INTRODUCTORY LECTURE 
DELIVERED BY D. WARREN BRICKELL, M. D. PROFESSOR OF OBSTETRICS, N. 0. SCHOOL OF MEDICINE, 
NOVEMBER 3, 1857. 
$uUijsf)tlr i>8 Jatqiujst of tTj * &lzgs. 
NEW ORLEANS: PRINTED AT TUB BULLETIN OFFICE, 35 AND 37 QBATIBE 9TKEET. 
1857. 


1857 J 


INTRODUCTORY LECTURE. 
Gentlemen—I have been chosen by my colleagues to welcome you to these halls, and to deliver the Introductory Lecture of this, our second session. The first named duty, I feel that I know how to perform, though I fail to find words with which to express the greeting we cordially extend you this day. It must be sufficient for you to know, that each one of you stands forth in our estimation as a great centre, on which is heaped all that we have of ambition, hope and energy; and from which must radiate the history of our failure or our success. 
We welcome you, then, in the name of the science and art you are about to cultivate; we welcome you as the prompt patrons of honorable private enterprise to effect a great good; we welcome you as friends; we welcome you to these halls, and we extend you the unspeakable welcome of our firesides: we welcome you as students of medicine, and we welcome you as Christian strangers in a Christian strange land : give me but words, and I will speak your welcome; but, barren of them as I am, I can only hope that you will believe that our hearts are now throbbing only joyous welcomes as you lavish on us your sympathy and your favor. 
And now to the performance of the second duty. Contrary to the established rule amongst the Medical Colleges of this country, we have determined to have but one introductory lecture at the beginning of each term; but you will find this to be one of the minor innovations only which we have adopted. We think it a duty which we owe you, to economise your 


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time, and we know by experience that the week usually devoted to introductory lectures is just one week lost to the student of medicine. 
I very much doubt my ability to interest you this morning, for I fear you have assembled here to be really refreshed after the fatigue of your long journeys. I have never had much taste for gaudy declamation, and I never stopped in my journey thus far through life to gather a bouquet from the parterre of rhetoric. I like to bask in the rays of poetic fire, to gaze on the beautiful, and to loiter on the strains of joyous music; but I am neither poet, painter nor musician. You will, consequently, have to submit philosophically to a plain, unvarnished account of the institution to which you are now attaching yourselves. This seems to me a most fit occasion on which to speak of, not only what our institution is, but of what she hopes to be: we have initiated a great and important enterprise, and it is meet that you and the world should know the basis on which we stand—the soil in which we have planted ourselves. 
And here, gentlemen, I am irresistibly led to ask, what it is that you really seek at our hands ? Why is it that we find this building, whose walls still ring under the plasterer's trowel, thus filled with those whose footsteps were wont to point northward and westward— anywhere but in I the direction of our great Southern metropolis ? Why is it that you come : to us, on some of whom the reproof of youth has been heaped, because of our so-called temerity ? What is there more alluring about our temple, that you seek shelter here ? Where did you, who are " first course students," hear of us 1 and why do you, who are " second course students," turn from your old gods and seek to worship new ones ? Gentlemen, the one great answer to all these questions is written in letters of living light on each and every brow before me. We are the humble, yet zealous pioneers in medical progress and reform, and we have stepped forth at a time when the atmosphere which surrounded us was polluted by dull doubt and sickly trepidation, to lend our united and unstinted efforts to the proper development of the very best natural resources in our land. For years and years New Orleans has presented a field for medical inquiry and instruction, totally unrivalled in our country, and yet this field has to a great extent lain a barren waste, because competition was not known here, and doubts and fears continually haunted the brains of men who did sometimes dream of change. The city which should have been attracting its thousand students annually, was being outstripped in the great race amongst Southern Medical Colleges. In five short years energy and industry had attracted to the inland city of Nashville over three hundred students (a number 


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unknown to New Orleans until we opened the doors of this institution), and this despite the very best natural resources known to our country. Instead of New Orleans, with its great Charity Hospital, its superabundance of anatomical material, and its liberal laws which permit the freest use of these great privileges, being the medical metropolis of the South— if not of our whole country—she was fast becoming a fifth-rate point in the estimation of our youth. Louisville was ahead of her; Charleston had surpassed her; Augusta had rivalled her; and now Nashville had left them all in the distance. 
It was in this hour that we stepped forth armed for the redemption of our city, as well as to strike for the cause of medical progress and reform throughout our land; and your presence here to-day is but the loud and cheering echo to our call for troops to fight our way to victory. 
But little more than eighteen months ago the spot on which we now stand was a barren lot of ground, an eyesore to the community, and considered comparatively worthless on account of its contiguity to a great Hospital. Now, there rears its proud head a noble edifice, which not only pleases the eye of the passer, because it is ornamental, but which elicits the admiration of the philanthropist, because of its acknowledged utility. Here, where but a few short months ago rank and noisome weeds monopolized the soil, and merry frogs sent forth their nightly serenade to the inmates of yon vast sick-house, we now find not only a rich profusion of all the regalia with which science is wont to clothe herself, but we also find a fit shelter for her gear, and halls on halls for the liberal reception of all the captives she may make when she walks forth over the land to war against ignorance. 
What has worked this wondrous change ? What could have worked so entire a transformation, save energy, industry and determination? Not energy, industry and determination to work a ruin, and then rise on the spoils; but a firm and unflinching purpose to carry out a useful project, through the legitimate and wide channels so liberally furnished by a wise Providence. I take it that every man was born to serve some useful purpose. If it be true that the minutest animalcule serves some important end in the great plan of the universe, can it be philosophical, or even morally right, for the most obscure individual in a civilized community to cower under the causes of his obscurity, and say that he forms no part of the machinery of this great world ? No; it is this very consciousness, that utility lies at the bottom of our existence, that engenders within us 


