6 •w-C f Jf. O ji tisfr4A 0ontl)-tt)e0krti ilTtt>kal SUroocate- EDITED BY JAMES CONQUEST CROSS, M. D., Professor of tfie Institutes of Medicine and Medical Jurisprudence in the Memphis Medical College; assisted by his Colleagues. "Z,' incredulite en medecine n'cnfaule que laparesse, el uefait q?ie servir de voile a I Hg- 7iora7ice."—Cabanis. NO. 1. MEMPHIS, TENNESSEE, JULY 1847. VOL. 1. AN INAUGURAL DISCOURSE, On the Policy of establishing a School of Medicine in the City hose treatment they happened to fall. The newly arrived practitioners, with a few exceptions, have alwaysnad the fortune to have an extraordinary proportion of des- perate and protracted cases; and if their patients at length recovered, [which we judge was seldom,] they had of course performed the greatest miracles. Two persons in the same house, or on opposite sides of a street would be attacked in the same manner, and with the same disease. Each, having a different medical attendant, and a differ- ent course of medical treatment would present a difierent result in its course, duration and termination. A new form of disease has frequently sprung up, and continued, un- der the care and treatment of a new physician.'" From personal observation we are pre- pared to confirm substantially the above statement of Dr. Monette. In his "Observations on the w>c of Large Uoscs -f Quinine in the Treatment of Bilious 6 An Inaugural Discourse. With the exception of those of Kentucky, Ohio, South Caroli- na, Georgia and Louisiana, the Schools of the United States are supported by students who generally reside North of the 38th or 40th deg. of North latitude, three-fourths of whom will follow the profession in cold and inclement latitudes. Having a personal Remittent Fevers,"1"1 to be found in the second volume of the New Orleans Medical Jour- nal, Dr. Tuck, of Memphis, says:—"The mode of treatment of remittent fevers by large doses of quinine, was not alluded to so far as I remember, during an attendance on two courses of lectures, in Philadelphia, in the winter's of 1839-40, and the sum- mer of the latter year; and the first time I ever became aware of it, was through the conversation of a young gentleman from Ala., who was my room-mate, and who had determined to write a thesis upon the success of this mode of treatment, (as he had been convinced of its correctness from the success attending the practice;) from which I attempted to dissuade him, as his views were so contradictory to what 1 had been taught, and believed lobe the opinions of the professors; and I feared that such ultra notions might occasion his rejection. [A very high idea is thus impliedly expressed of the enlightened liberality of those who arrogantly presume to dictate to the profession of the United States.] By my own preceptor, a distinguished physician of Virginia, I had been taught, (and this, so far as I was acquainted, was the opinion of the most eminent professors in the country,) that the smallest quantity of quinine would be almost sudden death, if administered in a case of remittent fever. Whether the young genfeman allu- ded to presented his thesis, [an event that is hardly probable, since such ideas of the liberality of Philadelphia professors were entertained by those who attended their lec- tures,] I am not aware, as he was not a candidate for graduation until a year after I left. Removing to the South-west in 1840,1 had an opportunity of meeting with some distinguished physicians, of enlarged experience, and who, for a number of years, had employed quinine in large doses, in the treatment of bilious remittent fevers, with the most signal success; but my prejudices were so strong,from early education, [quite nat- ural,] against such a course, that I could scarcely be made to believe it, until I had an opportunity of witnessing the success with my own eyes during the following summer. ......But, however, this treatment by large doses of quinine originated, or whoever may have been the author, it must be gratifying to every friend ofhumanity, that so useful a discovery has been made, and that it is now becoming the established practice amongst the most intelligent physicians of the South; and that where, former- ly, death swept over the land with a resistless tide, destroying thousands in his career, we are now able to arrest his destructive march, and almost insure a speedy return of health where, previously, even a hope to live would have been looked upon as folly." Dr. Holmes of the Medical Staff of the United States Army, in his remarks on qui- nine and malaria to be found in the October number for 1846, of "The American Jour- nal of the Medical Sciences,1'' says:—"On my arrival in Florida, knowing nothing of Southern diseases from practice, and being stationed alone at a distant and unhealthy post, I learned the rules by experience alone, guided by which I have since successfully administered quinine, [of course, if his North-eastern education was not a disadvan- tage, which it is difficult to believe, it was of no use to him,] I practised on Northern precepts, annoying the patient without arresting the disease, by a continued succes- sion of two grain pills; occasionally at long intervals checking the disease by those means, but much more frequently vexed for weeks by the continued sickness of the soldier. I rose finally to ten grains, and continued to give thi3 quantiiy at once; I more frequently succeeded by this practice, but not yet to my satisfaction..... Finally convinced that large doses of quinine are necessary in the South, I increased my minimum dose for intermittent fever to fifteen grains given at once.''1 After the fullest proof of the efficiency of large doses of quinine in bilious remittent fever, Dr. Condie, of Philadelphia, in his edition of Watson's Practice of Physic, remarks:—"Ma- ny of the physicians of the Southern and Western portions of the United States place their chief reliance, in congestive remittent fever, upon the sulphate of quinine pre- scribed in enormous doses—twenty, thirty, and even fifty grains repeated at short in- tervals until the solution of the disease is obtained; butalthough we are convinced of the propriety of large and frequent doses, those alluded to are certainly excessive and uncalled for." How does he know? Has he ever seen a case of congestive remittent fever in the South? No. Then he knows nothing about it, and has no right to ques- tion the skill and judgment of those who are fimiliar wiih the subject. This is like the philippic which Dr. Dudley is in the annual habit of pronouncing against quinine and iodine; and yet he has the assurance to tell his clastes he never employed them in his life. An Inaugural Discourse. 7 knowledge of the diseases peculiar to cold regions, the teachers in those institutions are qualified adequately to instruct those who remain there, but those who shall migrate South, will soon find in their new homes that they have yet to learn the art of physic. The Schools of Kentucky particularly, as well as that of Cin- cinnati, derive their principal support from the States of Ken- tucky, Ohio, Tennessee, Alabama and Mississippi, and were they organized with a reference to the necessities of the regions of country which they supply with physicians, the need for an addi- tional School of Medicine would be, in a great degree, obviated. Without designing to impugn the motives of those who control those institutions, or desiring to intimate that they intended to make an invidious distinction between the North and the South, we must be permitted to say on behalf of science and the interests of the public, that they are not; for in neither of them can be found a single teacher of a practical branch of medicine, who ever prac- tised the profession South of Kentucky. This we hold to be a fun- damental defect in the organization of the Faculties of the Schools alluded to. The diseases of the northern part of Kentucky, and of the whole of Ohio, differ in several striking respects, from those that are observed in lower latitudes; those, therefore, who under- take to teach medicine in either Louisville, Cincinnati or Lexing- ton, without having previously acquired a personal knowledge of those of the latter, will never, so long as they remain in those ci- ties become competent teachers of those who intend practising the profession in the South. In the mere existence, therefore, of those institutions, especially when we consider the manner in which they have been administered, no argument can be found against the establishment of another School of Medicine. Perhaps it may be urged, that although the schools of Ken- tucky and Ohio may not be so constituted as to supply the wants of the southern and south-western portions of the United States, no necessity for another school can exist inasmuch as the medi- cal institutions of Charleston, Augusta and New Orleans abound with teachers whose practical knowledge of disease has been ac- quired almost exclusively in Southern latitudes. The foTcc of this argument we shall not attempt to invalidate by denying the al- leged and indisputable fact; but there arc other reasons which in- duce us to believe that the existence of those institutions do not 8 An Inaugural Discourse. preclude the necessity for another School of Medicine. Amongst these may be mentioned the prominent and controling considera- tion, that they are situated on the extreme Southern and South- eastern borders of the Union, and consequently on account of their distance receive comparatively little support from Ten- nessee, Alabama, Arkansas, the northern part of Mississippi, the South-western portion of Kentucky, the south-eastern sections of Illinois and Missouri, which vield at least two-thirds of the pat- ronage received by Louisville and Lexington, but which, and for reasons utterly incontestable, should be supplied with physicians who have been taught by men of Southern or South-western ex- cxperiencc. In the present condition of things, however, hun- dreds of physicians are annually sent to the South from the schools of Louisville, Cincinnati and Lexington, who have been educa- ted by those who have had no personal acquaintance with the diseases of which they profess to impart a knowledge. That the Alumni of those institutions should, from the outset, prove success- ful practitioners, is not only improbable, but utterly impossible; for no material difference is observed to exist between the "great pathological and therapeutical principles" taught in them and those inculcated in Philadelphia, New York and Boston, and no instance can be found of a Northern graduate being able to de- fend Northern principles, or to enforce successfully Northern practice in a Southern latitude. To the truth of this assertion all experience fully testifies. These he has been invariably obliged, sooner or later, radically to modify, or to recant altogether. This single fact independently of every other consideration, and we be- lieve it to be entirely indisputable, conclusively establishes the important position that those who have acquired their practical knowledge of disease in high latitudes, are not competent to ed- ucate those who intend to reside and practice in the South. It is Southern teachers only who are qualified to make successful Southern practitioners of Medicine, and if this proposition is not self-evidently true, it is at least, susceptible of the most satisfac- tory proof. If this be denied, why, we ask, does it happen, that as a gener- al rule, those who have been educated in Northern or Western institutions, and who settle in the South or South-west find it ne- cessary to remove, after a residence of a few months from their An Inaugural Discourse. 9 places of original settlement? This we know to be true, not only from personal observation, but from statements that have been made to us by others whose attention had been directed to the subject. Nor is this fact, which is not less peculiar than are the characteristics of Southern and South-western diseases, difficult of explanation. When they first settle, being generally fresh from College, are proud of course of the lessons they have received from those whom they justly regard as able and learned men; but who are—but this they do not know—utterly ignorant of the pe- culiar nature and still more peculiar treatment of the maladies of warm climates. Flushed with hope, but unhackneyed and unprac- tised in the ways of the world, they, in the simplicity of their hearts, confidently imagine they will soon be able to write to their friends and venerated,—often venerable—preceptors, veni, vidi, vici. One season, however, of personal acquaintance with Southern endemics, is commonly sufficient to dispel the delusion from the minds of those who are sensible and sagacious enough to profit by observation. Want of success, and not the want of patients, will have, in this time, destroyed their confidence in the princi- ples they had been taught, while at the same time, to their morti- fication and discredit, it will have destroyed the confidence of the public in their skill and judgment as physicians. The con- sequence is, that they, as a general rule, are obliged to seek out new homes, where, after having abandoned the precepts, the principles, and the practice that had been taught them, they may be permitted to make a profitable use of the results of personal ob- servation and experience; then their obligations and indebtedness to their original pi eceptors, are without a feeling of regret or a pang of remorse, at once, and forever canceled. Than this no more conclusive fact can be appealed to in proof of the position as- sumed, which is, that something more than great book-learn- ing is necessary in Northern and Western professors, to enable them to educate properly Southern physicians. Nor will you find the generality of those who come for the purpose of settlement in the South, better qualified for the arduous duties of the profes- sion, until such time as they shall be educated by those who have acquired a knowledge of the nature and treatment of the diseas- es peculiar to the South from observation and experience. That these views, however true, will not be willingly or uni- •> 10 An Inaugural