ttcminiecetue© of ©reat Sritain in ttje Summer of 1S55. A LECTURE INTRODUCTORY TO THE COURSE jtffraon Stoical College of |^MtI^ra, DELIVERED OCTOBER 10, 1855, ROBERT M. HUSTON, M. D. PROFESSOR, ETC. FUBLTSHED SIf THE CLASS. PHILADELPHIA: JOSEPH M. WILSON, SOUTH-WEST CORNER OF NINTH AND ARCH STREETS. 1855. CORRESPONDENCE. Philadelphia, October 24, 1855. Professor R. M. Huston, Sir,—The undersigned, a special committee, in behalf of the class of the Jefferson Medical College, most respectfully solicit a copy of your Introductory Address for publication. Trusting you will accede to our request, and to the wishes of our fellow-students, We remain, Yours, Very Respectfully, W. T. Pryor, Tenn., Secretary, T. P. Mathews, Va., President, Henry Gresham, Va., George Torbet, Ind., James Butts, Ga., J. M. Selfridge, N. Y., J. W. Mitchell, Penn., George H. Humphreys, Penn., John Hill, N. C, D. C. Gordon, Miss., T. R. Jones, Miss., J- M. Rennard, Md. Arch Street, Nov. 1, 1855. To Messrs. T. P. Mathews, W. T. Pryor, and others, Gentlemen, I have received your communication of the 24th ult., request- ing, "in behalf of the class of the Jefferson Medical College," a copy of my Intro- ductory Address for publication. It was hastily written for a temporary purpose, without supposing it would be deemed worthy of further notice. Nevertheless, if the class think it worth possessing, imperfect as it is, it shall be at their disposal. Be pleased to present to the class, and accept for yourselves, the assurance of the profound consideration with which I am, &c, R. M. Huston. toeral iTnmmittw nf mi from rnrji Itntr. ELY McCLELLAND,..........................................Pennsylvania THOMAS W. SIMPSON,.....................................Maryland A. M. COOPER,.................................................New Jersey LUCIUS W.BRAAVN'ER,.....................................Georgia JOHN It. PARKER,...........................................Virginia ANDREW SABINO, ..........................................Ohio ' L. F. DUCHETTS, ..............................................South Carolina W. E. AVEATIIERLY, .........................................Mississippi M. D. D. JORDAN,.............................................Tennessee JNO. C PATTERSON,........................................North Carolina WILLIAM B. PRICE, ........................................Illinois H. C GIIANT....................................................Alabama DANIEL SHAW,;................................................Texas J. F. MAHON,....................................................Kentucky AVM. S. ROBERTSON,........................................Iowa J. F. SAUNDERS,..............................................Rhode Island A. S. FRYE,.......................................................Maine MANSEN II. AVRIGHT, .....................................Indiana ROBERT SCOTT,................................................Florida SAMUEL H. HALL,...........................................Connecticut J. W. BEDDEN,.................................................Delaware 0. H. HUNTLEY,................................................New Hampshire JAMES II. STEINBERG,....................................Massachusetts J. F. McKNEELY,..............................................Louisiana WM. B. HARDY,................................................Missouri PHILIP 0. HOOPER...........................................Arkansas INGRAHAM B. FREEMAN,................................Novascotia WM. McCLURE.................................................Canada AVest AVM. J. BUHOT,.................................................Barbadoes JAS. De CIIOUDENS,..........................................Corsica. Gentlemen :— For a long series of years, this has been a period of great in- terest in Philadelphia. Formerly, it was the season when fierce epidemics, such as have lately desolated our sister cities of the South, afflicted the inhabitants. But, thanks to the better hygienic influences which of later years have prevailed, under Providence, we have been spared the return of such scourges. It has, however, been more generally interesting, especially to medical men, as the time when our streets are thronged with young aspirants, not only from "Where roll Ohio's streams,Missouri's floods, Beneath the umbrage of eternal woods," but from the various States and countries on this Continent, in the pursuit of the knowledge and of the honours which may lead to fu- ture distinctions in useful efforts, and well-founded claims to public gratitude. The importance of medical teaching is never rightly appreciated by the community but when some wide-spreading epidemic sweeps, like a destroying angel, through the length and breadth of the land. Where are then your quacks, your boastful pretenders to superior skill and acquirements, and where do we find their adA'Ocates? It is at such times that the well educated and skilful physician has his triumph; a triumph the more grateful from a conviction that it is merited, and because there are none to dispute its justice. Every voice is raised then in praise of those who stand between the pesti- lence and the people. It is known to many of you that my last course of lectures was given while suffering from the consequences of a severe injury, Avhich greatly debilitated me in body, as well as exerted a most depressing influence over my usual mental vigour. The time which has elapsed since then has been employed, as far as practicable, in seeking such aids for recovery as my experience, and the best medical advice suggested, as the most likely to con- duce to that end. 6 Among other means, a