qh^(J>L$j -, to. tAv\ REPORT CAUSES WHICH IMPEDE THE PROGRESS AMERICAN MEDICAL LITERATURE. BY SAMUEL D. GROSS, M. D. 2y. EXTRACTED FROM THE TRANSACTIONS OF THE AMERICAN MEDICAL ASSOCIATION. PHILADELPHIA: T. K. AND P. G. COLLINS, PRINTERS. 1856. REPORT CAUSES WHICH IMPEDE THE PROGRESS AMERICAN MEDICAL LITERATURE. BY SAMUEL D. GROSS, M. D. /ff EXTRACTED FROM THE TRANSACTIONS OF THE AMERICAN MEDICAL ASSOCIATION. PHILADELPHIA: T. K. AND P. G. COLLINS, PRINTERS. 1856. REPORT ON THE CAUSES WHICH IMPEDE THE PROGRESS OF AMERICAN MEDICAL LITERATURE. To write a report on the causes which impede the progress of American Medical Literature is no easy task. It requires labor, thought, judgment, courage. It is environed by many difficulties ; it involves serious responsibility. On the one hand, I find that the labor is much greater than I had anticipated; and, on the other, that it is almost impossible to discuss the various topics embraced in it without incurring the risk of exciting displeasure, or of having my motives and feelings misapprehended and misrepre- sented. While I do not shrink from the former, I sincerely hope and trust that I shall escape the latter. While I shall present my views with great freedom, nothing is further from my intention than a desire wilfully to wound the feelings of a professional brother, or to cast any unjust reflections upon our medical schools, our medical press, and our medical charities. Duty, however, to this body, not less than to myself, requires that, in my attempt to unfold the causes under consideration, I should speak " the truth, the whole truth, and nothing but the truth," in regard to every subject which comes legitimately within the province of this re- port. My motto shall be, " My country first, my profession next." Have we a national medical literature ? If so, what are its nature and extent? It requires no labored argument to answer these questions. Un- doubtedly we have a national medical literature; but that its cha- racter and extent are not what they should be, or what we hope they ultimately will be, is equally true. It is an immature, an in- fantile literature, destitute of bone, and muscle, and sinew, gradually but steadily developing itself, and destined, ere long, to take its 4 place by the side of that of other nations. Literature, regarded in the abstract, has, like the arts and sciences, nay, like governments and nations, its rise and progress, its trials and difficulties, its pros- perity, its decline, and its downfall. It does not, Minerva-like, spring in full vigor and perfection from the brain of the heathen god. It does not send forth its rich and fertilizing influences at once upon a people. Its ascent is gradual, its growth tardy, often, indeed, almost imperceptible. To this rule the medical literature of the world forms no exception. What it is, and what it has been, it has become by slow degrees, by hard labor, by indomitable zeal for the national welfare and the national honor. The medical literature of America was conceived in adversity, rocked in the cradle of sorrow, and reared on a diet of bread and water; and yet, as will appear by and by, it is not destitute of value to the pos- sessor, or without honor to the giver. Young as it is, and beset as its progress has been, and still is, with trials and perplexities, it is as a living fountain to our profession, from which all who thirst may drink and be refreshed; as a mine of precious ore, abounding in the golden sands of science and erudition. If it lacks the stately proportions of the medical literature of some of the more refined and cultivated nations of Europe, it possesses the vigor of a healthy and steady growth, surely, though slowly, advancing to the full maturity of a sound and sturdy manhood. When we reflect upon the history of our country, its long depend- ence upon a foreign power, its struggles for liberty, and the vast toils necessary for the maintenance of its political existence, we are not surprised that its medical literature is still in its infancy, but that it should have any medical literature at all. Ages elapsed before England, France, Germany, and Italy, the most favored learned, and scientific nations of the Old World, had even made a beginning in medical authorship. The medical literature of Great Britain dates no further back than the time of Harvey and Syden- ham, in the early part of the seventeenth century. Until the ap- pearance of those illustrious men, the pride and glory of English medicine, England had no medical writers who survived the gene- rations of which they formed a par.t; and, even for a long time sub- sequently, she ^hardly produced a solitary work which is now re- membered except by its title. Richard Wiseman was her first great surgical author, and generations passed away before she pro- duced a Pott and a Hunter. In anatomy, physiology, chemistry, materia medica, medical jurisprudence, toxicology, obstetrics, and 5 practical medicine, she had literally no great works until the com- mencement of the present century. In pathological anatomy and general pathology she has not even yet a solitary treatise worthy of her noble profession. The same is true, though not in an equal degree, of the medical literature of some of the other nations of Europe. During our colonial existence, medical literature and medical science made no progress. The clerical and legal professions were much more ably represented than the medical. The religious per- secutions of Europe induced some of the most able and learned divines to forsake the Old World to seek an asylum and a home in the New. They brought with them their piety, their zeal, their erudition, and their enterprise, which they devoted, without stint, without money, and without price, to the service of the church, of education, and of literature. They became the founders of some of our most valuable and distinguished literary institutions, and the authors of eminently creditable works on theology and history. The most important judicial offices were held by men of learning and legal acumen, sent hither by the British crown; and many of the governors of the different provinces were Englishmen, distin- guished for their literary and scientific tastes and attainments. The medical profession, on the contrary, was at a low ebb. It had no antecedents, no present, no future. The country, until a short time prior to the revolution, held out no inducements to the refined and educated physicians of Europe, to seek their fortunes in the wilds of the new world. Sparsely settled, overrun by the Indian and the panther, destitute of roads and bridges, so necessary to the comfort and convenience of medical practitioners, and frequently visited by epidemics, as terrific as they were obscure and un- manageable, it attracted to its shores none but daring adventurers, little skilled in the art of healing, and still less disposed to engage in its exercise. Other avenues were more alluring to their ambition and their avarice. Nor were the native physicians in a condition to build up and sustain a medical literature. In the absence of medical schools, it was impossible for them to obtain an adequate medical education, except by going abroad, which few of them, in the then existing state of things, had an opportunity of doing. The consequence was that, until about the middle of the last century, few physicians of science, learning, or great respectability were found in the colonies. The first American medical college was erected in 1763 ; and, although another was soon added, yet both 6 were compelled to close their halls during the Revolution; nor was any attempt made to revive them until after the establishment of peace