V*T **>>v! *fc >-<*' * >i s I 4- ^ ,— I Sur?e "- T.4X —=—*sg jeon General's Office ^----_—___*.----~—Yj. • V A LECTURE INTRODUCTORY TO THE COURSE ON OBSTETRICS AND DISEASES OF WOMEN AND CHILDREN, IN THE UNIVERSITY OF PENNSYLVANIA, FOR THE SESSION OF 1835-6. _____/^l BY HUGH L. HODGE, M. D. PUBLISHED BY THE MEMBERS OF THE CLASS. PHILADELPHIA: J. G. AUNER, 331, MARKET ST. PBIKTED BY THOMAS B. TOWN, 143 NORTH BECONB STBEXT. 1835. H3£ Philadelphia, November 21, 1835. Sir: At a meeting of the Medical Class of the University of Penn- sylvania, held this afternoon, we were appointed a committee to request a copy of your eloquent and very appropriate introductory lecture, for publication. Should this request meet your approbation, it will afford us great pleasure to communicate it to the Class. With sentiments of regard and esteem, We remain, sir, Your obedient servants, HENRY S. PATTERSON, ASA FRISBY, VVM. HOPE, FRED'K. GRAFF, JAMES H. CARR, THOMAS S. PAGE. To Hugh L. Hodge, M. D. Philadelphia, Nov. 21, 1835. Gentlemen: The request of the Medical Class for the publication of the Introductory Lecture yesterday delivered, was very gratifying. Although, the observations therein made were hastily thrown to- gether for the occasion, without any expectation of their being rendered more public, they are cheerfully submitted to the disposal of the Class, in compliance with their wishes. With sentiments of respect, yours, HUGH L. HODGE. Messrs. Henry S. Patterson, Asa Frisby, Win. Hope, Fred'k. > Graff, James H. Carr, Thomas IS. Page. \ INTRODUCTORY LECTURE. Gentlemen of the Medical Class— As you are all aware of the very peculiar circumstances* under which I address you, it would seem unnecessary to make any prefatory observations. But although the initia- tory steps have been taken by my colleague, the Professor of Anatomy,-)- and although you are all actively engaged in the course of instruction adopted by this institution, my own feel- ings will not allow me to commence the duties assigned me without adverting to that distinguished individual who so lately occupied this place, but whose increasing age and infirmities have induced him to vacate a situation, on which he has con- ferred honor; and the importance of which, he, as much as any other, has displayed in the eyes of an intelligent com- munity. It is an event, gentlemen, deeply to be lamented, * The present course of Lectures on Obstetrics, was commenced by the late Professor Dewees, on Thursday, the 5th of Nov.—On Tuesday the 10th instant, his resignation was presented to the Board of Trustees, and accepted. His successor was elected on Saturday, the 14th, and this Lecture was delivered on Friday, the 20th. t Doctor Horner, who had demonstrated, during the interval, between the resignation of Doctor Dewees, and the appointment of a successor, the anatomical peculiarities of the female pelvisy and its contents. 6 not only by his friends, but also by the medical profession, and by you, in an especial manner. Nearly half a century has elapsed since Dr. William P. Dewees commenced his professional life as a practitioner of medicine in the village of Abington, north of Philadelphia. Although not then twenty years of age, he secured the prac- tice of the country, and might have spent his life, the first man in the community in which he then nourished. But, gentlemen, he had a nobler ambition, and aspired to a higher destiny. He was conscious of superior talents, and very soon sought in this city, afield more suited to the displays of genius, and for the exercise of professional knowledge. He came to Philadelphia about the year 1793, when Shippen, Kuhn, Rush, and other founders of this medical school, were in the zenith of their reputation, and where he entered the lists of noble and courteous rivalry, with a Wistar, a Barton, and a James, who have since been the supporters of the University, and dif- fused its reputation through the country. With such competi- tors, Dr. Dewees commenced with many disadvantages. Diffi- culties, however, are but stimuli to genius—they serve only to arouse the energies of the mind, and render success the more glorious. His opportunities were, however, excellent, and superior, in one respect, at least, to any that can again oc- cur in this community. The Practice of Midwifery was, at that period, almost exclusively in the hands of ignorant females, who very frequently created difficulties, to be reliev- ed only by the well directed efforts of the scientific Accoucheur. Few medical men, however, attended at that time, to the par- turient female, and a still smaller number was acquainted with 7 the fundamental principles of the science, or devoted them- selves to its cultivation, and practice. This fine opportunity was discovered, and successfully embraced by Dr. Dewees, whose reputation, especially in the operative department of his profession, was quickly, and permanently established. This, however, was not sufficient. His maxim appeared to be, that nothing was done, while any thing remained to be done. There