sea voyage, with change of climate and the other hygienic accompaniments, seemed to promise the most advantages. Accordingly, as early as the season and other circum- stances would permit, I embarked for Europe, where I arrived, after a prosperous voyage, in the month of June. The city of Liverpool, at Avhich I arrived first, is a great com- mercial entrepot, but being neither genial in climate, nor present- ing many attractions for a man of science, I spent little time there, but proceeded, with convenient speed, to Dublin, that ancient seat of government and of the sciences in Ireland. In that pleasant city, I found not only many enlightened mem- bers of our profession, as I Avas prepared to expect, but much to admire, as Avell as to instruct a disciple of Hippocrates. As it is not my purpose, however, to tire you with details of mere matters of personal interest, I shall take the liberty of passing over these things, and simply state such facts and suggestions as presented themselves to my observation as being most likely to interest those of kindred thoughts and pursuits. One of the most renowned institutions in that refined and in- telligent community is Trinity College—the ancient seat of classi- cal literature, of the arts, and of the sciences. Trinity College is richly endowed, and contains one of the most extensive and interest- ing libraries in Europe, as well as a most curious collection of the marvels of nature and art. The college buildings, which are exten- sive, are placed in the centre of the city, and are arranged in the form of a hollow square, containing several acres of ground, besides one or more extensive rows of buildings for the accommodation of such of the fellows as have the right, and find it convenient to lodge there. The other buildings are devoted to the general objects of the college, such as the library, museum, chapel, recitation rooms, &c. It Avas strange, to a plain republican, to see the Vice-Provost at. his prayers, in his college cap and gown, and the fellows passing about the buildings, as well as the students at their desks, in the same habiliments! Medicine is not one of the leading objects of instruction in the Institution, although the organization includes a medical faculty consisting of some of the first physicians in Ireland, so that it is not altogether excluded; and I saw one young man poring over an ana- tomical work with an attention which led me to suppose that he was about to adopt medicine as a profession. But the great interest that attaches to Trinity College as a school i for medical education, arises principally from the circumstance that it is one of the three Universities of the kingdom, to which are ac- corded extraordinary privileges, the most valuable of which is the right of its graduates to practise in the city of London, and seven miles round, without special license—the other two being Cam- bridge and Oxford. In none of these is medicine taught by regu- lar lectures as in the purely medical colleges, and, of course, edu- cation in them is rather scholastic than strictly professional. There are, besides, in Dublin, a number of well-appointed hospi- tal, to Avhich medical schools are attached, in which many well- qualified teachers lecture on the various branches of medical science; and although these have not the privilege of granting degrees, their certificates are received by the chief universities and licensing boards in the United Kingdom. I visited several of these hospi- tals, heard occasional clinical remarks, and witnessed a few surgical operations. Not many students were in attendance, but I heard and saw enough to satisfy me of the high character of the Dublin school of medicine. I visited, too, the great Dublin Lying-in Hospital, breakfasted in company with my friend Dr. Churchill and others, with the ac- complished master of the Institution. After a pleasant chat with Dr. McClintock and his amiable family, we walked through the wards, and saw their general arrangement. I was pained to observe that here, as in all the hospitals and infirmaries that I visited in Europe, the same evil prevails as with us, of connecting all the wards by a long corridor; so that, as might be expected, whatever offensiAre odours occur in any of the wards, are communicated una- voidably to all. Hence it is, that with them, as in the United States, epidemic erysipelas and puerperal fever frequently occur, and are often highly mortal in their results. The latter disease prevailed extensively throughout Dublin last winter, especially in the Lying-in Hospital. From an interesting Report by the master, presented by him to the Dublin Obstetric Society, I am indebted for an account of the disease as it appeared, from which I learn that it was of a decidedly adynamic character. There Avas brown and dry tongue, soft, compressible pulse, much prostration, and great intolerance of depletion. Indeed, Avhile some of the strongest marked cases recovered under the use of active stimulation, all sank who were subjected to the contrary treatment. I Avas favoured by the President of the College of Physicians with an invitation to be present at a convocation of that learned body, 8 and "to meet his Excellency the Lieutenant Governor," which af- forded me a fine but rare opportunity of seeing many of the dis- tinguished physicians and high dignitaries of the place. Beside* the Earl of Carlisle (Lieutenant Governor,) there were present Archbishop Whately, the Lord Chancellor, Attorney General, Sir P. Crampton, Sir II. Marsh, Drs. Montgomery, Kennedy, Stokes, Churchill, and many other men of note. A discourse of about