in 1783. Up to this period, and, indeed, until shortly after the commencement of the present century, hardly any work, de- serving of the name, had appeared on medicine from the pen of a native physician. The most valuable treatises then extant were Bard's Midwifery and Jones's Surgery, both greatly esteemed in their day on account of their practical character. It cannot be supposed that a nation, fresh from the hands of God, and just emerging from a long, bloody, and desolating war, would be in a fit condition for the cultivation of the arts and sciences. Its time was fully occupied by more important business, the pursuits of agriculture and the mechanic arts, and the solution of the great and vital problem of self-government. It had to supply the means for the necessities of the body rather than for the necessities of the mind. Its citizens had no leisure for writing books, painting pic- tures, or fashioning men out of marble. God, the great architect and chemist of nature, was their only artist. They were in a transi- tion state, unable satisfactorily even to foresee their own destiny, but gradually clearing away the stumps and rocks of their mental soil, to fit it for the reception of the seed which has since been sown, and which has produced such noble fruitage. They were preparing the way for those great and astounding enterprises, which, while they have enabled them to tie together the beams and joists of the republic with cords of adamant, have secured for them a strong and abiding rank among the nations of the earth. They were occupied in infusing into each other a love of country, and into the different professions a love of research and a spirit of kindness, which, we trust in God, will continue to animate their successors in all time to come. In a word, they set each other in motion, and gave each other a proper impulse and a proper direction, and thus infused a quickening, vitalizing influence into the national mind. Under the genial influences here described, a more auspicious day soon began to dawn upon our country. Literary and scientific institutions sprang up, as if by magic, in every section of the youthful Union; the sword was transformed into the ploughshare, the pruning knife, the sickle, and the pen; men began to take a long breath, and to sigh for the labors of the closet; the spirit of composition descended upon them, and thus was gradually laid, in a broad and substantial form, the foundation of a nation's litera- ture. In this general upheaving of the mind, this outburst ol 7 science and of letters, the medical profession largely participated, as it had previously in the great struggle for American Independ- ence. Medical institutions, medical societies, medical charities, and, finally, medical periodicals, sprang up in every direction, and afforded employment and labor for the best intellects of the day. As a necessary result, book after book has appeared, until we shall soon cease to be able to count them. The early part of the present century supplied us with the writings of Rush and Barton, the System of Anatomy by Wistar, Dorsey's Surgery, so long used as a text-book in the University of Edinburgh, Chapman's Therapeutics and Materia Medica, Coxe's Dispensatory, Thatcher's Practice of Medicine, and several other productions of minor note. As yet, the profession had not pro- duced one solitary great work on any subject. Then appeared, in pretty rapid succession, the valuable treatises of T. R. Beck, Gibson, Dewees, Horner, Eberle, Hare, Silliman; and, at a still later period, those of Dunglison, Wood & Bache, N. R. Smith, Meigs, Wood, Dickson, Oliver, Paine, Condie, Bell, Warren, Stewart, Ray, Ger- hard, Bartlett, McClellan, Pancoast, Morton, Miller, Mitchell, Frost, Henry H. Smith, and others. The last few years have been unu- sually prolific in valuable monographs, as is exemplified by the publications of the younger Meigs, the two Stilled, Swett, Carno- chan, Frick, Drake, and La Roche, the last two of which may justly be regarded as forming an epoch in the literature of the profession. If the preceding statements be true, no one acquainted with the subject can accuse the profession of the United States, of the pre- sent day, either of lethargy, idleness, ignorance, or indifference. The numerous works which annually issue from our press, the exist- ence of forty medical periodicals, nearly all of them respectably if not ably conducted, and the successful operation of nearly forty medical schools, which annually send forth upwards of one thou- sand graduates, all attest, in the strongest possible terms, the zeal, the learning, the intelligence, and the enterprise of its members, and afford a guarantee that its great interests are safe in their hands. Considered in its aggregate capacity, it unquestionably comprises a greater amount of talent, erudition, science and activity than any other of the liberal professions in America; thus nobly reversing the order of things, in regard to these professions, which existed prior to the Revolution. Having made these remarks, which seemed to me to be necessary to a more perfect appreciation of the main subject of this report, I 8 shall proceed to inquire into the causes which still obstruct the progress of our national medical literature, and close by making a few comments on the remedies which, in my judgment, are neces- sary for their successful removal. These causes, although numerous and diversified, maybe grouped under four principal heads: 1. The identity of the language of this country with that of Great Britain. 2. A disposition in the profession to patronize English works in preference to American. 3. A want of independence in our peri- odical press. 4. A lack of industry in observing and recording facts in private and hospital practice. Let us examine these points somewhat in detail. 1. One of the great disadvantages, as it respects the present subject, abstractly considered, under which the people of the United States are and have been laboring, is the circumstance that they speak the same language as the inhabitants of Great Britain, from whom, as from a common stock, they originally descended. It fol- lows, as a natural consequence of this identity of language, that they should feel a deep interest in the writers of that country, and a strong desire to become acquainted with their works, either by direct importation of them or through the medium of American reprints. As English books are very costly, on account of the heavy duty imposed upon them by government, the latter method is the one usually adopted. To so great an extent, indeed, does the practice obtain, that, for many years past, every English work of any note or merit, real or fictitious, has been issued on this side of the Atlantic within a very short period after its publication at home. This is true of every species of literature, general, medical, theo- logical, and legal; so that, if we had no native authors, the Ameri- can mind could hardly suffer for the want of proper nutriment from this cause, so abundant and diversified is the foreign supply. The republication of British works has, for nearly half a century, been a source of constant occupation with some of the best firms of the Atlantic cities, affording a safe and profitable investment for their capital, and steady employment to many thousand per- sons. The business has, in fact, grown into a great and flourishing trade, requiring millions of dollars for its prosecution. Some of these firms have amassed great wealth, derived from no other source. In the absence of an international copyright law, securing to every author a just compensation for his labors, the works thus furnished are