h°<\»^ r-^/fe.
MEDICAL COMMENCEMENT
UNIVERSITY OF PENNSYLVANIA,
Saturday, April 5, 1851
VALEDICTORY
W. E. HORNER, M. D.,


 PROFESSOR OP ANATOMY. x'k \*'
        / \ *- ■■"

        /*■■'' ■■
 
 
MEDICAL COMMENCEMENT
UNIVERSITY OF PENNSYLVANIA,
Saturday, April 5, 1851:
VALEDICTORY
BY
W. E. HORNER, M. D.,
PKOFESSOE"OF ANATOMY.    ^<ZT\% .'** •■." vN.
SECOND EDITION,
       PHILADELPHIA:
L. R. BAILEY, PRINTER, 26 N. FIFTH STREET.
           185 1. 
 
frof.  Mnmtt's  jfobbirforg Bktm. 
CORRESPONDENCE.
                                          University of Pennsylvania, )
                                               March 25th, 1851.     $

Dear Sir :
  The Students of the Medical Class of the University of Pennsylvania, desirous
of having your parting counsel in a form suitable for future reference, earnestly
solicit a copy of the address for publication.  May we not hope, that your un-
tiring devotion to their interests, will induce from you this additional favor.
  With the kindest personal feelings, we have the pleasure, dear sir, of awaiting
your immediate reply.
                                      STEPHEN  B. KIEFFER, of Pa.,
                                      A. OWEN  STILLE, ofPhila.,
                                      THOMAS J. GOFF, ofTenn.,
                                      AUGUSTUS WILSON, of Cuba,
                                      CHARLES H. WANNER, of Pa.,
                                      FREDERICK HORNER JR., of Va.,
                                      EDWARD  A. SMITH, of Mass.,
                                                               Committee.
                                          University of Pennsylvania, )
                                               March 26th, 1851.     \

  To Messrs. Kieffer, Stille, Gqff, Wilson, Wanner, Horner and Smith.

Gentlemen:
  In acquiescing in the request of the Medical  Class, concerning my contem-
plated address to the Candidates of the Season, so politely conveyed in your
communication of the 25th inst.; I beg you to believe that my only reluctance to
its publication is a sense of the production having so few claims to this dis-
tinction.  Wishing you individually, as well as your constituents, all the success
and happiness in life which your well merited honors deserve,
                 I have the pleasure to subscribe myself
                                        Your sincere friend,
                                               W. E. HORNER,
                                                    Professor of Anatomy. 
VALEDICTORY.
   Commissioned to present this day the parting advice of the
University of Pennsylvania to her children who are on the eve
of issuing, many of them forever, from her walls, and in the
hearing of this dignified audience, the witness of the ceremony
just passed; it may be justly presumed by you, my fellow citi-
zens, one  and all,  that  I feel deeply the responsibility of the
task.   Conscious certainly of my own  unfitness for its proper
execution, I have on my right and on  my left, colleagues  and
friends who could have brought much higher powers to its ac-
complishment, and secured a much larger amount of gratifica-
tion for your time thus applied. It is, nevertheless, in just suc-
cession, a  duty to use my best efforts in  this cause,  and to make
amends, so far as practicable, for a deficient performance by the
zeal  and sincerity with which it is undertaken.
  Under the  circumstances  of my position, I find myself ad-
dressing parties representing very different interests.  1. To the
Audience  I am introducing, as fit for  their favorable  notice,
young  gentlemen who have distinguished  themselves  in their
studies, and obtained corresponding honors.   2. To the Gradu-
ates of the occasion I have  to give those  precepts, on which
the good and the wise  are all of common consent.  3. To the
Constituted Authorities and Guardians of this ancient Institution,
I am to report how far  the trust committed to its  Medical Fa-
culty has been executed  in the spirit of its appointment.   4. And
to the  Collective Assemblage, I have to exhibit the tendencies
and policy of a School of Medicine which has occupied  uninter-
ruptedly,  a large share of public confidence and  attention, in
this division of  the globe, for nearly a  century—a period  cer-
tainly distant in its inception, when compared with  what we see 
vz
around us, of meri and  of things, in this most progressive and
favored of countries.
  1st.  To my polished and condescending auditors, among
whom I see so many of the fair daughters of America, and of
its noble matrons; who in their places will serve or have served
in developing the high destinies of our glorious Union;  let me
say, you have just passed in review young gentlemen who, by
unremitted ardor  and  attention in  the  prosecution  of their
studies, have well deserved the confidence reposed in them,
and fully  merited  those ribbons, the badges of their success,
with which their persons are decorated.   I also add my attesta-
tion of the irreproachable and urbane conduct which has attend-
ed the progress of their studies.
  The University of Pennsylvania has just cause of pride in the
reflection, that the ancient renown of her graduates is in no wise
tarnished  by  the class which, on this occasion,  represents her.
On  the contrary, she confidently looks forward to the period
when these, the youngest of her children, will be amongst the
brightest  of her ornaments, and serve also to perpetuate her
reputation.
  A careful examination and inquiry by the Medical Faculty
into their qualifications, has satisfied  the Faculty that their
time  has  been diligently employed; that their proficiency in
medicine  is such, that the interests and  dignity of the science
are safe  with them—and that the lives of  the  people may
be confided to their care.  They have now in custody a pass-
port to rank  and consideration wherever medical education is
of any value; but that  this passport may be so managed as to
secure, augment, and perpetuate their respectability, there are
some  points of advice to them which their new position in so-
ciety naturally suggests.
