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             ON THE UTILITY


                      OF



Country Medical Institutions.





                      AN


      INTRODUCTORY LECTURE.


               DELIVERED AT THE


 OToUcflr of ytjiisfcfans antr Surgeons


                    OF THE


   WESTERN DISTRICT. OF THE STATE OF NEW-YORK


                December 13, 1824.
     By T. ROMEYN BECK, M. D.
                         mm    7
Professor of the Institutes of Medicine ami Lecturer on Medical Jurisprudence in

 the College of Physicians anrl Surg-eons of the Western District of the State

 of New-York, he. kc,
PUBLISHED AT THE REQUEST OF THE CLASS.
               /'•Y ' ° y-s


\J            ALBANY :

 ..-*"*'   PRINTF.P BY WEBSTERS AM) SKl.NNrB*
1825. 
 
iraavA<o:
  The Professor of the Theory and Practice of Medicine in the New-
York Medical College, recently published in the  New-York Prints an
extract from his Introductory Lecture.  In that  production, the fol-
lowing sentences occur :

  " The  State of New-York, powerful in wealth, and ample beyond
<' all comparison in resources, with a capital that holds a distinguished
" pre-eminence among her sister cities, cannot be blind to the obvious
" propriety of  contributing to one institution  that support  which can
" alone make an adequate return to the community ; instead of wasl-
" ing her strength in various and comparatively unimportant county in-
" stitutions. Indeed, it may reasonably be anticipated, that not only
" the Legislature of this  state, but of every other in the union,  will
" soon perceive the wisdom of concentrating their efforts upon the
" School of the Metropolis, instead of multiplying  Medical  Acade-
" mies in towns and villages, that  of  necessity  can  only  furnish the
" first lessons of education,  instead of the great practical results that
 ' are derived from extensive clinical observation and experience."
  The application of the above remarks will be readily understood by
the most  careless reader, when he is informed, that the only Medical
School in the state, beside New-York, is the Western Medical College
at Fairfield.  He should also be apprised  of the fact, that both institu-
tions have  an  equal standing in the  eye  of the  law—that  both have
been incorporated by the Regents of the University,  and that both have
been endowed by the liberality of the  state.   It  must also be added,
that there are not, within the knowledge  of the writer, or his medical
friends throughout the state,  any County Medical  Institutions in it.
  These  facts,  in the judgment of the author, justify the publication
of the following Lecture.  He trusts that the ideas advanced in it, are
deserving of some consideration,  and although prepared in  haste, and
amidst the pressure of many  engagements, is  willing that the manner
should be criticised, provided the matter  finds favour. 
 
