V*Vi, "' ADDRESS y to THE MEDICAL GRADUATES JEFFERSON MEDICAL COLLEGE. DELIVERED MARCH 11, 1837. BY ROBLEY DUNGLISON, M. D., • •• PROFESSOR OF THE INSTITUTES OF MEDICINE AND MEDICAL JURISPRUDENCE. . ■ i\n .v :icnr Published by the Graduates PHILADELPHIA : PRINTED BY ADAM WALDIE, 46 CARPENTER STREET. 1837. V w . - £7 , - Jefferson Medical College, March 11th. Sir, At a meeting of the graduates of Jefferson Medical College, held to-day, it was unanimously resolved, that a copy of your very excellent and appro- priate Address, delivered to them, be respectfully requested for publication. We, a committee appointed for this purpose, take great pleasure in present- ing you this request, to which we add our solicitations. We are, sir, Yours with much respect, Frederick R. Harvey, 1 To Professor Robley Donglison. James McClellan, Thomas C. Tebbs, )■ Committee. Josiah J. Janney, | William H. Muse, J Philadelphia, March 11th, 1837. Gentlemen, I need hardly express to you, that I feel extremely gratified that the Address, which I had this day the honour to deliver to the Graduates, should have met with their approbation. You have all been made aware of the objections I have to the publication of such productions, but having twice this session declined to furnish copies of lectures on the application of the class, it might appear most ungracious and ungrateful in me to decline a third application. With best wishes for the welfare of yourselves, and of those of whom you are the representatives, believe me, most fervently, Your friend and servant, Robley Dunglison. ADDRESS. GENTLEMEN, When I last had the pleasure to meet you, it was as members of the class of Institutes of Medicine and Medical Jurisprudence of Jefferson Medical College. At that time, I little dreamed that it would be my pleasing duty to again address you, assembled, as you now are, before me, and under circumstances so deeply inte- resting to you, to the Institution of which you have proved your- selves worthy of the highest honours it can bestow, and to the community, of which I trust you are destined to be most useful members. The desires of my colleagues—although, owing to unavoidable circumstances, communicated to me at a short notice—that I should embrace this opportunity for presenting to you their fervent gratu- lations on the distinctions you have attained, and their warmest aspirations for your future success, have been felt by me as commands, and although I may regret that they should not have selected some one more capable of expounding to you the fervour and sincerity of their feelings, I cheerfully avail myself of the proffered occasion, to urge upon your attention some of those great principles of ethics, which, as Professor of Medical Jurispru- dence, I have already esteemed it important to inculcate, if not with ability, with a degree of zeal, which has occasioned them, I feel satisfied, to sink deep into the minds of most, if not of all of you. This day, gentlemen, is the closing scene, the crowning result, of your course of collegiate study. I need scarcely say to you, that you have not yet acquired all the knowledge which you will pos- sess of the healthy and morbid movements of that wonderfully complicated machine, the nature of which has been, for a few years past, the object of your earnest enquiry. You, doubtless, well recollect, that in the very earliest lecture which I had the 4 honour to address to you, I emphatically stated, in the language of a modern writer on medical education, that the moment a practi- tioner ceases to be a student, he is no longer worthy of the confi- dence of the public, and that the life of a physician can only be truly useful and honourable, when it is unremittingly employed in study, in determining the truth of theoretical opinions by observa- tion, and in improving the value of practical suggestions by the test of experience. No matter what may be the amount of your abilities, they cannot be developed without a certain degree of application, and although this amount may vary according to the precise capability, no marked development can occur in any case without study. The extensive improvements that have taken place, of late years more especially, render it utterly impossible for any practitioner to pursue his avocation with satisfaction to him- self, unless he bestows upon every case, that demands it, a degree of scrutinising investigation, which is needless to the empirical pretender, and which would only confuse his mind, and render him afraid of adapting his agent to every case—however dissimilar it might be in its character. Ignorant of the operations of the animal economy, he prescribes recklessly, and if the morbid condi- tion should become aggravated, he sees not the connection between the agent employed and the mischief effected ; and, in his state of blissful ignorance, he consoles himself, perhaps, that his patient has fallen a victim to a malady, the fatal progress of which no human effort could have averted. This is truly a condition where ignorance is bliss! and how blissful, compared with the anxiety that rests on the mind of the philosophical practitioner. Aware of the manner in which the functions of the economy are executed in health : equally aware of the aberrations that constitute the diseased manifestations; instructed, from his own observation, as well as from the recorded observations of others, of the results which his various therapeutic agents are capable of effecting, he weighs carefully and hesitatingly the symptoms that guide him to the formation of his indications of treatment in formidable cases; sensitively alive to the safety and welfare of his patient, and to the relief of his sufferings, what anxiety does he not endure in the application of his remedial measures; what mental uneasiness does he not experience, until he finds that the threatened danger has passed away; and then, what an enviable happiness doeshe not feel, that a life, and perhaps a valuable life, has been spared to the community, and this by the care and skill which he has bestowed upon the case! If, in the former assumed instance, 5 " ignorance be bliss," surely the latter does not indicate that it is " folly to be wise." You live, gentlemen, in an age characterised by the activity, ability, and success with which your profession is cultivated. Not more than a hundred or a hundred and fifty years ago, it was the theme of ridicule with the various satirists. Yet medicine has ever kept pace with the condition of physics and