  2d. Your recent studies, young gentlemen, have presented to
you, as you know, an exposition of the structure and functions
of the human frame—of the diseases and perversions of action
to which  it is liable, and of the resources furnished by botany,
chemistry, pharmacy, and the principles of medical practice, to
arrest  its  disorders,  and to  re-instate it in its  healthy action.
You have been laboring in a field of extensive and varied phi- 
13
losophical research, each of the divisions of which when properly
investigated, requires the almost entire time and powers of one
individual.  In the courses of instruction which you have just ter-
minated, many of the ideas which have been imparted to you in
one hour of lecturing, are the results of weeks of toil and of reflec-
tion on the part of your teachers.  The remembrance that these
and other acquisitions of knowledge are to you of recent date,
and that they have been made with at least some  degree  of
precipitation, will suggest to you that to be profitable  they must
be made familiar to the understanding,  and deeply  impressed
upon the mind.  There are many things in  medicine which it
would be want of loyalty to forget, and the moment that the
physician suspects his memory of a treacherous part, he ought
to repair its lapses.  He ought  indeed to be constantly on the
alert for the possibility of such accidents, and to avert them by
a frequent re-perusal of the elementary works which were the
companions of his early studies.
  It may not be apparent to you now, but the  time  will come
when you will join in the general sentiment of the  advanced
members of the profession, that  the best conducted medical
education leaves much to be acquired at the subsequent periods
of life.   Lectures and demonstrations  must unavoidably be
more or  less compendious; the  limited  appropriations of time
under which they are given compel them to be so.  The faculty
of attention has also its own limits; with  the most  ardent in-
clinations for a branch, we cannot,  so long  as  it is new to us,
attach ourselves  to its minute details.  Our familiarity with it
must advance—its ideas must be more or less incorporated with
our common-place stock of  knowledge, before we can feel ade-
quate interest.  It is only  the accomplished scholar who can
have such inspiration of his subjects, that  when  he turns  his
mind to  them, they seem not matters of memory only,  but points
of personal identity or incorporation with  his  very nature.   I
have no doubt that there are among you those who strongly ap-
prove of what is  now said, who  are conscious that there are
numerous subjects from which their attention has  been wholly
withheld or very partially given, and which it is their firm reso-
lution to master  at the  first moment of leisure.  Let me, then, 
14
recommend every one of you who may be under this convic-
tion of deficiencies, to carry his resolution into effect, and not to
allow such time to pass as will extinguish almost the recollection
that he ever had the intention.
  There is unquestionably no profession which requires^ more
intimate acquaintance with  its rules of practice  and with its
materials, than medicine.  Cases of sudden emergency are con-
stantly arising in which the se}f-possession of the practitioner is
the only barrier between therpatient and death—the slightest
confusion of mind or agitation, of hand becomes the  turning
point of safety.  Every one sfTould prepare  himself for scenes
of the kind, for there are noneVof us who have been engaged to
any extent in the practice of medicine, who have not been called
upon to take a part in them.  Let me ask, from what source
are we then to look for clear ideas, self-possession, and steady,
decisive  action, except  in the information  gained and digested
in the hours of study ? Lucky chance, or undeserved inspiration,
cannot be expected at those periods of  trial;  and if we fail, we
must appear afterwards as inadequate  to the occasion, and as
having proved ourselves incapable of fulfilling just expectations.
  Besides a revision and a supplementary course of study, it is
also incumbent on you to be a diligent observer of what is pass-
ing around, and  to  increase your stock  of knowledge  by a
liberal intercourse with  the  most intelligent members of your
profession, and by  a perusal of the   most  esteemed medical
periodicals and works of the day.
  Indolence in the  early  years  of professional life  is by all
means to be avoided; a pre-occupation of the  public attention
by seniors and by men of acknowledged  skill, will necessarily
leave the young  practitioner in  obscurity and without much
reward.  Many men are irrevocably discouraged by their deep
sense of  these disadvantages, and as they cannot get an imme-
diate reward, have not the force  of character to  labor for the
emoluments  which come in, only after the expiration of ten or of
fifteen years.  The  difference between individuals is strongly
marked in this respect,  because there are  some who, notwith-
standing this tedious postponement, yet  consent to labor on, and
to do so even diligently, under a strong  hope that their reward 
15
 must at length come.  In surveying the state of our profession
 here, elsewhere in the cities of the United States, and in  the
 largest of cities in Europe, as London and Paris; it will be found
 that the most distinguished and able members  of the time  are
 those choice spirits who in early life devoted days and nights
 to study; and to threading  obscure  alleys, the  abodes of sick-
 ness and of wretched poverty; but having now passed through
 that probation, they are enjoying all the advantlges and dignity
 of their high calling.
   With the time appropriated to his practice, to his studies, and
 to his  notes,  no physician can devote  much to the ordinary
 pleasures and pursuits of life.   He  has  indeed to exercise the
 most severe vigilance upon  the distribution of his hours, to pre-
 vent the misapplication of them.  If his  talents are admired by
 the public, and called into action, he will find, that wherever he
 pays a  professional visit, there is a strong disposition on the part
 of the patient, or his friends, to extend its duration by conver-
 sation of a familiar and interesting kind.  In the more improved
 circles of society this is particularly the case; and the conversa-
 tion from such quarters is so frequently sustained by high intel-
 ligence, grace and vivacity, that it requires the  strongest effort
 to withdraw from  it.   To this invasion  of time may be added
 the more seductive one of invitations for convivial purposes.
