ANNUAL ADDRESS DELIVERED BY W.O. BALDWIN, M.D., BEFORE THE /ASSOCIATION, AT NEW ORLEANS, LA., MAY 4, 186£ [From the Richmond and Louisville Medical Journal, July, 1869. LOUISVILLE, KY.: BELL AND COMPANY, PRINTERS. 1869. ANNUAL ADDRESS DELIVERED BY W.O. BALDWIN, M.D., BEFORE THE yVLEDICAL NEV ORLEANS, LA., MAY 4, 186^ [From the Richmond and Louisville Medical Journal, July, 1869.] LOUISVILLE, KY.: BELL AND COMPANY, PRINTERS. 1869. ADDRESS. Gentlemen of the American Medical Association: I con- gratulate you on the return of an occasion which permits us to renew that fraternity of intellect, no less than that sympathy of feeling by which our life and vocation as physicians are beautified and ennobled. Of no profession are the inspired words more true than of ours, that we are “members one of another.” The ideal of our pro- fession is that of complete and thorough oneness. What is scientific truth for one is scientific truth for all. We have a common estate in the facts, aims and purposes that belong to the science of medicine, and hence we do a wise work, when we acknowledge the exalted unity of the medical profession by this annual assemblage. The nature of this occasion reconciles me in some de- gree to the task which I have now to perform. When I remember that the position I occupy was first filled by the distinguished Chapman, and that the succeeding an- niversaries have been presided over by men whose genius had shed not only light but lustre on the annals of our profession, I feel that nothing but the inspiration which breathes through affections kindled into life by this As- sociation, could sustain me under the sense of incompe- tency for the duties to which your kindness has called me. Relying on the same spirit which prompted you to confer on me the highest distinction within the gift of, the medical profession of America, and hoping that my deficiencies may be forgotten in the interest and magni- tude of the subjects awaiting your deliberation, I proceed to discharge the duty, which the custom of my prede- cessors has imposed upon your presiding officer. The spirit of a profession is the true sign of its char- acter, as it is the measure of that respect with which its talents and services are regarded. Manly sentiment, springing from broad and genial sympathies, is the soul of every profession, and if it is wanting, no learning, no skill, not even usefulness, can prevent it from sure and speedy degradation. The first and last requisite of pro- fessional life is not power of intellect, however valuable that may be, nor those acquisitions of knowledge that enrich our thoughts, but that other and finer quality of generous manhood which, as a subtle and pervading es- sence, enters with its healthy vigor and animating im- pulse into all its connexions. Of our profession, this is eminently true, and, on this account, I rejoice that the records of this Association give no evidence of sectional unkindness and prejudice, even during the period of our bloody war. To me, gentlemen, this occasion is one of solemnity and significance. Standing here in the great commercial metropolis of the South, I find myself surrounded by men representing nearly every section of a country so lately arrayed in hostile strife. At a time when every other organization has been shaken to its centre by the passions of deadliest hate; at a time when the most ma- tured conservatism has been over-mastered by the vin- dictive fury which has swayed the popular mind; at a time when even instinct has been treacherous to its ends, you have been drawn hither from homes far distant, over highways full of painful historic incidents, through terri- tories watered by the blood and tears of a sorrowing nation, and you have assembled here as brothers and friends to unite your offerings to a common science. The mournful witnesses of this terrific struggle have con- fronted your eyes ; the shadowy phantoms still linger on the stage where these tragedies have been performed; the air we breathe has not yet lost its echoing groans of dying heroism, nor the pathetic anguish of sorrowing relatives. Amid these circumstances so sundering to the most sacred companionships of life, you have met in the spirit of Him who is this world’s greatest and best Healer —that Divine one who, opening and continuing his min- istry of service, by curing all manner of diseases, finished its majestic self-denial in the reconciliations of the cross. Eight years ago we were separated by civil wmr. That war engendered the bitterest feeling in every other na- tional organization, whether scientific, 'political or Chris- tian ; but the members of this Association, without words of crimination or reproach for one another, as- sumed the respective places assigned them by the obliga- tions of citizenship. Through the long and bloody contest which ensued, this Association, in its resources, honor and renown, was in the keeping of our northern brethren; and during those memorable years when the sense of bitter wrong and burning hate filled all hearts, and when friendships and affections born of the hallowed ties of consanguinity sent their messages—once of love and ten- derness—at the point of the bayonet or through the can- non’s mouth, what were the feelings which moved this Association ? At the first meeting, two years, after the war be- gan, they indulged only in expressions of profound regret that “the brethren who once knelt with them at the same holy altar and drank with them at the same pure fountain”* had been separated from them by civil war, endangering thereby the claims of the Association ‘to an unselfish nationality, and robbing it of the presence and the counsel of many of its warmest adherents,”! while praying at the following meeting that the period would soon come when we should again be “one in our political, professional and social relations.”J The same humane and catholic spirit continued during the war to mark the conduct of the members of this As- sociation. Each of the divided sections met the tasks required by its respective position. But wherever found, whether sharing the hardships of the campaign or dis- charging the duties of private practice, they compre- hended the essential difference between what might prove on the one hand a transitory evil, and what on the other hand, they knew would be a lasting good. Accordingly they remained the consistent representatives of a noble brotherhood. If they did not sink the patriot in the physician, they did not sink the physician in the patriot. The imperative instincts of each character true to its trusts and faithful to its requirements, acted for them- selves and in the direction of their own ends. Amid the shouts of battle and the shock of arms, they raised them- selves to the height and grandeur of their calling, and thus stood far above the embittered prejudices that en- circled all other classes of men. So far from allowing the fugitive passions of the times to betray them from their professional allegiance, they vindicated their sagacity, no less than their manliness, by looking to the future—by contemplating results not the less certain because remote, * Transactions, 1863. f Transactions, 1863. 