generally sold at less than one-half of the price of the English editions; and hence it often happens, both in medicine and in other 9 departments of learning, that they have a much wider circulation here than at home. Sometimes, in truth, English works, neglected or imperfectly appreciated in Great Britain, are, perhaps, for the first time, fairly introduced to the notice of the public by and through the American press. It was thus with the writings of De Quincey, which were first collected and issued in a uniform edition by a pub- lishing house at Boston. Dr. Stokes' Lectures on the Theory and Practice of Physic met with the same courtesy at the hands of a Phi- ladelphia firm, having prior to this not even appeared in book form, but being safely locked up in an Irish periodical, published at Dublin. A number of other works, having a very limited circula- tion at home, have been largely read in this country. Mr. Fergus- son's Practical Surgery, for example, has passed through at least one edition more in America than in England; and a similar com- pliment has been extended to another meritorious work, Watson's Practice of Medicine. Such marks of attention must, even in the absence of copyright remuneration, be extremely gratifying to the authors of Great Britain; but the force of the compliment is weak- ened when it is recollected that these reprints are made indiscrimi- nately, and therefore without any special reference to their intrinsic merits. In a word, they are made simply because they serve to fill the pockets of those who incur the responsibility of becoming their sponsors. If they were obliged to purchase the copyright at a fair value, the number of American issues of British works would be far less than it now is. It is owing to this circumstance, one of the most remarkable anomalies of our age and country, that the litera- ture of the United States exhibits, even at the present moment, more of a foreign than of a domestic aspect, the number of English works circulated among us being greater than the number of native productions. It cannot be denied that this practice of republication is of great advantage to the public; for it serves to diffuse among the people, in a cheap and accessible form, a vast amount of knowledge that would otherwise be beyond their reach. It brings the works of our transatlantic brethren directly to our doors, at the same time that it serves to extend the name and fame of the authors. But, while it accomplishes all this, it unfortunately interferes, in the most positive manner, with the establishment of our national literature, considered in its widest as well as in its professional sense. It de- presses native talent, native genius, native aspiration and enterprise. It narrows the road of authorship, and besets it with obstacles and 2 10 difficulties almost insurmountable by ordinary means. The man who attempts to scale it must do so at the risk of a long probation, without the prospect even of much ultimate pecuniary reward, when his reputation shall have been firmly established by the pro- duct of his pen. When his literary labors are completed, and he places his MS. into the hands of his publisher, should he be so for- tunate as to find one, he is pretty sure to be informed that there are already before the public so many works on the same subject as to render the success of his own too uncertain to justify the offer of a stipulated sum for the copyright of the first edition. Should the sale go off well, he may ultimately receive a few hundred dollars for what ought to have brought so many thousand, if the book had no foreign competitors in the form of reprints. In short, he finds his only recompense and solace in the prospective fame of his lite- rary labors. I do not now speak of the novelist, the poet, the tour- ist, and other writers of light literature, who always find readers, however trashy their productions, but of men of science and letters, the solid and substantial authors of a country. These men must be encouraged, patronized, and sustained in their efforts to improve the literature of the nation, and thus advance its honor and glory. If it be said, in reply to these remarks, that every work must stand ' on its own merits, we do not perceive the force of the rejoinder. If the market is already glutted with foreign productions, it must be obvious that the wants of the public are, at least in part, if not fully, supplied; and hence the native work, however meritorious, must labor under the disadvantage of a degree of competition, which, especially if we consider the additional disadvantage of its higher price, may throw it into the shade, or altogether prevent its success. If, for instance, an American physician were to write a work on surgery, his success would be sure to be tardy, because the country is already flooded with foreign treatises; and so in regard to most of the other departments of the profession, as well as of literature in general. If the people of Europe spoke but one lan- guage, and there existed no international copyright laws, there would be comparatively few authors of any kind; the necessity for writing would be much diminished; the same book would answer for all; and men of literary taste and attainment would seek other channels for the exercise of their talents. But such is not the fact. Every nation has a distinct and separate language; a distinct and separate literature. The works of Sydenham and Harvey, of Yan Swieten, Bichat, Haller, Baglivi, and Scarpa can be read out of their 11 own countries by the mass of the profession only through the me- dium of a translation. Speaking, as we do, the same language as the people of Great Britain, and republishing, as we do, at pleasure any of their works that come within our reach, Shakspeare has more readers by ten to one on the shores of the Ohio than on the banks of the Avon. 2. A second cause of impediment to the complete and satisfac- tory establishment of a national medical literature is the disposition, more or less strongly felt and evinced by the profession, to patronize foreign works, especially English, in preference to our own. On this subject no doubt exists. The disposition is exhibited constantly and in a variety of ways, as will be seen as we proceed with the discussion of the subject. In the first place, the fact here mentioned is evinced, most une- quivocally, by the use which is made of foreign works as text-books in our medical colleges and universities. Of the forty schools which at this moment exist in the United States, there is not one which, so far as my information extends, confines itself exclusively to Ame- rican works. In a number of them, indeed, hardly any other than English are employed; and frequently, even when American are recommended, it is done in such a manner as clearly to indicate a preference for the former. Even in the Jefferson College, Philadel- phia, most of the members of whose Faculty are authors, several foreign works are mentioned in the list of text-books. In the insti- tution with which I have the honor to be connected, the principal text-books, until recently, were Wilson's and Quain's Anatomy, Carpenter's and Kirkes's Physiobgy, Liston's Surgery, Chaillie^s Mid- wifery, Ash well's Treatise on the Diseases of Females, Pereira's Materia Medica, Watson's and Stokes' Practice. By a resolution of the Faculty, in 1854, it was agreed that, thenceforth, no European publi- cations should be recommended to our pupils as text-books. So far as I am informed, this is the only American School in which such an attempt has been made, although even here it has not been strictly carried out. Of the many strange and unaccountable things which