 These,  apparently harmless indulgences,  have to be watched so
 as to keep  them  within proper limits;  but  there can  be  no
 doubt of the sentiments and conduct proper to a physician, when
 he finds himself near a gambling table, a race course, or a politi-
 cal junto.  They are all three so destructive to his good habits, and
 the feelings and  passions they elicit are so entirely incompatible
 with his duties and improvement, that he  cannot engage in them
 without serious  detriment.  Some writers are so strict on the
 head, of an exact and unflinching attention of a physician to his
 profession ; that, they declare, he cannot  while in practice take
 consistently upon himself the  duties of another occupation or
profession, however honorable or unexceptionable it may be.
 Thus he ought to decline serving as a legislator or acting as a
magistrate.
  A more common union of office,  and  perhaps a more natu- 
16
ral one, is also  prohibited, to wit, the ecclesiastical with the
medical.   In the early stages of human society, the ministers of
religion, in being the depositories of the Divine will, also occu-
pied themselves with the science  and learning of the  period.
To this they were peculiarly fitted by their studious and con-
templative lives.  Under the then existing state of things, with
a rude and incoercible barbarism on every side, the  combina-
tion of medicine with the priestly office, grew out  of circum-
stances, and was both justifiable and appropriate.  In  this
country, where the population is in certain  places thin, and the
elements of society not  yet arranged so as to assign to  each
individual his personal and exclusive duty, the clerical and the
medical character are still found occasionally in the same man.
No exception can be taken to this either; it is probably in most
instances  rather the result of social necessity than  of  choice.
But in our larger cities, and more populous places where people
of good education can be found in adequate numbers, this union
of the two professions may be  justly reprobated as inexpedient
and weakening to both.  Either assiduously served must occupy
all the powers of reflection, the opportunities of study, and the
practical attention of any one person.  Where there is an entire
transition  from one profession to the other, it is of course unex-
ceptionable as  a point of conduct.  It is generally beneficial
to the profession of the last choice, for the step is  mostly one
of great deliberation, and the result of a strong conviction of the
value and importance of the change, and of ardent attachment
to its objects and duties.  Some of the most interesting men of
our country have made this transition from  medicine to the pul-
pit, and are distinguished both by the ardor of their attachment
to their new duties,  and by the powerful  illustrations and the
exact method of reasoning derived from their first studies.
  We can indeed scarcely admit less  than a close  affinity be-
tween the two professions, from their both having for object the
diminution of  human suffering; and from  the same  scenes of
human wretchedness being exposed to both.  One of the most
memorable instances of this affiliation occurred during the reign
of terror in the first French Revolution.  The temples being dese-
crated—the altars upturned,  and the clergy forced into exile; 
17
 numbers of the young men destined for the holy office being
 driven from their pursuit, entered as students of medicine, from
 its congeniality with what they desired.  The  Institutes and
 habits of Christianity then,should always be treated with the most
 marked respect by physicians, notwithstanding we may depre-
 cate the professional amalgamation just alluded to as injurious
 to  both.  This respect we owe to them not only on account of
 their origin, but from their value in the  social order.' I assert,
 confidently, that the most desirable patients to the educated and
 polished physician, are such as are governed  by the Christian
 code; they are more tractable, more confiding, more sincere in
 their intercourse with him—are less despondent in sickness, and
 are less under the influence of the various perversions of imagi-
 nation and of judgment, which are the  lot of the children  of
 Adam.
   The terms of intimacy between a physician and the families
 under his charge, are  apt to become so close and binding, that
 whatever may be the disposition of parties to keep upon a rela-
 tion strictly professional,  this guard is finally relaxed and feel-
 ings of private esteem and interest are almost unavoidably gene-
 rated. In this relation of the physician to the domestic circle, it
 is important for him to be, as far as human nature will allow, an
 example of virtue and of purity of conduct, so that nothing may
 be exhibited  in his deportment  and language unfavorable  to a
 high state of morals.   The  deference  paid  to his judgment by
 the young as the guardian of health and the preserver of life,
 inclines them, if he be also  a man  of letters, to confide in his
judgment on points which are extra-professional; on principles
 which decide the tone of character and of morals.  Under such
 circumstances should  his  own  notions of  moral rectitude be
 perverted  or wavering, the poison infused  by his conversation
 may vitiate or corrupt deeply the morals of his admirers.  Not
unfrequently the most secret concerns of families are exposed  to
him either by accident or through deliberative action.
   No physician can safely make a  habit of speaking, even on
the indifferent concerns of the families he attends; otherwise, he
becomes a sort of news-monger for society,  and when their do-
mestic occurrences.of a more serious and exciting kind attract
                 c 
18
the attention of people,  he is looked to as the person  who can
assuage the curious itchings of every body  who  chooses  to in-
terrogate him.  It is scarcely necessary for me  to  say that in-
formation  acquired through  professional channels and confi-
dence, should have a seal  as solemn as that of death put  upon
it;  and that neither fine nor  imprisonment, nor torture should
have influence enough to make the physician  break this seal.