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that God-like attribute called ambition, without which man is never the full measure of his nature. 
We tell you, then, that energy, industry and determination, all backed by an irrepressible ambition to be useful in our day and generation—these are the levers which have lifted the New Orleans School of Medicine into an already enviable existence; and while we are permitted to labor in the vast and fertile field before us—while the genius of Liberty hovers o'er our land and permits man to be ambitious—we hope tojceep a jealous eye to these attributes, believing, as we do, that they are alike indispensable to permanent success and honorable to all who cultivate them. 
The spirit in which this Institution was conceived can never appear objectionable in the eye of the most fastidious, and the whole plan through which we are laboring to effect her permanent establishment will, we feel assured, stand the test of the most jealous scrutiny. While the spirit of the age seems to be to establish medical schools with the single object of making money —as is evinced in the location of such institutions where few or none of the necessary natural advantages exist; by diminishing, rather than increasing, the number of professors; by diminishing the price of tickets, or by even giving them away—while such seems to have been the mania of the day, and while open rebellion against the highest medical tribunal of the land was being more and more seriously threatened, we have come forth, not to pour oil on the troubled waters, but to raise a beacon light, which shall guide the distressed into a haven of safety. 
For ten long years, the medical profession of this country, through all the legitimate channels from which its voice could be heard, ha» been complaining of various obvious causes which tend to degrade us, among which stands most prominent the subject of deficiency in the system of medical education. I will not attempt here to review the history of this decade, but I desire to impress on your minds the fact, that tacit and effectual resistance, on the part of the schools, to the urgently expressed will of the mass of the profession (a will expressed through their numerous representatives in the American Medical Association) has been so unrelentingly carried on, that the popular voice has been almost completely stifled, and the best friends of Medicine have almost yielded in despair. Instead of our great National Council of the People being the tribunal to which all should look with profound respect, and whose reasonable will should command the obedience of all who are there represented, we have witnessed the strange spectacle of a minority representation of the schools 


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fraternizing with the people at their annual meetings, cajoling them out of all the posts of honor and distinction, swearing under the same code of ethics, and the same constitution, and yet resisting to the bitter end the expressed will of the Association on the subject of deepest interest to us all; until, at the last meeting, a professor in a medical school has the temerity to rise and offer a resolution to the effect, that the American Medical Association has no power to control the subject of Medical Education ! 
In other words, and in plain language, gentlemen, the people of the profession in this country have seen grievous evils existing in our ranks; professors in medical schools acquiesced in the belief of their existence; then people and professors got together, under the aagis of one code of ethics and one constitution, and sent forth to the world the balm for the frightful wounds under which we labored; the schools acknowleged to the people the necessity for reform in their system of instruction, and they were called on to institute it. Have they ever done it ? No. Do I exaggerate ? Then search the records of the past for my vindication from the charge. I only find language too feeble to express my astonishment at the humiliating condition into which we have fallen. 
It is at a time like this that the Faculty of the New Orleans School of Medicine united themselves into one little band, and resolved to enter the field in defense of the popular will, in defense of natural right, in defense of time-honored Science, in defense of Progress and Reform ! What if we should fail ? Is it not better to die martyrs in the cause of good, than to live writhing under the never-satiated sting of evil seated on a throne attained by usurpation 1 Who would not sooner fail in endeavoring to do his whole duty, than live in slothful obscurity, or go all his life staggering along through the mephitic atmosphere of evil piled on evil ? But, like Richelieu, we know no such word as fail. The New Orleans School of Medicine has come forward to adopt and carry out to their fullest meaning and intent all the recommendations of the American Medical Association for the improvement of the system of medical education ; and such is her confidence in the constituents of the popular and legitimate majority of that Association, she does not think it possible to fail. 
We come not, as did one or two schools some years ago, to make half-way concessions to the popular will, and merely to lengthen our lecture term, to see how it will answer, and this at a time when the Association is most popular; but we come at a time when despair has seized the best 