charac- terize the present times, in this country, that of using foreign works as text-books in our medical schools is one of the most extra- ordinary. The fact implies, clearly and unmistakably, that Ameri- can teachers have either no confidence in American authors, or that they are sadly deficient in genuine patriotism; or, what is still worse, and more to their shame, that they are influenced, in their 12 conduct in this matter by feelings of jealousy and avarice; afraid lest, by recommending to their pupils the works of their country- men, their pupils should chance to discover that their countrymen can write books ; afraid lest, by giving them this information, their pupils should stray off, and patronize the schools of which so many of these authors are members. If these are not the true reasons of this conduct, so disreputable to our profession, to our country, and to our age, I confess my ignorance and my inability to assign any other. During our colonial existence, and for more than a quarter of a century after the American Revolution, which severed that exist- ence, we were necessarily dependent upon England for all our literature, medical as well as miscellaneous, and the debt thereby incurred forms no small item against us ; but the time has gone by when we require such assistance, and it is, therefore, clearly our duty to declare ourselves free and independent of our transatlantic brethren, as we did eighty years ago declare ourselves free and independent of the British crown. To continue longer in our vassalage is as incompatible with the genius of our government, as it is disgraceful to us as men and physicians. But, while we en- deavor to perform this duty, a duty in which all true patriots in the profession should cordially unite, let us not forget the debt we owe to the mother country, but use our best exertions to reflect back upon her the light of science and of literature from our own. The thoughts and the actions of her great men, as expressed in their writings, have been, for generations, a portion of our daily intellectual nutriment. In the infancy of a nation which has no resources except the virtue of its citizens, and a doubtful tenure upon its soil, men are often forced to do that which, under opposite circumstances, would be repugnant both to their pride and to their patriotism. It was thus with our forefathers in regard to the adoption of foreign works as text-books in our seminaries, colleges, and universities; the exigencies of the times forbade any other course. And it was thus with Mr. Jefferson, when he was engaged, in 1819, in organizing the University of Yirginia, which he afterwards fostered and protected with the care and affection which a fond and doting parent bestows upon his favorite offspring. Anxious to fill its various chairs with none but able men, he scanned with a scrutinizing eye the claims of his own fellow-citizens, determined to give them the preference over foreigners, provided they possessed equal or greater merit in 13 their respective departments; but to seek his teachers abroad if they possessed qualities superior to native Americans. Dr. Bow- ditch, who stood at the head of the mathematicians of the United States, having declined the chair of mathematics, it was tendered to and accepted by Mr. Bonnycastle, an Englishman. Dr. Dunglison, also an Englishman, was invited to the chair of medicine, and Dr. Emmett, an Irishman, to that of chemistry. At present, all the chairs of that celebrated university, at least as respects its medical department, are occupied by native-born citizens. This is as it should be. In the infancy of the institution the course pursued by Mr. Jefferson was eminently proper; his object was to build up a great seminary of learning and of science, and to place it at once upon the best and surest foundation. This object accomplished, the importation of foreign professors ceased, and Americans now occupy their place. To institute a comparison between the medical authors of the United States and those of Great Britain, or, what is the same thing, between their works, hardly comes within the scope of this report; but I may be permitted to refer to a few of our native treatises as worthy of being employed as text-books in our medical schools. To begin, where is there, it may be asked, in the English language, a medical dictionary at all comparable with that of Profes- sor Dunglison? or a treatise on physiology superior to that of the same distinguished author? Since the days of Haller, I have hardly seen a more learned, systematic, or comprehensive treatise on the subject in any language, certainly not in the English. It is all that such a work should be for the pupil and practitioner; plain, simple, perspicuous, and perfectly methodical, with an amount of erudition as rare as it is profound and astonishing. Our works on anatomy are amply sufficient for all the purposes of the class-room, for which they have all been employed, to a greater or less extent, by some of our schools. The system of Wistar has maintained its place in the esteem and affection of the American student for nearly half a century, and, with the emendations and additions of Professor Pan- coast, bids fair to hold out half a century longer. Horner's treatise has passed through numerous editions ; and the works of Morton, Richardson, and Handy are, in every respect, superior to that of Wilson, which figures so conspicuously upon the catalogues and annual announcements of our colleges. In practical medicine we have just cause to be proud of the labors of Eberle, Wood, Dun- glison and Dickson, to say nothing of those of Hosack, Dewees, 14 Thatcher and Bell, the latter of which, however, is too much mixed up with that of Dr. Stokes to give it a national air. In materia medica and therapeutics, the treatises of Chapman, Eberle, and Dunglison, have long been held in the highest esteem. The second of these works was honored, soon after its appearance, with a Ger- man translation, and its author with a membership of the Medico- Chirurgical Society of Berlin. The treatise of the late Dr. John B. Beck, a more recent production than any of the above, is, I con- ceive, a model for a text-book ; clear, graphic, concise, yet suf- ficiently comprehensive for all possible purposes to which such a book can be applied. In obstetrics we have the admirable and original works of Dewees, Meigs, and Miller, which all enjoy a European reputation, and a wide appreciation at home. On the diseases of children, the treatises of Eberle, Condie, Stewart, and Meigs are without rivals in the English language. In medical jurisprudence there was no work, until recently, that was at all equal to that of T. R. Beck, the merits of which have been acknow- ledged even in Great Britain by several reprints, and in Germany, by at least one translation. The recent production of the late lamented Moreton Stille', on the same subject, is destined to attain a high rank in the medical literature of the country. The dispensa- tory of Wood and Bache is, beyond doubt, the most able work of the kind extant. If we have no great treatises on surgery, chemistry, toxicology, and some other subjects, is it to be supposed that Ave are incapable of supplying them ? Certainly not. What has been done for the other departments of medicine may assuredly be done for these. We have the power; it is only necessary to exert it. Ages elapsed before Great Britain produced one solitary great work on surgery, obstetrics, practical medicine, toxicology, chemistry, medical jurisprudence, and anatomy. The Universities of Oxford and Cambridge had existed for centuries before she even began to dream of a national medical