metaphysics ; and in periods when they were defective, the science, of which we are happy to say we are this day mutual members, exhibited the same failings. There was one cause, however, which kept it somewhat behind its sister sciences. This was the degraded devotion that was paid to authority and established routine ;—a folly which has been well castigated in the L'Amour Medecin, of Moliere. The censures of Moliere were well warranted at, the period when he lived—at the termination of the last century but one—and especially by his countrymen, who were longer, perhaps, in casting off the trammels of ancient authority, than those of certain other countries. In modern, not solely in young, France, however, the shackles have been rent asunder, and we have witnessed the substitution of an example of bold systematism, the novelty and dogmatism of which attracted to it the attention of many; but now that the novelty has passed away, and that time has permitted the dogmatism to be examined narrowly, its exclusive portions are ne- glected, and the minds of men have become sobered down to the calm and unbiased observation of nature. There is something dazzling, gentlemen, in daring innovation ; something brilliant in wandering from the beaten track; some- thing excessively attracting in the appearance of originality which it presents; and we are apt to extend our admiration to what we esteem flights of genius, and to regard with indifference, almost amounting to entire apathy, the calm, reflecting, steady, and perse- vering course of him, who employs his hours in the quiet observa- tion of nature; who pursues no exclusive view ; who has no phantom perpetually flitting before his eyes to distract his midnight musings; and yet, whose productions may constitute more solid additions to science than all the wayward imaginings of him, who is regarded as the man of genius. The one is like the meteor, which appears, ever and anon, in the firmament, dazzling, by its momentary splendour, obscuring for a time the steady light of the fixed occupants of the heavens, but soon passing away, its tran- sient brilliancy forgotten, whilst the other continues to shed, from 6 age to age, its subdued, but more efficient, light, to guide successive wanderers in their paths. But let me not seem to withhold proper justice from the labours of the distinguished systematist to whom I have alluded. He has the merit of having directed the attention of observers to patholo- gical conditions of certain portions of the organism, which were at one time but little understood, and are still, perhaps, too little heeded; and of having impressed upon physicians the necessity for making the physiological or healthy conditions of the frame a topic of earnest study—a point of departure for their pathological and therapeutical deductions; and although his contributions to science have been eclipsed by the exertions of contemporaneous pathologists, and he is doomed to see his amphitheatre compara- tively deserted, whilst those of others are filled to repletion, it cannot be doubted, that the novel doctrines of Broussais had much to do in eliciting the powers of other eminent pathologists of France—I may say, indeed, of every country where medicine is at all cultivated as a science; and hence, that his name will ever stand prominently amongst the illustrious worthies who must be esteemed promoters of medical science. It is to the contributions of the French writers—of the present century more especially—that we are indebted for a host of valuable facts and deductions, which have largely extended the domain of medicine. To them we acknowledge our gratitude for a better system of anatomy than was previously taught; and for the exten- sion, if not for the introduction, of general anatomy or the anatomy of the textures; whilst philosophy and pathology owe much of their improved condition to their well directed labours ; and tran- scendental anatomy,—or that department which treats of the organisation as exhibited in the whole range of created beino-s, and philosophises on the unity of organic structure, and on the existence and functions of parts, which are apparently useless in a particular species or individual, and yet are capable of being called into activity under favourable circumstances,—belongs to them in conjunction with the Germans. At some of the generalisations of the transcendental anatomists, we may be disposed to smile; but the ingenuity, displayed on numerous topics, has suggested materials for reflection to the enquiring mind, and has led to investigations which might other- wise have wholly escaped attention. It is but recently that any publications upon this interesting subject have appeared in Great Britain ; and one of the best, if not the very best, of these was from 7 the gifted pen of one, from whom, alas ! we can look for no other contribution. In the first part of the u Rudiments of Physiology" of the late Dr. Fletcher, who was an eminent lecturer on physiology and on medical jurisprudence in Edinburgh, we have a section " on the unity of organic structure of animals," which conveys the leading ideas of the philosophical or transcendental anatomists in a concise yet perspicuous manner, so as to impress the reader with the extent of information, and the active and discriminating: mind of the lamented author, and to cause him to regret that the life of one who possessed such a capacity for rendering service to his fellows, should have been so prematurely terminated. Nor does it detract from the intensity of our regret, that he is considered to have ---"wing'd the shaft that quiver'd in his heart," that his death was hastened by his unremitting devotion to his intellectual labours. I stated that medicine has ever proceeded side by side with the sister sciences of physics and metaphysics ; and that where these have been marked by folly and credulity, our science has exhibited the like imperfections. Whenever, therefore, we cast our regards back into the dim obscure of by-gone ages, and notice the irrational conceits, the inane ideas, and the faulty logic every where apparent, we must seek for the explanation in the state of philosophy of the period. There was a time in the history of medical science, when the materia medica consisted almost entirely of the machinery of magic, and when certain cabalistic words, scrawled on parchment, or figured on amulets, were presumed to cool fever, to arrest ague, and to prevent many diseases, especially if the words were uttered in a