111 AN IHTROBXJCT0RY LECTURE DELIVERED AT THE OPENING OF WASHINGTON MEDICAL COLLEGE OP BALTIMORE* BV HORATIO O.JAMESON, Xft. D. Presttrent of the iFacttlts, >ICN0BARY MEMBER OF THE MEDICAL SOCIETT OF MARYLAND, OF THI MBBI CAL SOCIETY OF FITTSBI7BG, &C. FOR 1827 & '8. Baltimore: PRINTED BV R. J. MATCHETT, 51, SOUTH ST, s &•':?}} / n^i 1 *r'. £ 1828, T31i INTRODUCTORY FOR 1827 AND '8. —&&&— • Few men, I believe, pass to old age, or even to the me- redian of life, without anticipating with fondness and con- stancy some favourite object of pursuit—they look to the possession of that object as a resting place, from, at least a portion of their cares and toil. In other instances, influenced by an ambitiousness for fame, notoriety, or a desire to be more useful to mankind, they look forward to some supposed period, when they shall be numbered with the hero, man of letters, or of high professional skill. A very large portion of the good and evil in the moral world has been owing to such a trait in the human charac- ter; and it is with this respectable audience, and the public, to judge by what motives my colleagues, and myself, have been actuated in the pursuit of the measures which have led to your assemblage, in this house, to-day. Permit me to say a few words for myself.—Thirty^ years of my life have been principally devoted to the cultivation of medical knowledge, and the practice of medicine and sur- gery—but, I have long had h/gher objects in view: that is, 1 have long since hoped to enlarge the field of my useful- ness, by writing and teaching in the science and practice, to which I have been devoted. The interesting period has at length arrived when, aided by my colleagues, I may hope to have attained, in a good de- gree, the object of my pursuit. It remains to be seen, whe- ther I am grasping after an ignis fatuus, or whether we, who have embarked in the present undertaking, are now about to extend the sphere of our usefulness to mankind. I have reached the height of my present expectations—the harvest is ready for the sickle, time alone can tell whether I am to reap a portion of the golden harvest, or thorns and thistles. With these preliminary remarks, I proceed to otter some re- flections upon medical surgery. , Medical knowledge and the practical application of that knowledge, so far as is known in the present day, had been but little cultivated before the days of Hippocrates—what- 4 ever may have been claimed, by historians, for .^Esculapius, nothing of much importance, in medical science, has reached into times of faithful record, anterior to the sage of Cos. Hippocrates having lived about four hundred years before the Christian aera, and, therefore, at a time that the Grecian language had attained considerable perfection; and this lan- guage being alike copious, and well suited to the formation of technical phrqses, from significant radicals, it has followed, that (while the writings of this author have descended down to the present day, without losing aught of their high destiny,) the language in which he wrote, has maintained so high a character to the present time, that almost all our technical phrases have been borrowed from it, at least where attempts have been made to improve nomenclature, by ren- dering it significant. The systems of Linneus and Darwin, are perhaps, the only exceptions to this remark. The Greek affording greater facilities for combination than the Latin, leads one to suspect these authors to have been governed by caprice, or a desire for singularity in choosing Latinity. The Grecian language having in some degree preceded medical science would prepare the way for significant terms in medicine, and, hence, we find chirugia, that is, surgery, to be derived from x*>h a hand, and %fynt work or manual operation. Chirugeon is said to be derived from zupcvpyos, one who heals by outward applications. We perceive here, that neither of these terms means exactly what we un- derstand by the words surgery or surgeon. The term cheir- ater, seems more appropriate, being derived from Xuf, a hand and txrf0?, a physician. This term, however, has become obsolete, and it is only necessary that we remember in using the word surgeon or chirurgeon, that it is deiived from radicals implying manual application. But as it is now well known that, the skill and success of the surgical practi- tioner depends much on internal and general remedies, to be correct in our phraseology it is only necessary to use'the term medical surgery. This is free from ambiguity, and, indeed, equivalent to the ancient phrase cheiriater, no lonjrer in use. ° \V hat we technically term medicine and surgery are so inseparable, that, we can only perfectly understand either by stuovmgboth. We may remark, however, this difference,, hat thep vs-e.an may be learned and skilful, and know almost nothing of surgery; but no man can arrive at pre-eminence m surgery who is not a good physician. 