literature. She has not even yet anything like a great medical and surgical dictionary, one to be compared, in point of extent and erudition, with those of France and Germany. In descriptive anatomy, until the appearance of the treatise of Mr. Quain, only a few years ago, she had never furnished one great, respectable, or reliable work; and in materia medica toxicology, juridical medicine and obstetrics, she was equally des- titute. In operative surgery she has produced nothing equal to the elaborate and beautiful work of Dr. Pancoast, with, perhaps, 15 the single exception of that of Mr. Fergusson, so well known and so highly appreciated in this country. If we turn our attention to specialties, we have no reason to be ashamed of our labors. The monographs of Gerhard, Swett, and Austin Flint; of Warren, N. R. Smith, and Carnochan; of Ray; of Bell; of Bartlett, Barton, Drake, and La Roche; are highly merito- rious, and eminently creditable to the country. The two latter evince an amount of research and erudition which have no parallel in English medical literature. With regard to American periodical literature, it is but justice to say that it is entitled to the highest praise. In point of extent, variety, and practical value, it is unequalled by that of any other nation. Nearly forty presses are employed in its service. Many of the best minds in the country contribute to its pages. If it be true that it is not all equally respectable in matter, taste, and style, enough is left, if we deduct the bad from the good, to satisfy the most fastidious, and to supply, in the most ample manner, the wants of the profession. The matter thus furnished, much of which is never seen by our transatlantic brethren, forms many volumes annually, and contributes, perhaps as much as anything else, to edify and enlighten the profession of the United States. It consti- tutes, indeed, a most valuable source of information. From the preceding facts, and the observations founded upon them, it will be perceived that, in most of the departments of the healing art, we have laid a deep and solid foundation for the super- structure of a permanent national medical literature. We have seen that there is no need of borrowing books from Great Britain as text-books for our medical schools; we have shown that many of our writers are men of great talents and erudition, wielding a ready and prolific pen; and we have endeavored to prove that it is due to them, to us, to our profession, and to our common country, to declare ourselves free and independent of all foreign nations, as it respects the elementary instruction of our pupils. Let us not be misunderstood. We would lay no embargo upon foreign works, or in any manner, form, or degree, disparage their merits, or discountenance their just claims upon the favor and patronage of the American profession. Literature, the arts and sciences, are cosmopolitan, acknowledging no " pent up Utica" as their home. Like the breezes of heaven, which fan and fertilize the earth, and refresh its laborers, they belong to no country and to no age, but to the whole world and to all time. We need no in- 16 ternational copyright laws ; let there be a free interchange of our intellectual products; let us not place upon them any restrictions, as we do upon calico and other articles of manufacture. The time will come, if it has not already come, when the medical profession of Great Britain will be glad to receive, in par exchange, the results of our mental labor for theirs. Intimately associated with this branch of the subject is another, hardly of less importance than that just discussed. I allude to the editing of British works by American physicians. So common is this practice that it now amounts to a trade. Pursued by young men and old men, men without reputation and men with reputation, it has become a crying evil, an evil which is directly instrumental in fostering and protecting British influence to the detriment of American authors. The main object of this practice generally is not to enhance the value of the reprint, but to promote its circula- tion by imparting to it somewhat of an American air. The book is indorsed, and it accordingly goes before the profession under a new prestige. The name of the editor is supposed to be a guaran- tee for its excellence; it serves the same purpose to the work that a letter of introduction serves to a traveller. It secures it notice; perhaps a cup of tea, and a permanent home. In this manner it often happens that works, destitute of real merit, or which fall still- born from the British press, meet with a wide and rapid circulation in the United States, to the injury of deserving native authors, and the detriment of our medical literature. For fifty, a hundred, or two hundred dollars, men may be found, in almost every portion of the land, ready and willing to lend their aid and support to what the English press so constantly denounces and stigmatizes as lite- rary piracies. What is remarkable, is that this kind of labor is often much more remunerative than the authorship of original works, which, as is well known to those engaged in it, is seldom adequately rewarded on this side of the Atlantic. Now, I do not, as has been already seen, object to the republi- cation of British works, but I do protest, and that in the strongest terms, against this practice of editing them by members of our pro- fession. Let these works stand on their own merits; it is due to their authors at least that they should not be mutilated and dis- figured with notes, annotations, and alterations. If they possess intrinsic merit, they will be sure to find their way into the pro- fession, and to receive the favor and patronage to which they are entitled. If they do not, let them fall, as they deserve, stillborn 17 from the American press. But whatever may be their fate, let us discountenance the humiliating custom of affixing our names to their title-page, and of ushering them into notice under the seal and sanction of our influence. If the diseases and accidents of Great Britain were different from those of this continent, and, above all, if they required a different or modified treatment, then there would be some show of reason for this practice; but no man acquainted with the subject will plead such an excuse. Nor can he, in extenuation of his conduct, excuse himself on the ground that a similar practice is pursued by the legal profession of this country. Such a course is indispensable, on account of the references which are obliged to be made to the decisions of American cases, and which always greatly enhance the value of the reprint. Indeed, so true is this that, as I am informed by intelligent lawyers, no Eng- lish treatise on law, without such additions, would meet with any circulation in its new home. The practice here spoken of, so humiliating to our national pride, and so opposed to every feeling of patriotism, has never met with any encouragement in Great Britain. The only American works of any note that have ever been republished in that country, are Dorsey's Surgery, Beck's Medical Jurisprudence, Ray's Treatise on Insanity, and Warren's Observations on Tumors. If there were a strict, or even a moderate share of reciprocity on the subject be- tween the two nations, much of the objection that now lies against the practice would cease; but English pride, English prejudice, and English patriotism would shrink from such an act. The practice, therefore, being one-sided, is disreputable, and should be discounte- nanced by all fair and honorable means. We now and then hear of physicians who think that authors who are medical teachers should not be permitted to recommend their works as