certain form, and a certain number of times. There was a time when the touch of royalty was esteemed a sovereign remedy for the removal of scrofulous affections, or of what was termed the king's evil. There was a time, when dressings, in the case of wounds, were applied not to the injured parts, but to the weapon that inflicted them; and when sympathetic powders and armatory unguents furnished materials for the inventive powers of many of the most eminent individuals of the age. There was a time, again, when every natural substance, that possesses any medicinal virtue, was supposed to indicate, by an obvious and well-marked external character, the disease for which it is a remedy, or the object for which it is employed. It was held, that each plant, for example, had its " signature," as it was termed, and that whereas turmeric is of a yellow colour, it must be capable of curing the jaundice ; that ths 8 Euphrasia or eyebright, having a black spot on its flower resem- bling the pupil of the eye, must be an excellent application in affections of that organ; that inasmuch as the pulmonaria or " lungwort" resembles, in its leaves, the texture of the lungs, it must "be good in pulmonary affections; and, for the same reason, the hepatica or " liverwort," in affections of the liver;—but all these phantasies—the offspring of credulity and superstition—have long passed away from the mind of the educated physician, although several of them still cling, with surprising pertinacity, to the unini- tiated. The ages, in which these and other emanations of faulty phi- losophy flourished, were characterised by the most marvellous credulity. It may be said of credulity as of its twin sister, super- stition, that ---"Not to rank or sex confined Is this vain ague of the mind; Hearts firm as steel, as marble hard, 'Gainst faith and love and pity barred, Have quaked, like aspen leaves in May, Beneath its universal sway." The passion for the marvellous prevailed equally in the closet and in the laboratory—in the learned few, and in the ignorant many. We have numerous examples to exhibit, that, in those credulous times, the members of the learned professions of divinity and law maintained doctrines and opinions not less irrational than those I have instanced as appertaining to our own professional ancestors. At the commencemeut of the seventeenth century, two learned English prelates perplexed themselves with the readiest way to get to the moon. The first production—according to the date of its appearance—formed a tract, that was republished in the Harleian Miscellany, and was written by Dr. Francis Goodwin, bishop of Landaff, who died in 1633. It was entitled "The Man in the Moon, or the Discourse of a Voyage thither, by Domingo Gonsales;" and the second was written in 1638, by Dr. John Wilkins, bishop of Chester. It was entitled, " The Dis- covery of a New World, or a discourse tending to prove that it is probable there may be another habitable world in the moon, with a discourse concerning the possibility of a passage thither." The two works differ essentially, however, from each other. In Bishop Goodwin's, we have men of enormous stature, and prodi- gious longevity, with a flying chariot, and some other slight points of resemblance to the vagaries of Swift; whilst that of Bishop 9 Wilkins is honestly intended to demonstrate scientifically, " that it is possible for some of our posterity to find out a conveyance to this other world ; and if there be inhabitants there, (and the good bishop settles satisfactorily to himself that there are) to have com- merce with them." From the first of these, Swift derived many hints in the composition of his Voyage to Laputa, and improved them into those humorous and instructive allusions which have caused the reputation of the author of Gulliver's Travels to be extended to every portion of the civilised globe. Bishop Wilkins maintains, " seriously and on good grounds," to employ his own language, " that it is possible to make a flying chariot, in which a man may sit, and give such a motion unto it, as shall convey him through the air; and this might perhaps be made large enough to carry divers men at the same time, together with food for the viaticum and commodities for traffic." The viaticum—especially the food—was, however, a severe stumbling block to the learned bishop. He remarks, that if men could fly, the swiftest of them would probably be half a year in reaching the end of his journey; and hence, he says, a problem would arise, " how it were possible to tarry so long without sleep or diet ?" Of the former obstacle he quickly disposes. " Seeing we do not then spend ourselves in any labour, we shall not, it may be, need the refreshment of sleep; but if we do, we cannot desire a softer bed than the air, where we may repose ourselves firmly and safely as in our chambers." The diet he finds somewhat more difficult to manage :—" and here," he says, " it is considerable, that, since our bodies will then be devoid of gravity and other impediments of motion, we shall not at all spend ourselves in any labour, and so, consequently, not much need the reparation of diet, but may per- haps live altogether without it, as those creatures have done, who, by reason of their sleeping for many days together, have not spent any spirits, and so not wanted any food, which is commonly related of serpents, crocodiles, bears, cuckoos, swallows, and such like. To this purpose, Mendoza reckons up divers strange relations, as that of Epimenides, who is storied to have slept seventy-five years, and another of a rustic in Germany, who, being accidentally covered with a hay-rick, slept there for all the autumn and the winter follow- ing without nourishment. Or, if we must needs feed upon some- thing else," says the bishop, " why may not smells nourish us ? Plutarch and Pliny, and divers other ancients, tell us of a nation in India, that lived only on pleasing odours ; and it is the common opinion of physicians, that these do strangely both strengthen and 2 10 repair the spirits. Hence was it, that Democrifus was able, for divers days together, to feed himself with the mere smell of hot bread. Or, if it be necessary that our stomachs must receive food, why then it is not impossible that the purity of the ethereal air, being not mixed with any improper vapours, may be so agreeable to our bodies as to yield us sufficient nourishment;"—with many other delusive phantasies of a similar nature.1 In these periods of comparative darkness, there was scarcely