INTRODUCTORY  LECTURE.
GENTLEMEN,

  THE revolution of another year has  brought
together in this place, the teacher and the student.
On  entering  into  this interesting connection, I
beg, on  my part,  to offer you  my best  wishes,
and to assure you, of my earnest  and most assidu-
ous exertions to promote your  advancement  in
medical science.
  It is now upwards of twelve  years,  since this
institution was incorporated.  During  that peri-
od,  its fortunes  have been various, and its pros-
pects  often discouraging.  But  it  has  struggled
through  its period  of infancy,  and I  trust may
now be  considered as steadily advancing  in pros-
perity and utility.   Its pupils  have for  several
years slowly  but regularly increased,* and many,
(indeed  I may add)  a great  proportion of them,
have returned a second, and even a third time,  to
avail themselves of  its advantages.  The senior
members of the board of professors have also the
pleasure of learning from time to time, that  num-
 "In 1820—1, the number of students attending, was 43.
    1821—2,                         62.
    1822—3,                         91.
    1823—4,                         96.
    1824—5.                         120.
•A- <4 
6
bers of their students arc acquiring a respectable
professional  standing in society,  and while thus
rising  to  merited  distinction, are not unmindful
of their alma mater.   The pupils of former stu-
dents of this college form  no inconsiderable part
of its present classes.
  These  results  are doubly grateful.  They  at
once announce, that success has already attended
our endeavouis,  and they promise a continuation
of usefulness.
  The  period is  now, I trust, for ever past, when
doubts  will be entertained concerning the necessi-
ty of a well educated medical profession.  Public
opinion, that mighty engine in a free country, will
no  longer tolerate insufficiency  in  preliminary
knowledge.  It understands the  true distinction
between experienee and experiment. It has ascer-
tained  that the practitioner  who  boasts that he
knows only the results of the former; drawn from
his  own observation, has frequently done nothing
more than  employ the latter, at the hazard, and
even at the  expense of the lives  of his patients-
And such undoubtedly  must  sooner or later br
the invariable result in every instance.
  Take an individual of this description,  under
the most favourable circumstances—that of hav-
ing studied in the office of a physician during the
time prescribed by law.  Wheii that period is com-
pleted,  he enters  on the duties of his profession.
He has seen  the diseases of a small,  confined dis-
trict, for a few years.   His knowledge of anatomy 
i
has been derived from books, or it may be, from
the examination of a skeleton.  He has probably
viewed one or  two  surgical operations,  and at-
tended a few cases of midwifery, perfectly natural
in every respect.   His range of  medicines  is con-
fined to such which his instructor used,  and be-
yond these, let it be remembered, he seldom ven-
tures : for there is certainly no prejudice more firm
or  uualterable in persons of limited education,
than an attachment  to particular  articles of the
materia  raedica.   Let a person  thus prepared be
called into the ordinary routine of practice, witli
one who has regularly studied anatomy,  surgery,
and midwifery—who has learnt the virtues of nu-
merous and various medicaments,  and is aware of
the  many  ills to which " flesh is heir."   With
whom is the possession of that boasted experience,
which is so much used as a catch-word to depreci-
ate  the advantages of learning  ?   Is it not with
him who has gained an acquaintance with what is
already  known in the science, and who can thus
safely and knowingly proceed  in the application
of  curative means ?   The contrary doctrine leads
to this conclusion as a legitimate deduction from
it—no knowledge is valuable except it be  derived
from personal experience.   An opinion more de-
structive to the improvement  of the understanding,
or the happiness  of society, can  hardly be imagin-
ed by the most ingenious sophist.
   Education then is  indispensible to the  medical
student.   The love of self, the dictates of an hon- 
8
ourable ambition, the feelings of humanity,  all
prompt us  to its  acquisition.  The  spirit of the
age calls for it.   It imperiously prescribes a pro-
portionate  advancement in  the  elements of our
science with what  is made in other professional
pursuits, and if we regard either our happiness,
or our reputation,  we shall not neglect its dic-
tates.
  The triumphant  establishment of this doctrine
brings us however  only to  the  threshold of our
subject.  It is not enough to prove that education
is important and  valuable—we must show how it
is to be attained,  and in doing this, I must be per-
mitted to offer some preliminary observations on
the state of our country.
  The scattered state of our population is certain-
ly one of its most striking political features.   We
have hardly any district in which the denseness
of its  inhabitants approaches that  of European
countries, and even our large and crowded cities
are few in  comparison with those of  the eastern
continent.  Our ten millions of human beings cov-
er an immense tract of country from the  Atlantic
to the deserts  of  the Rocky Mountains, and they
form small and  separate  communities,  leaving
room  for indefinite expansion in every direction.
This is even the  case in our more populous settle-
ments.  The  American  farmer  frequently occu-
pies an extent of ground which in Germany would
constitute a principality,  and in Great Britain  a
baronial manor. 
9
   A state of things like this leads to several pe-
culiar results,  both in domestic life as well as in
public concerns.  The services of religion, for ex-
ample, can only  be attended  at  a considerable
distance from the residence of the farmer.  If he
finds it necessary to  engage in legal controversy,