an hour was delivered by the President of the College, after Avhich Ave were invited to partake of refreshments, which concluded the civili- ties of the evening. The next city of importance that I visited was Glasgow, in Scot- land; but, although containing a large population, (400,000,) an infirmary, medical school, &c, the city had not acquired that high reputation as a seat of medical learning that led me to make much stay in the place; so, after viewing its clean streets, beautiful public squares, and regularly built rows of dwellings, I proceeded to Edin- burgh. This ancient city, although greatly inferior in population to the latter, has long had, and still possesses the highest reputation as the seat of medical learning, not only in Scotland, but is scarcely surpassed by any other place in Europe. From the days of Cullen and the Monros to the present, the Faculty of the University has comprised some of the best medical authorities of the age. In con- sequence, it has attracted support and renown from all parts of the world. There may be seen, among the students, representatives from all nations—from the dusky brown of the Indies, to the straight hair and bright complexion of the European descendants of the Cau- casian race. To a question on this point, propounded to one of the professors, he informed me that, in Edinburgh, no prejudices exist in regard to colour; that, if a young man possesses the education and refinement of a gentleman, it is deemed sufficient to admit him, not only into the medical class, but also into general society. The same want of exclusiveness seems also to exist in both Dublin and Paris, where, in the closest intimacy, may be seen natiA'es of all countries and of every clime. To the polite attention and kindness of Professor Christison, I was indebted for a general view of the University buildings, and a very full account of the purposes of its several halls. The lecture- rooms seemed to be in excellent order, and well adapted to their various objects. The cabinet of Materia Medica contained some rare and curious specimens; and the Anatomical Museum was ex- 9 tensive and complete. But that which inspired most interest Avas the great library. It occupies a hall extending the Avhole length of one of the buildings, forming one entire side of the square, and con- tains a vast collection of books, ancient and modern, on medicine and its collateral branches. Here, too, are to be seen the portraits of Cullen and other great men whose lectures have shed so much lustre on the school. The class usually in attendance on the several lectures is undoubtedly large, although, from the antiquity and ce- lebrity of the University, not equal to what Ave might reasonably ex- pect, and certainly not equal to that which annually frequents this school. Connected with the University is an extensive infirmary, the buildings of which have recently been much enlarged and improved. It appears to be a dispensary as well as a general hospital, and its corps of medical and surgical officers comprises some of the most emine'nt medical men of the age. Among the resident officers of the Institution, I was gratified to find Dr. Humphrey, of Connecticut, one of our own graduates of the spring, 18o4. To his kind attention I am indebted for an in- spection of the buildings, and an account of the general economy of the establishment. It is supported by annual contributions from the citizens of Edinburgh and the surrounding towns and villages, which, in the aggregate, amount to a handsome sum. As all these places supply their quota of patients, it is proper that they should contribute towards its support. Professor Simpson, to whom I carried a letter of introduction from a mutual friend, I found just preparing to start on his morning tour of duty to his patients, and by his invitation, I took a seat in his carriage, which enabled me to see some of his patients, and wit- ness his treatment of the cases, and to visit his pretty little cottage by the sea-side, as well as a considerable part of the city, and many pleasant places in the environs. About one o'clock we returned to lunch, and found his spacious house, almost every room in it, filled with lady patients, from nearly all parts of Europe, waiting to consult him. By his politeness I was favoured Avith an opportunity of examining some of the cases, and of learning his views of their pathology and treatment; and, although I could not always concur with him on either of these points, it was gratifying to be made acquainted with his views, the more especially as they were peculiar to himself. Dr. Simpson uses chloroform with a freedom and confidence that, I confess, surprised me. To my remark that in Philadelphia we had 10 not been gratified with its effects, he replied that the article we em- ployed was probably not properly freed from its contamination Avith aldehyde. This was an important suggestion, which I am endea- A'ouring to profit by. Dr. Simpson is a remarkable man—remarkable not only for his bodily powers, but for his great mental activity. He probably visits and prescribes for more patients, in private practice, than almost any other man in Europe, besides writing extensively, and being engaged in the regular deliArery of a course of lectures, in the Uni- versity, on obstetrics and the diseases of females, and in hospital practice. He is at present experimenting with the salts of the new metals, in the treatment of some chronic diseases of the mucous surfaces, and fancies he attains good results; but of this and other matters, I shall have occasion to speak in the course of the winter. The