I ft J* j Ik i ) PROFESSOR PAINE'S \ k- j\ i piFEQ^e i fl*r$ie«il profession united states fX*s*UL> DEFENCE OF THE MEDICAL PROFESSION OF THE UNITED STATES; BEING A VALEDICTORY ADDRESS TO THE GRADUATING CLASS AT THE . MEDICAL COMMENCEMENT OF THE UNIVERSITY OF NEW YORK, DELIVERED, MARCH 11, 1846, B Y MARTYN PAINE, A. M. M. D., fj It. /. Professor of the Institutes of Medicine and of Materia Medica in the University of New York : Member of the Royal Verein fiir Heilkunde in Preussen ; of the Medical Society of Leipsic; of the Montreal Natural History Society, and other Learned Associations. ninth: edition.- / £&££> NEW YORJ PUBLISHED FOR THE AUTHOR, BY SAMUEL S. & WILLIAM WOOD, NO. 261 PEARL STREET. JENNINGS & DANIELS, PRINTERS, 122 NASSAU STREET. 1846. EXTRACT OF A LETTER From Charles Caldwell, M. D., Professor of the Institutes of Medicine in the Louisville Medical Institute. " Louisville, Ky., April 5, 1846. " My Dear Sir—Allow me to commence my letter by asking your acceptance of my thanks for a copy, received a few days ago, of your very earnest and able 'Defence of the Medical Profession of the United States.' " On perhaps every point of your unsparing career through your task, from begin- ning to end, my sentiments accompany you, and probably on one, at least, leave you a little in the rear. I allude to the practical superiority, which the physicians of our own country hold, in general, over those of Europe, and I presume also, of course, over every other portion of the globe." " I am not apprised of your having stated that the American youth can be much better educated in medicine in their own country than in any foreign one. Yet is the fact unquestionably true. I mean that it is a fact, and not a narrow-minded, selfish assertion. The real proximate ele?>ients of medicine are more thoroughly taught in some American schools than in any European ones I have ever visited. This is especially true in relation to the Principles or Philosophy of Medicine; without an acquaintance with which, the practice of the profession is ran* quackery." PROFESSOR PAINE'S DEFENCE OF THE MEDICAL PROFESSION OF THE UNITED STATES Gentlemen, Graduates ! It devolves upon me to congratulate you on the attainment of that distinguished honor which denotes a high order of in- tellectual culture, and thus to welcome you to the bosom of the Medical Profession. And this, gentlemen, I do with greater cordiality, from my general acquaintance with you, and from my knowledge of your qualifications for the exalted functions of Doctors in Medicine. You enter, my friends, upon your career, with the certainty of immediate usefulness; for although more extended observa- tion of disease will impart greater confidence and skill, you have acquired a knowledge of those great principles in medi- cine which assemble the facts and the experience of ages, and which, especially, are to form your guide in the treatment of «I have done my part," says Sydenham, " by mentioning the indications to be considered, and pointing out the time, and manner of doing it; for the practice of physic consists chiefly in beinc able to discover the true curative indications, and not medicines to answer them; and they who have overlooked this point have taught empyrics to imitate physicians." The illus- trious Senac sets forth the true aspect of this subject in his work on Fever. "For the better illustration," he says, "of the method of cure, I had prepared for publication a number of cases. But, it appeared best, on reflection, that these should be omitted. There are not two cases of disease precisely alike; whence there are not two in which the same remedies will pro- duce precisely the same effects. It seems more advisable, there- fore to reduce, to certain general laws, all the facts which ex- perience has brought to light, and from these, to deduce a mode of cure accommodated to the state and condition of each patient." 4 And such have been the conclusions of all the great apostles of medicine. Experience, and facts, in the first place; and then let us have them reduced to principles as substitutes for them. I speak, however, of that experience which Zimmerman says is "generally considered the simple produce of the senses. The understanding seems to come in for so small a share, that every thing intellectual in it is regarded as having as much materiali- ty in it as the perceptions of the senses. This," he says, " is what I call false experience. It is a blind routine, directed by no law whatever,"—and hence, "the old man is generally sup- posed to have thought more than a young one, because he has seen more." But, says the same eminent philosopher,—" it, has been already remarked, long before my time, that the increased number of years and patients only serve to remove physicians, destitute of genius, farther from true physic. The more their practice is augmented, the more numerous and considerable are their errors. On the contrary, we observe, that, by the aid of sound judg- ment and knowledge, a physician is enabled to penetrate the greatest difficulties, even from his youth ; and that with these to guide and support him, he rises superior to every obstacle." It was the opinion, indeed, of this accurate observer of man, that,—" he, who at thirty years of age is not an able minister, an able general, or an able physician, will never be so." It is not, therefore, my young friends, the great number of undigested cases, but the comparatively few that are well ob- served, and well considered, that contribute, with the great principles of medicine, to form the enlightened and successful practitioner. Hippocrates, according to Galen, gathered his knowledge in small towns, insufficient to support a single phy- sician. In this acception he was only a country practitioner. But, as Socrates said of another ancient, "he spent his time in inquiring, considering, and consulting; " and was thus enabled to lay a foundation which will forever procure for him the familiar appellations of " The Father of Medicine,"—" the senex divinus," the divine old man. I have thus, gentlemen, stated to you the conclusions at which the most observing and enlightened physicians have arrived in respect to the early qualifications of the industrious student for the practice of medicine, that I may do you the justice to which I know you are so well entitled ; that 1 may contribute to your immediate rank amongst the more advanced in professional ex- perience ; that I may stimulate the tardy confidence of society in the knowledge and ability of the young, but well educated graduate in medicine; and that, they may" know from mature age itself, fromthe long experience in which their confidence has grown into a sentiment of veneration, that gray hairs and a 5 furrowed brow are comparatively insignificant testimonials of knowledge and skill, with the credentials of those who are al- lowed to be amongst the foremost in medical rank, who are al- lowed to cherish the science as the most sacred of all the gifts to man of the Great Wise and Beneficent Being. This day, gentlemen, you have been officially transformed from the pupil into the teacher,—from the advised into the adviser,—and he who now addresses you, so late your monitor at the bed-side of the sick, is now on common ground with yourselves, may meet you to-morrow to deliberate upon the intricacies of disease, and is bound to yield the same respect to your opinions that he may desire for his own. You have been, my young friends, sifted from the "chaff; " you have proved yourselves worthy the elevated post which you now occupy amongst the family of mankind ; that you are capa- ble of its responsible duties; and there