. V ALE DICTORyTe C T U• B E, DELIVERED BEFORE THE CLASS / RUSH MEDICAL COLLEGE dJSiisi^isio?^ ISdHa s203^Q^7o Q BY JOHN M'LEAN, M. D. PROFESSOR OF MATERIA MEDICA AND THERAPEUTICS, tfV*7 ROBERT FERGUS, TYPOGRAPHER. SALOON BUILDING, CLARK STREET. 1847. t I VALEDICTORY LECTURE DELIVERED BEFORE THE CLASS RUSH MEDICAL COLLEGE JJ&smxsa&liP^ ^<£L& ZL&Klz&v BY JOHN M'LEAN, M. D. * PROFESSOR OF MATERIA MEDICA AND THERAPEUTICS. ROBERT FERGUS, TYPOGRAPHER, SALOON BUILDING, CLARK STREET. 1^47. At a meeting of the students of Rush Medical College, on the 2d day of January, 1847, J. R. Bradway was appointed President, and M. I». Elgin, Secretary. On motion, a committee of three was appointed, consisting of Joseph Blount, Joseph W. Freer and A. V. Gilbert, to wait upon Prof. McLean, and solicit from him a copy of his vale- dictory address for publication. J. R. BRADWAY, Pres't. M. B. Elgin, Secretary. CORRESPONDENCE. Prof. McLean—Sin: The class of Rush Medical College, through us, their Committee, would respectfully solicit from you a copy of your valedictory address, for publication. Yours with respect, J. BLOUNT, ) J. W. FREER, > Committee. A. V. GILBERT. ) J. McLean, M. D., Prof, of Materia Medica and Thera- peutics. Chicago, Jan. 4, 1^47. Gentlemen:—In compliance with your request as the Committee of the class of Rush Medical College, I place at your disposal the manuscript of my valedictory lecture, with sincere acknowledgements for the favor with which it has been received by the class. Yours respectfully, JOHN McLEAN. To Messrs. Blount. Freer, and Gilbert. LECTURE OF PROF. McLEAN Gentlemen :—We have now finished our course of in- struction on Materia Medir-;i. and General Therapeutics, and hope that we have been, in some measure, successful in im- pressing upon your minds the importance of this department of medicine ; and also in giving such instruction as will be found useful in the discharge of those responsible duties that will soon devolve upon you, when engaged in the practice of the medical profession. Materia Medica and General Therapeutics are most impor- tant branches of a medical education. General Therapeu- tics, as you must have discovered, treat of those great and fundamental principles of applying agents for the cure of dis- eases, and which you may, at all times, turn to a profitable account in the application of medicinal agents. These (icncral Principles should always be well stored in the mind. They are the true elements for the proper appli- cation of medicines. A knowledge of them will save you the tax of remembering many isolated facts in relation to the treatment of special diseases. If acquainted with the true na- ture of remedies, and their varied operation upon the system, in all possible doses, both in health and in varied pathological conditions, we may then apply them to the cure of special disease in all her aspects and complications. We cannot become acquainted with the true operation and therapeutical application of medicine, except by the study of it as a distinct branch. They are not taught in works on the Theory and Practice of Medicine ; for it is generally suppos- ed that the student is fully acquainted with their properties and operation, and they merely speak of the use of such and such medicines in particular diseases. They do not speak so fully of their operations as the student should be acquainted with. They do not, in detail, consider the different doses and their varied operations ; and, generally, they do not give their 6 compatihles and incompatible?. These things it is supposed that the student is already familiar with. Furthe: -more, disease assumes so many aspects, is modified by so many causes, and oftentimes so complicated in its na- ture, that it would be difficult to point out all the peculiarities of treatment under all possible circumstances. But with a sound pathological knowledge, and a proper understanding of tho nature and operation of medicine, we may readily arrive at correct conclusions in relation to the mode of treat- ment. Materia Medica .and General Therapeutics arc the ground- work upon which the administration of medicine is based.— They do not teach j'ou anything in relation to diagnosis and prognosis—these belong to another department of medicine. A proper knowledge of the Materia Medica by the Phys- ician, may be compared lo a mechanic's correct understand- ing of the use of the tools with which he works. Without this knowledge, he would make but a. bungling workman.— He might see what he wished to accomplish, but he could not perform. How oiien are physicians puzzled to decide whether this or that medicine would be applicable in acertain disease ; whereas, if they were better acquainted with the nature of medicinal agents, they might easily decide. In consultation, physicians are as frequently called upon to decide what rem- edies shall be applied, as they are to determine the nature of the disease, and I think we may safely say, more frequently for tho former than they are for the latter object. Let a phy- sician weli understand the groundworks of medicine, and he will, thousands of times, find cases where he can apply them for the development of new truths, and in deciding as to the applicability of particular remedies in special disease. Here are two individuals, equally talented in all other re- spects, but whose course of medical education has been quite difTerent. The one has not only read of special disease and tJie mode of treatment, but is thoroughly acquainted with the na- ture of the agents to be used in each case. He knows their chemical composition, compatibles mid incompatibles, opera- tion in all possible doses, and the nice shades of variation in their medicinal action in various pathological conditions.