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UNITED STATES OF AMERICA
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WASHINGTON,  D. C
GPO  16—67244-1 
 
 
PRACTICAL ESSAYS
MEDICAL EDUCATION,
[
AND THE
MEDICAL, PROFESSION,
    IN THE


United  States.
    BY DANIEL DRAKE, M. D.
Professor in the Medical College of Ohio.
   ttfucinnatt* <£fito:
PUBLISHED BY ROFF &. YOUNG.
1832. 
 
TO the
     STUDENTS  composing the TWELFTH CLASS

                         OF  THE

         MEDICAL COLLEGE OF OHIO:
    Young Gentlemen,

  In dedicating to you this little volume, permit me to bear public
testimony to your industry, sound morals, and dignified deport.
ment, since we came into the endearing relation of pupils and
professor.  In the hope, that what I have written, may contribute
to preserve yourselves, and your future students, from some of the
errors and defects of my own professional education,
                       I remain, affectionately,
                                Your friend,
                                  DANIEL DRAKE.
    Cincinnati, Ohio, January 19th, 1832 
                    CONTENTS.

          !•                                            Page
Selection and Preparatory Education of Pupils,             5
         II.
Private  Pupilage,                                         20
         III.
Medical Colleges,                                         45
         IV.
Studies, Duties, and Interests of Young Physicians,          60

Causes of Error in the Medical and Physical Sciences,      69
         VI.
Legislative Enactments,                                   89
         VII.
Professional Quarrels,                                     96 
        ESSAYS

             ON



          AND  THE

MEDICAL PROFESSION.
                        ESSAY I.


    Selection and Preparatory Education  of Pupils.

   Of the various occupations in society, scarcely one requires
greater talent and knowledge, than  the  medical profession.
This is especially true in the United States, where almost
every  practitioner must be, at the same time, physician,
surgeon  and apothecary.   Obvious  as  this  proposition is
to many, its truth, unfortunately, is not generally perceived
by those who are about to dedicate their sons to the profes-
sion—in other words, by  the persons who above all others
should feel and acknowledge its reality.   Hence it results,
that the ranks of  the profession are in a  great degree filled
up with recruits, deficient either  in  abilities or acquire-
ments—too often  indeed in both—who thus doom it to a me-
diocrity, incompatible with both its nature and objects.  Other
causes  contribute to its degradation; but this I am persuaded
is  one  of the most  frequent and  most difficult to obviate.
Still much might be done, if those who have the power, would
open their eyes to the  evil, and  exert their influence in its
suppression.
                            A 
d
medical education.
          Few of those who are put to the study of medicine, can
        be aware of the magnitude of the  undertaking, or of the in-
        sufficiency  of their capacity and  preparation; for the ob-
        vious reason, that  they are, in general, young and inexperi-
        enced.  There are, however, two  classes  of persons, who
        might be expected to judge  more correctly,  and have much
•       in their power.   These are parents ai d physicians, both of
        whom rather than our sons, should feel  responsible to society
        on this subject; and to them I beg leave respectfully to ad-
        dress myself.
          In the selection of boys for the study of medicine, many
        circumstances  entirely  disconnected with their fitness, too
        often exert a dominant influence; when their sway should be
        kept subordinate, or even regarded as entirely inadmissible. A
        neighbouring physician wants a student  to reside in his office;
        or one son of the family is thought too  weakly to laboui on
        the.  farm or in the work shop; he is indolent and  averse to
        bodily exertion; or addicted to study,but too stupid for the
        Bar, or too immoral for  the Pulpit; the parents wish to have
        one  gentleman in the family, and a doctor is  a gmtleman:—
        these and many other extraneous considerations, not unfre-
        quently decide the choice and swell the numbers, while they
        impair the character of the profession.
          Both parents and physicians should know, that boys of feeble
        frame and unsound constitution, cannot endure close study,and
        are best strengthened by bard labour; they should not, indeed,
        ever be put to the learned professions, unless they chance to
        possess extraordinary genius.  Every  physician must have
        seen many, who dragged out the whole period of their brief
        and reluctant pupilage,  with dyspepsia, a pain in the breast,
        or hypochondraism conditions which either preclude all intense
        and successful  application; or render it the cause of some
        other  distressing  malady, which  terminates  in  premature
        death.
           But it is not sufficient that hoys  selected for the study  of
        medicine,should have good constitutions; they ought, equal-
        ly, to be endowed with vigorous and inquiring minds.  With-
        out these, whatever may bv the appr. trances of success, they
         must  at last make incompetent  physicians.   It is  especially 
MEDICAL EDUCATION.
and indispensably necessary, that they possess, in a high de-
gree, the  faculties of  observation  and judgment; without
which,  they  can neither comprehend  the  principles of the
science, nor apply them correctly in the treatment of disea-
ses.   Notwithstanding this obvious  fact, hundreds are put
to  the  study of medicine, whose utmost grasp of intellect
never encompasses the rudiments of the  profession.   As a
matter of course, they slur over every difficult proposition;
and afterwards grope their way for forty years, unconscious-
ly committing 'sins of omission or commission,' throughout the
whole of that long period.  It is in vain to rely on society to
correct this great evil, by  discriminating  among the  candi-
dates for their confidence;  for the  knowledge  necessary to
a correct selection, does not exist among them.  In the  other
learned professions,this species of empyricism cannot produce
the same mischief.  The incompetent Divine, at most but occu-
pies the place of an abler teacher, and the superficial Lawyer, is
either driven from the  Bar, by the exposure of his errors, or
they  are rendered harmless, by the skill of competent asso-
ciates.  But the physician, who has passed through the  usual
forms of a professional education,  without  the capacity to
improve by his opportunities, is presumed by the people, to
be  qualified for  every emergency;  and sometimes  even
preferred to the ablest practitioners.
   The  student of medicine should not only be  of sound un-
derstanding, but imbued  with  ambition.   A mere love of
knowledge is not to be relied upon, for the greatest lovers of
knowledge, are not'unfrequently deficient in executive tal-
ents, and  go on  acquiring  without learning  how to appro-
priate.  Let parents,  therefore, not he misled by  the  signs
which  indicate  a fondness for study, unless the desire in-
volves a feeling of emulation.   A thirst for fame, is indeed
a safer  guaranty, than  a taste  for learning; as it generates
those  executive efforts, which are  indispensable to the suc-
cessful practice of the profession.
  Further, the  temperament  of the youth, should be that
of industry and perseverance; without which be will balk at
every difficulty,  and  require to be goaded on through all sta- 
8
MEDICAL EDUCATION.
 ges of his pupilage.   An indolent or irresolute student, what-
 ever may be his genius, can never figure as a physician; and
 should, without delay, be apprenticed to some vocation, in
 which the destruction of limbs and life will not be the inevi-
 table consequence of idleness and discouragement.
   Finally, parents who are  too poor to afford  their sons the
 necessary opportunities, should not aim at making them phy-
 sicians.   If we now and then see one, whose talents, ambition
 and  enterprize, have enabled  him to acquire  distinction,
 in despite of every obstacle, we meet with many more, who
 all their  lives remain  unfinished and imperfect, from the
 want of adequate time  and opportunities, while  engaged in
 their professional studies.   I am the more disposed to insist
 on these truths, because so many fathers are ignorant of
 what is really necessary to make their sons good physicians;
 and place them to the study of physic before they have accu-
 rately counted the cost.   Of all the causes which  impede the
 progress  of medicine in the United States, not one is more
 operative than this.   The amiable vanity in which it  origi-
 nates, can scarcely be condemned; but parents  should be ad-
 monished to look  at the consequences of such an  indulgence
 of feeling.  Under the  most limited opportunities, a son can
 make acquirements that may satisfy a fond father, who knows
 but little  of the  extent and complexity of the  medical scien-
 ces; to he prepared, however,  for the various exigencies of
 the  profession,  is  a  much  more difficult affair.   Paternal
 affection may blind us to the errors of our sons, but cannot
 obviate their prejudicial influence on society.
  Having briefly considered the moral and  physical qualities
 which fit  young men for the study of medicine, I come now
 to say, that a  majority  of those who are  selected for that
 purpose, are  deficient in one or both  classes  of requisites.
Let us enquire into the principal causes of this  state of things
—so unfavourable to the dignity of the profession and preju-
 dicial to the interests of  humanity.
  The current opinion, that men of slender abilities  are com-
 petent to  the practice of physic, is, obviously, a great cause
why  so many feeble minded boys are dedicated to its  study> 
MEDICAL EDUCATION,
<S
 There never existed a time, when this opinion was well foun-
 ded.  In past ages, when medicine could not claim a place in
 the ranks of philosophy, it was still a science of observation,
 and called for an acute and discriminating mind.   Though it
 could not  rise above  the grade of an experimental art, it
 never sunk to a trade  the results of  which were purely acci-
 dental,except when it fell into the hands of the imbecile or the
 unprincipled.   At the present time,  when the  intricacies
 of the human structure have been unravelled, and many of
 its functions are understood; when the accumulated experi-
 ence of centuries has developed numerous general truths, and
 the spirit of inductive  philosophy has arranged them into a
 science—imperfect it is true, but still a science—when chem-
 istry, natural philosophy, botany and natural history, have be-
 come essential preliminary branches, nothing can be more ad-
 venturous,  than to  engage in the  study of the  profession
 without  a logical and comprehensive mind.
   Another cause of the evil which we deprecate, is the liberal
 proportion of inferior  men, who unfortunately belong to the
 profession, and so often succeed  in acquiring business and
 popularity.   An observation  of this  fact, not a little mortify-
 ing to the more talented members of the profession, encour-
 ages parents  to set apart for the study of medicine, those
 sons who are least remarkable for strength of mind; reserving,
 the better class, for  pursuits which in their opinion require
 more vigour of intellect, or promise greater distinction.  Thus
 a  degraded state  of the  profession is made  to perpetuate
 itself, by influencing  not only the  ignorant, but the well
 informed; for when a  father, who has a just estimate of  the
 strong talents  necessary to the study and practice  of physic?
 apprehends that a son, of whose genius he is proud, may,
 on entering the arena, meet with many whose  emulation is
 vitiated  with envy;  who labour to please rather  than pre-
 serve their patients; or whose  skill consists  more in the arts
 of  imposture  than of cure;  it is not unnatural for him to
 shrink from the anticipation of  the rude struggle.
   The root of this  great evil is planted in  society itself.
Some persons are too  dull to discriminate among  the mem- 
01
MEDICAL EDUCATION.
bers of the profession, others allow themselves to be captiva-
ted by pleasant manners, and not a few call for cheap doctoring,
all of which tend directly to elevate false pretension and de-
press real merit.
  But there are causes which attract, as well as repel,young
men of genius from the profession.
  It will not be denied, that.no passion is  more intense and
universal, than the love of gain.  If not the first to be devel-
oped, it is the  last to  be extinguished; and, taken in the
aggregate, perhaps no other exercises so much sway over the
course and conduct of man.    But in  most  parts of the
United States, the practice of medicine offers little to gratify
this  desire, in  comparison  with commercial pursuits;  and
hence we find, that they exert an influence, which draws into
the vortex of trade, no inconsiderable part of the talents and
enterprise of the  nation.
  Strong, however, as  the attractions of commerce unques-
tionably are, their influence is  trifling, compared  with those
of law and politics.  In  no  other country is the union of
those two sciences so intimate, as in the United States.   The
regular course of promotion is  from the county court house
to the capital of  the  state, thence to the halls of congress,
and, finally to the presidential  palace; whose lofty  entabla-
tures, by  a kind  of looming,  are seen with magical effect
from every part of the union.
  It is marvellous to see with what lustre, the 'seals of office
glitter in  the eyes' of the good people of these United States.
The whole world furnishes no parallel case.   The number
of state and federal offices is so great, as to awaken political
aspirations on our entire male population; and some of them
are invested with  sufficient emolument, power, and patronage,
to excite the most intense emulation—1 ought rather to say,
the angriest rivalry.  Thus are the genius and ambition of the
nation drawn  into the race  of  political  glory.  But for
this, the law would scarcely exert stronger attractions upon
the talent of the country, than medicine; for its own intrinsic
rewards  are not  of a higher ord^r, as the problems which it
offers, do not require for  their  solution, a greater amount of 
MEDICAL EDUCATION.
11
intellect, than the practice of medicine.   How long this will
continue to be the  case, it is difficult to foresee; but as our
population is progressive, while the number of political offices
is nearly stationary, we may hope that the time is not distant,
when the proportion of talented youth who are  dedicated to
the study of physic, will be much greater than at present.
  The  consequences of this deficiency of talent in  the pro-
fession, are of serious import to the science  and to  the peo-
ple at large.  It is  unquestionably one of the causes, which
retard the progress of discovery  and improvement.   Of the
thousands  who annually go forth with diploma? or licenses,
or without either, to engage in the practical duties of the
profession, very few ever contribute a single new fact  to its
archives,  or communicate an impulse to  the minutest wheel
in  its complicated machinery.  Acting  on  the precepts of
others, they may, it is true, do some good, but they also  do
much harm; while  to the great work of revising and correc-
ting the principles  of the science, they are of course utterly
incompetent.
  But  this incompetency is not the  effect of inferior talents
only, it results, perhaps, in  an  equal degree, from  want of
education and mental discipline, on the extent  and causes of
which I shall now proceed to speak.
  Although medicine is ranked  with the learned professions,
not a few of its professors are signally deficient in learning.*
This is the case not only in the  Western states, where for
obvious  reasons  it might be expected;  but  in  almost every
part  of the union,  with the exception of some of our  large
cities.  Writing  as I do for practical effect, and to  promote
reform, I am constrained to say, that even at this late period,
the profession abounds in students and practitioners, who are
radicall y defective in spelling,grammar, etymology, descriptive
geography.arithmetic, and,T mi j!;ht add book-keeping, but that
th_v generally apply themselves to the study of that important

  *Of course, on this occasion, I expect tbe reader  to understand
the word professor as synonymous with practitioner, and not su= refer-
ring to  public  teachers; whose commissions must be regarded as
evidence of learning,  should other proofs happen now and then  to be
wanting. 
12
MEDICAL EDUCATION.
 branch,  with a diligence which supplies the want  of early
 opportunities.   Grammar  and spelling especially, (to  use
 the language in which I once heard a physician speak of the
 circulation of the blood,) appear to be among the 'secret arca-
 nums of nature which Dr. Hamilton said never would be found
 out.''  Nothing is more common than to commit gross violations
 of both, in the directions which we  write  for our patients;
 and, what is still more humbling to the  pride of the profes-
 sion,notafewof usneverlearn to spell the names, eitherof the
 medicines which  we  administer, or the diseases  which we
 cure.  Were this confined  to unauthorized members of the
 profession, it would be an affair of little magnitude; but ex-
tending to many of the graduates  of all our  Universities,  it
 calls for unreserved exposure  and unqualified reprehension.
 Before the Revolution, the  schools  of the Colonies were gen-
 erally bad, and till  lately those of the West  were not fitted
 to impart a good  elementary education; but at present they
 are so improved, as to leave no excuse, for the literary igno-
 rance which disgraces the  profession.   The  taint, however,
 is hereditary, and may yet  run through several generations,
 unless the authoritative members of the faculty can be moved
 to unite their prescriptions  upon it.  It would certainly not
 be  unreasonable to require, that every youth who aspires  to
 connect  himself with a liberal pursuit, should  first learn
 to spell and write his mother tongue  with as much accuracy
 as a country schoolmaster; if either his genius or misfortunes
 preclude such acquirements, he had better take to some cal-
 ling which does not demand them.
  On reading the foregoing sentences  to a  friend, I found
 him sceptical as to their accuracy; which leads me  to declare,
 that /am entirely convinced of it.  Nothing could be further
 from my heart, than a desire to disparage  the character  of
 a profession, to which, 'man and boy,' I have been attached
 for nearly thirty years; and to the( advancement of which
 my humble exertions have been  devoted  for most of that
 period.  During this time,I have become acquainted with the
 literary  and professional ignorance of so  many  students
 and physicians, in and of, various parts of the Union, that I 
MEDICAL  EDUCATION.
13
cannot  be mistaken in asserting,  that the  majority of the
profession in America, are deficient in common school learn-
ing.  If such be  the  fact, it should not be considered libel-
lous to publish it, especially when done by one who claims no
exemption from  the  imperfections which he deplores.   So
long  as we 'measure  ourselves by ourselves  and compare
ourselves among ourselves' we are not likely either to perceive
or supply our defects.  There can be no true reformation
without a consciousness of its necessity; and if these remarks
should contribute,but in the slightest degree, to excite it, I shall
submit cheerfully to the odium which they may bring upon
me, from those who find recrimination more convenient than
improvement.
   But is the education which our  common schools confer, a
sufficient preparation  for the study of medicine?   It certain-
ly is  not.   To a familiar acquaintance with  the branches
which have  been  enumerated, the intended student of medi-
cine, should add a competent knowledge of the elements of
physical geography, general  history, the art of composition,
algebra, geometry, and mechanics.  If these  acquirements
are not made before he enters on his professional studies, he
will most probably  remain without them through his whole
life; the effects of which will be sufficiently obvious toothers,
if not felt by himself.   After what has been said, concerning
our deficiencies in the rudiments of learning, it will scarce-
ly be supposed, that our  acquaintance  with the  sciences of
this second group, is such as to constitute a suitable introduc-
tion to  medical  studies.   In truth, most of  us live  and die
in utter  ignorance  of them.   There was a time, when this
ignorance, particularly of mechanical philosophy, would have
been thought fatal  to the success  of a student of medicine.
Our science was then,  held  to be a branch of general phys-
ics; and the laws of the  living system, a mere modification
of those  which  govern the  operations of dead  matter.  I
would  be among the last  to desire the revival of these ex-
ploded errors; but that we have  passed from one extreme to
another,  seems to me an  unquestionable  fact.   We  cannot
explain  the phenomena of living bodies, by the principles of
                           B 
1*1
rlEDlCAL EDUCATION.
natural philosophy, but at the same time are unable to com-
prehend  them, without  the aid of those principles.   The
functions of seeing, hearing, locomotion, respiration, and the
circulation of the blood, can no more be understood without
an acquaintance with the laws of natural  philosophy, than
the movements of the  atmosphere or the heavenly bodies:
but their agency in the two cases is widely different.  In the
movements  of the universe, we behold only the influence of
these principles; but in the functions  of organized beings,
they are  subordinate  to a vital power; the laws  of which
constitute the science of life, or physiology.  Thus, organized
bodies present us  with  a case, in which the general laws of
matter are not repealed,but subjected to modification. Among
all the works of God, we meet with no others which present such
a  great assemblage of agencies;—so diversified, yet co-oper-
ative—so admirably  balanced—so  harmonious, though com-
plex and apparently involved—so productive of striking and
beautiful forms!  The  human system is, indeed, the great
mystery of creation, offering problems of matchless intricacy.
and shrouded from human observation, by a veil which none
should attempt to draw aside, without deep and varied
preparation.
   Suppose, what is  not the  fact, that to common-school
attainments, our students added the first principles of mathe-
matics, and  the other sciences, constituting an academical
course, would they then be properly qualified?  I again an-
swer they would not; and this  brings us to the consideration
of the learned languages, as an introduction to professional
studies.   I shall not attempt to travel over the whole ground.
  The United States  are, perhaps, the only civilized country
in modern times, where it has been seriously doubted, wheth-
er the languages and  literature of the ancients, should make
a part of the studies of professional men.   Of the various
causes which have combined to suggest this  question, one
of the most operative  is the spirit of liberal inquiry, which
originated, and is cherished  by, our  free institutions.  No
people are so unshackled by prejudices and precedents;none
so excursive; none so  experimental, as  the  American.  If 
MEDICAL EDUCATION
15
 ihey do not'try all things, and hold fast to that which is good,'
 they try  many, and are strongly disposed to fix  upon some-
 thing new.
   Another cause contributing to excite the same doubt, is the
 successful acquisition  of business by physicians, who lived
 and died  in ignorance of Greek and Latin.   With such ex-
 amples before us, it was natural to ask, whether the study of
 the dead  languages  should be regarded  as indispensable, or
 even beneficial, to the candidate for the honors of the profes-
 sion ; and not a few have, at all times, been ready to answer
 in the negative.  In this inquiry there has been much to lead
 us astray.
   Our forefathers, (most of whom were illiterate) emigrated
 to a forest, which it has been the occupation of  their sons to
 subdue.   In the prosecution of this Herculean task, and the
 subsequent establishment  of institutions—political, social,
 and literary, they frequently  experienced a  want of appro-
 priate means, and were compelled by the exigencies of their
 novel and trying situation, to think and act with originality.
 Hence arose  a feeling of self reliance;  a spirit of indepen-
 dence; a  disregard of ancient customs; to which we may in
 ,i great degree ascribe that indifference to the languages and
 learning  of antiquity, which  characterizes the   majority of
 our citizens.
   Thus physical circumstances have, indirectly, exercised  a
 mastery over moral causes, and given a deflection to our Eu-
 ropean character, which promises  to  become   permanent.
 Moral causes, however, have contributed to the  same effect.
 In migrating from  the old world, our ancestors took leave of
 the institutions devoted to classical instruction; and  hence  a
 generation,of necessity, grew up in  comparative ignorance.
 It would be in vain to hope, that a due respect for the learned
 languages, or even a conviction of their utility, could survive
 such a transition; and hence we find, that in the United States,
 a want of acquaintance with them, has been no serious obsta-
cle to the  attainment of high relative  distinction, in any of the
puisuits of society.   How long  this will be  the  case, it is
not easy foresee.  A perception of their value appears to be 
16
MEDICAL EDUCATION-
 returning; but I cannot  suppose, that  they will ever attain
 to the rank which they hold in the estimation  of our elder
 brethren of Europe.
  Mean while, it is the duty of those who can exercise any control
 over  public sentiment in this respect, to  exert themselves;
 and, if all who are  interested in  the dignity  of the medical
 profession, could be  brought to unite their efforts in favor
 of a more classical preparation of young  men  designed for
 the study, it cannot be doubted, that much  might be accom-
 plished, even in a single generation.
   A physician who is ignorant of the Latin and Greek lan-
 guages, whatever may be his genius and  professional  skill,
 must, to  the eye of sound scholarship, appear defective and
 uncultivated.  For  more than two thousand years, these lan-
 guages, especially the former, were the vehicles of all medi-
 cal knowledge,except the little contributed by the Arabians;
 and, till within a century, our professional  ancestors wrote,
 and prescribed, and thought, and lectured, in Latin.   It was,
 indeed, to the  profession a universal language;  affording the
 means of an easy and accurate  correspondence,amoig all
 the schools and  physicians  of Europe.  Even  down to the
 present time, the lectures in most of the Italian  and German
 Universities, are delivered in Latin; while the examination of
 candidates; in many others, is conducted  in  the  same  lan-
 guage.   Thus it has had a  most protracted and intimate
 companionship with medicine; to  the nomenclature of which
 it has freely lent its  opulent vocabulary.  Many of its words,
 no doubt, as well as those drawn from the dialects of Greece,
 are intended to convey, in their new situation, ideas materi-
ally different from their vernacular import; but in attempting
 to understand  even these, the student is greatly assisted  by
 an acquaintance with their primitive significations.  With this
 knowledge of our dependence on  the  languages and litera-
 ture of the ancients, to deny that the study of them must be
beneficial, is scarcely less absurd, than to affirm, on the other
hand, that every classical  scholar  is  of necessity  a phy-
 sician. 
MEDICAL EDUCATION.
17
  But a thorough course of preparatory learning is useful, in
more ways than one.  It establishes early habits of applica-
tion; generates  a love of knowledge; trains the faculties-
and inspires that firmness of purpose, which prevents him who
puts his hand to the plough, from looking back.   These are
the  cardinal virtues of a  student;  and they  are in a great
degree the  effect of cultivation.  We  look  instinctively at
the grand and beautiful aspects of nature, but this is poetry,
not philosophy.   A poet delineates the surface, a philosopher
decomposes the substance of things.  One is born, the other
called to his vocation.  Education never made a great poet,
nor  nature  a good philosopher.   He  is essentially  the pro-
duct of art.   Toil is his destiny.   He must sink a deep shaft,
and  draw  up his treasures from below.  Therefore he should
be strengthened by  timely and active effort.  He  must be
inured to  labour, and acquire adroitness in its performance.
Hence he should begin early, for then only can suitable hab-
its  be formed.   As well  might  he attempt, at twenty, to
learn fencing, dancing, or a delicate and difficult art, as to
commence at that age, without previous study, a course of phi-
losophy.   In both cases his awkwardness gives  birth to  the
most discouraging failures.   He feels, incessantly, the want
of that  strength  and discipline, which are the  offspring of
practice, and are derived from  it only.  I would  admonish
parents to consider this subject anxiously and  deeply.  Many
who place their sons to the study of medicine, are themselves
illiterate, and do not apprehend the importance of early intel-
lectual discipline. They transfer the objects of their care, from
the plough to thedoctor's shop; and require them to exchange
the  recipies of agriculture  for those of pharmacy.   Of the
multitude, a few, by the force of an irrepressible genius, may
rise  to eminence; but  the  majority must lag forever in  the
under walks of the profession.  Not having learned to climb,
when the art might have been acquired, they may assault, but
cannot scale the rugged steeps of science.
  It is  sorrowful to see, what  every physician  must have
seen, the  exertions  of a  generous your*:g   man consigned
to the study of medicine, with a mind untutored and unstor- 
lb
MEDICAL EDUCATION.
ed;—to  witness his  ill  directed  efforts—strong  but  com-
paratively  unavailing; his fitful application; his embarrass-
ments  under every difficulty; his  disappointments and des-
pondency;  above all his mortification, from a  consciousness of
superior abilities united with a perpetual conviction of infe-
rior progress.   No devotedness to  study, no  intensity of am-
bition, no energy of intellect, not  the whole combined, can
make such  an one what he would have been with  early cul-
ture, nor raise him to  the standard  erected by his  own  vivid
imagination.   He  may satisfy his  friends, but must himself
remain dissatisfied and unhappy.
  But let us turn to  a more common  case.   Suppose the
youth as deficient in strength, as he is in discipline of mind;—
what will then be his progress?  To answer with a solecism, it
will be no  progress.   There can be no advancement,  when
both nature and art  array themselves  in opposition.   The
first lessons of science, are to such  a person, a 'sealed book;'
which, like the  worm, he may perforate,  but  can  never
open.  Or, to use a more  national  figure, he  is a militia man
without courage or discipline, when one, at least, is indispen-
sable to success.  He cannot take  captive, the  vanguard of
postulates, axioms,and definitions which lie in his way; and of
course the citadel remains permanently hidden from his dim and
uneducated vision.   If dull young men must be apprenticed to
medicine, common sense dictates, and common justice to them
and society requires, that the pedagogue should begin his dril-
lings early; for  dunces are neither plastic  nor acquisitive,
and where the tree of knowledge grows slowly, it should not
be planted late.
  With these remarks 1 close this branch of  our subject.   If
I have spoken freely, it has been as a friend,  not an enemy of
the profession.   I have notwritten from the recesses of a clois-
ter, but  in the midst of  society.   Observation  and per-
sonal  experience have  dictated every  sentence, and   affor-
ded me satisfactory evidence of its truth.  For this, moreover,
I might appeal to all my enlightened brethren of the United
States.  Not one of them  could venture to gainsay, what has
been asserted; nor commend the apathy which connives at the 
MEDICAL EDUCATION.
19
errors and abuses, which  have been exposed.  Let them be-
gin the  good work of reformation, and  society will come
quickly to their aid, 
ESSAY II.
                   Private Pupilage.
  It is impossible to approach this subject without emotion.
I know of no other, the free discussion of which would be so
likely  to agitate the  profession  in  America.   That  I shall
treat  it  without prepossession, prejudice or passion, is  not
probable; nor is it certain, that I shall say all which should
be said; but intending to write with courage and candour, I
may  hope to awaken, if not to guide, the spirit of reform.
  To come at once, to a full understanding with the reader,
I shall assume the general proposition, that our system of pri-
vate tuition is essentially bad.   But, in truth, we have no system;
and it would be more  correct to say, that in the United States
a good system of private pupilage is imperiously required.
  In  the preceding essay, on  the preparatory education of
students, I have endeavored to show, that its errors and im-
perfections are  permanently stamped on our literary charac-
ter. If this be the fact, we can scarcely doubt, that a defective
elementary education, in medicine, must greatly retard  our
advancement to professional excellence;  and whatever does
 this, demands the gravest attention.
  The ordinary time of private instruction is so short, as to
require that it should be well employed.   If the  rudiments
of the profession are not then acquired, they are seldom prop-
erly understood.  It is not easy, afterwards, to supply  the
omissions, or correct the errors of that period.  I have never
known it done.   Every stage of life has its peculiar tastes and
appropriate studies.  In youth we acquire elementary truths
—in manhood arrange them into general principles—in the me-
ridian of life, apply them to the production of practical results.
Such is the law  of nature; and was it inscribed on  the doors
of every medical library, they would not so often be opened
 to no beneficial  effect. 
                   MEDICAL  EDUCATION.                 21