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friends of Medicine; we come at a time when all hope of reform has fled, and we come pledging ourselves to fulfill the entire scheme of lengthening our lecture term, dividing the labors amongst a greater number of teachers, and then practically demonstrating the subjects taught, so that our graduates shall go forth ready to recognize and treat disease, and not merely instilled with the theories of our Art and Science. We ask of you whether we are to fail in such a holy enterprise as this ? Nor should we question you thus. Your appearance here to-day is the ever-living answer, no.' 
In the best of all books, gentlemen, we are told that St. Andrew, one of the followers of our Saviour, when threatened with crucifixion for preaching the Gospel, boldly told his accusers, that he would not have preached the glory of the Cross, had he feared to die on it. In the most humble spirit of comparison, permit me to tell you that we would never have enlisted in the cause of our Science, had we feared to die martyrs. No! lash us with an endless cord, transfix us with a thousand nails ; so that we be lashed and nailed to the great Tree of Science, we know no pain, and our joy is complete. No murmur shall pass our lips to mar the gentle requiem of wind and bough and leaf, as they mingle in sweetest concord o'er our glorious place of rest. 
Pardon a digression here, gentlemen. Even before our long summer season permitted you to cheer us with your presence, we had had the seal of success indelibly stamped on our banner by the noble little band which rallied around us in the commencement of our career. Every American patriot must have fully impressed on his heart the " spirit of ; 76." That was an era in the history of our country to which every heart reverts with throbs of pride too high, too holy to be expressed in words, and the very school boy, as, in his early mathematics, he brings the glorious figures in appropriate union, starts to the imagined strains of our " Yankee Doodle" or our " Hail Columbia." To us all there is a charm unspeakable in these two symbols of number and of quantity, and the history of Liberty has encircled them with a halo even more grateful to our souls than the rainbow which spans the glorious sky and tells us that the storm is o'er. You will not wonder, then, if I tell you I have a strange superstition —that the loud prophecy ot success rings in my ear, because the first class of the New Orleans School of Medicine numbered precisely 76 ! 
But I have told you that we present ourselves to you as the champions of reform. Perhaps it is necessary that I should corroborate the assumption, or I may be charged with vain boasting. The American Medical 


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Aisooiation (and I would have you, once for all, remember that its voice is that of the mass of the profession) has said repeatedl y, that it is absolutely necessary to lengthen the lecture term to six months, in order that th« lecturer may be the better enabled to perform his duties, and the student to digest what he hears. We have made our term five montns, without reference to preliminary lectures—and we will extend it to six, the moment we find that we will be supported in the innovation. And is net this proposition to lengthen the term to six months the most, reasonable one in the world ? For my part, gentlemen, I confess that I am more than surprised that the four months system should ever have been a dopted j I more than wonder that it should be still pursued by teachers who have any other result at heart than the lining of their pockets, and I hardly know what to say I do think of men who will, in this enlightened age, persist in defending it. Sometimes, when I read the lucubrations of men who make you students of medicine the basis of all their arguments in favor of the system, I really ask myself whether it is possible th it I know what a student of medicine is, and if I were in the slightest digree leaning towards the belief of the polygenists, I should certainly hav< to set yo 1 down as a distinct species amongst the so-called indigenous race? of the e;irth. I am sure you do not know in what an unenviable light you are held before the world by your own loud-mouthed friends, and I wilt take this occasion to shoW you the picture that is drawn of you by artists who claim to be best acquainted with you, and most thoroughly identified with your interests. 
All those who defend the four months system frsnkly acknowledge, as a starting point in their many dissertations, that it is " preposterous, in violation of all laws of health, physical or mentalall of them shrink from any legitimate defense of it on the ground of philosophy or utility, and on your backs they pack all the blame which the world is most justly laying at their doors. Gentlemen, they tell us that you are so far inferior to all other intelligent beings, that you have no just conception of the mission on which you have embarked, and that it is a little scrap of parchment you seek, and not the proudest gift to man on earth— useful knowledge 1 They tell us you cannot possibly be kept in attendance on lectures more than four months, and the latest chaste and delicate touch to the canvass, by a Western editor and professor represents—" The first end of the class leaving in their shirt sleeves, and the last with their breeches rolled up to their knees I" I give you the precise language of the author, though I freely contess that it by no means embellishes my address. 
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Is it possible, gentlemen, that this picture faithfully represents th*t portion of society known as students of medicine ? Is it possible that you who are soon to become the guardians of the public health, you who are to be looked up to for the relief of the manifold physical ills of poor humanity, you of whom society expects more than of all others besides, are so totally insensible to the importance of your mission, so entirely unconscious of the responsibility you are about to assume, that you will weigh time or money in the same scale with that knowledge at the fountain of which no life time affords opportunity to satiate even a reasonable thirst ? Can it be true, that the student of medicine alone, of all who are found walking in the paths of science, contents himself with learning the mere alphabet of his future vocation ? Gentlemen, if there be one amongst you who has come here this season in the spirit indicated by the Western artist just quoted, let him ponder well one thing, and if his soul be not dead to all those emotions which go to make up the real man, then he must pause in his reckless career. Remember, that he who doles out stingily his time or his money here, does it at the heavy cost of hundreds, or may be thousands, of his suffering fellow beings who may hereafter throw themselves on him for relief; while he who liberally spends both now, in the acquirement of knowledge, does it at his own cost only. Let any man who thinks he can strike a parallel between the two withhold his name from our matriculation list, for he can never help us to that goal whither our ambition now leads us. 
To show you the utter absurdity of the four months' system, and to prove to you that the North American Medico-Chirurgical Review was right (though inconsistent) when it proclaimed that it was "preposterous, in violation of all laws of health, physical or mental," I will mention here, that we have in this city a Law School attached to the University of Louisiana ; in it there are but four professorships; yet there is but one lecture daily, and these lectures are continued during five months I Now, tell me whether the amount of knowledge requisite for these law students will at all compare with that which every one of you possessed of a conscience must feel that you require. And tell me, too, whether the esprit clu corps, the ambition, of those students of law transcends your own. Are you willing to admit, that you will suffer by the comparison ? 
Gentlemen, all effects are preceded by causes, and it is a beautiful, though often too profound study to start at the one, and work back, step by step, through the labyrinths of thought, to the other; but there are 