is no act of my life which yields me higher gratification than that I am thus war- ranted in commending you to the confidence of your fellow men. And now, that I have done all this, you must never forget that something is due to him, and to those, who offer this pledge of your professional merit,—never forget that it is in your behalf, and through their relations to the community, that this demonstration of confidence is made,—never betray your in- structors, your advocates, your guarantees, by one act that shall degrade yourselves, or bring mortification to your early bene- factors, or one stain upon your Heaven-born profession. Assume, therefore, gentlemen, at on,ce, a manly confidence in yourselves ; go forth to improve the general condition of soci- ety, to minister relief to suffering humanity, to warm many a heart with the purest and noblest sentiment of gratitude, to gather fresh laurels for yourselves and for your profession, and you shall find that the practice of industry, and virtue, and benevolence, will unceasingly urge you on to a strife within your own bosoms for greater deeds of that unalloyed happiness which awaits the blessed in God. But, although you be now qualified as good practitioners, you will become better and better as observation goes on, and as you study the experience and the wisdom of the past. As I said to your predecessors in my Introductory Lecture on the Improvement op Medical Education in the United States, " you must aspire at the goal of medical philosophers, before you may comprehend or enjoy, in its ample dimensions, the philosophy of medicine. You must have willing minds, and steady purpose, before you will study the elaborate writings of its sages, and bring to 6 their interpretation, and an exposition of their uses, the requi- site habits of observation through the wide domain of Nature." Nor can I do better, at this time, than to recite another passage from that Lecture on medical education. I said to my audience, that, " when your professional harvest begins, then is the time for the most salutary stimulus of ambi- tion ; and, whoever yields to its spur, will find abundant oppor- tunity to carry his knowledge to the highest stretch of his intellectual constitution. He has but to remember that profes- sional rank can only be acquired by various learning; and in the language of Johnson, ' he, who proposes to grow eminent by learning, should carry in his mind at once the difficulty of excellence and the force of industry; and never forget that fame is not conferred but as the recompense of labor; and that labor, vigorously continued, has not often failed of its reward.' These indisputable precepts compel the aspirant at medical renown, or even at the highest practical success, to limit his enjoyments to a social intercourse with his patients, to a participation in the general enterprises of society, to the study of nature, and, lastly, to all the literature which may elevate the mind. These should be his recreations as well as his employment; and as knowledge flows in, an inexhaustible fountain of happiness is acquired, whose very spray clouds the gaieties of life, and renders the pleasures of the intellectual man as circumscribed as the volup- tuousness of wealth is discursive in its search after sensual grat- ifications. One is a steady, refined, and unalloyed enjoyment; the other, gross, discontented, and forever sated with every thing but the new. Philosophical happiness, says Burke,' is to want little; vulgar happiness is to want much, and to enjoy much.' "A great work," I said, gentlemen, "is to be done by the physician. But industry, like love, will conquer all things. ' Amor vincit omnia?—Industria omnia vincit; and in propor- tion as deficiencies abound when the physician assumes the high responsibilities of his profession, it becomes him to inves- tigate well every step of his experience, to employ his hours, or his momerits, of leisure, by day and by night, in garnering the experience which is supplied by the literature of the profession ; and, by rendering experimental observation and theoretical prin- ciples mutually subservient, he shall come, by degrees, to the attainment of distinguished worth, and the applause of mankind." Such, then, were some of the remarks which I addressed to novices in medicine, that they might be early led to consider the difficulties which laid before them. The same remarks are more appropriate to yourselves, who are about to assume the responsibilities of the profession, and to take an active part in promoting the advancement and the dignity of medicine. 7 And this leads me, gentlemen, to consider the objects of the approaching National Convention of Physicians in this city, and how far the interests of medicine are likely to be promoted by this contemplated event. The present occasion seems pecu- liarly appropriate for casting a broad glance over the existing state of medicine in this country, of considering its defects, and how they may be removed, and how, in other respects, our noble science may receive, at the hands of a National Convention, that impulse which must be ardently desired by every enlightened and honorable mind. But it is due to my colleagues to say, that in all which I shall set forth, I am alone responsible,—am alone aware of the subject which I am about to discuss. The project of this National Convention of Physicians origi- nated with a young man in the township of Binghampton. It may be also proper that I should premise that he was sub- sequently elevated to the dignity of Chairman of the Commit- tee of the New York State Medical Society, by whom his project had been espoused. To him has been delegated the work of expounding the contemplated objects of the Convention, and, unfortunately, to him the correspondence with the Medical Colleges. But, gentlemen, it is now time that I should lay before you the Circular of the State Medical Society, .concerning a general meeting of the profession. That "Circular" sets forth,—that:— Whereas, It is believed that a National Medical Con- vention would be conducive to the elevation of the standard of Medical Education in the United States. And " Whereas, There is no mode of accomplishing so desirable an object without concert of action on the part of the Medical Societies, Colleges, and Institutions of all the States. Therefore, " Resolved, That the New York State Medical Soci- ety earnestly recommends a National Medical Convention of Delegates from Medical Societies and Colleges in the whole Union, to convene in the city of New York, on the first Tues- day in May in the year 1846, for the purpose of adopting some concerted action on the subject alluded to in the foregoing preamble. " Resolved, That Doctors N. S. Davis, James McNaughton, and Peter Yan Buren be a committee to carry into effect the above resolution. Peter Van Buren, M. D. Secretary of New- York State Medical Society. [Dated,] Albany, February 6th, 1845." When I first heard of this Circular, I had hoped much from amicable and dignified consultations amongst the Delegates that might be assembled from all parts of our Union ; but, finding, at 8 a later period, that the Projector of the Convention and Chair- man of the Committee was traducing the profession and the Med- ical Colleges through the medical periodical press, my hopes gave way to apprehensions that the objects of the Convention had not been conceived in the spirit which had been set forth by the Circular. I had already submitted to the profession my own views of the state of medical education in this country, and of the embarrassments which it would be required to encounter, till a greater diffusion of wealth