next objects of interest which I visited were the springs of Harrowgate, in Yorkshire, England, the waters of which have been long celebrated for their therapeutic effects in various diseases. Of these springs there are several, scattered through the village, which contain quite a variety of constituents, consisting mainly of sulphur and iron, variously combined with salts of potassa, lime, magnesia, soda, alumina, &c. Of sulphur, the Hospital Sulphur Springs are the most remarkable; and of those containing iron, the Montpellier Chalybeates are the most deserving of attention. The waters of all, however, with country air and exercise, cannot fail to materially modify nutrition, and in the cases to which their active constituents are adapted, must prove valuable as curative agents. From HarroAA'gate I next proceeded to London—that Babel of the day—where are concentrated the great and the little, the learned and the ignorant, the good and the vile, the rich and the poor, in a degree beyond any other city in Christendom. Besides a popula- tion of two millions and a half, a vast commerce, the world's centre of exchanges, and everything of that sort, it likewise contains ex- tensive parks, zoological and botanical gardens, museums, libraries, hospitals, colleges, and schools of learning and of the arts, that cannot fail to excite the Avonder and admiration of the most thought- less mind. A letter of introduction from an early and cherished friend of Dr. Copland enabled me to call upon that Nestor of our profession. Although threescore years or more old, he appeared to be as labo- riously employed as ever. It was delightful to see how labour and lengthened years haA'e passed so lightly over him. He is, indeed, 11 a fine specimen of the "old English gentleman." Stout and healthly, gay, but not garrulous, he has all the buoyancy of youth without its frivolity. I Avas glad toiiear from him that he had just completed another part of the great work upon which he has so long been en- gaged, and that noAV comparatively little more remains to be ac- complished. As a Spaniard would say, "May he live a thousand years!" The next thing to be done was to visit some of the large hospitals, and principal physicians, and institutions of the place, and to see and hear what was to be learned in the line of our profession. St. Bartholomew's Hospital, besides being one of the oldest, is one of the most extensive hospitals in London. The number prescribed for in the course of a year is very nearly 100,000, the cases being of the varied character that present themselves in a general hospital of a large city, united to a general dispensary. Indeed, the hospitals and infirmaries of the large British towns appear to be very com- monly of that mixed character; Avhile the cases that are suitable for inmates of a hospital are accommodated, those who are not able to walk thither, or find it convenient to be attended at their own residences, are not declined. The extensive endowment of St. Bartholomew's Hospital enables the officers to extend such facilities to the crowds that apply for relief; whilst the high character of those who compose the medical staff at all times secures to the In- stitution a liberal share of applicants. I saw nothing peculiar to note at St. Bartholomew's, except an extensive laboratory, where they prepare many of their own medicines, as tinctures, infusions, &c. The wards, bedding, &c, were very clean and neat, and re- markably free from hospital odours, notwithstanding there did not appear to be any special arrangement for ATentilation, and there were many cases that had recently undergone surgical operations. The same good management seemed to prevail, indeed, at the British hospitals generally. The hospital medical staff at St. Bartholomew's is composed of Drs. Hue, Roupell, and Burrows, assisted by Drs. Farre, Jeaffre- son, Black, Baly, and Kirkes. The surgeons are Mr. Lawrence, Mr. Stanley, Mr. Lloyd, with Messrs. Skey, Wormald, Paget, M'Whinnie and Coote as assistants, and Dr. West as Physician Accoucheur. I was particularly struck with King's College Hospital, which, although not one of the largest in London, is especially to be com- mended for the cleanliness of its wards, as it certainly is distinguished 12 for the high character and abilities of its medical officers. An in- stitution which enumerates among its physicians such men as Dr. Watson, Dr. Ferguson, and Dr. Guy; and in the list of its surgeons presents such names as Mr. W. Ferguson, Mr. Partridge, and Mr. Bowman, will always be distinguished. My visit was rendered the more agreeable to me by the intro- ductory cards of Dr. Copland, addressed to Mr. Bowman and Mr. Ferguson, both of whom were on duty at the time. The latter gentleman stands deservedly high with the British members of the profession, for his great dexterity and tact as an operator, and I was fortunate in witnessing several of his achieve- ments in that way. The first case which he addressed himself to was that of a middle- aged woman, labouring under chronic enlargement of the tonsils. After some prefatory remarks on the pathology of such cases, in the course of which he stated his preference of the bistoury over the instrument commonly used in such operations, he seized the organ with a pair of long dressing forceps, and then passing the bistoury around and beneath the indurated gland, it was removed with great ease and dexterity; and the next one in the same manner. They were of extraordinary size, and the operation was accomplished with little hemorrhage or expression of pain. A small girl was next brought in, labouring under