob-
vious that both cannot be right; it is not  impossible that both
may be to a certain extent erroneous, because while it is not
only desirable, but  ought to  be  imperative, to demand from
the  applicant all that is necessary, it would on the other hand
be  oppressive and  improper to  require  attainments, which,
however ornamental and distingue,  are not essential  to the
objects he purposes to achieve.  The principle which  should
regulate action on this topic will be recognized by all who are
familiar with the mental resources requisite for the successful
prosecution of medical studies.  The extent to which the prin-
ciple must be carried in  its practical application  presents a
difficulty which can only  be solved  by assigning such  limits
as while it maintains the dignity and utility of the profession
and the  safety of the public, shall  not infringe the rights of
the  applicant, or create unnecessary and insuperable obstacles
to the accomplishment of his wishes.   Details based upon this
position may be easily so arranged as to admit all who are at
all  qualified  or prepared to enter on the study of  medicine,
while others, more fortunate in their circumstances, may avail
themselves to any  extent of the  advantages of enlarged edu-
cation, which they may be so happy as to possess.  Conceding
the  propriety of these views, there  will  still be various opi-
nions as to the  minimum qualification which  should  be re-
quired ; and  more  than  that it would, under existing circum-
stances, be unwise to demand, because any attempt  at sudden
and violent infraction of accustomed  usage would certainly be
unsuccessful.  Content, then, to dispense with intellectual luxu-
ries, and to require only such necessaries as are indispensable
to the comfortable and successful progress of the student, we
should at least expect  him to have acquired  a thorough En-
glish education and a competent knowledge of the Greek and
Latin languages.   Without the mental discipline and habits of 
15
thought, the result of previous study, it is impossible to en-
gage  in the  pursuit of professional knowledge with either
pleasure or success, because  every  page which the  student
reads will require an acquaintance with his own language and
with  those from  which it  and ihe  technical phraseology of
medicine are mainly derived.  In addressing an audience of
medical men, it is unnecessary to dwell on this topic ; it is to
them a self-evident  proposition ; their own  experience has
taught them that  the ordinary nomenclature of  anatomy, ma-
teria medica and disease are incomprehensible and unintelli-
gible, when ignorant of the languages in which they are ex-
pressed.  I know, and have shewn, that the standard of pre-
liminary education indicated  is far, very far below that re-
quired in Europe; but I know too, that the  European  stan-
dard is beyond that which we  can at present hope to attain.
Let us, then,  seek not what  we would,  but what we may
achieve, and having set the ball in motion, wait with patience
for it to arrive  at its full momentum.  But it may be asked,
admitting the alleged  defects in preliminary education actu-
ally to exist, How is  the evil to be abated ?   Having ascer-
tained the disease by correct diagnosis,  What remedy is sug-
gested to  relieve  it ?   The suggestion of the  remedy is suffi-
ciently  easy—its exhibition may be somewhat more embar-
rassing, but while our powers as a body are limited, we may,
nevertheless, as individuals, do much to effect an object so de-
sirable.  The student  takes his first professional step in the
office  of  the private  practitioner.  We may require  from
him evidence of  the preliminary qualifications we  think in-
dispensable, and  if  he possess them  not, refuse to  receive
him:  an applicant for admission into the medical office will
listen with respect and obedience  to  advice manifestly in-
tended for his personal benefit.   We may tell him kindly and
respectfully, that a year or  two spent in the acquisition of the
necessary education will tend vastly more to his ultimate suc-
cess than to employ the same time in futile attempts to acquire
knowledge for the reception of which he is not suitably pre-
pared ; that without it he cannot progress, and lhat the attempt 
16
to acquire it as he proceeds will  cost him more time than to
devote his attention exclusively to its  attainment, and that he
will thus expedite instead of retarding the accomplishment of
his ultimate object.  He will, in  most instances, listen to the
counsels of experience wiih deference and acquiescence, but if
he will not, let him be firmly and decisively rejected.  Another
remedy, adopted  by the Medical Society of the State of New
York, consists in the establishment, b}' state and local societies,
of primary boards of examiners,  whose certificates shall al-
ways be required prior to  the reception of students into the
offices of practitioners or teachers.  When we shall have suc-
ceeded, as I trust we shall, in extending the  influence of this
our parent society over the broad limits of our state, so as to
cause the organization of one or more local societies in every
county, this plan of the New York society may doubtless be
adopted by us with efficiency and success.
  But, however imperfect the  preliminary education  of  the
medical student,  it cannot well be more superficial than  his
subsequent medical  course.  Nor is this remark intended to
be in any degree disrespectful to the  schools.  It  is incident
to the system, for which individual institutions are not  re-
sponsible, and we remark now, as we  shall perhaps hereafter
demonstrate, that no effort, however decided and intelligent—
on  the part of one or more isolated schools,  can remedy the
existing evils.  That remedy is in other hands: meritorious
schools, which  are  honestly endeavoring to elevate the stan-
dard for the degree, may aid in its application; but unassisted
by other influences, they are  impotent to accomplish  the ob-
jects which every right minded member of our  profession so
ardently desires.  But even at the hazard of  being misunder-
stood by those whom we so  much admire, and respect, and
whose good feelings and opinions we covet, and would  cherish
by  every  honorable  effort, we  must deal honestly with  our-
selves and with the interest and welfare of the  profession we
love, by admitting, however reluctantly, the truth and justice
of the conclusions of  the American Medical Association on
the subject of medical education as conducted in this country. 
17
Lest, however, any of us be seduced, by self-love or national
vanity, to dissent from those conclusions, and to contend that
the American educatee  enjoys equal opportunities of instruc-
tion, and  is subjected to  tests  of qualification, before  he  is
permitted to  practise, as  severe as those instituted  in  other
countries, let us refer to the actual condition of medical edu-
cation  in the United  States, and compare it with that of the
other hemisphere.