Discourse. versally adopted, may be certainly inferred from the following declaration made in the last annual announcement of one of the first Schools of Medicine in the Union:—"The facilities which Philadelphia affords for medical instiuction are certainly varied and ample, and adapted for every region. The great principles of pathology and therapeutics can never be sectional; they are of universal application." In opposition to the authority of a very learned body, we beg leave to quote an equally emphatic declar- ation from a recent and an able French writer, who had, for many years, been a close observer of disease in very various cli- mates. He says:—"De meme que pays possede son regne vege- tal et son regne animal caracteristiques; dememeil possede aussi eon regne pathologique a lui; il a ses maladies propres, et exclu- sives de certaines autres." But this question, so important and in- teresting, is not to be settled by a reference to authorities, but by an appeal to facts. Now what is a "great principle?" To our understanding it is an ultimate fact or law, to which the various phenomena in any department of observation and experience are referred, as is illustrated by the reference that is made of the phenomena observed in the inanimate world to certain laws of motion, of gravitation, of chemical affinity, &c. Dr. Bartlett in- forms us that, "A law, or principle, of physical science consists in a rigorous and [an] absolute generalization of facts, phenomena, events and relationships; and in nothing else. It is identical with the universality of a phenomenon, or the invariableness of a rela- tionship," which is equivalent to what Mr. Mill says in his "System of Logic," that "Ultimate laws are observed uniformities of Nature which cannot be resolved into more general laws;" or as Webster defines a principle to be "a truth admitted without proof, or considered as having been before proved." Without desiring to intimate that medicine is a vague and an uncertain sci- ence, we ask is there any thing in pathology or therapeutics which 1 o But if it be admitted as a general therapeutical principle, that blood-letting may be resorted to in certain sections of the country with safety and success, does it follow that it is, in all latitudes, of universal application? No one who has practised in more than doute, ou parce qu'ily a eu erreur de diagnostic, ou paree que remission sanguine a eu lieu a une epoque avancee de la maladie, quand cell—ci etait voisine de son declin." {After inveighing in the bitterest language against blood-letting, Dr. Dickson in his "Principles of the Chrono-T hermal System of Medicine" exclaims:—"How few are the diseases which loss of blood may not of itself produce! Ifitcannotcau.se the eruptions of small pox, nor the glandular swellings of plague, it has given rise to disorders more frequently and inevitably fatal than either. What think you of cholera asphyxia- Asiatic cholera? Gentlemen, the symptoms of that disease are the identical symp- toms of a person bleedings hwly away from life! The vomiting, the cramps, the sighing, the long gasp for breath—theleaden and livid countenance which the painter gives to the dying in his battle pieces—these are equally the symptoms of cholera and loss of blood! Among the numerous diseases which it can produce, Darwin says:—"a par- oxysm of gout is liable to recur on bleeding." John Hunter mentions "lock-jaw and dropsy," amongst its injurious effects—Travers, "blindness and palsy,"—Marshall Hall, "mania,"—Blundell, "dysentery"—Broussais,—"fever and convulsions!" "When an animal loses a considerable quantity of blood," says John Hunter, "the heart in- creases in its frequency of strokes, as also in its violence.'1 Yet these are the indica- tions for which professors tell you to bleed! You must bleed in every inflammation they tell you. Yet is not inflammation a daily effect of loss of blood! Magendie mentions "pneumonia" as having been produced by it, completely confirming the evidence of Mr. Hume upon that point. He further tells us that he has witnessed among its effects "the entire train of what people are pleased to call inflammatory phenomena; and mark," he says, "the extraordinary fact, that this inflammation will have been pro- duced by the very agent which is daily used to combat it!" What a long dream of false security have mankind been dreaming! they have laid themselves down on the laps of their medical mentors, they have slept a long sleep; while these, like the fabled vampire of the poets, taking advantage of a dark night of barbarism and ignorance, have thought it no sin to rob them of their life's blood during the profoundness of their slumber." ||"The influenza, or epidemic catarrh, which was almost universal in this town [London] in the years 1333 and 1837, afforded a striking illustration of the point I am endeavoring to set before you. The inflammatory symptoms—the bronchetis and pneumonia—were in many cases strongly marked, and it was necessary to abstract blood; but persons suffering under influenza bare bleeding exceedingly ill, and where the use of the lancet could not bo avoided, it was never resorted to without reluctance and misgiving."'— ( Watson'* Practice of Physic.) Not only did the patients laboring under the epidemics of which Dr. Watson speaks, bear blood-letting "exceedingly ill," but recovered more rapidly and in larger proportion in the hands of those who abstained from it altogether and relied upon tonics and stimulants. This is proved by a num- ber of papers to be found in the London Lancet and London Medical Gazette, extracts from which we would quote were they accessible. "But of late years, more reliance has been placed by practitioners upon local stim- ulants, for checking this horrible malady, (purulent op thalmia) than upon general or topical bleeding. A priori, we should expect that the caustic application would add to the existing mischief and destroy all chance of saving the inflamed eye. But it is not so. Even Air. Lawrence, who was, I have reason to think, formerly very scepti- cal on this point, appears to be so no longer."—Ibid. It is wonderful that when physicians see what is called inflammation yield under their eyes to the direct application of tonics and stimulants, they should still hold in horror, the internal administration of them. Occasionally, however, "great therapeu- tical principles of universal application" have been abandoned, and good results have followed. When the allied arrnies were in Paris, in 1814, the Cossacits suffered dread- fully from pneumonia, and they died, sajs Mr. Rostan, almost to a man, so long aa they were bled, but recovered rapidly and completely after the practice of giving them Brandy was instituted. At a meeting of the Medico-Chirurgical Society, Mr. Trav- ers is reported to have stated, that in "a great many instances (of Erysipelas) he found the most decided benefit from the use of tinrk and other tonics, and which, at the com- mencement of the disease, he had often seen highly useful in the practice of others, even in cases where he would have, employed the antiph'ogiftic treatment, it the patients had fallen into his own hands."—London Lancet. 14 An Inaugural Discourse. one climate, or whose judgment is not warped by selfish and indi- vidual considerations, will venture to make any such assertion. In the Northern and even in the temperate sections of the Union, frequent and copious depletions are commonly resorted to, and this is considered the orthodox mode of treating inflammation, but they, in other latitudes, are either altogether proscribed from the methodus medendi, or are used with the utmost caution and re- serve.* Similar and equally pointed remarks might, with per- fect propriety, be made in relation to all the other power- fully debilitant remedies, which are so popular and so generally confided in by the physicians of North-eastern latitudes. That the pathological phenomena and therapeutical indica- tions of Southern maladies should differ from those that prevail in the colder regions of the earth, will not cause surprise in those who reflect that the population of the South is exposed to the ac- tion of, at least, two powerful causes, from both of which those of Northern and temperate latitudes are comparatively exempt. Al- lusion is made to intense solar heat and a miasmatic atmosphere. These morbiferous agents are of powerful and extensive operation. They are of themselves not only specific causes of disease, but they modify the character of all the maladies which occur within the sphere of their influence. We cannot pause to inquire into the •"Nulle part dans le nord de l'Europe je n'ai vu la forme inflammatoire se dissiner nvec plus dintensite que sur le plateau des Castilles, un des plus eleves de l'Europe, et notamment a Madrid. Les clirnats continentaux, refrodis par les vents sont plus fe- conds en inflammations que les clirnats insulaires ou littoraux, a egale distance dea tropiques, et ce fait justifie pleinement la judicieuse remark de Coelius Aurelianus, d'apres laquelle les saignees aggravaient les pleuresies d'Athenes et de Rome, et qu'elles reussissaient au contraire contre les pleuresies de Paria et de l'Hellespoit."— Boudin's Essai de Geographie Medicate. Dr. Boling in an article "On the Treatment of the Inflammatory Aflectionsof' Malari'• ous Districts," to be found in the July number for 1844 of "The American Journal of the Medical Sciences," says:—"Another striking peculiarity about these inflammations, is the obstinacy with which they resist what is generally considered a purely antiphlo- gistic treatment, a treatment that would be in most cases speedily successful in the phlesrmasiae of those living in an atmosphere untainted with malarta, and the facili- ty which, as a general rule, they yield to a course of practice, applicable, in its pecu- liar features, to the treatment of the uncomplicated fevers of the same regions. The fatality of these affections, for instance of the disease generally known as bilious or typhoid pneumonia, under a purely antiphlogistic treatment, (by this I mean bleeding, tartar-emetic, purging and blistering,) or under a systematic exhibition of mercurials; or under another system of treatment pursued by a few physicians of the South, viz: the exhibition day after day of drastic purgatives, is very great; whereas under the use of gentle laxatives occasionally, mild antiphlogistics, and the free but judicious use of Peruvian bark or its preparations, the fatality is comparatively limited. Compared with the practice of a few years back, a system of treatment much more judicious and Buccessful, is rapidly being adopted by the physicians of the South, and the number of those who would take pride in boasting of their hundred grain doses of calomel, or the number oi drastic pills given in a dose, is small, indeed; and this too, notwith- standing the influence of professional dicta, and college impressions." An Inaugural Discourse. 15 methodus aegendi of those agents in producing their peculiar and characteristic results, but the general pathological phenomena to which they give rise, may be briefly stated to consist in a less ve- hement, forcible, persistent and general reaction than is observed in higher latitudes, together with a periodicity, more or lesa marked in almost every case, and an unequivocal hepatic de- rangement, varying in its degree of intensity, no matter what may be the organ originally attacked, for the liver is sure to suf- fer, more or less, as a cause or consequence of disease in hot and malarious latitudes. Nor are these peculiarities unimportant in a theoretical or practical point of view. So far indeed is this from being the case, the peculiarities to which we refer, uni- formly command the practitioners earliest and most earnest at- tention. Instead of the blood-letting and antimonial heroisms, so much confided in and practised in higher latitudes, and which arc very sparingly, if at all, used in the South, resort is had to such agents as rectify biliary derangement and prevent the paroxys- mal recurrence of disease. But the Alumni of the Atlantic Schools, as well as those of Kentucky and Ohio, regardless of the great fundamental facts that the pathological phenomena and ther- apeutical indications of the maladies of the South, differ widely from those that are observed in such as occur independently of in- tense heat and a malarious atmosphere, and believing they have been taught correctly, without hesitation or remorse, subject the Southern constitution to rules of treatment that are no less absurd in principle, than they are frightfully fatal in practice. We feel authorized in asserting, as the result of the multiplied experience and observation of all ages in low latitudes, that the liver is the great emporium of both health and disease in hot cli- mates. In all its pathological and therapeutical relations, it is an organ of paramount importance to the practitioner, for it is, as we have said, directly or indirectly concerned in most of the modes of morbid action which prevail in the South. A thorough acquain- tance with the physiology, pathology and therapeutics of that great organ, so far as understood, is therefore entirely indispensa- ble to the successful treatment of Southern maladies. Affections of the liver, especially in their graver forms, so far from being common or prevalent in Northern or temperate re- gions, are rarely if ever observed; it would, therefore, be absurd 16 An Inaugural Discourse. to expect from those who have not enjoyed extensive opportuni- ties of observation and experience in regard to them, such an amount and such a kind of knowledge as would enable any one to understand their nature or to treat them successfully. This we confidently assert to be utterly impossible, and ask with equal assurance those who are disposed to venture a contradiction, for what the profession is indebted to those who have practised ex- clusively in Northern or even temperate latitudes, in relation to the physiology of the liver, or the pathology and therapeutics -^of that organ? While we concede to them all that can be de- manded on the score of anatomy, we answer, absolutely nothing. In proof of this, perhaps, uncourtly assertion, we ask those who are in the habit of enquiring into such matters, but who have not had their attention arrested by this particular fact, to look into the books which have been written by Northern men or those of temperate latitudes, but who had not enjoyed opportunities for the acquisition of Southern experience, and it will be found, with but a very few exceptions, that the liver is regarded by them as an organ comparatively unimportant. This is a natural result of the deduction of pathological and therapeutical conclusions from an observation of the forms of morbid action most prevalent in Northern and temperate latitudes, for they generally leave, as dis- eases of protracted duration and much debility almost uniformly do, more or less of traces of congestion or inflammation of the in- testinal mucus membrane. But the liver, whatever may be said by those who, in reality, know nothing on the subject, but who, from motives perfectly intelligible, may be disposed to set aside or obscure the perception of the truth, is as much of a pathological autocrat in the South, as the lungs are in Philadelphia or Boston ■—in Louisville, Cincinnati or Lexington; and the other organs of the body are as completely under the presidency of the former in the South, as they are under that of the latter at the North. In different latitudes both organs are more frequently than any oth- ers, the subjects of violent and dangerous maladies, and had we time to dwell on the subject or were the occasion a suitable one, it would not be difficult to prove that it cannot be otherwise. The joint and common function perform by them renders this inevitable. This necessarily constitutes both the liver and lungs, organs of the first importance in a pathological as well An Inaugural Discourse. 