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instances in which no such labor is required; we see light, and we see as quiokly the sun which produces it. In the case before us, the sun is not more palpably the cause of light, than is the four months' system of stuffing and cramming the cause of the premature withdrawal of the student from the lecture room and the hospital. I assume that it is impossible for the proper pursuit of the alluring study of Medicine to pall the intellectual appetite, and it must be the " preposterous " system under consideration which drives the Student from the school. The mind of the Student becomes wearied; it is absolutely prostrated by the unceasing labor to which it is subjected, and it is nauseated by the very superabundance of the food spread before it. 
The American Medical Association has, also, insisted that a greater amount of hospital instruction is indispensable to the Student of Medicine. This has been the point more strenuously urged, perhaps, than any other; we think it more than reasonable; we have adopted their views, and we are willing to leave the decision even to our enemies (if we have any), whether we do not afford greater advantages to our pupils in this respect, than any other School in the land. Six, out of ten, of us give daily bed-side instruction in the great Charity Hospital, and the remaining members give tri-weekly dispensary clinics at our Free Dispensary under this roof, where an average of one hundred patients a week present themselves for treatment. Indeed, such is the proximity of the Charity Hospital, that all our patients, numbering hundreds, are right here at our very door, and our pupils do not have to travel miles, or even cross rivers, in their visits to the sick. 
Does any other School in the land do this '( We desire to draw no invidious distinctions, but we have assumed a virtue, and it is our privilege, our right—or our duty, if you will, to prove that we have it, by all the strength of truth. And yet I will not compare our Institution to those around us, and which may be considered our honorable rivals; but we will travel far from home, and dare a comparison with Schools located in the so-called l< Medical Metropolis " of our country. We will go with you to Philadelphia, the hitherto fashionable resort of Southern Students, and we will have the boldness to place ourselves beside the time-honored University of Pennsylvania, and the gigantic Jefferson. Surely these Institutions will not object to the comparison. The classes of these two Schools amount, in the aggregate, to at least nine hundred pupils. What are their facilities for Hospital instruction ? Every man who has ever pursued the 


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study of Medicine in Philadelphia, knows that the old Pennsylvania Hospital is the grand rallying point—it is the all in all of our Philadelphia brethren, in the way of " hospital advantages." Yet, who docs not know that the Pennsylvania is, and always has been, in the hands of the friends of the University, whose Faculty control the clinical advantages, and that the " ticket" furnished gratuitously to Students of other Schools is a mere nominal privilege ? I quote from the late announcements of the University a nd the JelFerson to prove that in Philadelphia, so far from the Student's being afforded facilities for daily bed-side instruction—the very best he can possibly seek —he goes but twice a week to the Pennsylvania Hospital, and there seats himself in a crowded amphitheatre—a room not capable of holding more than one-fourth of the Students who flock to that city—to listen to abstract lectures on patients who are brought into the room, it is true, but on whom the sense of sight alone can possibly be brought to bear. The University announcement says: 
" The Professor of the Theory and Practice of Medicine, whilst conducting the Course in the University, also lectures, twice a week, on Clinical Medicine in the Pennsylvania Hospital, during his term of service as Senior Physician to this Institution. 
" The Surgeons of this Hospital perform similar valuable Clinical service in connection with the branch of Clinical Surgery." 
The Jefferson announcement says: " The hours of attendance at the Clinic of the College are so arranged as to permit the Students to attend every Wednesday and Saturday the Clinic held at the Pennsylvania Hospital. The Course adopted in that Clinic is the same as at the Clin: c of the College. With so large a class in attendance, it is impracticable to visit the sick from be 1 to bed, and hence, on the days named, the patients are brought into the amphitheatre, and there treated and lectured on." 
So that, in the v inter season, when twelve hundred Students are collected in Philadelphia—hundreds of them from the South—amphitheatre Clinics, twice a wee*, at the College and in the Pennsylvania Hospital, constitute the much vaunted " Clinical advantages" of the " Medical Metropolis" of our Country ! There are no opportunities for studying disease at the bed-si le, except in the summer, and we all know how few of the twelve hundred are to be found there after the lectures close in the spring. 
But what a very farce is this system of amphitheatre Clinics, when compared to daily bed-side observation of disease ! It is all well to intro- 


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duce surgical cases before Students in this way, when you intend to operate, for then it is the sight alone that is'to be brought into play, and the amphitheatre affords the best opportunity for the whole class; but to properly comprehend the true nature of the affection, even in these cases, it is necessary that the Student should have seen the patient previously in his bed. What shall we say, then, of the Clinical Lectures in Philadelphia on the Practice of Medicine ? Do they take a patient who is laboring under pneumonia, or pleurisy, or enteritis, or any of the acute and dangerous diseases—do they take him, I say, out of his bed and carry him into an amphitheatre, and there lecture on him ? Or, rather, does not every dictate of humanity, every duty which the physician owes his patient, forbid any such unwarrantable disturbance and exposure ? Or even if such patients were thus rudely served, does the Student who listens} to the lectures feel the pulse, or auscult and percuss the chest ? Does he have any opportunity of practicing the art of his profession ? Why, gentlemen, I have seen a learned professor deliver one of the most interesting lectures imaginable on the sick man, who sat by him in the amphitheatre, and then find that he had been lecturing on the wrong patient. 
The truth of the matter is, these amphitheatre clinical lectures, with the exception of their adaptation to surgical operations, and the exhibition of some of the more palpable external phenomena of chronic disease, are the medical humbugs of the age. Imagine the professor, with the cadaver before him in an amphitheatre, demonstrating the pathological condition of the organs! Or imagine him exhibiting to the class a case of cataract, or a fistula lachrymalis! Cannot a man with half an eye perceive that the system is rotten to the very core ? 
But leave the gate of the Pennsylvania Hospital, which I have shown to be utterly incapable of accommodating the crowds of students who flock to Philadelphia, and where in that city will you point me to another hospital fitted and devoted to the purposes of the student ? There is not one. The much vaunted Blockley is the only other establishment which pretends to offer any advantages. It is large and accommodates many patients, but it is at least three miles away from any school, and is across the Schuylkill river; indeed it is utterly inaccessible to the student who attends lectures. I have tried it, and I speak knowingly. 
If, then, as the Jefferson Circular says—" with so large a class in attendance, it is impracticable to visit the sick from bed to bed," and even 