  As the evening of life advances and closes,  abundant will be
the consolations of a physician's life thus well spent.  Unstung by
the remorses of conscience, his reflections and  his self-examina-
tion prepare him for the great crisis which he  has so often wit-
nessed in patients. He feels as if his mission had been  properly
accomplished, and that usefulness to others  having  been its
great and redeeming object, he had lived  not  for himself alone
but for the  comfort and happiness of those around him.

  To the preceding suggestions in regard to the undisputed obli-
gations and duties of a physician, let me call your  attention to
one of a more  debateful kind,  and  concerning which  there
are now  many differences of opinion and of action.  I mean
Medical Education.  Immediately on leaving this room you be-
come participants in the  discussion, and must by your influence
and example, affect its result.  We all know and feel that in a
country like ours,  whose progressive march, outstripping all
the ordinary rules of experience, seems  to demand an  expe-
rience of its own—that simple experiment is always largely in
advance, for it belongs to the  genius of our people.  In one or
more States of the Union any man may, if he chooses, legally
plead  his own cause; and in most  of them any man who thinks
himself in  a state of medical inspiration, or  wishes others to
believe so, may undertake the cure of disease.  This unres-
trained freedom of action, in  being perfectly  in harmony with
the cast of  our institutions, applies itself also to medical educa-
tion, and out of the various accommodations of the latter, each
school is left entirely at  liberty to follow its own bent.  Some
therefore, hold up a higher scale,  both in  regard  to acquisition
and to  time; others are  contented to let their alumni settle for
themselves, the amount of information they stand in need of for
their particular localities and calls. 
19
   We also live at a period  when individual will prevails, to a
large extent, over system; when  mere personal convenience
frequently defies, successfully, the suggestions of experience and
of good order; in other  words, the world is progressive, and
this spirit of progression  is exhibited not only in matters which
are decidedly useful, but in such as are  simply experimental
and abortive.  We can scarcely doubt that full education  in an
exact science and one of observation can only be the result of
time and  attention, and  yet there  are too many persons  who
escape successfully from  this law, not to leave a perpetual in-
fluence acting against it.   The  most splendid acquisitions of
medical wealth in this and  other cities, I cannot say dignity,
are the accumulations of nostrum-venders and of charlatans.
The prominence of such exceptions is such as not unfrequently
to cast a doubt over the value of the entire science of medicine
—and hence mere exceptions to a  rule, affect the rule itself so
as to put it in no  small danger.
   I am not  prophet enough to foresee the final result of this
struggle of antagonisms, but I trust it may be propitious to the
cause of science.  I at least have the consolation of representing
here to-day an Institution which, the first in the country  in its
period of organization, has also led the way in the efforts to
advance medical education—and while other institutions decline
going counter to a popular current, is herself endeavoring to
stem it, and, if possible, to give it a better direction.   Whether
we are to succeed or to fail in this effort, time has yet to deter-
mine.  We would  cordially invoke a greater  number of sister
schools to lay aside their fears and to co-operate with us.  There
will, I have no doubt, be a temporary sacrifice to them, as  with
us, but most probably an increased benefit  will subsequently
result. A sense of discrimination by the public may finally pre-
vail, so as to understand that while there are many institutions
having the  right  of issuing diplomas; so there must be  other
guarantees of proper education  besides  the mere exhibition of
a parchment.
   We can scarcely doubt that, viewing a diploma as a commo-
dity, it will continue to be furnished from some place or other
at the smallest expense of trouble and time that parties desiring 
20
it may demand—that if it cannot be obtained in an accommo-
dating way at one place, other places will be found more yield-
ing; but it is also true that there are some objections to its mer-
cantile  character—that there  are  ulterior  considerations  of
importance which must arise in the course of its use.   First of
all  it is impossible, whatever may be the  finish or size  of a
diploma, that it will cover the ground of information  actually
required in the practice of medicine.  An immatured study leaves
its'  proselyte without  aid or  resource, when  he most  requires
both; he must unavoidably expose  himself in the first crisis of
professional skill.  Secondly, a belief exists largely on the pub-
lic mind that experience is the only safe guide in medical mat-
ters.  A young man, returning to a neighborhood in which he
was raised, is  nearly always closely  scanned in regard to his
claims to public confidence in business; he is in fact more apt
to be placed  below than above the just point.  But should his
course of study be actually much shorter than what public con-
viction demands as necessary, he enters upon a career of not
only severe competition, but  of opposition  from the beginning.
That opposition will not be of the loud, clamorous kind which
affords right and left an indication of its existence. But it is the
opposition of the private conferences of individuals, the expres-
sion of distrust  from one mind to another, without the parties
to it having the slighest desire to injure or to disparage the  indi-
vidual concerned, but merely the disposition to  find a true ver-
dict.   Instances of ignorance and want of skill may perhaps be
quoted;  the  senior physicians are  interrogated whether  it  is
likely that such a young man had qualified himself as a practi-
tioner of medicine in half the time only that every body said
was necessary.   The answer, without any inclination  to injus-
tice, will unavoidably be No: it will be said time must be taken,
observations must be made  on diseases, to justify any one in
assuming the duties  of practitioner of medicine.  There  is no
doubt that these private chanuels of opinion will be fatal in many
instances not only to the really undeserving, but also to such as
by singular talent and fidelity to their studies do not merit such
a catastrophe.   To such of you, therefore, as  aspire to the more
elevated conditions of public confidence, let me commend not 
21
 only what you  have just done, but also advise a continuance
 in close study and in ardent devotion to your profession.