should enable us to compete with the European States ; and I had hoped that some mitigating expe- dients might be honorably and amicably devised by which that large and poorer class of medical students might be so aided as to enable us to extend the term of instruction. Nevertheless, I demonstrated then, as I had already done in my Medical and Physiological Commentaries, a great ascen- dency in the practical habits, and in the successful treatment of disease, by American over European physicians. The last expo- sition of these views was made in my Introductory Address on the "Improvement of Medical Education in the United States." Having, therefore, in that Address, considered the existing defects of medical education in this country, and the difficul- ties it encountered, it would be unprofitable to travel again over the same ground. My convictions, as then expressed, have, through the light of farther experience, received the most entire confirmation. It may not be superfluous, however, for your present infor- mation, should I recite a passage from that Lecture, which com- prehends the fundamental principle that lies in our way to those early achievements in science which are more common in the wealthy countries of Europe. I said, gentlemen, in that Lecture, as a deduction from my premises :— " Thus, then, I destroy the parallel which has been attempted between our own and European States, and show it the merest fiction of the visionary mind. Exact from our physicians the intellectual culture, and rear in this land the high standard of medical acquirements which are so noble and fascinating in some of the schools of Europe, and quackery will reign almost uni- versal from one end of the continent to the other. Is not the whole multitude, whether rich or poor, pressing forward either for greater wealth, or for the pittance of their daily bread ? Nay, more, do not all our Medical Colleges holdout the temptation of moderate fees, and give, in their annual announcements, a con- spicuous place to the humble charges for the necessaries of life? But what are these compared with the expenses attendant on the prolonged and higher grades of academic and medical learn- ing in some of the European States? And who does not see the inconsistency that would hold in one hand professions of 9 cheapness to allure the student through our present system of medical discipline, and threaten with the other augmented fees and an impossible exaction upon time ? The same principle runs through all our primary schools, our academic, collegiate, legal, clerical and political institutions. Cheapness of education, and a corresponding adaptation of time, are found indispensable to the general condition of society. " The question is therefore settled upon the immutable princi- ples of truth—of a truth which is founded in the exigencies of our country. We have not the means, we have not the leisure, to follow the standard of European wealth; nor can we control our destinies by European legislation. He, who, in America, aims at the profession of medicine, with honors and dignities as inviting as in the aristocracies of Europe, but less seductive than the allurements of wealth, comes from a class where the blan- dishments of the latter have no existence. He has worked his way from elementary schools through the higher departments of academic learning, under the frigid discipline of poverty, and he enters our halls of medical education with little else than the hope that his career may not be arrested by insane exactions, now for the first time borrowed from the overgrown wealth of Europe, and her old and rich institutions. "Raise, therefore, beyond a certain limited poise, our standard of absolute requirements, and I repeat it, with no fear of contra- diction, we shall turn from our medical schools most of their aspirants into more humble channels, or into the walks of empi- ricism. The exigencies of American physicians demand an early application to the business of life. If we would cultivate the field of medicine, we must look for an early harvest, or, my word for it, it will be soon overrun with weeds. But these necessities by no means preclude the highest advancement in med- ical attainments." So far the Lecture. But it seems proper that I should state that it has been objected to my broad principle, that there are professional men in the populous towns of Europe, who have risen to the highest eminence under the most severe pres- sure of want. And so, gentlemen, is there an average propor- tion of the same description in the United States. But these are examples in which genius displays its greatest attribute,— examples which have rendered it a familiar proverb, that " genius struggles with poverty" They are examples, as. the Chairman of the Committee says, of " minds, so endowed by nature, that despite of all the contracting and evil influences of our system of education, will rise superior to every obstacle, and shaking off one embarrassment after another, will roam over, and revel in, all the fields of science untrammeled and free." But he is an imperfect observer of man, who carries the principle through 10 the community, or supposes that one in a hundred may be induced, or compelled, to struggle with poverty for the sake of an "elevated standard of science." Gentlemen, it is a delusion, which admonishes us of the danger of rendering what is rare the general rule. It remains now only to consider at this time, how far the objects of the Convention, as contemplated by the State Medical Society, are likely to be fulfilled under the auspices of that Society. Nothing can be gathered, of a specific nature, from the general Circular, and we must therefore go for information to exposi- tions set forth by the Projector of the Convention and Chair- man of the Committee. That he is duly authorized to make such Exposure ap- pears not only from the Circular itself, but from an article from his pen in the November number of the New York Jour- nal of Medicine and the Collateral Sciences, in which he says, that :— "There is, at present, a fair prospect for a full and animated Convention. This being the case, we, (the Committee,) hope it will not be deemed out of place, for us to write, and the medical press to publish, a few thoughts on the present condition and wants of the profession in relation to the education of its members, that the appropriate remedies may be the more clear and satisfactory."* That, also, I may not be supposed to have mistaken the origin of this National Convention, and as it may be useful to be assured of the fact, I will quote a passage from the January number of the same New York Journal of Medicine. Thus :— " We invite" says the editor, "particular attention to the following very just remarks from the gentleman who origina- ted the plan of a Convention, as recommended by the State M'dical Society." The article which then follows is from the Chairman of the Committee. Besides, we have it from the Chairman himself, in a letter to this Faculty, that such is his title to that distinguished conception ; although long before the subject of discussion by the profession at large. In that letter he says, what cannot be mistaken, that, "the propositio?i for a National Convention was made by myself." And having now thus settled this preliminary fact, and as all agree that he is the Chairman, and directs, from Binghampton, the movement of the 40,000, let us come, at once, to the specific objects of the State Medical Society, as expounded by the Projector of the Convention and Chairman of the Committee. This we may learn, in the first place, from the article to * The Capitals and Italics are often