5 Whatever exceptions may be made to this assertion in its move general acceptation, no one will doubt the truth of it, when applied to medical surgery. This close union of medicine and surgery admitted, it seems proper that in treating of medical surgery, I should glance at medical science in general; but, in doing this, I shall endeavour to arrive at some useful reflections on the branch of surgery now before me. It ha.s been common long since to declaim against theory in medicine. The whole stupendous philosophy which adorns our science, has been pronounced conjecture: much of it but the waking dreams of ingenious men. Although, we in candour, may be compelled to acknowledge the truth of these asser- tions, in some instances, yet, comparatively speaking, we can justly claim a high standing for medical science. In proof of this, I will take a slight glance at some of the other sciences. History supports the opinion, that one of the first studies which engages the human mind, in its emergency from men- tal darkness, is the contemplation of a superior intelligence; notions of a Deity however erroneous are cherished We will pass by the idolatrous nations, whose conceptions led them no higher than the con emplation of Deity in the sun, the moon, the stars, deceased heroes, brute animals, images, &c. instances of all which are familiar to those who have become acquainted with either sacred or profane history; and, we are informed in those same histories, that the Jewish nation, more than tour thousand years since, had knowledge of Jehovah. Prophets, patriarchs and sages, for centuries strove to estab- lish a theocracy, but in vain. Yet, amid the imperfections and failures, how much do we see to admire? The mind was awakened to the loftiest strains of poetry. The pro- foundest moral principles, and the most just conceptions of individual rights are clearly depicted in the Old Testament. Who does not acknowledge the towering genius displayed in the writings of Solomon and Isaiah; and the evidence of mental strength, portrayed in the sublime conceptions set forth in the book of Job. And yet, with all this intellectual attainment, the Jewish nation under the guidance of a theocracy, not only failed in realising happiness and prosperity, but were dispersed over the fo r quarters of the world. Here we see at the very threshhoid of our enquiry, thai, all natui.- is stamped with the eternal fiat, thus far shalt thou go but no farther. G The Christian doctrines were originally delivered in all simplicity of language. Laws of incalculable value have been offered which provide for the welfare of mankind. The genius of thousands of men of the highest attainments has been engaged for centuries, in expounding the law, and in ex- horting to the practice of virtue, and still down to the pre- sent day, sect after sect arise avowing new views, while a part of the old pertinaciously adhere to the old. Yet amid all the evil growing out of human frailty, and the abuse of laws perfect in themselves, who can refuse to acknowledge how much human nature has been embellished, and benefit- ted by Christianity, notwithstanding the want of harmony. If we turn our attention to the'civil law, we shall find that many sound principles were known as early as the days of Moses. Some of these bearing marks of Divine origin, were known, more or less, to Greece and Rome, in their days of prosperity: witness some of the dialogues of Lucian, an au- thor alike distinguished for his genius and his vanity: and it is known that Galen makes respectful mention of the Saviour. We know, moreover, that civilians laboured in both these nations to estalish codes of law, to which may be added, that all Europe, and England in particular, have laboured for centuries to reduce civil law to fixity; and I need not say how far they have fallen short. Notwithstanding the many luminaries which have adorned the British annals of law; no one who has lived one fourth of a century but must feel, in some degree, the truth of the opprobrium of the law; that it is marked with a "glorious uncertainty." Thus we see that after many ages have been devoted to the law, and men of exalted talents have striven in every civilized na- tion, to reduce a subject so important to mankind, to fixed principles; yet it remains inveloped in mystery, doubt and uncertainty. Of this we have almost daily proof in our courts of Justice, and yet no sensible man would think of re- jecting all the learning in the law because it remains imper- fect. Not a work of celebrity, but has its value, and its loss would occasion a void. He who would become a successful advocate must know what has been written, he must be learn- ed in the law or he cannot attain a high rank in the pro- fession. Ages of the Greeks and Romans were devoted almost wholly to philology, and notwithstanding the high attainments of Homer, and other writers of the former nation, and the many distinguished writers of the Latin, so numerous that it 7 would be invidious to select, we are not in possession of a perfect language. No one can be ignorant of the advantages to be derived from a careful study of the learned languages, at the same time, persons having a critical knowledge of them, have cause still to wish them more perfect. We are reminded here of what St. Pierre has said respecting critics: "That one Homer would make ten thousand critics, but ten thou- sand critics would not make one Homer." The same remark will apply in medicine. It is easy to condemn medical sci- ence wholesale, but while one father in physic affords mate- rial for tens of thousands of critics, tens of thousands of these would not equal one father in