   Under the circumstances,  you will find now on the return to
 your homes respectively that the currents of sympathy between
 yourselves and the older physicians of the neighborhood where
 you settle, are active—that they will consider you to have passed
 fairly through the probation of study recognized by experience
 and by public conviction of  its utility and necessity.
  ' The cure  of disease is really a practical  affair, and requires
 practical men to accomplish  it; the mere abstractions of medical
 education afford but a feeble glimmering of light to the line of
 duty.  Which of us in passing through an unknown country,
 would take a simple geographer for a guide, one whose obser-
 vations had never extended beyond the limits of his library ?
 would we not on the contrary, employ an experienced conductor
 —one  who knew the fordings of the streams, the best passes of
 the mountains, the places of rest and of accommodation ?
   We have heard of a medical education for California.  Suited
 however as California may be for  rapid growth of every kind,
 we doubt much whether what may suit California, will also be
 acceptable everywhere else.  Ample as that market may be for
 doctors of all kinds, it  is probable that it  will soon be over-
 stocked,  and as all who wish  an  education for  it, cannot be
 accommodated there, the overstock may be in some difficulty to
 find a congenial soil elsewhere.  But, watchful observers exist
 even there, in the' persons of experienced and educated physi-
 cians who to a large  extent influence the public mind,  and
 determine more or less upon questions of personal merit.
  Let us suppose that a man under some extraordinary faculty
 of acquiring knowledge, and devotion to his improvement,  had
 surmounted the  difficulties  of  a  short course of studies.   He
 finds himself, however, surrounded by others whose term of
 study has also been short, and  who are graduates of the same
 school with himself.  In case of his desiring  countenance  and
assistance in  a patient,  are  his fellow  alumni the  individuals
that  he calls  to his succor?  they are  not;  he knows too well
their attainments:  and he, therefore,  instead of honoring those
whom  he would  probably  most  desire, turns in a different 
22
direction, and thus marks his own pretensions as undeserving.
In this country we are as yet not prepared, as they are in Eu-
rope, for a finished course of study; we cannot take the five or
the seven years required there as a probation for practice;  but
we may do much towards a nearer approach to  that condition,
and it is to be hoped that every man will in his place contribute
thereto  by his example and his influence.
  3. To you, gentlemen Trustees, the dignified and the estima-
ble guardians of this ancient corporation,  I may say that  the
changes recently introduced into it, resulting as a consequence
of the ill health and the retirement of one of its most illustrious
Professors after a service of nearly forty years; have, as  you
know, put a new aspect on two branches—that of the Materia
Medica and  that of the Practice of Medicine.  The  first it is
acknowledged generally, has been most ably  sustained by its
present  incumbent, Dr. Carson, who, in bringing to its support
a well tried experience of many years' in  lecturing, from the
College  of Pharmacy, and also the science of an accomplished
botanist, has  proved all that the most ardent friend hoped for
or expected.  The second branch, that of the Practice of Medi-
cine, by Dr. Wood, has obtained a system  and an illustration
which probably gives it a position unrivalled in any part of the
world.  Preceded by a publication on  this  branch unequalled
in popularity by any  which went before it either here or in Eu-
rope; the simply didactic lessons of it have now  their illustration
in every lecture by models and by drawings of a most finished
and expensive character—by contributions from the pathologi-
cal  collection  of the  Anatomical Museum, and by the  living
exposition of disease  within the walls of the  Pennsylvania Hos-
pital.  A liberal and magnanimous spirit in appropriating freely
its purse and  its high mental  energies, to the  elevation of an
important branch of medicine, to the bringing it up to the actual
state of the times—I may justly say to the going ahead of the
latter and making itself a leader  of the times themselves—has
for  the last course done even more than was expected from it.
We may all feel justly proud that our distinguished colleague,
in such a  voluntary extension  of his duties, called  for cer-
tainly by no private  necessities, has  done  what will add  no 
23
small amount to the laurels of a school, as illustrated by the
names of a Shippen, a Rush, a Wistar, a Physick, a Chapman,
and others.
  The devotion of your honorable body, as individuals, to other
pursuits  than medicine, of a high and intellectual order; may
possibly have prevented you from learning to its full extent that
a question of great importance agitates the medical mind of the
United States, to wit, medical education preparatory to practice.
The points of this question are the amount of study due from
the student, the  duration  of study,  and the responsibility and
obligations of schools in  regard to it.  Some assert that the
medical schools are all under obligations to listen to the voice
of the profession in this matter, while others consider that the
medical  schools  are under no further obligation than to take
care of their  own interests.   The  medical schools for the most
part have taken the latter view, and under it  present almost
every diversity and degree of requisition which one might sup-
pose.  In some cases, but little further responsibility in the mat-
ter  is assumed than that of performing according to promise the
curriculum of lectures; the students graduate almost  as a mat-
ter  of course when the turn comes round, and  thus the public
is left only with  its own sagacity,  as in other matters, to learn
who is well qualified as a physician.   I propose, then, on this
occasion to  express  a  few  sentiments on  various  points  of
this subject of medical education.
  The position of this school is at present strikingly singular.