   What, then, is the course too frequently pursued by medical
students in this country, without let or hindrance either by
legislative or scholastic  interference ?   He enters the office of
his preceptor, as I  have already shewn, and  as we all  know
to be the fact, without any enquiry into his previous education.
If he has been so fortunate as to have received instruction  in
the ordinary branches of an English education, and to have
acquired a knowledge of ancient languages, it is well;  but if
he has  not, it is not demanded as a prerequisite,  any more
than if  he were about to  attempt  to learn any ordinary me-
chanical trade.  He reads, or professes  to read, medical
works in his  preceptor's office for about eight  months—a few
months more or less, as the case may be.  During this period
he learns something of materia medica and pharmacy by pre-
paring  medicine for the daily prescriptions of his preceptor;
but even this is an  advantage not always enjoyed, and  in  the
large cities of the Union, never.   He  is advised what  books
he should read, and they are furnished  him, and  such expla-
nations  are given him as he  may  from  time to time require ;
but beyond this he  receives little instruction, and is left to his
text books and his Medical Lexicon to get along as well as  he
can.  If it so happen that he is industrious and ardent in his
pursuit  of knowledge, he  is generally found  in the office en-
gaged in study ; but if otherwise, various seductions are ever
ready to induce neglect of office hours,  and he consoles him-
self with the  expectation that  the  lectures of the ensuing
winter will retrieve all loss of time and give him the requisite
information, without the self-denial demanded  by solitary and
laborious  study.   The winter approaches, the lectures com-
                  3 
18
mence, and perhaps for the first time he enters the precints of
a  splendid and attractive city, with an acute sensibility for
its excitements and its pleasures.   He purchases the tickets
which will admit him to the  lecture rooms of his professors,
but whether he avails himself or not of the privilege they are
intended to confer is an affair regulated exclusively by his
own inclinations.  Perhaps he is attracted by the eloquence
and ability of one or more of the professors, votes the others
humbugs, and either absents himself from their class  rooms or
amuses himself while there in  some of the various modes
which the proverbial wit and mischief of medical students so
readily concoct.  No test of his  attendance or his progress is
demanded, no faithful nor rigid study is exacted, no examina-
tions are instituted, no recitations required.   He may dissect
if he choose to do so, but if he does  not he may let it alone,
as in many of the schools  a  knowledge of anatomy  thus
acquired is not made  necessary to obtain a degree.   Nor is
clinical  instruction made obligatory—some  of  the   colleges
have  no hospital  under their control,  others  substitute a
weekly clinique, and others disregard the subject altogether.
  But if a practical knowledge of  anatomy  and clinical in-
formation are not  conditions  precedent to  the honors of the
doctorate, attendance on two courses of lectures is—or rather
the possession of two  sets of tickets; for if a soi disant stu-
dent is so inclined, he need not actually attend lectures at all,
because no evidence whatever is  required  that  he has done
so, but the possession of his tickets entitles him  to claim his
examination for a degree at the close of the second course of
four  months' lectures  as a matter of right.   Accordingly, at
the termination of his first course of lectures, he returns to his
preceptor's office, where he spends  his summer pretty much
as he had the preceding, attends the  next winter on the lec-
tures  ut antea, is  examined the  next  spring, obtains his di-
ploma, and his medical education is complete.   I appeal to
every physician now present to say  whether this  is not a cor-
rect statement of the progress of many medical students, from
the commencement of their pupilage to its close.   Of course, 
19
I do not wish to be understood  to intimate that it isrgenerally
so, or that it is even a very frequent occurrence; but that it is
a veracious history of many cases,  and that  there is nothing
in our present system to prevent examples of this sort,  will, I
presume, be readily admitted.   But it may be said, that while
the student has it in his power to be as regardless as he pleases
of the opportunities of instruction afforded  him, the develop-
ment comes with  his examination,  which exposes his  negli-
gence, and his  rejection ensues as  a necessary consequence.
Such would doubtless be the fact if a single examination be a
sufficient test of qualification, and that examination be so con-
ducted as to fulfill its intended  function ; but  whatever be the
cause, the fact  is unquestionable, that entire incompetency is
not  always a bar to the  attainment of the diploma.  Of this
fact, if it were not one  of common notoriety, the records of
the  army and  navy boards afford  conclusive evidence.  We
are  informed  by two naval surgeons of eminence,  in a com-
munication to  the American Medical Association in 1848, that
in an examination " before a recent  board, one gentleman de-
fined a lotion to be a ' kind of application,' and an evaporating
lotion, ' one that does not  evaporate.'   Another confessed his
ignorance of  the  freezing and boiling points  of water, and
contended that knowledge on such  points was useless.  One
candidate determined castor  oil to  be the ' oil  of castor—an
animal.'   Another located the  solar plexus in the sole of the
foot.  All these were graduates."  The  most ardent advocate
for the American  system  of medical  education will scarcely
contend  for  the  perfection or even  sufficiency  of any  sys-
tem  which would invest with diplomatic honors  examples
such as  these.   Let it moreover be recollected  that  in this
country the diploma is something more than a mere collegiate
honor.    In  most  of the  countries  of Europe it is nothing
more—it confers no  license to practise, and does  not place in
the hands of the recipient either the lives of his fellow-citizens
or the reputation  of the  profession. Here it is, not legally,
because in most of the states the law demands no license, but
it is practically the license to practise  medicine, because it is 
20
the certificate of men believed to be both  competent and ho-
nest, that the possessor of the parchment is  " in artis medico,
scientia plcnivs instruction" and  it is therefore a passport to
public confidence, and confers a title to respect which is with-
held from the practitioner who does not possess it.  Such be-
ing the fact, the conferring the degree  involves a double re-
sponsibility—a  respnsibility which there  is much reason to
believe is not always properly appreciated.