17 as in a practical point of view. That the physicians of Northern and temperate climates should understand better, and treat pulmo- nary affections with more judgment, skill and success, than those of Southern latitudes, is what their large opportunities of experience, in such complaints, would lead us to expect, but to alledge that they have as correct a knowledge of the nature, and are as competent to treat hepatic affections as those of the South, is preposterous and ab- surd. They know nothing in fact upon the subject but what they have derived from books, and from such books too, as are of but little or no authority with Southern physicians, while such as have been written by authors qualified, from having studied them in the field of actual observation, to impart accurate and satisfactory information, are rather unceremoniously discarded or condemned, and for no better reason, as is apprehended, than because they conflict with preconceived theoretical opinions, or some gratuitous- ly assumed "great pathological or therapeutical principle." Per- sonally unacquainted with Southern complaints, holding the results of Southern experience in little esteem, and the produc- tions of Southern pens in less, the teachers in the Schools of the Atlantic States and those of the West, are no better fitted to train and instruct Southern physicians than the generality of the works that have been written in the United States on the Practice of Physic ; which have commonly led the physician into grave errors, while they have rarely, if ever, instructed or enlightened him on those points, with which it is important that he should be familiar.* *That the teachers of the sections of country referred to, are no better qualified for tho purpose mentioned, than those who have furnished them with treatises on the " Practice of Physic," we think will be generally admitted without hesitation. Now, of the practice so common and firmly established in the South-west, of suddenly ar- resting, or jugulating, as the French call it, remittent fever, they seem" to be entirely ignorant; and to prove that we do them no injustice, the following brief compendium of their views on the subject is extracted from Dr. Ford's article on " Intermittent Fever," etc: "Look, o. g., at the objects proposed in the treatment, in Ebcrle's Practice—a work which has had so large a share in forming the opinions of medical men and shaping their practice : "In the treatment of this disease, there arc throe primary pathological conditions, according to which the general indications of remediate management must be directed, viz: 1. Functional derangement of the liver and alimentary canal. 2. Redundancy of morbid or vitiated secretions, and consequent irritation in the intes- tinal lubo. 3. An irritated increased action of the heart and arteries. Hence, the principal indications in the treatment arc : 1, to moderate the febrile reaction of the arterial system ; 2, to remove out of the alimentary canal, the vitiated and irritating secretions which may be lodged in it; 3, to restore the healthy function.; of the liver and alimentary canal; and 1, to obviate gastro-intcsliaal lmUuoii.1 Among the ,n .fi hods of In at mi nt, wt a word i& said of an effort to an est it. " lu Dungliaon's practice, the whole routine iystcm of blooding, puking, purging, nvualhr' relri^.iatin,", blisturiiij. Sec... is examined, but not.a word ■).>; to the abpr- ' 3 " 18 An Inaugural Discourse. In relation to the various forms of fever, no "great pathologi- cal or therapeutical principle of universal application" has been settled or established. Indeed, so far are we from being able to set up any such pretension, many judicious writers maintain that we are not better informed on the subject than they were in the days of Hippocrates. That this is really the case with those who have been guided by systematic views, or have striven to found its treatment upon an anatomical base, we have no doubt, but we should be sorry to be obliged to make any such admission, in re- gard to those who have cultivated medicine in the South. Be this as it may, it is perfectly certain that no principle of universal ap- plication has been hitherto discovered in relation either to the causes by which it is produced, the intimate and original changes which constitute it, or the remedies by which it is treated. Ihe most common and generally admitted cause of fever is, doubtless, malaria, and yet the existence of this is denied by some pa- thologists. Even those who believe in its existence and consid- er it a cause of fever, are far from being perfectly agreed as to the particular forms that owe their production to its agency. Nor is there any uniformity in the pathological manifestations tive treatment. " The writer turns to the treatment of Remittent fever in a work published in 1846, by Dr. Clymer, whose aim has been, " to adapt it particularly to the necessities of the American Practitioner," and reads—"The indications of treatment in Remittent fe- ver do not materially differ from those of continued fever. The points more particu- larly to be attended to, are the reduction of the general fever, the obviating the effects of congestion and inflammatory action in the liver," and other organs. In a note, we are informed, that the simple expectant plan is the one which has been generally of late recommended by the experienced ! At the end of the note the indication t* •stated, in the Congestive fever, to prevent the recurrence of the paroxysm. " In Watson's Practice by Condie, Remittent fever forms the subject of a note—in which it is announced that the most important question that presents itself in the treat- ment is the propriety ot direct depletion by the lancet! And in Professor Dickson's Lectures, commended especially to the Southern student and practitioner, there is the same minute remark upon bloodletting, emetics, cathartics, calomel, cold, &c, &c, but not one word upon what must be regarded as the leading rational object—the checking of the paroxysm. Indeed upon this point, the necessary continuance of the disease when once formed is distinctly, though incidentally asserted. " Could we reasonably hope to prostrate the disease by a single blow, as is often done in the cure of the phlegmasioe, in pleurisy, &c, we might more implicitly trust to the lancet; but the cise is fcr otherwise. Here the atmospheric and climatic predispositions are perma- nent, and the poisonous cause is still diffused around the patient, impressing the tis- sues with a continuous and unavoidable agency. Success does not depend upon, nor can we hope or expect to attain it, by any single measure, however judicious and en- ergetic. " In Professor Chapman's Syllabus, by Kennedy, published in 1846, quinine, the spe- cific remedy for jugulating Remittent fever, is classed among the adjuvants of the old routine system of practice. _' And in Bell & Stokes' Practice, even in the latest edition, although the efficacy of the quinine practice is fully shown—the early unconditional use of quinine plainly ?et forth and triumphantly vindicated, yet in the treatment of the milder forms of re- mittent, this cardinal object of checking the recurrence of the paroxysm is not even i< nted at. "—Sou'hcn Med. and Surg. Jour. Aii Inaugural Discourse. 19 *b observed in the various forms of fever, whether they prevail in the same or in different* latitudes,* or corespondence of opinion amongst writers as to their essential nature. Without entering into particular details, we may say in general terms, that a lead- ing phenomenon in those that owe their origin to the action of malaria, is disorder of the liver, while those whose etiology is in a state of more uncertainty, such as typhoid fevers which are com- monly observed in Northern and temperate latitudes, follicular inflammation is a common, but not an universal lesion. The pa* thology of paroxysmal and continued or typhoid fevers, as de- duced from the researches of pathological anatomists, is not only fundamentally different, but there is much reason to believe that there is between them a sort antagonism, which renders it impos- sible for them to be equally prevalent under the same geographi- cal and geological circumstances—that the endemic prevalency of the former in certain latitudes, longitudes, and upon certain soils, excludes the latter altogether or causes them to be rarely obser- ved and vice-versarily. In relation to the treatment of fexcr, has any " great thera- peutical principle of universal application" been established? *Professor Alison in his " Outlines of Physiology and Pathology, " says : "that the morbid appearnces, found after fatal fevers, are often observed to be remarkably va- rious, even in cases, the leading symptonsof which are nearly the same; and that they are far from bearing any fixecf proportion to the intensity of the symptoms of affec- tion of the parts where they are found. " " L'autopsie des sujets morts de la fievre n'eclaire pas toujours le mtdecin sur la na ture du mat autant que veulent bien le dire les localisteset lea ultra anatomo—patholo- gistes, ce que du reste se comprend tres facilement quand on songe qu'il n'y a paa d'affections que offrent des alterations plus variees. Ainsi sans parler des cas dans le- quels on netrouve absoluementrien a l'autopsie, ni di ceuxou les alterations sont tout a fait insignifiantes, nous dirons que les memes affections determinent souvent des lesi- ons anatomiques tres differentes, et que depuis les traces les plus legeres d'injlamma- tion jusqu'aux ulcerations, et meme jusqu'a la decomposition des fluides, on a trouve chez les sujets qui ont peri tous les genres de lesion anatomique. " Mais, il y a un fait qui doit fixer toute notre attention, c'est qu'il est prouve qua lorsque la fievre a dure longtemps on trouve presque toujours a la utopsie unepluralit« de lesions qui demontrent clairement que la fievre n'est ni une gastrite, ni une gastro- enterite, en d'autres terms une reaction de tous lea organes."—Auber's Traete de Pkilos- ophie Medicate, Dr. Condie correctly states: "The bilious remittent fever is a disease ofhotcli- mates and of the season of greatest heat; thus, while it constitutes the summer endem- ic of the Southern portion of the Union, it seldom occurs in the middle or Northern States excepting during those summers that are marked by an unusual elevation of temperature, and here, as well as in the places where it prevails endemically, it cea- ses as the winter approaches. "—( Watson's Practice of Physic.) Typhoid fevers pre- vail almost, if not quite exclusively, in the middle and Northern States, and are moat prevalent during the colder seasons. Indeed Mr. Boudin from an extensive experience on the marshy snores of the Mediterranean, not only considers them independent of malaria, but has gone far to prove in his " Geographie Medicate, " that they are ex- cluded from those places in which fevers from that cause prevail. In paludal fevera the stomach and liver are the organs in which indications of disease are most com- monly detected, but in typhoid fevers, follicular inflammation of the email bowels i9 ihe most usual morbid appearance. 20 An Inaugural Discourse- On this point we run no risk in making a direct and positive neg- ative response. Indeed no therapeutical principle, for the treat- ment of diseases in general, has ever been suggested but what was not only derivative in its character, but was deduced, not from observed uniformities in the effects of medicinal agents, but as- sumed uniformities in relation to the effects of the causes of dis- eases. Though all medical history shows this to be the undeni- able fact, a celebrated and venerable teacher in Kentucky, ven- tured to utter the enormous absurdity, that students of medicine might go East to learn principles, but they jfmsfjbe educated in the West if they would acquire a knowledge of " the true mode of treating Western maladies." No new and popular pathological principle ever yet existed that did not, and at once, give rise to an equally novel and popular mode of treating disease.