had been no regular complete course of instruc- tion ever prepared, in this country, on the science of Obste- trics. The few lectures delivered by the then Professor of Anatomy, Surgery, and Midwifery, Dr. Shippen, were, of course, superficial, and imperfectly calculated to raise our art in the estimation of the public, or diffuse abroad, the principles upon which its usefulness depends. Doctor Dewees became a teacher of Midwifery in the year 1797, and although from that period to the present, he has had for rivals, such men as Church, and James, and Chapman, in this city, and in other parts of our country, yet he has always maintained his rank among his compeers, and by means of his students, scattered the fruits of his genius and experience to the most distant por- tions of our land. It is an observation, abundantly supported by reason and experience, that whatever reputation an individual may ac- quire, as a practitioner, or teacher in Medicine, is all transito- ry. Our patients, and our students, even when most grateful, and most fixed in their devotion, are like ourselves—mortal. And when they cease to exist, the character, dependant on their testimony alone, for its reputation, necessarily dies with them; or at most, is transmitted by the uncertain, and indis- tinct voice of tradition, with a brightness, continually, and rapidly diminishing. He who would be remembered by pos- terity, or (as I would propose a nobler object to your ambi- tion) he who would diligently, and anxiously labor, to benefit, not merely his own, but succeding generations, must record his observations, his discoveries, and his thoughts. He must, gentlemen, write, and publish. His books must be his mes- sengers to distant nations, and to remote generations. This monument, which is truly "perennius aere,'' our friend and predecessor, when in the full possesion of his mental and cor- poreal faculties, and when experience had tested what his ge- nius had dictated—this monument he has erected to his own memory. By his published works, especially by his books on Diseases of Females, on those of Children, and on Midwife- ry, he has already secured a reputation so great among the jealous savants of Europe, (jealous of every thing cis-atlantic) that hife opinions are regarded as authority, and his name freely associated with those who shine as the luminaries of our sci- ence, in ancient, and in modern times. This, gentlemen, is no mean honor for an American. I know not that it can be as freely awarded to any other medical man of whom our coun- try can boast. Such is the professional reputation of my immediate prede- cessor in this chair, as a practitioner, a teacher, and a writer on Obstetrics, and Diseases of Women and Children. A repu- tation acquired, let it be remarked, not by the accidents of birth or fortune, or even of education, but by the industrious and persevering employment of those talents, which his Crea- tor had most liberally entrusted to his care, for the welfare of g this community, may I not say, of the world. He thus becomes an example for you, gentlemen, as well as for my- self. Let us follow him in this path, and by patient industry let each cultivate the talent with which he is endowed, that our reward may be equal, and if possible, greater than what he enjoys. But while, gentlemen, I thus fix your thoughts on the liv- ing,—on one of whom you have all some personal knowledge, and with whom I would hope, some pleasant associations, you must excuse me while I perform a similar duty to another great man, personally unknown to most, perhaps to all of you, but who, for more than forty years practised Obstetrics in this city, and during the long period of thirty three years, was a private and public teacher of Midwifery;—an individual whose reputation has long been cherished in the hearts, and by the voices of devoted disciples, in every corner of thcjhind, but who, by the all-powerful hand of disease and of death, has been removed from the scenes of his usefulness. Doctor Thomas C. James, having enjoyed an excellent edu- cation, classical, as well as medical, in this country, and in Europe, commenced the practice of his professsion in Phila- delphia, in the fall of 1792, with a mind, richly endowed by nature, and well cultivated by a most sedulous improvement of the advantages at his command. As formerly intimated, he was the cotemporary of Dewees, as well as of Wistar and Barton, but owing to a natural diffidence of character, and to a delicate sensibility, which involuntarily shrunk from obser- vation, he for years toiled with comparatively little success B 10 and suffered those feelings which arise from disappointment, and from a consciousness of deserving better things. But, gen- tlemen, true merit cannot long be concealed by the rubbish of prejudice, by the detractions of envy, or even by the igno- rance of a community. Like the flame which has been ineffec- tually smothered, it will burst forth, and burns more brightly from the efforts made to restrain it. Dr. James' merits, first