mine. 11 which I have just referred, in the New York Journal of Med- icine. Thus, then, the Projector of the Convention ;—"In regard to remedies for the present defects in our system of education," he says, "first of all, and at the foundation of all, we place more care on the part of individual practitioners concerning the capacity and qualifications of young men whom they receive into their offices as students; and then more attention to their education after they are received." Now, that such evils exist, I concur with the Chairman ; and I also agree as to their becoming appropriate subjects for united deliberation. But, I differ with him as to their magnitude and universality, and the terms in which they are expressed. Thus, he goes on :— " No one can have failed to notice the almost total neglect every where apparent in this respect. Whoever takes a notion to study medicine; no matter if his primary education (I wish you to remark, gentlemen, his primary education)—no matter if his primary education should not enable him to write his own name intelligibly, much less to understand a sin- gle branch of Natural Science, and his intellectual faculties naturally as dull as the sleepiest drone in the country ; he is readily received into some office, shown a scantily filled case of Medical Text-books, and left to while away the time required by law before he can be honored with the title of Doc- tor. This is a great and all pervading evil ; and it is in vain to exert ourselves to elevate the standard of education, until it is removed. For so long as the mill is supplied with bad grain, it will grind out bad flour" Here I arrest my quotation, for the present, that you may en- joy a repetition of its closing metaphor, varied a little in the elegance of its phraseology, and as submitted in a letter to the Medical Department of this University. " If," says the Chairman, " we put bad grain into the hopper, (meaniingyou, gentlemen,)*we expect bad flour to come through the bolt." Perhaps, gentlemen, we have now seen enough of the im- puted prevalence of the radical evil; perhaps you have heard enough to abandon so unworthy, such a degraded profession,— scarcely advanced beyond that of Chili, of which Zimmerman says its members " blow about their patients, and think that they know enough when they know how to blow." But I will ven- ture to define yet farther the views of the Projector as to the extent of this delinquency, that you may the better comprehend who they are that are to meet together in convention and casti- gate each other into something better than merely bloioing about their patients, and teaching each other how to blow. Here it 12 is, then, fresh and pungent, from the Chairman himself. In the November number of the New York Journal already, quot- ed, the Projector says:—" There may, indeed, be found here and there, a mind, so endowed by nature, that despite of all the contracting and evil influences of such a system, will rise supe- rior to every obstacle, and shaking off one embarrassment after another, will roam over, and revel in, all the fields of science untrammeled and free. And it is such that constitute the ornament and honor of our profession. "But far otherwise is it with the great mass; the ninety nine out of every hundred. With no practical knowledge of chemistry and "botany; with but a smatter- ing of anator.iy and physiology, hastily caught during a sixteen weeks'' attendance on the anatomical theatre of a Medical College ; with still less of real pathology ; they enter the profession, having mastered just enough of the details of practice to give them the requisite self-assurance for commanding the confidence of the public ; but without either an adequate fund of knowledge, or that degree of mental discipline, and habits of patient study, which will enable them ever to supply their defects. Hence they plod on through life, with a fixed routine of practice, consist- ing of calomel, antimony, opium, and the lancet, almost as empyrically applied as is cayenne pepper, lobelia, and steam, by another class of men. And how can this ever be otherwise, while medical students, without regard to their previous qualifications, are shut up three years in the office of a country or village physicia?i, sent out to one or two courses of lectures, and then honored with the title of M. D. ? " " Indeed so radical are the defects in our present system of medical education, and so glaring are their effects on the condition and usefulness of the pro- fession, that no observing man will charge us with ex- aceration in the foregoing statements." Such, then, is the portrait of the medical profession in the United States, as deliberately drawn by the official hand of the Projector of the National Convention and Chairman of the Committee of the New York State Medical Society. I mean, gentlemen, the portrait of "ninety-nine out of every hundred " of the medical profession in this country, or 39,600 out of 40,000; which reduces the number of worthy members to 400. It may be also proper to say, that the articles from which I shall have quoted were before the community prior to 13 the meeting of the State Medical Society in February last, and that the same aspersions of the profession and of the Medical Colleges were then made by the Chairman, and by others of the Society. Now, gentlemen, the interesting question comes up, as to the composition of the approaching Medical Convention. You, and I, have too much modesty to believe that we can be allowed to form a fragment of that small number of whom the Chairman says, they " can rise superior to every obstacle, and roam over, and revel in, all the fields of science untrammeled and free."— We must, in all humility, go with the "great mass,"—with the 39,600; and it is now, therefore, for us to decide whether we will meet in convention and thus endorse the calumny, or give it up to the hundredth man who is said by the Chairman to be alone competent to the work of reformation ? But perhaps there may be some Medical Colleges who may not fully comprehend the rank which they are assigned amongst the 40,000 ; and I will, therefore, through you, call their atten- tion to the subject, that they may come hither the more under- standingly. The Chairman employs the device of contrasting the state of the profession in this country when we had scarcely a medical college, with its degraded state under the auspices of our thirty medical schools. Thus :— " Not a few," he says, in the Journal aforesaid, " educated at that period, with their heads silvered over with age, possess a degree of mental discipline and sound learning, which should put to the blush thousands of the graduates who now yearly emanate from our numerous well-endowed schools of medicine" We have often heard much of this clamor about the " thou- sands " who are annually let loose from the Medical Colleges, to carry havoc into the chambers of the sick. But, in sober truth, probably not more than one thousand receive medical degrees annually, from the whole thirty schools together; and a large proportion of these obtain their diplomas from such men as the Ja^ksons, Hare, Caldwell, Dunglison, Ware, Bigelow, Silliman, Horner, Nathan Smith, Gallup, Chapman, Dudley, Gross, Channing, Meigs, Mutter, Haywood, Drake, Yandell, Warren, Aikin, Bartlett, Gibson, Muzzey, Hodge, Harrison, and some others of not inferior note, whom I have thus hastily designated as controlling the " hopper " to which most of the "chaff'9 is sent, but who, I take it, the Chair- man will feel obliged to concede belong to the 400 who are worthy a place in the American Medical Profession. To whom else, gentlemen, can he