  " They order these things better in France," and indeed in
every other region which we  profess to rival in all  that re-
lates  to  science, art,  civilization  and  refinement.   In  the
Paris School of Medicine there  are eighteen distinct chairs:
twenty-six professors, aided by a number of assistants.  Four
years' study are required of the candidate, who has to undergo
five examinations, besides those on French, Greek, Latin, His-
tory and Geography.   He must be a bachelor of sciences, for
which  he is examined on Mathematics, Chemistry, Zoology,
Botany, Physics and Mineralogy.  In the  University of Edin-
burgh four years' study are necessary, at  least six months of
each of which must have been  passed in the Edinburgh or
other University authorized to  confer the degree of M. D.
Thirteen branches are taught by thirteen  professors.  If the
student is absent from the  lecture more than a limited  num-
ber of times the course counts  as nothing, and  must be fol-
lowed again.   In  the University of Berlin, there are 28 pro-
fessors and  39 assistants.   A candidate cannot  be examined
for a degree until after  four years' attendance on lectures—
from four to six  are usually required.   Besides the preliminary
examination prior  to  matriculation, three  others are required
by law before a degree can be obtained.   These examinations
are exceedingly severe, and the degree, after all, confers  no
right to practise.   The University of Munich in Bavaria re-
quires seven years of study: two preliminary, and an exa-
mination ; three didactic medicine and  an examination; two
in practice.  A public lecture is also required, two hours' de-
fence of a thesis written and published in Latin or German,
and an inaugural dissertation.   These are the terms on which 
21
a diploma  and right to practise are granted in Bavaria.  In
Italy, the University of Pavia has 21 professors and 21 assist-
ant professors appointed by concours.   The candidate must
pass five examinations—one every year for four years, and then
the fifth, which is extremely strict and practical. He publishes
a thesis and defends it in public, after which he receives a de-
gree which confers no  right to practise.   In Russia, the regu-
lations, courses of study, &c. are the same as in Berlin, and
the examinations are  very strict.   Heavy penalties are im-
posed on all who practise without a license.
   Notwithstanding the severity of the ordeal through which a
student must pass before he obtains his diploma, it is in many
countries of the  Eastern hemisphere a mere collegiate honor:
it  conveys  no authority to practise.   Before a license is granted
for this  purpose, other evidence of competency must  be  af-
forded.  This rule is not uniform, but obtains in many of the
countries to which reference has been made.  In Great Bri-
tain, the M. D. degrees of universities and licenses from royal
colleges entitle to practise, except in London and within seven
miles thereof.   This privilege is only conferred by the Royal
College  of Physicians, and  to obtain it the  candidate is re-
quired  to  undergo an examination before  the president and
censors on Latin and  Greek, and  likewise  three medical ex-
aminations, which  are conducted in the Latin language.  In
France, no person is permitted to practise  without regular li-
cense according to law. Regular graduates, holding diplomas
of M. D.,  may  practise anywhere in France.  Unauthorized
persons engaging in the practice of medicine, surgery or mid-
wifery, are liable to fine and  imprisonment.   In Germany, the
diploma conveys no right to practise, except in'Austria, and
there only to  graduates of the Universities of Vienna,  Pavia
or Padua.   This privilege is accorded, because the examina-
tion for the degree is conducted by duly selected general prac-
titioners, equal in  number to that of the faculty of the  univer-
sity, and who vote with the  faculty upon the reception or re-
jection of  the candidate.   In Prussia and  most of the other
German states, a candidate for license is compelled to exhibit 
22
a regular series of diplomas and  certificates, shewing the
course of academic study he has pursued, his morality, pro-
ficiency in general science, and also a diploma of M. D.  He
is then  subjected to five examinations conducted  by sixteen
physicians appointed by government, and called  state exami-
ners.   These examinations are minute  and searching to  an
extreme, each occupying  about two weeks, except the last;
embracing  oral examinations, theses publicly defended, ex-
temporary lectures, operations, clinical practice  and  written
descriptions of cases  and treatment, without  being allowed
reference to books or other assistance, selection of medicines
by their physical properties, minimum and  maximum doses of
twenty medicines, and the writing  out in full of five formulae
for the apothecary.  Unless  the  examinations  on surgery are
reported excellent, he  is specially prohibited from  using the
knife or performing surgical operations.  The number of can-
didates for  license is about 220 to 250 annually, and of these
nearly twenty per cent, are rejected.  In Switzerland, an ap-
plicant must, whether graduate or licentiate, obtain a permit
from the government, which exacts a rigorous practical exami-
nation.   The population is about  2,150,000, and  the  whole
number of  graduated  physicians at the period of the last cen-
sus was 450.  In Italy, a license from government is required,
and in Russia the heaviest penalties are inflicted upon all who
engage in practice without authority to do so, obtained either
through the royal academies or directly from the emperor.
  In  the United  Slates we  are  more tolerant.  If principle
may be inferred from practice, we  consider the savans of the
other hemisphere a party of old fogies, who are  behind the
spirit of  the age, deluded by the antiquated notion  that long
years of laborious  study are  necessary to  master the subject
of medicine and  its ancillary sciences, and  that critical and
rigid  examinations  are  necessary tests to ascertain whether
those years have been honestly devoted.  In young  America
we  patronize the  railway of mind as well  as of locomotion,
and our sons, like Minerva from the brain of Jupiter, spring
at once  into being, matured  in power and in wisdom.  Few 
23
of the states, therefore, require  either diploma or license.  In
our own state, in ancient enlightened Virginia, qualification
for the practice of medicine is tested by the ability to pay ten
dollars.  If the candidate cannot pass the examination of the
sheriff on this branch of science he is rejected ; but if he can,
the legal diploma and license are issued, and  he is recognized
as a doctor of medicine, entitled to all his privileges and immu-
nities, and  in the estimation of the law, as well qualified for
the practice of his profession as if he were a graduate of Mu-
nich and a licentiate of Prussia.  A candidate for the practice
of the law must  be certified to be of good moral character,
and his learning ascertained and vouched for by three  official
judges; a minister  must pass the examinations prescribed by
his order;  a mechanic must serve an apprenticeship,  and at
least  know the names and uses of his tools;  but the compe-
tency of a doctor of medicine is triumphantly evinced  by the
payment of ten dollars—a test of ability and learning which
reflects infinite credit on the ingenuity  and wisdom  of our
legislature.   It is true, however, that the law, with commen-
dable regard for  the public weal, wisely requires him to keep
pace  with the progress of science, and restrains all delinquency
by imposing an  annual examination by the  sheriff, and the
issue of a new diploma from that worthy functionary.