  Having spoken at  large of the selection of pupils, I come
now to the choice of preceptors.  This is a point of more im-
portance than most parents suppose.   Many of them, indeed,
seem to act on this important subject with but little discrimi-
nation.   The ciicumspection with which  they select masters,
when about to apprentice  their sons to mechanical occupa-
tions, is seldom manifested when a medical education is the
object.   They appear indeed to feel  themselves incompetent
to judge, in the latter case, and, generally, consult econonvy
or convenience; although in  so doing, they not unfrequently
determine for  their sons, a  far more imperfect and  limited
destiny than they intend.
   1. It is not necessary that the preceptor should be a man of
genius; but it is indispensable that he should possess a sound
and discriminating judgment, otherwise  he will he  a blind
guide.  Of his  qualifications in this respect, every parent with
opportunities of  personal intercourse, may form  a  correct
opinion.   It is not requisite, that he himself should be  ac-
quainted with  ths principles of the profession to judge of the
talents and common  sense of its practitioners: The most un-
learned can distinguish between a clouded and an unclouded
intellect.
   2. A preceptor should be learned, at least in his profession.
If a father wishes to make his  son a skilful  mechanic, he places
him with a good  workman—not a botch.  How can a  man
direct the studies of  a youth  through the elements of several
different sciences, if his own acquaintance with them is im-
perfect 'and confused?  As well might architecture be taught
by  one, who ignorantly  combined  in the same column, the
parts and proportions which belong to all the different orders.
To judge of the attainments  of professional men, is  a more
difficult task, than to  estimate their  abilities; but although  a
father may not be able  to do this by  direct inquiries,,he still
has much in his power in this respect.  The previous oppor-
tunities of the individual whom he scrutinizes, taken in con-
nexion with his existing habits,  will  generally enable him to
come to a correct conclusion.  If the former have been lim-
ited and the latter are idle, he may safely conclude, that the 
22
MEDICAL EDUCATION.
requisite attainments are wanting; and look elsewhere for the
aid which is indispensable to a rapid and logical prosecution
of studies.
  3. It is not sufficient that a private preceptor has talents
and learning.  He must be devoted to his profession, jealous
of its character, and ambitious of its honours.  With such
feelings, he will awaken high aspirations in the bosom of the
youth  whose destiny is committed to his  keeping, enamour
him with the  sciences whose rudiments he is to acquire, and
animate him in the toil which their difficulties impose.
  4. The preceptor should be conscientious in the perform-
ance of his duties; that is, he should feci the responsibilities
of his office, and studiously endeavour to discharge them.  It
is easy to deceive a father in regard to the  progress of a son,
in the study of a profession with which the former is unacquaint-
ed,  for all his partialities coincide with the flattering reports
of the master,-and cause them to be  received with credulity.
In this way many a tutor has repressed paternal anxiety, and
screened, from paternal vigilance, his inattention and neglect;
inspiring high hopes, at the very moment when his own crim-
inal derelictions of duty were sowing the seeds of their future
destruction.
  5. The private preceptor should, if possible, be  a man  of
business:—Punctual to his pecuniary engagements, accurate
in his accounts, and systematic in all his affairs.   He will thus
be an example for the imitation of  his  pupjls, on points  in
which too many students of medicine grow up with  deplora-
ble and enduring imperfections.
    6.  Finally, sound morals and chastened habits are not
among the least of those qualifications, which an anxious fa-
ther would require in the man,whose deportment and precepts
are to exert so great an influence on the character of his son.
It would he superfluous to  enumerate  all the vices, which
ought to disqualify a physician for the private tuition of bovs
and young men; but there are a few which  from their fre-
quency and effect, deserve, on every suitable occasion, to be
held up to the scorn of society.    A want of attention  to
professional promises, with a consequent fabrication of excuses 
MEDICAL EDUCATION.
23
and apologies,  is a failure which no preceptor can habitu-
ally  display, with impunity to  the morals of his pupil; and
ought to be regarded as a disqualification, with whatever gen-
ius and learning it might happen to be associated.   Gambling
is another vice, the morbid influence of which on the plastic
and imitative pupil,should be still more seriously deprecated;
since in addition to the corruption which it carries into the
youthful heart, it diverts from study, generates neglect of busi-
ness, and leads  to the loss of character and fortune.   Lastly,
intemperance not less than gaming, should  displace a physi-
cian from the ranks of those whom we entrust  with  the tui-
tion of young  men.   Intemperance, in the United States at
least, has been regarded as a prevailing vice of the profession,
and it has too often happened, that boys almost from necessity
have been apprenticed to drunken doctors.  I am proud to
say, that this necessity is rapidly diminishing.   Nevertheless,
the number of intemperate physicians is still  so great, that
parents should  proceed with care and caution in the choice of
preceptors.  One of the  greatest calamities they could  in-
flict on a son, would be to place him under the guardianship
of a drunkard: if unsusceptible of being corrupted by  ex-
ample, he  would suffer numerous embarrassments and mor-
tifications—if susceptible, he must be ruined.
   It would not be easy to estimate the injury  which has re-
sulted to individuals, to the profession, and to society at large,
from a want of discrimination in parents, when  about to place
their sons to the study of medicine.  Many a youth has, in this
manner, been sacrificed by an  ignorant or thoughtless father.
Irresolution has sunk into moral cowardice, dullness declined
into stupidity, and genius substituted its flights and phantasies
 for patient analysis; ambition has found its goal in the acqui-
 sition  of premature and badly earned certificates and diplo-
 mas; idleness relieved itself by  ceaseless changes from frivolity
 to frivolity; and the love of pleasure been left to luxuriate in-
 to licentiousness and vice.  It  is playing at cross purposes, for
 a father to dispense with the services of his son and incur the
 expense of  his professional education; and, at  the same time,
 to place him under an unqualified or unprincipled master.   It 
24
MEDICAL EDUCATION.
is due  to themselves and their children, that parents should
consider this  subject seriously.  It is, also, due to the profes-
sion and the community, that they discriminate on this point.
When they confide their sons to the ignorant, the indolent, or
the vicious, they encourage that, which every member of the
commonwealth is bound to discountenance; and withhold from
the learned and meritorious members of the profession, one
of the  legitimate rewards of their industry, zeal and  perse-
verance.  Could no  physician hope to attain  the distinction
of being a preceptor, without first establishing a character for
sound science and good morals, not a few who are now reck-
less of both, would be held firmly to their acquisition.
  Another  mistake which requires correction, relates to the
time of life  when medical  studies are  commenced.   Essen-
tially latitudinarian, the American people allow themselves in
this respect,  as in most others, a singular degree of liberty.
Many boys are put  to  the study  of physic at fifteen, while
men of twenty five or upwards, who have  been too  indolent
or too unskilful  to succeed in  their first .pursuits, are every
day seen to betake  themselves to this  most difficult and ele-
vated vocation without a single misgiving.   Examples  of suc-
cess might be cited  in support of both periods, but still they
are extremes.  When a boy begins the  study at fifteen or six-
teen, he generally sets up for himself at nineteen or twenty; a
time of life when he lacks judgment, whatever  may  be his
acuteness of  parts or the extent of his  information.   On the
other hand, he who takes his  first lessons after his mind has
attained maturity, will seldom  move with ease in the practical
duties of the profession, even  if his life have been spent in
studies up to  that period; and,  if this should not have been the
case, which in America is the general  fact, the  chances are
altogether against his ever becoming useful or acquiring pub-
lic confidence.   Seventeen or  eighteen, seems to me the most
proper age  to commence the study.  By that time, a due pre-
paratory education may be acquired; the mind and hands are
still so plastic, as to be directed in their operations; the rea-
soning faculties are sufficiently developed  to  investigate the
principles of the profession; and  the period between that and 
MEDICAL EDUCATION.
25
twenty one or twenty two, is about long enough to admit of
the necessary  acquisitions.
   The youth of the  United States, arc not only put to the
study of medicine at improper ages, but the period of  their
studies is too short.  Nothing is more common than for them
to enter on the practice, at the end of two years, or even eigh-
teen months, and three years are thought to be a protracted
and tiresome pupilage.  But I do not hesitate to assert, that
even that term  is too short; and that  four years should be
considered as indispensable.  Of the various causes, which
have retarded the advancement of the profession in this coun-
try, and inflicted upon it such multitudes of medical practi-
tioners  who leave behind them  no single monument of skill
or science, this is one  of the most operative and universal.—
The blame rests, in part, on our national impatience to engage
in practical exertions, but  still more  on the custom which
prevails among fathers who are indigent or but little above
that condition, of assigning their sons to the profession.  The
term of their  pupilage, is thus determined, not  by the scien-
ces which they ought to study, but their means of support.  ^^J
   The situation and  circumstances in  which a pupil should
prosecute his studies, deserve to be considered.  In the country
and all  the smaller towns of the United  States, the fashion is
for the student to reside and study in the shop or office of his
preceptor, and often  to become a  member of his family.—
The latter has its  advantages, as contributing to preserve him
from dissipation; but  his time is too often wasted in labours
foreign to  his studies, and he is  apt to  be introduced more
frequently into company, than is compatible with his interests
as a student.   Of the office, as a place for study, "much might
be said on both sides."   It is the resort of many persons  be-
sides those who call for medical assistance, and the student is
subjected  to  perpetual, if not protracted interruptions.   In
this way he loses many precious hours, which can never be
reclaimed.  At first, the effect of these interruptions is so
 distracting,as materially to impede his progress; but their
influence diminishes with the repetition, until at last he comes
to form habits that are not without their value in after life. 
26
MEDICAL EDUCATION.
To understand this, we need only recollect, that the practice
of his profession will subject him to incessant interruptions of
a similar kind; and if he has not early acquired the  art of
reading in the midst of them, he will not read at  all.  From
the want of this habit, many physicians pass their lives inca-
pable, as they conceive, from  the  vexations  of  business, of
reading as  many volumes, as  they  should study  every year.
Another compensating benefit, is the practical facility which
they acquire, from witnessing and assisting in the various little
clinical and surgical operations, of  which a Doctor's shop  is
the theatre.  This however, is not without its disadvantages,
as the student is liable to have his  mind bent upon practical
matters, long before he is able to comprehend their rationale;
by  which his attention is diverted from elementary studies,
and a foundation laid for future empyricism.   Of the differ-
ent modes of generating quacks, this is the most prolific; and,
as they bear the external marks of legitimacy, the most per-
nicious to society.   Every student,however, should spend a
part of his pupilage among the officinal substances, that are
the agents with which future objects are to be accomplished.
He should  learn their sensible qualities by observation, and
become familiar with all the compounds and pharmaceutic
processes  of the shop.   But to acquire this knowledge, it is
only necessary that he should be in the office, or  in the shop
of an apothecary, while prosecuting the study of chemistry
and pharmacy.  When engaged in anatomy, physiology, pa-
thology and botany, the dissecting room, his chamber and the
fields, are his appropriate situations.  After having, however,
acquired a competent knowledge of those branches, with the
principles  of surgery and the  classification of diseases, he
may and should return to the scenes of practical medicine; for
he is then  prepared to comprehend the nature  of what he
sees, and, to a certain extent, can engage understandingly in
the duties of the profession.  If, at this period, he be kept in
retirement, indecision of character may be  generated, and
his future usefulness materially abridged.
   The  portion of each day, which pupils  in medicine may
devote to their studies, consistently with good health and the 
MEDICAL EDUCATION.
27
future welfare of their constitutions, must necessarily vary in
different persons; but a safe average would be one half, or
twelve  hours.   This would give  seven for sleep—and few
young persons can do with less—two for meals, and three for
exercise, labour and society.   The  last of these divisions  is
abridged by some and lengthened by others; but in general
is profitless to all.  With most pupils, the hours of relaxation
from study, are hours of idleness, pleasure and gossip: Too
often of downright listlessness, or ruinous dissipation.  But
whether whiled or rioted away, they bring no renovation ei-
ther of  mind or body.   To answer the end  for which they
are set  apart, they must  be spent  in active  exertion in the
open air; which will not only prepare the mind for new la-
bours, but ward off dyspepsia, palpitations, hypochondraism,
and red eyes; and prevent that debility of frame, so falsely re-
garded as the necessary effect of  hard study, when it results
from the want of a sufficient amount of hard labour.
   Is it necessary or advisable,  that the student of medicine
should prosecute his studies on Sunday?  In answering this
question, I shall of course speak not as a divine, but a physi-
cian and teacher.   I  would say, then, that it  is not, but the
reverse.  As a general rule, his progress  will be greater, if he
suspend, than continue his studies through the sabbath.  The
mind, not less than the  body, requires not mere moments of
relaxation but hours of actual repose, at least from the par-
ticular  labours in which it is engaged.   Moreover, the stu-
dent comes into his medical pupilage, with established habits
in this respect, which  cannot be  violated with advantage.—
Finally, the moral and devotional feelings require cultivation,
and this can best be done by the  recurrence, at stated times,
of a day for that special object.  On the whole, therefore, I
regard  those preceptors, who encourage their pupils in the
prosecution of medical studies on the sabbath, as committing
an error in their plan of professional educatiDn.
   Closely connected with this subject  is  another of deep  in-
 terest to parents as well as pupils.   Few  things exert  a
 greater influence  on our prosperity than a systematic atten-
tion to pecuniary accounts, and the observance of a judicious 
28                 MEDIC 4L EDUCATION.
economy in our expenditures; all of which must be practised
in youth, to become matters of habit in manhood.   When  a
father  sends  his son from home to study the profession, he
should decide upon the style of living  (always simple and
unostentatious) in which the young man is to pass his appren-
ticeship; and, furnishing him, from time to time,  with the
necessary means, should require of him to  render at stated
periods an account  of their appropriation.   This would com-
pel him not only to limit his expenditures to his resources, but
give him at an early period, a habit of recording his disburse-
ments and keeping his accounts, that would be of great ad-
vantage in  all after years.   I have known many  physicians,
who were neither accurate accountants nor good economists,
merely because they had grown up in the habitual neglect of
the duties which I have indicated.
  Other studies  than medicine, should  occupy a  portion of
the students time.   In the preceding essay, I have said, that
a majority of our students of medicine, particularly those of
the West, enter upon their pupilage with a most incompetent
education.   For all such there is no alternative, but to culti-
vate the elements of literature and science  during their med-
ical pupilage, or to  remain superficial  scholars throughout
their lives.  1 regret to say, that the majority choose the lat-
ter.   But  ar« those who have enjoyed the  advantages of a
collegiate education, exempted from the  necessity which rests
upon their less favoured brethren?  It is obvious that they are
not.   Few minds are so retentive as to keep what they have
acquired at school, if they do  not add to it,  by a subsequent
cultivation of the same branches.   To secure this important
object, it is absolutely necessary, that the student should de-
vote to it a stated portion of every day—forexample the morn-
ing or evening; and suffer  no controllable circumstance to
interfere with his plan.  A small part of his time thus  occu-
pied, will in the course of four or five years make him a pas-
sable scholar, should his learning have even been at the mini-
mum; but when he has the happiness to engage in professionl
Studies with the attainments of a bachelor.he may by the course
 here  recommended, so far extend his literary acquirements, 
MEDICAL EDUCATION.
2§
as to enter on the  theatre of life with an enviable character
for sound erudition.
   It ought to be mortifying to our national pride, to observe
how few of those who might thus become ripe scholars, ever
attain to that distinction.  Even many of our writers, except
by the Latin mottos and quotations with which they seek to
adorn their writings, would  not be  suspected of having pre-
tensions to a liberal education; while to the majority of their
professional readers, the whole garniture of classical common
places, is occult and unintelligible.
   The principal branches of literature and  auxiliary science,
to which the student of medicine should  devote a portion of
his time are:—
   First, English grammar and  the art of composition; with-
out an  attention  to which,  after the commencement of his
medical studies, no young man  need hope  to become even a
tolerable writer.
   Secondly, Physical geography, embracing the leading facts
in meteorology, which constitutes a foundation for the  study
of the physical condition and diseases of man, in the various
countries  and climates of the earth; a comprehensive view
which should be taken by every physician.
   Thirdly, The outlines  of history;  that he may be able to
trace the progress of the  profession through the different na-
tions which have transmitted it to his own; and come to un-
derstand  the  influence of moral causes upon the physical
system, whose aberrations he is to rectify.
   Fourthly, The elements of mathematicks and natural phi-
losophy; not merely for the purpose of invigorating his rea-
soning powers, but because the latter has many points of illus-
trative association  with medicine.
   Fifthly, The French language; since the subjects of morbid
anatomy, physiology and  pathology, have been recently cul-
tivated with extraordinary success by the French physicians;
but a small part of whose voluminous and classical writings,
are translated into our vernacular tongue.  To avail himself
of this source of improvement, it is not  necessary that the
student should conquer the difficulties of the French pronwn- 
30                 MEDICAL EDUCATION.
 ciation.  A few elementary books, with or without a teacher,
 are all that are requisite to open to him the rich treasures  of
 medical knowledge, which that enterprising people have ac-
 cumulated.
   Sixthly,  The Latin and Greek  languages.   Of  all the
 branches of literature which have been named, it is, perhaps,
 most  necessary, for  those who would retain or establish the
 character of good scholars, to continue the study  of these
 languages,  through the  period of their medical pupilage.—
 Their daily readings will extend their acquaintance with our
 own language; but  without  a special effort their  classical
 knowledge will speedily depart from them.  But few students
 are apprized of this fact, until they  learn it from experience;
 wh^n the discovery in general comes too late to he useful; for
 that which is lost by indolence is seldom reclaimed by indus-
 trv.   A few minutes of daily attention to Greek  and Latin,
would not only prevent deterioration, but ensure actual ad-
vancement; while  a longer,  but not objectionable  period,
would bring an uneducated pupil,  to such an  acquaintance
with  the grammar and  vocabulary of those  languages,  as
wouid prove in the end quite equal, to all that is generally left
at forty,of the classical acquisitions of twenty.
   Having  disposed  of the chief preliminary topics, we are
 prepared  for inquiries of greater technicality and moment;
 and shall next consider the plan on which the pupil should  be
 conducted  through his professional studies.  'Method,'says
 Liinaeus, 'is the soul of science,' an apothegm to which most
 private preceptors in this country seem to be strangers.  With
 their  own professional knowledge unarranged,but provided
 with a small assortment of medicines, a meagre collection  of
 books, chiefly practical compilations and compends, a few sur-
 gical instruments, and the fragments of a skeleton, they set
 up for preceptors;as unconscious of their incapacity, as they
 are ignorant of the defects in their means cf  instruction.—
 Their case, however, is far from hopeless; for in fact they win
 the confidence of the publick, by the palpable honesty with
 which they set forth their pretensions to its patronage.   A stu-
 ient once acquired, he is turned loose into the shop, and, left ta 
MEDICAL EDUCATION.
31
cater for himself, where he becomes a real eclectic.   Generally,
however, he begins with descriptive anatomy; which, proving
a dry pursuit, he abandons in due season, and seldom fails to hit
upon materia medica,from which he proceeds to the practice
of physic, obstetrics and surgery.  He is now on  elevated
ground, and looks down on chemistry, pharmacy, botany, gen-
eral anatomy,  physiology  and  pathology, as matters well
enough in their place, but  lying so far  below, that he cannot
descend to them without  disgrace.  This occupies the first
year; when  being qualified to 'practise,' or at least for'seeing
practice,' his mind turns  upon  recepies;and he spends the
second year, in collecting and cramming his master's patients
with 'infallible  cures.'   After this, according to his pecuniary
means, he either attends lectures, or 'opens shop' for himself.
For the first half of this course of studies, the preceptor gener-
pUy does not think it worth while to interfere; but the second
passes  under his  watchful  eye, and he is thus enabled to cer-
tify, that his eleve is amply prepared for the duties of the pro-
fession, and  promises fair to become one  of its brightest or-
naments.
  In medicine, as the other sciences, that method  is best,
which requires the student to take nothing on trust—to anti-
cipate no principle or leading fact.   The whole course should,
therefore, as far as possible, be purely synthetical.
  In conformity with this opinion, he  ought to begin with
Chemistry; provided that science had not made a part of his
academical or collegiate studies.  It is not necessary, however,
that he  should  go extensively or minutely into the practical
details of this science; as the object is merely to prepare him
for a proper understanding of the chemical terms, with which
he will meet in the study of physiology.
  Relinquishing chemistry  he should engage in special Anat-
omy, which  may be  studied in the following  order: 1—the
bones,  2—the muscles, 3—the viscera, 4—the  blood and  ab-
sorbent vessels, 5—the  brain and nerves.  He  is now pre-
pared for general  anatomy, and should make himself familiar
with the anatomical  relations and dependencies of the vari-
ous organs. 
32
MEDICAL EDUCATION.
   He will thus qualify himself for the study of Physiology,
the foundations of which are anatomy and chemistry; and
his progress, in that important branch of the profession, will,
coeteris paribus,  be in proportion to the accuracy of his anatom-
ical and chemical knowledge.  Having made a survey of the
nutritive or vegetative functions, he should proceed to the
animal; terminating his inquiries with the intellectual.  Thus
the close of his physiological course, will embrace the Phi-
losophy of Mind; a branch of science, if science I can as yet
be called, whose dignity, and undeniable connexion with the
study of mental alienation, may eompensate for the obscurity
of its data and the uncertainty of its deductions.
  From physiology he may  either  recur  to  the studies  of
which chemistr}' is the basis; or, Recording to his taste or the
judgment of his teacher,  proceed  by a natural transition  to
acquire an outline of  Pathology.   The latter is perhaps, on