1864. by regarding with thoughts chastened and subdued that state of man in which the interests of life and death meet together; and by considering as paramount to all selfish motives the claims of that science with whose undis- closed mysteries they must yet wrestle for the well-being of mankind. Above all, they looked to the transcendent value of a virtue, which should contrast in broad masses of light, its purity and power with the corruptions and frailties of the hour, which should, by reason of its dis- interestedness, diffuse itself through the affections of na- tions, and reach, in the large outgoings of its sympathy, the hearts of generations yet unborn. When at last this dispensation of carnage ended, and whilst as yet the war-path was crimsoned with the blood or whitened with the unburied bones of our brethren, this Association again met. Like the surges of the sea, dark, tumultuous, raging, though the storm, has passed from the sky and fled beyond the horizon, the meaner instincts of hatred, revenge and persecution still swayed the multitude. The mob of fanatical intellect unappeased and the mob of popular passions thirsting for new strife, joined their hands to prolong the wretched alienation. The avenging angel had lifted his brooding wings from the landscape, and cried, “It is enough;” but now other vials of wrath seemed about to be poured forth on a land hopeless because helpless. You then met to pour oil on the unquiet waters. Here was scope fora statesmanship, aye, for a generalship grander than any which the -war had developed. Here was the best of opportunities to inaugurate a new epoch of fraternal sympathy. Hor were you unmindful of its solemn behests. True to your past professions of regret over our separation, you saw the vacant seats in this Association of your Southern brethren, and, actuated by the higher instincts of man- hood, and scorning the base ambition to degrade a fallen antagonist, whom the saddest experience had taught the bitterest lessons of life, you set the nation an example of dignity, moderation and virtue, to which no other organ- ization in the land has yet had the wisdom or the sensi- bility to rise. Within a few weeks after the cessation of hostilities, this Association held its regular annual meeting in the of and there renewed with manly sym- pathy its former expressions of kindness, inviting us to come again and be their brethren. I quote their language on that occasion when I say—“the unhappy feud which for years has divided the nation has ceased and peace has come, we trust forever; so we hope soon again to meet our members and delegates from the South on the platform of fraternization, and to this end we ex- tend to them a cordial welcome.”* At a subsequent meeting you repeated this sentiment in the following language: “we would fain meet again those from whom we have been separated, draw the mantle of forgetfulness over the past, renew to them the expressions of regard, and with them, dedicate the hour and the occasion to the sacred cause of learning, friendship and truth.”f And when at the last meeting we met our Northern brethren, how were we received? They met us as equals in the past and equals in the present, saying in effect, if not in words : “if quarrel we ever had it is over; we have no explanations to offer, no apologies to demand; we know that we have done our duty ; we feel that you have done no more, and that you would have been unworthy your noble vocation had you done less; we have guarded faithfully the institution so long left in our charge, in which we now claim but an equal interest with you; with the incense which we have burned in its sacred fane we have not permitted the poisonous spirit of party to min- gle, and we now invite you to go with us to the smiling and peaceful fields of that science whose interests it shall be our common work to foster and advance; here we will walk with you to the stern realities and sublime grandeur of labor and thought, and find in their quiet paths a relief from the gloom of the past; here we will divide with yomthe toils and share with you the rewards of labor., the of success.” Against the insolence of the day; against its unreasoning pride, its overweening vanity and its shameless scorns, your conduct bore a moral protest, which while acting directly on our profession, has had no small agency in producing those indications of a return to reciprocal sentiments of confidence and re- spect in which all the good men of the country rejoice. The mythical war between the Athenians and Amazons, led in the midst of arms to the most intimate friendship JretwßOß,.j&£deaders. When Pirithous and Theseus introduced by Dr. J. R. Van Kleek, of New York, and adopted.—Transactions for 1865. Vol. 16, p. 57. t Address of Committee of Arrangements through their Chairman, Transactions for 1866. Vol. 17, p. 10. finally met on the plains of Marathon, after many a hard fought battle, the former regarding himself and army, as said to the latter; “Be judge thyself; what sat- isfaction dost thou require ?” The noble Athenian re- plied : “Thy friendship,” and they swore inviolable fidel- ity, and were ever after true brothers in arms. Alas, that the nineteenth century has so often to recur to classical heathenism to find its illustrations of genuine magna- nimity ! Looking at these facts, am I not warranted in asking if any organization has emerged from our late convul- sions with so much dignity ? lias it not come forth from the sharp ordeal with those graceful virtues that belong to our higher nature ? The world may have its conven- tional rules of intercourse between man and man—its creed of moral philosophy—its code of honor, its accred- ited formula of behavior, while it lavishes its praise on the charms of human brotherhood; but it has been left to the American Medical Association to teach practically the intellects of the land one of the most ennobling les- _JS0nqjjjfr the dignity, beauty and glory of refined and civ- ilized life; a lesson that not only hallows the spirit of our professional character, but instructs the physician in those spiritual sentiments which lead to the highest virtues, among which are reckoned Charity and Forgiveness. Of the one, we are told, that the archangel, who never knew the feeling of hatred, has reason to envy the man who subdues it; while of the other, it is said, that when we practice forgiveness to the man who has pierced our heart, he stands to us in the relation of the sea-worm that perforates the shell of the muscle, which straight- way closes the wound with a pearl. Ao apology, gentlemen, is necessary for dwelling so long on the moral spirit of this Association. If I had not believed, that a moral sentiment, underlies all-pro- found thought, all true research, all genuine wisdom; that it is the strength of civilization, the security against those covert forms of heathenishness and brutality that lurk under the imposing hypocrisies of outward splendor, and the ulterior end for which nations and mankind ex- ist ; if I had not been assured that our profession rests on this basis, and can rest on no other, I should not have devoted so much time to this subject. Turning from these reflections, so naturally suggested by the circum- stances of our present meeting, I am reminded that other points of great practical significance claim our attention. 1 almost fear to name to yon, gentlemen, the subject I have chosen for a few remarks. So frequently has it been the theme of discussion, that some may be wearied by its repetition. I approach it, too, with much diffidence, be- cause it has been handled by so many abler minds. I al- lude to the subject of MEDICAL EDUCATION. If it is an old topic, and, moreover, somewhat worn, it has the advantage of a deep, vital and permanent inter- est, from which the want of novelty cannot detract. Furthermore, it is a topic that has recently assumed new aspects. Yast changes have lately occurred, not only in human progress, but in the specific direction which that progress has assumed. Physical science is achieving un- precedented results. The mind of man, liberated from its long but salutary apprenticeship to the external phe- nomena of the universe, seems to be approaching its maturation, by penetrating into the secrets of matter, evoking its mightiest forces, and subordinating them to the advance of civilization. In all departments of prac- tical science wo see a resoluteness of investigation, a con- stancy of indomitable will, a scope of rational inquiry, that are remarkable. The breadth of this movement embraces all the divisions of human knowledge, and its characteristic features are thoroughness and complete- ness. If the chemist, the engineer, the natural philoso- pher, have to adjust themselves to these extraordinary changes : if the inter-relations of the sciences and arts are constantly acting to impel each one of these sciences and arts to wider researches and a fuller mastery of its own legitimate facts, it cannot be expected that medical edu- cation will fail to feel the impulses of the age. A pro- fession that does not equal the age in its educational machinery, that is unable or unwilling to represent its modes of thought and its forward tendencies in its de- mands from those who seek