advert, if he exclude from the four 14 hundred those men who sit in judgment upon the qualifica- tions of most of the medical graduates in the United States ? These are they, gentlemen, who are denounced as sending forth "annually thousands" to inflict the mischief of abject jo-norance upon a helpless community, and then are asked to come here and sanction the ignominious reproach. Why. gentlemen, what inconsistency. The Chairman cannot hesitate to allow that abler or more honest men cannot be founol in the ranks of the profession ; and yet he says that these very men dispense their approbation, the highest honors of medicine, upon ignorance and stupidity. Nevertheless, gentlemen, they are, what the State Medical Society, through the Chairman of their Committee, must admit to be amongst the best ornaments of the profession in this country ;—aye, gentlemen, without superiors in the best of European Seminaries,—the Dii im- mortales of our profession. In the hands of such men, our profession, our country, are safe ! But what would be the destinies of that profession, the honor of that country, were they to fall into the hands of those who can see nothing in " ninety nine out of every hundred " of their professional brethren but abject ignorance and its cruel dispensations? Since, therefore, it must be conceded, on all hands, that the professors in the principal medical schools of this country are eminently able and honest, do you not believe that they would sooner surrender their lofty and responsible trust than allow, according to the allegations of the Chairman, so much "chaff" to slip through the " hopper ? " We can, therefore, only hope that the profession will continue to supply the colleges with the same " sort of chaff," till better can be produced, and we will engage to turn out a quality of "flour" that shall pass for the best in any European market; quite as good, at least, as any that is manufactured by the Censors of State or County Medical Societies ; and perhaps, therefore, it might be well for the country if a little more il grist" were brought to the " hopper." Perhaps it would not be amiss if even the " thousands," so appalling to the State Medical Soci- ety, were annually turned out of the collegiate " hopper." And after all, gentlemen, may it not be. is it not probable, that the choice few, the 400 out of the 40,000, those scattered "ornaments of the profession who roam over, and revel in, all the fields of science, untrammeled and free," are quite as likely to have been "bolted" at the collegiate mill, as in the "green room " of the "holier" Censor? And this leads me, reluctantly, to notice the remarkable fact, that amidst all the outcry about Medical Colleges, not a word has been ever alleged against those numerous " hoppers " which 15 exist in the shape of " Censors " of State and County Medical Societies. Not a word, gentlemen ; for that would be the " outs " against themselves,—against the aspirations of a noisy few, and against that plentiful "toll" which is deducted from every " licentiate " before he is allowed to run through the accommodation "hopper." And now, perhaps, we shall have no difficulty in under- standing why it is so earnestly desired to extend the term of instruction in our Medical Colleges, and also as a pieliminary requisite to admission into these institutions. There is an aristocratic feature in this movement of the worst omen, how- ever the spirit by which it is prompted may belong to the Agra- rian policy. It is oppression towards the poor, for the sake of crippling the principal Medical Colleges. You, and all of us know, as I have already said, that the " great mass " of professional men in this country, Lawyers, Divines, and Physicians, belong to the poorer class of society; and should the wire-pullers effect an extended tefm of education, it must exclude a large proportion of the "great mass" from the advantages of collegiate instruc- tion ; whilst the aristocratic feature will be rendered still more offensive by limiting the attendants at Medical Colleges to the few who may spring from families of wealth. If such be the principles of republicans, if such the basis of our institutions of learning, their founders were less conscious of their objects than they who would degrade the poor by oppressive exactions. I shall not, gentlemen, discuss this small affair any farther with the State Medical Society, who speak to us'through their organ, the Chairman of their Committee ; but I will read to you a paragraph which occurs in the same number of the Journal of Medicine, from which I have made a quotation from one of the Chairman's animadversions upon his profession, and which has the merit of following, almost immediately, the article contribu- ted by the Chairman. It is an extract from Percival's Medical Ethics; and, gentlemen, whether you remain members of the profession, or seek other employment, I trust the sentiment will be forever the foremost amongst your hallowed obligations. Here it is, brief, as it is sacred :—" Every man," says Percival, "who enters into a fraternity engages, by tacit compact, not only to submit to the laws, but to promote the honor and the interest of the association, so far as they are consistent with morality, and the general good of mankind. A physician, there- fore, should cautiously guard against whatever may injure the general respectability of his profession; and should avoid all contumelious representations of the faculty." I say, gentlemen, that I trust,—I have no doubt that that sen- timent has become as intimately incorporated with your very nature as is your soul with your organic fabric. 16 I said, gentlemen, that I did not intend to discuss this subject any farther with the State Medical Society. But, as a member of that "great mass" of the profession, the "ninety nine out of every hundred," who have been presented to the world as a rot- ten excrescence, I shall state to you what had been my own views of its condition before I was elevated to a professorial chair, and which it is now my happiness to confirm by greater observation, and by the contribution which the Medical Depart- ment of the University has this day made to the general weal. This is due, at least, to myself as one of the "ninety-nine" designated by the Chairman, and I trust will not be ungraciously received by my companions in ignominy. In my Medical and Physiological Commentaries, published in 1840, there occur the following remarks:— " With these habits and means of information, I am now pre- pared to say, that it is the result of no little investigation that American Physicians greatly surpass all other* nations not only in the decision, but in the success of their practice. They have followed the Hippocratic rule, that 'severe diseases require extreme and exquisite remedies,' and so in proportion through all their gradations : nor do they adopt the expectant plan, till there is a manifest disposition in nature to take upon herself the completion of the cure. And here I may say her suggestions are equally regarded. " I have already justified these conclusions as they respect many of our most prominent writers. Other, and ample records exist to sustain the statement which I make ; and placed in a right position, by a charge of imbecility by the morbid anato- mists, to illustrate the doctrines and practice of Hippocratists, it has been necessary to contrast their results with those of the school who derive their indications of cure from the debris of the body. And, that I am right as to the neglect of all efficient remedies by the school of morbid anatomy, in a general sense, I appeal to what I have already stated in other places, to what will appear in my Essay on the Writings of Louis, and, may I not add, to what is proverbially known of the present " expectant" treat- ment in France, and of the " stimulant" and expectant in Great Britain. "In America," I also said, that, "practice is not only heroic, but remarkably coincident in relation to the same diseases ; which farther shows that our indications are taken from the proper source."