Jit re HELL (T.V.) THE a © AN INTRODUCTORY LECTURE, DELIVERED IN THE HALL OF THE PHILADELPHIA COLLEGE OF MEDICINE, OCTOBER 15th, l£49, " 96q C[iomns D. Mitral, M. 1., ..... PROFESSOR OF THE THEORY AND PRACTICE OF .^^^Wlk^^J^Jpf Jtni7\ {PUBLISHED BY THE CLASS.) PHILADELPHIA: CRAIG & YOUNG, PRINTERS, 116 CHESNUT STREET, BELOW FOURTH. 1849. /■: ' v THE STUDY OF MEDICINE; AN INTRODUCTORY LECTURE, DELIVERED IN THE HALL OF THE PHILADELPHIA COLLEGE OF MEDICINE, OCTOBER 15th, 1849, %\\ Gorans 1. y&\\t\t\\, M. 1., PROFESSOR OF THE THEORY AND PRACTICE OF MEDICINE. (PUBLISHED BY THE GLASS.) r > PHILADELPHIA: ^ J>JbJS-^-- CRAIG & YOUNG, PRINTERS, 116 CHESNUT STREET, BELOW FOURTH, 1849. S f Philadelphia, October 17th, 1849. To Professor Titos. D. Mitchell, M. D. Dear Sir, At a meeting of the Students of the Philadelphia College of Medicine, held last evening, Mr. Angney in the Chair and Mr. Zeigler, Secretary, the undersigned were appointed a Committee to wait upon you and request a copy of your very excellent Introductory Address, delivered before the class on Monday evening last, for publication. Hoping you will comply, We are very truly and Respectfully yours, &c. J. R. Bresee, J. F. Cuningham, Geo. C Burg, Wm. K. Campbell, A. W. Lobach, Martin Rizer, Isaac W. Snowden, T. Garwood Rowand, Thos. J. Keily, Jno. W. Swift, A. Marshall, Joseph A. Leonard. To Messrs. Bresee, Cuningham, &c. &c. Gentlemen, Your note of Yesterday, in behalf of the Medical Class, requesting a copy of my Introductory Lecture for publication, has been re- ceived; and after thanking you for the unmerited compliment, I have only to 6ay, that the manuscript is at your service. Very Respectfully, Yours, &c. THOS. D. MITCHELL. No. 297 Pine Street, Philadelphia, *" October 18th, 1649. THE STUDY OF MEDICINE. Gentlemen of the Medical Class, The day for introducing you to an acquaintance with the Phila< delphia College of Medicine has now arrived, and he who stands before you has been commissioned to perform the ceremony. It has been decreed by the powers that be, that a single hour is abundantly sufficient for this duty, and that while the schools around us prefer to consume a whole week with this etiquette, we will hazard the innovation of a better course, by dispatching the formality forthwith, that we may pass, without delay, to the legitimate objects of the session. Regarding me as the representative of the College, on this Introductory occasion, you will probably expect something like an institutional creed, setting forth what we hold to be the great cardinal principles that lie at the foundation of all truth in me- dicine. Such an exposition it is proposed to make at this time, and while we do not presume to identify our colleagues with every point that may be urged for your consideration, we doubt not, that an expression will be given of the leading views of this faculty, and of many of the ablest minds in the profession. The topic for discussion is vast and comprehensive; a world in a nut shell, an ocean in a drop. And yet it has been as a household phrase in the mouth of pupil and preceptor, ever since, and long before, the brilliant era of the man of Cos. The Study of Me- dicine is our theme, which, though attempted to be analysed a thousand times, is unexhausted still, and wherefore? Forsooth, 4 because its perpetual familiarity has every where induced the belief that its fundamental elements were self-evident. And yet, to this hour, no phraseology is more imperfectly understood. In the estimation of some, it would seem to have no definite meaning. They deport themselves as though it were the merest bagatelle, a thing to be bandied by every flippant tongue, as caprice or folly may dictate. No one has drawn the picture of such imbecillity, so graphi- cally, as the poet Shelley, in his Scenes from Calderon. The sketch is in the form of dialogue, and thus it runs: " Demon. And such is ignorance! Even in the sight of know- ledge it can draw no profit from it. Cyprian. Have you studied much ? Demon. No: and yet I know enough not to be wholly igno- rant. Cyprian. Pray, Sir, what sciences may you know ? Demon. Many. Cyprian. Alas! much pains must we expend on one alone, and even then attain it not; but you have the presumption to assert, that you know many, without study. Demon. And with truth, for in the country whence I come, sciences require no learning; they are known. Cyprian. Oh! would I were of that bright country! for in this, the more we study, we the more discover our great igno- rance." The reading world abounds with self-constituted Solomons, who never knew what the labor and toil of study meant. Over pages without number they have diligently travelled, it may be, by night oftener than by day, entrenching on the hours consecrated by nature to repose; but they have not studied one hour in their whole lives. This remark is, peradventure, not without appli- cation to some who are recognised as medical pupils, who, it is to be feared, study little, and read less. At such a season as this, and just in such a place as this, a more important question cannot be propounded than the one now before us, What is the Study of Medicine ? Has it any truly weighty import; or is it an ignis fatuus, a deceptive device, from first to last. If it be a veritable, vast reality, embracing some of the most momentous interests of time, and pointing its moni- 5 tory index, now and then, beyond this vale of tears, it may justly claim a patient investigation. Truth and duty compel us to re- gard it in the light of a very grave subject. At our hands, it can have no mid-way toleration. Neutral ground, here, is high treason against the best interests of the profession, and of civil- ized man. Let me, then, Gentlemen, have your patient attention, while I make a feeble, yet honest and zealous effort, to enter the secret recesses of this interesting topic, and to develope its radical prin- ciples so evidently, that the weakest intellect may comprehend its true import. What, then, is the Study of Medicine ? We respond, in very general terms, that it implies such an in- timacy with the prominent facts and doctrines of the various de- partments of the science, as will fit a man to discharge the prac- tical duties of the profession, with credit to himself, and with safety to the community. But, in order to a more explicit un- derstanding of this very important query, we propose to inquire, briefly, into several fundamental items which have too long been obscured and mystified. If these be duly cleared of the rubbish that has concealed their true character, we think it will not be a difficult task to decide, intelligently, the question now under con- sideration. Do not mistake our meaning. A boastful spirit that claims superior