a calculus in the bladder. The bladder had become very irritable, and the stone being a soft phosphate and of small size, the surgeon concluded to crush it and allow the fragments to pass away gradually and spon- taneously. To this patient chloroform was administered. The next two were plastic operations on females who had had sloughing,— the one of the loAver lip, and the other of a portion of the left cheek, forming a round hole communicating with the mouth. In both cases the operations were preceded by the administration of chloroform. The operations were conducted in the usual way, by paring the edges, and then bringing them together by the hare-lip suture, taking care, in the lip case, so to detach the surrounding connexions as to take off all strain. This case had already been operated on once before, and failed, probably, from want of this precaution. The only circumstances to be remarked in these cases, were the absence of any considerable suffering, of hemorrhage, or any unto- ward symptoms. Mr. Ferguson ascribed these favourable results to the influence of the chloroform, which he uses in all severe operations 13 (and plastic operations about the face are always severe,) and re- gards it as having decided advantages on these accounts over sul- phuric ether. This appears to be the prevailing opinion among British hospital surgeons with regard to the relative advantages of these two anae- sthetic agents. They prefer the chloroform, not merely on these accounts, but they allege that patients recover more promptly and completely from its effects than from the ether. One thing, I think, is undeniable, that, in British practice, they are more successful with chloroform than the practitioners of this country. Whether this is owing to the reason assigned by Dr. Simpson, or to other causes not yet ascertained, it seems incumbent on us to find out. It certainly is not for want of skill on the part of American sur- geons, but must arise from some difference in the articles used, or in their manner of administration. The mode employed in giving the article by the British, so far as I could learn, is precisely the same as practised with us, that is, by pouring the medicine on a pocket handkerchief, and holding it over the mouth and nose, renewing it from time to time, until a sufficient effect is produced. Of this, they judge by the state of the respira- tion and the condition of the pupil of the eye, and seem to pay little attention to the effects on the pulse. One other circumstance is deserving of remark. The British use chloroform with a confidence, and to an extent far greater than is customary with us. I do not say this to persuade my countrymen to be guilty of a want of care, but to impress them with the im- portant fact, that, although the first to use anaesthetics, we are, nevertheless, behind our English brethren in a complete know- ledge of their true character, and the extent of their usefulness. We are apt, in this country, to consider the profession in Europe as greatly in advance of us in the learning and educational advan- tages they possess. In this respect, " distance lends enchantment to the view;" a nearer inspection, however, dispels the delusion. The sources of this error are several fold. 1st. They who visit Europe are, for the most part, very young members of the profession, whose inexperience, with even the actual progress of medicine in their own country, makes them but poorly qualified for forming a judgment of the relative condition by well- considered comparison. 2d. The publications which are put forth by the different colleges and licensing bodies, especially in Great Britain, setting forth the 14 requisites for graduation, in the various ranks of the profession, are well calculated to create this impression by the number of dif- ferent branches, for the most part only collateral, Avhich are indi- cated, the tefm required to be devoted to preparation, the number of examinations, &c. Although the subjects which candidates are required to study, as implied by the requisites for final examination, certainly, in the- aggregate, present a most imposing array; when Ave examine the details, they will be found either such as relate to general scholar- ship rather than special science; or the lectures are given in the summer season, as on botany and forensic medicine, when many of the class are scattered abroad, and cannot be present; so that the regulation is in a great measure null. At Edinburgh, for instance, where there are all advantages for attracting a class in botany, as an extensiAre and well arranged gar- den under the charge and supported by the public authorities, where the teacher is the profe'ssor of that branch in the University, and an accomplished botanist, I had the pleasure of being present at a lecture when there were not more than 100 or 150 in attend- ance, although the subject is embraced in the curriculum prescribed by the University, and by the Royal College of Surgeons for gra- duation. Here were abundance of materials for illustrating the lectures, a teacher admirably qualified to do justice to the subject, and the study of it made incumbent on the candidates of both schools, and yet the class was comparatively small. That this is no overdrawn picture of the system pursued in Great Britain, we have the authority of one of their most competent Avri- ters for declaring: "In England," he remarks, "with few excep- tions, (and even in those exceptions, the kind of instruction is very meagre,) there is little or no preparatory education required by the different colleges and licensing bodies. The student is