—"There is only a limited school which approximates the Brunonian, in America ; and I have adverted to its tenets not only upon principle, but to sustain the comparison I have drawn between practical medicine in' Europe and these United States I know of no instance, nor have I ever heard of one in 17 this country, where a practitioner has been addicted to the ' expectant' plan of treatment." Again, after referring in my Commentaries to the same kind of obloquy upon the American medical profession which the Chair- man of the Committee, in behalf of the State Medical Society, has heaped upon " ninety-nine outof every hundred " of the American Faculty, and when contrasting the success of their treatment of dis- ease with that of the English and French nations, I said,—"Such is the practice of hundreds in our wilderness. But, they do more, and more wisely. They abjure bark and wine, and carry out a vig- orous treatment of inflammations, and of their terribly prostrating fevers,bythe lancet. And may I not inquire, also,howall this com- pares with the dominant treatment, in France, of the same diseases by ' gum potions,'' ia decoction oftriticum1 or of the ''five roots,1 * bullock's gall,1 ' millipides,1 ' magnetized steel,1 i a pinch of chervil,1 i aromatic fumigations under the bed-clothes,1 as set forth in my Essay on the Writings of Louis. Or, is it a less efficient system than the treatment of "the worst forms of fever by table salt," as commended and practised by some of the mostdistinguishedofthe British Faculty? "Ifsuch patients," says one of their own commentators, the eminent Beddoes;—" If such patients had a Rush by the side of their bed, they would not be transferred from it to the grave." 1 The pleurisy,' says the same English philosopher, ' which I am informed was so destructive among our soldiers and sailors till the lancet was used with a boldness almost totally abandoned in this country, proves that it is not American diseases and American constitutions only that require such treatment' 'But our own!' exclaims Beddoes, 'The first existing!— Well, then, our own, some of our own, scandalized at the dis- grace of the common art, (just as now with our State Medical Society,) did begin to give lessons amain across the Atlantic. The lessons, indeed, were received as the irrelevant effusions of men who set themselves to harangue against facts. And Amer- ican pride was destined ere long to have a fearful revenge. Gibraltar, Gibraltar, is pitted against Philadelphia!' "1 need not tell you what fearful odds drew from a Briton the honest declaration, that, — 'After all British reproaches against the American government and American physicians, for permitting the yellow fever to commit such ravages, this yellow fever made incomparably greater proportional ravages in a Brit- ish garrison, where the authority of medical police was unlimit- ed.' ' And yet again,' he says :—' In the West Indies, on the Continent of Europe, at home, wherever the British Army was posted during the last war, its history of health has offered not only pretexts to a challenged rival, to scorn the arrogated supe- 2 18 riority of the British modern medical practice, but also reasons for an impartial man to pause upon the claim" Such, it appears, was the admitted superiority of American over British practitioners of medicine, admitted, too, by the most able and eminent of the British profession,—by Beddoes, Robert Jackson, and others of equal renown,—when there was only one medical school in all America, entitled to any consi- deration, and but few practitioners who had received the honor of a diploma. There was, therefore, gentlemen, in those halcyon days, no rankling jealousy, six only of the 180 professorial chairs for the watchful eye of envy, no extensive superiority to be adjusted to the Agrarian system. But, we have now some thirty excellent Medical Colleges scattered over the land, whose chairs are filled, in numerous instances, by some of the ablest men who adorn the medical profession. And what is more, and more to the honor, and welfare of our country, these thirty institutions are annually contributing about one thousand well educated men to the ranks of the profession, whose light sparkles in every hamlet, and exposes the darkness which is now rolling itself into a mut- tering cloud. Or, shall it be entertained, with the Chairman of the Committee, in behalf of the State Medical Society, that know- ledge recedes in proportion to its means of multiplication? Gentlemen, in justice to myself, and the general cause which I advocate, I must be permitted to make one quotation more from my Medical and Physiological Commentaries. " It cannot be denied," I have there said, " that the Faculty of America, in a general sense, have neglected the literature of the profession, and have been even hurried by the necessities of life into its most responsible occupation without those preliminary qualifications which accomplish the minds of Europeans. This may seem to conflict with what 1 have said in another place of the advantages of learning. But, it is in no respect an argument against us. Much is owing to the national character of Ameri- cans, which is early formed in the most active scenes of life, and renders each in his place a subject of irresistible impulses in all practical pursuits. "The influence of such habits on the physician I have already shown. American physicians, also, are generally conversant with the writings of those illustrious observers whom I have mentioned as their chief counsellors in the interpretation of na- ture ; and it is only within a brief period that their attention has been at all directed to those physical theories of life which have so extensively supplanted the Hippocratic and Hunterian philo- sophy in Europe. No obstacle, therefore, having been interpos- ed to divert him from his habits of observing nature, and having no leisure for ambitious views, the American physician has gone 19 on with his former conceptions of the vital nature of disease, and of the operation of remedial agents, and would as soon wait for the plough to move itself in the furrow, as to adopt the expect- ant treatment. I agree, therefore, that a more extended and varied knowledge of true science would have exalted him even higher in the scale of philosophy, and the practical pursuit of his calling. "In the mean time, let us go on as we have been going,— ' gathering, like the bee, from abroad, but digesting that which, is gathered by his own virtues,' still leaving the nu- merical system, and all others like it, 'to spin out, like the spi- der, all its own bowels? and thanking ' the empyrical philoso- phers, who, like pismires, only lay up and use their own store,' for any proportion of their harvest they may be willing to spare,—being ever willing to receive from the anatomical school their continued castigations for our undaunted energy in the treatment of disease, or their maledictions for waiting upon na- ture when art has won its triumph. Esto perpetual " I will not carry out my conclusions beyond the limit of prac- tical habits and results which I had proposed as a test of medical philosophy. It is certainly humiliating that I should be so far compelled to depart from any becoming