physic as benefactors to mankind. Hopes have been entertained, that the science of medicine, like that of mathematics, might be reduced to fixed princi- ples; and, because, that expectation could not be realized, our science has been less esteemed. I am not disposed to call in question the importance, nor the exalted character of the higher branches of mathematics; but we are at first sight struck with the simplicity of this science, in comparison with the general scope of medical science; embracing within its grasp, more or less, of every other art and science. Ma- thematics partake of but two fundamental laws, that is, arithmetical, and geometrical proportion, and is, indeed, but the science of proportion, and, all quantities being determina- ble, every problem admits of a definitive solution, as simple, in its various parts, as that three and two make five. We cannot, for one moment, doubt the transcendant acu- men, which led an Euclid, a Galileo, a Newton, to explore new regions, by which the human mind has been enabled to soar aloft to celestial objects; and reduce the momentum, size, and distance of planetary orbs to a precision which marks, in boldest character, the presence of Omnipotence. But, when we come down to the mere rules of the science, we see it attainable by minds fitted for common preception, and strong in memory—the mind in this study being wholly engaged in ideas of resemblance. With moderate mental powers—close application, and the power of abstraction from other studies, men may become highly respectable as mathematicians—a proof that if mathematics rank high, from their richness in truth, it is by that very circumstance ren- rWed more easily attainable, than the progressive sciences. s On the contrary, in the atudy of medicine there are no actual fixities, no determinable quantities, no exact sirnili* tudes—as differ the faces of men, so differs their organiza- tion; and as differs their organization, so also their constitu- tions. Indeed, the very ground work of our science is that of dissimilarity—there are countless idiosyncracies of habit, &c. which incessantly call on our perceptions, memory, and judgment So much is this the case, that every age of man- kind requires its own pathology—that which suits one age, or one country, will not suit others. Let us not be dissatis- fied then, if the great fathers in physic, in writing systems of pathology, for their cotemporaries. have not written what applies equally well in our time. I shall presently notice this subject, more at length; but to conclude our notice of mathematics, this science may be compared to the language of the semi-barbarian, whose language is natural, and full of strength, often dignified; while the study of medicine, em- bracing a wider range, gives play to more of the higher at- tributes of the mind, and may be resembled to the skill and attainments of an accomplished philologist, who is not only acquainted intimately with his own language, but also with many others. Having taken this cursory view of some of the higher sciences, with a view of shewing, that however much they may have served to adorn and enoble our nature, still they are all beset with imperfections—I am brought now to speak of the subject, more particularly, under consideration. Every man, well read in medicine, will readily acknow- ledge the untiring zeal, the philanthropy, and the many higher virtues which characterise the works of the greater fathers in physic. Whether we examine them for their mo- ral worth, or richness of talent, these works stand inferior to none in other departments of learning. Whom should the world delight to honor before Hippocrates, Sydenham, and Rush, these great luminaries, in the medical hemisphere, have left us three fixed points in medicine. These points are governing stars in medical constellations; and are . nature doing much; no wonder then, if he should be- come an admirer of the vis medicalrix natitrcc. The state of sock.ty in which he lived, not only made his reasonings valua- ble at the time he wrote, but they apply more or less to every condition of every nation, and, beyond all this, while indica- tion was little understood, and the virtues of medicinals little known, how could the philosopher have shown greater judg- mei.t than in trusting much to nature, while he endeavoured by observation, and induction to reach her arcana. To find out the cause, to designate and group symptoms antieipate their results- and apply their antidotes, was a task truly Herculean. Whatever may be the errors to be found in the works of Hippocrates, the advances which he made, in medical science, are not less stupendous, nor less import- ant to mankind, than those of Newton, in mathematical science. We may, therefore, cease to wonder, at the fact, that an emergency from mental darkness, to a philosophical view of diseases, should have immortalized the name of the Grecian fat ier of physic. Nor is there much room for wonder, that his norks should have captivated for ages, in a science alike ab>truse, and indefinitely diversified. The writings of Hippocrates, as regards the philosophy of medicine, underwent but little change through several ages. And, when we come down to modern times, we find some of his fundamental doctrines still advocated. We find