light, and a fee simple in the unknown territory of infallibility, is not our moving spring. Yet we do hope by the use of plain English, unfettered by the tinsel drapery of a taw- dry rhetoric, to impart such views as will awaken a spirit of inquiry and lead to benign results. We inquire, in the first place, whether the study of medicine consists in reading, merely. Does it follow, as a thing of course, that a man must be well versed in medical science, because he has read every page in a thousand volumes ? And here, let none mistake us, and conclude, that we are so much in love with our vocation of teaching medicine by public lectures, as to repudiate the just value of reading. We never doubted that a medical pupil could derive much advantage from a well ordered course of reading; in fact, we hold this to be indispensable. But, when a young man takes a book in hand to read against time, so that he may boast of the hundreds and thousands of pages he has travel- u led over in a week, we demur to the utility of the labor, and are compelled to decide against the judgment prompting to such a waste of time. It is labour lost, for labor it certainly is, and justly merits the well known obstetrical distinction of laborious labor. We knew a medical pupil, in our boyish days, who read the whole of Cullen's large quarto volumes on Materia Medica, in less than a week; not once merely, but twice through and through. It was his initiatory effort, and he hoped to make a capital beginning. His preceptor made a few inquiries, to deter- mine, how far the young man comprehended the author; and very soon discovering that he was utterly ignorant of almost every point, very wisely directed him to retrace his steps. It will not be denied, that some who are called medical stu- dents, do not possess a sufficient amount of mental capacity to comprehend the meaning of the works placed in their hands. Their memories, it may be, are exceedingly retentive. They can repeat much of the text, and may therefore be able to answer with apparent ease, not a few questions that may be propounded. Being mere memorising readers, and incapable of appreciating the course of argument, they rely wholly on the quantity of mat- ter through which they laboriously wade, and of which it may be their pleasure to boast. Now, it must be abundantly obvious to every reflecting mind, that reading, ad infinitum, (if that were possible,) in the manner just adverted to, can have no claim to the character and dignity of study. A parrot can be taught to repeat words and sentences, on the principle of imitation, and were it practicable to pro- nounce a long oration in the same way, none of the auditors could mistake the effort and regard it as the bird's own produc- tion. And of how much more real value is the acquisition of him, who predicates his medical learning on the possession of many books, and the hasty reading of every new work. To study, something nobler far imports Than to possess a library of splendid tomes With backs and edges brilliant as the Sun, And all arranged in glittering cases, Beauteous to the eye. In such society, E'en Balaam's long-eared courser might appear To be exceeding wise. 7 It is due to truth to say here, very explicitly, that much of the evils incident to the mere reading of medical books, attaches itself to the neglect of private preceptors, or their ignorance in regard to the proper mode of conducting the studies of young men who enter their offices. It is the duty of all such persons to designate what books shall be read, and how much in a given length of time, and to ascertain, by proper inquiries, whe- ther the authors so read, have been studied and their import comprehended. So long as this kind of care is not bestowed, of what real value is the rule adopted and published by the schools, that in order to become a candidate for graduation, a man must have read or studied medicine for the space of three years ? As this important matter is now managed, in many parts of our country, the three years of study or reading, so generally re- quired, are made up of most incongruous odds and ends, that have far less bearing on study, than on the preceptor's purse. And yet, the young man is called a medical student. He reads a lit- tle in Cullen, or Watson, or Gregory, just by way of variety and to kill time. He pours deliciously over all the love tales in the weekly and monthly journals, and so thoroughly and inwardly digests them, that they seem to enter into his very nature; pos- sibly he rolls a few pills and mixes a julap now and then, (not al- ways, however, secundem artem,) and takes his turn at making entries of visits and medicine in his preceptor's day-book. Not a question about theoretical or practical medicine, is he asked, in the two or three years, during which, he has the credit of reading medicine in Doctor A. or B.'s office. Who can be so blind as not to see, that the study of medicine, and such a system of reading, are two very different things. But, we inquire, further, does the study of medicine consist in attending lectures? This may be regarded in the light of a delicate question. Most assuredly, we who hold the post of teachers, cannot consistently decry such an exercise. We are decidedly in favor of a rule that would require every person called a medical student, to attend at least two courses of lec- tures, and yet it is our deep conviction that the study of medi- cine means more than all this. We are aware, that the National Medical Convention of 1847 attempted to rectify what was re- garded an error in respect of medical lectures, in the expectation 8 that the suggested corrective would add to the intrinsic value of medical studies. A recommendation was sent forth to all the schools to prolong their sessions from four to six months, on the ground that too much matter was compressed into a four months' course for the human mind properly to digest. But, Gentlemen, a pupil may register his name for two full courses of lectures, each of six month's duration nominally, and so acquire a reputation for attending lectures, when, in fact, he may not hear one entire lecture, nor listen in such a way as to derive any solid benefit. His attendance on lectures and his reading may be conducted on the same principle; that is, on no principle at all. For final success in the green box examination, he trusts to family connexion and influence, or to the kind feel- ings of some prominent member of a medical Faculty, idly dream- ing that any defects he may realize after graduation, will be fully met by the details of practice. Hence he attends lectures and reads, if he read at all, without incurring the drudgery of study. Let me tell you, Gentlemen, that if a young man, possessed of good