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when driven to their amphitheatres for clinical instruction, we find the crowd in Philadelphia too great, what sane man will compare their advantages for clinical instruction with ours ? There they have three or four physicians and surgeons, who are all directly or indirectly connected with the University, to deliver amphitheatre clinical lectures to twelve hundred students twice a week: here we have six, out of ten, of the professors in our institution alone in possession of ten or twelve wards, with our class divided amongst them, and visiting the sick every day of the week at the bedside itself: and the lecture hours are so arranged that the student has the privilege of walking this vast sick house during 2i hours of each day, and may thus make the visit with several different professors every morning. Here there is no occasion for a rush and a squeeze : such is the praiseworthy liberality of the Hospital regulations, any and every student, who properly demeans himself, may visit any patient in advance of or after the teacher, and thus quietly and profitably pursue the investigation of disease. I do not hesitate to assert, then, that New Orleans is this day capable of affording more clinical advantages to a larger number of students than any city in the Union. It will not do for men who have never been amongst us to deny this : all they have to do is to come and look, and they will give it up. I have personally visited all the larger Northern cities, and I speak without fear of successful contradiction. 
If there be one amongst you, however, who imagines that by this comparison I desire to detract one iota from the full measure of praise universally accorded our Philadelphia brethren, let bim at once rid himself of the impression. I have not words with which to express the high estimation in which I hold the noble spirits from whom I derived my medical education : no man ever heard me utter one word derogatory to such men as Chapman, Wood, Horner, Gerhard, Norris, Meigs, and a host of others; but the day has arrived when the medical men in the South must awake to the fact that the lecture rooms of these worthy men are crowded to such an excess, that it is no longer a matter of doubt that the Southern student of medicine, who goes North, leaves behind him advantages far greater than he can possibly meet with there, and this is a sufficiently weighty argument in favor of home patronage, without reference to the even more important truism, that the student who intends to practice in the South, should be conversant with Southern diseases. 
But it has become fashionable, gentlemen, for us Southerners to be charged with " Sectionalism" the moment we open our mouths, either in 


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favor of the advantages which We know we possess, or against the suicidal course pursued by our population, of running to the North for the very things we have amongst ourselves in greater profusion and of better quality. The cry has been sounded long and loudly, and even medical men have now come under the ban. Now, I believe I am possessed of a full share of patriotism, I believe I love my whole country as fondly as an American can or should love ; and, with all the enthusiasm I may exhibit in favor of my home, I can freely declare that I have no grudge against our neighbors of the North, nor would I willingly detract one iota from the full meed of praise due them in every way; yet such is the fashionable cant of the day, I believe I shall be charged with sectionalism for the comparison I have drawn. 
But what of this ? If to love one's own home more dearly than we do our brother's; if to think the woodbine which creeps o'er the doorway of our little cottage blooms forth sweeter fragrance than all others; if to prefer our own glowing, genial Southern sun to the icy breath of Boreas; if to compare our condition with that of others, and, by the comparison, to become more content with our own ; if to exert ourselves by all honorable means to excel even our brother in cherishing and developing the resources by which we are surrounded ; in fine, if to search out the blessings which a great and a just God has showered on us, and, having found them, to labor to enjoy them ; if all this be the hated " Sectionalism," then is sectionalism our banner, and it shall be planted on the topmost brick of this edifice, and on it shall be inscribed in letters of living light —Home, Progress and Reform ! 
I have shown you, then, gentlemen, that we are in reality laboring with the American Association for a sound reformation in the system of medical teaching in our country; we have lengthened our lecture season materially, and we are willing to go even farther; and we offer to the student opportunities which we have never seen equalled in this country. But the Association has gone a step farther ; it asserts that the standard of preliminary education amongst students of medicine is entirely too low, and it recommends that this standard be elevated by the Medical Schools.— Now, this is a subject over which I have pondered much, and the more I think of it, the more thoroughly satisfied I become, that it is a matter which the People of the profession can manage themselves far better than we can; indeed, I do not see how we are to manage it at all. If the Association imagines for one moment that any set of professors should, at the 