Doctor Stahl advocating, and, in some degree, modifying the views of Hippocrates, respecting the conservative powers of na- ture. The latter ascribed the restorative power of the hu- man system to an all pervading principle which he named » Puns', and, which, he supposed to be the motive, pow- er i« combustion, fermentation, and animal life. A more en- lightened chemistry led the former to ascribe these several phenomena to different principles; and, hence, we find an appropriate name for that principle by which the human body is sustained, and relieved from disease, that is the anima medica; or, as Cullen, and others have it, the vis medicatrix naturae. With the people among whom Stahl practised, this theory, all things considered, was well adapted. In Germany, a country generally healthy, with inhabitants of vyjiou-, stamina, and simplicity of life, the theory of Dr. Stahl was judiciously applied; and the more so from the 11 fact of our science being, comparatively, in its infancy, which rendered it more safe to do little than prescribe in uncertainty. I have already said that to arrive at pre-eminence in sur- gery requires a general knowledge of disease. Fever is so invariable an attendant upon aberrations from health, and upon wounds, that the study of fever, in all its forms, with a view to a rational and successful practice, is alike necessa- ry, for the surgeon and physician. We are not only to expect fever from wounds, but, our surgical patients, being surrounded by the usual remote causes of fever, are liable to be assailed by bilious and other fevers, and thus be cut off unexpectedly. It may be proper to relate a case in point. A practioner, who once stood high as a surgeon, in this city, was called to see a boy affected with scrofulous sores of the thigh. He was aware that the patient had just come from a miasmatic situation. He prog- nosticated most unfavourably, saying the boy was far ad- vanced in hectic fever, &c. The physician who was in at- tendance, at once undeceived him, by giving such explana- tions as led him to see, that the boy was affected with a bil- ious remittent—suitable treatment, in a few days, restored the patient to his ordinary health, but the cure of his limb was the work of time. This is a matter of vast importance, since we now and then lose surgical patients, from their being overtaken by dis- eases which prove fatal; and their death is ascribed to the operation. I lost two of the most interesting patients I ever had, in this way; one by the supervention of influenza., and the other by cholera, followed by bilious fever. I had, in my own mind, the satisfaction, in these cases, to reflect that neither of those diseases were prevalent at the time of the operation. We see here, then, at a glance, how important it is to avoid all capital operations, that will admit of delay, in sickly seasons; or that patients exposed to endemic disease, as may often be the case, should be removed before the ope- ration' where it is a matter of choice. Such being the indissoluble tie between surgery, and the practice of medicine, we need no apology for making a pass- ing remark or two, upon the medical character of Dr. Sy- denham. In him you see verified the wonderful truth that superior judgment, aided by clinical observation, will enable men to prescribe skilfully, although they may be guided by erro- neous theory, I would nevertheless, maintain, that this ai. !£ thor's writings, show that men to become great, as physi- cians, must theorize. No philosophic mind, and this is a pre-requisite to the successful study of medicine, can be con- tent with the mere observation and record, of simple facts. To cease to reason is to debase ourselves, and the science of medicine. Indeed the efforts which have been made to invalidate, and to suppress theory, by Lieutaud and others, have only served to shew, that such a thing is neither desir- able nor practicable. It is therefore the duty of the votaries of our science, to become acquainted with the prominent features of every the- ory that has obtained celebrity. There is not one but will reward him for his pains. It remains here to say, that the works of Sydenham, abounding as they do in error of theory, are, nevertheless, highly valuable, and have a direct bearing upon the present subject, from the fact just noticed, that the surgeon not only must be prepared to meet symptomatic fever, but ready to recognize other supervening diseases. Having now briefly noticed the importance of the Qvo-is of Hippocrates, and the clinical observation of Sydenham, it remains to say a few words, respecting the unity of diseases, by Rush. This majestic truth in medicine, not less important than its predecessors, just pointed out, has, so far, met a very differ- ent fate. While they have dragged their millions of admirers and defenders, this has to undergo the fiery ordeal of mo- dern times. In a sceptical age, alike distinguished for pro- found erudition, and distrust of new Opinions; no wonder that a proposition so momentous, and magnificent should startle the medical enquirer; or fall under the displeasure of many, who, already in their own opinion, have arrived at the ne- plus ultra of what is known. The limits of this'discourse will not admit of even a brief defence of this great truth in medicine; at present, there- fore, I must be content to remark that not only does the prac- tice of every day serve to confirm it; and show its impor- tance, but the latest writings on medicine support it, although few European authors acknowledge what they owe to our countryman. Why is it that we bleed in dropsy, chronic inflammation, typhus fever,and other diseases, long supposed to be diseases of an asthentic character. In short, our experience more and more leads us into a sameness of practice, and to the belief, that, in most instances. 