admission to its ranks, ceases to be a profession, because it loses its claims to a scientific character. The methods of thought now developed among the thinkers of every science, are educated methods. I mean by this, that they observe an orderly routine, follow the established laws of inquiry, never anticipate their own cautious action, never predicate final conclusions until successive steps have justified their emphatic declaration. With these methods of thought, our modes of investiga- tion, our instruments and agencies, agree, so that the intelligent mind of the day has its counterpart in the appliances it employs to attain its ends. Natural endow- ments still have their value. Individual skill, personal ingenuity, the keen insight of native genius, yet have their worth. But, nevertheless, a professional man of the present time, much more than ever before, must rely for honorable success on an exact and extended education. This is just as true of medical education, perhaps more true, than of any other form of education. The simplest principles of medical practice, such has been the progress of science, take hold now on a large body of facts; kin- dred sciences and arts have come to our aid; the way of treating disease is daily becoming more philosophic; our knowledge is better systematized; and hence, while the science of medicine has greater power to educate than at any previous period, the necessity tor a physician to he educated, in order to avail himself of the advantages of increased. Yet it must be acknowledged that the proper standard of medical education in this country has not been approximately reached. Nearly a quarter of a century has elapsed since this Association was organized for specific objects, the chief ot which was the elevation of medical education. The deplorable ignorance of many young men who receive the distinction of a diploma, is known to all. The calls for reform have been loud and earnest. We have had inves- tigations, reports, addresses, until the subject has been presented in every variety of phase. The argument has been fully made and as fully accepted: it has been en- dorsed by the medical journals of the country, by the medical colleges themselves, between which and the pro- fession, no difference of opinion exists as to the theoret- ical questions involved. Yet, practically, the subject re- mains just where it was when it first claimed the anxious consideration of the profession in this country, and led to the creation of this body, with a view to organized efforts for a radical change. I do not allude to this subject, in the hope of adding any new facts, or of bringing forth any arguments more forcible than those contained in your former Transactions. But my purpose is to keep it before the mind of the Association, as a matter of vital importance to every in- terest in the country. Standards of requirements, vary- ing somewhat in degree, but always deemed moderate, ■wise and just, have been submitted to this Association, and recommended by its action to the adoption of the medical colleges; and whilst they have seemingly met the approval of all, wTith perhaps one exception, they have yet failed to obtain the compliance of any. To en- force reformation where so many different and conflicting interests are concerned, is a most difficult and embarass- ing task. In governments, revolutions are sometimes quick and violent. The dethronement of monarchs, the overthrow of empires, the downfall of nations, the blot- ting out of statute books which may have been the slow product of ages, may be the coup d’etat of a day or an hour. Such, however, is not the case with the laws and usages regulating the modes and forms of education. The capricious vicissitudes of human fortune which pass by us in such rapid succession, working in some instances the most speedy and salutary changes, are un- known to those arrangements which relate to the propa- gation of scientific truths. Revolutions of this kind may properly claim the calm and deliberate attention of the leaders of thought, and particularly when they involve the tedious and toilsome work of training the mind for an arduous profession. Yet, conceding the difficulties of the case, wre must confess that twenty-two years of organized effort, di- rected mainly to one object, and characterized by the diligence, industry and zeal, of a numerous and learned body of men, should have presented some substantial re- sults as the reward of so much valuable thought and untiring labor. Respite the earnest and pleading appeals that have gone from this Association, a strange and fatal neglect exists among our medical colleges, in regard to the highest interest of the profession, viz : the introduc- tion of such modes and the appliances of such tests, in connection with professional education, as shall secure the ends of instruction and disciplinary training. If pro- fessional education means anything, it means a special- ized form of culture—such a culture as consists in acquir- ing pertinent facts and precise principles; and, furthermore, the intellectual art of using aaasfcifacts and principles with a reasonable degree of dexterity and skill. It pre supposes the ordinary education of a gentleman; it begins at that point; and, if this be lacking, the specific profes- sional education is, in a majority of instances, radically vitiated, and so vitiated because few men are competent to receive a specific form of culture, unless they have antecedently had a good general culture. Yet the dis- tinguished Prof. Henry Miller, one of the former Presi- dents of this Association, and for years a teacher of medicine in one of the first medical schools in the United in his official address before this body, in that he was constrained to say, “ Even at this late period, the profession abounds in students and prac- titioners who are radically deficient in spelling, grammar, etymology, descriptive geography, arithmetic, and, I might add book-keeping, but that they generally apply themselves to the study of this important branch with a diligence that supplies the want of early opportunities.” And he adds, “ all candid men who have had any experi- ence in medical schools, must confess that the examina- tions of the green room annually reveal a sum of ignorance or of vague and misty perceptions of fundamental medi- cal truth, even in many who are invested with the honors (?) of the Doctorate, which is truly amazing. For myself, I ccn solemnly declare, that the most mournful and humiliating passages in my professional life, have been these annually recurring examinations, in which such scanty harvests have been reaped as the reward of a winter’s faithful toil.” Think for a moment what the idea of an educated physician embraces, and then place it in antithesis to the statement made by Dr. Miller. Apart from the prelimi- nary culture that initiates him into the world of knowl- edge, and secures him some tolerable command of his mental faculties, a physician is expected to understand the human body, its complicated structure, its nervous and muscular offices, its various organs and their inter- actions on one another, its laws of health and disease, its relations to soil and climate, and its susceptibilities to the influence of mind and civilization. Add to these the remedial agents he employs, the use of those resources which his art has provided, and his unceasing need for an acquaintance with chemistry, and its co-related sci- ences. What is equally essential, a physician’s habit of thought must be estimated—and what a scope this in- cludes; what a compass of calm but intense insight, of philosophic clearness, of studious induction! When I think of the single faculty of judgment, of the infinite pains-taking necessary for its cultivation; of the coordi- nate functions of association, suggestion and comparison that attend its action; of the vast number of constituent qualities that combine to form a truthful, reliable and trustworthy judgment; and when I think that this is the master-power of a physician, and can only be acquired as the latest fruit of broad and comprehensive generali- zations, and as such is mainly due to early habits of patient and assiduous study under the best