   For the expose of medical education in Europe  which I
have  presented, I am mainly indebted to the exceedingly able
and elaborate  report of Dr. F.  Campbell Stewart of New
York to the American Medical  Association of 1849—a report
which, together with that of Dr. Haxall in 1847  and of Dr.
W. Hooker in 1851,1 would commend to the careful perusal
of every member of this society who desires  to  compare the
systems of  European and American medical education and
requirement.  Nothing, certainly, will be  developed by that
comparison calculated to flatter our national vanity or autho-
rize the assumption that all other nations of the earth are mere
outside barbarians.   Truth to say, we are too much disposed
to imitate the Chinese in this respect.  But  " let that pass."
When we compare our aggregate attendance of eight months 
24
 in the colleges with  their several years, our period of private
 study with theirs, our six or seven professors with their scores,
 our curriculum with theirs, our single examination, which does
 not even disclose  our ignorance of the boiling and freezing
 points of water, with the number  they institute, of the seve-
 rity of either  of which the limits of this address would  not
 allow me to present the least  idea, we  are driven to the con-
 clusion that we have a great work to perform before we  can
 claim that scientific position  among the nations of the earth
 to which the intellectual powers conferred on  us by the great
 Author of our being permit us to aspire.  But, gentlemen, an
 honest contemplation of facts, as they really exist, should not
 exert even a depressing influence, but  should only stimulate
 us to  the exertion  necessary to  elevate our standard of pro-
 fessional  acquirement.  " The fault is in ourselves, not in our
 stars, that we are  underlings."  Let us address ourselves to
 the work with  energy and perseverance, until the physicians
 of this country, individually and in the aggregate, shall proudly
 take rank with their  brethren of other lands, whom the world
 has so long been  accustomed to regard with veneration  for
 their  learning and gratitude for the practical blessings they
 have conferred on mankind.  Let us contribute our share of in-
 fluence and effort to those now in progress throughout the length
 and breadth of the land we live in,  and success, tardy though
 it be,  will at last be ours, and the public and the profession will
 alike  recognize our  purity of motive  and  the value  of  our
 achievement.   I am no  deteriorationist.  However I may la-
 ment  the defects of our system of medical education, I by
 no means wish to contend that we have made no progress__
 that medicine is not better taught now than it was in the days
 of Morgan and Kuhn and Shippen.
  I love  to look back through the vista of bygone years upon
 the past,  and to yield to the  professional worthies who origi-
 nated medical instruction in this country  the  homage of  my
 veneration and my gratitude.  But in rendering to them this
 their  merited tribute, I would not brighten the  halo of their
glory  with a single  ray abstracted from  the distinguished 
25
teachers of the present day, nor wither one leaf of the civic
wreath which  encircles their brows.  Nobly have they won
their honors—long and richly may they wear them.   I know
many of them personally and well;  I know their ability, their
honesty and their zeal; I know their love for their profession
and their anxiety to advance its honor, its fame and its utility.
Let it be ours to investigate, and so  far as we can, to remove,
the counteracting influences which  now impede their efforts,
and  relieve  them from the  false position which the sordid
motives of others compel them reluctantly to retain.  The
proposition, then, which  I assert is, not that medicine in the
best schools  is  now more imperfectly taught than formerly,
but that its advance is controlled by circumstances which, if
not vanquished,  must lead to its  decadence  as  a science and
deprive it of the respect and consideration to which it is legi-
timately entitled.  One of these circumstances, in the opinion
of many of the most disinterested and accurate observers, is
the unnecessary  multiplication of schools authorized  to grant
the degree of  M. D.;  a degree which confers an equal rank,
and  is equally a passport  to public consideration,  whether
issued by the most obscure or  the most accomplished and
eminent teachers in the land.  Competition is said  to be the
life of trade, and so to a certain extent it  doubtless is ; and
the remark  is equally true  applied  to  almost every other
object of human  avocation as it is to merchandize.   Even in
the learned professions, a certain amount of competition tends
merely to excite salutary emulation, and conduces as well to
the benefit of the public  as to the  improvement of the indi-
viduals  immediately interested.   But so soon as the supply
exceeds the demand, the article manufactured or vended dete-
riorates in quality, that it may be afforded to the purchaser at
a smaller price, and not only afford the usual profit, but enable
the vender to attract the customers of his competitor, who is
thus compelled to resort to similar expedients.  Then succeeds
a  system  of  puffing and underbidding, and the adoption of
every other disreputable artifice.   The number of competitors
increasing, new  purchasers are induced, by the apparently
                  4 
26
 decreased  price, which is in truth owing  to the worthless
 character of the article, until finally the suffering public  de-
 tects the fraud,  the trade is ruined, and  its  prosecutors
 consigned to merited disgrace.