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beginning of each session, examine each individual of a class of one, two, three, or even four hundred students, for the purpose of ascertaining the extent of his knowledge of Latin, Greek, Mathematics, Philosophy, etc., etc., then they have a far more exalted idea of the physical endurance of said professors than I could ever have imagined. It is our province to teach you medicine, and we shall conscientiously examine you as to your qualifications in this respect. One of our requirements is thai each individual applying for the degree shall furnish a thesis on some subject connected with medicine, and the whole character of every such document, including orthography, diction, etc., will certainly receive our careful attention. But it is not a part of our duty to go farther than this. While we are the warm advocates of the most thorough system of education, we cannot admit that a man must have studied Latin and Greek in order to be a good physician. We cheerfully admit that he who has studied them has great advantages over him who has not, and we would strongly urge every one of you to acquire some knowledge of them; but that a man cannot comprehend the philosophy of the action of the gastrocnemius muscle, or diagnosticate gastrodynia, or properly administer Hydrargiri Ghloridum Mitis, because he does not understand the derivation of these terms, we cannot admit. Ignorance of this kind forms a great stumbling block in the way of the student of medicine, and no matter how long he lives, or how closely he applies himself, he will ever regret his deficiency in this respect. The man who is fairly informed in the languages which form the basis of our literature and nomenclature, and who has an accurate conception of the laws of physics, etc., etc., will most probably be more useful, and at the same time he will be ornamental to society; but it does not follow that he who is deficient in these respects must be a mere cypher or even a disgrace to the profession. I tell you now, gentlemen, I stand here as no apologist for ignorance; on the contrary, I believe myself to be enthusiastic on the subject of liberal education; but I have great faith in that thing called common sen$e, and I would sooner trust my sick body to the man well imbued with this indispensable attribute, and who had been educated at the bedside, than to him with the polished education all derived from books and abstract amphitheatre lectures. I draw this comparison merely to show you that there may be two kinds ot really good doctors. Again, I say, understand me not as saying one word by way of encouragement of ignorance of any kind (I wish I had been ten times more thoroughly educated than I am this day,) but understand me only as saying, that it 


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will be hard for the People of the profession to fix a standard of preliminary education up to which a man must come before he can be admitted into the fraternity of students of medicine. Our geography, our migratory habits, the nature of our institutions, all are such, that there are now, and must ever be, two distinct classes of medical men in our land, viz : those who are more or less highly educated, and who have, consequently, the opportunity for being both useful and ornamental to society; and those who are more or less deficient in what is called preliminary education, and, consequently, cannot reasonably expect to be more than useful in their day and generation, and perhaps even this usefulness curtailed by the deficiency under which they labor. In the language of Professor Hartshorne, of Philadelphia, in a recent introductory lecture on medical education : 
" Two views are possible as to the scope of medical education; 1st. That which regards all that would be desirable in the preparation of the medical man; and, 2nd, That which considers what is indispensable." In other words, gentlemen, there is so much that a man may know, and which every one of us should desire to know; and then there is just so much that every man muat know, in order to be a physician; 
Few, very few, can attain all the knowledge that would be embraced under the first head; all of us can and should'be possessed of all embraced under the latter. Then, he who is working upwards from the lower to the higher degree, is deserving of all praise, and is fulfilling his obligations to his fellow men. 
We say, then, that it rests with preceptors —those who send young men to Medical Schools—to effect reform in preliminary education. Few young men study medicine except under the advice of some medical friend, and these very friends have a far better opportunity for knowing the capacity, tastes and acquirements of those they are advising than we can possibly have. At any rate, let the reform begin with pre. ceptors; then we can the better see what is wanted, and if any co-operation on our part be feasible, we shall bo proud to come to their assistance. We will never be found even tardy in 'uniting with our brethren in any practicable plan for the elevation of the standard of medicine. 
I have told you, then, of our acquiescence in the recommendations of the American Medical Association in relation to lengthening the lecture term, and largely increasing the opportunities for bed-side instruction. I have yet to tell you that we have, in other respects, gone far ahead of all this, and have successfully effected other radical changes, which we have 
3 


18 
not only found to work admirably, but which, if we are allowed to base our predictions on " the signs of the times," will force themselves on other schools in the country. 
Experience as students of medicine, and as lookers-on at the general working of our prevalent system of medical teaching, had taught us that one great error lay in the fact, that the number of professorships was too limited, and that, consequently, some of the chairs were burthened with an amount of labor that no one man could possibly perform in the space of time allotted him. Those of us who commenced the organization of this faculty at once determined on a subdivision of labor, and the result was the establishment of two separate and distinct chairs—the one sharing the onerous duties of the Professor of Theory and Practice; the other taking from the chair of Obstetrics the really distinct branch of Diseases of Women and Children. To those of you who are second course students, there will at once appear a real necessity for these innovations, and the first course student will soon learn to wonder how we could otherwise have done our duty properly. Those who attended their first course with us last winter know full well that the professors in these new chairs had their hands full; and those who attended their first course elsewhere will at once admit that thry neither heard a full course on Theory and Practice, nor the fiftieth part of a course on the Diseases of Women and Children. 
In order to teach you both the science and the art of practicing medicine, it seemed to us absolutely indispensable that there should be more than one individual to perform the labor, and the experience of last winter has demonstrated that we were right. The teacher who calls the attention of his class to a disease once, or even twice, during the session, is not properly preparing his pupils for thereafter encountering that disease on their own responsibility. You must see it again, and again, and again : indeed all the senses must be properly and repeatedly brought to bear on the subject before you can have a just appreciation of it. This is what we call acquiring experience, and to acquire this experience it is that we would carry you daily through the wards of the Hospital. When the young physician oflfers his services to the public, the universal cry is—" he is inexperienced," and if any one can tell me how we can otherwise rid you of this stumbling block in your way, and at the same time do your communities a signal service, I shall be pleased to consider the plan. 
We call our new chair " Clinical Medicine, and Auscultation and Percussion," and it is the duty of this Professor to practically demonstrate to 