a superstition too gross to be credited. Even the great author—as he is usually styled—of the inductive philosophy, exhibits numer- ous evidences of the spirit of the age, in his Novum Organon; and although he was doubtful of the effect ascribed by Sir Kenelm Digby, and others, to the means and appliances used in the " cure by sympathy," to which I have alluded, he gave his full credence to the power of witchcraft. Perhaps we have not a stronger example of the depth of this dye, than in the facts which I mentioned to you in the first lecture I delivered on medical jurisprudence, in reference to the belief— universal, at one time, amongst the learned and the unlearned— that the wounds of a murdered person will bleed afresh if the body be touched ever so lightly, in any part, by the murderer ; a belief which is referred to by Shakspeare, Webster, and others of the older poets. On the occasion to which I refer, I gave you many cases from the annals of judicial enquiry, to show how strongly the idea had root in the minds of the wisest of the members of the sister profes- sions of divinity and law, which have numbered in their ranks, at all periods, the most enlightened of the community. "That as to the body bleeding,"—says Mr. Jones, the king's advocate, on the trial of the parricide, Philip Stansfield, for the murder of his father, Sir Philip Stansfield,—"although several persons touched it, none of their hands were besmeared with blood but the prisoner's ; and that the body having lain two days in the grave, in a cold season, the blood must naturally be congealed. That the lifting about the body, and even the incision that was made, causing no such effusion before, but only of some water or gore, and should, upon the prisoner's first touching it, begin to bleed afresh, he must ascribe it to the wonderful providence of God, who in this manner discovers murder." The improvement in the habits of reasoning and observation— the better system introduced of tracing the relation between cause 1 See a review, by the author, in the American Quarterly Review, No. V. 11 and effect—has long banished those irrational notions from the imaginations of the educated. Still, amongst the people, multi- tudes are to be found, who repose their firm belief in the operation of charms ; and some, who do not deny their credence to the efficacy of the "Trial by Bier-right," of which such inimitable use has been made in St. Valentine's Day or the "Fair Maid of Perth," by its illustrious author. Unhappily too many, again, although they may not believe in the doctrine of signatures—as respects the medicinal efficacy of plants—are led to give their faith to other similitudes, which have no existence except in the prolific—and, too often, interested— imaginations of their promulgators. I know not, gentlemen, how this is to be avoided, except by the diffusion of a greater degree of knowledge—respecting the nature and powers of our profession—amongst the community. It has always appeared to me, that if the public were acquainted with the rigid system of induction—the careful observation and com- parison of facts—practised by those of the profession who keep pace with its present advanced and advancing condition ; if they knew how necessary it is to be acquainted, not only with the mode in which the functions are executed in health, but with the various derangements they suffer in disease; if they were aware of the nicety of discrimination, which is demanded of the practitioner; and the necessity for knowledge derived both from his own observation, and from the recorded and accumulated experience of ages, they would pause before they had recourse to remedies of which they know nothing; and to pseudo-physicians, who, neither by educa- tion nor by habits, can possibly be equal to the important functions they assume. The public are singularly ill-informed regarding the qualifica- tions of the physician. His art, instead of being looked upon as inductive, is presumed to be enveloped in mystery, which no effort of theirs can penetrate ; and hence the success, that every where attends quackery and imposture. It is, indeed, to be regretted, that medicine is not studied more as a branch of liberal education. The distinguished founder of the University of Virginia was struck with the importance of this view, and originally the instruc- tion from the chair of medicine in that school was intended mainly as a department of collegiate study. How many persons are so situated in life, that a knowledge of the principles of medical science would be most desirable and con- solatory to them! doomed, frequently; to call upon a stranger for 12 aid in dangerous cases, and incapable of forming an accurate estimate of his professional qualifications ; frequently, too, situated where medical assistance cannot be obtained ! What other mode is there, by which the community can be steeled against the nefarious arts of the unprincipled empiric, the rule of whose con- duct is—" Populus vult decipi, et decipietur?" Credulity forms, as it were, a part of our very nature, and it can only be banished by the process of mental improvement that has dispelled the disposition to the marvellous, which, as we have seen, prevailed in former ages, even with the learned. At no period of medical history has the cultivation of medical science been better conducted than at present. The physician is aware, that there is no study which requires more rigid enquiry; none which demands a greater union of moral and physical reasoning. How idle, then, to speak of a man being born a physician ! That one man may have a better original capacity than another, no one will attempt to deny. Nor will it be disputed that the poet, the mathematician, and the musician, who deploy their "geniuses"— as the French term them—at a very early age, are gifted differently from those, who show no taste whatever for poetic imagery, for the close reasoning of the exact sciences, or for the "concord'of sweet sounds;" but the science of medicine, it, need scarcely be said, is not in this category. Its facts and reasonings can only be attained by self-inspection and communion, combined with a knowledge of that which has been done by others. The man, who forms his own judgment from his own observation and reflection only, has a small capital for his operations, compared with him, who has his mind stored—in addition—with the accu- mulated wisdom of ages : he has, moreover, no mode of knowing and correcting the fallacy of his observations ; so that