mental powers, and these properly disciplined by preliminary education, will do what he can do, he will learn more of medical science by attending one four month's course of lectures, even though there be seven lectures a day, than the indolent and idle pretender to study can acquire, whose name is twice enrolled on the matriculant books of a school that boasts of its six month's term of instruction. Hence it happens, that some men become more thoroughly versed in medical science, by hearing a single course of lectures, and by studiously reading for even less than a year, than others who have lounged in medical offices for three or four years, and have been published in catalogues as regular pupils of three sessions. It is the fixed purpose of the pupil, and not the rules or recom- mendations of medical conventions, that can make medical lec- tures available. By no system of legislation can young men be compelled or persuaded to do that, aside from which, every species of rule and every form of discipline, must be inefficacious. Many of the most respectable and intelligent Physicians of the United States acquired their education, partly, by attendance of seven lectures a day, during sessions of four months. But they did something more than attend lectures. They pondered well on 9 what they heard; they thus made the truths imparted, their own; in short, they studied. The medical pupil of the present day has advantages and facil- ities that were neither known, nor thought of, forty years ago. His attendance on public lectures is now a pleasing duty, com- pared to what it would have been, had he lived in the times when diagrams, and paintings and models formed no part of the plans of teaching. Then, the labor of study, to make a course of lec- tures profitable, was much increased by the lack of the expedients referred to, and which now make the same exercise, a sort of recre- ation, to the man who seeks after knowledge, as for hidden trea- sure, determined to make the pearl his own. The name of attending lectures, is well enough, as far as it goes. But the reality of attending, is far more desirable; better still, the well formed habit of studying with care, daily and hourly, all the lessons imparted during the entire course. Never forget, that mere attendance on lectures, is not the Study of Medicine. Nor, can the advantages to be derived from seeing patients of all descriptions, in private practice, or in large hospitals, be a substitute for the study of medicine. In its appropriate place, clinical instruction is of great value, but unfortunately, it is often sought at the wrong time, and under circumstances when its merits cannot be appreciated, nor turned to a profitable account. Young men, sometimes at their own suggestion, and occasionally under the advice of bad counsellors, seek this kind of knowledge, at the very outset of their pupilage. They seem to think, that all they have to do, is to become practitioners, and the sooner the end can be reached, the better. Thus misguided, some pupils have spoiled their collegiate tuition, by taking the practical tickets only, in their first attendance on medical lectures. The elementary de- partments that confessedly constitute the basis of all sound know- ledge in medicine, are deferred until the next session; and ere that arrives, the young man makes the discovery, that he began at the wrong end. To see patients and to prescribe for their maladies, is the con- summation of medical studies. It is the end, and not the means or way to that end. Hence, the folly of attempting to begin the study of medicine, by greedily seizing every opportunity to watch 2 10 the progress of disease. The youth has yet to learn, that in order to judge correctly of the nature of the derangements of a machine, he must first be conversant with its structure, with the functions of the more important parts, and the laws that regulate the whole. The bed side is the last place for the accurate study of anatomy, physiology, materia medica or chemistry; and in order to be qua- lified to form an opinion of the value of a symptom, or the efficacy of a prescription, he must learn somewhere else, what go to make up the great elementary truths, the substrata of medical science. Often have I been amused to watch the anxiety of pupils to be first at the bed side in the .Pennsylvania Hospital, and to note down every word, and especially every prescription of the attend- ing physician; when, in all probability, some of them did not know whether the great foramen of the skull led to the stomach, or to the cavity of the spinal column; whether the heart was in the abdomen or the chest. Why, gentlemen, I knew a man, a veritable green-horn, who, although he had been a practitioner for eight or ten years, was most profoundly ignorant of elementary facts. He visited a celebrated school for the avowed purpose of attending its lectures, and his name was duly placed on the regis- ter. But it was soon discovered, that his main anxiety was to see patients, to have the full benefit of clinical instruction. Although he had been a practitioner, he desired to become more perfect, and hence the idea of a hospital was constantly before him. It was in the month of October; and most unfortunately one Pro- fessor was laboring with all his energies to unfold the mysteries of Physical diagnosis, while another was attempting an outline of medical jurisprudence. The man looked, at first, a little scared, presently somewhat wild, and certainly, more than embarrassed; and, in a few days, the Janitor reported of him, non est inventus. The frightened bird had flown, and, lo! when the inquiry was raised, it turned out that the poor fellow had lost his wits amid the din and confusion of physical diagnosis and medical jurispru- dence ; for until then he had never heard the subjects named. "A place for every thing, and every thing in its place," is a maxim that commends itself to the common sense of every man; and yet, how frequently is it overlooked or forgotten by medical pupils and their advisers. The fitness of the elementary branches of medicine, as the foundation of medical knowledge, is so obvious, 11 that 7one would suppose, no reflecting man could fail to perceive it. Yet, we are compelled, ever and anon, to lament the folly of a course that wholly inverts this natural order and relation. But, if neither of the substitutes of which we have spoken, can come in place of the study of medicine, much less will it serve the end in view, to be called and known by the name of a medical student. There is melody, it is said, in this cognomen, and espe- cially so, to those who have abandoned some other avocation, in the indulgence of lofty aspirations for eminence and distinction. Oh how