preceptors, I am unable to imagine any temerity more rash, any arro- gance more supercilious, any ignorance so fatal, as those which can rush unprepared into the responsible duties of the profession of medicine. I know of no man whose professional education, as to stringency of obligation and sanctity of motive, can rest upon truthfulness of heart with such weighty considerations. I know of no man on ■whose intellectual and educational fitness for his position, so much depends, either for weal or for woe. Without the least exaggeration, it may be affirmed, that there is not a single attribute of mind or body which is not sus- ceptible, in a physician of such education, as to enhance his professional worth to himself and the community. The proper development of his senses, the eye that can see accurately, the ear that can discriminate among the faintest sounds, the touch that responds to the slightest impression; the management of his own nervous system, so that it can sustain his intellect when most severely taxed; the exactness of memory in the retention of im- pressions ; the almost artistic vividness necessary for precise delineations; these functions of observation, re- flection and analysis, as fundamental to higher processes of mind, are capable of an extraordinary degree of edu- cation, and hence require the most mature and systematic training to give them a right direction. If this ideal of medical education is not overdrawn, it is not surprising that our Association has shown such a deep sensibility to the current deficiencies of professional training. The full and able report of 1849, by your Committee on Medical Education, composed of men of the highest distinction in our ranks, holds this language; “We regret that candor and justice compel us to admit, that the most deplorable ignorance and unfitness for the re- sponsible duties of a physician are often exhibited by those who hold the diploma, and who are thus endorsed as being qualified and competent. This fact is so notori- ous that it would be a waste of time to cite instances in support of it.” This is the language of the committee, and numerous other extracts equally authoritative and de- cisive could be furnished from your own Transactions, in confirmation of the fact under notice; nor has there yet been any substantial advance towards correcting the evil. The practical questions are then, with whom lies the fault and what is the remedy ? The first and, undoubtedly, the fundamental error in our system, is one already adverted to: a defective pre- liminary education. Nearly all writers on this subject have tried to rest the blame upon the private preceptor, into whose office the student of medicine is first received. Contending that it is his duty to ascertain the fitness of his preparatory education to qualify the student for the study of medicine, they put upon the onus of deciding this point. I cannot see the j ustggflK of this demand, nor do I think it safe to place the responsibility upon this party. In the first place the colleges have no standard for preliminary education, and this the precep- tor knows. And in the next place, the preceptor him- self may be one of those spoken of by ProfessonsMiller,* and hence, incompetent to decide even on acquirements in spelling, grammar, etc., to say nothing of the ill-grace he would show in closing his office against a young aspi- rant on the ground of deficiencies, which in his own case the Medical Colleges have overlooked. Nor is the stu- dent to blame, since he cannot see the necessity for a pre- paratory culture, while, perchance, he has made it a matter of calculation on mere grounds of business. If he enters on the study of medicine as a trade, (as undoubtedly many do,) he wishes to get his profession with the least possible outlay of labor, time and money; so that viewing it from his standpoint, if the diploma can be obtained on the basis of an imperfect scholastic knowledge, he justifies himself in his neglect. Granting that the private pre- ceptor should inquire into this matter, (and it is certainly better that he should do so,) yet through the imperfec- tion of his own standard or through insensible favorit- ism, he may accord to the student qualifications not pos- sessed. But whatever may be the judgment of the pre- ceptor, however well or ill his initial duty may have been discharged, the responsibility of the medical college for his matriculation remains unaffected. The power is in its hands to arrest the evil in its rncipiency, and it is pre- cisely at this point, that the power which has been lodged in its possession as a chartered right, and which consti- tutes it the safeguard of the profession, should be firmly and emphatically asserted. Kot only is a medical col- lege bound to give instruction and training, but it is equally bound to see that its matriculants are fit subjects for its instruction and training. The shipping merchant looks to the sea-worthiness of his ship as well as to the skill of the captain, to whom he entrusts his cargo; and the farmer examines the soil as anxiously as the seed, if he has any pretensions to the science of agriculture. _ But, in many instances, our col- leges ignore the necessity for a parallel inquiry into the capacity of young men to receive the benefit of their teaching. Foundation or no foundation—they are the architects of a superstructure; corner-stone or not, they are intent on towering stories, pilasters, architrave and dome. ISlor indeed need the rain descend, nor the floods come, nor the winds blow and beat upon that house until it fall; nature may spare the punishment of its sandy basis—it falls by its own nothingness. To see this subject in a full light, bear with me while I sketch a medical student’s life in this country. There are many exceptions to what I shall say, but while this is gladly admitted, the tendencies of our present mode of education may be faithfully represented. I honor these exceptions in students who prepare themselves for the study of medicine, and in those colleges that have due respect to the character of the profession in the confer- ment of the doctorate. But in the ratio that these ex- ceptions are distinctly marked, the system itself stands condemned. When a young man has determined to study medicine, he applies to a physician for admission into his office, or not infrequently for the loan of his books, preferring to study at home in order to save ex- pense. The preceptor, thus selected, is generally the friend and physician of the applicant’s family, and re- ceives him, in most instances, without hesitation and without inquiry. A work on anatomy is put in the stu- dent’s hands, and perchance a few plates or bones super- added, which, when left to himself, he studies and under- stands to but little profit. Engaged in private practice, often limited in means, struggling for daily bread, the preceptor has frequently neither the time nor the appli- ances, (if, indeed, he has the professional education,) to render that assistance to his student which his crude in- telligence and unformed habits demand. The art of the teacher, the rarest and noblest ot arts, which, combining in itself the endowments of nature and the acquirements of knowledge and experience—this directing and inspir- ing art is denied the student at that period, when his age and impressibility most urgently require its presence. Ordinarily, the preceptor has no ambition to be a teacher; seldom has he pupils sufficient to remunerate his labor or enlist his feelings; while the sense of responsibility is materially lessened by the fact, that the student will pass from his hands to the oversight of those whose business obliges them to superintend his preparation for active life. The more fortunate students have, perhaps, the aid of lectures and demonstrations in addition to instruction and text examinations, but even in these instances, the want of method and of systematic training greatly abridges the theoretic benefit. A year or a portion of a year passed in this way, what- ever the progress, or whether any progress at all, the student then enters a medical college. Here he is expected to receive “two full courses of lectures,” which usually occupy the succeeding