   At no very  distant period of the past there were only some
 two or three medical schools in the United States.  The suc-
 cess of these excited the ambition and cupidity of individuals
 in every section of the Union, and we now have about forty
 authorized by  chartered rights to confer the diploma.  Among
 those of comparatively recent origin  are many who number
 among their professors the jewels of our vocation, who, fully
 competent to teach  thoroughly its various branches, would, if
 they were permitted to obey their own impulses, acknowledge
 as their alumni none  but the worthy and well informed;  and I
 may be allowed to say, without suspicion of sectional feeling
 or a disposition to institute invidious comparison, that many of
 these examples may be found in our own South.   There are
 also many of the same character in the Northern, Eastern and
 Western states, but it  is  painful to remark, that among the
 forty schools there are many which are mere trading concerns,
 established from sordid  motive, and continued without  those
 lofty aspirations for reputation and usefulness which  make
 " ambition virtue."   But though powerless for good, such  in-
 stitutions are potent  for mischief.   Pupils must  be obtained,
 and every inducement is offered, not only to those who are  al-
 ready engaged in the  study of medicine, but  to  others who
 have not selected their vocation, to buy their  tickets, with at
 least a tacit  assurance that the degree shall be granted with
 the least possible  expenditure of time,  money  or intellect.
 Fees are cheapened, terms of study are  abbreviated, exami-
 nations  reduced, until  the  Doctor  Last of the great English
 comedian is  no longer a fictitious character, and the perfection
 of machinery for all other manufactures must yield, in celerity
 of execution and certainty of effect, to that patented for the
 making of doctors.   The  youth in  search of some employ-
 ment by which he may obtain a support, is made aware of this;
agriculture and merchandize require capital, the  mechanical 
27
arts  a long  apprenticeship and  subsequent physical labor;
everybody cannot obtain office, and  the learned professions
are, in the opinion of the public, easily attained, not at all la-
borious in practice, and withal highly respectable;  but  the
ministry in most denominations demands a classical education,
and  moreover don't pay ; law requires  some talent for public
speaking, and ignorance is thus certainly detected ; but phy-
sic presents none of these difficulties;  anybody can  make a
doctor; the portals of the colleges stand  open and  offer to
complete the work for a small consideration; submission to the
prejudices and  exactions  of the  great  and little vulgar, and
cheap charges, will ensure patronage even in competition with
the most learned and skillful opponent, and there can therefore
be no hesitation as to the  selection of his trade.   He deter-
mines to be a doctor, and so in a short time he is, sure enough.
There was a time when some  little talent and attainment were
considered  necessary for  high political office or a position in
either of the learned professions, but now  " nous avons changi
tout cela" and  the  apprehension  may  reasonably  be enter-
tained, that without a united and vigorous  effort to  sustain its
ancient glory, medicine, like  the lost  pleiad, will disappear
from  the  brilliant constellation of sciences, which has for so
many centuries challenged the respect, the confidence, and the
admiration of mankind.
   The necessary result of all this is a too crowded profession.
About 1600 pupils are annually converted  into graduates by
the aggregate will of the different colleges of the Union, and
it is a deplorable truth that many inherit from their alma ma-
ter more of cunning and stratagem than of professional skill.
The  humiliating artifice which she employed to lure them into
an occupation for which they were totally unprepared is trans-
ferred from the chair of the professor to the office of the prac-
titioner, and the low arts of the demagogue, the self-laudation
of the charlatan, and the secret arrangements of the hireling,
are the filthy byeways to  patronage which they tread, in
preference to the broad and  open highway of a noble  and ho-
norable profession. 
28
  Such, gentlemen, are some of the causes  which  have in-
duced the apprehension among those who appreciate the va-
lue and would  sustain the dignity of scientific medicine, that
we are about to realize the  "facilis descensus averni;"  and it
devolves  on  you, as  influential constituents of the medical
body politic of the United States, to suggest  and to advance
such measures as in your judgment may best  tend to avert
the catastrophe.  The protection of the interests of the medi-
cal profession  of the United  States, the  maintenance of its
honor and respectability, the  advancement of its knowledge
and the extension of its usefulness, are the avowed objects of
the American Medical Association.  Its efforts to accomplish
those objects are of necessity  divided into the two classes of
intrinsic and extrinsic action—the former including such  pro-
ceedings as it  may originate  and complete within itself; the
latter such as it may suggest and promote, but is impotent to
complete, without the  aid of  the members of the profession
residing in the various sections of the country.  The con-
densed abstract which I have  given of some of the  labors of
the association I have restricted to the latter class, because it
is in reference to that class only that our aid is invoked.
  In a country constituted like ours, without  a central  autho-
rity, either political or professional, it  is  manifest that all at-
tempts to effect the purposes  of the association  must prove
abortive, unless they are sustained by the government and the
profession of the individual states.   It is there that the diffu-
sion of medical progress must receive its  most effective im-
pulse—there  that the great battle of medical reform must be
fought—there that future generations will recognize the Aus-
terlitz or the Waterloo of American medicine.  It is in the se-
parate states  that the medical  profession, by zealous, dignified
and disinterested effort, must enlighten public opinion, convince
it of the personal interest  which every individual of the com-
monwealth has in producing and fostering a corps of  intelli-
gent, well educated and moral medical men, and through its
influence and with its sanction obtain  from the legislatures
such enactments as will exclude from the ranks of the regular 
29
profession all except the worthy and properly qualified phy-
sician.  There is, I know, in the human mind a natural ten-
dency to be  attracted by the  marvellous and to be deceived
by extravagant and delusive promises.  It is on this principle
that quackery operates and obtains from betrayed confidence
its rich rewards.   But all the immature and imperfect opinions
of the masses on medical subjects are derived originally from
physicians in whom  they have great, though perhaps unac-
knowledged, confidence.  In all their views we may perceive
the debris of exploded theories  and  practice, their respect for
medical men always  inducing the  adoption of their opinions
on medical  subjects when they believe them to be fairly and
honestly expressed.   Your influence, then, on public opinion
on these topics is almost unlimited, and in this country public
opinion  is omnipotent.  No law can be refused which it de-
mands,  and none can  be executed of which  it disapproves.