the bauble fame bedims the vision! The plough has lost its charms, the work-shop can be tolerated no longer. A snuff of the breeze at the vestibule of the temple has fired the man with an inextinguishable desire to dilate his lungs, and to in- vigorate his whole soul with the balmy breath of science. To be, or not to be a Doctor, that is now the question, and the only point that claims consideration; and hence the glory of being called a Medical Student. Far be it from us to censure such transitions as those to which we have just now referred, provided the parties possess strong mental powers, and have enjoyed the advantages of education. To all such we tender a hearty welcome to our halls of medicine, and will cheerfully back their zealous efforts to gain the boon they seek. But we warn them, not to rest satisfied with the name of being a medical student. If they intend to rise above the nothing- ness of ciphers, they must give their whole soul to study, improve every hour, make the most of every opportunity. There are those however, who, overlooking the importance of a correct course of reading, and a proper attendance of medical lec- tures, seem to think, that every thing is gained, if they can but procure a medical diploma. Is it not a little singular, that a young man who knows well that he is extremely ignorant of medi- cine, in all its departments, should be solicitous to have a parch- ment awarded to him, on the face of which a recorded falsehood meets his eye, whenever he gazes on it, and which though signed and sealed officially, is utterly worthless as a substitute for, or as evidence of the study of medicine ? Why, Gentlemen, it seems to me, that a man must feel ineffa- bly mean to accept a diploma, even if attempted to be forced on him, under such degrading circumstances; and yet, how often is this outrage perpetrated ? 12 But think you, that a parchment, however bedizened with rib- bands, red, blue and white, and the broad seal of official authority stamped on it, can long stand in the place of the study of medi- cine ? I tell you nay. A fool, with a diploma from every medi- cal school on the face of the globe, and all of them stowed away most carefully in a gold case set with diamonds, would be a fool still. It is not in the power of all the medical faculties on earth combined, to give one man brains, or common sense, or medical knowledge, by a mere certificate which makes the essence of a diploma. From the depths of my soul do I pity the youth who wastes his precious time, squanders in idleness and folly, if not in vice, the generous gifts of parental kindness, and although called a medi- cal student, never studies; who is oftener out of the lecture room than in it, and who hopes to make full amends for all this insan- ity, by taking his chance for a diploma, in the crazy lottery of his erratic course. Far greater is the wisdom of the disciples of Aberdeen, who without the delay of a sham attendance on medi- cal lectures, or the pretence of reading, purchase the parchment for a few pounds, and so, without even the name of study, become, in law at least, Medicinse Doctores! This zeal for an official certificate, to compensate for the con- scious want of the thing certified, has evinced itself in more ways than one; and all the facts serve to prove the strong desire of some, to put the diploma in the place of the study of medicine. I knew a man who professed to have graduated in Edinburgh, but whose utter ignorance of medicine was the surest evidence, either that he had not received a degree, or that he was not worthy of it from any school. He was a fool and a sot into the bargain; and yet had learned enough of the weakness of the popular mind, to be prompted, somehow or other, to procure a diploma. An opportunity presented of gaining the boon, by a very brief course of study; in short, he stole the document filled with another's name, which he obliterated by means of oxalic acid, and in the blank, had his own name written. Thus, he became an M. D., just as fast as theft, oxalic acid, pen and ink could operate; but he was not, and probably never had been a student of medicine. More than this. It is certain that the Latin certificates of mem- bership in medical schools have been exhibited as real diplomas 13 and proofs of finished professional education. Possibly the own- ers of these documents had attended but partial courses of lec- tures, and taken tickets only in the practical departments. They were determined on obtaining practice at all risks, and hence the deception referred to. This device and the kindred effort to pass for graduates, without ever having heard a lecture, prove conclu- sively how strong and prevailing is the desire to put a mere cer- tificate of knowledge in the room of knowledge itself. Much more honorable is it for a young man to read assiduously for the space of three or four years in the office of an intelligent and judicious private preceptor, and then to enter on the duties of practical medicine, without ever having heard a medical lecture or seen a diploma. Such men are to be found in various parts of our land, and they are sometimes recognised as among the most successful and well informed physicians in the neighbourhood. And we learn from all the facts, that while the want of a diploma does not necessarily imply professional ignorance and incompe- tency, neither does the ownership of such a document prove that its possessor ever knew what it was, to engage in the study of medicine. And here allow a suggestion in reference to the use of the Latin language in diplomas and medical certificates, generally. What- ever may have given rise to this mode of setting forth medical qualifications, it is quite obvious that abuses have frequently attended it. Let the evil be abolished by the substitution of plain English, so that the humblest peasant may read and comprehend the true intent and value of the document. The University of Virginia has placed before the Schools, an example worthy of imi- tation. And now, Gentlemen, you may be ready to inquire, in what does the study of medicine consist, if not in reading, nor in at- tending lectures, nor in seeing patients, nor in being called a medical student, nor in getting a diploma ? Perhaps we may reach the merits of the question, most certainly, by noticing with appropriate brevity, a few things which it seems to pre-supposc And first, the study of medicine pre-supposes, that the person about to study, has a mind and heart fitted for the object. These may be regarded as absolutely essential to a pursuit, having as its ultimate end, the practical duties of the profession. But who 14 shall judge in this matter? Is the youth competent to the task? Are his parents the proper arbiters