winters, though in some instances attendance upon a winter and a summer course imme- diately following, will entitle him to an examination. Ho conditions are imposed upon him by the college. Ho examination is had into his capacity to profit by profes- sional instruction. If he matriculates and purchases the Professor’s tickets, it is enough. Any man can enter a medical college in this country, without having gone through even the jest or mockery of spending a year in a private preceptor’s office, and by simply paying the fees required, which, in addition to being, at times, ridic- ulously small, may often be conveniently arranged by promissory notes to be paid out of his future professional income. The matriculation and purchase of the Professors’ tickets, constitute him a member of the class. Ho rules compel him to attend the lectures; no means are employed to ascertain whether he does so or not. If he choose, he may submit to daily examinations, or he may avoid them altogether. Should he leave the lectures and return home, it does not impair his right to be a candidate for gradua- tion at the next term. The exercises of the college, which he now has the privilege of attending, if he sees proper, generally continue about sixteen weeks, sometimes less, in a few instances more. From six to twelve Professors occupy the term, more frequently seven or eight, each of whom delivers from three to six lectures a week. Little time is left the student, if he attends these lectures. Ample provision is in most instances made for dissection, and nominally some time is demanded, by a few of the colleges, for its prosecution during the second term, but any close and earnest attention to it is impossible, unless other duties, deemed by the student of equal importance, are neglected ; and hence, few acquire an intimate and practical knowledge of anatomy during their pupilage. In some of the colleges he may attend hospital clinics two or three times a week or daily. Owing, however, to his very limited time at college, and the multitude of other duties crowded into this brief period, together with the rare opportunities afforded for a personal and satisfactory examination of cases by the student, this very important auxiliary to the study of medicine is used to but little purpose, in view of the large amount of materials for clinical instruction which many of the colleges control. Thus with lectures through the day; private quiz-clubs, lager beer saloons and night, the student con- sumes his first term, which, though short cnoiigTr, he is apt to desert several weeks, in advance of its close for the hospitable lounges and easy tasks of his early preceptor. Here six or eight months are spent much like the first period of pupilage, except, as he is im- proved by attendance on the college lectures. At the end of this time, he returns to college to complete his second or graduation term, which consists in the repeti- tion of the same routine through which he had previously passed. His recollection of his former self-indulgence, his consciousness of his own defects, and his sharpened sense of lost opportunities, now call for semi-professional treatment. Heady to his hand, standing on watchful tiptoe for a call, one of those experts called crammers, who hang around the skirts of medical colleges, and attain celebrity in the practice of educational quackery, seizes on this unfledged Moses and gives him green spectacles, “with silver rims and shagreen cases” by the gross, through whose shining glass, he may see all the wonders and mysteries of an examination in the green-room ! Here, with the aid of conspectuses, vade mecums, convenient analyses, compendiums, and such like books, he is taught all the short roads and by-paths through which he may obtain the degree without understanding anything of the great fundamental truths and principles of the science of medicine. With these easy and convenient appliances, the cheap terms and moderate demands of the colleges before alluded to, added to the very liberal “beneficiary” system lately coming into vogue, used for the double pur- pose of obtaining State and municipal aid and swelling catalogues, it is but a short step from the plow-handle to the diploma. Ido not desire to depreciate the class of hooks alluded to, they doubtless have their uses, though they are certainly not such as should constitute the chief reliance of the student. Make the best possible supposition; admit that the student had a sufficient preliminary education; grant that he has been diligent, constant, energetic; yet no one can imagine that this student is learned enough in this brief period to entitle him to the degree of doctor of medicine in any other highly civilized country in the world. But who knows what he is or what he has done ? He has submitted or not to examinations; has attended lectures and hospitals or not; has engaged in dissections or not; has been a spend-thrift of time or not—-just as it suited his taste and temper. Despite of all, he is allowed to offer himself for the honors of a degree and to undergo perhaps the first and only examination to which he has ever been subjected. The exceeding rareness of such an event, one would venture to surmise, would clothe it with dignity, if not indeed, with majesty. Previous to this, a few enquiries are put to him, the first of which is as to whether he is twenty-one years of age. If he is only two or three years short of this, many consider it no valid reason to forego the examination. The next re- quirement is, that he shall have been engaged for at least three years in the study of medicine, including his pri- vate study with a respectable physician, and his atten- dance upon lectures. If put at all, the question as to this requisite, is often a matter of form and Answered nega- tively, which is not likely, would hardly debar the student from the privilege of an examination. It is by no means an uncommon circumstance for students to begin the study of medicine by attendance on a winter’s course of lectures, without everhaving looked into a medical book, and then graduate at the succeeding term. The next requisite is, that he shall have attended two full courses of lectures, the last one being in the school in which he proposes to graduate. Answer and proof are in the production of the tickets. He may have attended two full courses—attended one lecture a week or none at all—and the professor be none the wiser. Tickets reply to the question. Ho check has been instituted, no re- source against imposition, no roll calls, no cards, no weekly or monthly registry of names, no witness of any sort, as to attendance upon lectures, or even as to his pres- ence at the college since the purchase of the tickets. Another step follows—“an acceptable thesis in the hand- writing of the candidate,” must be presented. He is not examined upon it; whether it is the production of his own brain or not, is not ascertained; the hand-writing is conclusive proof as to authorship, and the genuineness of this, in most instances perhaps, taken for granted. Proper testimonials of a good moral character, form the final requisition- So far as my information extends, this requisite finds a place only in published announce ments or in the closed pages of charters and by-laws, being seldom demanded and still more rarely furnished Professors have been known to visit city prisons to become bondsmen for students who have violated the common decencies of life, and within a few days thereafter affix their names to the diplomas of these men. Such are the nominal requisites preliminary to an ex- amination for a degree in most of our colleges. Few, simple and reasonable enough certainly, yet we have rea son for believing that frequently they are not insisted on, (the one touching the tickets excepted,) or if urged, that they may be answered in the negative, and yet the can didate not refused an examination. The theory of this examination is founded on the idea of three years of study. But if the time is fairly measured, no one can suppose that more than one year is judiciously employed, or what would be the equivalent of one year spent in a first-class school under competent masters. The student now goes before the