modesty ; but, truth must not be suppressed where the most vital interests of the healing art may demand its promulgation. It is right that I should thus in- quire into the practical habits of an almost entire profession de- voted to the Hippocratic mode of observing nature, and contrast them with the fruits of that philosophy which is founded on the ruins of nature, or seeks an interpretation of her vital phenom- ena in the crucible of the chemist, or through the glass of the op- tician." So far the Commentaries ; and when, gentlemen, 1 delivered my Introductory Lecture on Medical Education in the United States, in 1843, little did I suppose that I should so soon realize a far more important application of a remark which occurs at the close of that Lecture. The remark is in the following words :— " Well may we, therefore, spurn the imputations of practical inferiority which have been sometimes heaped upon us even by those who derive their principal title to consideration from being born in the midst of so much enterprise and worth. It is the jealousy of narrow ambition, or the envy of more selfish, or of weaker minds." And now again, gentlemen, for the third time, I stand up alone, in the broad expanse of America, in an open defence of the honor and dignity of the profession of which 1 am a humble member. I stand up to contribute my feeble effort in rescuing my country from the degradation to which its own citizens, they, to whom are committed the honor and respectability of its no- 20 blest pride, would consign it in the estimation of the world; and, that I may render this service more effectual, it is my design to incorporate an abstract of this Address in a Sketch of the His- tory of the Medical Department of the University, intended for publication when I shall have "gone hence to be here no more." Nor shall I have discharged the office which 1 had assigned to myself till I also place on record who they are that malign "the great mass" of American physicians, who are rendering more service to the cause of humanity than any equal propor- tion of the same profession in the most favored states of Europe. It is not the man who has officially promulgated the views of the State Medical Society, nor the Journals through which the contumelious representation of the profession is circulated, that should be held responsible any farther than as they, also, hold an influence over the public mind, and according, also^ to the animus, and the extent in which that influence may be exerted. We must rather go to the fountain from which it emanates, and with acids and caustics try its purity. We must go to the State Medical Society itself, interrogate the general character of those who annually convene at Albany during the very opportune session of the Legislature, inquire how far, and in what ways they contribute to the dignity of the profession, and advance the interests of medical science. Nor would I invite an investigation of this nature for the same reasons that I have quoted from Percival's Medical Ethics, were those members of the State Medical Society, who annually convene at Albany, and do the mining operations, more than a bare handful of the " outs," and were they not so erroneously supposed to represent the voice of the profession. But, that they do not thus convey to the world the sentiments of their " out- side" brethren, is sufficiently evident from what I have quoted from the organ of the Society. That there are members, how- ever, of this Association who properly regard the transactions of the few, and who leave to those few the practical existence of the Society, I am most happy to know : though we must lament the necessity which is thus imposed by self-respect. But, it may be useful to understand, also, who he is that has thus spoken in behalf of the Society; since we shall the better understand the qualifications of those in whom the Society re- poses its greatest trust, and thus, also, become more enlightened as to those members by whom the sacred trust is delegated to individuals of their own body. Of the Chairman of the Committee and Projector of the Con- vention, then, I know nothing but from report, and from what I have seen and quoted from medical periodicals, and from his correspondence with the Medical Faculty of this University. Perhaps my quotations are enough to enlighten you upon the 21 whole merits of the man and his associates at Albany ; but since he puts himself forth as the Projector of a National Convention for the reformation of universal abuses, and pronounces "nine- ty-nine out of every hundred," of the American medical profes- sion as deficient in the elements of an English education,—so deficient, he says, that when admitted as medical students, it was " no matter if their primary education should not enable them to write their oion names intelligibly," it becomes worth our while to ascertain how far qualified may be the Chairman of the Committee of the New York State Medical Society to be entrusted with the solemn duty of pronouncing judgment even upon the "primary education" of our medical graduates. This, fortunately, I have it in my power to do by an official letter from the Chairman to the Medical Faculty of this Univer- sity, and which I now hold in my hand. I shall, therefore, read to you a short paragraph from that letter, and then leave the matter to your own conclusions. Thus:— "The above Circular," says the Chairman, "is an Extract from the proceedings of the New York State Medical Society at its last anual meeting in Feb., 1845. The object of the pro- posed convention is sufficiently indicated in the preamble and resolution itself. The Committee, in the discharge of their duty, have corresponded with the Medical Societies and Colleges in all the States where such institutions exist, and the replies which have been received are unanymously in favor of the proposed convention. "Indeed, several Colleges have already appointed delegates; consequently, there is no longer any doubt but that a convention will be held. If the subject has not already been before the Faculty of the Medical Department of the University, will you not, without further delay, bring it to their notise? (Signed,) J. N. Davis, Nov. 25, 1845. Chairman of Com., SfC, Binghampton, N. Y." Now, gentlemen, there certainly appears nothing very re- markable in the extract which I have just read. And yet, be- yond doubt, however enigmatical it may seem, there is something latent in that extract which shall raise your admiration, and prove to you how well qualified the Chairman may be to sit in judgment upon your "primary education." There are, O tem- poral in that brief extract not less than three familiar words whose orthography is wrong. " Unanymously" is written with two ys; "notise" with an s; and annual is spelt "a-n-u-a-l,"— the Chairman having derived the last from the wrong Latin word ; which shows, also, the extent of his professional fami- liarity with that language of which he accuses " ninety-nine out of every hundred" American physicians with being utterly ignorant. That this orthography is not accidental appears not only from 22 the frequency with which it occurs, but also from a similar evi- dence respecting "a primary education" in the Chairman's second letter to the Faculty ; where, besides other errors, the word an- nual is again dishonored by a single n. Here, gentlemen, I leave this subject; for although I would be just to you, I would be merciful to your accuser. But, there will be no want of commiseration for the champion and favorite of the State Medical Society, if I prove to this audience, and through them to the world, by your own hand writing, that