he has often to proceed a day's  journey before he
can  reach  the seat of justice.  The mill is many
a weary mile from his home, and the mechanic can
only be found at distant intervals along the main
road.  How is it as to the  physician in these dis-
tricts ?  One, or at most two, of this profession re.
side within a compass of  eight or ten miles,  and
attend with infinite labour to the calls of their scat-
tered patients.
   This is a brief, but I believe, an accurate state-
ment of the condition  of a large portion of the
United  States.  Its wants deserve attention—its
peculiarities require consideration, and he who ne-
glects or despises these, has but little of the fore-
sight of the statesman, or the feelings of the  pa-
triot.
   It need hardly be  added, that wealth is but
sparingly  diffused among  communities such as
those we have described.  The  farmer lives by
the labour of his hands—his family is supported
from the hard-won avails of honest industry,  and
though he may look forward  with just confidence
to the period  when his possessions, through the
increase of population  and their  proper cultiva-
tion, will greatly  swell in value, yet  these are
                       "7 
10
prospects  for the future.   The present must be
provided for with more economical views.   And
among the many subjects of parental anxiety,
there is none which more  engages his  attention
than that of a proper  education for his offspring.
All feel the value of this—all appreciate its im-
portance—the most  ignorant as well as those who
are comparatively well informed.   The country,
through the medium of its legislatures, has nobly
fostered these wishes, and has placed within the
reach of all who will avail themselves of it, the
means of  elementary  instruction.  Its effects can
hardly be yet appreciated,  but it is surely a max-
im  attested by experience  and hallowed by age,
that knowledge and virtue are  the only permanent
supports of a republican government.
  Talent  is here elicited and developed—a thirst
for  knowledge is created.   Not satisfied with  his
present information—aware that he has only mas-
tered the  elements of knowledge—the ingenuous
youth pants for new opportunities to  increase his
little  stock.   Self  instruction  often  supplies  a
part.   He gradually advances, until he has reach-
ed  the  full extent  of  his powers, and he has to
search  for more elevated sources.    These  are
supplied by our  academies and colleges.   In il-
lustration of these remarks, is it necessary for me
to  recapitulate  the  history of  many a man in our
own nation who thus commenced his career,  who
thus struggled through his youthful years in com-
parative poverty of  body and of mind, and who is 
11
mow the ornament and the pride of his state, or
his country ?
   The poet Gray, in his elegy written in a coun-
try church-yard, thus  apostrophizes  one  of the
tombs :
      Perhaps in this neglected spot is laid
        A heart once pregnant with celestial fire,
       Hands that the rod of empire might have swayed
        Or waked to extacy the living lyre.
 Was  this a fancy of the imagination ?  Did not
such men in former times emerge from the obscu-
 rity of a village ?  Why then not some of these ?
 He gives us the answer.
       But knowledge to their eyes her ample page
        Rich with the spoils of time did ne'er unroll,
       Chill penury repressed their noble rage,
        And froze the genial current of the soul.
 Penury and the want of knowledge—these are the
 obstacles to advancement, and these are to be ob-
 viated by all the means which patriotism can sug-
 gest.   Our state has  for  this  purpose endowed
 academies  and  colleges—she has poured forth
 her wealth to advance the cause of education, and
 she  exhorts  her citizens to  aid in these philan-
 thropic exertions.   I  will  not indulge in any
 comparison between  the  two  kinds of  literary
 institutions  that I  have mentioned,   nor  depre-
 ciate the  one by exalting the  other  ; but in  the
 view which 1  have taken of the present subject,
 it is indispensable to suggest, that academies are
 probably more generally useful than colleges, from
 the fact that in the former are educated the teach- 
12
ets of our common schools.   They are also more"
numerous, and although the instruction is less ex-
tensive than that  obtained  in  higher  seminaries.
yet it is acquired  at a cheaper rate, and is impart-
ed  to a greater number of  individuals.  The per-
fection of a national system of education undoubt-
edly would be, that all  who  possess  competent
talents should be enabled to pass from step to step
through  all  the  branches  of knowledge.   This
was the scheme of that sagacious individual who
not many years  since, guided  the  destinies of
France.   But it  can hardly be  realized during
many years in this country, and we must hence
encourage that plan  which promises  the most ex-
tensive  diffusion  of  science and  learning-—com-
mensurate with the means of our citizens.   Public
or private beneficence,  when needed,  seldom de-
serts the youth of talents and virtue, when he has
acquired the  rudiments of classical  education—it
carries him through  his dbllegiate course, and al-
lows him  to enter into public pursuits with advan-
tages  equal to his wealthy competitor.
  I may now  ask whether the observations that
I have made apply to students of the medical pro-
fession ?  Is the  statement  correct  as to the at-
tainment of education  generally—and does it uot
apply to a component part of it ? Are all  medical
students the sons of wealthy parents ?  Can they
at pleasure avail themselves of the advantages of
the ancient medical institutions of Europe,  or the
establishments in the large cities of our own con- 
13
tinent ?  If not—should the study of  the profes-
sion be confined to such ? Are parents and sons,
thus circumstanced, willing to agree to  this, or has