if he should commence wrong, and treasure up the results of his false expe- rience, the whole of his professional existence might constitute but one series of blunders ; unless, indeed, some fortunate accident should reveal to him that which a brief study of the registered observations of others would have at once indicated. It&was to physicians—truly learned in their calling—that the philologist Parr alluded, when he affirmed, " whilst" I allow that peculiar advantages arise from the appropriate studies of the three learned professions, I must confess, that in erudition and science, and in habits of deep and comprehensive thinking, the pre-eminence in some degree, must be assigned to physicians." It was of such physicians that Mr. Dugald Stewart spoke, when he expressed 13 the opinion, that physicians are calculated to be the best meta- physicians. Similar feelings have occasioned the universal desire of court, counsel, and jury, that the testimony of the medical witness should always be invoked in cases of insanity; not because the physician can necessarily furnish any physical evi- dence, that may prove the existence of the infirmity, but because his habits of close discrimination between different maladies, and between the varying shades of the same malady, may enable him to detect the aberrations of a " mind diseased," more readily than they whose course of observation has been less discriminating. In exercising the honourable—the dignified—calling you have embraced, regard it not simply as a means of acquiring a creditable subsistence, but as a science nobly devoted to the relief of human suffering. Endeavour zealously, as I have often inculcated, to sepa- rate the known from the unknown, the fact and the theory from the hypothesis. Watch, in the spirit of true philosophy and with dili- gence, the march of nature ; discard all blind empiricism; and, although you may become somewhat more notorious by embracing an exclusive sect or system, and by endeavouring to make all natu- ral phenomena bend to it, recollect that, by such a course, you are wandering from the true path, to which, as years roll away, and time mellows the over excitement of your imagination, you will be sure to return. Follow the less brilliant—but more certain- course of the eclectic. With no other motive than the discovery of truth, choose from every passing sect that which is good; rejecting, without remorse, the crumbling materials of which the superstructure is too generally erected. Where, it may be asked, is the system, professional or empirical, from which the philosophical enquirer may not cull something useful 1 In the history of medicine, as well as of empiricism, I know not a single system from which useful information has not been derived. The belief in the agency of charms, and of animal magnetism, in its various shapes, and the cures, doubtless effected by them, have attracted the attention of the medical philosopher still more to the influence, exerted by the moral over the physique, by the mind over the body. The cure by sympathy—the wound being carefully bound up, whilst the armatory powder or unguent was applied to the weapon that inflicted it—is supposed to have given the first hint to the surgeon to bring the edges of the wound together, and to unite them by what, you are aware, is called the "first intention." The mystery of the operations of St. John Long, and the mode in which his liniment produced its effects, have 14 been recently unveiled by Mr. Guthrie, who found that its virtues were dependent on the mode in which the friction was managed, and not upon the liniment; inasmuch, as when friction was made, in the appropriate manner, with soapsuds, exactly the same result supervened. The impunity, in some cases, with which a hardy class of empirics, common in every portion of the United States, push their stimulating practice, with the advantage accruing from it to others; and the good effects produced, in chronic ailments especially, by another set of practitioners, from their expectant method of treatment, have not been without their useful points. The latter, like the old medicina expectans, is truly " the art of amusing the patient, whilst nature cures the disease." Need I, gentlemen, repeat to you what I have said on the im- portance of temperance and sobriety; on the possession of presence of mind to adapt you for every sudden and trying emergency ; on your obligations to secrecy, discretion, and honour ; on the import- ance of attending to your manners and address, so that they may be liberal and polished, compassionate and gentle; and on the advantage of your being open and candid, disdaining all unnecesa sary artifice. Constantly will you be doomed to contradictions and disappointments; perpetually will you have to gratify whims and caprices, often of the most unreasonable character; but learn to bear these evils with equanimity; regard it as a part of your duty to fall in with them, with at least apparent cheerfulness, whenever you can do so with propriety; yet never allow your flexibility to induce you to consent to that which, in your opinion, is contrary to the interests of your patients, however pleasing it may be to their inclinations. Too great pliancy will lessen their confidence, and when this has occurred, contempt and estrange- ment are apt to follow. In no profession is sympathy for suffering more essential than in that of medicine ; in no avocation are the noblest attributes of the head and heart more invoked. What science is so well calcu- lated to exhibit, in bold relief, those sentiments that ennoble the mind of man ? Instead of the sight of suffering hardening the heart of the practitioner, I would appeal to my professional brethren, who have originally possessed the kindlier sympathies, whether they have not, year after year, found those sympathies developed, their benevolent feelings enhanced, as new scenes of sufferino- presented themselves, in succession, to their notice. The maxim " that habit blunts the sensibility" is true only within certain limits. The practitioner—busily and benevolently engaged—well 15 knows that his feelings are constantly and painfully excited ; and the doer of good works—the active dispenser of charity, of which we see so many honourable examples around us, and every where —visiting the miserable cabin of the poor and the afflicted, would spurn the idea, that familiarity with scenes of wretchedness has rendered him less susceptible of sympathy. It was properly observed by him, who