text-books to their pupils, on the ground, as they allege, that the practice is a serious evil, tending to trammel the student in his choice of books, and thereby promoting the publication and circulation of productions of inferior merit. It is difficult to dis- cover the force of such an objection, the direct effect of which is to disparage native authorship, to repress native enterprise, to mortify native pride, ambition, and patriotism. If the works of American authors are so indifferent, so worthless, or so utterly bad as not to be used as text-books in American schools, then I maintain that they ought not to be read and countenanced by American physicians. If they are good enough for the latter, they ought assuredly to be 18 good enough for the former. Is this the estimate that should be placed upon the works of Chapman, Dewees, Eberle, Horner, Wood, Meigs, Miller, Dunglison, Pancoast, Condie, Bell, Drake, Dickson, La Roche, and a host of others equally able and useful ? Have not their merits been acknowledged everywhere, in Europe as well as in America? Who among us will rise up, and attempt to reverse the verdict that has been pronounced upon them by the profession, or undo what has been hallowed by the genius of medicine? In Germany the custom has long prevailed among teachers of medi- cine to prepare works expressly as text-books for their pupils; and there is no school in that country, from the most humble to the most exalted, in which the custom has not been attended with salutary effects. If, as a general rule, professors are not qualified to write text-books, who are ? They certainly, better than any other class of men, ought to be able to appreciate and supply the wants of their pupils. If they are not qualified to write, how can they be qualified to teach ? 3. I proceed, in the third place, to notice the influence which is exerted upon American medical literature by the American medical press. That this influence is not imaginary, but real and positive, admits, I think, of easy demonstration. The number of medical journals now in existence among us cannot be short of forty, comprising every grade from the weekly to the monthly, the bi-monthly, and the quarterly. These periodi- cals are issued in various sections of the Union, so that few even of the younger States are without a representative. It may be stated, in general terms, that they are edited with taste and ability, and that their pages afford evidence of research, erudition, and use- fulness. Their original communications are, for the most part, of a practical nature, comparing favorably, in this and many other respects, with similar articles in the medical journals of other coun- tries. But it cannot be denied that, in the department of criticism, they are generally deficient in boldness, force, and judgment, falling far below the common standard in the same branch of literature in Great Britain. The reviews are, with few exceptions, written without taste and without point, as if their authors were afraid lest they should be accused of unkindness, harshness, or ill-nature. They are characterized more by politeness than by a manly and independent tone, which is not afraid to utter its real sentiments and to affix the seal of its unbiassed judgment. They are marked by none of the masculine vigor which is so well calculated to impart 19 zest to the reader, and cause him to regret that he is so near the end of his task; which infuses life and spirit into a journal, and makes it a welcome guest at the table of the physician; which fashions and directs the dart, but blunts its point before it is per- mitted to strike its victim; which metes out equal justice to all men who come within its vitalizing, soul-stirring influence ; which blends mercy with severity; which, when occasion requires, wounds but does not kill. It is a criticism which is neither alkaline nor acid, nor yet wholly neutral, but so nearly neutral as to render it impossible to determine its real character. It is a jesting, good- natured criticism, which, for fear of doing mischief, or of being thought unkind, is bound in swaddling clothes, lest, by its sudden and inadvertent jerks, it should kick over the milk and water in the inkstand of the happy, self-complacent reviewer. In fine, it is an inert, a tame, a spiritless criticism; a criticism without body, without strength, without soul, deaf and dumb, and blind and halt. What the criticism of the medical press of the country should be must be apparent to every enlightened, right-thinking physician. It has an important mission to perform. It should be free and independent of all extraneous influence, foreign and domestic. It should exercise its functions openly, boldly, vigorously; with an eye single to the honor of the profession and the glory of America. While it should ever be ready to rebuke egotism, presumption, and ignorance, however exhibited, or from whatever source ema- nating, it should also be ready to speak the word of gentleness and kindness to the brother who adds his feeble mite to the general stock of knowledge and experience. While it does not cover, as with a mantle, his sins of omission and commission, it should endeavor to point out his defects in the spirit of affection and en- couragement. It should hail his efforts as a good omen, as an evidence of his zeal and devotion to the cause of science, as a desire to render himself useful, and not to bury his talent in the earth, and lead the life of a drone. It should encourage him to proceed, to renew his efforts, to try again. It should not aim to extinguish him by the discharge of its gall, by harsh rebuke, insolent assertion, or, worse than all, by faint praise, which has so often blasted the aspirations of genius, and damped the energies of mediocrity. Nor should it indulge in undue severity against the works of our European brethren, but extend to them a cordial, a hearty, a three- fold welcome. It should, in the discharge of its noble mission, institute a thorough examination into their merits, and award them 20 praise or censure, according to the dictates of its honest convictions. It should truckle to no man, clique, or faction; it should be sub- servient to no interests, save those of truth and justice. It should be patriotic, and at the same time cosmopolitan; local, and at the same time universal; for time, and at the same time for eternity. Like the judge upon the bench, it should, in all doubtful cases, lean to the side of mercy, and never condemn without adequate testimony. It should be blind, yet far-sighted; mild, yet stern and uncompromising, watching, as with an eagle's eye, the honor, dignity, and interests of American medicine. Such,.I conceive, is the criti- cism which should animate and characterize the medical press of the country. Any other than this is illiberal, and unworthy of its high mission. I have said that the American medical press lacks independence; and I may now add that this spirit, or, more properly speaking, this want of spirit, is nowhere more strikingly exhibited than in its reviews and notices of European reprints. That I may not make a charge, especially one of so grave a character as this, without reason, let me appeal to facts to verify and sustain my assertion. It is notorious that American publishers of foreign works are in the habit of sending copies of every book, as soon as issued, to the editors of our medical journals, with a view to an early notice. The object of this notice, of course, is, not to disparage but to praise the book, in order that it may thus find its way rapidly to the profes- sion. It is intended, indeed, by the publisher as an advertisement, to proclaim the peculiar fitness