in such a case ? Here is a point, which the laborious efforts of the various com- mittees acting under authority of the National Medical Conven- tion, have entirely overlooked; or if they have noticed at all, it has been incidentally alluded to, and not honored with that special regard, to which its merits entitle it. We contended, in an ad- dress published nearly thirty years ago, that one of the chief defects in medical education, was the neglect of the points now before us; and we are confident, that compared with these, all the objections raised to collegiate instruction are less than the small dust of the balance. On this principle, we have felt it our duty to act, in regard to a candidate for the place of medical student, and to reject the applicant, because his intellect and moral quali- ties proclaimed his unfitness for the study or the practice of medicine. The bedimming influence of self-love, and the false bias likely to be exerted by parental weakness, forbid that either the youth or his parents be the judges in a case of the kind now under con- sideration. And we do not believe, that the task can be as pro- perly discharged by any one, as by a judicious private preceptor. He is to be the instructor, if the youth is to be, in fact, his pupil; and the contemplated relation constitutes him the only right judge of qualification. Let it be supposed, for a moment, that every young man desi- rous of becoming a student of medicine, was the subject of the examination here contemplated, and that the examination being faithfully made, no youth could be matriculated at a medical school, who did not carry with him a certificate setting forth the facts, accordingly. Would not our schools present a very dif- ferent aspect from that now exhibited; and would not the fruits of collegiate instruction be vastly more signal, as well as more beneficial to the great interests of the profession ? Who can doubt for a moment ? The course proposed to be adopted, strikes us, as it has ever done, as the truest exemplification of beginning at the beginning, in the important work of medical tuition. Does it need a particle of argument to prove, that a man with- out mind and with bad morals, never can become even an en- durable physician, unless a miracle bo wrought in his behalf? Is 15 it possible to make a passable reality even, out of a mental non- entity, made worse by moral delinquencies? And yet, in the face of these palpable absurdities, our country abounds with phy- sicians who do not hesitate to send just such characters, for the purpose of becoming pupils in medical schools. Nay more; there are some who have furnished this kind of materials to the colleges, and have urged professors to pass them through the final ordeal, who have been among the noisiest declaimers against the laxity of faculty examinations. We beg such fierce advocates for thorough train:');?, to start aright in their own proper duty, and then it may be hoped, that the official acts of Professors, done under the solemnity of their oaths, will be more acceptable to the profes- sion. The secret of the difficulty lies here. A physician of some- what lofty aspirings, determines to be the great man of his neigh- borhood. He is bent on having more patients, and more pupils, than any of his competitors. Every body is soon acquainted with his wishes, and he is gratified abundantly. This patient and another, whose influence he cannot afford to lose, has an imbecile son, who never could master the multiplication table, and much less, learn the difference between an angle and a triangle; but as the lad is a seventh son, or because his dear mother dreamt that her boy was a Doctor, he is doomed to be added to the list of nominal students in the popular shop of the village. There he is, a mere automaton, only a little worse; for, acting out the pro- pensities of his nature, he is the centre and soul of all the law- lessness of the place. He goes to college, and again he goes; and by and by, the final hour arrives in which he is to be exam- ined, as a candidate for graduation. His preceptor has been wide awake to all this pantomime and farce. The candidate is a son of one of his best paying and most influential families. For their sake, it will not do to permit a catastrophe so sad as the rejection of the candidate; and besides, his own ambition could not endure the shock of such a calamity. To prevent, therefore, a result which he is conscious would be simply an act of justice, he writes to one or more of the prominent members of the Faculty, imploring that such a terrible issue may be averted; in short, that this depraved dullard may be honored with a diploma. A distinguished teacher in one of-the largest schools in America 16 assured me, that he had received just such letters, on just such a theme, and from a man too, who, in less than six months after, was exceedingly clamorous for medical reform. Now, be it known to all men, that we whose province it is to teach in medical schools, have never raised an objection to large classes. We can just as well, indeed far more comfortably, teach five hundred as fifty pupils, and upon the whole, I suppose the larger number would suit my colleagues best. But really we prefer, if a preference may be conceded, to have pupils who can compre- hend our instructions, and whose deportment will be an honor to the institution, rather than a reproach in the community. To all this, we feel assured, every intelligent and honorable pupil will give a hearty Amen. But, in addition to the possession of native mental powers and proper moral qualities, the study of medicine presupposes, a suit- able culture, by preliminary education. And there seems to be a very general agreement, that some kind or degree of education is really necessary, as a preparative for the study of medicine. The point of difference refers to the extent of education essentially needful and indispensable. By not a few it has been contended, as it was argued in the National Convention of 1847, that medi- cal education should be based on nothing short of a complete col- legiate course. Some appeared to think, that a good Latin and Greek education was absolutely requisite. And it will be seen, on reference to the printed minutes of the Convention, that those languages were insisted on, so far at least as to enable a student to read with ease, all the varieties of prescription that are found in the Latin language. We are decidedly in favor of preliminary education, and have strenuously contended for it, publicly and in private, for more than thirty years. When a pupil in the palmiest days of the University of Pennsylvania, we had certain knowledge of the fact, that preliminary education, even then and there, was too much