13 debility is either the predisposing cause of disease, or the consequence of disease merely. If there be a tew excep- tions to this assertion, we may say, they are really so few as to leave this unity of disease, and sameness of medical treatment at least one of the most general and important rules or doctrines, in the science. I have said that the study of medicine must, in its very nature, be somewhat precarious. A science whose basis is ever fluctuating, may be resembled to the great ark float- ing upon the vasty deep, it may be driven to and fro, by the winds of heaven, but amid the revolution of elements, it rides majestically and safely, carrying in its bosom intellectu- al frieght which shall, in due season, disseminate new light, and replenish the medical world with renewed strength; and thus it has been, when our science was about to be deluged, some good prophet builded an ark, and rode the crashing el- ements into harmony, alike beautiful and felicitous. I do not wish to be understood to say, that, the almost endless variety of diseased action which we see, seated in the multiform structures of the human body, and modified by end- less idiosyncrasies, are absolutely and essentially one and the same thing; nay, we know they are the offspring of various causes, have peculiarities, &c. But, I maintain with Dr. Rush, that they are all but a war with nature, an aberration from health. They are like the inequalities and variegated scenery of the mountain surface, multitudinous, but rooted in the same soil, and all governed by a few general principles in their economy. But, to drop the figure, our more modern therapia, at some period of every disease, are ninety-nine cases in the hundred founded on the antiphogistic indication. Thus we arrive at this conclusion, that in medical surge- ry, like in the practice of medicine, technically so called, our ground work is to study the animal economy, the etiology of disease, and on these found our indications of cure. Hav- ing attained this proficiency with Hippocrates, we come to the bed-side with Sydenham to combine and mature our les- sons. With him we shall learn that nature is often found op- pressed and unable to exhibit the symptoms suitable to the disease; that while we are never to lose sight of the natural resources of the system, we are to take peculiar care that we do not mistake, accidental phenomena, for salutary ope- rations of the vis medicatrix natural, and thus suffer the sys- tem to sink under morbid action, over which the animal eco- nomy has little control. Such lessons prepare us to approach 14 the sick bed with Rush. Now armed with the knowledge that in disease there still presides a sustaining innate princi- ple, that, with the knowledge of causes, we are in an es- pecial manner to mark and become well acquainted with symptomatology, at the bed-side, we are prepared to under- stand, and apply the great truth, that almost all diseased ac- tion consists of undue excitement, that every disease has its rise, its acme, and declination. That the incipient stage or growth has been named, by Rush, the forming stage of dis- ease, and, by properly appreciating this important truth, we may often nip the most formidable diseases, so to speak, in the bud, while we on the other hand avoid one of the most singular and destructive applications of blood-letting, which has been so extensively employed, by many of the best prac- tioners of medicine in Europe, and this country—that is, bleeding in anticipation, as a preventive of fever and inflam- mation. A proper knowledge of Rush's views, will keep us constantly, with a single eye, to symptoms, and there- fore we will neither refrain from bleeding, because we see a feeble pulse, from over stimulation; nor with a view to pre- vent inflammation, bleed in anticipation. There is nothing, in sound reason, to justify such conduct —keep to symptoms, meet them at the threshold—confide not that to nature which belongs to medicine, and if it turns out that unity of disease is a mere truism, you will find your practice simple and successful. It remains to make a few concluding remarks, they are more particularly designed for medical students. Enjoying, as we do, in this country, under Providence, civil liberty, and consequently, equal rights and privileges, it would seem to be unnecessary to detain you a single minute, with any re- marks with a view either of claiming for ourselves, the com- mon privileges of our countrymen, or of noticing reports, which have a tendency to influence the minds of medical stu- dents, in withholding from us the privileges which belong to the profession in common. But, as I am aware, that reports have been kept in circulation, which are ill-founded and un- generous, I have been induced reluctantly to say a few words, in explanation of our arrangements, and in refutation of objections, which we know to have been made against our operations. I have deemed it necessary to advert briefly to some of the usages, laws, and other circumstances, con- nected with medical schools. 