We have announced to us from every quarter, that the sessions
of cotemporary schools have  been brought to a close, and that
their  commencements have  already  occurred,  several  weeks
ago.  We on the contrary, have only within a few days been
released  from the  obligation of lectures; and are at this com-
paratively late period, bestowing the  reward of studies  in the
form of a diploma.  Every one, whose attention is  turned  to
the subject, may properly ask, why is  this so ? and many actu-
ally present this question.   To you it may be necessary to say,
that in our present attitude,  we are in correspondence with the
views deliberately expressed of the American Medical Associ-
ation, which has  now  for  five years in succession held its 
24
sessions, and strenuously urged its convictions, on the impor-
tant  point of an  improved  medical  education.  It had  been
perceived that an advance ought to take place upon preceding
usages,—that young men should go into the practice of medi-
cine  with  higher  attainments than formerly: the  older prac-
titioners were beginning to feel themselves incommoded by the
numerous settlements of the younger ones around them, said to
be badly educated.
  Every cross-road it was alleged, was not supplied but infested
by its young doctor, and public disparagement  of  the  profes-
sion  had gone so far, that the annual egress of young men from
the schools, was spoken of with as much levity  as the flight of
a flock of  wild  pigeons, and with almost as little regard for it.
We  have, moreover, lately seen announced  that an  old phy-
sician had made application to the legislature of New York, for
bleeding in  the case of disease to be  made a criminal offense.
Not  knowing the gentleman, we may conclude that if his views
are not those of the  deepest wisdom, they at least express an
experience derived  from some disastrous proceedings  in the
case  of badly instructed  practitioners, possibly very young and
inexperienced ones.
  In the uneasy state of the public mind just alluded to, it was
hoped  that a great national  embodying of opinion, would in-
troduce improvements and correct abuses;  and that by the
discountenancing of such schools as refused to acquiesce in its
decisions,  and throwing patronage upon such as united in the
movement, everything would be accommodated  properly:  Or
that, at any rate, two grades of practitioners would be formed,
one  of advanced  education  and whose course  of study and
amount of information could bear successfully all the scrutiny
likely to be directed to it; while the other grade would not fail
to experience the disadvantage of their more  limited claim for
public consideration, and that  the final result would thus be
improvement everywhere,andabatementof the evils in existence.
  The oldest school in the country was designated particularly,
as the one to lead off in this matter, and it has been done in good
faith, both from respect to the source from which the idea ema-
nated, and from a sincere conviction of the dignity and utility 
25
 of such a policy.   In this, there were  many considerations
 which  governed the Medical Faculty of this University, and
 that we have acted sincerely in our  professions, I adduce the
 following proofs.
   The  Session  for  1850-51  opened on Monday, October 7th.
 The  first week having  been given  up  to introductories, the
 lectures began regularly on  the 14th of the same month, and
 with the exception of a holiday for a week at Christmas, were
 continued  uninterruptedly till the last week of March, 1851.
 Our lectures, in occupying twenty-two weeks exclusive of the
 opening week and of Christmas, presented a curriculum, includ-
 ing hospital instruction, of about seven hundred and four lectures
 of one hour each, a duration we believe much in advance of the
 curriculum  of any other  in  the country.   The University  of
 Virginia  by her  session of thirty-six  weeks,  and the very
 commendable diligence  of  her professors, so arranges her
 studies, that they may be considered as  amounting to about
 six hundred and forty-eight lectures,  should we include  in
 the  latter  the  time devoted to  the  very  useful practice  of
 recitation,  the  presence  of the  students at which we under-
 stand is obligatory.   The  latter with us  is generally done  at
 extra hours,  on the part of such professors as choose to engage
 in it, but is chiefly in the hands of the junior members of the
 profession.
   Our course of Demonstrative Medicine was rich and instruc-
 tive, in  the variety of cases which it brought forward; and our
 course of Demonstrative Surgery,  presented every week from
 its opening, to the close of the same  on the 1st day of March,
 cases of absorbing interest, involving  many varieties of capital
 operations as they are called.   We might devote a few lines  to
 an allusion to them, were this a proper place.
  While these  steps were in progress at  the University, the
Pennsylvania Hospital  was  co-operating  by the lectures  of
Dr. Wood, as the Professor of Clinical Medicine also, and by the
lectures of Dr. Norris, Professor of Clinical Surgery.
  Of  the whole  matriculating list, amounting to four hundred
and sixty-eight all told, we may say in round sum that four hun-
dred and ten, at least, were regular students.  On the matricu-
                  D 
26
lating list, there were sixty graduates, about forty-three being
from the University of Pennsylvania, and seventeen from other
institutions,  some of whom contemplated finishing their studies
by graduation in this Institution.  Two hundred and thirty-five
were first course students, and one hundred and  seventy-five'
were consequently second course or more.  Of the present gra-
duating list, amounting to one hundred and sixty-one, there were
forty-three ad eundem candidates.  The relation of graduates
to students is therefore about forty in one hundred—a propor-
tion not exceeding an average of twelve years, as  presented in
our annual report for the year 1845.