faculty, for his final examination. All require that he shall stand “a satisfac tory examination,” though the meaning of these words is very different in different schools, as well as the modes of examination. In some instances one hour is consid- ered sufficient for the purpose, allowing to each professor some eight or more minutes. In other instances, when these oral examinations are made separately, perhaps as much as thirty or forty minutes may be consumed the professor in forming his estimate of qualifications of the candidate, with whom he is j-binrq, perhaps for the first time in his life, brought into close contact, and with whose moral, intellectual and educational fitness he has been, up to that moment, a total stranger, often com- mencing his examination by an enquiry as to the name. Although some of the colleges are more rigid than others, yet it so happens that he must be signalized by dullness and stupidity if he fails to obtain his diploma at the end of the second term from the best of them. The student is now a physician. Can any one deny that the honor of the doctorate has been too cheaply bought ? Give such a man talents or even genius ; give him the acquiring virtues that concentrate, intensify and inspire intellectual exertion; exhaust means and agencies in his behalf, and what are the probabilities that he is furnished for his work, trained for its toils, fortified for its trials, and imbued with its formative spirit? Is he ready for “the high endeavor success ?” A plea__ in justification is offered in the demand for doctors. ' But are these men doctors, or likely to become doctors in any other sense than a diploma constitutes a doctor? If there did exist a demand for ignorance and incapacity, our plain duty would be to refuse such demand. The argu- ment was always weak; it is now pitiable. It may have some force as to certain trades, but the status of a pro- fession has always been self-determined; its title to con- fidence and respect is the product of its own mind; and whenever it primarily looks to the outer world for the assurance of its strength and the measure of its renown, it has extinguished the instinct of its life and let itself down to the sordid level of the market-place. Moreover, it is a libel on the powers of nature to sup- pose, that the world needs indifferent doctors, when good ones cannot be procured. The quality of good, as pro- fessionally applied to physicians, can only be ascertained through its conventional meaning—its relation to the highest standard approved by the civilized world. Com- parisons are doubtless odious, but a sound judgment is impossible without them. If then the medical colleges of this country, forming so important an element in its social structure, identified with a nation that has achieved magnificent results in art, science and general civilization, and throbbed its awakening life far beyond its continen- tal limits ; if these Institutions, charged with the honor and usefulness of a calling that belongs to the first of the accredited sciences, claim the right to bestow the pre- rogatives of the profession upon men who would be deemed, in most other civilized countries, unworthy JsS* the position of subordinates in a hospital, it is not un- reasonable that those who have a common interest with them and are painfully observant of those flagrant abuses, should give a just expression to their disapprobation, should enforce that expression from the deep impulses of mortification, should kindle its words, if need be, with the fires of impassioned jealousy ? Let none imagine that the remonstrance is other than the dictate of truth and justice; made, not with the desire to wound or irritate; but with the hope of awakening convictions as to exist- ing abuses and of exciting an enlightened effort for their removal. Every right-minded man likes to praise much more than to blame; but when we see the irregular and imperfect system of training, under which the medical student is educated in this country, and witness the alarming ease with which the diploma may be obtained, with the most trifling qualifications, and compare these with the established systems and rigid demands of the European schools, we cannot help feeling that the useful- ness of our profession and the interests of society are seriously hazarded, and it surely becomes us to forget ourselves and all individual interests in an effort to cor- rect the evil. Without doubt we have master-minds in our profession in this country engaged in teaching. Tried by any stan- dard which the older civilization of Europe may set up, many of the professors are men entitled to fame and just distinction, but are such men the natural outgrowth of our system of education or in despite ofOne of, the peculiarities of genius is its self-creating which it -hrunw, circumstances to its will, shapes them to its purpose and stamps them with its image. The real test of systems of education is in the average intellect they call into healthful activity and direct to great ends. Such exceptional men as we have spoken of—men, who like streaks in the early dawn, shine forth from the dark- ness out of which they spring—possess that sure instinct of greatness which the paucity of early helps cannot re- strain. Besides, many of these men obtain their highest training by visiting the schools of Europe. Who ever heard of the reverse being true? Who ever heard of a gentleman leaving the schools of Paris or London for a more thorough education in America ? If then we have the rare felicity of admiring these men—these great lights which rise in the face of our present system, a better sys- tem would multiply their number, and what is equally desirable, or, even more to be coveted, it would furnish us a vast body of thoroughly enlightened and intelligent physicians—physicians for the million, t&atr, like the table-lands of our continent, would spread their 'broad space for our wonder and delight. Advanced thinkers, discoverers of new truths, origin- ating intellects, these we must have; but, besides them we must have medium capacity that may appropriate their thoughts, assimilate their influence, and diffuse the advan- tages of their superior culture. Perhaps nineteen-twen- tieths or more of the practical duties of the profession are discharged by this class of intellects. Nor can this end be attained without a liberal method of general edu- cation. Our men of genius are largely lost to the pro- fession. simply for the reason that hundreds of physicians are positively incompetent to appreciate them and their immense services. And this humiliating state of things cannot be changed until we educate our youth to a higher recognition of themselves, and thereby place them in closer sympathy with the gifted and learned of our pro- fession. To see how far we are behind the age, let us now glance at medical education abroad. I can tell you noth- ing on this subject, which is not familiar to you all, and refer to it only for the purpose of comparison. Though the systems in Europe differ somewhat in details, they yet have a marked uniformity as to the measure of at- tainments necessary for a degree. All these systems have more or less the cardinal idea of a professional edu- cation. which is two-fold; first, the preliminary culture requisite to form an intelligent gentleman ; and, secondly, the specific culture branching out from that and directed to a definite object. Acting upon that high sense of in- tellectual truth, which centuries of local civilization have perfected, they demand that one shall be an educated man before he becomes a physician. The French nation, perhaps, presents a fair type of the educational demands of the European schools. Before a student can matricu- late in a medical University of France, he must present his diploma of “Bachelor of Letters,” and previous to graduation, he must show his diploma of “Bachelor of Sciences,” equal to the degree of A. B. in the colleges of this country. ]STor are the requirements as to age and moral character dead letters, for they are met by well authenticated certificates or proofs. Uo man can matric- ulate who is under the required age, or who has been convicted of any crime. Ho favoritism and no