overlooked. The evil continues, and possibly, it is on the in- crease. How shall it be met ? That a medical pupil can be too well educated, none will dare assert. Were he familiar with every language of the globe, and deeply versed in all the departments of the arts and sciences known among men, who believes he would make the worse Doc- 17 tor, for his unbounded erudition ? Not one, who is sane enough to resist a commission of lunacy. But some will tell us, this is not the question at all; that the point to be settled is, not what amount of learning a student may acquire without being thereby spoiled for the task of studying medicine; but what is the minimum of education that must be imparted to a youth, as preliminary to such study ? And we are told in this connexion, not without force either, that the circum- stances of the East and the West are so widely dissimilar, that a rule suited to the one, may not be exactly just and proper for the other; that the comparative infancy of all Western institu- tions of learning is a valid reason, why the educational standard for students of medicine should not be so high in the West as in the East. And some will point us to Abernethey and John Hun- ter, as two of the most illustrious names in the profession, and tell us, as they may with truth affirm, that neither the one nor the other enjoyed the advantages of a classical education. Let it be so; and with all this and even more cheerfully con- ceded, we contend, as in former days, that no young man, East or West, North or South, should be admitted as a medical pupil, with any qualification short of a very respectable acquaintance with the English language. He should be able to comprehend any ordinary work written in his native tongue, and to write cor- rectly in the same. If he be not, in the usual sense of the term, an English Scholar, rest assured, the profession can get along without the addition of his name to the great roll. I am well aware, that some of the extra zealous reformers of the day will denounce the standard of education here suggested, as quite too low. " What! only a good English education, for a Doctor ? that will never do; it is impossible for the profession to maintain an erect position, without Latin and Greek props to hold it up." Softly friends, if you please; you may have forgotten, that some of the advocates of the dead languages, who never learned them, and not a few who were really, in some sort, taught the classics, cannot write ten lines of English, correctly, on any subject. It is well known, that professional men who perpetrate the most abominable outrages on the English language, in their med- ical Essays, are generally unconscious of the glaring defects which 3 18 strike the discerning eye as offensively, as would a wine-bud on the cheek of an otherwise lovely female. I am acquainted with a gentleman of this description, who places a very high mark on his merits, and especially on his college education, who has been moved more than once, to glorify himself in the public journals of the profession. An editor, who I presume did tell the truth now and then, assured me that this gentleman gave him immense trouble with his papers. Said he, "there is not a particle of ori- nality or interest in any thing he writes, and then, I am compel- led to copy the whole, before it is fit for the printer's eye. Gram- mar is violated and orthography murdered in almost every line; and yet, if I did not publish for him, his displeasure would be in- curable." It has occurred to me, that if a few of these very ori- ginal papers were permitted to go to press in their new-born style, the virgin dress untouched, more would be gained for the cause of preliminary education, than has ever been achieved by the re»> ports and resolves of Conventions. "Oh ! wad some power the giftie gie us. To see oursels as ithers see u*." By far the worst Thesis, considered as an English production, I was ever obliged to read, abounded with Latin and even Greek quotations. In vain was the paper returned to the candidate for correction. It might have been made more redundant of classic lore, but to render it any thing better than a caricature of the Anglo-Saxon, was impracticable, on the very simple principle, that if you add nothing to nothing, there can be neither increase nor improvement. It may be said, that it would be difficult to ascertain in every case, the nature and extent of a young man's preliminary instruc- tion. This objection is void of force, because fully met in the salutary method pursued in the examination of candidates for the post of Assistant Surgeon in the Navy. The trial in these cases commences with the lodgment of the candidate in a room by him- self, where his reflections may be undisturbed. He is furnished with a sheet of paper, having a theme written as a caption on it, upon which he is to write his views as far as the paper will afford space. From books of every description he is excluded; and whatever he may be able to write, must come from the cogitations of his own mind. 19 Notice if you please the ends accomplished by this very simple kind of exercise. It serves to display the true autograph of the candidate, his powers of English composition, and his knowledge of the medical subject presented for investigation. And, if in all respects, the performance be positively discreditable, the ex- amination proceeds no further, and the candidate is virtually re- jected. In this, we discern most obvious propriety. Assistant Surgeons are bound to hold frequent correspondence with [the Medical Bureau at Washington, and their communications are open for inspection. And as ours is placed among the learned professions, it would be held positively disgraceful to have docu- ments filed there, written in a scrawling hand, in the true zig zag or worm fence style, with every other word offering violence to orthography and the rules of grammar. Now I ask, can there be any impropriety or indelicacy, or any thing like Avrong, in applying this plan to all young men, who propose to become students of medicine ? Certainly not. Every private preceptor can, with little labour or loss of time, ascertain all that is desirable touching preliminary education. And no pe- riod is so suitable for such an inquiry, as the very moment when a parent offers his son, for the place of Student. Unhappily for the profession, the only show of an examination now made into the literary acquirements of a medical pupil, occurs when it can avail nothing, or be defeated with great ease. The candidate for graduation is required to present a thesis,, and it is expected to be correctly written. But, every one one knows, that this is no test at all, of preliminary education. And the sooner the example of