* This pop- ularity it continued to enjoy until the results of experience, which have, in every instance, been fatal to the pretensions of " every pathological and therapeutical principle of universal application," proved the theory to be fake and the practice it enjoined fatal. We presume the sepai/ftc and independent existence of principles and practice was never before suggested, but the writer we sup- pose Relieved in the existence of " great pathological " but not in " great therapeutical principles of universal application. " He need not,however, have admitted the former and denied the lat- ter, for if the principles of Eastern and Western medicine resem- ble, their practice, is almost, if not quite identical. Nor could it be otherwise according to present arrangements, for every practical branch of the science in the schools of the West, is taught either by Eastern men, or men of Eastern principles and prejudices. . We might successfully refer to the various modes of treat- ment, followed in different latitudes, and Hvhich are said to be *" To what errors have not mankind been. led in the employment and denomina- tion of medicines? They created deobslruents when the"theory of obstruction was in fashion; and incisives when that of the thickening of the humors prevailed. The ex- pressions diluents and ailenuanls, were common before this period. When it was ne- cessary to blunt the acrid particles, they created inviscants, incrassants, &c. Those who saw in diseases only relaxation and tension of the fibres, the laxum and strictum as they called it, employed astringents and relaxants. 'Refrigerants and heating medi- cines were brought into use by those who had a special regard in diseases to an excess or deficiency of caloric. The same identical remedies have been employed under different names, according to the manner in which they were supposed to act. Deobslruents in one case, relaxant in other, refrigerant in another, the same medicines have been em- ployed with all these opposite views; so true is it that the mind of man grotipes jn the dark, when it is guided only by the wildness of opinion. "—BichaPs General Anatomn. An Inaugural Discourse. 21 successful in illustration and proof of the assertion, that no " great therapeutical principle of universal application" exists; but this we hold to be supererogatory, for, from all we can learn, no therapeutical principle, cither partial or universal, is confided in by the generality of the physicians of Northern and tem- perate latitudes. This is especially the case with those who arc regarded as authorities in the profession, for according to them, the treatment of fever is vague, unsatisfactory, and in an emi- nent degree, uncertain. Nor is this all. They have failed so signally in the treatment of disease in general, that they have be- come almost perfect infidels as to the remediate powers of the ar- ticles of the Materia Medica. As a natural consequence, they arc daily increasing the number of "self-limiting diseases"—that is of maladies which will run their course—that cannot be abridg- ed by treatment.* In other words, they failed to cure the dis- eases which they had an opportunity of observing and treating, and absurdly concluded that they are cither, in their nature, abso- lutely incurable, or that the healing art is impotent. The statis- tical results of Dance's experience, or rather experiments, as cm- bodied in his Treatise on Fever, arc a melancholy comment on the curative efficacy of French medicine, of which North-eastern practice is almost a literal transcript, for medical expectation, which, Asccpiadcs properly called a meditation on death, constitutes the sum and substance of the former, is thecommon and current practice of the latter, t He assures us that he ob- tained nearly the same ratio of success from the anti-spasmodic, dcpletant, tonic, evacuant and revulsive modes of treatment. At this, however, we arc not surprised. No better result could have been expected by a rational or an experienced physician. His facts were accumulated in a hospital, where, from personal ob- servation, we assert cases arc arbitrarily classified, while no al- *" Of late the list of'self-limiting diseases,' ha3 received very large additions at the hands of writers of high authority. In their speculations upon the subject, however, these gentlemen seem to me, to have been misled, either by an original inclination to the 'medicine expect^nte,' or by the failure of their therapeutical experiments. Bige- low and Smith in our own country, and the celebrated Louis in France, have ranked typhus fever, or 'typhoid affections,' as the phrase is, under this head ; and the latter, the father of the 'numerical system,' has gone so far ns to maintain the same views in reference to peripneumony and other phlegmasia?. "—IH<-ksim',8 Practice. tSee the note on page 18, in which we are informed by Dr. Clymer, of Philadelphia, that " the indications of treafmcnt in Remittent fever do not materially difler from those of continued fever, " and " IhaltJic simple expectantplan, is the one, which has been generally of late recommended by the experienced." ').") An Inaugural Discourse. lowance is made for peculiarities of constitution, and all the ca- ses of any type of disease, are treated as if they were perfectly identical.* From facts thus collected, the therapia of France, and we would judge that of the Northern cities of this Union also, is deduced, and consequently there is no reason for surprise that it should possess little or no efficacy, or that it has caused, in par- ticular latitudes, a wide spread infidelity in all ranks of the pro- fession.! But this is very far from being the case in the latitudes of the South. The physicians here have a well grounded confidence in the powerful and certain curative efficacy of the modes of treat- ment generally followed. Disease has a fixed, certain and al- most inevitable tendency to death, and physicians have been obliged to look out for the means of counteracting it.J If active- *" I have set forth the facts, which......enforce the importance of re- jecting all army statistics, and other reports, as forming an improper foundation for great pathological and therapeutical conclusions; and have endeavored to show that all such conclusions should be drawn exclusively from the private walks of the profes- sion, where the constitution is natural, the habits good, and disease early and judi- diciously treated, and where especially, the superintending physician is, bona fide, the prescriber and critical observer, and more anxious for the recovery of his patient than for a post mortem examination. Hospital reports represent nature in her most distor- ted aspects, the treatment of disease being often begun at its moribund stages, and when the system is full of organic lesions; this treatment, is too often experimental, and without reference to fundamental physiological principles."—Paine's Institutes of Medicin". " I know," says Zimmerman, " a certain Esculapius who has fifty or sixty patients every morning in his anti-chamber. He just listens a moment to the complaints of each, and then arranges them in four divisions. To the first he prescribes bloodlet- ting ; to the second a purge; to the third a clyster ; and to the_ fourth change of air ! The same vulgar prejudice leads people to have a great idea of the practice of large hospitals. I have seen in my travels, some of the largest hospitals in Europe; anal have often said to myself, Heaven surely will have pity on these miserable victims."— ibid. f" Grace a cette philosophic, on ne tardera pas a prendre une idee plus favorable de la therapeutiqe, et nous ne rencontrerons plus, il faut l'esperer, une foule de gens du monde, et meme quelques confreres, qui nous demandent tout bas a l'oreille, et de bon- ne foi, si nous croyons a la therapeutique. Selon eux, la medecine devrait etre, jusqu a un certain point, assimilee a la science de ces augures qui ne pouvaient se regarder sans rire. Cartes, il y a de quoi s'affliger pour le vrai medicin, en entendant parler ainsi aujourd'hui de la medecine. Qu'on s'etonne apres cela, si I'homoepathre, quine vaut pas assurement beaucoup plus que la science des augures, exploite largement l'ignor- ant6 credulite du vulgaire! "—aouillaud's Essai sur la Philoscphie Meaicale. t" There is a stiong tendency in remittent fever to a fatal termination when left to nature or injudiciously treated; in some slowly, in others with great rapidity. In almost all every symptom indicating an unfavorable termimtion augments with each exacerbation. In each exacerbation the organic lesions, by which death is brought about, are increased in number and variety. There is rarely, I mean in cases origin- ally of medium severity, anything like a spontaneous amendment. Besides this reg- ular and gradual increase most generally observed, there are, at times, as has alrea? dy been noticed, sudden and unlookedfor changes for the worse, rapidly and unexpec, tedly leading to a fatal termination. In the language of Lamphiere, (Diseases in the Army of Jamaica,) "from a state apparently of little danger, without any assigna. ble cause to death, there are frequently but a few hours interval. " How different from the slow and gradual progress and the moderate tendency to death, under an expectant treatment of the continued fevers of colder regions. Few Southern practition- frs could be found to agree in the sentiment expressed by Dr. Miner, of Connecticut, An Inaugural Discourse. 23 ly employed in the practical duties of the profession, and if qual. ified to acquire knowledge by opportunities of observation, the physician will learn more of the real nature and the proper mode of treating disease, during a residence of a few years in the South or South-west, than is possible during a whole life time in most Nor- thern or temperate regions. In the former the annual endemicity of disease is one of its chief characteristics—its recurrence is looked for with as much certainty as the arrival of the summer solstice,- consequently ample opportunities for studying its nature and of as- certaining the proper mode of treating it are enjoyed. The princi- ples of treatment are therefore soon understood, and when applied to practice, they are found to be generally successful. Annually called on to encounter disease on a large scale—not in little fora- ging parties, as is the case in colder climates, but in vast cohorts that require energy, decision and skill for its subjugation, he soon learns the value of treatment, and soon acquires confidence in the resources of the profession. In the latter, however, sporadicity ia a chief characteristic of disease ; it occurs, comparatively speak- ing, rarely, irregularly and generally at distant intervals. This necessarily makes the field for observation limited and commonly unfruitful, as is proved by the fact, that the modes of treatment followed are vague, variable and fluctuating, and as a natural re- sult the physicians become more or less sceptical. When epidemics occur they commonly pay no respect to latitude, longitude or soil, and consequently in relation to them there is probably no difference, as to the knowledge possessed by the physicians of the different divisions of the globe. Nor is the ex- perience acquired in the treatment of them of much value, or the knowledge possessed of sporadic cases of apparently the same disease, calculated to shed much light on their nature or treat- ment. No physician has ever witnessed two epidemics of pre- cisely the same character, that would yield to precisely the same treatment, or that would submit to the management followed with success in sporadic cases. There is a tendency to death in a par- ticular way in each epidemic, and this the physician must discover and if possible resist. tha7 whiiTfew w^ptiona "he never saw a regular case of fever either run its course or prove fatal, that might not fairly be attributed to some obvious neglect or roisman. dement on the part of tho patient, or nuree, or physician. "-Baling on hem,tnnt 24 An Inaugural Discourse. That the principles of treatment arc nothing like as fixed or as uniform in the North-eastern and Western as they are in the South-western portions of the United States, is conclusively proved by the fact, that the diseases of the former, although less violent and malignant than in the latter, the proportional mortality amongst those who sicken is greater. In one of the Western States, with a section of which we are personally familiar, the mortality from fever in particular, considering the small number of cases that occur, is so frightful, we are very sure that were it to happen in any South-western community, it would certainly bring irrecoverable disgrace and ruin upon all those concerned in it. So far are we from shrinking from the responsibility of this declaration, we make the further and perhaps still more haz- ardous assertion, that we believe from personal observation in va- rious latitudes, that if accurate statistics could be obtained, it would be found that fever is treated in no part of the world so successfully as it is in the South and South-west.* Whether this be literally true or not it is absolutely certain that, so far from being in possession of any " great principles of patbology and therapeutics of universal application," the patho- logical phenomena and therapeutical indications of different lati- tudes and longitudes differ very widely. This being, as it must be, conceded, it follows as an irresislable consequence, that those who design to follow the profession in the South-west, should be ed- *" The general proguosis in bilious remittent differs somewhat in different localities, and in successive years of the same locality. From the authentic records of its mor- tality, it is certain that the proportional success of the modes of treatment in the South and South-west, must be greater; or that the violence and fatal tendency shown by the disease must be less, than in other malarious regions. From all that I can learn on the subject, I am not disposed to rate the proportion of deaths within our city (Charleston,) at more than one in thirty; it may exceed that amount, yet not great- ly, in the country practice throughout the Southern States. Il is not among us, then, that converts are to be made to the obsolete temporising measures of the ancients ; the medicine expectante ; the homoiopalhy of the German dreamer ; nor to the iced water, inches,muci- lage and lemonade system of the modern Frenchman."