19 
you all such diseases as may appear in his wards during the season, and to thoroughly instruct you in the art of Auscultation and Percussion. If there be a man amongst you who thinks this post a sinecure, let him just devote himself to the practical study of the latter art alone, and then tell me at the end of the season if he has learnt any too much. I might talk to you in an amphitheatre for five years about the normal respiratory murmur, and then about bronchial and crepitant rales, and all the other abnormal sounds about the diseased chest, and, although you might most thoroughly know what all these were in theory, and might even be able to discourse quite eloquently in relation to them, you could not go into a sick room and recognize them if you were to be hanged for it. You would, then, have to go hence to learn on your suffering patients that which you should have learned here. With the means at hand, then, for giving you this indispensable knowledge, is there any possible reason why we should not offer it to you ? or when offered, is there any reason why you who are here should neglect to receive it, or why other Southern students should turn their backs on such opportunities, and run away North ? 
But alas! for our poor sick women and children. Can any man tell us why, in this oountry, where woman is more thoroughly appreciated, and where she occupies a more exalted position than in any other portion of the globe; and where little children are more tenderly nurtured,and have more nourishing food and purer air than can elsewhere be found, —will any man, I say, save our shame, and satisfactorily explain why it is that the only consideration the maladies of our wives and children have hitherto received at the hands of our Medioal Schools has been to print them on the backs of their circulars, and, by totally ignoring them in their lectures, to impress the mind of the Student with the idea that they were either wholly unimportant, or so easily comprehended and mastered as to require no collegiate consideration. Gentlemen, I blush, but I do not fear to record the truism, that until the Faculty of the New Orleans School of Medicine established a distinct Chair of Diseases of Women and Children, no Student ever graduated in this country satisfied with the amount of knowledge he had acquired on this most important of all the orancnes of Medicine. And I say without fear of contradiction, that it is utterly impossible for any Professor of Obstetrics, in any Medical School, under the prevalent system to teach both Obstetrics and the Diseases of Women and Children; and yet, on to this same Chair of Obstetrics do w find tacked the latter most important duty. The Annual Circular of the 


20 
School is embellished with an array of inducements to the Student; the Professor cannot perform the duty assigned him; the Student is promised, and pays for, that which he never receives; and the very best portion of our community is neglected by the medioal man —all because, perhaps, the multiplication of professorships will produce long-division of nett proceeds. The idea seems to have been, that Students must attend lectures whether they are taught this important branch or not, and $20,000 or $50,000 is muoh more satisfactorily divided by seven than by nine. 
But I will not dwell longer on this subject. The innovation we have established is too palpably important to require argument in its defense. As well might I enter into an argument to prove that we love our mothers, our wives, our sisters, and our babes. Already has one of the most prominent teachers in the West (the Editor of the Western Lancet) endorsed our editorial remarks, in our Medical Journal, on this subject, and proclaimed that his Medical College has at last made arrangements for teaching the Diseases of Women and Children; and I tell you now, that this is but the first voice in the rapidly approaching, loud and general echo which our humble yet earnest call for reform shall elicit. I fearlessly .predict that this branch of Medicine will receive the highest consideration at the hands of all respectable Medical Schools in this country in less than ten years; and oh! that I could, by predicting thus, wipe out the stain that rests upon us for our past unpardonable negligence. I stand here to prophecy good that is surely coming; yet I blush while I prophecy. The joy that I feel in unwavering confidence that we may be useful in even commencing a wholesome revolution, is clouded by the recollection of the present and past delinquency of our Profession. 
I must not omit to mention another innovation we have made. You have been in the wards of the great Charity Hospital, and have there seen the unlimited amount of disease subject to your investigation. Notwithstanding this, we have, under the conviction that you should all have free scope for observation, established on this side the street, and within this building, a Free Medical and Surgical Dispensary. This additional advantage needs no praise at our hands. Suffice it to say, that there are three spacious rooms devoted to the purpose —one for men, one for women and children, and one for an apothecary shop. Here Disease, in all variety, presents itself, to the extent of one hundred patients a week, and on three days of each week the Student is afforded the amplest opportunities for personal investigation of all the phenomena which characterize the sick 


21 
man. Onr Dispensary is not a little room to which the sick resort, so that the Professors may select from them such as they think fit subjects for hospital displays; but all our Students, both First and Second Course, have the freest access to our prescribing table, and there each one can examine the patients for himself. Besides this, the apothecary shop, in connection with the Dispensary, affords opportunities for practical information in relation to compounding and dispensing medicines. 
Besides all these, you see around you, in rich profusion, all that is necessary for the complete demonstration of the different branches of Medicine. Our Chemist's Laboratory is stored with all the Chemical and Philosophical apparatus that can be desired, and everything is of the very best quality and latest style. Our Museum we consider fully equal to any in the land for all that can be required for the proper demonstration of the different branches, and in some respects we think it superior to any in the South. For the study of Practical Anatomy, we believe we offer the very best opportunities known. Our Rooms for this purpose are well ventilated, most liberally gas lighted, and furnished with pure cistern water in abundance. Such is the pleasant looation, the extent, neatness and oomfort of these apartments, that the Dissecting Boom is fairly robbed of half its terrors to the novice, and is a pleasant resort to the adept. 
Nor have we, while moat careful to collect together all that is necessary for your instruction, been unmindful of those minor details which will tend to insure your comfort. Besides all apartments usually found in Medical Colleges, we have prepared for your reception a spacious and well-arranged Assembly Room, where your leisure moments may be spent in agreeable social intercourse with each other. Indeed, in every direction, you cannot fail to perceive the evidences of our willingness, our desire to make your sojourn with us in every respect agreeable and instructive. It is our ambition to satisfy all your reasonable desires, so that you will leave us as friends, and in your future careers labor for us with the same hearty good will that shall always characterize our labor for you. 
I have thus cursorily called your attention to what we believe to be the absolute advantages of our institution, and I have compared these with such as our Southern students of medicine have been in the habit of considering the best in our country. We are now more than willing to abide by the decision of any of you who have attended your first course at the North; and if any who are now about to attend their first course with us think there is anything better to be found at the North, we say, go next 