the whole, the  better course; for when the mind of a pupil is
deeply interested in the contemplation of the  healthy  func-
tions, it passes  with facility to the study of their disordered
states; and thus, with little difficulty, comes to comprehend
the general principles of pathology:—But  he should, on
no account, be permitted to stray beyond the rudiments of the
science of diseased actions.  And here I will take occasion  to
remark, that I know of no distinct treatise on the elements  of
pathology which is adapted to this stage of  a pupil's studies;
and, hence, it is necessary, that a selection should  be  made
by the preceptor, of such parts of various works on the theory
and practice of medicine and surgery, as will convey a correct
general idea of the existing state of pathological science.
  Having gone thus far in the study of the animal economy,
in its healthy and morbid conditions, he must stop.   In  going
further, he would instantly reach matters which he could not
understand, for want of an acquaintance with branches which
I shall now proceed to enumerate.
   The first of these is Botany.   It requires but little obser-
vation to perceive, that the science of the vegetable kingdom
has many important relations with medicine.   Plants and an-
imals offer  numerous anologies, in their structure, and the 
MEDICAL EDUCATION.
33
physiology of one, contributes to enlighten us, in reference to
the other.  But the connexions of botany with materia med-
ica, are still more intimate than with physiology, and cannot
be overlooked by the most unobserving; and yet the majority
of physicians are as ignorant of that beautiful science, as of
algebra or astronomy.   It  is by no means necessary, that a
physician should be a practical botanist; but it argues little for
the taste or ambition of a student of medicine, that he is con-
tent to remain ignorant of the fundamental laws of  any de-
partment of organized nature.  The fashionable excuse for ma-
king a pons asinorum of the science of botany, is the extent and
difficulty  of its nomenclature.   But admitting, that in this
respect, it  even transcends anatomy, while its utility  is  com-
paratively  limited, I can perceive nothing in the case which
should frighten a young man of courage and inquisitiveness,
from the undertaking.   If his knowledge  of the Greek and
Latin languages is considerable, the  technicology of botany,
can present no obstacles which a little resolute industry will
not remove; and if he is nearly ignorant of those languages,
the condition of most medical students, the study of botanical
terms, will materially improve his knowledge of their vocab-
ularies.  In  botany, more  than most other sciences, that
which is repulsive lies at the entrance.   It might be likened
to a garden hedged in with thorns and thistles: the  tangled
enclosure once  penetrated, a rich possession of flowers and
fruit is the reward.  In  addition to its utility, as a collateral
aid to physiology,and an  introduction to materia medica, there
is another advantage in  the study of botany, which deserves
to be set forth.   Plants are arranged by their external charac-
ters, among which there are innumerable  affinities that can-
not be seen and contemplated, without imparting acuteness to
the faculties of observation, and establishing a habit  of natu-
ral classification which is beneficial throughout life.   In these
respects, I know of no  science that can be  compared with
botany.
   Secondly.   An outline of Zoology, although less  necessa-
ry, should be regarded as desirable, and might easily be acqui-
red. No man can be a profound physiologist, without studying 
34;                MEDICAL EDUCATION.
 the modifications of the organs and functions in the different
 natural families of animals; every physician, therefore,should
 have a smattering (I do not venture to recommend more) of
 zoological  science.  Several  medicines,  moreover, to  say
 nothing of aliments,  are derived  from the  animal kingdom,
 establishing a different and not unimportant relation between
 its study and that of  materia medica.
   Thirdly.   Mineralogy.   This science has many relations
 with aetiology; while its associations with materia medica  are
 still more  numerous  and intimate.   To recount them would
 involve the recollection of half the objects of that science.
 It would be superfluous, therefore, to insist on  the necessity
 of some acquaintance with the mineral kingdom, did we  not
 know, that this, as well as  many other preliminary studies, is
 utterly neglected by most  candidates for the  honors of  the
 profession.
  Having thus added to his chemistry, a competent knowl-
edge of the first principles of Natural History, the student ap-
proaches the composite science of Materia Mf.dica, with con-
scious  preparation, and a confidence favourable  to success.
It is  the duty of his teacher to acquaint him with  the impor-
tant  fact, that the natural and  pharmaceutic history of medi-
cines, is totally distinct from the study of their effects  upon
the living  body,  either in health  or disease, and should first
engage  his attention.   This, however, is  seldom  done, and
the student is allowed to fix his mind upon the latter, before
he has made acquaintance with the former;—an inversion in
the order  of study, which lays the foundation of many  fu-
ture imperfections.   He should, therefore, be held rigorously
to the natural history, composition, and  preparations, of  the
different medicines; until he becomes familiar with the whole.
He may then proceed to examine into  their effects, on  the
animal system; and  here, again, he will  be in  danger of in-
verting the order of inquiry.  Most students are prone to con-
nect the names of particular medicines with particular disea-
ses, by  which they  lose the disposition to generalize, and
establish wrong associations that often continue throughout
life.   The first object should be to arrange the articles of  the 
MEDICAi EDUCATION.
35
materia medica, according to their effects, not in the cure of
diseases, but on the different functions; and beyond this im-
portant and  difficult task, the pupil at this stage of his  stu-
dies should never be allowed  to  proceed, as the very next
step would  be taken in  the dark.  It is necessary, therefore,
that he should again change his course, and direct his inquiries
upon other objects, which I shall now proceed to consider.
   I will not say, that in returning to the study of diseases, the
pupil should review his anatomy, for in fact this fundamental
branch of the profession, should not have been neglected in
any period of his course, as  no kind of knowledge is so diffi-
cult to retain.  Hence he should, as far as practicable, asso-
ciate it with all his  other knowledge, a measuie that will
contribute greatly to its  retention and usefulness.   He should,
however, review his physiology ;not by re-perusing the authors
already gone over, but some treatise or compilation which he
had  not  before read, ad which  presenting new facts and
speculations, or old ones in a new aspect, may clear up his
doubts and fix his principles.  This being accomplished, he re-
sumes  the sludy of pathology, with acquirements that  will
enable him to discuss  the  theories of physic and surgery to
their utmost  limits.   These theories  he  is not to itgard as
separable into distinct sciences, for they are in  fact one and
indivisible.   Their primary  elements are the same.   Every
physician need not be  an operative surgeon, but  every good
surgeon must be likewise a physician.  The  mere operator,
if* any such there be, is but a  mechanic.  The amputation
of a limb is a mechanical process; but the treatment which
might have been employed to subdue inflammation and ward
off the gangrene that rendered the operation necessary, could
only be guided by the principles of clinical medicine.  Take
another example.  The extraction of  the calculus is effected
by the use of instruments, moved according to certainyb/vnw-
Ice; but the diathesis which generates the stone, is among the
most occult and complicated subjects which can tax the gen-
ius of the  physiological pathologist, or animate his clinical
efforts.   The desideratum is, in fact, a method of treatment
that will render a resort  to the cruel and hazardous opera- 
36
*EDIC*L EDUCATION.
 tion of lithotomy unnecessary.   The surgery of this case,
 then, as  of most others, grows out of the imperfection and
 constitutes the opprobrium, of its therapeuticks; and the man
 who might limit himself to the former, would justly  be  re-
 garded as an empyrick.  Again. The whole subject of inflam-
 mation, belongs equally to medicine and surgery, and may be
 studied without a special reference to either, while they con-
 tribute alike to the illustration of its origin, progress and ter-
 mination.
   Whatever, then, may be the ultimate aims of different pu-
 pils, their  pathological  studies should  be the  same.   They
 must seek  to  acquire distinct and  vivid conceptions  of the
morbid states  which are supposed  to  be indicated by the
 terms congestion, irritation, inflammation, fever, nervous irri-
 tation, morbid sensibility, sympathy, spasm, morbid secretion,
 metastasis, vicarious rction, collapse, torpor, debility, exhaus-
 tion, proximate cause, organic lsesion, vis medicatrix, obstruc-
 tion, local  determination,  malignity,   and many  others of
 subordinate moment, which constitute the elements of pathol-
 ogy, whether clinical or surgical.  When they have grappled
for a sufficient time, with the difficulties which every attempt
to learn  the true import of these common, but  equivocal
words  unavoidably  imposes, they may  proceed to consider
 the varieties of inflammation, fever, spasm, and the other mor-
bid states, which will bring them to Nosology, or the classi-
 fication of diseases;  when for the first time, they will perceive
 the paths by which  those who intend  to limit themselves to
clinical medicine, and those who propose to cultivate opera-
tive surgery, are to diverge from each other.   Having looked
into  the systems of nosology, with sufficient care to perceive,
 both their importance and their imperfections, the coadjutors
 may betake themselves in some degree  to separate studies:—
 the student of physick to functional, the student of surgery
 to organic  derangements.   The  latter are, however, in all
 cases—mechanical  injuries  excepted—the offspring, as in
 turn they become the occasion, of the former; and hence they
 must both be studied by each class of pupils, though not in
 an equal degree.   In his nosological  inquiries, the student 
MEDICAL EDUCATION.
87
becomes acquainted  with what tb.e naturalists  call essen-
tial characters; but, arriving at the  investigation of partic-
ular maladies, whether medical or surgical, he will of course
extend and correct his knowledge of Symptoms logy; en-
deavouring by the utmost effort of his understanding to  con-
nect each sjmptoms with the morbid state of which it is the
sign.   In doi"gtliis he will behd to enlarge his knowledge of
Morbid Anatomy, the first ideas of  which might have been
received while engaged on general p;it! ologv.
   In this stage of  his progress, he is qualified to investigate
the causes of disease, a subject so enveloped in obscurity, that
ma y students give it but a passing attention.   Aetiology is,
however, a branch of medical science of sufficient importance
to justify, I should rather sav, demand an attentive investiga-
tion;  and the vory difficulties with which it  is beset, should
stimulate a  pupil to its deep and protracted  examination.—
Scarcely any  portion of  his studies will bring into requisition
all his knowledge of nature and art, like that of which  I am
speaking.  Of the origin, combination and mode of action of
the causas morborum, much remains undeveloped; partly from
the intrinsic difficulty of the subject,  but  still more from the
loose and limited  manner in which it has been generally stu-
died.   With these convictions, I would indicate it to students
of medicine, as a department of the profession in which  they
may labour with a well founded hope, of doing good to society
and credit to themselves.
   Finally, he arrives, by a regular transition,  at the Practice
of the profession—its therapeuticks and operations.   He stu-
dies the indications of cure,  and  labours  to  establish ia his
mind, correct associations between symptoms and remedies—
an  association not arbitrary and empyrical,  but founded on
an ample and accurate  knowledge  of the functions of the
living body, in their regular and irregular conditions; and of
the influence of external agents in  the production and  cure
of diseases.   The popular  distinction between phjsic  and
surgery now becomes more apparent than before; and I shall
proceed to speak of them separately. 
36
medical education.
   The student who intends to  limit himself to the practice
 of physic, must recollect, that even  in countries where  the
 line of separation is drawn with an absurd and unnatural pre-
 cision, the physician  is compelled  to  prescribe for a great
 number, and variety of cases which belong equally to the prov-
 ince of the surgeon.  If this be the case in Europe, it must
 be much  more so in the  United States, where out  of the
 large cities, there are no professed surgeons.  In fact, all our
 physicians are surgeons likewise; and differ from the  practi-
 tioners so called, only in declining the performance of a  few
 of the greater  operations—such as those for hernia, lithoto-
 my,  aneurism,  deep  seated tumours,  cataract, and  a  few
 others. To the reduction of dislocation and fractures, the
 management  of  ulcers,  trephining,  amputating, dressing
 wounds, and other duties of a similar kind, which, from their
 frequency, make up the mass of surgical business, every phy-
 sician is presumed to be competent.   The pupil then, even
 when engaged in his practical studies, is by no means to limit
 himself to that which is technically called physic; but, extend-
 ing his inquiries  to  surgery, stops short of nothing  but its
 higher operations.
  Every part of a course of medical studies abounds in diffi-
culties, and calls for intense and sustained application;  but no
 stage is so trying to the powers of the student, as that which
 may be called the therapeutick.   Hitherto he has occupied him-
self,  successively, upon distinct sciences, which  he  perceived
to abound in connexions favourable to tfceir union into a sys-
 tem of professional knowledge; and (hat union, in reference to
his own mind, he is now  to effect.   He is faithfully represent-
ed by  the commander, who having embodied and  equipped
a great variety of separate military corps, has at length to con-
solidate them into an army and direct its active operations.
  It  is difficult to furnish a student with rules for the organi-
zation  of his various attainments into a practical system, and
much must necessarily be left to his own genius and judgment.
A few hints, however, may not be without their utility.
  1.  If he now finds deficiences in any of his preliminary  ac-
quirements, he should supply them, without delay, by a recur- 
MEDICAL EDUCATION.
39
rence to the branches in which they are discovered to exist.
  2. In ascertaining general principles, he should carefully
note those which are of a doubtful character, and rest upon
them as few rules of practice as possible.
  3. His practical maxims, in all cases, should be logical de-
ductions from his principles.
  4. If they do not conform to those of the great and origina
writers of the profession, he  should  doubt their correctness,
and act upon them cautiously; but not reject  them without a
trial.
  5. He should recollect that the same  diseases, in  different
countries, frequently require variations in their treatment,
and that he must not implicitly adopt the rules of practice
that have been found successful elsewhere.
  6. When he  meets, in practical works, with different modes
of treatment for the same disease, he should not suppose that
one  only can be correct, and  the others  necessarily errone-
ous; for diseases may be cured by various methods.  In be-
coming an eclectic, in these cases, he must carefully examine
the whole,  and test  their merits by  the  great principles of
pathology and therapeuticks, which compose  his own system.
When  he attempts  to select from  among them, he  should
avoid  uniting  rules or recipies that are incompatible, and
would therefore countervail or neutralize each other.
  7. In his practical readings, he should always  prefer ori-
ginal works to  compilations, and monographs to systems.
  8. He must be on his guard against the delusion of a fan-
cied simplicity, in the system which he constructs.  Every
complex machine is liable  to a variety of irregular move-
ments, which can only be reduced to order by  a corresponding
diversity of means.   But of all machines  the human body is
the most complicated, exhibits the greatest number of disor-
dered  actions, all differing from each other, and requires the
greatest variety of remedial applications.
   9. When arrived at this  stage of his studies, he should no
longer stand aloof from the practical duties of the profession;
but avail himself of frequent opportunities to make an appli-
cation of his knowledge.   This is the end for which he has 
40
MEDKUL EDUCATION.
studied, and Ins final success will be  proportionate to the fa-
cility and effect with which he can  make such ;ij.j lira  o; .—
Skill i'  practice does notarise, however, from the number of
cases he may see or treat, so much as the mailer in  which
be contemplates them.   Ei< h one should be a study, and all
things relating  to it,  shouts be connected with the principles
that guide him, and which, in turn, they may serve to illustrate
or overthrow.
   Should the student intend to make  Operative Sukgkey, his
principal object, he may observe most of the foregoing sug-
gestions, while he bestows especial  attention on the following
subjects:—
   1. The anatomy of the parts which  are  the  seats  of the
greater operations of the art.  With these parts, particularly
such of them as cannot be cut into withouj danger, he  should
be  perfectly familiar:—Not merely  able  to enumerate the
muscles, and fasciae, and nerves, and bloodvessels of  which
they are composed, but to conceive accurately of the relative
situation of those anatomical elements.  He should, moreo-
ver, learn to know each part, not only by the eye, but by the
finger; as it will frequently happen, in deep and bloody ope-
rations, that the sense of touch is the  only one he can employ.
   2. He should practice  the  various operations on the dead
subject; for by practice or.ly, can he become adroit, or acquire
that confidence which g'ves self possession in moments of dif-
ficulty  and  doubt.   In  this stage  of his practical studies, he
will often find it advantageous to supply the deficiency of hu-
man subjects, by a resort to dead animals; in the selection of
which he will be materially aided by some acquaintance with
zoology.
   3. He should practise on the living or the dead subject, the
application  of the various kinds of bandages and apparatus
of surgery.   For the neat and efficient discharge of this duty,
more experience is necessary, than  many persons suppose un-
til they come to the trial in cases of real injury, when it is too
late to prepare themselves.
   I shall conclude this branch of the  subject with a reference
to obstetrics.  This department of  the profession is empha- 
MEDICAL EDUCATION.
41
tically a compound of physic and surgery, and on this account
not less than many others, it should be the last which a pupil
studies.   The healthy  functions of the uterine system  how-
ever, will have been leared by him, as a portion of physiology.
As to obstetrical studies, the most important observation I can
make, is, that the young physician will be called  upon to act,
with less of practical information, than in  any other branch of
the profession, for in no  stage of his pupilage can he have
many opportunities of acquiring that kind of  knowledge.
Hence he should study the subject in books, and  by means of
plates and  models, with extraordinary care  and diligence.—
Without doing this, he may be thrown into situations of respon-
sibilky,most harrowing to his feelings,if not fatal to his patient.
   With these intimations, I shall close what it seems necessa-
ry to say,  concerning the method on which a course of pro-
fessional studies should  be conducted;  and in  conclusion,
shall speak  of the aid which the pupil  should receive from
his preceptor.
   At the risk of being  thought severe, and perhaps tedious, I
feel constrained to repeat, as a general fact, that the physicians
of the United States, are culpably inattentive to the studies of
their pupils; and that this is one of the causes which retard
the improvement, and  arrest the elevation of the profession.
Exceptions to this (apparently invidious) remark, are frequent-
ly met with, especially in the great cities; but still they are
only exceptions.  Without presuming to inquire, at large, into
the causes of this default, I may mention  that which seems to
me, the most operative.   The  price of tuition is too low.
The preceptor feels   no business obligation, and too often
forgets what he owes to society and the profession.  Like oth-
er men, he gives in proportion as he receives, and when a pu-
pil comes  without money, permits him to depart without
knowledge.   He would thus, by implication, cast the  whole
blame on the father,  but the fault is equally his own.  He
ought not to take a student, without the design of making him
a good practitioner, and when  an inadequate fee is^proffer-
edbythefather,should decline the application. Ifhe does not, 
42
MEDICAL EDUCATION.
but graduates  his aid according to the reward, he degrades
the profession  and is accessory to an imposture on the com-
munity.  On this subject unfortunately we have no esprit du
corps, no uniformity, no emulation; while the whole are  im-
periously required.  The conscience which  warms and puri-
fies our professional efforts in the sick chamber, is too often
dumb in the study, where its promptings  are equally deman-
ded.  Tuition  is an art, but not governed by fixed  and uni-
versal laws.  The student is to be urged onward from the
'known to the unknown' through a variety of complex and dif-
ficult sciences.  In this proceeding, the mere ipse  dixit of his
preceptor can do but little good; while  a well directed superin-
tendance will confer lasting benefits.  The kind and manner of
assistance must necessarily vary with the  idiosyncracies of
both master and scholar;  for that which facilitates the pro-
gress of one  pupil, sometimes retards  another, who requires
a different regimen; and the methods which one preceptor fol-
lows with success, are often impracticable for another, from
being inconsistent with his temperament  and habits.  But in
the midst of these diversities of character, to which an exces-
sive importance ought not to  be attached, we may  perceive,
several methods which  are applicable to  every case, and 1
shall proceed to enumerate them.
   1. The physician who  proposes to become an instructor,
should provide the requisite books, engravings, preparations
and apparatus.  He must not rely on his own attainments, as
they cannot be transferred to his pupils, but through the instru-
mentality of established means.
   2. He should form a plan of elementary studies and require
his pupils to follow it.   To this end he must designate every
 book that is to be read,  and debar  them  from  the  perusal
 of any others.   It is even necessary,  to  mark portions which
 should be passed over, as being incomprehensible without
 ampler  preparation, or  as  having been proven erroneous.
 All our systematic works abound in chapters of the latter kind,
 the study of which cannot be too strongly reprobated, as plant-
 ing errors in the young mind  which may  never be eradicated. 
MEDICAL EDUCATION.                43
 3. He should encourage his students to ask him questions and
solicit his aid, on the obscure and difficult parts of every au-
thor ; that nothing may be passed through without being under-
stood.
   4. As a further  means of effecting the same object, he
ought to examine every one on  the book he has just finished;
and, thus, not only correct his errors, but animate him to
close and accurate application.
   5. At least once a week he ought to assemble his  pupils
into a class, and subject them to systematic  examinations on
the studies in which they are then engaged.   When such ex-
aminations are ably conducted,  they constitute the most inter-
esting and valuable.exercises in which students ever engage.
By a series of well directed questions  he may guide them
through the labyrinths of the most complicated  subject; and
enable  them to analyze that which they would otherwise find
impenetrable and hopeless.  Their errors of principle and
nomenclature will  be corrected; and  their confidence  in the
truth established; their scattered acquirements solidified into
a system, its deficiences made manifest, and the mode  of sup-
plying them indicated.  Thus they will be led to contemplate
and comprehend the relations which unite facts, that in badly
educated minds remain insulated and in apparent variance.
 Above all, he can in this way and no other, relieve the tedium
of solitary reading; invest the study with charms that render
it attractive; and inspire an emulation for relative excellence,
that will seldom fail to work out positive distinction.
   6. He should require each pupil, at least once a month, to
write a thesis.  This exercise should  commence with  his stu-
 dies, and continue till it terminates in his inaugural disserta-
 tion.   Its advantages are manifold, not the least of which is
the pleasure, which, in a short time, it affords to every aspiring
 and inquisitive student.  When studying anatomy, his theses
 will of course be  purely descriptive, a kind of writing in
 which none can be  proficient without practice.   As he ad-
 vances, they may assume a higher and more diversified char-