—Dickson's Practice. " Though the fevers there," Dr. Holmes remarks, " do not require such large doses of this article (quinine) as in the South, they require very different ones from those that are now given. I have known in Chester county, Pennsylvania, in a small district, one-fourth the number of patients die who were seizid with a pure miasmatic congestive fever, differing from that of Florida only in its lighter grade; yet the disease as treat- ed by army surgeons in Florida, with quinine, mas one of the least mortal, probably not more than one case in forty proving fatal.—(Am. Jour. Med. Science, for Oct. 1846.) l)r .Tosiah Nott, of Mobile, in his article on " Life Insurance at the South," says:—" We will remark in passing the low degree of mortality amongst children in Charleston compared with Northern cities. In Charleston, the mortality under five years is 31 per cent, while in Boston it is 46, and in other Northern and European cities the per centage is still greater. " The average mortality for the hist six years in Charleston for all ages, is 1 in 51 including all classes. ''—{Commercial Review.) This is a mortalii v much less than hJ met with in any Northern, or,it h believed any Wfiicrn city. An Inaugural Discourse. 25 ucated under the supervision of those who have acquired a per- sonal knowledge of the complaints peculiar to and characteristic of it. Others may speak learnedly on the subject, but they can- not, in the nature of things, teach wisely or successfully. It is be- yond dispute, that to communicate information to others on any subject, it is absolutely necessary that those who undertake to give instruction should be perfectly familiar with it themselves. To affirm, therefore, or maintain that the teachers in Northern Schools, or even those in the temperate latitudes of the United States, are competent to train physicians for the duties and emer- gencies of the profession in Southern or South-western climates, is to utter an absurdity as great, as if it were asserted that clin- ical instruction is an useless and unnecessary part of medical education. If what has been urged be true, and we invite contradiction, the pertinent question at once addresses itself to every intelli- gent mind, in what consists the wisdom or propriety, or even safety of sending young men to Northern institutions for medical instruction, if it is designed that they shall practice in the South-west? Such a course of conduct viewed in the most flatter- ing light must be regarded as palpably absurd, if not ridiculous. There, it is evident they can learn little or nothing that can be relied on as to the nature of, or the proper modes of managing South-western maladies. Nor is this the worst that is to be appre- hended. Their minds will be familiarized with much, that in- stead of being useful, will prove positively disadvantageous to them. It is a fact which the fullest experience has confirmed and established, that when such individuals settle in the lower lati- tudes of this Union, they are obliged to relinquish most, if not all, the theoretical and practical principles in which they had been indoctrinated. This will take time, and as it necessarily involves a sacrifice, and one too at which both prejudice and pride will in- stinctively revolt, nothing but the threatened danger of a for- feiture of character, and the extinguishment of all hope of rising in the profession will force them to submit to it.* The inability of Northern physicians as well as of those who re- side in temperate latitudes to treat successfully the maladies of th^ South-west, is conclusively proved by the enormous comparative *Vid. Dr. Tuck's testimony on pag^ 3, 4 28 An Inaugural Discourse. mortality which is observed amongst those who, after having resi- ded for months, in succession, in a malarious region, migrate to cold- er latitudes and subsequently sicken. From what we have actually observed, we do not hesitate to affirm that it is almost equivalent to a sentence of death, for South-western men to sicken of any acute disease, and especially of fever in any of the Northern or middle States of this Union. The reason is very obvious. The physicians into whose hands they generally fall have not seen, and consequently know little or nothing of South-western complaints. Nor is this all. So wedded are they to precon- ceived principles of pathology and practice, or in other words, it would perhaps be more correct to say, that having no settled views in regard either to the one or the other, should there be any thing so peculiar in their character as to render a special mode of management necessary, death is a too certain and common result. They are commonly subjected to modes of treatment in which those who enforce them have little or no confidence, and when this happens, the result is without difficulty foretold. This event has so frequently occured, that it is not at all uncom- mon to hear persons who reside in the South-west, but who, during the hot months go North in order, as they suppose, to escape its diseases, alledge that the latitudes to which we refer are actually more sickly and their maladies more dangerous, than those which, at home, they so much dreaded. But this is a very great error. The febrific principle remains for weeks and often, even, months in a perfectly dormant state in the systems of those who have breathed the air of a malarious district,* consequently those who protract their sojourn too far into the summer months, as is often the case, before they migrate North, carry with them the seeds of disease. *" Mais quelle est la duree reelle de la periode de latence de l'intoxication des ma- rais ? en d'autres termes, pendant comben de temps l'homme qui a subi Pinfluence de leurs miasms, reste-t-il apres avoir quitte le foyer, expose a des'maladies de nature paludeenne? Cette question a ete resolue de plusieurs manieres": M. Nepple par ex- emples'est conten'e de nier simplement cette periode de latence; Lind en a fixe les limites at 12, Baumes a 15 jours. Hamilton raconi.e que sur un battalion anglais d'environ 700 hommes, qui avaient sejourne a Walcheren, la maladie, qui avait fait tant de victimes dans cette ile, ne se manifesta que 7 a 8 mois apres le ratour en An- gleterre, et avec une telle vehemence que 21 seulement lui echapperent et qu'une cen- taine en perit. Sur 300 chasseurs de la Vielle-Garde qui s'etaient arretes 12 jours a Breskens, en 1811, ancun ne fut atteint de fievre sur les lieux memes, tandis que plu- sieurs furent frappes, un auplus tard, sur les bords du Niemen. Pour notre compte, et en consultant les nombreuses observations que nous avons pu faire en France, a des epoques et en des lieux exempts de fievres d'acces, sur des hommes venues de la partie, marecageusede la Corse, de Moree ou de I'Afrique, nous n'hesitons pas un instant a declarer que la periode de latence de l'intoxication des marais est susceptible de se prolonger audela de dix-huitmois."—Boudin's Ejsaide Geographie Medicate. An Inaugural Discourse- 27 Nor is this all. There is reason to believe, that to continue in a malarious atmosphere after having been exposed to it, is less dangerous than to leave it. It is a prevalent opinion in some parts of the country, that the pure air itself, after such exposure, is an exciting cause of fever. If so, it may serve to explain the reason why so many South-western people sicken when they go North, and it should admonish them of the necessity of observing all proper hygienic precautions.* When hundreds of miles from home, however, from a feeling of security, they too often reck- lessly expose themselves to the exciting causes of diseases which exist in sufficient abundance in all climates. They consequently sicken in considerable numbers, and being treated by those who do not understand their complaints, many of them fall victims to the joint influence of temerity on their part and ignorance on that of their medical advisers. No matter what may be the form of mala- dy from which they may suffer, it will certainly, to a greater or lesser extent, present itself, if we may use the expression, in a malarious livery. Ignorant of this, and therefore making no al- lowance for it, no corresponding modification is introduced into the treatment, it is of necessity managned in an improper man- mer, and too often unsuccessfully. The existence of the febrific principle in the systems of students of medicine, after hav- ing been exposed to a malarious atmosphere during the summer and autumn, and who have the courage to go to a cold, bleak and an excessively variable climate in search of medical instruction, is a chief cause of the sickness and mortality that prevails amongst them. It is proverbially true that in the class of individuals just alluded to, there is more sickness and mortality than amongst all others who attend the medical institutions of the North-east and West. Should it so happen, however, that while exposed to the perils of a winter residence in a cold and an inclement latitude, they nei- *" Farther it is not only alledged that one who has remained within a malaria dis- trict long enough to become affected by its influences, is more likely to be attacked by fever if he remove thence or change the air, as the phrase is, but it is absolutely proved that the consequent attack will by such change be rendered far more serious and even malignant. "......"Besides this a similar aggravation of vio- lence and danger is affirmed to occur every where, when a subject efficiently exposed to the influences of febrific miasmata, has removed during the latent period to a pure and salubrious atmosphere. This is true, as Flint tells us, of the upland prairies of the far west, and as I have more than once had the unhappy occasion to note it in our own lofty mountain regions."—Dickson's Practice. 28 An Inaugural Discourse. ther sicken nor die, doesit follow that the foundation has not been laid for the subsequent developement of ulterior and fatal maladies? Certainly not, for experience has proved it to be en- tirely otherwise. The scrofulous diathesis, though not generally suspected, is known to be almost, if not quite as common in hot as it is in cold climates, although actual scrofulous disease is in- frequent there.* This results from the fact that the exciting causes, such for example as cold and wet, do not exist to anything like the same extent in the former that they do in the latter. So long as they do not expose themselves to the action of these they rarely, if ever, suffer from scrofulous complaints. But expose a Southerner in whom this unfortunate diathesis exists during the period of a whole winter to their conjoint action, and they are unavoidable in a Northern or a temperate latitude, and he will almost certainly return home labouring under unequivocal evi- dence of incurable disease.! The soft and balmy air of the South, together with the therapeutical agency of a malarious atmos- phere will delay its progress, and in some instances effect a cure,} but this is generally a respite only, for in a majority of cases his doom is already, before he returns home, irretrievably *"It is however, a mistake not be formed in hot climates t0 suppose, that the tendency to scrofulous disease can- lhe long continued application of heat, in early life, . „,„„, .----j r '—r ,. u - *-«""""t-u appneauon oi neat, in early me, is weakening and thereiore favorable to the formation of the scrofulous habit; and it ia found by experience, that the natives of these climiles, both white and black, are peculiarly fnt? SZtUtUS :leasec whe? fey c?me i0 the colder cUmates : »om which it obviously iffcf th5 rarry of ?croflU0us diseases in the warmer regions of the globe, is the ™£™prWT ffi"? ltS eXlernal causes-i>om cold of sufficient intensity, and more especially of sufficient endurance ;-but that it is not the eflect of the absence of £«Z n%rl Pred,ls£?sltTt0 su5h0diseases, in the inhabitants of those regions "-A?i- »on's Outlines of Physiology and Pathology. h " The native inhabitants of hot regions are by nomeana, however exemot from Btruma in any of its forms. When they come to these latitudesuh™afemo^ulkctt htfn Z uJ6 °Ur-SdT ar4\. \nd ^he sa«>e effect of climate is very dTstinctly vLi- ble in the lower animals. The physicians in ordinary to the inmates of the ZooWi- w„W t>VlU te-\y us' "—Boudtn's Geologic Medicate. *" It is a gastro-enterUe, cry the disciples of Broussais and there can be no cure but the leach. It is cerebral inflammation, respond the followers of Clutterbuck, and the only remedy is venesection. Purgatives are the true treatment, proclaims the Edin- burgh School. They are irritating and dangerous, replies that of London. In fact, all are equally right and all are equally wrong if they fail to note times and seasona, the nature of the epidemic, and the characteristic tendencies of the patient's con- stitution, his powers to bear the operation of medicine, and his ability to resist the tendency to death. "—Ferguson's Notes and Recollections of a Professional Life. " And this brings me in mind of an honest Quaker of the profession, who being very ill, had three doctors to attend him, Mr. Abernethy, Dr. Blundell, and a physician whose name I now forget. Each of these had his own notion of the disease. Mr. Abernethy, " [the sepulchretum of Dr. W. B. Dudley's originality, for it is from him that he derived all that he annually doles out to his patient classes about " cky-l.opo- et-ic derangement,] "of course said, it was all owing to the state of the "digestive or- gans, " Dr.------, being a stethoscopic man, maintained that the " heart was affec- ted, " and Dr. Blundell, in the true spirit of a man midwife, declared that their pa- tient was only "hysterical." Now the patient though a Quaker, was a humorist; bo he ordered in his will, that when his body should be opened after his death, his di- gestive organs should be presented to Mr. Abernethy, his heart to Dr.