— 7 The other knows no more about them than he has learned of their use by reading works on theory and practice. In whose medical skill would you have the greatest confi- dence V I can readily anticipate what your answer would be. As sound and safe practitioners, the one would hardly bear any comparison with the other. The one would have a knowl- edge to guide him in the choice and application of medicine; he could act upon rational principles, and suit his means to apply to any slight change in disease. He would not grope and stumble in darkness, for his path would be illumined by the light of fixed and general principles. The other mi^ht proceed just, so far as he could follow the directions of his au- thor; but when some slight complication of disease might arise, so that he could not clearly see the resemblance in all particulars to the description given, then would he be involv- ed in mazes, and overwhelmed in confusion. In a word, be would be a blind routinist, and could not proceed a step fur- ther than led by his authors. I U: would be entirely ignorant of the many little, but important things, relating to the nature, operation, and administration of medicine. He would be a hap-hazard prescriber; an unsafe man to have the manage- ment of disease. The longer you practice, the more will you become con- vinced of the truth of these remarks; and he who neglects this department during the years of his pupilage, will find it one of the very first to engage his attention when he commen- ces the practice of Medicine. The general principles of Ther- apeutics are unchanging—disease may assume many aspects, in consequence of complications ; but medicines under similar circumstances produce similar effects. A few of these gene- ral principles will, in practice, cover a large field of diseases. As the fundamental rules of Arithmetic may be applied to the various forms of calculation, so may a few of these general and fixed principles of Therapeutics be largely applied to the treatment of the multifarious forms of disease. If thoroughly acquainted with these general principles, and also with the pathology of disease, you may many times arrive at correct conclusions in regard to the mode of treatment, without blind- ly following what ihi* or that man nnv prescribe- Without this knowledge, you would have to depend upon the etlbrt of memory to remember what this or that man might have recommended; and this too, without knowing the why's or wherefore's of such a recommendation. Sad, indeed, must be the condition of that physician who goes forth to con- quer disease, but who is unacquainted with the weapons of his warfare. What but bad management and ill success could be expected from such a person ? We have not treated of as many substances as are usually found in works of Materia Medica ; but you have lost nothing by this omission : but, on the contrary,' have been rather the gainers. The number of articles in most of our Materia Medicas arc too numerous for the medical student. There is not one student in ten thousand, nor one practitioner in five thousand, who has become intimately acquainted with all the various articles with which our opulent Materia Medicas abound. Such wonld be a useless task to perform, for where is the physician who is in the habit of using more than one third of the articles with which their pages are filled. We do not wish to be understood as condemning our larger works on Materia Medica—far from it, for we are always glad to see such works as Pereira's, or the U. S. Dispensatory, although it would be an unprofitable task for the student to endeavor to become intimately acquainted with all the articles which they contain. They are useful works for reference, and the practising physician often finds it necessary to resort to them as such. They are books which should be in the library of every physician. In these works, and especially the former, are contained the main therapeutical agents, with a full de- tail of all their properties, chemical, physical and medicinal, and with which the student should perfectly familiarize him- self. Let the student first make himself familiar with the general principles of therapeutics, and with those agents upon which our mam dependence is at all times to be placed. Neglect not these for the more inefficient and uncertain remedies. When familiar with these, then will it be time to direct atten- tion to the other class. It is desirable that the practitioner should have: an extensive knowledge of the various articles 9 thai, are recommended from time to time, so that he may not be imposed upon by the inefficient and doubtful, for the more potent and certain agents. This extensive acquaintance, however, is to be acquired by a life of professional industry. We would recommend simplicity in prescriptions. En- deavor to have a clear object in view for every agent and combination which you may prescribe. To mingle together a multitude of articles, the combined effects of which no man can tell, argues a lack of knowledge in the fundamental pijn- ciples of Therapeutics, and of the medicinal properties of agepts. Those who thus practice, do so for the want of clear ideas of pathology and the operation ol medicine, with a blind hope that some article in this heterogeneous compound may possibly favorably affect the disease. It is a bad indication to see physicians in the habit of shift- ing about from one mode of treatment to another, in hopes ot finding something to accomplish their wish ; but how it is to do it, they cannot tell. You will generally find such shifting from one mode of treatment to another, so rapidly that they scarcely give the previous medicine time to produce any change in the disease, before a new one is substituted in its stead. And if the patient finally recovers, they cannot tell whether this or that, any or all of them, had any agency in producing the cure. Thus they derive no benefit from expe- rience. They commenced in the dark, and are likely to re- main in the dark until they change their course. Much bet- ter is it to be well acquainted with your weapons, and to have them well ordered in your minds, than to possess but an