more than one in a hundred of you are able to write your own names, as denied by the Chairman. But I mean, gentlemen, to prove also, by the same inductive process, far more than that. The hand writing, especially of one's own name, when made under special circumstances, is an index to the mind itself, to its acquirements, to its native vigor. You all know how much has been inferred of the talent, and firmness, and conscious so- lidity of knowledge, from the autographs of the Signers of our Declaration of Independence. Now, it so happens, whether providentially or not, I am enabled to prove to the world by a single momentary demonstration, that not only every one of you can write your own names, but that they are generally better written than even the autographs which are appended to the Declaration of Independence. They were written too, under even more embarrassing circumstances ; writ- ten in a standing posture, and when reputation, and your future calling, and happiness, were at stake;—for they were written at the moment before I began my examination of each one, respec- tively, upon the Institutes of Medicine,—the most difficult and profound of all human inquiries. It has been my practice, uniformly, throughout the five ses- sions of this School, to solicit the autographs of the candidates for graduation, at the moment preceding my examination; partly with a view to pleasant reminiscences, and in part, that I might be thus aided in reading the mental condition. Here is the large folio volume in which all are written, and which is open to the inspection of those who are seated around me. They shall bear me testimony, that nearly every autograph proves how little competent is the Chairman of the Committee to ap- preciate any advances beyond "an elementary education," how undeserved his rebuke of Medical Colleges, how extraordinary his slander of the almost entire profession from which he, and the State Medical Society, derive their livelihood and their stand- ing in the community, and, as I doubt not, with the special object of degrading those few who are contributing their time and their best efforts, and sacrificing health, and enjoyments, and profes- sional business, not only for the advancement and diffusion of med- ical knowledge, but in promoting the general interests of science. If there be here and there, though rarely, indeed, a name 23 amongst the multitude of autographs, which betrays a faltering hand, time will probably show what their destiny has been, and how true it is that the autograph of a medical student made at the moment which precedes the crisis that is to elevate or de- grade his rank, tells us of the state of the inward man. Gentlemen, the ever sure revolution of time has brought us to the close of another, session,—it has brought us near to the last moment when you, and I, and all of us, are about to start upon new scenes, and on other duties; though, God be praised, we have a common avocation, through which mutual recollec- tions, and mutual sympathies, shall daily, hourly, maintain us as a band of brothers, and, in the language of organic science, as one united, harmonious whole. Aye, my young friends, the pursuit of medicine to cultivated minds is what the sympathetic nerve is to the various parts of organic life. What is felt by one is thus felt by the rest; and whether healthy or deleterious causes may affect the condition of any part, it is enjoyed, or suffered, by all the rest. Each, in its turn, and all together, conspire in recuperative effort for the good of any member that may sustain aught of evil. Gentlemen, we part; but it is only to cultivate and enjoy the magnificent law of "remote sympathy," and to feel that, how- ever distant from each other, we are still but parts of a common whole, and that the most remote member is as near to the whole, and can as speedily reach the whole by a glance of the mind, as the heart can light up a glow of joy through that same mind in its connection with organic sympathy. And should any rude cause offend the "sensibility" of your Alma Mater, the great nervous centre,—the sensorium commune,—then shall the " mo- tor power" as quickly brace every arm to her vigorous defence. For the present, we part to enter upon the great duties of life, and to carry out the final causes of our being. What an elevated sentiment to know that you are so well prepared to answer the intentions of Providence in his greatest dispensation of benevo- lence to suffering humanity,—to know that you have entered a field of nature untrodden by other men,—that you are so far in advance of the rest of your race,—which places all others, for weal or for woe, under your magic power,—which assimilates mind and its attainments, more than all things else, to the char- acteristics of the Great First Cause. With what cheerfulness should you pursue this noble employ- ment,—with what ardor should you strive to enlarge its boun- daries,—with what gratitude should you contemplate the power which you have acquired over the sufferings and wretchedness of your fellow men. Gentlemen, I part with you with reluctance. Let us part, however, as it becomes men who have pressing duties before them. But let us first interchange pledges of mutual friendship. 24 Let us pledge ourselves to each other, that we will co-operate in the great work of medical knowledge ; nor leave one effort un- attempted which may promise a new fact for the great cause of humanity, or which may enlarge still farther our conceptions of Almighty Design in the stupendous system of organic nature. And, finally, gentlemen, when you shall have reached the hall of refreshment, and your weariness, after my long discourse, shall have subsided into the merriment of song, let a glass be devoted to your Alma Mater, and a voice go forth that shall strike dis- may into every heart that meditates her wrong. I could wish, gentlemen, to have seen more of you, to have cultivated more intimately the ties of friendship, and to have been often made happy by more social intercourse. But, gentle- men, the advice which I have given to you, I have ever adopted as rule of action for myself. ' Versate nocturna manu, versate diurna' and through sixteen long years of unabating disease, has been my hourly precept to myself. I have toiled both night and day,and more for the public than for myself. We have little time, therefore, for other intercourse than as we meet on the highways of life. Here we greet each other in terms of amity ; and our em- braces over, we hasten away to do—"whatsoever our hand findeth to do, with all our might ;m for there is no work, nor device, nor knowledge, nor wisdom in the grave." Happy, however, shall I always be to often renew our pledges of friendship, and to con- fer with you on the events of life and on the interests of medi- cine. I hope, too, that we may maintain our social relations, as well by correspondence, as by personal intercourse; and such of you as may be disposed to address me by letter will always find me a prompt and thankful correspondent. Finally, gentlemen, you know your duties to society, to your profession, to your Alma Mater, to each other. To your brethren be just, and to mankind at large, Be ye faithful to all, and all duty discharge. To each one let 's be kind, to each one yield his right, On all other topics, let each one try his might. To superior claims you should gracefully yield, But only to merit sprung from honor's green field. To age be respectful, to its faults ever blind, To your equals be courteous, to inferiors kind. To woman be gentle,—with a smile greet the child, And honors shall crown you, and your griefs shall be mild. THE END.