------, and to Dr. Blundell his womb, if he could find one. "—Dickson's Chrono- Thermal System ij Medicine 30 An Inaugural Discourse. the medical mind. This, whatever it happened to be at the time, dictated the course that was pursued in the treatment of disease. Being of universal application " or rather being universally ap- plied," if it did any good it was an exception to and not the gen- eral result. This necessarily caused the study of symptoms and the indications deducible from them, to fall into desuetude—-the effects of medicinal agents generally could not be observed, for under the dominion of every system that has ever prevailed, the treatment consisted of a unity or a duality, and everything not included in the popular therapia was unceremoniously discarded as either useless or injurious. The uniform inapplicability of the "great therapeutical principles" which obtained vogue on the authority of systemtists in medicine, to the treatment of disease, has caused them, after a brief trial, not only to be abandoned, but it has lead to a too prevalent distrust of the powers of the heal- ing art. That the practice enjoined by systems has not in a sin- gle instance been deduced from a careful observation of the ef- fects of therapeutical agen Is in disease, but from some "great pa- thological principle" gratuitously assumed, cannot be denied. The result has been, as might have been expected, and as has been already intimated, that it has not only wholly failed to an- swer expectation—but has brought discredit upon medicine as a science, and caused a wide spread infidelity to prevail amongst those who practice it as an art. Nor have the anatomo- pathologists in their efforts, which have been directed exclusively to the localization of disease, contributed in any way whatever, to strengthen or confirm confidence in the curative powers of med- icine. They have asserted, and it is still, very generally believed by their disciples, that a knowledge of the precise seat of a dis- ease is essential to the institution of a successful course of treat- ment. Than this no assumption could be more gratuitous, and no dogma in medicine has been productive of more unhappy con- sequences. Of the seats of many diseases we know absolutely nothing, and yet we manage them with a very satisfactory suc- cess by a treatment which has resulted from experience and ob- servation only. This is especially the case with intermittent and remittent fevers, which are treated with marvellous success at the South-west. With some of their leading pathological phenomena we are, it is true, familiar, but no one conversant with them pre- An Inaugural Discourse. 31 tends to have any knowledge of their precise locality. We might mention many other affections which are in exactly the same condition as to the information that is possessed of their respective seats but which we are enabled to bring under com- plete subjugation without difficulty. What, however, has heen the result, in a therapeutical point of view, in regard to those mal- adies which the anatomo-pathologists imagine they have succeed- ed in localizing? They effect to believe and with wonderful unanimity, although equally competent judges not only doubt but deny it, that they have succeeded in proving that typhoid fever consists in follicular inflammation. What has been the result? A diminution ofthe obituary lists in Northern and tem- perate latitudes where the varieties of that form of fever are known to prevail? Certainly not, for so far as a knowledge of follicular inflammation has influenced treatment, there is suffi- cient reason to believe that the mortality from typhoid fever has actually incensed. It is certainly not less fatal than it was half a a century ago, while amongst modern physicians, those who have paid little or no attention to the lesion of Peyer's glands, which is so alarming to the imaginations of anatomo-pathologists, have ob- tained decidedly the most success. With all the pretended light that has been shed by the anotomo-pathologist upon the seat of typhoid fever, no treatment, in which a general confidence is re- posed, has been introduced by them. Indeed, in relation to the very form of fever which they have investigated with the most zeal and profess to understand the most perfectly all that is known of its treatment, is involved in vagueness and uncertainty, indecision and infidelity. Nor is this the case in relation to ty- phoid fever only. For more than a quarter of a century the minds of physicians in general, but more especially of those of Northern and temperate latitudes, have been so haunted with the idea of gastro-enteric irritation, so apprehensive of exasperating this imaginary lesion, that they have been deterred from the em- ployment of other than such agents as are supposed to be specially adapted to the treatment of inflammation. All other remedies have been condemned on grounds purely hypothetical. Even the use of purgatives, once so popular in the West, it has caused to be proscribed to the great prejudice of the art. We are well satisfied that, for a number of years, this valuable class of medicines ha* 33 An Inaugural Discourse. suffered very unjustly in professional estimation.* Finding that the use of such remedies as were deduced from this "great pa- thological principle," failed to procure such an amount of suc- cess as was expected, it was abandoned, and faith in the curative resources of the art was thus far shaken. This feeling of distrust has gone on progressively increasing until at the present moment, especially in those parts of the world where the most books are written and medicine is erroneously supposed to be cultivated with the most success, almost all confidence in its resources is destroyed. As a natural and legitimate consequence of existing modes of thinking and acting, medical expectation and homoepathy, which are only learned terms for a deeply rooted infidelity, have be- come the order of the day.t We believe it may be safely asser- ted that those who have seen the least of disease and conse- quently know less of it than all others, have arrogantly assumed the prerogatives, office and functions of dictators to the profession, and therefore, what does not quadrate with iaeir cabinet cogita- tions is discarded and denounced. The value of any given treatment, consequently, is not judged of by the actual results of experience, but by its accordance with some " great pathologi- cal principle," or its ability to stand on an anatomical basis. Thus it is that the destinies of the profession are in the hands of men who have much literary leisure, but few opportunities of becoming personally acquainted with disease as it actually exists. Their authority, however, is imperatively binding on those only, who, like themselves, see little of human suffering, and consc- * Within a few years it has been a very popular affirmation that in enteritis "pur- gatives must necessarily add to the existing irritation and inflammation. " On thia subject a distinguished Southern teacher justly remarks:—" However plausible this may seem, no prejudice can be more ill founded. Nor do I consider any point in practice better settled, than the importance and propriety of the administration of purgatives, in the case under consideration. Nay, it is asserted in round terms, by one of the most respectable of modern writers, that " if in the course of a reasonable time, free feculent discharges can be procured from the bowels, the pains will gradu- ally diminish, the pulse abate in quickness, and the patient be in the way of re^overv, and that the cure almost entirely depends upon our success on this point.' '—Dickson's Practice. tThe vis medicatrix and medical expectation are convertible terms, and read what Dr. Russell, an homoepathist, says of the former :—" If ever medicine suffer utter deg- radation, it will be brought about by means of this new school. The leaders of the rofession are engendering a scepticism in medicine which, unless counteracted, will light it to the core. Practitioners of physic will become divided into two classes,— the one believing nothing, but yet acting as if they did, and giving the countenance of their high talents and acquirements to the rankest hypocrisy; the other class believing any thing or every thing, but have no substantial grounds for their belief; cold, cultivated sceptics will be the aristocracy, and ignorant but energetic dupes of their own credulity the democracy, of this noble and glorious profession. "—British Journal of Homoepathy. An Inaugural Discourse. 33 quently have but scanty opportunities of judging of the correct- ness of prevailing opinions and practice. In the South, however, on account of the large number of cases that occur as well as of their malignancy, physicians are obliged to be active and close observers of the nature, tendency and treatment of disease, and therefore, soon discover the f-llacy of systematic assump- tions, the absurdity of "great pathological and therapeutical prin- ciples of universal application," and discarding them they by stu- dying and treating disease as Sydenham did, scon acquire con- fidence in the art. The revolution which, within the last twenty-five years, has been effected in the science, and the deplorable condition to which it has been reduced, has been in a great degree, the work of the anatomo-pathologists. They have been almost uniformly timid and irresolute, if not pusillanimous physicians,* or infidels in medicine.! Besides the fact that not one of them has ever become celebrated as a practitioner, or has, in any way, contributed to en- large or multiply the resources of the art, they have, so far as their influence has extended, served to paralyze the right of arm physic and to destroy confidence in the healing art. This has been done by those very men who repudiated all philosophy and who profess to believe that- medicine may be made, by study- ing the dead instead of the living body, to assume the certainty and precision of an exact science. The avowed enemies of theory attempted this great achievement by assuming, for example, in regard to inflammation, a " great pathological and therapeutical principle," which is as grossly fake in point of fact as it is pos- sible to conceive. First, that inflammation consists in increased vital action of the vessels, and consequently that the employ- " Ruysch, rVlalpighi and others were scarcely known as physicians; the great Wins- low trembled when heordered-a purge, and Bouillaud holds them in such horror that we have known him positively refuse to visit a physician because he had taken a ca- thartic. The celebrated Duverncy thought himself struck with a mortal sickness when but slightly indisposed: "Comment, luiditgaimentDumoulin en l'abordan. vousperclez la tete et vous vous effrayez pour si peu de chose, pour une paralle bagatelle? Helas! rephqua Duverney, c'est que, ceqneje sais d'anatomie me iait trembler...... Eh bien rassurez-vous, dit le vieux praticien, vousconnakscz certainementvetre corps mieux que moi mais a coup sur je le guearai mieux que vous."—Aube-r's I'hilosopiiie Medicate., t" So great a stumbling-block to a proper knowledge of medicine has been this ex- clusive and too minute attention to dissection, that Dr. Baillie, its greatest patron, af- ter retiring from practice confessed his total want of faith in physic. The experience of his whole life was equally a sn tire on his anatomical knowledge, and the value too often attaching to a medical reputation. "—Dickson's Chrono-T hernial System of Medicine. 5 34 An Inaugural Discourse. ment of anti-phlogistic remedies is alone indicated. Of what in- flammation, in its essence, precisely consists, we, in fact, know noth- ing. Should it, however, be present in every instance in which the anatomo-pathologist believe that it is, it is not by theoretically dedu- cing a " great therapeutical principle '* from the supposed increased vital action of the vessels of an inflamed part, that we shall be dij rected to the adoption of the proper mode of treatment. This can result only from the uniformities observed in the effects of remediate agents administered in the circumstances in which it is believed that inflammation exists. This position is established by the fact that those who have studied disease in the sick-chamber instead of the dead-house, have determined that the pathological character of what is called inflammation is not always and under all circumstances precisely the same. It is now the result of abundant experience, that in different cases—different seasons, and in different circumstances, it yields, and apparently with equal readiness, to modes of treatment that differ funda- mentally in character. These constitute discoveries which the systematist and anatomo-pathologist would never haVe made, and it follows that in but one class of cases of inflammation would they have any chance of success. That anatomo-pathologists should be unsuccessful practition- ers, and have little or no faith in the curative powers of remediate agents, is not surprising, when we reflect that, and this every thinking man must admit, they have almost invariably taken ef- fects for causes. Their therapeutical indications always rest up- on an anatomical basis, and this basis consists of the consequen- ces of protracted morbid action which throw little or no light up- on the essential nature or proximate cause of the malady. In inflammation, for example, the indication is to disgorge the san- guiferous system, but this so far from always moderating or sub- duing, sometimes exasperates the symptoms, and if persevered in, destroys life. This should long since have taught them that there is something more in inflammation than mere morbid ful- ness or increased action of the vascular system. In the face of the direst results, the thought seems never to have been suggested to them, that they have been acting upon an erroneous principle, and that practical medicine has not been and never can be improved by the course they have been pursuing* An Inaugural Discourse. 