See to it, then, that this most potent agent is not disregarded.
I have a strong and abiding confidence in public sentiment
when it is wisely instructed.   It may for a time be deceived
and misled, but it is equally its interest and  its policy to ar-
rive at just  conclusions, and hence it is always accessible to
the teachings of  those in whose honor and intelligence  it con-
fides.   Respect for you and for your opinions on subjects con-
nected with your vocation induce it to adopt them ;  tardily, it
may be, but all experience and observation prove that  it will
be guided by your convictions.  I  desire to impress this ob-
ject forcibly on your attention, and  to invoke for it all your in-
fluence.  It is the  first outwork to  be conquered, and the first
and greatest victory to be won.   Without it, nothing  can be
accomplished—with it, everything.   Essential, however, as
public esteem undoubtedly is to all efforts at medical reform,
it cannot be long retained, unless some means can be devised
to prevent the ingress of the uneducated and the unworthy.  As
certainly as the whole is formed by a combination of parts, so
certainly will the profession of medicine  in the aggregate be
estimated by the intellectual character of its individual mem-
bers.   The public ever has and  ever will judge the claims of 
30
 medicine to respect and consideration by the abilities of those
 who practise it.  They are certified by the recognized autho-
 rity to be fully instructed  in the science and art of medicine,
 and the public naturally infer that all the defects are defects
 of the science and not of the individual.  Every physician,
 therefore, has a direct personal interest in the  professional
 proficiency of his colleagues—for in  that his own reputation
 is, to a great extent, involved.   The character of medicine as
 a science is placed in the keeping of those who possess the
 diploma; and those who confer  it  are equally responsible to
 the public, to the profession and to the science itself, for  the
 faithful exercise of the trust. Influences, however, are at work,
 as we have shewn, which, practically  superior to all  other
 considerations, induce many who would do good to do it not,
 and the evil they would not, that they do.  So apparent was
 this fact, that one of the first efforts of the American Medical
 Association was to exclude the uneducated from the  honors of
 the doctorate  by an attempt to elevate the standard of medi-
 cal education.
   It  was conceded *"that there is too much  truth in the
 charge that almost  every  person who has  gone through the
 course prescribed by the colleges is allowed to pass, and that
 thus the people are imposed on and the profession degraded ;"
 and t" unless some decided change in the policy of legislative
 bodies should be effected,  or some  measures should be insti-
 stuted by the profession itself to guard the  exercise of the
 power" of granting degrees and licenses, "that abuses would
 continue to exist;"  but it was  predicted that  the profession,
 when organized, had {"but to urge in the spirit  of kindness,
 but with firm resolve, such changes  in the existing plans of
 medical education, or in the modes of examination, as appear
 to be most imperatively demanded  for the  protection of the
common  interests and  for the good of humanity,  and the col-
leges which  are dependent  on the  profession for favor and sup-
port would respond to the appeal."   Relying on this reason-
            * Minority report on Bartle's resolution, p. 108.
            t Majority    "        «<          jjg
            *    "      "        "          12L 
31
able expectation, the appeal  was made, and the association,
with all the moral power it possessed, urged upon the schools
to lengthen their  terms of study from  four to six months,
slightly to increase the number of their teachers, and to intro-
duce alterations in the examinations of candidates  for the de-
gree.  But, unfortunately, the result has not vindicated the
sagacity of  the prediction.   The suggestions  were partially
adopted by some  of the best institutions of the country, but
by the large  majority they were totally  repudiated.  Expe-
rience has demonstrated that unanimity was essential to the suc-
cess of the effort, and those who adopted the plan, after a mag-
nanimous struggle with the disastrous effects on their prospe-
rity, have been reluctantly compelled to abandon the high po-
sition they had assumed.  Even before the organization of the
association, we  are informed  by Professor Joseph A. Eve, the
faculty and  trustees of the Medical College of Georgia, de-
ploring the defectiveness of the system of medical education
in the colleges of  the United  States, earnestly  endeavored to
correct it.  They  recognized the shortness of the  term as an
important  defect,  and  trusting that the  advantages of a pro-
longed term would be appreciated and acknowledged by phy-
sicians and students, they increased it to six months, and per-
severed in the effort for five  successive years.  They had the
mortification to lecture to seats almost vacant, and to behold
medical students  hastening  in crowds to fill the halls of four
months colleges.  They were compelled to recede  and adopt
the four months term, after  which their  classes increased ra-
pidly—far beyond the expectations of  their  most sanguine
friends.  And thus it  will ever be; no  matter how desirous
some  schools may be to effect the desired reformation—they
cannot succeed unless sustained by the unanimous action of
the privileged institutions.  It is not to be anticipated that this
will ever be attained—and if it were, such is the  facility  for
obtaining charters, that other aspirants would avail themselves
of the illegitimate advantage, and  establish new  schools of
lower grade, which would monopolize patronage.  Let us not,
then, censure the  schools for  failing to do that which is mani- 
                           32

festly impracticable.  So long as the diploma is the only pass-
port to public confidence, and is therefore virtually the license
to practise, so long will the diploma be the great object of the
aspirations of the student; and if it be equally valuable from
one source as from another it will ever be sought where it can
be most easily and most cheaply obtained.
   The license to practise is not, however,  the inherent pro-
perty of the diploma;  and the only mode of abating the nui-
sance is, to adopt some plan which, while  it recognizes it as
an  academic honor, will  deprive it of the  licensing power.
The power to grant the license to practise should be confided
to a board of examination,  appointed by the authority of the
state, competent to ascertain the qualifications of candidates,
but totally unconnected with any school of medicine.  The
diploma should be required as  evidence  that  the  applicant
had received a medical education and had passed an exami-
nation satisfactory to the constituted authorities of his college.