has been regarded as the leviathan of English literature, that "every man has found in physicians great liberality and dignity of sentiment; very prompt effusion of beneficence, and willingness to exert a lucrative art, where there was no hope of lucre." Our cities could furnish nume- rous examples of the truth of this remark. It well depicts the habits and the feelings of the whole profession ; but the extent to which this benevolence is carried is exhibited more conspicuously in country situations. Day after day, and night after night, is the country practitioner summoned, at a moment's warning, to leave his home, " the resort Of love and joy, of peace and plenty, where, Supporting and supported, polish'd friends And dear relations mingle into bliss," to travel—perhaps at the hour of midnight—through pathless wilds, and exposed to the peltings of the storm, to visit some poor inmate of a wretched hovel, from whom he neither expects nor asks for compensation. Look again on the daily evidences pre- sented to us, of the physician, who is endowed with that sympathy, which, like mercy, " is not strained," gladdening the hearts of the sick, and of the anxious relatives, by visits, which he pays without the slightest intention of pecuniary reward, and which, indeed, cannot be compensated by any remuneration whatever. Spurn not, my young friends, emotions that are so creditable to humanity. You are elevated by their possession. Cultivate, rather than dis- card them; and, with the eloquent author of a useful production on the duties and qualifications of the physician,1 regard the insinuation, that a compassionate and feeling heart is commonly accompanied with a weak understanding and feeble mind, to be malignant and false. Let not even that ingratitude, to which the best of you may be subjected in occasional cases, divert you from the indulgence of such beneficent and sympathising sentiments. The most trying cases to you are those in which all earthly hope is lost; where every resource of art has been found unavail- 1 Dr. John Gregory. 16 ing. Even here, the attention of the physician is most consolatory. It is indeed his duty to persevere unremittingly in his cares, how- ever distressing to his feelings this may be; and, until the very last, to smooth the pillow of suffering. A euthanasia, or easy death, it is supposed, may be facilitated by his agency, and hence his aid is often invoked until the very period of dissolution. The idea of intense torment immediately preceding death is so general, that the term " agony" has been applied to it in many languages. In its origin, the word means nothing more than a violent contest or strife; but it has been extended so as to embrace the pangs of death, and any violent pain. The agony of death, however —physiologically speaking—instead of being a state of mental and corporeal turmoil and anguish, is one of insensibility. The hurried and laboured breathing, the peculiar sound on inspira- tion, and the turned up eyeball, instead of being evidences of suffering, are now admitted to be signs, that the brain has lost all, or almost all, sensibility to impressions. Whilst the brain is possessed of consciousness, the eye is directed as the will com- mands, by the appropriate voluntary muscles of the organ ; but as soon as consciousness is lost, and the will no longer acts, the eye- ball is drawn up involuntarily under the upper eyelid.1 How consolotary, then, for the afflicted attendants on the "last scene of all," to be informed, that all these indications of painful strife are such in appearance only. Even the convulsive agita- tions, occasionally perceived, are of the nature of epileptic spasms, which we know to be produced in total insensibility, and to afford no more evidence of corporeal suffering, than the case of the heart- broken female, who is represented by one of the most distinguished of British bards, to have withered for twelve days and nights, till "At last Without a groan or sigh or glance to show A parting pang, the spirit from her pass'd: And they, who watch'd her nearest, could not know The very instant, till the change that cast Her sweet face into shadow, dull and slow Glazed o'er her eyes—the beautiful, the black! Oh! to possess such lustre, and then lack." This kind of euthanasia is what all must desire, and, fortunately, whatever may have been the previous pangs, the closing scene, in most ailments, is generally of this character. »See a bibliographical notice, by the author, in the « American Journal of the Medical Sciences," for May last. 17 Go then, my young friends, whither your duty or inclination calls you ; but let me affectionately solicit for my colleagues and myself, that when you are scattered to the north and the south, to the east and the west of this far spread country, your thoughts may occasionally revert to those who have had the delightful office of guiding you in your labours, and whose pride and plea- sure it has been to remove from your path every obstacle to your onward progress. In the name of the Trustees and Faculty of Jefferson Medical College. I welcome you to the ranks of the profession, of which you have this day received your testimonials as accepted members. In their name, and in the name of that profession, I exhort you to follow the dignified calling you have embraced, with zeal, circumspection, and honour; to let no ungenerous feeling lurk in your minds towards any one, but especially towards a professional brother, or any honourable association of your brethren, who may be labouring for the ad- vancement of science; to do, in all respects, unto them as you would that they should do unto you : then, indeed, will the pros- perous Alma Mater, of which you are the Alumni, have just cause to glory in you. May you, gentlemen, at the termination of, I trust, a long, happy, prosperous, and well-spent life, merit those rich rewards which have been promised, on the highest of all authorities, to the good and faithful servant. 