35 Their failures they ascribe either to the incurability of disease or the impracticability to abridge its course, and that it is self-limited in its character. To encourage this spirit is to impair public confi- dence in the profession, to multiply rapidly the number of self-limifr- ing diseases, and ultimately to impress the public with the belief of the complete impotency of the art. Thus homoepathy has sprung up from the seeds sown by the anatomo-pathologists, and has veg- etated so luxuriautly that it threatens to overshadow, with its in- fluence, the Northern and temperate latitudes of the United States. In those sections of the Union the allopathists are dumb with amazement and paralyzed with fear at the triumphs that have been won over them by the homoepathists. It is amu- sing, if not laughable, to hear the former ascribe this result to the stupidity and gullibility of the public, when, in fact, it is obvi- ously owing to the infidelity that prevails amongst themselves as to the efficacy of the healing art. Between medical expectation and homoepathy there is no real difference,* for they are equally impotent. But the homoepathist professes to have unlimited con- fidence in the power and efficacy of infinitesimal doses, while the anatomo-pathologist has little or no faith in physic. It is not surprising, therefore, that the public should not patronize those who have no confidence in the art which they profess to prac- tice.! It must be admitted, however, that there is a fundamen- tal and an important difference between them ;—the former makes "hope spring eternal" in the patient's breast, while the latter extinguishes the "last pale hope that trembles at his heart." This being the case, the triumphs of the former and the defeats of the latter will excite surprise in the minds of anatomo-pathol- *" On a voniu substituer a ce principe [contraria contrariis curantur] celui de similia similibus curantur. II semble que le pere de l'homoepathie ait lui-meme senti l'enor- me absurdite d'un pared dogme en appliquant la division infinitesimale aux medica- ments qu'el administre. En effet, grace a cet artifice, le danger de sa pratique, ce veritable type de la medicine negative ou expectanle, se trouve, sous un rapport, com- me non avenu. En dosant les medicaments a l'nstar des allopathts, les homoepa- thes eussent fait trop de mal ponr pouvoir trouvcr quelques partisans, "—bouiUawd's Philosophie Medicate. . . - tOne of the correspondents of Dr. Forbes, exclaims, "What more melancholy tact can be presented to the mere prescriber, when he first enters upon the duties ot his benevolent profession with the euthusiasm of unsoured philanthropy, than the contin- ued assurance of the Nestors of the profession, that the greater our experience the more positive our conviction that we can do nothing? And it only proves the im- mense force of habit that, with such convictions, we do not see men quit a profession which under such circumstances, requires a coustant exercise ot hypocrisy and a con, gtant sacrifice of principle. "—British and Foreign Medical Reaxew. 36 An Inaugural Discourse. ogists only. All others understand the cause of it, and prosecu- ting the profession in a proper spirit, they act accordingly. In the South-west, however, neither the homoepathist nor the anatomo-pathologist will find countenance or encouragement. Disease is much too violent and malignant, and the efficacy of active and energetic treatment has been too often witnessed, is too well understood, and is too justly appreciated for either of them to be able to take root or to flourish. This is impossible unless the homccpathis'; practises secretly what he has not cour- age or honesty enough openly to avew, and this it is believed he does in all latitudes, or the anatomo-pathologist abandons the an- anatomical basis of treatment, and endeavours to relieve human suile.ring by studying and analyzing symptoms and observing the effects of remediate ageuts. Since, therefore, the public in the North-eastern portions of the United States has been reduced to the desperate necessity of selecting between homoepathy and medical expectation, and as, from a full trial of both, it has been constrained to decide in favor of the former, it must appear to every intelligent and reflecting individual, at all acquainted with the complaints that result from malaria or intense heat, the most preposterous of all absurd idea-, to send young men to the North- east or West,in order to prepare them for the practical duties of the nrcfossion in the South-west. If there were no other rea- sons why this course of conduct should be condemned, {he gener- al unsuccessful^s* of the Alumni of the Atlantic and Western Schools of Medicine on their first settlement in the South-west— the frequent discovery, by them, of new forms of disease unfamil- iar to them and uncomprehended in their nosologies, but which the experienced physicians of the country recognize as old acquaintances,* and their ultimate and complete abandonment of the " great pathological and therapeutical principles of uni- versal application" which they had aeon taught, should be suf- ficient to cause the practice to be at once and forever discon- tinued. This being a populate, as we believe, hardly open to controversy, and the Southern institutions already in existence not being adequate to the wants of t\\e country, the necessity for another Medical School, io a suitable situation, for the purpose of •See Dr. Monette's statement on pa^e .">. An Inaugural Discourse. 37 teaching South-western medicine, properly so called, cannot be doubted. Although what has been already urged may be regarded as sufficient to remove all doubt from the dullest and most preju- diced minds, there are important considerations of a different kind which go to illustrate the necessity that exists for a School of Medicine, that is strictly and emphatically South-western in its character. Besides the fact that North-eastern as well as Western teachers are incompetent to qualify physicians for the , emergencies of South-western practice, the practitioners in the latter region of country need an institution in, which their claims to consideration and respect will be boldly asserted and fear- lessly defended. That these are great and peculiar, no one can doubt who has attended to the foregoing part of this discourse, yet they have not a single representative in a North-eastern or Western Schccl of Medicine. This is a faqt worthy of notice, especially in reference to the three most popular Western Schools, for they educate a very large number of physicians who ultimately settle in the Southern and South-western sections of the United States. It is useless, perhaps, to say that we allude to these of Louisville, Cincinnati and Lexington. In neither of them can a teacher be found by whom the pathological and ther- aoeutical principles upon which the treatment of South-western maladies is regulated are taught. This every sensible man must regard as a great defect in the organization of the Faculties of those institutions, for at least one half their Alumni are destined to find homes and to seek their fortunes in the lower latitudes of the Union. Nor is this all or the most mortifying or discouraging part of the truth on this subject. Whenever an occasion has arisen which put it in their power to reflect honor and distinc- tion by promotion to the dignity of a professorship, they have almost invariably preferred North-eastern men, who knew noth- ing of Western and especially of South-western maladies. That such persons are unfit for the functions they are expected to per- form, we have already shown. That they will always remain so we assert from personal observation, as we know it to be im- possible to divorce the confirmed and committed anatomo-pa- thologist from his "great pathological and therapeutical princi- ples." Two of the institutions of which we have spoken hav« \ 38 An Inaugural Discourse. been in existence for more than a quarter of a century, and yet it is a most singular fact, that from their foundation to the present moment, but two professors who had enjoyed opportunities of ex- perience in the South, have been permitted to teach in them.* What is the reason of this discreditable imputation being im- - ;d}^ cast upon South-western physicians? Does it consist in . fact that from amongst the almost countless host of those o cultivate medicine throughout the South-western States, „ "tent and able teachers are not to be found? No one be- a this and those who, by their conduct leave it to be in- 'e-rei, dare not,in plain language, make the allegation. Wheth- er, however, the charge of incompetency be directly or implied- ly preferred, it amounts to the same thing so far as their interests arc concerned, and we pronounce it to be false and indefensible. The reasons why they have not been permitted to take a more distinguished part in the teaching of medicine in the United States are obvious and intelligible, They observe and reflect more but write less than the physicians of the large cities of this :'nion,—because what they do write is for the instruction of the erofession, and not to sustain some "great pathological princi- 'e of universal application, "—because they aim to become prac- ;ally useful as practitioners, and if need be, teachers, and not : i win conspicuous stations by becoming voluminous compilers of : e results of other men's experience—because they have less e ook but more clinical knowledge, and finally, because the trade —'criticism is exercised by North-eastern men almost exclusively. The result is, North-eastern books and North-eastern men are : raised with little reference to their intrinsic merits, while South- western books and South-western men are overlooked and ne2- :cted or condemned. While this continues to be the case, it is per- ': ctly absurd for the physicians of the South or South-west to ex- ;e ict that their claims will be impartially considered—their just ngbts acknowledged, or that a national reputation will be the reward of the achievements of their brightest lustres. They have already impliedly acknowledged the authority, and paid tribute too long to North-eastern and Western institutions of Medicine, and it is full time that this should cease. Their rights have been •These were Dr. Samuel Brown and the Author of this Discourse. An Inaugural Discourse* 39 withheld, and they should now be asserted and defended. This can be successfully accomplished only through their own Schools and Journals of Medicine—through the instrumentality of insti- tutions in which the ablest of themselves are the teachers, and in publications for which the most industrious, observing and talented of them are the writers. Let union on this subject prevail through- out the South-west, and in a short time the physicians of the low- er latitudes will soon win their proper position in public respec- tability. Let this matter be viewed in its proper light) and we hazard nothing in asserting that in tert years the young men of the South-west will as soon put themselves under the tuition of Hahnemann himself or his disciples, as to go to arty Of the Schools referred to for the elements of a medical education. With a view to the promotion of what we conceive to be the interests of the South and South-west, it has been determined that with the exception of Anatomy, Chemistry, and perhaps, Surgery* the Chairs in the Memphis Medical College will be constantly filled by teachers who are personally conversant with the diseases of the region of country from which her classes are expected to come. Nor will the chairs particularly mentioned, be suffered to constitute exceptions to the general principle upon which it is intended to act, if it be possible to do otherwise. Although it may be conceded that the cause of medicine in the South-west will be subserved by the establishment of a good School of Medicine at a proper point, the question may be perti- nently asked, is Memphis the site that should be selected for the purpose contemplated? To this question we boldly respond, no city in the South-west presents so many advantages or is so suita- ble in all respects for such an institution. On the score! of lati- tude, longitude, and the maladies that prevail in this city and its neighborhood, it is altogether unexceptionable. Being sufficient- ly far South to enable those who teach in the Memphis Medical College to form a practical and familiar acquaintance with the diseases of the South-west, it is not so far South as to render the temperature of the winters so high as to interfere in any way with the successful prosecution of anatomical studies, which must be a source of very considerable inconvenience at New Orleans^ Charleston, and perhaps Augusta. On another ground the loca- tion selected is particularly advantageous. The winters, besides 40 An Inaugural Discourse- offering no obstruction to anatomical pursuits, are not so intense as to expose those of delicate constitutions who may come from lower latitudes to Memphis for medical instruction, to any risk of a deterioration of health, while it will furnish a safe refuge to those who may desire to escape the perils of the winter in a high- er latitude. This circumstance should make the Memphis Medi- cal College an object of great interest to both of the classes allu- ded to. When it is recollected that the teachers in it are, and will continue to be, strictly and in every sense of the word, South-western men, and that a large majority of those educated in the Schools of the West settle in the Southern and South- western States, the Memphis Memical College cannot fail to prove attractive to a considerable number who have been in the habit of repairing to those institutions, especially those of them who may happen to be in infirm health. But aside from such considerations which will not and cannot fail to have their proper weight with the sensible and reflecting, there may be others of some importance in determining whether or not it would be a suitable site for a School of Medicine. Though the most flourishing institutions of this kind in Europe as well as in the United States, are in cities of considerable magni- tude, something mare than a very populous city is essential to their success. Boston is a much larger city than New Haven, and yet the School of the latter has always been more flourishing than that of the former. This is the case with those of New York and Philadelphia. While the classes of the former never, until within a very few years, exceeded three hundred, for a quar- ter of a century they have ranged from six to twelve hundred in the latter. Louisville is not half so large as Cincinnati, nor has its school been in existence half so long, and yet its classes for the last two years have been nearly, if not quite, twice as large. Lex- ington which docs not contain over eight thousand inhabitants, had for many the second, and for some years the third medical insti- tution in the United States, although at present, from causes to which it is now useless to advert, it has sunk so low as to be, we believe, the tenth or twelfth in the Union. There is no reason for apprehension on account of, the size of this city, for it al- ready contains a population of ten thousand. This too, taken in connection with the fact that during the winter there is always a An Inaugural Discount. 