   It will thus be seen  that this Institution has  acted sincerely
under  its professions to  aid the medical body  at large, in the
advance of  education, and  in putting  its honors under  such
restrictions as may be  most conducive  to this  end;—that we
have, on the present occasion, actually graduated only in a ratio
heretofore observed, and  perhaps in smaller number.  Under the
circumstances, undiminished confidence may be placed in the
administration of this  Institution  by parents and  preceptors,
the public at  large may possibly unite  in this  sentiment, and
will, I hope  be gratified.   But what is more, the alumni of this
school will 1 trust have the particular benefit of this confidence,
by a large share of its  immediate enjoyment, and the increased
skill with which they will be endowed, so as to justify it.  When
I inform you, gentlemen, that out of the small number in the
aggregate of medical students belonging to this populous Empo-
rium, sixty-four were  entered for the course of lectures in this
Institution, with the view to obtain their degree in it, you will
then know  whether the  present policy of  the University  in
regard to course of study, is the most consonant to public feel-
ing in  Philadelphia.
   From the solicitude  exhibited by letter and by personal ap-
plications on  this  subject, I am induced to  conclude that the
class of this Institution could  have been augmented from fifty
to one hundred at least, possibly more;  by its throwing off the
restraints which have  been  placed upon the conferring of its
honors, and upon the admissions to its lectures. It has, however,
preferred the honorable course of falling into the views of the 
27
American Medical Association, and in that way exhibiting its
loyalty to the important cause in which we are engaged.  But
even with this  curtailing policy actually in exercise, and with
an antagonistic action in the general tendency of things  in this
country, we have had a class larger  than could be accommo-
dated with convenience in  one of the most important lecture
rooms; and it will therefore be the duty of the Faculty so to ex-
tend the accommodations,  that this inconvenience may not be
repeated, unless a class should convene much beyond any size
heretofore in our walls.
  Gentlemen, with this address I close a circle of forty courses
of lectures in the University of Pennsylvania.   The forty years
which they represent, have been in every way the eventful ones
of my life : they include education, business, wife, children and
friends.   My connection with this distinguished school was first as
a student; your partialities, too little merited, elevated me at an
early period of life, to the honorable distinction of a place in its
medical faculty. I became finally the successor in full of a Ship-
pen, a Wistar, and a Physick, names too illustrious to need at the
present  moment further notice.  1  now find myself, though not
very old, yet at a period of life when  most men may look for
retirement at a day not distant; either from  the necessities of
health or in view of making place for the deserving who are
close upon their steps.  As this is moreover  the last  time in
which I am likely, in the  regular order of rotation, to perform
an office similar to the  present, I will take this only opportunity
of speaking strongly, but with all respect to you.
  Let me then say, I trust that at no  period, either while 1 am
with  you  or  subsequently,  the  high principles which have
hitherto  governed this  school may be  abated; or that an honor
suited only to minds of the higher cast of intelligence, shall be
permitted to become a simple commodity, whose price of time
and  of  labor is to  be  regulated by  the freedom,  with which
the supply may come from other quarters. As we have here-
tofore survived the  influence of the latter policy from  various
directions, ever since my first connection with you, so may you
survive  it long  after I am gone.
  4.  It is to many a subject of regret  that the circumstances of 
28
our country do not admit of those positive legal enactments on
medical qualification, that are found in the kingdoms of Europe.
As this is an affair under the action of state legislatures,  I do
not myself entertain any expectation that uniformity of an ad-
vanced kind will ever  exist;  it could only  emanate  from  a
national  body.   The American Medical Association have now
been repeatedly  brought together,  with the principal object of
action, to prevail  on the schools to extend their course of lectures,
and to elevate the standard of medical  education by requiring
more on examination; but as yet their efforts have not succeed-
ed.*  Our own School and one in New York, the College  of Phy-
sicians and Surgeons, have followed this expression of opinion.
Some of the schools have extended their term a little, but many
have stood aloof from it, with positive disregard of the recom-
mendation ; and  so far from falling into the measure, are  pur-
suing almost  the contrary course.   The profession itself  does
not appear to me  to have acted as energetically in this matter,
as may have been expected from all that was said.  It will cer-
tainly be deplorable if,  after all, the ebbing of opinion  should
leave things in a worse state  than  previously.  That there will
be a uniform code for  the  whole  United States is,  however,
very improbable : it is not at all likely that rural districts where
the annual receipt of the physician does not exceed more  than
four or  five  times that of a day  laborer; will be  furnished
with physicians  whose education has cost a very great  sum of
money,  and  a  long devotion of time.   The  physician will
necessarily be assimilated to the condition  of those around him.t
   The practical duration of medical  studies, as observed by
usage of the Medical Schools of the United States, varies  from
twelve months  to eighteen months or three years, according to
the school. I believe that none of the schools admit of much less
                               •
   * Possibly some good would arise from an arrangement  under the patronage of
 the American Medical Association, having  in view  a beneficial object as an an-
 nuity fund for decayed physicians or their families after their death, the admission
 to which, besides the ordinary  premium, should be qualified by medical education
 of a certain standard.
   t In Europe, provision is  made for such a  state of society by the issue of
 licenses of an inferior order, and by the Apothecaries practising. 
29
time than  twelve months,  or demand by positive  requisition
more than three years;* though some of the graduates are found
to have accomplished four years or more.
   The course of education on the continent of Europe is widely
different from our own; from five to seven years of study, and
under the most favorable circumstances, are demanded.  If one
of their eminent savans, their Mullers,  their Civiales, their
Velpeaus,  their   Rokitanskys, their  Von Rosas,  and  their
Louis,  were  told  that  in  the United States of America, a
Doctor  of  Medicine could  be made and  was really made  in
eighteen months, his eyes  would open to their utmost  limit.