3 At a Commencement held on the lith of March, 1837, in the city of Philadelphia, the degree of Doctor of Medicine was conferred on the following gentlemen. ALABAMA. Mania a Potu. DELAWARE. Blood-letting. Rachialgitis. Marriage. Josiah T. Evans, Louis H. Beatty, C. T. Chamberlain, Alexander J. Jones, DISTRICT OF COLUMBIA James L. Brooks, Theo. J. Krouse, Otis McDonald, Wm. J. Anderson, James M. Green, Thos. J. Johnson, Wm. G. McBride, R. S. Key, Jas. B. Bush, P. E. Smith, Thos. C. Tebbs, James W. Henry, William H. Howard, Wm. H. Muse, Hillary Pitts, Thos. G. Turton, David Trimble, Jas. Q. Williams, Henry Zeller, Richard G. King, D. S. Newell, B. L. Phillips, On the Urine, &c. Remittent Fever. Inflammation. GEORGIA. Intermittent Fever. Bilious Fever. Calorification. Specific Medicines. INDIANA. Puerperal Fever. KENTUCKY. The Circulation. Acute Hepatitis. Cholera. MARYLAND. Cinchona. Hernia. Gonorrhoea. Acute Rheumatism. Rheumatism. Scrofula. Variola. Bilious Fever. MISSISSIPPI. The Coagulation of the Blood. Cholera. Inflammation. H. W. Stackhouse, Wm. R. Morrell, Thos. H. Browne, P. S. Conner, S. C. Foster, Thos. Kittredge, E. E. Marcy, Columbus Beach, Barzillai Gray, MISSOURI. Tartarised Antimony. MAINE. Apoplexy. MASSACHUSETTS. Blood-letting. Puerperal Peritonitis. Kreosote. Rheumatism. The Influence of the Mind in curing Diseases. NEW JERSEY. The Pulse. Remittent Fever. 19 Geo. R. Robbins, Jno. S. Stout, Chas. Skelton, Jno. Wiley, Frederick A. Cad well, Edwin Griffin, Wm. T. Green, Thos. K. Kerr, Wm. C. Lawrence, Charles Schiissler, Blin S. Sill, Jno. W. Stearns, Jr. Lawrence F. Storm, Daniel Thomas, F. R. Harvey, Daniel McGill, Dudley Allen, Patrick Cassidy, Michael Garst, Sherman Goodwin, Levi G. Harley, James B. Hutchinson, Wm. L. Knight, Wellington Stanbery, Pernett Thomas, Elijah Young, Alex. Black, Wm. Coryell, Jno. M. Cassel, James Fleming, Jonathan H. Gilbert, Isaac W. Garretson, S. M. E. Goheen, Howard H. Hopkins, Joseph B. Jones, Joseph C. M. Kane, Jno. Leaman, Jno. A Morrison, Jno. C. Murray, Jno. A. McFarland, James McClelland, Luke V. Newton, Ely Parry, James L. Reed, Ross B. Richardson, Wm. H. Salter, Croup. Acute Hepatitis. Electricity. Intermittent Fever. NEW YORK. Phthisis. Concussion of Brain. Acute Rheumatism. Mediate Auscultation. Practical Anatomy. Prosopalgia. . Gout. Chronic Diarrhoea. Athrosa Acuta. Masturbation. NEW HAMPSHIRE. Rachialgitis. NORTH CAROLINA. Puerperal Fever. OHIO. Pleuro-peripneumonia. Metaphysics. Scarlatina. Burns. Cataract. Aphthas. Hydrocephalus. Hooping Cough. Pneumonitis. Indigestion. PENNSYLVANIA. Chronic Bronchitis. Local Diseases. The Science of Medicine. Sanguinaria Canadensis. The Animal Economy. Modus Operandi of Medicines. Rachialgitis. Scarlatina. Hydrocephalus. Cantharides. Emetics. Typhus. Inflammation. Croup. Aneurism. Rubeola. Diseases of the Teeth. Mania. Intestinal Veins. Intermittent Fever. 20 Jno. Seiberling, Abraham D. Wily, Saml. Webster, James W. AVilson, James H. Eldridge, Jno. P. Wallace Samuel S. Coffin, David M. Henning, Jno. A. Jordan, Jno. H. Marable. Wm. H. Meriwethei Wm. N. Anderson, Robt. B. Banister, Robt. L. Blakey, James W. Burnett, Joseph W. Bronaugh, Albert G. Conway, H. W. Chapline, E. A. Currie, P. D. Ewing, R. H. Edwards, Robt. T. Gibbs, Robt. B. Hall, Josiah J. Janney, Robt. F. Kennedy, F. C. A. Kellam, Wm. D. Lewis, Milton R. May, Jno. F. Miller, Richd. Mcintosh, Geo. L. Nicolson. Thos. W. Neal, Napoleon J. M. Smith, Gustavus A. Tompkins Wm. S. Thruston, Geo. S. Thomas, Lucius T. Wootten, Wm. M. Hunter, Robt. McLean, David See, Gabriel Lachance, Puerperal Convulsions. Acute Rheumatism. Diet. Croup. RHODE ISLAND. Iodine. SOUTH CAROLINA. Typhus. TENNESSEE. Cholera. , Malaria. Angina Pectoris. Amenorrhea. Curved Spine. VIRGINIA. Diabetes. Ulcers. Phlegtaasiae of the Lungs. Compression of the Brain. Puerperal Peritonitis. Fever. Blood-letting. Intermittent Fever. Syphilis. Dysentery. Indigestion. Tetanus. Typhus. Apoplexy. Acute Dysentery. Iodine. Phrenitis. Diabetes Mellitus. Cold. Malaria. Innervation. Chronic Hepatitis. Flatulent Colic. Stricture of the Urethra. Menstruation. Delirium Tremens.. IRELAND. Hydrocephalus. UPPER CANADA. Croup. LOWER CANADA. Scrofula. Cholera. H. H. Hayden, Baltimore. Robt. Thompson, Pennsylvania. Jno H. Kain, Connecticut. THE AMERICAN MEDICAL LIBRARY AND INTELLIGENCER. EDITED BY ROBLEY DUNGLISON, M. D. PUBLISHED BY ADAM WALDIE, CARPENTER STREET, PHILADELPHIA. The publication of this work has been delayed, from unforeseen causes, beyond the time of its original announcement; but arrangements are now completed for its prosecution, and it will appear regularly, as originally advertised, on the first and fifteenth of every month, the first number to appear on the first day of April. The whole will be under the sole editorial management of Dr. Robley Dunglison, as mentioned in the accompanying prospectus, a gentleman too well known, by his various works and extensive medico-literary attainments, among the profession, to require any further evidence than the simple assurance of his superintendence, to guarantee a work of great practical and general interest. As the postage may be considered by some an important item of expense, it is suggested, that the " I^telligexcer," the original depart- ment, be sent by mail, and the " Library," the reprint, be obtained through some private conveyance. The " Intelligencer," containing a synoptic view of the current proceedings of the medical world, will be the most immediately interesting, and the books entire can lose little of their interest by a short delay. The subscribers' wishes will be care- fully attended to. As some, whom this may reach, may not have seen the original prospectus, the following leading features of the plan are reprinted: Each No. will contain 128 octavo pages, and will be divided into two parts, the " Library" and the "Intelligencer." The latter will occupy, in each number, from 16 to 20 pages, printed on a paper, and in the type and form, of the specimen which accompanies the prospectus. This part of the work will contain "a concentrated record of medical science and literature," to be made up of information of the fol- lowing kinds :—1st. Editorials. 2d. Short original communications of interest, furnished from the practice of the editor or his friends. 3d. Critical and analytical notices of all original American medical publications. 4th. Analytical notices of the different American medical journals. 