 acter.    Some of  them should be simply abridgements of
 chapters written with dilfuseness, of which, unfortunately. 
44
MEDICAL  EDUCATION.
there is  no lack; others might be purely  analytical;  others
critical, or in the manner of reviews; and a portion, mere com-
mentaries on authors of a concise and aphoristick cast.  In this
way, he  will form habits of attention, and be  led  to study
with profit, what he would hive passed by with carelessness.
In the latter periods of study, his essays may take on  a still
higher character.   He may  begin to unite facts into regular
dissertations, according to the rules of a sound philosophical
logic; investigating principles, and constructing the elements
of tne system which is to guide and govern his future  efforts
in the. practice.
   Was the custom  of writing enjoined on every pupil, we
should not have so many candidates for .graduation, incapa-
ble of composing thair own theses; nor so many good  physi-
cians, who are unqualified to lay before the profession the re-
sults of their experience.   Not  a few  of them, indeed, from
neglecting what is here recommended, find themselves, in af-
ter life, unable to write a single sheet of professional  direc-
tions with simplicity, taste  and perspicuity.
  7. Lastly.  It is the duty of the preceptor, when his pupil
is prepared  for  clinical observations, to select for him such
cases as  will be  profitable.   The Diagnosis of diseases pre-
sents many  difficulties, and can be successfully  studied only
at the  bed side.  To introduce a student indiscriminately to
all cases, is more likely  to confuse  than enlighten his mind.
He should first study those  which present a well defined char-
acter, and proceed gradually to the more  obscure and com-
plicated.   But the most judicious selection of cases, will im-
part but  little instruction, unless they are made the subjects
of conversation and comment by the preceptor.  In these clini-
cal lectures, the  benefit which he confers upon his disciple, if
not  greater, will be more deeply felt, than in any other pe-
riod of their connexion. The utility of what he has been teach-
ing will  now be made  apparent;  and the endearing rela-
tion  finally  dissolved,  with f>el> >gs  of gratitude in one, and
self approving consciousness in  the other. 
Essay hi.
                   Medical Colleges.
   Medical colleges, on their present plan, were not known
till since the revival of letters, in Europe.  For two or three
centuries, they were few in number, and chiefly sustained by
the genius and labors of individual professors; of whom Boer-
haave, Haller, and the first Monro, may be cited as illustrious
examples.  The 18th century augmented their number, and
established their importance; but it was reserved for the
19th to multiply them to an unprecedented degree, and show,
that they may be composed in part, of men whom the pride
of science would, formerly, have pronounced unfit for such
a lofty and difficult duty.
   In the United States, the number at the close of the last
century, did not  exceed three:  it is  now at least  fifteen,
and others are annually springing  up.  This extraordinary
increase, may  be ascribed, in part, to the great number of
state sovereignties which make up our confederacy, each of
which, instead of the federal government, grants college and
university charters; and is ambitious to rival its neighbors in.
the number, if not the excellence of its  institutions.   But
another cause  is equally operative.  This is the want of due
care in the selection  of professors; by which the standard of
professorial excellence is depressed to a level, that brings the
office within the  reach of unqualified aspirants; and offers to
mediocrity of talents, a degree of encouragement  which no
age or nation ever before held out.
   Did the best talent of the American profession find its way
into our numerous schools, it cannot be doubted  that they
would be ably sustained; but truth and justice  require me
to say, that this is not always the case; and that every part
of the union, presents men of loftier genius, sounder learn-
                          F 
46
MEDICAL education.
 ing, and purer  eloquence, than many of those, whom  the
 trustees of our different institutions, from  time to time, se-
 lect as professors.
   In most of our schools the  number  of  professors is  too
 small.  Some there arc, or have  been, which  carry on all
 their operations, and graduate their pupils, with only four.
 Several have but five, and six are  regarded as  a maximum,
 which need never be exceeded.   In Europe, however,  the
 number is much greater; and in this respect we have unwise-
 ly departed from her example.
   Nothing can be said in favor of this feature of our insti-
 tutions.  It has certainly not arisen from any new investiga-
 tion of the principles, on which medical schools should be
 established.  It  cannot  be viewed  but as  the offspring of a
 competition, which has  taken the downward, instead of  the
 upward course;  and offers a premium for pupils,-in the small
 amount of its aggregate fees of tuition.   Another uspect
 under which the same spirit manifests itself, is to be seen in
 certain  schools,  which have the ordinary number of profes-
 sors, but charge little more than half the ordinary price for
 their tickets.  Such  institutions may be lauded as favoring
 the poor, but the real motive is, the acquisition of students,
 by the only means they are competent to wield.
   For myself, I am convinced, that every medical school
 ought to have eight professors; and that with less than  six,
 it should, in the phrase  of Lord Bacon, 'be noted as defect-
 ive.'  As to the distribution of the  duties, there may be some
 diversity of opinion; but the profession, generally, would
 perhaps concur in  the following: 1. Anniomy. 2. Institutes of
Medicine.  3. Practice of Medicine and Clinical cases.   4. Sur-
gery.  5. Materia Medica.  G. Chemistry and Pharmacy.  1.  Ob-
 stetrics.   8. Medical Jurisprudence.  In addition to  these
 branches, some of the professors, if qualified, should, in  the
 summer, deliver  lectures on the elements of Botany, Zoology
 and Comjirative  Anatomy, Mineralogy and Meteorology;
 all of which have relations with the  medical profession, which
 will be perceived  and appreciated, in proportion as juster 
MEDICAL EDUCATION.
47
and nobler views of its extent and dignity are disseminated.
If but six professorships are  established, Physiology should
be  united with Anatomy; the remainder of  the Institutes
with  the Practice;  and Medical  Jurisprudence distributed
among the  chnirs  of  Anatomy,  Surgery,  the  Practice  of
Physic, Chemistry,  and Obstetrics; an extent of association,
which at once discloses the magnitude and complexity of this
neglected branch of the profession, and  evinces the necessi-
ty of confiding it to a separate professor.
   In all the medical schools of the United States, the lectures
of  each preceding year, are, as to topics, the same with the
last; and there is no classification of students, according to
the different stages of their  studies.  Hence, it is not un-
common, to see a youth, in the first year of his  studies, at-
tempting to comprehend lectures on the Practice of Medicine,
Operative Surgery, and even Practical Obstetrics, while, by
his side will be seated, a candidate for graduation, attending
to the first lessons in Descriptive Anatomy and Pharmaceutic
Chemistry.   There must  be something  wrong in a system,
which leads  to so great a sacrifice of time.  I am not pre-
pared to assert, that it would be practicable to  class our
students of medicine into juniors and seniors, and have lec-
tures adapted to each division, but 1 would strongly recom-
mend, to every student who visits a medical school, to direct
his attention, chiefly, during the first course, upon Descript-
ive Anatomy, the Institutes  of Medicine  and c-f Surgery,
Chemistry, Pharmacy, and the  Natural History  of Medi-
cines; reserving, as  the great objects of  study for the second
course, General and Surgical Anatomy, Operative Surgery,
Therapeutic  Materia Medica, Obstetrics, and the Diseases
of Women and Children.   In proportion as he observes this
order, his time will be efficiently  employed, and his know-
ledge well arranged.
  A still greater evil than any of  these, is the short sessions
of our American schools.  In some, the session continues but
two or three  months, and four are the prevailing term.  The
late celebrated Professor Wistar, admitted to me, in the year 
43
MEDICAL EDUCATION.
 1816, thatthe founders of the Philadelphia school, had com-
 mitted  a great error, in not establishing a session of six
 months, which would, doubtless, have been imitated by those
 who founded other institutions.   The projector of the Med-
 ical College of Ohio, fixed its session at five months; which
 was, afterwards, unwisely reduced to four, although found to
 meet the approbation of the pupils.  Were the different in-
 stitutions  of  the United States, to agree to extend their
 sessions to five or six months, they would do more to elevate
 the profession, than could be done by any other single act;
 and all who wish well to the dignity of the profession and
 the interests of humanity, should unite in effecting so desi-
 rable an object.
   By extending the  term, the existing evil of so many lec-
 tures each day, would be obviated, and  the student could
 find time to digest all that might be administered to him; as
 well as to compare what he should hear, with what he might
 see in the different text*and standard work*.  Under existing
 circumstances, this is well known to be impracticable.
   Four lectures a day, are as many as can be appropriated
 to itself, by an ordinary mind, and the number should never
 exceed  five. But few students can listen to six, with as much
advantage as  they would derive from  two-thirds of that
 number.  They become cloyed and oppressed; and  long
 before the end of the fourth month,find themselves fatigued,
 impatient, and irritable, and prepare to depart.  1 have no
 doubt, that they would endure a session of six months, with
 fewer lectures, daily, in greater contentment, than they now
 bear our short sessions.
   The daily succession of lectures, which requires the atten-
 tion of the student to pass, rapidly,  from subject to subject,
 which have no natural relations to each other, is trying to
 the intellect of pupils, and necessarily  detracts  much from
 the value of our instruction.  For this evil, there is, perhaps
 no practicable remedy; and students, generally, do not com-
 plain of it, as  the change is refreshing, and serves to recon-
 cile them to the wearisome existence of the lecture room. 
MEDICAL BDUCATION.
49
  Experiments  and demonstrations  are, or should be, the
great object, in every medical institution.  Much  that is
taught in lecture  rooms, might  be  as successfully studied
elsewhere; but Anatomy, Chemistry, Pharmacy, Operative
Surgery, and Obstetrics, demand exhibitions to the eye,and
no medical school is worthy of patronage, if deficient in the
means of illustrating these important branches of the  pro-
fession.   Those, however, who endow and govern our insti-
tutions, should  recollect, that the accumulation of the mate-
riel of science, cannot be made a substitute for skill in its
use;  and that  a  department  loaded  with apparatus, will
confer on students no substantial advantage, if  the professor
be deficient in talents and practical tac'.
   The subject of hospital practice, must not be passed over
in silence.  That it might be made  a source  of great im-
provement to students, no one can deny; that it  is such, no
one, I believe, will venture to assert.   For a few weeks after
the  commencement of the  course of  lectures,  students are
zealous  in their  attendance  at the  hospital, on  prescribing
 days; but each one soon discovers, that in the throng,his op-
portunities for  accurate personal  observations,  on the condi-
tion of the sick, are  too few  and momentary,  to render his
attendance in the  wards of any substantial benefit; and his
visits, thenceforward, become occasional and still more un-
productive,because made under a feeling of discouragement.
To derive benefit from hospital practice, students, who have
the means, should attend upon it through the vacation, when
the number is  smaller, and  the  opportunities for personal
observation, are, consequently, much  greater.
   Lecture room examinations are an important means of sus-
taining the attention of a class, but they are often misplaced
and sometimes worse  than useless.   The common practice
of examining students, at  the opening of a lecture, on the
subject of the preceding day,  is unfavorable, except  when it
 serves  to prepare the mind  for the  investigations on  which
the professor is about to enter.   Whenever the topics to be
discussed, are foreign to those of th« last lecture, it  should 
50
MEDICAL EDUCATION.
not  be recalled, to pre-occupy  the  attention of the class.
Under such  circumstances, a few questions on the matters
which are to be immediately presented for examination, will
prepare the minds of the  pupils  for engaging in them, and
can  never fail  to awaken  a spirit of  inquiry.  During a lec-
ture, interrogatories on the subjects then before them, arc
well calculated to arouse the attention of the students from
its passive condition,  and  contribute greatly  to  relieve the
tedium of their situation.  But it is at the close, that exami-
nations are of the greatest value; as a recapitulation of the
leading points, will, in this  manner,  be indelibly  impressed
on the mind.
  Medical professors should be men of learning, but the lec-
ture room is not the most proper place to display the extent of
their book researches.   The citation of a great number of
authorities, is seldom  profitable  to students.   They should
expect from their teachers, an account, clearly and method-
ically expressed, of the ascertained facts of the science; and,
in general, the less this account is encumbered with quota-
tions and references, the better v ill it be understood, and the
deeper will  be the impression.   Great learning may excite
the admiration of students; but their thirst for useful know-
ledge can only be satisfied by  accurate analysis, and the
skilful arrangement,  of common and generally admitted
facts.
  The abolition  of the practice of publishing inaugural
theses, seems to me to have been made inconsiderately.  It
has certainly destroyed one of the motives for close appli-
cation, and while it has relieved the candidate  from some
trouble and  expense, it unquestionably has diminished his
exertions. It  is well known, that when inaugural theses were
printed, the desire to afford, in  their first publication,  an
earnest of future distinction, led many students, into extend-
ed courses of observation, research, or experiment; which
served to awaken them to a proper estimate of their powers,
and  by committing them to the public as young men of Iear- 
MEDICAL EDUCATION,
11
 ning or genius, gave an  impulse of character, which  often
 continued through all after life.
   The rule that a student may matriculate at any time with-
 in the first month of the  course, leads to great procrastina-
 tion in  starting from  home; and  in its bad effects is only
 equalled by the absurd custom of leaving the university  be-
 fore the  expiration of  the lectures.   They  cannot be  too
 strongly reprobated.  In  all the schools of the United States,
 these customs prevail  to a degree  that calls for an immedi-
 ate corrective.   But a single week should be allowed  for
 matriculation after the introductory lectures arc  finished;
 and the student who leaves  the  school without permission,
 before the end of the  lectures, should not be allowed credit
 for a course, when he proposes to  graduate.  In losing  the
 two or three last  weeks of the  session, he does  himself
 much injury, and  disturbs  the  regular progress  of  those
 friends  who have greater firmness of purpose, by turning
 their minds upon  home  and its endearments.  The whole
 evil would be corrected, by requiring them to take of  the
 Dean of the Faculty,  a  parting ticket,  and I cannot  but
 hope that this practice will  be adopted in all the schools of
 the Union.
   I come now to speak of things which depend more  espe-
 cially on the students themselves.
   Many students commence attendance upon lectures, with-
 out due preparation.   If they reside, or prosecute their stu-
dies from (he beginning, in the neighborhood of medical
 schools, they may, with advantage, begin the study of Ana-
 tomy, Chemistry, and Pharmacy, by attending the lectures
on those subjects.  But little advantage can result from their
 commencing other branches of the profession, in the lecture
 room.  From twelve to eighteen  months of diligent reading
 is necessary, to prepare a student  k >  listening with profit,
and without  confusion  of mind, to lecturers on  Surgery,  the
 Practice of Medicine, Materia Medica, and Obstetrics.
  A timely entrance upon the course of the lectures,is scarce-
ly less important, than a due preparation by previous studies. 
52
MEDICAL EDUCATION.
To avail himself of the full benefits of the session, a student
should arrive and take comfortable lodgings, before the lec-
tures commence.   He thus brings his mind into  a suitable
condition  for study,  and from the beginning, is able to de-
rive advantage from what he hears.
   Disorderly conduct and  noise, in the lecture rooms, are
great drawbacks  on improvement.  The idle and unambi-
tious are, generally, the  instigators of this confusion ;  which
should be met and put down, by the public sentiment of the
class, in conjunction with the moral power of the professor ;
neither of which  is,  in general, exerted in the manner it
might be.   Not a little, of the disorder which lecture rooms
present, arises from the  practice of coming in after the lec-
ture commences, or  going out  before  it is  finished.  No
member of  the  class should feel himself at liberty, thus to
violate the laws  of courtesy,  and disturb the attention of
those, who, unlike himself, are desirous of acquiring knowl-
edge, the great end for which they are assembled.
   Students should not only enter the lecture room  in due
time,but, as far as possible, return to the same seats, respec-
tively; the advantage of which, both to pupils and professor,
would be found in the uniform appearance which the room
would present,  from  day  to day, whereby  the  attention
would not be distracted  by  new combinations and aspects of
the class.   Indeed, a  return to  the same seat is necessarily
attended with an association of  ideas, which is favorable to
study, and, ceteris pirib'is, those who^practice  it most, will be
most benefitted by the lectures.
  The practice of cutting the benches, and otherwise marring,
or eviscerating the room, should be punished, as a depreda-
tion, while the class  should frown upon it, as puerile, and
unfavorable to rapid improvement;  which cannot fail to be
more or less impeded,by the petty violations, which transform
a beautiful and well ordered apartment,  into a scene of dirt
and desolation.
   In short, students of medicine should  he gentlemen in the
lecture room, as well as the drawing room;  and consider it 
MEDICAL EDUCATION.
53
discreditable, to abandon themselves to levity, mischief, and
idleness; all of which are not less at variance with propriety
than improvement.
  Taking notes is an important employment of the lecture
room, and one for which but few students are prepared.  At
the beginning of the course, most of them are zealous in this
labour; but its difficulties,  in many cases, speedily diminish
this zeal, which is  often succeeded by downright indiffer-
ence.  The  pupil  should  be careful  never to attempt too
much, particularly  during  the first course.  On  Anatomy,
Physiology, Chemistry, Pharmacy,  Operative. Surgery, and
practical obstetrics, as a general observation,  notes should
never be taken ; and  much of what  constitutes courses of
lectures on the Institutes and Practice of Medicine, Materia
Medica, the Principles of  Surgery, the diseases of women
and children, and Medical Jurisprudence, need not be record-
ed, because it may be found in the books. In the last century,
when the practice of publishing every  thing, did not prevail,
as in the present age,  the necessity  of making  notes was
much greater.  There is  a value,  however,  in this labor,
distinct from the manuscript information of which it puts the
student in possession.  It in some degree, secures and sustains
his attention, and the extension and filling out of his notes,
at his room, is a valuable exercise,  leading to a kind of intel-
lectual rumination, and favoring advancement in the import-
ant art of composition.  Students,  however, who can com-
mand their attention, and  have  retentive memories, would
do well to write down but little, till they retire;  when they
should record such facts and principles, as appear to be orig-
inal  or of great practical utility.    In the perception of
these, more, perhaps, than in any thing else, will the descrim-
inating or  instinctive sagacity  of the  pupil, manifest itself.
As students who write in the lecture room, can only record
a part of what is said, they should exercise a quick, and, in
loose phraseology, an intuitive judgment, as to what  espe-
cially deserves to be recorded; otherwise, in labouring upon
                           G 
54
MEDICAL EDUCATION.
the common-place, the new and valuable may entirely escape
their attention.
   All the reading of the student, during the session, should
have a reference  to the lectures.  He  will find  time for no
other, if he properly study the great variety of topics, which
will be daily presented to his attention.   In the prosecution
of these, reading will be of essential service, as  connecting,
in his mind, the information received through two senses, and
from at least  two teachers—the lecturer and the author.
They will be made to rectify and illustrate each other, and
the curiosity to see how far  the former is  indebted to, or
surpasses, the latter, will prove a beneficial stimulus.
   Conversation and examining clubs, are productive of much
advantage, provided they are conducted with order—that is,
by fixed laws: if not, they are worse than useless, as attract-
ing the student from solitary study.
   Practical Anatomy should  engage the attention of every
pupil.   In a country where all physicians must, to a greater
or less extent, be operative surgeons, every candidate for the
profession should learn the use of the scalpel; and work his
way,  for  once at least,  through the intricate fibres of the
'human body.   Having seen, and with  his own hands separ-
ated the parts from each other, their forms and relations will
be well  understood,  and remembered for  a much longer
period.  Moieover, unforeseen events, or the developement
of a new taste, may at length incite him, who was, originally,
disinclined to the practice of surgery in  its higher operations,
to turn his attention to that elevated department of the pro-
fession, when he  will find great difficulties to encounter, un-
less, while a student, he acquires a facility in the use of the
knife and scissors, together  with a  sound knowledge of the
anatomy  of those  parts, which are the chief seats of the
greater operations.
   As to the number of courses, I would say, that  all students
Who have adequate pecuniary means,  should  attend  three,
before they graduate; and the second, if convenient, should
be in a different  institution, from the first and third, which 
MEDICAL EDUCATION.
55
should be in the same.   I know from  personal observation,
that a great number of students graduate, prematurely; that
is, without  the extent and maturity of  knowledge, which fits
them for safe and efficient practice.   It is a point of honor
to graduate at the end of the second  course, but the ambi-
tion of a student should  be,  to graduate "with honor,  rather
than within a given time.  Relaxation in elementary studies,
is, commonly, the first effect of graduation; and he who is im-
perfect then, generally remains imperfect throughout life.
   Almost all candidates have more or less perplexity.on the
subject of  their inaugural dissertations.   This arises in a
great degree from delay.  The summer preceding the last
course of lectures, is the time, when the thesis ought to be
prepared;  but  the  majority  postpone it till the midst of the
second session,  when its composition is attended with numer-
ous difficulties; and sometimes keeps the candidate from the
lecture room for many days, when his anxiety to be in regu-
lar attendance and prepare for his examination, is, generally,
greater than at any  preceding period.  Such  are the unsa-
voury fruits of procrastination.
   Finally,  students  when in attendance  on lectures, should
look carefully to the preservation of their health.  The new
causes which may impair it, are, first, a more inactive and
sedentary life;  secondly, a fuller and more  stimulating diet,
than most of them have been accustomed to at home; third-
ly, a change in the hours of eating, especially, breakfast
and dinner, both of them being too late—the former for an
obvious reason, the  latter, because, the appetite becomes
importunate, and leads to  gastric repletion; fourthly,  in
many cases, abridgment of the hours of sleep; fifthly, intense
and perplexing application of mind; sixthly, crowded  and
badly ventilated lodging rooms; finally,dissipated pleasures,
into which  they are too often seduced by the allurements of
great cities,  the common  and most proper  sites for medical
institutions.  From  the operation of these, and other causes,
the health of medical students, during the session, is exceed-
ingly apt to become impaired.  The maladies to which they 
56
MEDICAL EDUCATION.
   are most liable are constipation, hepatic torpor and engorge-
   ment, dyspepsia, headache, chronic ophthalmia, palpitation
   of the heart, hypochondraism, ennui, jactatition, fidgets,  and