at perfect liberty to choose what lectures, or how many, he will first attend; the object being, not how he can best prepare his mind by initiatory degrees, for the more mature branches of study, but how he can soonest, easiest, and cheapest, become possessed of the certificates of attendance on the lectures he has never heard. There are no tests required as to his knowledge of any of the subjects he is sup- posed to study till the hour of his examination; and when this ex- amination does arrive, the chances that he is never asked a question, except upon anatomy and surgery, and a little physiology, arc, in 15 the chief licensing institutions of Great Britain, so slight as almost to amount to a certainty." On the Continent, and especially in France, it is little if at all better. The majority of the practitioners with them, outside of the hospitals and large cities, are the Officiers de Sante—men of very inferior education. As regards didactic, and, to a considerable extent, demonstrative and clinical instruction, we are not a whit behind our brethren in Europe. This is true, at least in several of our large schools. 1 make the statement on the authority of very intelligent gentlemen, who, after passing the usual period of their.pupilage here, have sought to enlarge their knowledge by a residence abroad. My own observation and inquiries on the spot have confirmed these accounts. It is a trait in the human mind to undervalue the advantages we possess, and to attach an over-estimate to those which are not at our command. This false prejudice has been greatly increased of late years by the injudicious croakings of some among us, who, Avithout having had an opportunity of personally examining into the state of medical education abroad, or even, in many instances, of forming a correct judgment of things at home, have presumed to condemn the system usually pursued in America as Avholly deficient. Instead, then, of following their bad example, let us strive to ele- vate our profession, not by abusing everything American and ser- vilely adopting every foreign dogma and suggestion, but by observing the course and the causes of our diseases, especially, epidemics, and investigating our native Materia Medica. Rush, Miller, Drake, and others, have made valuable contributions to our knoAvledge on the first of these subjects, while Archer, Stearns, and Morton have done much for science in regard to the other. By this course, we shall confer lasting benefits on science, and honour and dignity on ourselves. Many of our European brethren are deserving of all praise for their efforts to extend the boundaries of medical science; and al- though their propositions are neither always new nor always true, still, constant exertions in the same direction cannot always fail of success. Floundering experiments, without any definite aim or well devised plan, seldom lead to any good results; but the cautious ob- servation of phenomena, their comparison with established truths, and right consideration of their weight and bearing on the object in view, will generally, at least, bring us nearer to the desired end. Upon the younger members of the profession, such labours ap- 16 propriately devolve; for they are not yet embarrassed Avlth the en- grossing duties of a large practice, nor are their minds worn out and enervated by the harassing cares and anxious responsibilities of the daily struggle Avith disease. Many a youthful thesis has propounded laws in science or pointed out facts which have shed honour on the riper years of their authors. Who can tell, of those Avhom I have now the honour to address, how many future Hunters, or Jenners, or Harveys, or Laennecs there may be, whose genius and labours may surprise the Avorld, and confer lasting benefits on science ? Let this thought animate each one of you, and resolve to press forward, like the mariner on the trackless ocean, inspired with the bright hope that the haven is before you. Every one, perhaps, may not be able to distinguish himself, for genius and op- portunity are not conferred on all, but it will be in the power of each of you to become honoured and useful citizens. On the Avhole subject of medical education, I have neither seen nor learned anything to change the opinions that I have long en- tertained. Several years ago, in an introductory which I delivered in Jhis place, and Avhich the class did me the honour to publish at the time, I uttered the following language: "A tree, we are told, is judged by the fruit which it bears. Let our American colleges and American physicians be tried by this test, and we shall have no- thing to blush for. In no portion of the world are the physicians more skilful in the practice of their art than the members of the regular profession in the United States; nor is there a place Avhere the great and benevolent objects of our profession are more nobly carried out. "It is the utilitarian character of the American mind that most distinguishes it from all others. Without much fondness for recon- dite subjects, or the ingenious speculations of dreamy philosophers, our people have a keen perception of whatever ministers to the com- fort and convenience of the species, and a power of adaptation of which the world can afford no equal. American medical teachers and practitioners share this characteristic in common with their countrymen. In our schools, Avhatever is attempted *is as clearly and as forcibly taught as in the most renowned transatlantic uni- versities; whilst in our hospitals and in private practice, as noble achievements of science and art are displayed as the world can exhibit."