The reputation  and prosperity of a school would then depend
on the proficiency of its pupils,  not  on  the  size of its classes
or the number  of  its graduates.   The quality  and not the
quantity of its work would be the measure of its worth.  A
fair and honorable competition would thus be  created among
medical institutions.   They would graduate only those who
were really fully instructed, because that institution, whose
pupils were frequently rejected for incompetency by the ex-
amining board, would be  deserted  in favor of  those whose
teachings  were  more  perfect.   The  various expedients now
employed  to obtain  notoriety would be of no avail, because
the merits or demerits of every college would  be  disclosed
by the acquirements of its pupils; and  by this test it would
obtain an enviable  celebrity  or fall into  merited disrepute.
The certificate of qualification would be of no practical value
unless ratified by  the  licensing board ; and the inducement
to grant it unworthily would  not only be  annulled but  it
would be  withheld, because every  untrue  certificate would
be positively injurious to the reputation of the institution from
which it emanated.   As the diploma, moreover, would be of 
33
*
no value lo ihe student unless deservedly conferred, it Would
be earnestly sought as  the necessary prelude to the ulterior
object of his ambition—the licence to practise; and the same
motive would induce him to mitriculate in  th;it school which
would offjr him t!i3 fullest instruction, not  the easiest  access
to the  degree of M. D.  An examining  board, therefore,
which demanded the diploma, would exert a salutary influ-
ence on the schools as well as on the pupils.
   Bui there are other considerations which  should restrain all
action which  would depreciate the value  of the diploma, or
lessen the respect  to whit h it is entitled when restricted  to
its legitimate sphere. It is the ancient ami honorable  certifi-
cate of  high professional attainment:  such  is  its design, and
as such it is estimated by the most  enlightened nations of the
earth.  To  destroy  its  reputation and its  influence, because
circumstances  have led to ihe abuse of the trust reposed in
those who  are authorized  lo confer it, would !»e bolh unwise
and  unjust.   Let us rather seek to  neutralize  the  effect of
those circumstances, and  to restore it to the proud position it
once  occupied.  Most  of us  recollect the  exultation with
which we ourselves  received it; nm\ for myself I confess that
I still regard it as an early friend, whom I would nol willingly
desert in his extremit}r.
   The  indispensable importance of well  conducted medical
schools  cannot be contested, and unless the diploma is required
for admission to a final examination for the  license, candidates
will  present  themselves who  have never  entered a college,
and  will probably pass, with fir inferior  qualifications than
are now necessary.  Nor do I perceive how we shall elevata
the standard of medical education by withdrawing the licens-
ing power from one body, and conferring it  exclusively on  an-
other.   One  examination is admitted to be an imperfect test
of qualification—it  is indeed one of the  most potent evils of
which we complain; and if the diploma be dispensed with,
we shall still have but one, and that one liable as now to ma-
lign  influences, incident to any  single examination, and  too
obvious to occupy the time which would be consumed in  act-
                  5 
fc.
34
 verting to them.  Nor would the mischievous effect of repu-
 diating the diploma cease here.  The respect which is felt for
 it by the  public will be effaced, the restraints which it imposes
 will be destroyed, and a plan subslitulcd which any legislature
 may repeal, and leave the community and the profession with-
 out the slightest  protection  from evils vastly greater than
 those we are now endeavoring to correct.  Let us then, as far
 as our influence will  sustain us, insist on  both  ihe diploma
 and a final examination  by a board appointed by the stale—
 let us be conservatives, not radicals—let us seek reform, nol re-
 volution ; demanding the diploma as a sine qua non for  the ex-
 amination for license—not only demanding it as evidence of
 qualification, but consenting to its acceptance only from such
 schools as have a full  curriculum  and terms of study of suf-
 ficient duration to authorize the belief that il has been worthily
 obtained.
   To render these views operative, we shall be told, legislative
 assistance must be invoked,  and  that,  the legislature will not
 respond to our appeal.  I am  aware of ihe difficulties  which
 envelop this subject, of the clamor which  will be  raised  by
 Thompsonians,  and Homceopathists, Hydropathists and the
 host of-other sutlers  and followers of the  camp;  bul ii the
 representative be deaf to the voice of reason and of justice,
 let us appeal  to the constituent.   Let the public be enlight-
 ened  on  a subject of  which, nol withstanding its intimate
 connection  with the  happiness of  every  individual  in  the
 community, it is now  strangely ignorant, and conviction of  its
 own interests in the cause will  ensure our success.   There is
 no  subject on which  popular views are so erroneous  as  on
 that of medicine.   By a  large portion of the  populace it  is
 regarded  merely as a trade,  and disease as a substance  or
 essence to be cured  by a specific, which  by some witchery
removes it.  Even the better informed  will  assert that though
 surgery has improved medicine has not—that doctors diflt-rln
opinion on medical subjects, and that consequently there is no
certainty in their views.   It is in vain  to reply ihat men will
differ on all subjects, where conclusions are  to  be inferred 
35
4
from facts and circumstances—that law, theology, politics are
liable to the same objection—that even the constitution ,of the
United  States—a written document that all  profess to vene-
rate—is variously understood, and that on their principles each
of these would be denied their confidence.   These are subjects
on which difference ma}' be tolerated, but  medicine must be
everything, or it is nothing.  Like the usurper of the Scottish
throne,  it would  " throw physic  to  the   dogs," because it
cannot
                    '- Minister to a mind diseased.
             Pluck from the memory a rooted sorrow,
             Raze out ihe written troubles of the brain,
             Ami, with some sweet oblivious antidote,
            Cleanse the stuffed bosom of that perilous stuff
             Which weighs upon the heart."
   They would  require  it to  perform  functions  reserved  lo
Omnipotence itself, and  if it  fail in this, refuse it all credence,
or degrade it to the art of the empiric  and  nostrum vender.