   other forms of nervous irritation.  With any of these maladies
   upon him, the student will make but sorry progress;  most of
   them, however, might be prevented, by  temperance, exer-
   cise  in the  open air, and general  regularity of life  and
   conduct.
     I shall here offer a summary view of the desiderata which
   our medical institutions seem to me to present; and shall
   make no other apology  for the repetition it may  involve,
   than  the great importance of  the subject.
f~*   1.  An  increase of the  length of our  sessions  to at least
   five months.  This could readily  be effected, by a simulta-
   neous resolution of the  more popular and frequented insti-
   tutions, in which  our venerable Alma Mater, the university
   of Pennsylvania, ought,  in justice  to her age and relative
   rank, to take the lead.
     2.  An  augmentation  of the number of professors to at
   least  seven, with a general refusal to recognize schools  that
  have  not more than four or five.
     3.  The election of professors for five or seven years, in-
   stead of an indefinite time; with the general  understanding,
   that a re-election would in all cases take place, if the incum-
  bent had acquitted himself with zeal and  competent  ability.
   If pupils  were not compelled to take all the tickets twice,
   dull and unskilful professors would be neglected,  and might
   at  length, resign.  But, as in nearly all our schools, the
   pupils are required, at each  session,  to purchase the whole
   of the tickets, the strong professors are made to sustain the
   weak, who of course do  not  resign, but clog the institution,
   impede its progress, and depress the standard of excellence.
   Septenniel elections might prove a corrective to these evils,
   though I am not prepared to say, that a better could not be
   devised.
     4.  Students should not be allowed credit for a  course,
   unless they matriculated by the end of the first week of the 
MEDICAL EDUCATION.
57
didactic  lectures,  and then  remained  to  the end  of the
session.
   5.  At least four years should elapse, from the commence-
ment of the pupil's studies, until his graduation.
   6.  He  should be required to show that he is twenty-one
years old.
   7.  Increased attention should be paid to the preparatory
or academical attainments  of candidates.
   8.  The examinations for a  degree should be more  search-
ing.than they are generally  made.   This, it is true, would
diminish the amount of graduation fees received  by profes-
sors, but the public would be gainers,
   9.  Every  candidate  should  be required to publish his
thesis; and a premium  should be awarded to the author of
the ablest of these productions.
   10.  Summer  lectures, especially on the collateral and
auxiliary  sciences, ought to  be encouraged, and the candi-
date should be required to have  some  knowledge of those
branches.
   11.  A stricter regard should be had to the moral charac-
ter of candidates, who should never be admitted to examina-
tion, until they had deposited with the dean, satisfactory evi-
dences of good reputation.
   12.  Lastly, as a means  of promoting this  object, and of
advancing the respectability of the piofession, there  should
be, in every medical school, a series of Sunday morning dis-
courses, by one of the professors, on the morale of the pro-
fession, and the virtues and vices of medical men, embracing  J
their duties to their patients,  and a system of medical ethics.
  A strict attention to these different points, could not fail
to improve the  condition  of our  schools,  and elevate the
character of. the American profession.
  I shall conclude with a few  hints to professors, on the
means of making their prelections interesting and instructive.
  A dull lecture is a great evil.   Politeness may  reconcile
the majority of  a  class to  such a  lecture, but it falls de«d-
born from the lip of the professor.  To listen, day after day, 
58                MEDICAL EDUCATION.
for several hours, through  four months, even to animated
speakers, is a serious  undertaking; but to sit, from hour to
hour, beneath those, who,
       'Through the long, heavy, painful page, drawl on,'
is intolerable to all, who have not a facility in resorting to
early and sound sleep;  the usual and best resource, under
such a calamity.   As  instruction is the object of all medical
lectures, the end for which they were instituted will not be
attained, if the attention of the class be not kept in activity.
The moment it flags, improvement is at an end, and the pro-
fessor had better fold  up his manuscript, and permit the pu-
pils to return to their chambers.  There is an eloquence of
the lecture room, as  well as of the  Bar and. Pulpit, which
every professor should attain, or feel himself in duty bound
to resign, so as  not to exclude a competent man.  A com-
manding knowledge of the subject, is an indispensable pre-
requisite; but earnestness and animation of manner, are of
equal importance; for without them, the profoundest learn-
ing and*the acutest logic, are of no avail.  At first, they may
fix the.attention, but, unaided by the arts of oratory, their
power is soon  lost, even upon the  inquisitive and"the reso-
lute;  while the  remainder, pars major, neither  hear nor
think.
   The faculty of awakening and sustaining the attention of
an audience, is, in some  degree, a gift of nature, and maybe
wanting, when other requisites are not.   An original or ec-
centric manner, is often the secret of success; illustration
by means of anecdotes,  skillfully introduced, produces the
same effect; episodes  may be so managed as to answer the
purpose; flights of fancy, if well timed, will accomplish the
end in view;  while, in the absence of a talent for the whole
of these, unexpected and pertinent questions, with familiar,
conversational remarks, on the answers that may be given,
will resuscitate the drooping energies of the class, and ena-
ble them to hold out to the end.   Professors who speak ex
tempore, have, in this  respect, a great advantage over  those,
who read manuscripts, for the speaker must think, while the 
MEDICAL EDUCATION.
59
reader need not; and the class will generally follow their
example.   It has  been objected to extemporary lectures,
that they arc apt to be repetitions, and deficient in method.
Precision  and arrangement, however, depend more on the
mind of the teacher, than the  circumstances  under which
his lectures are  delivered.   But in sciences so imperfect as
most of those taught  in  our medical schools, a natural ar-
rangement is not practicable; and extreme attention to meth-
od,  is often  prejudicial, as it leads to assumptions, and the
introduction of dubious facts, to eke out in argument, which,
in the  present state of the profession, should be left defect-
ive. Written lectures, moreover, are not easily altered, and
when once finished, are apt to be kept nearly in their origi-
nal condition.  Thus, what  might have  been as perfect, at
first, as the stale of the science permitted, is  soon  left be-
hind, in the march of improvement;  while  the annual repe-
tition of the same formula of words, diminishes  the simpli-
city and force with which it is pronounced;
          •And every year grows  duller than the Jast.1 
ESSAY IV.
    Studies, Duties, and Interests of Young Physicians.
   A diploma constitutes the great object of  ambition with
 every student of medicine.   This being acquired, he feels
 disposed to relax in his efforts; and enjoy his new dignity.  In
 the opinion of his teachers, and, of course, of himself, he is
 qualified for the practical duties of the  profession; and a
 happy feeling of self complacency, sometimes  of self-suffi-
 ciency,  springs up.   He is  no longer a pupil, but a physi-
 cian—walks  on  a  higher  level—is  surrounded  by new
 associates—and either turns  his thoughts towards new ob-
 jects, or to none at all.
   The  length of this period, varies with the temper and
 necessities of .each  individual.   If voluntarily  prolonged,
 the omen is decidedly bad.   It indicates a want of ambition,
 of industry,  of conscientiousness,  or  of  the  amor scientiis.
 I am grieved to say, that too many of  our young physicians,
 are deficient  in one or more of these  important elements of
 future eminence; and through life, prefer to vegetate in  the
 lower walks of the profession, when they might ascend and
 flourish in its higher regions.
  The young man of merit regards a diploma, as only one of
the series of honors which lie within his grasp.  He stops to
 breathe, but still  remembers that he has passed through his
tiovitiate  only; and  must  speedily resume  the labors by
 which alone he can hope to reach the  highest honors of  the
 profession.  Many desire, even resolve, to be distinguished,
 but neglect to employ the  proper means. Aware of  the
 necessity of study, they intend to recommence  it; but put
off the day of renewed  labor, till  it is too late.   Habits of
idleness are formed; the  allurements of society establish their
 fascination; examples of partial oil temporary success in the 
MEDICAL EDUCATION.
61
acquisition of  business, without an attention to studies, un-
fortunately surround and encourage  them; the ignorance
and  credulity of the world, disclose to them the possibility
of acquiring,  without  deserving its confidence; hard study
begins to appear  less indispensable, and  more repulsive;
their noble resolves are forgotten—their destiny  becomes
fixed, and  a humble one it is.  Such  are  the  course and
terminations of a majority of those who are put to the study
of medicine in the United States.
   The  physician  who neglects his studies for the few first
years after graduation, will seldom resume them.  In many
respects,  this is one of  the most  important periods of his
whole life.  The omissions of youth may be supplied—those
of manhood are fatal to our prospects, in proportion to their
numbtr and magnitude.
   The young physician is not aware how soon  his elemen-
tary knowledge—much of which is historical and descriptive,
rather than philosophical—will fade from his mind, when he
ceases to study.  That which he possesses, can only be re-
tained by new additions.   He cannot remain stationary; the
moment he ceases to acquire, he loses; and this is true, not
merely  of professional, but of  classical and general knowl-
edge, as I have  warned him in  a previous essay.
   Hence,  every young  physician, should devote a stated
portion of  time to the  branches of learning which  enga-
ged (or should have engaged) his attention, before he began
the study of medicine.  By doing this, he would, if previous-
ly  well  taught, soon  make  himself an  able and accurate
scholar; or, having been denied the advantage of early oppor-
tunities, he might supply many deficiencies, and save himself
from gross illiterateness.   It is  this ignorance, still  more
than defective professional attainment, that constitutes the
 difference between the physicians of America  and Europe.
 It perpetuates itself, because the majority of us, being in the
 same condition, are  disposed, mutually,  to  sustain  each
 other against the contempt of sound scholarship.
                          H 
62
MEDICAL EDUCATION.
  It is equally necessary for  the young physician to review
his professional studies, especially his  Anatomy.   Should it
once glide from him, the  substratum of his Surgery,  Physi-
ology, and Pathology, is gone.  To prevent this, he should
study it in connexion with these important branches, and
unite the whole into one system;  by which  only, can it be
retained, or they illustrated.   But he must  not merely re-
view, he must extend his  professional  studies.   Previous to
graduation, the most industrious student can study but a
small part of the books, which are current in the profession.
He has had before him but a few specimens in each depart-
ment—a large [portion remain to be studied.  In this duty
he should proceed  with  method; and I will mention two
principles which should govern him:—First, he ought suc-
cessively to  undertake the study of particular diseases, or
groups of diseases, and seek, in all the books consecutively,
for what relates to them.  In this manner, he will form his
own monographs.  Secondly, when  actual cases of disease
present themselves, be should read whatever may be within
his reach in reference to  them.  Such readings are more
profitable than any  others, because  the motives  which
prompt him, sustain his attention and invigorate hia under-
standing.
  The same is the appropriate period, for the study of re-
trospective medical literature.  But  few of the works  of
past ages should be put into the hands of an under gradu-
ater;butno physician should regard his education as in any
degree complete, until he has read the  writings of most of
the great observers, and original geniuses, who have adorn-
ed the  profession in different ages.  He  will thus trace up
established principles, through all their modifications, to
their sources,  perhaps in a remote  antiquity.   He will, at
every step, amass  important but  neglected facts.   He will
be taught how to think.   Finally, his mind will be enlarged
and liberalized,  by an acquaintance  with the revolutions
which the science has undergone. 
MEDICAL EDUCATION.
63
   The auxiliary sciences should  claim the attention of the
young physician.  The most important of these, are, com-
parative Anatomy, Zoology, Botany, Mineralogy, and Meteo-
rology ; all of which, he will soon discover, have many inter-
esting relations with  the  profession.   With the utmost
assiduity, he cannot, in the course of a three years' medical
pupilage,  acquire  even  the rudiments of these collateral
sciences;  and  if he postpone the study of them till he has
acquired  professional  business, he will have but little time
to devote to their  elements, although many opportunities
must offer in the midst of business for reducing such knowl-
edge to practice.
   I  would be superfluous,  to  say more  on the subject of
study, in the first years of professional life.  To regard that
period as one  of admissible leisure, argues either a pitiable
ignorance of the extended limits of the medical profession,
or a culpable disregard for its weighty and dignified respon-
sibilities.
   This is especially true, of country practitioners; who
would find their time on distant visits, profitably occupied,
in observing and collecting the natural  productions of the
district of country in which they  reside;  and, over which,
most of them continue  to travel for years, in utter ignorance
of the interesting objects which it  presents.   By a very mo-
derate attention to  Botany and Mineralogy,  the  country
physician, without the smallest neglect  of  his  professional
duties, would, in a short time become  well acquainted with
the plants and minerals of his vicinity;  and might thus make
important contributions to the natural history of his country,
while the tcedium of his  solitary rides would be effectually
obviated.
   The young physician  should write as  well as read.   He
should study with his common-place book by his side, espe-
cially when engaged in works which he does  not expect to
peruse a second time—and make to them such references,
or, from them such extracts, or, of them such abridgements,
as may seem advantageous.  It is a most  useful exerciee, to 
64
MEDICAL EDUCATION.
abridge  and re-write  such parts of the greater authors, ne
relate to some interesting subject, and place them in juxta
position,  for the  purpose of comparison or  contrast.   He
 should sometimes epitomize entire works, for the mere value
of the  exercise in professional composition; and to the same
end translate, largely,  from  all the  languages he may culti-
vate.  He ought carefully to record his own observations and
experiments;  not in a  diffuse and inaccurate style, but with
precision and perspicuity.  He should  from time to  time
write essays and dissertations on speculatve topics, and at
subsequent  periods subject  them  to a  rigid criticism.   By
these various exercises, he will, at length, acquire a habit of
expressing  himself with facility  and clearness, if he should
never  attain to elegance; while these repeated  attempts at
arranging and connecting  facts, will have strengthened his
reasoning powers, and  given him habits of method.   It is la-
mentable to see how few of us write well, that is, with sim-
plicity, conciseness and purity.  The fault lies quite as much
in the  neglect of practice in composition, as in the want of
previous education.  Neither will do alone;  but of the two,
the former is, perhaps, the more injurious.
   Young physicians should write much but publish little.
Every  good composition is not worthy of being read.   It is
easy to make new  digests of common  facts, in the form of
essays and dissertations; or  to report new cases,  which dif-
fer in no essential  point from those with which the books
are already crowded.    Such  contributions  swell, without
enriching the archives  of the profession. Every new arrange-
ment of facts, should establish or subvert some principle, or
rule of pratice;  and every reported case, should  present, at
least, one point  of novelty.  In reference to style, the desid-
 eratum of the former, is method—of the latter, brevity;  and
without these requisites, neither will be read with pleasure,
 whatever may be the value of the materials.
   Inexperienced physicians should avail themselves of every
 opportunity, to reduce their theoretical  knowledge to prac-
 tice.   They must never wait for select cases, nor shrink from 
MEDICAL EDUCATION.                 65
a professional duty, however  repulsive.   Every young phy-
sician must expect to begin his career among the poor.  So-
ciety attaches  great importance  to experience; and those
who can command the services of one who has had practice,
will not confide in a novice, whatever may be his genius or
attainments.
   The epoch of professional  life  now under consideration,
is the time to perfect those habits of observation, which begin
in our pupilage.  Every  clinical  case ought to be a study,
and nothing connected with it should be overlooked.  I nev-
er knew a skilful practitioner  who was not an acute observer.
Whatever may be a physician's judgment, he should  not be
confided in, if obtuse in his powers of observation. To arrive
at correct results, the first and greatest requisite, is to have
correct data:which can  only be acquired by  accurate and
patient observation.
   It is a prevailing opinion, that  a physician should  many
young.  The beneficial influence of this step on the business
of a young physician, is I think overrated.  I have  seen
many acquire a respectable practice before marriage; and
others fail in that  particular, although they married early.
A compliance with the maxim has, moreover, often led to a
premature settlement of this kind, and done irreparable in-
jury to the individual, by augmenting his expenses beyond
his slender income; thus multiplying his cares and*anxieties,
so as greatly to abridge and distract his hours of profession-
al study.  On the whole, however, it is necessary and prop-
er for a physician to marry, as early as prudence will justify;
for, to a certain extent,  it does promote the  acquisition of
business;  while it prevents the formation of habits of solitary
study, which he cannot  afterwards change.  I look upon
such habits, in  a country  where  the domestic relations are
so generally cherished in the United States, as exceedingly
detrimental to  the cultivation of  the profession.  The phy-
sician who cannot study in  the  bosom of.his  family, and
amidst  the interruptions produced by  domestic duties and
professional  labors, must neglect either one  or the other. 
66
MEDICAL EDUCATION.
Early  marriage, before  the  establishment of fixed habits of
secluded study, will, in general, save a professional man from
this unfortunate dilemma.   If he begin,in due time,to read
and write, at the family fire-side, he will daily devote many
hours  to both, that would  otherwise be entirely lost; and
thus be made, not  only a bettei physician, but a better hus-
band and father.
   The same period of life, is that in which a physician is to
form his manners, or rather  his manner.   In no vocation is
manner more influential.  Many young physicians have  ac-
quired popularity, by the mere force of manner, while others,
of equal or greater  professional skill, from the same cause,
have never become favorites  with the public.   Fot such
cases I can offer no infallible recipe. Dignity, tenderness, and
modesty, would  seem to be  appropriate elements in the  de-
portment of a young physician, whatever may be their effect
on the people.  They may not inspire confidence in the vul-
gar, in comparison with  impudence and garrulity; but,soon-
er or later, their influence will be felt and acknowledged.
It must, howeverf be admitted, that public favor is not always
the meed of unexceptionable manners, even when sustained
by competent skill.
   In these instances, however, there  is,  generally, in  the
midst of prevailing excellences, some particular defect. For
example, "the individual may be deficient in tact; or wanting
in attention and earnestness—a defect, which, more than
most others, will retard  the  acquisition of business.   Noth-
ing captivates  the  friends of a -sick person so much, as an
earnest and anxious manner on the part of the physician.
None are insensible to such a manner, while many will  re-
ceive it as a substitute both for skill and social refinement.
  But  of all the extraneous  aids to the acquisition of busi-
ness, some peculiarity of manaer is, perhaps, the most effi-
cient.   Should it even border on the absurd or the  ridicu-
lous, it is still in the opinion of the people, an indication of
genius, and seldom fails  to secure their  confidence.   To  be
effective, however, it must be natural, not assumed, as  affect- 
MEDICAL EDUCATION.
67
ation is with difficulty concealed, and its discovery of course,
brings contempt.
  One of  the  first questions which perplexes a young man
after his graduation, is the choice of a residence. He should,
if possible, place himself within the pale of good, that is, of
intelligent society.   In  any other  situation, both his mind
and manners will  degenerate.   His companionship should
be with the enlightened and refined of both sexes; for his
character is to be formed, and should be modelled after good
examples.  It is not important that he should remain perma-
nently in  his first locality.  He should not leave it, howev-
er,  till he has passed through a period of probation, and
acquired a competent amount of practical knowledge.  He
may then remove to a more extended theatre of action,
where he ought to spend his life.  If he have commenced
within the precincts of such a situation, he  should hold on
till he acquires public confidence, however slow it may seem
to be in coming.  Not unfrequently this is a protracted pe-
riod, and  abounds in anxieties, hopes and fears, impatience,
and hypochondriaism.   Under  these  feelings, the  young
physician too often resolves on a change of residence;  and,
at the moment, when  he is on the eve of acquiring busi-
ness,  transfers himself to another town, where, being  a
stranger,  he is doomed to a second probation.  Such remo-
vals, several  times  repeated, have proved fatal to the pros-
pects of many, who, remaining patiently in one situation,
would have found it productive of all they could desire.
  Nearly  connected in  its nature and consqeuences, wiu
this subject, is an attention to some other business, than tha
which is professional.   In some instances the young physi
cian relinquishes his profession, determining to resume i
after a time; but, oftener,he attaches to it, some other pur
suit, which is, generally, that of an apothecary.   Both ex
periments are dangerous, and too often lead to the destruc
tion of all professional prospects.  It is far better for ayounj.
practitioner, however straitened may be his circumstances.
to struggle on, with professional distinction exclusively in 
68
MEDICAL EDUCATION.
 view;  and the attention of the public directed tu him as a
 physician and surgeon only.   Society is not disposed to ad-
 mire or regard a man, in more than one character; and all
 who are candidates for  public  patronage, should present
 themselves in the character which they are most anxious to
 sustain.  A young  physician, moreover, is, in general, not
 qualified for any business but that of his profession; and in-
 curs the  risk of pecaniary  embarrassments, whenever he
 attempts a vocation, to which he  has  not been educated.
 And this leads me to warn the young physician against con-
 tracting debts and  liabilities.  The young merchant  may
 contract debts with propriety and  advantage.  His charac-
 ter for punctuality is a part of his capital, and  should be
 used;  but the only capital of a young physician is his repu-
 tation  for professional learning, diligence,  and fidelity.   On
 this character he should place his sole reliance.   All his
 efforts  should  be directed te its establishment; and whatev-
 er can  interfere, with  this  important and difficult object,
 should be studiously avoided.
   He who relies on his  earnings  for support, will be  led,
not only to practice economy, but to keep  his accounts with
 accuracy, and to attend carefully  to the collection of his
 debts,—habits that will  exert a beneficial influence on his
 character and happiness  throughout life.
   I am aware, that much of what is contained in this essay,
 will be regarded as common place; but I cannot admit, that
 it is not ultimately connected with the  dignity of the  pro-
 fession, and  the prosperity of its  members.   The former,
 indeed, can only result from  the  latter.   Hence all  who
 desire  the advancement of the profession, should labor to
 render those  who practice it, respectable in all their  rela-
 tions to society.  In proportion as  this is accomplished, will
 the profession exert that influence to which it may justly
 aspire. 
ESSAY T.
Causes of Error in the  Medical and Physical Sciences.*