15 Colleges in the infancy of the sciences, required the fos- tering care of government, hence it was tha governments, in extending endowments to such institutions, took them into special care. Perhaps, at that time they required the fos- tering hand of government, both in relation to their fiscal concerns, and also, with a view of clothing them with a share of power and dignity, which could alone secure to them the respect of unenlightened men. It has continued to be the interest of the rulers of European contries, to keep up the power which they acquired at this early period, as well in medical schools as in their earlier colleges. But it is not easy to imagine why it has happened in this country, where the fundamental doctrines in the government, are directly the reverse of those of European countries, we should continue such a usage. In those countries, the first law upon which governmental operations are conducted, is, that the chosen few shall govern the many: in this contry we acknowledge no such aristocratical power. Why is it then, that a chosen few in this country, in literary concerns, are to govern the many. I am aware that common colleges, require in this country, the fostering care of government, and hence the pro- priety of the state governments reserving a portion of con- trol over institutions to which they have extended endow- ments. But can we for a moment imagine that if it were the interest of an individual or company to establish a col- lege, give certificates of proficiency in the languages, belles- lettres &c. that such an establishment would be in any degree repugnant to the dignity of the state,'or contrary to the laws of the state. It must he admitted that in every department of literature, laws bearing on it, can have but a negative bear- ing. No state has said that it is unlawful to establish schools in any department of literature or science- But they have magnanimously fostered such institutions because they were supposed to require it; and common colleges do still require it; but I shall show presently that medical colleges, in the present day do not. No one will doubt, I presume, that all degrees or diplo- mas from chartered colleges are upon a perfect equality as to their legality. Let me ask then what authority or privilege does the possessor of the degree of Bachelor of Arts carry with him over that of any other gentleman of equal acquire- ments. Is it not the same thing in every state of the Union, or even in Europe, whether it be a Maryland or a Pennsylvania degree. Does it not follow that that power which presumes id t» give a privilege beyond its jurisdiction, must be giving a nullity. Every college presumes to be omnipotent, as far as civilization extends over this globe; that very presumption is prima facie evidence of their having no positive power foun- ded in reason or equity. 1 might then again ask, why is it that in this country, where aristocracy and monopoly are considered hateful, and repulsed by the strong arm of the law, and the still stronger arm of public opinion in the affairs of goverement, in the arts, com- merce and religion, are nevertheless cherished inliterary con- cerns. We, who have long since struck off the shackles with which our forefathers were fettered in other countries, in more common matters, are yet assenting to the yoke and fetters with which our ancestors, were enslaved in literary matters, and while we are slumbering in chains, the lite- rati of England already awakened from the stupor, and de- gradation, to which they have long submitted, are rising with the strength of the lion of the forest, and shaking off from their hands the tinsel cords of government, as does the lion the dews of the morning, which exposed to the sun, gild his mane with the bright colours of the rainbow—In both cases the colouring is alike deceptive and unsubstantial. I allude here to the university now going into operation in London without a charter. A portion of the literati of Eng- land, resolved no longer to submit to the power which has heretofore been exercised over them by government, have established an independent university, well knowing men cannot be made great by law; and I would here ask, is there a solitary individual in this country, wholly free from preju- dice, who will not admit, that where literary men are left to stand upon their own merit, there is it most likely that those of the greatest talents will rise uppermost. What would a man of nobleness of soul, think of a professional man who clappmghis hands, shall exclaim, well, I know my neighbour has greater qualifications and merits than myself, but thank God, I am shielded by the arm of the law; I have not only a guarantee from the competition of this man, by act of assembly during my own life, but, I shall not fail to secure my present station for whomsoever I please—and do we not sometimes see the verification of all this. If the foregoing observations be correct, they amount to this, that literary men are the