of the new candidate for public patronage. For this purpose the book is sent as a gratuity, and it is so regarded by the recipient. Thus, almost without his con- sciousness, he incurs an obligation, which he can only repay, not in kind but in form; that is, by a laudatory notice or review. If he fail to do this, he necessarily gives offence to the publisher, if he do not actually make him his enemy. That this is a natural consequence of this kind of intercourse between journalists and booksellers must, I think, be admitted by every one who has be- stowed any reflection upon the subject. How can a man be so ungracious as to disparage the present of his friend or even of a stranger ? Will not his sense of politeness prompt him to speak kindly of it, even if it be comparatively unacceptable, unimportant, or worthless ? Does not the very fact that the book is a present frequently disarm just criticism ? But is editorial courtesy the only consideration which enters 21 into the merits of this question? Has self-interest no part in it? Does not the journalist derive direct " aid and comfort" from this source? Does not every book thus received add one more volume to his library ? If an editor were charged with venality, or even with unconscious subserviency to the publishers of foreign reprints, he would repel the assault, and no doubt very justly, as false and slanderous. And yet editors do not differ from other men. Self- interest governs, to a greater or less extent, the whole human race. A journalist may make it a practice to speak favorably of every book that is presented to him, without any reference to pecuniary benefit, or without meaning or intending any harm to any one. He acquires a sort of habit, which, once established, his good nature induces him to continue; and thus he may go on, year after year, utterly unconscious of the injury which he is inflicting upon the profession and the progress of sound medical literature. Another editor, perhaps less kind, but more independent, and more considerate for the advancement of his profession, pursues a different course. He, too, receives presents of books, but, governed by opposite motives, he does not hesitate to estimate them at their true value, and to publish to the world the convictions of his judg- ment. He commends their merits, while he fearlessly denounces their faults and their shortcomings. But if he had indulged any hopes of filling his library with books thus obtained, he is sadly disappointed. He is at issue with their very source and fountain. He has offended the publisher, and he must be prepared to suffer the consequences. No more books arrive; he thinks it strange, but time only serves to convince him that he has committed afaux-pas. The supply is cut off, and henceforth he is compelled to rely upon other sources for his bibliothecal treasures. That this statement is not exaggerated is a fact familiar to every American journalist himself. A few years ago a certain firm in Philadelphia, who had always been in the habit of sending copies of their reprints to the Western Journal of Medicine and Surgery, all of a sudden withdrew their favor, for no other reason, as was afterwards ascertained, than because the editor of that periodical had dared to speak disparag- ingly of one of their publications. Several instances of a similar character fell under my own observation during my brief connec- tion with the medical press at Cincinnati. A case in point, but relating to another department of literature, and causing a great deal of notoriety at the time, occurred at Boston, last autumn. A political newspaper, the Boston Traveller, having published a severe 22 critique on Mr. Longfellow's Song of Hiawatha, the publishers, Messrs. Ticknor, Field & Co., immediately withdrew their adver- tising patronage, and ceased to send their publications. It is well known that the late Judge Story, the pride and glory of our judi- ciary, was the author of a work on Bills of Exchange, one of the ablest and most learned of his world-renowned productions. It might naturally be supposed that, inasmuch as he was the founder and chief ornament of the Law School at Cambridge, this work would be used, after his death, as it had been during his life, as a text-book in that institution. Far from it. The work employed for that object is that of Biles, an English treatise, republished by a Boston firm, one of whom happened to be a member of the board of trustees of Harvard University. These facts, which might be multiplied indefinitely, speak volumes; they show the influence which the publishers of reprints of foreign works exert upon the press of the country, miscellaneous and professional, and prove, in unmistakable terms, the truth of the statements set forth at the commencement of these remarks. In making these comments, I beg leave to disclaim all intention of casting any censure either upon medical editors or on the republishers of foreign works. I have merely alluded to what I believe to be a habit into which some of the journalists of the country have fallen unconsciously in regard to the subject under discussion, and which they are unconsciously perpetuating. Nor, on the other hand, would I accuse the respectable body of repub- lishers of any wrong intentions in their efforts to procure from the periodical press favorable notices of their productions. It is their business, as it is their interest, to promote the circulation of the works which they reprint. It is their pursuit; they live and grow fat by it. The American medical profession owes these re- publishers an immense debt, for affording them, in a cheap and ac- cessible form, the works of our transatlantic brethren; as they owe us an immense debt for purchasing these works, and promoting their circulation, by the influence which we wield through the press, in the lecture-room, and in our private intercourse with each other. Thus far, the obligation is mutual. But here let it cease. Let our journalists procure these reprints at their own expense, and we pre- dict that a healthier tone will soon become apparent in their critical notices and reviews. 4. I notice, in the fourth and last place, as a prominent cause of 23 the impediment under consideration, the little use that is made of the advantages afforded by private and hospital practice. Every physician, however slender his talents or limited his oppor- tunities, has it in his power to make himself useful to his profes- sion. It is only necessary that he should carefully observe and faithfully record the facts that pass daily, for fifteen, twenty, or twenty-five years, under his eye to enable him to become a most valuable contributor to medical science and medical literature. If this habit were universal, the profession, and mankind at large, would not now have to lament the many imperfections and the many incongruities of the healing art. Many diseases which now baffle the skill of the physician and attest his impotence, would be rendered amenable to his remedies, and cease to be regarded as opprobrious. And what is true of individual observation and ex- perience, is still more true of combined observation and experience, those compound pulleys and levers of the human mind. Our country is rich in medical charities, hospitals, almshouses, infirm- aries, and asylums of all kinds. In the larger cities of the Union, institutions of this description exist that would reflect credit upon the intelligence and philanthropy of any nation in the world. They are, in fact, the palaces of the poor of our country. It is impossi- ble, from the want of statistics, to form an accurate estimate of the number of sick and wounded that annually enjoy the benefits of