5th. A periscopic review and detail of the interesting facts 2 contained in the European medical periodicals. And, lastly, a summary of medical news. The former, the library department, will occupy 112 pages, and will be printed in the type and form of the specimen. It will contain reprints of the most valuable medical and surgical works which appear in Great Britain, and will occasionally be enriched with translations oi medical books, of great interest, from the French, German, or Italian presses. In selecting books for republication, the editor will always give a preference to those which are of a practical character, and such as, in his judgment, will be most interesting to his subscribers. As " The American Medical Library and Intelligencer" is intended to form " a concentrated record of medical science and literature,"—besides reprinting the valuable works on medicine and surgery which appear in Great Britain, and furnishing translations from the medical press of the continent of Europe, one part of it, " The Intelligencer," will contain a periscopic notice of the interesting Cases, Facts, and Discoveries, which appear in the medical journals of Europe, and likewise analytical reviews of the American medical periodicals. " The American Medical Library and Intelligencer" will therefore not only enrich the libraries of its subscribers with copies of the most valuable medical and surgical works published in Europe, but it will furnish them, in a concentrated form, with all the facts and discoveries of interest, which the innumerable medical periodicals of this country, and of Europe, contain; and, from the arrangements made to receive the European journals and works immediately on their publica- tion, they will be put in possession of these a few weeks after their appearance. TERMS. 1. The Library will be published semi-monthly, in numbers of 128 octavo pages each; 112 of which will consist of a reprint of a standard work.—the remainder, of original matter. The whole so arranged that each work may be bound separately. 2. The subscription price will be ten dollars per annum, payable in ad- vance. Any person remitting payment for ten copies, will be entitled to a copy gratis. 3. Subscriptions received in April or October of each year, at the publica- tiono ffice, 46 Carpenter street, Philadelphia NOTICE. Circumstances having rendered it necessary for his friend and col- league, Professor Pattison, to visit Europe for a few months in the inter- val between the sessions of the medical school to which he is attached, the editorship of the " American Medical Library and Intelli- gencer" will devolve wholly on the undersigned; whose utmost zeal and assiduity shall be devoted to fulfil the design of the work, as detailed in the prospectus, extensively issued some time ago. No effort shall be wanting to place before the subscribers every medical fact and observa- 3 tion of importance, which may appear, from time to time, at home or abroad. The desire of the undersigned will be, to make the work cosmopolite, as regards the sources whence its information is derived, and the reflections to which such information may give rise; whilst it shall be truly American in its character,—its pages being open to appropriate communications from every intelligent individual, and re- specting every honourable association of individuals, who may be labour- ing to promote the great interests of the republic of science. As one of the objects of the work is to publish short original com- munications, the undersigned solicits contributions on any topic which may be esteemed, by the writers, of interest to their professional brethren; and as such communications must, from the nature of the work, be brief, many who would pause before they commenced a long essay for a quar- terly publication, may readily decide upon furnishing a less elaborate account for a journal which appears more frequently, and which must necessarily be less formal and stately, although, it is hoped, equally dignified and useful. In the selection of works for the " Library," the undersigned, it need scarcely be said, will exert his best judgment. The correspondence established with Great Britain, France, Germany, and Italy, will enable him to command the best productions of those favoured countries, and although the " Library" will be chiefly made up from the most valuable works that issue from the press of Great Britain, he will eagerly embrace the opportunity afforded by the publication of a superior work in those other countries, to place an English version of it before his readers. At this moment he has before him many late French, German, and Italian periodicals, from which, as well as from the medical journals of this country, the best materials shall be transferred, in some form or other, into the pages of the " Intelligencer." In conclusion,—the undersigned may repeat, in the language of the prospectus, that no effort shall be wanting on his part to give interest and value to the publication, and to render it what it purports to be, "a concentrated record of medical science and literature." ROBLEY DUNGLISON. Books intended for notice, and original contributions, may be addressed to the publisher, who will also cheerfully exchange with other established medical publications. / Sir—Annexed is a Prospectus of a new medical library, which, from the plan already matured, and the means prepared for its fulfilment, is offered with confidence to your attention as a work destined to exercise a powerful and beneficial influence among the pro- fession throughout the country. The high price of medical books, added to the delay and difficulty of transporting them to the interior, has hitherto operated powerfully against the country physician. But by the plan here adopted, the barrier will be removed ; he will enjoy nearly all the medico- literary advantages of his professional brother in the city, as he will receive periodically, and at short intervals, authentic accounts of the latest discoveries in medical practice, reports of interesting and important cases, practical information of the success or failure of new theories, combined with the publication of entire standard works, thus forming a medical library of the most valuable description, at an expense almost imperceptible. The name of the editor is too well known to require any thing more than the simple announcement to guarantee the complete and satisfactory fulfilment oj the editorial department. For the punctuality of the publica- tion, the various works published by me for the last four years, during which not a number has failed, must be the evidence in my behalf. And of late, my facilities have been so increased, as to render punctuality still more certain. The American Medical. Library was originally announced to appear in January, but delayed from unforeseen causes unnecessary to be detailed here ;—these have been removed, and the work will now appear regularly. Subscriptions are respectfully solicited by Yours, very respectfully, ADAM WALDIE. Philadelphia, March, 1837. 5 TT92D2E0 U~1N 3NI0IQ3W do Aavuan "WNOI1VN NLM032028115