best judges, and the only com- petent judges, when and where literary institutions are ne- cessary. If they require pecuniary aid from government they must expect to give the government some share of con- ll trp] in their regulations, &c. Where they do not require that aid, government cannot possibly give them any valuable consideration, as an equivalent for any share of control which it might claim over such an institution. Common sense re- quires tha,t in all the affairs of men, there should be some re- ciprocity. , ■ A medical school is opened, no pecuniary aid is asked;the legislature cannot sharpen the senses, or increase the stores of knowledge of the men in that school—Let me ask then, what reciprocity is there in the case? To bring this reasoning home to ourselves,we have judged fit that a second school of medicine be established in Balti- more. 1st. Because there are two schools in Philadelphia, three in the state of New York, and a considerable number thoughout the country. 2d. Because we can prove by actual documents, that about two thirds, of between five and six hundred students, who annually visit Philadalphia, are from situations south of Baltimore. 3d. Because there are at pre- sent about two thousand medical students attending the dif- ferent schools in this country; and Baltimore being favourably located, and having a very large population, may still expect a considerable accession of students. 4th. Because compa- ratively, the fees are so liberal in medical institutions as to enable men of enterprise to obtain remuneration for their la- bours, to cause much money to be expended among the citi- zens, and enable professors to disseminate their experience abroad for the benefit of their pupils, and of the community at large. 5th. Because it is evident, to every man of common sense, that wherever the classes become very large in medi- cal, or any other schools, equal advantages cannot be had with those of smaller classes. Besides by a reasonable multipli- cation of medical schools, we engage more talent; science is more advanced, and there being more room for aspirants, as vacancies will oftener occur, there will be an additional inducement for men in the profession to improve themselves. Having now disposed of my subject so far as questionsot policy, may have any bearing on it, I shall detain you but a few minutes, while I speak of a few matters of fact. We have thought it most prudent to take things as we find them, however much we may wish to see a state of things more consonant to what we believe to be most beneficial to me- dical science. We have, therefore, in compliance with the usage of the country, made arrangements with a chartered college, for granting diplomas to such gentlemen as we the professors, of this school may ascertain to be worthy of that 18 distinction. Perhaps, every person within hearing is aware that Pennsvlvania diplomas, New York diplomas, and many others; even those of all the schools in Europe, are received here as prima facie evidence of qualification; or in other words, those diplomas are considered legal wherever pre- sented. A gentleman presents a degree from the Philadelphia college, another, a degree from Washington college, the aca- demical department of which is legally and in fact, equal to the Philadelphia,can any man tell me why one should be preferred to the other. Moreover, the powers of Washington college, under which we act, are equally ample, nay precisely simi- lar to that of the University of Pennsylvania. The medical faculty of the Philadelphia school were admitted to the pri vileges of the university, by the trustees of the institution, for which they pay an annuity. It has been said, that no college may create a faculty in another state—without stopping to investigate this matter, I most willingly say, we have not attempted such a measure. Every man of common sense must know, that the common faculty of a college can never be considered competent judges of qualification, of medical candidates—this under every arrangement, must be done by the medical professors, and in the very nature of the thing, no other arrangement can be made, but this. The faculty of the college are authorised to grant diplomas in all the arts and sciences—they are judges of qualification in their own department—in the medical depart- ment they must be directed by the professors. The whole matter under consideration amounts to this, we undertake to teach, and to judge of the qualifications of students; and hav- ing approved of their qualifications, an institution of our com- mon country, reposing confidence in us, and availing them- selves of the privileges of their charter will grant the de- gree of Doctor of Medicine, to such gentlemen as we recom- mend. So far as law is concerned, a degree from one chartered college is as good as that of any other. Our degrees then being indisputably legal, the only question is as to our com- petency to teach what we profess : on this point, inquire and think for yourselves, as it becomes freemen to do. In.^ word, we pledge ourselves, that we have taken legal advice, from men of the very first standing in the law, both in this State and in Pennsylvania, and every semblance of doubt is emoved from our minds. 1 ;~ I'1!'!1 ^^:'« ;';."»■ ifiiiSK; "IS*■'':<£ |i.iW