expedi- ency vary these rules. They are fixed and inflexible. The order of procedure compels the student to deposit his diploma of “Bachelor of Letters,” the written consent of his parents, the certificates of his birth and character, with the secretary of the faculty, before his name can be enrolled, and then a certificate of registration (“carte description”) is given. This inscription he renews quarterly, until he has registered sixteen times, thus re- quiring sixteen courses of lectures and four full years in the University. He cannot enter the college before he is eighteen years of age, and consequently cannot graduate before he has reached the age of twenty-two. In Austria, and perhaps some other countries, his pupilage may last from five to seven years before he offers for final examin- ation. Attendance upon lectures does not mean the purchase of tickets, (in most European schools the pro- fessors are paid by Government.) but it means actual at- tenti«fe hard study and satisfactory progress, as tested by repeated examinations. Anatomical dissections, practi- cal pharmacy, hospital attendance, are compulsory. In France, the student at the end of the third year, must produce his diploma of “Bachelor of Sciences,” be- sides being examined on the studies required for that year. Different courses are assigned to different years, the student being examined in July of the first, second, and third years, on the studies embraced in those years. Should he fail on either of these examinations, he can have a rehearing three months after, when, if he fails again, he cannot take out a new inscription until another year has passed. From the eighth quarterly inscription to the sixteenth, embracing a period of two years, he is required to attend the clinics of the hospitals, the reason of the rule being that two years of college instruction are deemed necessary to prepare him for clinical instruc- tion. Previous to graduation, five rigid examinations are had, and thorough proficiency required. The last one is entirely practical. Two medical or surgical cases are se- lected by the professor, and the candidate is expected, on the spot, to give the correct diagnosis, prognosis and treatment, in the presence of a number of the faculty. The thesis, which must be printed, and copies placed in the library of the faculty, is submitted to the closest scru- tiny, and its author required in public, viva voce discus- sions, to defend it against all assailants. Additional to this, he is tested on questions propounded by the Council Royal. To avoid all collusion or favoritism, these ques- tions are placed in an urn and drawn by lot, so that every possible safe-guard is adopted to secure thoroughness of preparation before a diploma is given. Rot only is great emphasis laid on a collegiate educa- tion as preliminary to medical study, but the branches taught in a medical course are much more numerous than in this country. The curriculum in most of our schools includes only eight or ten departments, while in Europe many of the Institutions embrace nearly three times that number. Some of the colleges have as many as fifty or sixty professors and assistant professors. In the medical department of the University of Paris, there are twenty- eight professors and twenty-nine assistant professors, be- sides a dean, while in the University of Berlin there are twenty-eight professors and thirty-eight assistant profes- sors. Besides this numerical strength, a professor in one of these Universities or colleges, is a thoroughly edu- cated gentleman, a man of general science, who, by vir- tue of large culture, has broad sympathies and is thereby able to dignify and adorn his own specialty by means of resources drawn from the wide domains of knowledge and thought. The selection of men for these positions is conducted with the utmost care. Rone are chosen ex- cept through competitive examinations, nor until the extent of their acquirements, the scope of their talents, and their aptitude, as teachers, have been most unequiv- ocally demonstrated. I need not detail how this is man- aged with our countrymen; the petty diplomacy, the artful manoeuvering, the agency of politicians, the concil- iations of sectional prejudices, the desire to advance personal interests, which belong to the machinery of elect- ing professors. Ro doubt this machinery will now be enlarged to take in military services and sacrifices, and that too in the face of the tact, that professors are found in this land, who could not matriculate as students of medicine in any of the respectable European Univer- sities. Happily for the hopes of reform, our wisest professors have been the most sensible of these evils and most sen- sitive to the immediate and urgent need for their removal. But a few weeks since I received a letter from a gentle- man, who is one of the most distinguished surgeons of the age; who has been engaged during the greater por- tion of a long and brilliant life in teaching; who has held professorships, at different times, in several of the fore- most colleges in the Union, and who now occupies a chair in a school which does honor to the profession through its forward tendencies on the subject of medical educa- tion—which contains the following most gloomy and disheartening allusion to this subject; “The future holds out no promise of amendment. We shall go on from bad to worse until the people can stand it no longer, and then we may hope to be able to effect some reform by our efforts as a great National Association. The medi- cal schools are getting worse every year, belowering the standard of education and opening their doors more widely by the reduction of their fees. The time is near at hand when honorable men will cease to take any in- terest in medical teaching,” If our foremost men in the colleges could accomplish this great revolution, it would soon be accomplished. But at every step, they are crippled by a power which they cannot persuade nor coerce, and which they can neither afford to respect nor despise. ISTo one can deny that we have colleges in this country, organized in fact for the sole purpose of advancing the local reputations of the professors, which have not the great interests of the profession at heart, but which have all the chartered rights of our first class colleges. If unsupported by these, our best schools exact of students the prerequisites for an honorable graduation, this will only end in augmenting the evil, since their patronage would forsake them and fly to schools less stringent. Your action in Baltimore, May, 1866, under a resolu- tion introduced by Professor Davis, of Chicago, secured a convention of representatives from about eighteen col- leges, which assembled May, 1867, in Cincinnati. The plan adopted by them, if accepted and executed by the colleges, would effect the greatest results. It was con- ceived in the spirit of moderation and with a full con- sciousness of the difficulties in the way of reform. The report was received hy the Association and published in your Transactions, but it will serve no purpose beyond evincing the wisdom and public spirit of these medical teachers, and your own appreciation thereof, unless new measures are devised to render it effective. By the very act of your creation, you stand committed to a reform in medical colleges, which, in your own lan- guage, shall establish “a uniform and elevated standard of requirements for the degree of M.D.” You have al- ready done much good in some directions, but so far as your original object is concerned, you still owe to the profession and to society, this unredeemed pledge. If the fulfillment of this aim was worthy the labor already bestowed, and which, though unavailing, has exemplified your cherished purpose, it deserves yet another effort. The sphere of your action has been wide; the sphere of your power has been narrow and limited to the means of advice and recommendation. The plan of action yon have adopted, that of endeav- oring to induce forty or fifty medical colleges, with con- flicting interests, to agree voluntarily and elevated standard of requirements for the degree ot M.D.,” and adopt it in good faith, has become almost a Utopian idea; a forlorn hope. Though urged