He may have heard of  California, and of its  unequalled  pro-
gress and  development.  He may  have  read the  enchanting
imaginings of  Ovidt on the  reproduction of the  human race,
after the great flood: by Deucalion and Pyrrha casting the stones
of the  earth behind them.  He may say with the poet himself,
           " Saxa (quis hoc credat, nisi sit pro teste vetustas) ?
            Ponere duritiem coepere, suumque rigorem,
            Mollirique mora, mollitaque ducere formam."
He may admit the  possibility of a crop of armed men grow-
ing up from  the field, in which the warrior Cadmus had  sown
the dragon's teeth.  In all this a European savant  might con-
ceive that  a  new empire could arise in two or three years, by
hordes of a numerous and enterprizing people migrating into it
—that a creative power from stones  or  bones  or any inor-
ganic or organic element whatever, by an effort of its energy,
could reproduce  a  nation  or even re-people  the world,—but
it would  remain  to  him  an incomprehensible  enigma,  ex-
cept on the principle of divine inspiration, that in  a period of
time too short in Europe for learning even the  meaning and
use  of  medical terms—the  same time applied in  the United
States of America, was so managed as to  qualify in Chemistry,

  * It is remarkable  that while these mitigations prevail on a higher branch of
medicine, a collateral  one and in theory at least, under the direction of the first, is
more exacting.  The Apothecaries  of Philadelphia, members of  the College of
Pharmacy, have to study four years for a degree, while Medical Colleges of the
United States are finishing their studies in from one to three years.
  t Metamorph. lib. i. 400. 
30
in Materia Medica, in Anatomy, in Obstetrics, in Surgery, in
the Institutes of Medicine, and in the  Practice of Medicine—
that in a science of  confessed obscurity  to experience itself,  the
Neophyte in Medicine should in eighteen months here, not only
learn to distinguish between equivocal and unfrequent  diseases,
but moreover, acquire the skill to cure them; and that if any one
doubted  such ability, there  was the diploma to give it legal
affirmation.
   It would be a matter of just curiosity  to see which one of two
physicians of this rapid growth, would by choice  trust his life
to the skill of the other, in a dangerous complaint.  And what
would be still more curious to learn, is which member  of a me-
dical faculty,  recommending so directly  to  public patronage an
individual thus  superficially educated, would take medicine at
his hands, and especially in a doubtful disease.
   It has been often observed, that progress in knowledge tends
to diminish one's  confidence, and  to  increase his humility.
Let us listen to the reflections of a powerful mind in the follow-
ing words:
   "What have those geniuses, who have  descended to  the
foundations of science, and risen by the boldest flights to the
loftiest speculations, told us ?  After having reached the utmost
limits of  the space which it is permitted  to the  human mind to
range  over—after  having  trodden  the most  secret paths  of
science, and sailed  on  the vast ocean  of  moral  and  physical
nature—the greatest minds of all ages have  returned dissatisfied
with the  results.  They have seen a beautiful  illusion appear
before their eyes,—the  brilliant image which enchanted them,
has vanished; when they thought they were about to enter a
region of light, they have found themselves surrounded with
darkness, and they have viewed with affright the extent of their
ignorance. It is for this reason that the greatest minds have so
little confidence in the strength of the human  intellect, although
they cannot but be fully aware, that they are superior to other
men.  The sciences,  in the profound observation of Pascal, have
two  extremes which meet each  other; the  first is, the pure,
natural state of ignorance in which men are at  their birth; the
other extreme is, that at which great minds  arrive  when, hav- 
31
ing reached the utmost extent of human knowledge, they find
that they know nothing, and that they are still in the same state
of ignorance as at first."*
  In  medicine, this feeling of affright at our insufficiency ad-
vances as we ourselves advance in observation.  The neophyte
then  who  launches  his  barge upon  an ocean of this extent,
without misgivings and  without remorse,  must have no  thin
cloud of darkness enveloping his mind, which prevents him from
seeing the hazardous character of the  enterprise.  To what ex-
tent he is morally culpable, is under  the decision of a tribunal
higher than one on earth.
  I acknowledge again, freely, that  in  our  widely extended
country, with its diversified interests and condition of things, an
identical  system of education for all is impossible, it is the qua-
drature of a circle which  cannot be accomplished.   On the  con-
trary, I admit  that  every school has a right to determine for
itself, a plan  of education which may be  the  most congenial
to its honest convictions, and to its interests; and that it  may
possibly, and does carry out its principles, such as they  are,
with  as  much or more  sincerity  and good  faith, than we
ourselves  can claim.   There are, however, many schools un-
questionably  in the  United  States, so well placed by their
locality and just  estimation, that they  can stand shoulder  to
shoulder  with  us in this enterprise of securing higher attain-
ments.  Let them henceforth come forward; their success, if
accomplished,  will be  the more glorious;  they will have the
additional satisfaction of being able to submit it to any kind  of
analysis, and to prove that what otherwise may possibly be attri-
buted to a mitigation of study and of acquisition; is on the  con-
trary a well founded and legitimate result of dignified exertion.
  With  the above views, my  young friends, I now  take an
affectionate adieu.  May you  henceforth enjoy all the advan-
tages of time so well devoted to your studies.
* Balmes, p. 45.  Bait, edit., 1851.