the Navy Board is followed by medical preceptors, the better will it be for the interests of the profession, and the welfare of the community. A very important end gained by preliminary education of the right stamp, is the formation of right habits, the putting forth of systematic efforts. The youth who enters on medical studies with these advantages, in advance, carries to the task a mind more or less disciplined as it should be, and the difficulties in his way shrink beneath his grasp. He feels that he has made a wise be- ginning, and lie has no fears for the issue. A sound, well bal- anced mind, trained and invigorated by the mellowing influent 20 of education, and backed by a determination to excel, can hardly fail in any good enterprise. The Study of Medicine, rightly understood, pre-supposes, moreover, a regular systematic training, during the entire period of pupilage. We have already hinted at the duty of private pre- ceptors in this relation, and shall here be very brief. We desire to record our testimony in favor of a stereotyped resolution for all future national medical conventions, which shall make it the imperative duty of every physician in the land, to require ample intellect and good morals, with the advantages of a sound pre- liminary education superadded, as indispensable to the reception of a youth as a student; and all these to be backed by his own regular efforts to train the pupil in such a way, as to fit him for attendance on medical lectures. Were he thus engaged in his own proper sphere of private preceptor, he would find neither time nor occasion for noisy declamation at the faults of public teachers. We do not deny, that some men have become excellent prac- titioners, who never enjoyed the benefits of such a system of training, as we hold to be essential to the proper study of medi- cine. Such persons are exceptions to a general rule, and their industry and perseverance merit high commendation. Still we maintain that the more correctly and thoroughly a student is instructed in the private office, the more likely will he be to profit by public lectures, and the more useful will he be, as a member of the profession We add, finally, as a thing pre-supposed by the Study of Me- dicine, the importance of ample and efficient collegiate instruc- tion. It is too late in the day, to speak of the all-sufficiency of private teaching, in the work of medical education. We know full well, that good physicians have occasionally been formed in this way, nor do we deny, that the same result may be achieved by the same means still. But, the experience of the entire civil- ized world has abundantly shown, how vastly superior to the best private efforts, are the matured plans of public teaching, that are now adopted in all countries where medicine is cultivated as a science. It required but little reflection and discernment to make the decision, whose justice has been corroborated by ample expe- 21 rience, that nine-tenths of all who study medicine can be more thoroughly indoctrinated through the medium of the sight and hearing combined, than by the help of the eye alone. Hence the preference given to lectures with accompanying demonstrations. We have hinted at the question so seriously agitated of late, touching the length of our collegiate sessions, and have expressed a preference for the term of four months, instead of six. We believe most firmly, that the best interests of the pupil and finally of the profession would be advanced, if each student were required to attend three full courses of lectures of four months each, preparatory to examination for the degree of M. D. By such an arrangement, the probability of a much more extended course of reading than is now required, would be secured; and in place of sixteen or twenty months of nominal study, the can- didate should be obliged to wait the full period of three years, before he could be permitted to offer for a degree. I am aware that the written laws of the schools call for three years of study as a qualification for final examination, but I know too, that this is a mere paper manifesto, in many cases at least. A prominent professor has admitted pupils into his office in October, and allowed them to be candidates in seventeen months from that date. In truth this violation of rule has been so frequent, that I would not name the instance cited, but for the fact, that the gentleman alluded to has quite suddenly made the discovery, that the profession has most awfully deteriorated, and greatly needs reform. Whatever may be the length of the course of lectures, it is the duty and interest of the pupil to hear every lecture through- out the term, and to reflect carefully on all that he has heard, at the close of each day. If he be a ready writer, and can record in a note book, the more important matters discussed, without losing any valuable ideas by the effort, he will derive profit from the exercise. Notes, thus made, will be good refer- ences, when he is about to review the subjects that have occupied his mind in the lecture room. The speaker knows from his own experience, and from abundant opportunities for observation, that an industrious pupil can find time to review all the lectures of the day, and take an hour for pedestrian exercise, and have ample time to recuperate his jaded energies by sleep. The healthful */-■) balance, thus established between the mental and physical powers, has often exerted a most salutary influence on constitutions apparently too frail to embark in the enterprise. We have endeavored, Gentlemen, in this discourse, to show what the Study of Medicine is not, as well as what it is. Our remarks have presented only an epitome of the subject, and have necessarily passed by many of the details that really constitute a part of the theme. The time allotted for this exercise forbade a more extended investigation. Quite enough has been brought to view, however, to give you some just impressions of the mag- nitude of the great business that has brought you hither. You perceive that not an hour can be spared for dissipation or frivi- lous amusement, from the entire session on which you have entered. Every moment, save the time demanded by the laws of Nature for invigoration and repose, should be pledged to study. The first week or two of attendance on lectures may be irksome and even oppressive to the novitiate; but as the mind fastens on the varied topics that are pressed upon it, the tedium will vanish, and the spirits regain their native buoyancy and vigor. It will be our constant aim to invest every topic with appropriate inte- rest, and to present truth in such a clear and alluring style, as to press all your powers into the service, in the confident expectation that full success