with all the force that truth could impart and enforced with all the appealing earnestness that the gravity of the subject could inspire, yet your views and wishes have not im- pressed themselves on the schools to such an extent, as to change their course of action. It seems to me that all hope of reform through this means must be abandoned. Nor can we expect to reach the end proposed by measures of State legislation. The obstacles here are too palpable to need enumeration. They are many ; and they are in- surmountable. Almost any body of medical men may obtain a charter for a medical college in most of the States of this Union, with pretty much such regulations and privileges as they may agree upon among themselves and ask for. I despair, therefore, of seeing this Association attain its object through any of the agencies heretofore em- ployed. If, however, this great work ought to be done, it can be done. I believe it is within the reach of the power of this Association. But I can see no mode, by which it can be accomplished, except through Time does not permit me to enter into details, if, in- deed, I felt myself competent to discharge such a task. I shall, therefore, only make a few brief, crude and im- perfect suggestions, in the hope that they may engage the earnest thoughts of those more competent to assist them to a practical and finished direction. I would advise that we appoint a committee of our wisest and best men to digest a plan for one or more National Medical Schools, and to memorialize Con- gress in behalf of the enterprise. Let the plan embrace, as a basis, the features presented by the Cincinnati Con- vention of Teachers ; let these schools or Universities confer such distinctions and privileges, as will he propor- tionate to the superiority they demand, and such as will make the attainment of their diploma an object to the ambition of those who engage in the study of medicine; let the chairs he open to all aspirants, and the appoint- ment or election of professors so guarded as to secure the very highest talents, the most profound learning, with the most fully demonstrated capacity for teaching. Make the salaries of the professors large, and not to depend upon the number of students; and, let the Federal Gov- ernment assume a proper share of the expenses incurred. The number of these schools may be multiplied as ex- perience may demonstrate their superiority and necessity. Our present medical schools, and such as hereafter obtain their charters from State Governments, may adopt their own regulations, and such as do not conform to the Na- tional standard, will either become tributaries or prepar- atory schools to the National Universities, or dwindle into merited neglect. I am persuaded, that such assistance on the part of Congress, can be obtained. I think that a committee could demonstrate vast amount of labor and money expended annually for the public good; a portion could not better be bestowed for the welfare of humanity and the interests of American civilization, than in creat- ing and upholding one or more Universities which will perfect the object for which this Association was organ- ized. Such reforms have not been elsewhere effected, ex- cept through governmental interposition, and our own experience has amply shown that it is vain for us to hope for them through any other means. I am perfectly aware that any plan looking to the Gen- FEDERAL LEGISLATION. eral Government for sanction and support lias its embar- rassments, and that it will be opposed on the ground of incompatibility with republican institutions, but I do not doubt that all objections can be tully answered. The most moderate view taken of the offices of Government, specifies protection as its main end, and where, if not here, is protection demanded? Utilitarianism proclaims its conquering motto in the words : “the greatest good to the greatest numberand where, if not here, has the motto a consummate application. The recent changes in political science, as well unpractical revolutions in the in- stitutions and relations of" the age, show clearly enough that whether for good or ill, governments are becoming more direct representatives of the prevailing public opin- ion, and are acting more immediately from the popular heart; tell me how this Government could more effectu- ally permeate our homes, our tenderest sentiments, our truest earthly well-being, than by lending its mighty aid to a measure so fraught with patriotic philanthrophy ? No profession has a sublimer human ideal than ours; none comes closer to the daily evolutions of Providence; none touches the individual and social happiness of men at so many points; and yet, standing in this high rela- tion, it is almost alone in the facility, with which ignor- ance may enter and work its mischief. If a student of law receives license to practice his profession, his blun- ders in the conduct of his cases do not often affect the happiness or well-being of a family; and besides, his er- rors may be corrected; his case may be reargued; and withal, he belongs to a professionVvhich compels a man to show what are his merits, to demonstrate to the court, the bar, the jury and the world, his precise abilities, and allows him to win no success not based on professional capacity. But when a young man obtains his diploma from a medical college, he has passed through the only trial the law demands, and has obtained that which so- ciety recognizes as the test of merit. Uext to the min- ister of the gospel, the physician appeals to the sentiments of the public mind, and particularly to those sympathies which are least inclined to make close examinations of pretensions. The atmosphere in which he moves is un- favorable to keen criticism; the circumstances of anxiety and often of sorrow, as well as the feeling of dependence under which his professional skill is sought, indispose families to scrutinize his ability, and he is usually accepted ■with implicit reliance. Outside of the medical colleges, what safeguard protects a community from impositions of ignorance, stupidity and recklessness in our profes- sion? You all know that society has no redress at the hands of physicians themselves, since their lips are sealed as to censuring comments on the practice of their pro- fessional brethren. Two physicians may receive diplo- mas from the same or different colleges, one may be highly intelligent, the other grossly ignorant. Yet they stand before the community as equally learned and equally authoritative. Through a pleasing and artful address the ignorant brother may outstrip his more ac- complished rival in acquiring the confidence of the com- munity in which they live. The latter may daily witness the gross and even fatal blunders of the former, yet, in view of the creed of common courtesy, recognized by general society, as well as the code of ethics established by yourselves, nothing would be more unwise than for him to attempt the exposure of his weak and ignorant brother. There is then, gentlemen, no safeguard but in a thorough preparation of those who seek to be clothed with the doctorate. To this end you are pledged, and from this position you cannot recede without discredit to yourselves and certain degradation to that calling of whose interests you are the highest representatives—the recognized and rightful guardians. A profession like ours, that is invested with a power of unequaled benefi- cence, that disdains all mystery, all prestige of authority and all superstitious veneration for traditional dogmas; that asks for confidence on the sure basis of scientific knowledge, appropriates no discovery to selfish aggran- dizement, holds its resources as the gift of heaven, open to the good of all mankind, and labors to imitate Him, who, nearly nineteen centuries ago, healed the infirmities of the multitude that awaited on His ministry of love and wisdom; such a profession should never falter in giving heed to its own instincts, never waver in strenu- ous and persistent exertions to elevate still higher its practical ideal, and never abate those heroic convictions which are at once the proof of its high vocation, the cre- dentials of its claims on public respect, and the pledges of its sure success.