  The Causes which prevent the discovery of Truth in the
Medical and Physical  Sciences, are too numerous to be
embraced in a single essay;  while  many of them are  too
much concealed, to be brought to light, by any but a man of
genius and  extensive observation.  Those of which I pro-
pose to treat, are  common, and, therefore, susceptible of
being exposed.


  The first of these, is the disproportion between the
strength  and  grasp of our  intellectual faculties,and
the  number and variety of objects  upon which they are
TO be exercised.

  In  styling himself'lord of the creation,' man has, perhaps,
consulted  his  pride more than his  powers.  Certain it is,
that  he is not less dependent on the other objects of creation,
than they are on  him.  These .objects,  either animate  or
inanimate, are, to him, absolutely innumerable—they touch

   *This Essay embraces the subitanee  of a public i»troduct»ry
lecture, which will account for its declamatory style.
                           I 
70
MEDICAL EDUCATION.
 him on every side,  and stretch  from him indefinitely in all
 directions.   Their relations with him and with each other,
 are never  the same for two successive  moments;—for the
 group which now surrounds him, will soon surround him  no
 more;  and  while he yet contemplates it, changes of compo-
 sition  and  character have taken place, which he could nei-
 ther foresee nor prevent.  Even individual objects confound
 him;  and when actually in the focus of his physical or intel-
 lectual vision,  undergo transformations, which surpass his
 comprehension, and teach him lessons of wisdom and humil-
 ity.   Suppose that all his observations were correct—would
 this enable him to arrive at philosophical  truth?   It would
 not,—unless those observations were extended to all  the in-
 dividual qualities and relations  of  every  object  requiring
 examination.  In constructing a system of science, it is not
 merely necessary to have no bad materials, but an adequate
 number of  good ones.   Ignorance is said to be better than
error; but this adage refers chiefly to the condition of the
 mind in regard to further  improvement; for, in establishing
 a system of science, ignorance and error are perhaps, equal-
 ly unpropitious.
   Nature, moreover, is not only  too unlimited in the number
of her objects, but their structure and functions are too com-
plicated to be studied without mistake.  The very 'clods of
the valley' present to the philosopher, in their composition,
a problem which he cannot undertake to solve without error,
 —the grass, which he tramples under foot, when he stoops to
 examine it, offers appearances which he can neither  under-
stand nor report with accuracy—while his own body—an as-
 semblage of intricate organs,  mysteriously united, and har-
moniously acting and re-acting on each other,from a principle
 of motion equally mysteriously, presents him with a case, in
which  the utmost  exertion of  his powers of observation and
 reflection, will not secure  him from false  conclusions.  If
 such be the inefficiency of genius, how deplorable must be
 the failures of imbecility:—let  dulness, then inquire with
 anxiety, and publish  in doubt and hesitation. 
MEDICAL EDUCATION.
71
   Another reason why we slowly arrive at philosophi-
 cal truth, is that we seek it without due preparation.

   The chemist who  attempts  the  analysis of compounds,
 without having previously studied the laws of affinity, prose-
 cutes and ends his labors in error; while the pharmacopolist
 who alters  the formulas and recipies of the profession, with-
out a previous  knowledge of practical Chemistry, decomposes
 and adulterates what he seeks to improve.  In the science
of Materia Medica, the  man who expects to  advance our
 therapeutick knowledge, without a previous acquaintance
with the nature and chemical history of medicines, and their
 modus operandi on the  body in health, falls into an error almost
 as great, as if he were to rely exclusively on that preliminary
knowledge, to direct  him as to  their curative powers, which
 can only be known by the additional labor of administering
them to the sick, and  registering their effects.   The opera-
tive surgeon who omits the  cultivation of surgical anatomy,
necessarily commits ravages upon those whom he undertakes
and anxiously desires to  relieve.   Finally, the physician who
aims at a knowledge of pathology, without first devoting
himself to the study of the  animal economy, and frames his
rules of practice in his own office, instead  of the chambers
of the sick, may labor with diligence but will never command
success.  His conclusions, although  not always wrong, can-
not often be correct.   His prescriptions are like gilded pills
of noxious  qualities, in which the poison is concealed from
the eye, but works desolation and death in the unfortunate
patient.
  In all these cases,  and many others that might be cited,
the cause of error, is a violation of the rule of philosophising,
which commands us to 'proceed from the known to the un-
known.'  It is not a deficiency of object, of time, of means
or of intellect, that precludes the attainment of truth, but a
neglect of due preparation, a presumptious disregard of things
that lie near, for those which are more remote; but which. 
72
MEDICAL EDUCATION.
 when examined cannot be understood, because they have
 been prematurely reached.


   The next cause of failure  in the pursuit of philo-
 sophical truth, is more deeply rooted.  It consists not
 SO MUCH in the deficiencies, as the errors of early edu-
 cation.

   From the very nature of our associations in infancy and
 childhood, much of what we learn is erroneous; and through-
 out the whole period of our studies, except when engaged
 in the exact sciences, we daily imbibe falsehood with truth;
 and, unconscious of the  combination, retain the whole under
 the  name of knowledge.  The tenacity  with  which the
 mind clings to these false impressions, is often not less, than
 the facility  with which,in early life, it receives them;  and
 as they exclude an equal portion of real knowledge, and
 vitiate all our conclusions, their  influence cannot  be too
 strongly deprecated.  It becomes both pupils and physicians,
 frequently to review their past studies, and anxiously to in-
 quire into the circumstances under which  their knowledge
 was acquired.  By such retrospection, carefully and humbly
 made, they will often be able to detect the occasion, or the
 dictum, which led  them into error, and thus  purify and fit
 their minds for the reception of new truths.


  Another impediment to  the acquisition  of truth, is
 fickleness of attention.

  Childhood is the epoch of mutuability, in which impres-
 sions rapidly succeed and supersede each other.  Children
 do not dwell long enough on any object, or group of objects,
to acquire correct and ascertained ideas of their properties
and relations, and hence they investigate badly.  This pro-
pensity to  pass from subject to subject, is a  principle of our
nature; and is designed  to introduce us to  a first  interview 
medical education.
73
with the multitude of surrounding objects, with which it is
the business of after life to become more intimately acquaint-
ed.  But like every other principle of action, it requires
controul and  discipline.  Appertaining, as we  have seen,
especially to childhood and youth, it belongs to  a good
education, to keep it subordinate in  manhood.  Those in
whom this is neglected, grow up deficient in habits of pro-
tracted investigation, and seldom dwell long enough on any
subject,  to  comprehend it fully.  Such persons  may be
styled  adult children, and the number is  not a few.   Ga-
zing for a moment on the superficies of many objects, but
looking into the  deep  structure of  none,  they  seldom
perceive the truth, as in most cases, it lies  far beneath the
surface.

   Anoter cause of error consists in forming conclusions,
while  we should  still be observing.

   Persons of this intellectual temperament may see deeply,
but  they look in one direction only; and of course form an
opinion, before all  the facts in relation  to the case, have been
reviewed.   They  might be compared  to the judge, who de-
cides on the testimony of one of the  parties, unconscious
that another waits  for an audience. The judgment may be
honest, and a correct inference from  the facts before him,
but still it is wrong.  Many of the errors which  vitiate the
experimental  sciences,  as well as the affairs of social life,
are referable to this head; and as the authors of them are
conscious, not only of loving truth but think  they have in-
vestigated their premises warily, it is not uncommon to see
them cling  with pertinacity to their conclusions.   A singu-
larity  exhibited by  such persons is, that at different times,
they are the honest advocates of opposite opinions.   The
facts, which at one period  were  presented to  them and led
to a particular  inference, are forgotten; and, subsequently,
those of an  adverse tendency  are casually offered to their
notice, when with  equal honesty and promptness, they stand 
74
MEDICAL EDUCATION.
 forth as the champions of a contrary doctrine.   The fault
 of this character, consists in imperfect and limited sugges-
 tion—a  sort  of intellectual  strabismus  or  squinting—by
 which the  fields  of mental  vision is  narrowed, and the
 partial  mistaken for the  universal.  The opinions of such
 men are entitled to  respect for their sincerity, but not to
 adoption for their soundness.  They may be true, but should
 always be presumed erroneous.  The proper remedy, is a
 constant recurrence to protracted and  comprehensive re-
 search; that all the facts in the case may be fully represent-
 ed in the deduction—when this is realized the judgment is
 true, and then only.


   The  next obstacle  to the discovery of truth, is viv-
 idness OF FANCY.

   Many cases of madness have seemed to grow out of this
 exuberance.  It tends to abstract us from external objects,
 and causes inattention to the impressions which they make,
or might make upon us.  Such philosophical fanatics, require
but a glimpse, to afford  them, as they believe, an accurate
knowledge of the properties and relations of the most com-
plicated group of objects.  Their  senses do not resemble a
camera obscura so much as a magic lanthern.  A single sen-
sation can spring along train of ideas; and cause new cre-
 ations to succeed each  other, like the spectres in that ma-
chine, and generally with as little conformity to truth and
 nature.   Philosophers of this excessive mobility, are right
 only by accident, and it is equally accidental, if they discover
 themselves to be wrong.  They do not so often change from
 error to truth, as from one illusion to another.  They sup-
 pose themselves men of genius, when, in  fact, they are en-
 dowed  with but one of its attributes.   They  are  great
 builders of hypothesis, but all their pyramids are inverted.
 They never  investigate closely, but to sustain a pre-concei-
 ved notion, and th«n instinctively reject every fact which 
medical education.
75
 militates against it.  Their ardor and  obstinacy are often
 so great, as to inspire confidence in their opinions, and make
 proselytes of those who should labor to expel their delusion,
 and bring them back to the sober realities of the external
 world.   Such an enterprize, would, however, in most cases,
 prove ineffectual; and hence students and young physicians,
 should guard  vigilantly against the earliest illusions of this
 ignis fatuus of the mind.   If it  once attract them from the
 straight and  narrow path of  inductive philosophy, their
 faculties will speedily glide into the mazes of error;  and, if
 practitioners, their prescriptions will  become sentences of
 death, instead of warrants of health and life.


   The next obstacle to the discovery of truth, is impa-
 tience.

   Patience, which is not a greater  virtue in morals than in
 science, has been brought into disrepute, chiefly by the sect
 of philosophers which I have just described; if they indeed,
 can be called a sect, who unfortunately are never embodied,
 but contaminate  all others.  It  is difficult to bring patience
 into favor and  fashion. Being very commonly an attribute of
 inquisitive dullness, many young men of lively feelings, have
 not courage  to practise it, lest  they should be suspected of
 belonging to that class, in which no human  being ever yet
 enrolled  himself without a struggle.  The highest  eulogy
that could be pronounced upon  patience in research, is that
 it constitutes the great secret of that success, which men of
 inferior  talent so often attain.   It must, therefore,  be a pow-
 erful auxiliary, and why should any  man  reject its assist-
 ance?   To say that strength of intellect can  render it un-
 necessary, is not true, unless that intellect be employed upon
 inferior  objects;  and  genius should condescend to dispute
 with stupidity, for the subjects which legitimately  belong to
 the latter.  In his own elevated sphere, the ablest philoso-
 pher will  find patience essential  to  the developement of 
76
medical education.
truth.   Nature is not an oracle of Delphi, to be bribed or
flattered into responses.  Her severe majesty requires that
she should  be interrogated patiently, and listened to with
meekness;  and even when thus besought, her replies may
not always be as prompt and explicit as we could  desire;
bat they will neither be interested nor erroneous.
   At the risk of being found tedious, I must  appropriate
some  additional  paragraphs  to this  part  of  our subject.
There are students and physicians, intrinsically industrious
and patient in the  exercise of their mental powers, who,
nevertheless, have a fastidiousness in regard to manual la-
bor, especially what is  unpleasant,  which materially inter-
feres with the discovery of truth, in their own  and its aux-
iliary sciences.   Let us pause for a moment, and, notwith-
standing the enumerations in our previous essays, inquire
what they are:   Anatomy and Physiology, Surgery, Clinical
Medicine  and Materia Medica, Chemistry and Pharmacy,
Zoology, Botany and Mineralogy, Physical  Geography, Ge-
ology, Pneumatics, Hydrostatics,  Meteorology, Astronomy,
Mechanics, and the Chemical,  Mechanical, and Fine Arts,
are, in fact, but a part of them.  Physical science is, indeed,
the science of material nature, and comprehends as its own
proper objects, not only the globe, and every thing living and
dead, within its bowels or spread over its surface, with all
which  constitute or inhabit  its  atmosphere; but, also, the
boundless system of celestial orbs, which, as suns, and plan-
ets, and satellites, and comets,  enliven the  dark and  dreary
regions of infinite space. Now, let us place before ourselves,
an imaginary picture of the objects to which I have referred,
and then contemplate their number, varieties and analogies,
their relative positions, their individual properties, their va-
ried uses, their attractions and repulsions, their dependen-
cies on each other, and the  influence which man exerts on
them and they on him, and we shall be prepared to estimate
the value of our remaining attainments, if  an acquaintance
with the forms and qualities of matter were expunged from
our minds.  But this would be impossible, for  material na- 
medical education.
77
ture is the foundation of all our knowledge, and in proportion
as we neglect its study, science becomes uncertain and un-
substantial—speculation supersedes experiment—hypothesis
replaces theory—and syllogisms usurp the office of induc-
tion.
  Our proper business, then, is the study of material objects,
and these must be examined by our organs of sense, to be
rightly  understood.  If this examination be reluctant and
superficial, the  results will of course be imperfect.  If we
come to it in a temper of fastidiousness, and shrink from the
necessary exertion, because we may have been unused  to
manual labor, or some parts of that'which should be done are
unpleasant or repulsive, we shall seldom  grasp the truth.
If we suppose, that not having been compelled to labor for
subsistence, but, nursed in the lap of wealth and luxury, we
may leave the drudgery of science, to hands already soiled
in the field or hardened in  the work shop, we shall, at last,
be disappointed in our dearest hopes; and mortified to see
those whom habits of toil and application, have prepared to
vanquish every difficulty, stretch  immeasurably beyond us,
in the race of emulation  and professional  fame.  In the
pursuit of physical truth, an examination of the objects of
nature, is the first and greatest work; and he who brings to
it the best manual dexterity, the  greatest self-dependence,
and most untiring industry, with the fullest command of his
feelings, in relation to  scenes  and objects, which are often
offensive and sometimes loathsome, will, cceteris paribus, be
most successful in his researches.   It is a prevalent and per-
nicious error, that the labors of the  devotee of  physical
science, are chiefly intellectual; or that we may view nature
from select positions, and  acquire  all  the necessary know-
ledge, by perspective views.  A much closer intimacy, is
requisite to a full acquaintance.   If we  read the biography
of the greatest men, who have  adorned the  profession or
dignified the ranks of physical. science, we shall find them
almost as remarkable  for  their labors of body as of mind.
The former, directed to the objects of  their ambition, sup-
                          PC 
78
MEDICAL education.
plied the pabulum, by which the latter was cherished. Such
is the order of nature, and no student or physician, who prizes
truth or reputation,should ever depart from it.


   Pride is a stubborn obstacle to the  discovery and re-
ception OF TRUTH.

   Meekness of spirit, is scarcely a more  necessary  predis-
position for the reception of divine, than  scientific truth.
The  self-sufficient philosopher, never enquires  into his de-
fects.  When he contemplates himself, it is rather to admire
his'excellences than to correct his imperfections. He views
the former with a mote,the'lalter with a beam in his 'mind's
eye.'  He employs a  mirror, which reflects only the beau-
ties of his character;  arid should it, at any time, become
true to nature, he turns from the unwelcome glimpse of his
deformities, as  from  things to be concealed and forgotten,
not corrected.  To expose them to society would  mortify
him still more. He is even reluctant to display his improve-
ments, as they would  imply previous defects of  knowledge,
and approximate him to mortals of a common  mould.  A
student of this class, often prefers to remain ignorant, rath-
er than appear so; but it is, especially  in advanced  life,
that pride interferes most fatally with improvement in sci-
ence.  In  youth, vanity sometimes tempers this indomita-
ble passion; but  in  process  of time, it not unfrequently
subdues every opposing sentiment, and,  becoming  fortified
by habit, governs the character  of the individual, with  the
spirit  of. a  tyrant.  Hence the obstinate  perseverance in
ancient errors, the cynical sneering at late discoveries, the
dogmatism, the pomp  and the real  or affected  scepticism,
which in medicine, so often render old age ridiculous, and
sometimes, seriously impede the dissemination of new truths.
I know of no cure for this' fungus hcematodes of the mind,
when it has become  deeply rooted, but in youth it  may be
eradicated, and every student should seek to cast it out. 
MEDICAL EDUCATION.
79
  Excessive deference for  authority—in some degree
the opposite of pride--contributes equally to the perpet-
uation of error.