41 very large floating population, will show that Memphis is fully able to furnish all the facilities enjoyed in larger cities.. Besides the fact that this city has grown. to its present magnitude in a very few years, it promises for the future to multiply its popula- tion in an increasing, if not in a reduplicating ratio. Suddenly as towns spring up and swell into importance in the United States, we believe there is no exaggeration in the assertion, that there ia not one, in the South-west at least, which, after having received a proper impulse derived from a knowledge of the many and great advantages of its situation and its abundant resources, has grown with such astonishing rapidity, or which promises so flatter- ingly to become in the course of a few years, not only a city of im- mense importance, but a great commercial emporium. Its present population is amply sufficient for all the purposes of a large School of Medicine, and if any advantage is to accrue from an augmen- tation of its size, Memphis promises to be every successive year an object of progressively increasing interest and attraction. Is the proximity of Memphis to other Schools of Medicine such as to render the establishment of a similar institution in it diffi- cult or impracticable? When you reflect how closely in the vi- cinity of each other are the Schools of Louisville, Cincinnati and Lexington, an answer satisfactory and conclusive will be given. Those cities form a triangle, neither side of which is more than one hundred, and two of them not more than eighty miles long, yet, judjinp; from the language of their catalogues, nearly eight hundred students of medicine are annually educated in them. Now the nearest city to Memphis in which a School of Medicine is to be found is distant about five hundred miles. Which are the States that furnish this large number of pupils to the institutions just mentioned? The Medical College of Ohio is supported al- most exclusively by Ohio, receiving but a very limited numher of students from the States of Indiana, Illinois and Kentucky. The Classes of Louisville and Lexington are made up almost ex- clusively by pupils from Kentucky, Tennessee, Alabama, Indi- ana and Mississippi. A few, it is true, are received from other quarters, but the States above enumerated constitute their chief reliance. Fiom the statistics furnished by the three Western Schools of Medicine just mentioned, we are satisfied that the States of Ken- 6 4ii An Inaugural Discourse. lucky, Tenncbsee, Indiana, Alabama and Mississippi, educate an- nually at least eight hundred young men for the medical profes- sion. Of the truth of this assertion you will be satisfied when the fact is stated, that they send about six hundred to the Schools of Louisville, Cincinnati and Lexington alone. From these States about two hundred more are scattered amongst the other schools of the United States. With these facts in view cast your eye over a map of the Uni- ted States—note the situation of Memphis, and you cannot fail to be convinced, that if three schools so closely in the proximity of each other as are those of Louisville, Cincinnati and Lexington are enabled to assemble about eight hundred students within their halls, the Memphis Medical College, distant about five hun- dred miles from any competitor and in the midst of a region of country that annually sends to Medical Colleges a very large num- ber of students, must by proper exertion on the part of those who have its administration in their hands, in the course of a very few years, receive as liberal and generous a patronage as the largest and most flourishing of the schools in the West. The city of Mem- phis is situated, we may say, at the junction of three States; i. e. Tennessee, Mississippi and Arkansas—States already great or des- tined to become so in a very few years. It is consequently more conveniently located in relation to the whole of Alabama, the Western half of Tennessee, the North and North-western por- tions of Georgia, the North-western comer of South Carolina, the Western part of Kentucky, the Southern portions of Indiana and Illinois, and the whole of Missouri and Louisiana, than any Western School of Medicine to which we have referred. The two last mentioned States, however, have schools of their own, and therefore, it is probable mere proximity to Memphis will not enable us to derive any considerable support from those quarters. But from all the other States enumerated with the exception, per- haps, of Ohio, Indiana, Kentucky and South Carolina, there is ev- ery substantial reason to believe that we shall be able, ultimately, to command a more liberal patronage than the three schools of Louisville, Cincinnati and Lexington combined. Tennessee her- self educates annually about two hundred physicians, and there a ground to believe that State pride and Slate interest will the mo ■mcc. litis decided that the Medic ed College of Memphis res An Inaugural Discourse. In prosecution of this idea another individual and myself pre- vailed on the Board of Trustees of Centre College of Kentucky, to create a medical department to be located at Louisville. A Faculty was organized, but the school was prevented from going into immediate operation by the consideration that a visit to the schools of Europe, it was thought, would enable me to enter upon the duties of the Chair to which I had been appointed with a better prospect of success, and the school would, perhaps, com- mence its career under more encouraging auspices. I visited Europe, but found on my return that the colleague upon whose co-operation I relied, had accepted a situation in an institution in a neighboring commonwealth. Thus situated, and when looking around for assistance and co-operation, I was offered a professor- ship in the Medical College of Ohio. This I accepted rather than renew efforts that had already made me an object of unjust hostility and unprovoked hatred. No sooner, however, was it ascertained that I had relinquished the Louisville enterprize than, at the suggestion of a man who subsequently deserted and punished them, those very individuals who had made upon me and upon the city of Louisville a war of extermination, began a system of machinations, the design of which was to effect the removal of the Medical Department of Transylvania University to that city. In this they were completely defeated, but their efforts, when charged home upon them by the arch traitor in whom they origi- nated, succeeded in effecting a dissolution of the Faculty and their dismission from the School. The members of the dissolved Faculty separated. One half of them remained in Lexington while the other half went off to Louisville where, in a few weeks, a Faculty was organized that commenced operations for the first time the ensuing November of 1837. This is now only nine years ago, and already the classes which assemble in that city, number between three hnndred and fifty and four hundred students. From this you discover that even though it should be possible for me to have exaggerated the inducements to undertake the estab- lishment of a School of Medicine in this city, I was not mistaken when I ventured to foretell the result, should a judicious attempt be made, to found one in Louisville. This fact is sufficient to prove that I have not laboured to inspire hopes whieh it is impos- sibla to be realized. Without, however, insisting upon your Professor Appointed—Exchanges. 47 adopting the conclusions to which I have arrived, permit me to say in all deference to the judgments of those who may be dis- posed to differ with me in opinion, that I am fully convinced that if properly directed exertion is made, the success of the Memphis Medical College will be as full and complete as that of any Wes tern or Southern institution has ever been. PROFESSOR APPOINTED. We have the pleasure of announcing to the profession, that the vacancy in the chair of Anatomy occasioned by the resignation of Prof. J. N. Bybee, has just been filled by the Board of Trustees, by the election of W. IL Donne, M. D., of Louisville, Kentucky. The experience and reputation of Dr. Donne present a suflicient guarantee of his usefulness and efficiency in the new and honora- ble position which has been assigned him, and the industry and energy which he will bring to the aid of his conceded acquire- ments, will doubtless enable him to give perfect satisfaction to the class, his colleagues and the Board of Trustees. The Faculty of this Institution being now complete, and every preparation made for the ensuing session, we shall, in our next number, publish such an announcement as shall serve to place il fairly upon the list of candidates for public patronage. Exchange?.—The Publishers of the various Medical Journals to whom this number of the "South-western Medical Ad coca le" will be directed, will oblige us by extending the usual courtesy of an exchange, and would still further add to the obligation by forwarding to us immediately, the last number of their respective periodicals already issued. We anticipate much, of pleasure and profit from the opportunity which will be thus afforded us to learn the opinions of our contemporaries in different sections of the Lnion, upon practical questions, as well as upon other topics of General interest to the profusion, TO THE PUBLIC. This number of the " South-western Medical Advocate, " it is hop"d the Publm will be so indulgent p s not to regard as a fair specimen of the character of those which are to succeed it. This is requested because the Inaugural Discourse of the Editor occupies much more space than was expected or than could have been desired. When, however, it is recollected that one of the objects of this Journal, as announced in the Prospectus, is to establish a medium of communication between the Memphis Medical College and the Medicd Public of the South-west, the length and copiousness of ita details will be palliated and excused if not pardoned. Besides giving a full exposition of the principles upon which it is proposed to conduct that Institution, we are not with- out the hope that the topics diseussed in it will prove, in some degree, interesting to medical enquirers. Our objects and aims we are desirous should be made fully and extensively known, for we are satisfied that if earnestly pursued in a proper spirit, they, and the exertions made for their achievement, cannot fail to command the ap- probation and to secure the zealous support of, at least, the South-western Medical Public. To the character of our future efforts in the cause of medical education in the South-west, we appeal for the proof of the sincerity of the professions which, after mature reflection, we ventured to make in our Inaugural Discourse. Nor can we be- lieve that our labours will fail to arouse the sympathies and procure the ardent and efficient co-operation of the regularly educated members of the profession in the South- west, especially when they call to mind the important and eventful fact that rank and reck- less empyricism. not content v;ith profaning with its unhalloued foots'ips the practical walks of a liberal and an enlighlt ned vocation, have impudently usurped iiie sacred right of dispensing its greatest honors. In future it is our intention to fill about one-half of each number with original com- munications, and these are earnestly solicited from all who are able to reflect any light upon the subjects proposed to be discussed. While those who conduct this Jour- nal wille>ort their powers to the utmost in redemption of every pledge or promise that has been made or implied, it must occur to every thinking individual, that they will be able to accomplish comparatively but little, unless their etfortj should be se- conded tind sustained by the physicians of the South-west. Nor do we ask or expect this exclusively on our own account. We confidently look for it on behalf of the just claims of an honorable and an extensively useful profession. Without thinking it neces- scry to give an inventory of the particular reasons for the position we take, it is affirmed that every regularly educated physician in the So7dh-west, tiasa direct and great person- al interest in the success of both the Memphis Medical College and the South-western Medical Advocate. We cannot believe that reflecting persons will doubt the strict truth (fthis asser- tion. To speakfurlher, more fully or explicitly on this topic is certainly unnecessary and would, perhaps, be improper, particularly as it musht to certain persons prove offensive. The other half of each number will be devoted to Bibliographical Notices, a Month- ly Periscope, Miscellaneous Memoranda and General Medical Intelligence. The special aim of each and every Department of this Journal will be to reflect as much light as possible on the causes, nature and, treatment of South-western diseases. In conclusion, the Editor would remark to his private Correspondents, that as hia personal affairs will require his presence in Kentucky for several weeks, he desires them to address him at Lexington until the l.">th of next September. During his ab- sence it i's!reqaested that all letters in relation to the Journal be addressed to Professor H. V. M. Miller, of Memphis. The Ed tor assures the Public, that although absent, hi" personal attention will be given to the South-western Medical Advocate almost, if n >> quite, as efficiently as if he were present. Memphis, July. 1*17. EDITOR