22 
winter, and try it. We hare been there, and we know what will be the result of your experience. I do not tell you that they have not much that is good there; nor do I tell you that there are not able and zealous teachers there, who will labor conscientiously for you; but I do claim that we have more to offer you here, and that of better quality; and we shall labor unceasingly for your advancement. We cannot, therefore, see the reason, or the propriety of your ignoring the worthy exertions of your own fellowcitizens, the unrivaled advantages heaped at your own doors, and spending your money out of the community, to which you will surely return and petition for a living. 
Gentlemen, I know no North, no South, no East, no West; but I do know that it is the imperative duty of every man to use his best efforts to promote the welfare of the land which gives him air to breathe and food to strengthen him. The South has awaked at last to the importance of this truism. She is finding out that it is cheaper to build our own railroads to ride on, and the* iron arms are stretching forth o'er mountain, plain and river, to hug home the wealth we were wont to ignore or to throw to the Northern winds. She is finding out that Hygeia has a habitation here, and our own Saratogas are springing into enviable existence. She is finding out that there is a real necessity for educating our youth at home, and at once the University of Virginia rises to eclipse even Yale and Harvard. Shall I say, then, that she has yet to find out that Southern physicians should not only be educated at home, but that the South is the best of all prepared to educate them ? 
But the hour admonishes me that I must close my address, and I propose to do so by offering you a few remarks in relation to the reciprocal duties of Professors and Students. I have already shown you that this Institution is no trifling little experiment of a parcel of niggards, who feel every desire to make money, who would fain feel the pecuniary pulse of the patrons of Medical Schools, and yet who would shrink from risking either labor or capital to attain their purposes. From its very incipiency it has been an enterprise of importance. Necessity was its mother, and energy and ambition have adopted the bantling, and have determined to give it a prominent position. You perceive that we have attained much in pushing forward our enterprise. We have even surprised ourselves in the results attained. Yet do not think we have traveled thus far o'er a smooth sea. On the contrary, be assured that we have had rather a rough voyage. We have had adverse winds and chopping seas. Sometimes even little 


23 
hurricanes have overtaken us. But, thanks to an Allwise Providence, we have bravely buffeted against all these, and now sail merrily along towards the harbor of success. In our enthusiasm, we launched our craft without coppering her, and of course the little barnacles attacked her; but they have failed to sink us, and we smile at the gigantic task before them. 
Gentlemen, it is the duty of the Professor and Teacher to be kind, courteous and always communicative to his pupils; it is his duty to labor unceasingly for their advancement in the arduous task before them; and it is his duty to know that he who receives from his hands the highest honor which can be conferred by the institution to which he belongs, is really worthy of that honor. 
Those of you who have hitherto labored with us know well whether we have filled the measure of these duties; and those of you who have for the first time placed yourselves under our care have only to look around you to see the fairest evidence of our disposition to fulfill all our obligations. Still, we hesitate not to renew our pledges to you to devote ourselves to your advancement, " heart and soul." 
But there are obligations on your part too, and these must be fairly fulfilled, if you would leave us perfectly contented. If you do not labor with us, we shall labor in vain for you. We bring you to the bedside, into the dissecting room, before the microscope, into the laboratory, that we may elaborate and explain what you read in your books. If you do not give us your undivided attention, we can be of little use to you. On the contrary, if you do your whole duty, we are willing to guaranty that you will go away satisfied. He who is called on to teach an inattentive and indolent pupil has an unsatisfactory and thankless task to perform; while he who walks hand in hand, along the intricate paths of science, with a pupil who is both ambitious and industrious, has a pleasant journey, and will be amply repaid for his labor. 
_ You are all anxious to learn. Are you, at the same time, willing to be directed ? Are you willing to be lead along the paths of science ? If so, we extend you our hands. Come; you have mountains on mountains to climb; you have dark valleys to penetrate, and broad and deep rivers to span; yet despair not: we, too, are traveling that way, and we can help you on. Remember! 
" The clouds may drop down titles and estates, Wealth may seek us—hut wisdom must be sought." 


INTRODUCTORY LECTURE 
DELIVERED BT D. WARREN BRICKELL, M. D. PROFESSOR OF OBSTETRICS, N. 0. SCHOOL OF MEDICINE, NOVEMBER 3, 1857. 
$u*n*&tlr 6b 3£Uqut*t of tfit tolase. 
NEW ORLEANS: PRINTED AT THE BULLETIN OFFICE, 35 AND 37 ORATIEE STREET. 
1867.