the  other, (and let it be remembered,) the more
numerous part of  the community cousented to the
exclusion ?  How, in fine, are physicians, if the
above views be correct, to be supplied  for the dis-
tricts that I have previously mentioned ?
   Like all other studies  and occupations in this
country, the votaries of medicine are  in this res-
pect of a mixed nature.   Their means vary, and
as a  necessary  consequence, their opportunities
must  vary.   But is it not  proper to  make some
public provision suited to these distinct conditions ?
Would  it be wise or just,  to afford all the facili-
 ties for  acquiring this learning  to a favoured few,
and leave the rest  in utter  darkness ? Fortunate-
ly in our own state, public opinion will not sanc-
 tion this.  It has ordained, through the medium of
 our laws, that a  certain course must be pursued,
 before the student can become a practitioner.   In
 furtherance of this salutary  regulation, it has en-
 dowed two  medical institutions, who are  to  im-
 part the required instruction—the  one situated in
 the imperial city  of our nation, and  the other in
 this place.
   It appears to me, that a calm and unprejudiced
 observer in noticing this arrangement, would con-
 ceive it somewhat adapted to the necessities of the
 case.  He might possibly  conjecture that some
 students could be found throughout the state, who 
14
were unable to avail themselves of the advantages
of an institution on the  sea-board.   Feeling some
sympathy on this point, the warmth of his philan-
thropy might possibly induce him to imagine  that
the country college, was  in some  degree useful,
and that  while the city university elevated  and
embellished the  scientific character of the coun-
try, the other, in its humbler  sphere, was training
its  pupils for their more  local and confined du-
ties.
  Such however is not the opinion of some of our
profession.  A few  weeks have  only  elapsed,
since  sentiments were  uttered from a  professor's
chair in the Medical College  of New-York,  con-
demnatory of all schools like  ours. It was gravely
urged, that " the state of New-York should contri-
" bute to  one institution that support  which  can
" alone make an adequate return  to the communi-
te ty,  instead of wasting her  strength  in various
" and comparatively  unimportant county institu-
" tions,"  and it was added  in the language  of
hope, that " our  legislature  would concentrate
" its efforts upon the schools of the metropolis, in-
" stead  of  multiplying   medical  academies  in
" towns and  villages, that of necessity can  only
"furnish the first lessons of education, instead of
iC the great practical results that are derived from
" extensive clinical observation and experience."
  Expressions like these coming from an individ-
ual of reputation, and published  in  our  public
prints, are calculated to excite some inquiry ; and 
15
we are naturally  led to ask whether  all this be
correct  or  not.  I venture to say, that the  ideas
advanced are far from being correct, and that on
points,  where  the  comparison  between city and
country institutions is intended to be most marked
and palpable, it is frequently but little discernible.
Such remarks, however, will justify us in respect-
fully defending the utility of country medical in-
stitutions,  and in endeavouring to point out some
of their advantages.
   1.  If the  views I have given in the preceding
part of  this lecture are founded in truth, do they
not in the first  place prove  the utility of country
medical institutions to those students, whose pecu-
niary means are confined ? Is it not advantageous
to society, to diffuse learning, even if only partial-
ly ; and is it not certain that many would be depri-
ved  of every opportunity of acquiring it, were the
institutions in question abolished ?  Believing then
that they are adapted to the wants  of a portion of
our community, and in fact imperiously demand-
ed,  I observe,
   2d. That the instruction they furnish goes be-
yond the  " first lessons of education f  as the
professor  terms it.   In  illustrating this  asser-
tion, it is  necessary to advert to the actual con-
dition of those medical colleges which  boast so
much of their means of education.  Comparisons
are indeed odious, but where they are so freely
preferred, it will not surely be improper to exam-
ine into the respective merits of each.  What then, 
16
 as an abstract question, is to prevent anatomy from
 being taught as perfectly in a country village, as
 in a large city, provided the proper  materials be
 at hand ? What constitutes the difference between
 one anatomical school and another ?  It is the op-
 portunities for dissection and the value of the mu-
 seum.   Again, as to chemistry,  if the apparatus
 required be at hand,  can it not be taught as per-
 fectly here as  elsewhere ?  May not all the doc-
 trines of surgery, of midwifery and of the practice
 be developed and illustrated ? But it is observed,
 that in such institutions as ours, the results of
 clinical observation and experience are  wanting.
 I would be the last  to undervalue these.   None
 prizes them higher than I do, or feels more their
 importance  and place in  a well regulated educa-
 tion. But I assert, and it is a fair argument on the
 present occasion,  that these benefits are not ob-
 tained in a proper degree, even in our other state
 institution, and that she should therefore be the last
to notice and enlarge on this defect.  In proof of this,
let me direct your attention to a single fact.   The
professor  of   clinical medicine appointed   under
the authority of this state, was  a short time  since,
for two years, without a ward in the hospital—an
institution also richly  endowred through the  liber-
ality of the state of New-York.   Under the pres-
ent order of things indeed, the incumbent is now
a physician of that charity, but he too is depend-
ent on the will of a foreign body, and may  be re-