  An overweening  regard  for authority in the sciences, is
the offspring, either of a slender  understanding  or a timid
spirit, still further  enfeebled by  bad education.  It shows
itself, not  merely  in  an  unsuspicious assent to alledged
facts—a pardonable credulity—but in aq implicit adoption
of the conclusions of eminent men, when we should exam-
ine for ourselves, both their premises and reasonings.   The
latter species of intellectual servility, has done much harm
to the profession, and through it to society at large. In gen-
eral, we are under the necessity of  receiving  as true, that
which the archives  of medicine present to us as fact; for it
is impossible to repeat every experiment, and many observa-
tions  can never be made a second time, because the same
combination of circumstances may not. recur; but nothing
should "be taken on trust, when it can be avoided; as that
which is reported correctly, may have been seen incorrectly,
and the professions of  truth with  which a subject is intro-
duced, may be designed  by the author, to protect it from
suspicion.  But the reasonings of an author, a professor or a
colleague, are  legitimate subjects of scrutiny,  and he who
passes timidly over them, admits an inferiority, which fear-
less investigation might convince him, did not exist.  Hebe-
comes the slave of  opinions, instead of the servant of truth;
and contributes not more to the diffusion of falsehood, than
to the degradation  of his own character.   As  the opinions
of great men, have the widest circulation, and receive  the
most  implicit adoption, it becomes all who can be incited to
the duty of examining what -they are about to receive, to
subject those  of eminent  writers, to a carefuller criticism,
than  is  necessary  for the speculations of authors of lower
powers and more  limited  fame.   If this had been always
done, the genius which has been devoted to  the profes-
sion,  must have carried it far beyond its present elevation* 
80
MEDICAL EDUCATION.
   A  DEFECTIVE LOVE OF TRUTH, IS ANOTHER CAUSE OF ERROR
 IN THE PROFESSION.

   The love of  truth, although an original principle of hu-
 man nature, has various degrees of native energy; and from
 the operation of several causes, may decline, till we come to
 look upon error with complacency, and at last not only tol-
 erate, but  publish  falsehood.  Very few principles of our
 nature, are, indeed, beset with so many causes of corruption.
 I will name but two—self-interest and self-love.   The com-
bined influence of these, on the love and practice of truth,
in morals and society at large, is seen and admitted by all; and
it is equally great in the medical sciences, where, although
less  deprecated, it is perhaps still more mischievous.  Self-
 interest and self-love; it is true, sometimes animate us in the
pursuit of truth; but is is only when reward awaits its attain-
 ment, or disadvantage or disgrace would flow from failing to
 reach it.  Unhappily for the interests and diginity of human
nature,  such cases are few in number; and, hence,these
restless and unwearied principles of selfishness, are more sel-
 dom enlisted in the service  of truth than falsehood.  While
students, it is uncomfortable to feel, and sometimes mortify-
ing to acknowledge, that we do not fully comprehend a sub-
ject; and, strange as it may seem, we, now and then, so far
 compromise with the love of truth, as to pretend, and, per-
haps, sometimes almost  believe, that we are less ignorant,
 than is the fact.  After  having passed  through our pupilage,
and taken rank with the initiated, it becomes our business to
interpret nature to those below us; and as we should then
 consider it still more  discreditable to be at any time found
 wanting, the. motive to practice imposition is strengthened.
 But it is as physicians and surgeons, when we expect to re-
 ceive patronage, less in the proportion of our true knowledge,
 than of our plausibility, that the temptation to  deceive, both
 ourselves and  others, acquires an irresistable and frightful
 energy.   As the  naturalists find it necessary, to supply from
 analogy, the lost parts of a Mammoth  skeleton, befoie it can 
MEDICAL EDUCATION.
81
 satisfy vulgar curiosity, so physicians feel the importance of
 presenting an aspect of perfect knowledge, when they would
 acquire  public  confidence.  This  imposture, not often de-
 tected, is still more seldom frowned upon, by the hoodwinked
 community, whose  unreasonable demands  have invited it;
 and, as impunity promotes the repetition of crime, one im-
 position follows another, till the love of truth falls gradually
 into ruins; and the heart once honest and open,becomes  at
 last polluted with the principles of a criminal  selfishness.
 The guileless lineaments of unsophisticated nature, are now
 exchanged for the  studied imitations of art;  and the ques-
 tion no longer is, what does truth require, but what will best
 administer to the  insatiable cravings of self-interest, and
 where lie  the moral limits which cannot be overstepped, with-
 out injury of reputation?—Mark  the physician  who has thus
 degenerated, and you will no longer perceive in him any
 sacred  veneration for professional truth.  If  he purchase
 books, it is rather to appear learned," than-to become so; and
 when he reads, it is more to extend' his  notoriety  than his
 knowledge.  He may not purposely avoid the truth;  but he
 no more trims his midnight lamp, and diligently compares
 the recorded observations  of others, with his own,  made
 through the day; he relaxes in his efforts, to note down the
 facts which fall under his observation: or, what is more crim-
inal, suppresses or perverts them, to suit his prejudices, or dis-
play his conduct  and  character in a favorable aspect.   In
his practice, he often omits  the  performance of duties, be-
cause  they may  be servile and troublesome; when from
such omission,  the truth  could  not be ascertained, nor his
 patient treated with success.  In cases of extreme danger,
he  will neglect the investigations that   are  indispensable
 to a true knowledge  of the case,  and  occupy  himself on
 the means of satisfying those interested in the result, that he
has done all that could be done,  if not all that was required.
 He magnifies the danger through which those have passed,
who appeared to be seriously ill  when they  were not; and
 expects thus  to balance the account of profit and loss, when 
82                MEDICAL EDUCATION.
a patient.dies whom he ought to have saved.  In the applica-
tion of remedies, he yields to prejudices and apprehensions,
which it is his duty to encounter, and, if possible, overcome;
and neglects the use of means  which are  necessary to the
safety of his patient, lest censure should follow their unsuc-
cessful employment.  When required to confer with another
physician, he looks more to the preservation or extension of
his fame, than the life of the patient; now doubly joepard-
ized, by the complaint and the cor^ultation.  If the attend-
ing physician, he makes false or imperfect- statements—ad-
ding  or subtracting, in  his  narrative of the past treatment,
such  items, as he thinks necessary to a favorable estimate of
his sagacity;—if  the consulting  physician, to acquire  a
name for liberality, he sanctions with criminal courtesy what-
ever  has been done, and recommends its continuance; or re-
jecting the  whole, aims, like a cannibal, to fatten his popu-
larity on the despoiled  reputation of an able,  but artless,
associate.  Finally, should he at any time attempt to lay be-
fore the profession the results of his experience, he writes as
certain artists paint, merely  for  effect;—looking  to an in-
crease of his reputation, more than the dissemination of truth.
Or,captivated by the prospect of temporary applause, rather
than the desire for permanent fame, his histories are not made
correct transcripts, even of his experience; butresemble car-
ricatures, which strike  the vulgar by the'disproportion of
their parts, or the unnatural depth of their light and shade.
Were they equally harmless, it,would be happy for mankind,
but, unfortunately, they are poison  cast into the fountain,
and before  its waters can purify themselves, hundreds may
drink and die.

   A DEFECTIVE  AMIHTION, IS THE LAST SOURCE OF ERROR TO
WHICH 1 SHALL REFER.

   The want of  ambition, contributes signally to retard the
progress of medical science.  A  majority of those who be-
long  to the profession, are  destitute  of the excitement 
MEDICAL EDUCATION.
83
which it imparts; and, consequently, deficient in those exer-
tions by which only the profession can be advanced. In the
selection of boys for the study of medicine, no reference is,
in general, made, either to their talents or aspirations; and
most of them grow up and go down to the grave, inemulous
of distinction, and blind to every recompense, which cannot
be recorded  on  their ledgers.  The circumstances of our
country, have a large share in the production of mere rou-
tine practitioners.  In the midst of the  general  diffusion of
political and religious knowledge, literature and science
are but little cultivated or respected,  except in the larger
towns and about our seminaries of learning; and hence the
acquirements of medical gentlemen are not always proper-
ly appreciated.  Emulation,  moreover, requires contiguity
and  contact;  and is most-  energetic, where  the pressure
of rivalship is greatest.   But in the  United  States, from
the sparseness of population, and the small size of most of
the towns and villages, physicians are too detached and scat-
tered, to excite each others ambition, or to concur in opera-
tions for the improvement of the profession.   Thus, many
whose ambition, under a different state of things, might have
prompted them to great  and successful efforts, while away
their whole lives, without having the dorment fires of their
ambition once kindled into flame.   In the cultivation and
practice of a science which is imperfect and speculative, no
principle of action  is so powerful as ambition.   The love
of money will animate physicians in the acquisition of busi-
ness, but not to the discovery of scientific truth.  The pur-
suit of the latter, often, indeed, interferes materially  with
an accumulation of the former—which, with a few excep-
tions, has flown  into the hands of those who have neglected
the cultivation of the profession.  The love of knowledge is
a nobler affection, but cannot be relied upon to promote the
discovery of truth, or extend the boundaries of  our science.
Physicians of tins cla^s,  delight in  truth and detest error;
but having more of contemplation than action, spend their
lives in avparing knowledge, and neglect its appropriation. 
84
MEDICAL EDUCATION.
 They>are misers who horde fine gold only; but depend ex-
 clusively, on an increase of their stores, for  the  pleasure
 which should flow more.copiously from expenditure than ac-
 cumulation.  They industriously gather what they are,in
 general, too indolent  to apply, or even bequeath;  living as
 it were, for themselves only; and manifesting a character of
 refined and unoffending selfishness, which we can neither
 blame or applaud.  The body, the labors and the fame of such
 an one perish in the same grave; and the history of his virtues;
 his  taste and genius—his attainments, purified in the furn-
ace of a noble understanding—his unextinguishable love of
 truth—and his day dreams  of patriotism—are written but
 on the narrow tablet of the grave, and read by those only,
 who visit the. mansions of the dead.   I would not envy such
 ah one, the gratification which he experiences, in his inem-
 ulous retirement from the theatre of ambition and4usefulness;
 nor  can I agree that  the love of posthumous reputation,
 should be classed among  the vanities of human life.   The
 lover of  truth, who is  content  with  its acquisition, has less
 enjoyment, than he who superadds useful application  to ac-
curate attainment; and of all the original principles of our
 nature, the desire of honorable fame, is not only most ben-
 eficial to the  world, but one of the  most ennobling to the
 soul which it animates.
  We must not confound this ambition, either with pride or
 vanity.  The  former  preserves us from  little actions, but
never impells  us to great—the latter contents itself with
vulgar admiration, and incites us to those performances, only
which bring immediate applause.  Pride looks to society for
no reward,either present or prospective:  vanity undertakes
nothing on trust—is not willing to rely on posterity for pay-
ment—exacts daily returns from the surrounding multitude,
 and slakes its thirst with draughts of flattery and adulation.
 Ambition, in itself, has no element either of good or bad. It
 works as a mere animating principle; and rouses us to deeds
 of desperation and death, or schemes of beneficence and life,
 according to the moral sense and the objects of each indivi- 
MEDICAL EDUCATION.
85
dual.  When it subjugates  the heart, and arrays itself in
the armor of misanthropy, it delights in nothing, but new
advances over a terrified and prostrate world; but subordi-
nate to the heart, it becomes the bright sun of society, and
cheers and vivifies whatever its beams may fall upon.  Such
is the ambition,  which should glow in the bosom of every
physician;  he  would then  see no mountain  too lofty to be
scaled, nor so overhung with murky vapours, that he could not
discern the clear and beautiful sky that stretches out beyond
its summits.  Warmed by love for mankind, enamoured of
his profession and animated by the hope of rising higher,
than all who had  trodden  its rugged steeps before him, he
would move on  his upward  march,  with a never tiring
step.   Not  too proud to employ every honorable means,
however, humble; nor so vain  as to loiter, by the way to
catch the syren sounds of popular applause, he would see
and think and dream of nothing, but the grandeur which sur-
rounds the objects that allured him on.   He would suppose
all the time, that these being attained, he might sit down in
the midst of them, and give himself up to enjoyment.   But
the man of true ambition, never stops  to revel in the camp
of victory. He delights in action and anticipation, and looks
with rapture from his new elevation, at the distant and loft-
ier  pinnacles, which till then were hidden from his view.
Finally  the physician of honorable  ambition, has no quiet
sleep, while any are before him.  He would not keep them
back, but advance himself—he does  not regard  them witfc
envy, but emulation.  He even extends to them  his respect,
but this requires, no ordinary effort, and the magnanimity of
his character, is seen in the candor, with which he can bring
himself to view their merits, and  identify  their  fame with
the glory of his profession.
  I shall conclude this declamation  on some of the causes
which oppose the progress of medical science, in the United
States, with a passing  remark  on two or three points that
merit animadversion.
                          L 
86
MEDICAL EDUCATION.
   1.  It deserves to be considered, how far the union of the
 practice of Physic, Surgery  and Obstetricks, in the same
 individual, has contributed,  in the United States, to affect
 the progress of the profession.
   It is a plausible opinion, that these branches should be
 united, in the same individual, as  they  are  manifestly con-
 nected in theory.  Nearly the same principles of Physiology
 and Pathology are common to the whole, though they differ
 in Nosology and Therapeuticks.   No one can be prepared
 to practice either, without a  full elementary acquaintance
 with the whole.   But when we come  to the business details
 of the profession, who is capable of so executing them—still
 cultivating its general principles—as to become great in all?
 Cartainly none, hut men of genius  and  intense industry.
 All others sink into mere routinism.  From an attention, too
 incessant and diversified, to the details, they neglect the phi-
losophy of the profession; until, at last, they can give but few
 reasons for their many prescriptions.  It will not be denied,
 that such practitioners may do a great deal of good, in the
 midst of some mischief; but they are  not the men, who ad-
 vance the science.  They are mere operatives, and work on
 the plans of others.  They are unacquainted with the defecti
 et desiderata of the profession.  They have  not time, nor,
 after a few years, ability to  study their cases, in connex-
 ion with its principles; but rely exclusively on their own ex-
 perience, and the  recipies of their brethren.  They never
 originate schemes of reform  or  improvement, project ori-
 ginal experiments, or develope new elementsof knowledge.
 All this  results from  too much  variety in their practical
operations; for which  the  appropriate  remedy, would be
 concentration upon some part of the  profession.  To have
 depth, the diffused waters must be gathered into a narrower
 channel.  The  man, possessing even  ordinary talents, who
 devotes himself to Surgery, Medicine,orObstetrics,instead of
 the whole, may carry into his practical operations, an accu-
 curate and comprehensive knowledge of principles;  thus 
MEDICAL EDUCATION.                87
making his experience available, to the  rectification of the
errors which  vitiate them—augmenting their limits, and
defining their uncertain land marks.
   On the whole, I am  disposed to  conclude, that the want
of this concentration, is a cause that has  retarded, and con-
tinues to retard, the progress of the American profession, in
scientific improvement; though unquestionably, its members
are  eminently practical, and  generally efficient in their
efforts.
   2.  Among  physicians, surgeons, and obstetricians, there
are two classes, who run into opposite extremes. They might
be termed the philosophical, and  practical or empyrical.
The former delight in general principles, and with difficulty
concentrate their attention upon the practical maxims of the
profession: the latter,find such principles above their reach,
or deny their correctness, and occupy themselves, exclusive-
ly, on  the receipts and dogmas of  practice.  Each sect is
right as far as it goes;  but each is  imperfect.  The philos-
ophy of the science is found in its  general  principles; but
we cannot practice correctly without rules, and  principles
are but the  theorems by which rules are formed.   We
must  understand the  former  to be medical philosophers,
and act by latter to be clinical practitioners.  With princi-
ples, only, we are diffuse and ineffective—with rules alone,
either timid to a fault and suffer our patient to die, or rash
and reckless, and destroy many who might  have lived, had
death fought single handed against  them.
   3. The number  who venture on the practice of physic, is
indefinitely greater, than those who profess to practise surge-
ry in its higher branches. This arises, in part, from the greater
number of clinical  than surgical cases; but a very different
cause, likewise  contributes to the disparity.  The opera-
tions of surgery, expose  the  ignorance of the practitioner;
and, when unskilfully performed, injure his reputation and
subject him to the penalties of the law. But in the practice
of physic, the detection of errors, by the people, is gener-
ally impracticable.  Hence many will confess their ignorance 
88                MEDICAL EDUCATION.
of the former, while  all are  ready to profess a competent
knowledge of  the latter; although, in reality, physic  re-
quires in the aggregate, more profound and varied attain-
ments than surgery.   How  important it is, then, that  the
physician should be a conscientious man, who has other mo-
tives for investigating the principles of the profession, than
the fear of having his ignorance detected and exposed!  He
should shrink  with horror  from the idea of prescribing on
false premises, or by loose and unphilosophical analogies.  He
should recollect, that human life is at stake; that a human
being, in extremity, is confided to his skill and honor; and
that an ignorant or presumptuous stroke  of his pen, may
translate that confiding fellow creature—perhaps his bosom
friend—from time to eternity, to confront him with damning
testimony on the day of final retribution.   Although such
practice is not  legally felonious, it deserves unqualified  de-
nunciation; for in a moral  view, where lies the  line of dis-
tinction, between criminal  prescriptions, and  those which
prove fatal, through the criminal ignorance of their authors?
I  say criminal ignorance, for although, in the abstract, there
is no criminality, in being unacquainted with the truth, yet,
in the practice of medicine, to be ignorant of facts and prin-
ciples, which lie within  the grasp of common  minds under
common opportunities, and still to  undertake  that, which
they, only, who are acquainted with those facts can  accom-
plish, is to forget the divine maxim of doing to others as we
would be done unto;  and, literally to wage war upon  hu-
man life; not in malice prepence towards  any individual,
but with the senseless and fatal impartiality of an epidemic
disease. 
ESSAY VI.
                Legislative Enactments.