To obtain the sympithy  of the  constituent, and the consequent
assistance of the representative, reform must commence by in-
structing the public  mind on the subject of medicine.   Let it
be taught what  medicine  really  is,  in simple, intelligible  lan-
guage.   Be to it what a recent writer aptly terms a "rational
doctor."  To accomplish this  we may wisely take counsel of
and profit by the example of our adversaries.  Who will deny
the influence which quackery and falsehood have exerted by
means of the  popular press—by almanacs, pamphlets, news-
papers?  If  error can be successfully disseminated by such
means,  why is not the public mind equally  accessible to truth
and  reason, and  why may we not  avail ourselves of means
for  laudable  purposes, which  have been prostituted  lo those
which are mischievous and improper?   Politicians propagate
their tenets by public addresses—why may not we do likewise ?
Popular lectures  on  the principles of medicine, judiciously
adapted to  the  peculiar capacities of ihe audience, would
perhaps do more  lo  revolutionize and establish public opinion
than any other means that could be devised, excepting  that
most permanent and  substantial  basis for sound views on all 
                           86

subjects—early education.  If an  elementary knowledge of
anatomy and physiology were made a part of general educa-
tion—if to a sufficient extent they  were taught in our schools
and  colleges, so that our youlh would bring with them into
active life some acquaintance with the complicated and deli-
cate structure of the human  machine, and  the laws  which
govern it—think you its management and repair would be con-
fided to the unskilled and  the ignorant, with less hesitation
than if it were a watch or other implement of domestic utility?
Gentlemen, I feel that I have too long trespassed on  your at-
tention, and can therefore merely suggest these topics  for your
grave consideration.   I  pray you to ponder them thoroughly,
and  then act according to the decisions of your judgment and
your conscience.
   But no matter how intelligent and successful the investiga-
tion  of the causes which impede the progress of medicine—no
matter how wise and judicious and  will  adapted the  reme-
dies suggested—no mailer how distinguished or zealous or in-
fluential the individuals  engaged in the movement—all will be
unavailing so long as our efforts are isolated and unconnected.
Concentrated, combined,  harmonious, organized action,  di-
rected with energy, perseverance and zeal to meritorious ob-
jects, sanctioned and approved by all,  and conducive  to  ihe
best interests  of the community as well as of ourselves, can
alone be successful.   The  interests of the  schools, the inter-
ests of the luitv, the  interests of the public are one and iden-
tical.  Let there then be no divisions  among  us, but  let us
adopt a  platform large enough and  strong enough to  satisfy
and  sustain us all.   These are the elements of success, and
these  elements  can  only be  combined in a comprehensive
and  well devised system of medical organization—an organiza-
tion  which shall include within ils limits each insignificant
part as well as the grand and influential whole.  I congratulate
you. gentlemen, on  the prospect before us,  of accomplUiing
this  desirable object.  The assemblage which I have now the
honor to address is evidence that our noble old commonwealth 
37
is neither insensible  nor impassive.   Our state society is al-
ready firmed ;  let us cherish  and sustain  it, and  enlarge its
capacities, until it shall embrace every spot within the exten-
sive limits of our territory.  Then will every locality, incited
and encouraged by your counsel and your  example, have its
own society auxiliary to this our central organization, exert-
ing its wholesome influences on its  immediate neighborhood,
and contributing its quota to the promotion of the  usefulness,
honor  and interests of the profession.  Let not any one say
that he is loo old or too independent to aid in the great work
we have to perform.   Let him not fold his arms in apathy, be-
cause advancing age may prevent his participation in the bless-
ings which an  improved  profession will diffuse.   Had such
motives prevailed with the fathers of our civil institutions, we
had been now the serfs of a foreign monarchy.   I will not be-
lieve that among the votaries of our benevolent and self-deny-
ing vocation there exists such absence of professional patriot-
ism or such selfishness of feeling as would withhold effort  to
promote the happiness and welfare of those who will succeed
us.  Union is strength—and when we  have our local societies,
our state societies, and  the great American Medical Associa-
tion all fully organized, nil actuated by the same magnanimous
impulse, and all acting in united, harmonious concert, we shall
present a phalanx of talent  and power and influence irresisti-
ble and invincible.  The temple of science and of truth, which
our predecessors  have  been rearing  for more than twice a
thousand years, will  advance towards  its  completion, aided
by  our labors, and embellished and adorned by the contribu-
tions of a people unborn and a  country unknown when its
corner stone was first laid on the solid foundation of nature
and of nature's laws;  and when ihe sun of medical improve-
ment shall dispel the mists of  ignorance and  error, and shed
its unclouded beams on our gloiious edifice, exhibiting its spires
and lowers and buttresses in all their fair and just proportions,
their beauty unmarred and their strength unimpaired  by  sys-
tems of false philosophy or the hostile  assaults of arrogance 
38
and folly, we  may adopt  the  language of a  confrere* distin-
guished alike for professional eminence and literary taste:

          " See where aloft its hoary forehead  rears
            The towering pride of twice a thousand years!
            Far, far below the vast incumbent pile
            Sleeps the gray rock from art's ^Egean isle;
            Its massive courses, circling as they rise,
            Swell from the waves to mingle with the skies.
            There every quarry lends its marble spoil,
            And clustering ages blend their common toil:
            The Greek, the Roman, reared its ancient walls;
            The silent Arab arched its mystic halls;
            In that  fair niche, by countless billows laved,
            Trace the deep lines that Sydenham engraved;
            On yon broad front that breasts the changing swell,
            Mark where the ponderous 6ledge of Hunter fell;
            By that square buttress look where Louis  stands,
            The stone yet warm from his uplifted hands;
            And say, O Science, shall thy life blood freeze
            When  fluttering folly flaps on walls like these?"

                       * Dr. Oliver Wendel Holmes. 
 
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