moved at any moment and on the shortest notice. 
17
  Again, the diseases found in a hospital are gener-
ally (although I do not say universally,) those ori-
ginating from debility or from vice.  They are not,
in other words, the ordinary diseases seen in gen-
eral practice throughout the country, and of course
though  important to be understood, are  not  of the
first importance.   On the other hand, what is the
clinical instruction of the country  student ? It  is
this—after attending a course of lectures  on the
several branches  of medicine, and becoming ac-
quainted with their general bearing, he during the
summer repairs to the office of a  practitioner—at-
tends him in his visits to his  patients—views the
diseases peculiar to  different districts—observes
the treatment that situation or habits of  life indi-
cate,  and from day  to day verifies the lessons  he
has received.   Here then is evidently a direct pre-
paration for the life he intends to pursue.  So al-
so  with respect to surgery and midwifery.  Op-
portunities for improving in both may be readily
attained by studying with those who are eminent
in either branch, and I will venture to add, that the
variety of cases thus observed,  is not inferior  to
many of the boasted institutions  in our cities.
   3.  It may  be added  in the  third  place, that
country institutions are admirably adapted  to the
state of our country  as already developed.  Let
us  compare their results for a moment, with the
state of the  profession  generally in Europe,  or
more particularly in Great Britain.  The mass of
medical men there, as here, are general practition-
                       3 
is
ers—that is, the same person attends to medicine,
surgery or midwifery,  according as his services in
in each are required.   Their medical colleges are
confessedly very  eminent and  flourishing,  but
they are few in number and expensive in  instruc-
tion.   The  consequence  is, that  a considera-
ble part of the  profession are unable to attend
them.   Would not the public welfare be promo-
ted by rearing a few inland establishments, calcu-
lated for their  condition ?  Their compensation is
necessarily small—their lives obscure and labori-
ous, yet they probably superintend the health  of a
majority of the inhabitants of the kingdom It has
been  urged  by  medical  legislators, that  every
man should there, as here, be obliged to attend  a
course of medical lectures  before  he can practice.
The chief  obstacle to  such  a  measure,  unfortu-
nately  is, the expense attendant on  medical edu-
cation.
  A system like our own, on the other hand, insen-
sibly diffuses  knowledge,  prevents the mo6t  ob-
scure practitioner from being ignorant of the lead-
ing and valuable  parts  of his  profession—and
gives to  the remotest and  most scattered popula-
tion, the  blessings of proper advice.
  4. I  will only  add  another consideration, and
that is—the  secluded  situation  of  our  country
institutions  is  calculated  to direct  the  mind to
study.   If large cities have their advantages, they
have certainly also the disadvantages of luring
the youthful mind from habits of industry, or what 
19
is still more to be deplored, of inviting it to indulge
in  vicious dissipation.  To the anxious parent—
to  the ingenuous youth,  it is certainly an object
of some importance to find establishments, where
humanly  speaking,  the latter can be avoided, or
is  not to be dreaded.
   In offering these remarks to your consideration,
I have not, I trust, been led away by any prejudice
or partiality for this institution  particularly.   Al-
though  I am attached to  it by many  ties,  yet I
have endeavoured to consider the subject and pre-
sent it to you in a general manner, and to exhibit
to.you, as far  as 1 was able,  the advantages of
Country Medical Institutions.  You will not un-
derstand by what I have said, that it is my design
to  depreciate the institutions of our large cities.—
Ou the contrary, when  properly managed  and
honestly  conducted,  they have done and will do
much  to elevate and enlarge medical science.—
But I  also claim some small share of utility for
such: as ours.   When I see men in them  in differ-
ent parts of our country, whose  talents are ac-
knowledged, when their  students are from year
to year developing minds which do honour to them-
selves and their instructors, 1 cannot doubt  their
advantages.
   It is therefore idle, it is more—it is  illiberal to
depreciate them.  Our own is the  only one in this
state.  W^hy should it be visited with  destruc-
tion,  when on  our eastern  border, a cordon ex-
tends  at various intervals, from the boundaries of 
20
Canada to the  Atlantic.   Would  the recommen-
dation which I have quoted, of subverting it, if ef-
fected, destroy the system ? Would not anoth-
er, and yet another, spring up in the more western
parts of the state ?  Instead then of adopting this
advice,  I would foster every attempt at diffusing
medical knowledge, and hail  its progress  as a
promising token of good.
  The state of New-York we may safely predict,
will never adopt the counsel that has been given her.
Her  statesmen, her legislators, her learned  men,
and her citizens generally, have not thus estimated
the wants of the community ? Her course uniform-
ly has been to cherish learning  in every situation,
and to foster its first fruits with the care of a parent.
At this crisis, flourishing in arts, unrivalled in com-
merce, and exalted  in wealth, she surely will  not
stint  her supplies,  or  pour them with a partial
hand, into one portion  of her dominion, while she
leaves the other  to need.  She will not  destroy
what is flourishing, or  overturn what is becoming
permanent.   She will, as she  has ever done, re-
gard the interests of education with an impartial
eye.
  In thus doing, she  can alone perform her pro-
per duties, and fulfil the promises of her high des-
tiny. 
 
 
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