imperfect knowledge of their properties, and have them con- fusedly intermingled with a heterogeneous mass of compara- tively useless agents, and like a bewildered man, searching among the rubbish, in hopes to find that which the necessity of the case demands. Dr. Paris, in speaking of the interest with which the medical philosopher would regard an exten- sive and well arranged cabinet of Materia Medica, says ;- « With no less interest than instruction will the young prac- titioner on his professional career regard such a collection— In casting his eyes over so extensive and motley an assem- blage of substances, he will be forcibly impressed with the 10 palpable absurdity of some, the disgusting and loathsome na- ture of others, the total inactivity of many, and the uncertain and precarious nature of all. And he will be naturally im- pelled by an eager and laudable curiosity to inquire, how it can have happened, that substances at one period in the high- est esteem and of generally acknowledged utility, should ever have fallen into total neglect or disrepute ; why others, of humble pretensions and little significance, should have main- taiaed their ground for so many centuries; and by what ca- price or accident, materials of no energy whatever should have continued to receive the indisputable sanction and un- qualified support of the best and wisest practitioners of the age ; and, above all, he will inquire by what necromantic spell certain medicinal substances, after having run their ap- pointed course of trial, and been fairly denounced as inert or useless, could ever again have been raised into special favor, as if but to sink once more into deeper and more lasting dis- credit." Prof. Harrison, in his work on Materia Medica, has given us upwards of four hundred and fifty articles, including their preparations. Dunglison,in his work on Materia Medica, has given us more than Jive hundred, preparations included; and Pereira, in his very extensive and elaborate production, be- tween Jive and six hundred. If the student should endeavor to become acquainted with such a multiplicity, he would be very likely to become bewildered and confused. The minor and many unimportant agents, may be consulted by him who has thoroughly acquired the rudiments of the profession; but it is not expected that the medical student will study them with that care which should be bestowed upon the more im- portant agents. When a young physician*sets out in prac- tice, he is apt to use a greater variety of medicines than he will when in practice ten years. A good experience will teach him, that much more than he formerly expected may be accomplished by a few well selected agents, properly ad- ministered. W e do not, by these remarks, wish to be understood as lowering the requirements of the medical profession; but, on the contrary, we will forewarn you, that, in this profession, 11 you will always find something to learn, even though you be diligent students during a prolonged life. We would incul- cate the principle of learning well whatever you undertake.— When possible, never be content with a confused idea of any thing; but always endeavor to obtain a clear understanding as far as you go. And then you can practice and discharge the responsible duties of the profession with profit to your pa- tients, and satisfaction to yourselves. Let the object of your desires be elevated; Jet hope stimulate your exertions; let integrity of purpose direct your ways; and then will your course be marked by prosperity. During the past course of lectures, it was our desire to pre- sent, in a plain manner, such well-established facts as are of the greatest importance in the application of medicine to the cure of diseases. The minor points we dwelt upon less. As to those matters, on which there is difference of opinion, we gave you the main arguments on both sides; and lasdy, our own opinion, leaving you to judge for yourselves. During the past course of lectures, I have been much grat- ified at the apparent attention to, and interest taken in, this important branch of medical education. And for your pres- ence and gentlemanly deportment, you, gentiemen, will please accept my sincere thanks. Finally, in taking my leave of you on this the 2d day of Janu- ary, 1847, I would wish you all a happy and prosperous New Year. May your star of hope shine brightly; may your sun not go down in darkness; and may your sky, unruf- fled by the tempest's blast, be as calm as the summer morn We have now another year before us. How it will be with us durin- its course, we cannot tell. A good Provid- er,e for wis^ and useful purposes, has hid these things from our eyes. Were they revealed unto us, our energies would be paralyzed, and our ambition kept down. Let us. Ten like the skilful mariner, hope for good and work for the I, This we shall find the surest and easiest road to happi- ne 's and prosperity. This sea of life, upon which we have embarked! is boisterous, full of shoals and threatening rock, Tnel a skilful pUot to guide our ba*clear of those d. gers which threaten us on every side. This life * also 12 of warfare. Ease and vice, with all their well-trained band, would wage eternal war against our present good and future peace. Let us, there tore, gird on our weapons of warfare— hope, morality, and perseverance. Then shall we ride con- queror over our dastard foes. You cannot expect, gentlemen, that your sea of life will at all times be calm : but when her bosom is ruffled by the an- gry tempest, may your bark be safely piloted through all the threatening dangers. May your star of hope be cloudless, and may your progress be ever onward; and through all the changing scenes of the year now before us, yea, through every period of your lives, may the solace of a self-approving con- science be yours. And may a kind heaven smile upon you, and bless you all with health, long life, and prosperity. ^^Sd^m^m " sNSys^r"v' '.r,"i ."'cI^S^ RUSH MEDICAL COLLEGE.