will crown your patient efforts in the noble cause in which you have embarked. Call not on Hercules for help; his aid Ne'er serves the man, who will not serve himself. Thine own arm must the conflict meet, Thy purpose being the victory. Every medical pupil on the globe may be regarded as a candi- date for the world's patronage; and if by a proper course of study such as we have ventured to delineate, he become fully qualified for the diversified duties of professional life, it matters not whether he be called to spend his days on the burning sands of Africa, or in the blood-chilling regions of the North Pole. Not a youth within the compass of my voice, can tell where his lot will be cast in 1860. China, Yucatan, California, Greenland, any spot on the vast theatre where disease and death make their impress, may claim pupils from this hall, to be ministering angels in the chamber of suffering and sorrow. Conversant with the 2:4 great principles of medicine, as founded on the patient study of the human economy, and with the prominent facts of the science, as they have been confirmed and developed in all latitudes, you will be ready for service at a moment's warning, may acquit your- selves triumphantly, and reap the just recompense of industry and fidelity. Our science, Gentlemen, was made for the race. It scorns sectional limits, and laughs at all the puerile attempts to force it within the unnatural boundaries of geographical re- striction. Study medicine, therefore, as it deserves to be studied, as the claims of humanity require you to study it, with intelli- gence and unbroken constancy, under the abiding conviction, that however erring men may overlook your short comings and derelictions of duty, there is one tribunal whose scrutiny you cannot escape, where character and conduct are weighed in the balances of infallible justice. Deporting yourselves habitually in view of a standard thus elevated, it matters not whether a wise Providence shall point you to the North, to the South, to the East or to the West. With clear and well stored heads, with honest yet sympathising hearts, and a purpose to discharge your sacred trust, that death only can annihilate, you must, you will succeed. In conclusion, Gentlemen, allow me to say a word with special reference to this School of Medicine. To disguise the fact, that efforts have been put forth to stunt its growth and to kill it outright, would betray a sickly sensibility, unbecoming the cause of true science. Not the most insignificant feature in the hostility referred to, is the attempt to force the impression, that graduates of this College are grossly defective in professional knowledge, and, by consequence, that their teachers are incompetent. Touching the last item, I have nothing to say at present. But in respect of graduates, here and elsewhere, I have acquired a sort of right to speak out. Nearly twenty years of official con- nexion with schools of medicine, and a pretty large acquaintance with the graduating classes of the University of Pennsylvania during my pupilage, have endowed me with some degree of quali- fication, to judge of the comparative merits of candidates for the degree of Doctor of Medicine. And I now aver, that neither in the East nor in the West, have I ever known a class of graduates 24 to sustain a more satisfactory examination, than I have had the pleasure to witness, once and again, in this Institution. There are, doubtless, some weak brethren in every brotherhood; and old fashioned honesty, as well as common sense, would seem to inculcate the expediency, at least, of getting rid of the beam in our own eye, ere we make the silly attempt to magnify the mote in the eye of a neighbor. Of all people in the world, the conductors of medical schools should be the last to forget the trite, yet not less valuable maxim, " they who live in glass houses should not throw stones." There are those in this community who are familiar with the history of all its schools of medicine, the foibles of the elder and the shortcomings of the junior; and who could very clearly demonstrate, that human nature in the medical profession, to-day, is just what it was twenty, thirty, forty years ago. Not a complaint is now uttered against a new school, that was not, with equal zeal, proclaimed on the house top, many years ago, to blast the prospects of a rival enterprise. That rival enterprise we then sustained with all the energies of our nature, and its triumphant, onward march to glorious success, gives assurance to every infant institution, that persecution and denunciation do but accelerate the growth they were intended to paralyse. If medicine cannot be taught within these walls, as ably and as thoroughly as in any school in America, let the Phila- delphia College go down. It asks no special favors, at the hand of the profession. It rests its claims on the palpable evidence of its entire competency, as a School of Medicine. The stolid, artificial superiority that rests on clique, or aristocracy of name or wealth, has no breathing place in this hall. Its corner stone is full and perfect ability, to teach industrious and devoted pupils, who come hither, not for show nor form, but to engage honestly and faithfully in the Study of Medicine. PHILADELPHIA COLLEGE OF MEDICINE, Filth Street South of Walnut. The SPRING Course of Lectures for 1850 will be commenced on Monday, March 18th, 1850. The General Introductory will be given by Dr. J. Bryan. Degrees will be conferred about 20th July. FACULTY. James McClintock, M.D., General, Special, and Surgical Anatomy. Rush Van Dyke, M. D., Materia Medica and General Therapeutics. Thomas D. Mitchell, M. D., Theory and Practice of Medicine. James Bryan, M. D., Institutes of Medicine and Medical Jurispru- dence. Ezra S. Carr, M. D., Medical Chemistry. M. W. Dickeson, M. D., Comparative and Pathological Anatomy. James McClintock, M. D., Principles and Practice of Surgery. Abraham Bitner, M. D., Obstetrics and Diseases of Women and Children. N. R. Moseley, M. D., Demonstrator of Anatomy. Fee for the full course, - - $84 00 Matriculation, paid once only, - - - - 5 00 Graduation, - - - - - 30 00 Fee for those who have attended two full courses in other colleges, - - - - - - 45 00 Dissecting Ticket, - - - - -10 00 Perpetual Ticket, - - - - - 150 00 Full second course students will be furnished with the Pennsylvania Hospital ticket without charge. The fee for the respective tickets may be paid to each member of the Faculty, or the whole amount may be paid to the Dean, who will issue a certificate -which will entitle the student to the ticket of each Professor. For further information, inquire of JAMES MCCL.IWTOCK, M. D., Dean, No. 1 North Eleventh Street. Philadelphia, Nov. 26th, 1849. I