 No one can dispute the propriety of placing Medical schools
under the supervision of the law; and rendering them amen-
able to the sovereign power of the state.   It will avail but
little, however, that they are thus authorized, if that power
does not govern them with liberality, vigilance, and wisdom.
They should be regarded, not as private but public incorpo-
rations ; designed for the benefit of society, rather than of the
individuals who compose their faculties.   A medical profes-
sorship, is  indeed  a public office; and should be  filled or
made vacant from no other motive, than the general good.
No claims for admission, but those founded on  talents  and
general fitness, should ever be allowed; and the discovery of
a failure in these, and this only, should be regarded as ajus-
tifiable ground of dismissal.   The principle of rotation in
office, should never operate to effect the removal of a com-
petent professor.
  When a State  is  about to institute a medical  college, and
subsequently,  it should have a special  regard to several
points:
  1. The location.   The proper site for such a school,  is a
populous  city.  Uncommon  talents in the professors, may
secure, for a time,, the prosperity of a school in any situa- 
90
MEDICAL EDUCATION.
tion;  but, misplaced, it is liable, like a plant in barren soil,
to perish or decay, when committed to unskilful or indolent
keeping.
  2. The endowment.   Some kind of  revenue, or an actual
appropriation of adequate amount, should always accompany
the charter;  not as a bonus to professors, but to afford  them
the means of research and illustration.
  3. A hospital.  This should be as ample as possible, and
so planned and regulated,  as to be made a clinical school,
and a school of morbid anatomy.   The rights and duties of
the professors and  pupils,  should be clearly specified; and
both made so comprehensive, as to secure for the sick, the
best possible  attendance; while they, in turn, should repay
society  and  the profession, for the charity they receive, by
the benefits which their cases can be made to confer on the
pupils.
  4.  The supplies  for the anatomical hall.   Exhumation
should be prohibited, under the severest penalties, rigorous-
ly enforced;  bnt all who are found dead in the streets or
fields, or who die in hospitals, poor houses, houses of correc-
tion,jails and penitentiaries, and are not claimed by friends,
and taken away, to be interred at their own expense, should
be delivered  to the professors of the college.  This would
abolish the practice of  disinterment, which, otherwise, must
and will continue, until other sources of supply are opened.
The opposing demands and denunciations of society, on this
subject, indicate that the present is, indeed, but the age of
transition from a lower to a higher grade of civilization.
Society, in  former times,  did not require anatomical knowl-
edge, in those to whom it entrusted the limbs' and lives of
its members:  at a future period, it will afford  to its medical
guardians, the means of acquiring the knowledge it demands.
  5. The Trustees.  These should be chosen for  their qual-
ifications.  They should  not only be men of talents, intelli-
gence and literature; but, from taste, inclined  to devote
themselves to  a faithful execution of  their stewardship.
Above all, they should be men of honor and  impartiality— 
MEDICAL EDUCATION.
91
tolerating in their hearts neither prejudice nor preposses-
sion—and conducting the institution with a sole view to the
public good.  A part of them should be physicians, but not
of the city in which the college is established, lest collisions
in professional  business, between them and  the professors,
should disturb the harmony of the institution.
  6. The accountability of the trustees to those from whom
they derive their authority.  This should be made as rigor-
ous  as  possible.   The  trust being  strictly  eleemosynary,
should be confided to no board of trustees any longer, than
they  are found to render it beneficial to those for whom it
was granted.  Annual   detailed reports should be required
from the Board, accompanied by reports from the the Facul-
ty, and these should be submitted to the scrutiny of select and
competent committees, with instructions to investigate close-
ly, and  report impartially, on the state of the institution; all
which should finally be published, together with the new acts
of fostering or corrective legislation, which  they may have
suggested.  By these means, abuses would be detected, and
a powerful motive infused into the trustees, to act with the
skill, moderation, and justice, which befit those who should
be accountable to public opinion, as well as  the laws.
  Thus founded and governed Medical Schools,  are a bless-
ing to mankind, and reflect the highest honor on the govern-
ments from which they  emanate.
  A state which establishes and conducts a  medical institu-
tion  on  these  principles, will  have little need, of what are
styled laws to regulate the practice of physic.  It will regu-
late and depurate itself.   If the fountain of supply be pure,
the stream will seldom be tainted, and its waters will require
but little clarification.   Should they burst forth in a turbid
condition, the work of purification will be found both expen-
sive and dificult.   More  than half the states of  the  Union,
have laws to regulate the practice of medicine; but I am by
no means convinced, that they have ever done any real good
to  the profession or society.   New-York  and Ohio have
such laws:  Virginia and Kentucky none.   It remains to be 
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MEDICAL EDUCATION.
shown whether the profession in the two former, is  more
respectable  than in the latter.   I am disposed to believe it
is not.  Laws which admit to the practifce of medicine, those
who have not graduated, give many young men a passport to
the confidence of the public, who do not deserve that confi-
dence;  and  could  not easily have  acquired it without a
license.  Those,  moreover, who are rejected by boards of
censors are, in most cases, sustained by society on that very
account; and  the profession is charged with sinister  views.
The rejection of a candidate for a degree, by  the Faculty
of a college, brings him into  contempt; but  the refusal  to
grant a license, secures for the applicant a portion of public
sympathy and patronage.   The reason is  not  obscure.
When all the  physicians  of a state  are  incorporated, and
boards of examiners arc appointed by ballot, a great num-
ber, inevitably, belong to the corporation, and too often to
the examining tribunals,  whom the people do not regard as
qualified; and they are, therefore, not inclined to look quiet-
ly on the rejection of a young man, not inferior, perhaps, to
those who have put a veto on his aspirations.   It is difficult,
indeed, for these bodies to establish an authority, that society
or even the profession, will recognize; and equally difficult,
for them to  maintain  internal harmony, or adhere to a
standard of uniformity in their decisions.   The  office of
censor is essentially one of rotation, and, generally, becomes
an object of ambition.  Its acquisition is often attended with
circumstances of  management, that are discreditable to the
profession; and its administration, still oftener, perhaps, so
conducted, as to offend the feelings of those, who have an im-
mediate  interest, in the admission or rejection of such candi-
dates, as  are their own pupils. Thus feuds are  generated, and
a whole  district is degraded, by reciprocal charges of mal-
feasance in office; which, whether true or false, disturb the
harmony of a profession, whose very efforts to lie still, keep
it forever agitated. At last, what is a license but a certificate
of inferiority? A licehtiate  may be a good  physician,  and
become  a great man, but still there is an original  technical 
MEDICAL EDUCATION.
93
difference between him and a graduate, which every body
recognizes; and, as far as  testimonials are concerned, he is
one, who has not made the attainments, which entitle him to
a doctorate.  Too many, however, who are thus admitted,
and, legally, become members of the profession, rely on the
hope, that the mode of their  introduction, will be at length
forgotten; and never  afterwards, seek to qualify themselves
for those university honors, to which otherwise they would
have aspired.
   On the whole, I am convinced, that a state should acknowl-
edge none as members of the  profession, who have not grad-
uated; unless it could' not have a medical school, and was so
remote and insulated,  as not to receive an adequate supply of
educated  physicians.   To establish a school, and  then  to
admit into the profession,  by legal enactments,  those  who
have not availed themselves of its advantages, is inconsistent,
and playing at cross purposes.
  At the same time, I would not enact penalties against those
who choose to practice without a diploma;  for such laws are
never carried into effect, and, especially, are opposed by the
people; who often sustain a man, when thus persecuted, as
they call it, who would, otherwise, have made but little
progress in society.   For all practical purposes, it would be
sufficient, not to allow him to appear in  courts of justice, for
the collection of his professional earnings, on the sole ground,
that he could not show a diploma from an authorized univer-
sity.
   The profession of the Apothecary, should  receive atten-
tion from our legislatures.  The practice of keeping and
putting up their own  medicines, Is going rapidly out of.fash-
ion, among the physicians of all the cities and larger towns
of the Union.   In consequence of this,  the compounding of
prescriptions,  is  passing from  students of medicine, to the
clerks and shop keepers of druggists, most of whom, as well
as their operatives, are mere merchants, almost entirely  ig-
norant of the branches of science  connected with the busi-
                          M 
94
MEDICAL EDUCATION.
ness which they follow;  and equally destitute of classical
learning.
  They who put up physicians' prescriptions, should be ac-
quainted with  Botany,  Materia Medica, Chemistry, and
Pharmacy, and possess such a knowledge of the Latin lan-
guage, as would enable them to decipher, with correctness,
what is sent to them.  If ignorant in these respects, they are,
perpetually, liable to make mistakes, which may defeat the
objects of the physician, and even destroy the  life of the
patient.
  The law should, indeed, not only require apothecaries,
who undertake to compound the recipies of  the profession,
to be qualified, foi that nice and important duty; but, also,
to file and preserve the manuscripts sent to them, that a prop-
er responsibility may be established, and the blame of errors,
by which  the sick, may be seriously  injured, fixed on those
who commit them.  Without this  skill and precaution, the
lives of patients are in perpetual jeopardy.
  I shall close, with a reference to the law,of patents. The
practice of granting patents for nostrums' and panaceas, is
discreditable to the  age.  It originated in a period, when
medicine was far from its  present state of improvement; and
the science of legislation, correspondingly, imperfect.  The
day has arrived, when juster views should prevail.  A chem-
ist may, with propriety, receive a patent for the discovery
or invention of a new compound, but not for its administra-
tion to the sick".  He  might, for example, prepare  sulphate
of morphia, from a cheaper article than opium, and by in-
creasing the quantity, diminish the price to the consumers,
and should be rewarded by a patent; but if he asked for an
exclusive right, to administer some preparation of that medi-
cine in certain  diseases,  it should not be given;  because,
such an administration could not benefit the public, the ul-
timate object of every exclusive grant.   It will be acknow-
ledged by the profession, that no article of the Materia Med-
ica is beneficial, or even  safe, in every case of the disease, 
                   MEDICAL EDUCATION.                95
                                            •
 for which it is generally used.  To be successful it must be
adapted to the actual condition of the patients system, and
this can only be known to a competent  observer.  A patent
remedy, is therefore, an absurdity,  and too often a slow
poison.
   It may be said, however, that empyricism would palm its
nostrums on the credulous, if th'ey were not patented.  This
is  true;  but it is equally true, that patents are most authen-
tic passports to the confidence  of  the people;  which is well
understood by those who prepare quack medicines, and con-
stitutes  the chief motive for applying to the  patent office;
although the alledged reason maybe, to prevent counterfeits.
Hence the law promotes imposition on the ignorant, whom,
in fact, it ought to protect.   It is, therefore, prejudicial to
society, and should  be repealed.  To this end, our medical
colleges and  societies, ought to unite in memorializing the
general government. A joint and earnest effort, could scarcely
fail; and whether successful  or unsuccessful would reflect
credit on  the American Profession. 
                      ESSAY VII.

                 Professional Quarrels.

  The members of every vocation, have their peculiar rela-
tions, from the proper maintenance of which, results much of
their happiness, as well as the dignity and  influence, of  the
body which  they compose.   The causes which disturb  the
harmony of those, who, in the same place, are engaged in a
common  pursuit, must, of course, vary according to the na-
ture of the pursuit, and are far more operative in some call-
ings than others.
  The disputes and quarrels of the medical profession, have
been  thought disproportionately great; but their number, I
am inclined  to think, has  been overrated.  The quarrels of
the members of other professions (except the clerical,) are less
connected with the domestic and social relations, than those
of medical men, and therefore pass by comparatively unno-
ticed.
  But if the collisions of the profession, are more frequent and
bitter, than those of other casts of society, it may be safely
affirmed, that the causes which  originate them, are more
numerous.   This fact is, however, not always borne in mind,
or even perceived; and,  hence an undeserved  odium, has
been  sometimes thrown  upon physicians, by  shallow  and
cynical observers.  As far  as the dread  of sarcasm, may 
MEDICAL EDUCATION.
97
tend to counteract the causes of discord, which are inherent
 to the profession, it does good; but the motives of those who
 utter it, do not always correct themselves with this ameliora-
 tion.  Physicians, of course, are, naturally,  as  pacific  and
 quiet, as any other equal  number of men in society; since
 they were apprenticed to the medical profession, without any
 regard to their temper and social propensities.   I propose,
 briefly to lay open some of the causes, which  generate differ-
 ences and discord in  the profession, as I have  either observed
 or felt their operation.
   1. Rivalship  is a predisposing cause, (and sometimes the
 only one,) of much collision among physicians and surgeons.
 We observe the operation of this principle, in every depart-
 ment of society.  It constitutes the main spring of enterprise,
 in all branches of industry, in commerce, in the  army and
 navy, at the bar, and even shows itself in the  pulpit.  But
 no where, are its influences so likely to disturb the harmony
 of the rivals, as in medicine; because almost every where else,
 it is  restrained  by appropriate  checks.  The  parties, for
 example, may have but little personal intercourse with  each
 Other, may move in  distinct  orbits, derive advantage  from
 associated efforts, be overruled by a superior power, or the
 people may be competent  judges of the articles  they  pro-
 duce, or the services they render.  But little of all of which,
 is true of physicians.
   2. Envy,  a passion which prevails  in all  ranks of socie-
 ty, is not less operative in the medical  profession, than  else-
 where; and originates  not a few of the personal disputes
 which agitate it.  In many cases that might be cited, this
 feeling may be energetic, without breeding actual collisions.
 The judgment of the  community may be  so  correct and
 decisive, as  to repress its  workings; or the  unequal rivals,
 may be too  remote for personal  controversy; or the distinc-
 tion to which they  aspire,  like  that of poets  and philoso-
 phers, may  not connect itself with practical operations, or
 increase of  foitune.   But the profession has not the advan-
 tage of any of this  countervailing influences;  for its  rival 
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MEDICAL EDUCATION.
 members are contiguous, they labour in a common field, and
 acquire wealth in proportion to their popularity.  Disparity
 of success, when there was  original equality of pretension,
 begets arrogance in one, and suspicion, dislike and irritation
 in the other; while both may, in fact, be honorable, and, in
 reference to all the world beside, peaceable men.  Envy is
 emulation in disease, and where the causes of this state are
 most active, the morbid effects will of course be most con-
 spicuous.
    3.   Differences of opinion, on  the principles of  the
 profession, lejid  to many of the personal antipathies and con-
 troversies  which disturb  the  profession;  and, to a greater
 or less extent, involve the feelings of society.   This results,
 from the ultimate practical tendency, of every professional
 speculation.  If the theories in medicine, did not influence
 its practice, and, by that means, the business of its practi-
 tioners, conflicting opinions as to the seats, causes and treat-
 ment of diseases, would no more excite  personal altercation,
 than disputes on  the materiality of light, or the Eleusinian
 mysteries.  As every medical theory, is to stand or fall, by the
 test of experiment, the opposing partisans, naturally magnify
 their own, and  depreciate each others success; which of
 course leads to  reciprocal  charges of misrepresentation;
 and the conflict of opinion, cannot be long maintained, with-
 out engendering personal animosities.   From this cause, the
 quiet, even of great cities, has often been and will, hereafter,
 be disturbed, until  the  science of medicine  has acquired
 fixed principles,  in some  remote future era.
   4. The establishment of medical schools is a prolific source
 of discord in the profession.   In this there is nothing remark-
 able.  When a faculty is to be made up, there are in general
 many candidates, and of course many disappointed  men;
 who harbour a  secret feeling of dislike, towards  the  suc-
cessful aspirants.  Moreover, there are  at the present  time,
 nearly a hundred  medical professors in the  United States,
and at least a thousand physicians, who in their own and the
opinion of their friends, are as well, or better qualified, to fill 
MEDICAL EDUCATION.
99
 professorial  chairs, as the existing  incumbents.   These two
 great classes, of course, stand in a relation to  each other,
 which  predisposes them to hostility.   Such is the  law of
 human nature; and we see it as strikingly exemplified, in
 political as in medical pursuits.  If the professors, withdrew
 from practice, on being appointed, they would be viewed
 with very different feelings, by their brethren.  But a profes-
 sorship, is a passport  to business; and the  increase that fol-
 lows an appointment, is of course  at the  expense of those
 who surround the school;  an effect, under which, although
 pride or prudence may keep them  quiet, they cannot be
 expected to cherish the most friendly or pacific sentiments.
   5.  The people themselves occasion not a few of the jealous-
 ies and strifes of medical men.   Almost every family has its
 physician, who is generally, pronounced to be more skilful,
 or courteous, or attentive, than the man in whom its neigh-
 bour confides.   This comparative  praise, seldom fails to
 reach the  ear,of him, who is thus depreciated; and, by a
 natural association of ideas, he connects  the  idol  of the
 family with the idolators; aid comes to dislike  the person,
 whom he thinks unjustly elevated at his expense.  But still
 worse,  the enthusiast admirers of a particular physician,
 will often collect and circulate petty scandal, and sometimes
 actual falsehoods,  on a rival of their favourite; to which he
 will give  the  countenance which results from silence, when
 he shouldj in fact,  be the first to step forth in the defence of
 him, who  is thus assailed.   Professional fame, is the capital
 of a physician, and he must not suffer it to be  purloined,
 even should its defence involve him in quarrels.
   6. As neighboring  physicians  practice,  indiscriminately,
throughout the same community,  many occasions for misun-
 derstanding or actual hostility, will  necessarily arise.  They
are in perpetual  competition,  and every thing which main-
 tains the contest is personal; its immediate  object is public
favour, its  remote, the acquisition of property.   What  one
gives, is taken from another; and although the gainer may be
honorable, which is not always the cas#, the loser is not, on 
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MEDICAL EDUCATION.
that account, always reconciled to the loss.   He looks with
some degree of invidiousncss, on the man who has supplant-
ed him; and is prone to believe, that  the change has been
brought about by unfair means.  This is, indeed, sometimes
the case, though not so often, perhaps, as has been supposed;
for  many persons are capricious, and change from physician
to physician, through mere love of  novelty.
   7. Undercharging, is a source of personal difficulty among
physicians.  Underselling in trade, is far from producing the
same effect; because one involves  services and immaterial
capital—the other commodities and  material capital.   When
a merchant or manufacturer, sells goods for  less than cost,
he sustains an actual injury "of capital,  which, persevered in,
may ruin him,and here is a check; or,his competitors may,
for  a time, sell still lower,and thus bring him to terms; after
which they may all proceed together, on sound principles.
But when a  physician  charges less than the customary fees
of the place in which he lives, he does not exhaust his capi-
tal; and, generally,  augments the  demand  for his services,
till  he more than compensate^the  reduction of price.  In
this proceeding, he cannot be  met  by his  more reputable
brethren; because the  public sentiment of  the profession,
does not tolerate such, debasing competition; nor,  if they
once reduced their fees, could they afterwards, without dif-
ficulty,  raise them to the proper standard.   Hence it is not
strange,  that  this sinister  mode of  acquiring popularity,
should be frowned upon by those, to whom nature has denied
the  disposition  to adopt it, and that  personal difference,
should, therefore, be the consequences.
  8. Quackery of other kinds, not unfrequently disturbs the
repose of the profession.  Its members are so numerous, that
among them  there must always be  some, who are  willing to
recommend themselves, by the arts of charlatanerie; the in-
fluence of which on many persons, is irresistable.   It is the
duty of the honorable members of the profession, to  expose
and condemn such impostures.   But this is never done, with-
out exciting strife and trumoil;  in which the people com amorc 
MEDICAL EDUCATION.
101
 seldom fail to participate on the side of those who have im-
 posed upon them-
    9. When  a physician is sick or absent, another is of ne-
 cessity called in by his patients, if they need advice.   This
 often leads to heart burnings,  and sometimes to open  ani-
 mosities.  He who  is  summoned to this vicarious function,
 may  aim at retaining himself permanently in the place of the
 other, and practice extraordinary assiduities to effect his ob-
 ject.   If he succeed, the means of his success will generally
 be found out, by him who is superseded; and the effect of
 such  a discovery is obvious.  But even when the new prefer-
 ence, is not the offspring of unfair dealing on the part of the
 person preferred, the other is apt to feel  it unpleasantly: and
 to manifest his feelings  by reserve or coolness of deportment.
 If this be unmerited, it will be resented; and  both  parties,
 at length, come to a hostile attitude.
    10. Consultations are  copious sources of personal  diffi-
 culty in  the  profession.   I have already  alluded  to  this
 subject, in speaking of a defective  love of truth.  Great
 reliance is, generally, placed by the patient, or his friends, on
 the consulting physician, because the other is presumed to
 have exhausted his skill.   Should the patient die, it is often
 supposed, that  he might  have  lived,  if the consultation
 had been held earlier.  Thus the  consulting- physician, has
 nothing to lose, and much  to gain.   I have more than  once
 known the recovery of  the patient ascribed to his interpo-
 sition; when, in reality, the gentleman  called in, proposed
 nothing,  but concurred, in  the new suggestions of the attend-
 ing physician, and from this have arisen animosities.  The
consulting physician, moreover, is often questioned, apart from
 the other, on the past treatment and the probable issue of the
 case; when, if deficient in honor, he is apt to say,  or  look
 or insinuate, such things, as he  knows will operate  to the
 injury of his colleague; who of course resents the insidious
 attack on his character should he discover it.   Other difficult-
 ies still, are connected with consultations.   The principles
 of the treatment must be  discussed; but this may end in
 controversy instead of  conror*.   There is, then, no ovcrru-
                     N 
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MEDICAL EDUCATION.
ling power, as, in the other learned professions.  Divines can
appeal to the 'law and the testimony,' and members of the
Bar are silenced into acquiescence by theaulhority,ifnot the
wisdom, of the judge; but  physicians are without the bene-
fit of such a tribunal, to reconcile their jarring opinions,
and are liable to irritate each  other  into perseverance and
obstinacy.
   I have,  thus,  enumerated  some  of  the   causes  which
generate medical quarrels.  It will be admitted, from  the
specimens given, that the number is great; and that it is not
without reasons  connected  with  the  offices and economy of
the profession, that its members are so  often  embroiled.
This  altercation is deprecated and condemned by  society;
but its effects, upon the whole, are beneficial, because most
of it originates in the resistance of  the  good, against  the
arts and encroachments of the  bad; the most efficient means
of maintaining the purity of the profession.   After all  that I
have  experienced,  observed,  and thought,  of the differ-
ences among medical  men, I am unable to perceive,in what
respect they seriously degrade the profession, or injure soci-
ety.  .If the principles and rules of practice in medicine and
surgery, were fixed, and there was no room  for diversity of
method in their application;  and, if the members of  the
profession, were all men of honor, and gentlemen  in their
deportment, there would be little occasion for disputes, and
much discredit in their occurrence.  But until these causes
of controversy are obviated, its consequences are preferable
to the effects,  that  would follow its forcible suppression.
Where there is no impassioned discussion of medical opinions,
there will be no active spirit of medical inquiry; and, if the
honorable members of the profession,  should  submit quietly
to the tricks of the dishonorable, they  would soon be involved
in a common disgrace.  It  is not the quarrels of the profes-
sion, but the causes which  originate  them,  that throw  dis-
credit upon it.   Society is not disgraced, when the vigilance
of its police, enables it to apprehend and   punish a great
number of culprits; although a deeper agitation may altend 
MEDICAL EDUCATION.
10J
such an  administration of justice,  than one which would
suffer  bad man to go  at large, and continue their works of
wickedness.
  It is said, that the quarrels of medical men interfere with
their consultations, and often deprive individuals in society,
of the advantage of uniting in the treatment of their diseases,
those in whom they place the greatest confidence.   This, it
is true, may sometimes happen; but the number of such cases,
has, I think, been  estimated  too high; and, in general, it is
possible,  to arrive at the desired result, by other selections.
  It is a current opinion,  that  physicians, when  required,
should consult together,  whatever may  be their private
animosities, and the practice of the members of the Bar is
cited  in  support  of the  position.    But  the cases  are
not  analagous;  for  the circumstances  in  which a suit at
law is prosecuted, are entirely different from those  under
which  the treatment of a clinical case is conducted.  Ju-
dicial  proceedings are regulated by  fixed  precepts;  the
course to be pursued is dictated in the  books of precedents
and statutes; the doings of the party are in open court;  all
the advocates are  sworn to be true to their common client,
who knows the amount which they, respectively,  perform;
each may occupy himself on a particular branch of the sub-
ject; and every thing is controuled by the Bench.   On the
other hand, in clinical  consultations, there is no impartial,
upright and intelligent, presiding power; the deliberations are
private and the greatest possible latitude exists, for the  re-
ciprocal, insidious indulgence of personal feeling; those who
know how much the judgements of men are liable  to  be
biased by these circumstances, will have least confidence in
the results, of such consultations.  To believe, that  two or
more physicians, who  hate and despise each other, will, I
should rather say, can, act towards, and  view  each others
opinions, at the bed  side of the sick, in that spirit of can-
dour,  which is  necessary to a  proper  investigation of the
means of cure, indicates but a superficial view of the human
mind.  I should be unwilling, either as physician or patient, to 
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MEDICAL EDUCATION.
 belong to such a consultation.  Animositicr, it is true, arc sur-
 rendered up,and a joint effort heartily made, when our oim
 lives are menaced by a common danger; but I have yet to
 learn, that the welfare of others, can effect the same triumph
 of the will and judgment, over the passions.   Such of the
 parties, as are conscientious, will, of course,desire to act can-
 didly, when forced into these gladiatorial circles; but habit-
 ual  and inveterate  hostility  of feeling, is  not likely to be
 reduced to instant subjugation, either by the  mandates of
 wealth, or the claims of suffering humanity.  All  this may
 be wrong, but  it is  real;  and as  true of other men as
 physicians.  They who would surround  themselves, in sick-
 ness, with medica] gentlemen,  who are  unfriendly to each
 other, should labor, while in health, to reconcile them; instead
 of becoming partisans, as too often happens.  On the whole,
 it is  not proper  for physicians to be enemies to each other;
but being such, it is still more  improper for them to under-
take, conjointly, that which  personal  enmity can  scarcely
fail to render unavailing, if not  prejudicial to human life.
FINIS. 
 
 
M^oL. Hist,

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