these eleemosynary establishments. It cannot, at a rough calcula- tion, be short of 120,000. The physicians, surgeons, and accouch- eurs who have charge of them must amount to several hundred, embracing a large share of the best medical talent and intelligence of the country; and yet what have these institutions done, what have these physicians, surgeons, and accoucheurs done for American medical science, American medical art, and American medical lite- rature ? Where are the trophies which they have brought from this great battle-field of disease and accident? Where are the legacies which they have bequeathed, or which they are ready to bequeath, to their profession and their country ? Can any one point to one solitary work, of any note or respectability, that has emanated from their pen, as the legitimate result and effect of the immense oppor- tunities which they have thus enjoyed? Where are the treatises which they have furnished us on clinical medicine, clinical surgery, and clinical obstetrics; on fevers, on eruptive diseases, and on dis- eases of the digestive organs, the lungs, the heart, and the brain; on wounds, fractures, dislocations, injuries of the skull, tumors, 24 aneurism, amputations, resections, and various other important sub- jects? Where are their works on pathological anatomy and animal chemistry? Echo, alas! echo, alas! answers, where, where! We have accomplished, literally and absolutely, nothing in any of these par- ticulars. Need we be surprised, then, when a recent English writer1 exclaims: "We may safely say there is no American school of medicine; whereas there is a French, a German, an Italian, and an English. Our transatlantic offspring reprint, translate, and pi- rate the medical works of other nations, but they produce little of their own. Their pathology is chiefly French; their therapeutics English." Mortifying as such an accusation is, it is certainly not wholly destitute of truth. Some of the hospitals of our country have been in successful operation for upwards of a century, and yet, during all this time, they have literally been as sealed books to the bulk of the profes- sion. The only light that has ever emanated from any of them has been an occasional ray, apparently grudgingly bestowed, in the form of a contribution to some medical journal, more transient, perhaps, than the journal itself. We might, if it might not seem personal, point to some of these establishments where materials for the study of pathological anatomy abound that even a Rokitansky might envy; to some, where vast opportunities are constantly afforded for the study of all kinds of injuries, as wounds, fractures, and dislocations; to some, where syphilis might be investigated, in all its forms and phases, with the same facility and amplitude as at the Hopital du Midi in Paris; to some, where there are annually upwards of seven hundred cases of parturition, and any amount and variety of diseases of women and children; to some, where pulmonary, gastric, and intestinal affections are of constant occur- rence ; and, finally, to some, where eye and ear diseases are studied and treated as specialties. Of the 120,000 patients who, we have supposed, are annually admitted into the various hospitals, asylums, and other charitable institutions of the country, at least ten thousand die. The bodies of many of these are doubtless examined, but where are the records of the results? I am not aware that one solitary great and im- portant paper on pathological anatomy has ever appeared in our medical journals from the pen of a hospital physician, surgeon, or accoucheur. 1 Banking's Half-Yearly Abstract, No. 22, p. 305,1855. Philada., 1856. 25 The preceding facts require no comment; they speak for them- selves. The patriotic physician, patriotic in a double sense, pa- triotic to his profession and to his country, may well exclaim, as he contemplates these things, "Watchman, what of the night?" When will official station and opportunities be turned to account? When will the light of medical science be made to emanate from these institutions, and to shed its quickening and exhilarating influ- ence abroad upon the medical profession and the world ? Had the opportunities above alluded to been properly employed, how rich might our profession now be in great works on pathological ana- tomy, medicine, surgery, and obstetrics! What light might we not now send by every steamer to Europe in liquidation of our literary debt! Our foreign bonds would soon be cancelled, and American repudiation would cease to be a byword among our transatlantic brethren. Having thus pointed out, as briefly as was consistent with the nature of the importance of the subject, the principal causes which obstruct the progress of American medical literature, let me con- clude by offering a few remarks respecting the best means for removing them. Our course in relation to this subject is sufficiently obvious. Our duty, indeed, is self-evident. It is comprised in one solitary prin- ciple, namely, justice to ourselves, justice to our profession, justice to our country. If we discharge this duty faithfully and vigorously, as it becomes us as men, as physicians, as patriots, and as Christians, we shall be no longer subjected to the taunts and reproaches of the transatlantic press, when it asserts, in the very face of the constant and liberal use which it makes of our labors, that America has no medical school, no pathology, and no therapeutics, save what she borrows from France and England. We have simply to throw off the yoke which has so long galled and oppressed us; to declare our- selves, as far as our schools are concerned, free and independent of the literature of Europe, from whatever quarter emanating; to en- courage and foster our own authors ; and, finally, to make the best possible use of the means, private and public, which are at our dis- posal for the establishment of an original, a vigorous, and an inde- pendent national medical literature. In a word, it is only necessary that we should reclaim our heritage, which, Esau-like, we have well nigh sold for a mess of pottage to our European brethren ; to beat down Satan under our feet; and to assert the rights,privileges 3 26 and immunities which have been vouchsafed to us, to our profes- sion, and to our country, by an all-wise and beneficent God. In view of the speedy and successful accomplishment of these desirable ends, I beg leave to submit the following resolutions :— Resolved, That this Association earnestly and respectfully recom- mend, first, the universal adoption, whenever practicable, by our schools, of American works as text-books for their pupils; secondly, the discontinuance of the practice of editing foreign writings; thirdly, a more independent course of the medical periodical press towards foreign productions, and a more liberal one towards American; and, fourthly, a better and more efficient employment of the facts which are continually furnished by our public institu- tions for the elucidation of the nature of diseases and accidents, and, indirectly, for the formation of an original, a vigorous, and an inde- pendent national medical literature. Resolved, That we venerate the writings of the great medical men, past and present, of our country, and that we consider them as an important element of our professional and national glory. Resolved, That we shall always hail with pleasure any useful or valuable works emanating from the English press, and that we shall always extend to them a cordial welcome as books of reference, to acquaint us with the progress of legitimate medicine abroad, and to enlighten us in regard to any new facts of which they may be the repositories.