highly appreciated by his intimate associates, became apparent to the public, and his practice eventually was of the first or- der; indeed, for many years, none was superior. As a teacher of Obstetrics, he commenced as early as the year 1802, in conjunction with the late Dr. Church, to lecture to a very respectable class, with increasing confidence and suc- cess, and when in 1807, the Trustees of this University deter- mined to erect a separate chair of Midwifery distinct from the chair of Anatomy and Surgery to which it had originally been joined, he became its occupant with Professor Chapman, when a Dewees was his opponent. On the death of the great and venerable Rush, in the year 1813, Dr. Chapman was translated to the chair of Materia Medica, and Dr. James became the sole Professor of Obstetrics until 1825, when Dr. Dewees was appointed his adjunct. In 1834, he resigned all connection with the University, and in July of the present year, he paid the great debt of nature. As a lecturer he was admired and beloved, and he contributed in no slight degree, in sustaining and enlarg- ing this school of medicine, by the gentleness and suavity of his manners, by the unwavering kindness of his disposition, and by lectures which interested the hearers, not only from 11 the soundness of the instruction conveyed, but as specimens of literary and elegant composition. As a man, he was universally beloved by his pupils, and the community to whom he was personally known; for all per- ceived and felt the benevolence of his character—its spotless purity and its sterling excellencies—all admired, an individual, who while possessing a very superior mind, cultivated and adorned by literature and science, continually retired from ob- servation with a modesty almost feminine, arising as well from great native sensibility and delicacy, as from strong sentiments of deference and respect to his friends and compeers. Such characters, gentlemen, although seldom the most influential, or the most dazzling, are nevertheless worthy of all admira- tion. They present human nature in its best aspect, and when the grave has closed, as in the present case, over the per- ishable remains of mortality, the strong unwavering hope is excited, that they have gone to perfect in Heaven, the work so well commenced on earth. With such predecessors—gentlemen, you may imagine what must be my feelings on the present occasion, but you can never know how overwhelming these feelings are,until you are called to follow the course of the great and the good, while there is an internal consciousness of inferiority, and of inability to attain the lofty eminence on which they are placed. These senti- ments are but augmented, when we consider the importance, and dignity of the science which they taught, and the princi- ples of which it is my future duty to inculcate. Perhaps there is no branch of the healing art which has been more undervalued than that of Obstetrics. For centuries nothing 12 was known, even by the profession, of the nature of labour and of the mechanism of parturition. Medical men were consulted only in desperate cases, which, of course, from their inexperi- ence and ignorance they could not relieve. The attentions which theparturient female and her helpless offspring invariably required, were performed by sympathising but ignorant friends; or some still more ignorant, but bold and presuming empiric. No wonder then that sufferings indescribable, and that death of the child, or the mother, or of both were facts of common oc- currence. Obstetrics indeed, was hardly regarded as part of medicine, and men were ashamed to attend to what was deemed the appropriate and peculiar duties of the female sex. Even in this country, and in this city, the prejudice has hardly passed away. Thirty years ago, the mass, even of intelligent and well informed females, would entrust themselves and their progeny during the agonizing and dangerous process of partu- rition, to the most aged, and often to the most imbecile of their sex—a practice still common in most parts of our country, as many of you can testify. It was not until near the commence- ment of this century that regular instruction was even attaina- ble; and the year 1813, had actually arrived before the Trustees of the University of Pennsylvania determined that a professor- ship of Obstetrics was a competent portion of a medical faculty, or that a knowledge of Obstetrics was essential for graduating in medicine. The argument by which all this prejudice was sustained, was plausible indeed, but altogether without weight, because by the admirable and most wonderful adaptation of means to an end, the great Author of our existence had rendered parturition 13 a perfectly natural process, it did not follow that no accident, no disease, could interfere with his arrangements, and render labours tedious, difficult, dangerous, and fatal to the mother or her offspring. Experience has abundantly testified that how- ever parturition is in accordance with the original structure of the female, and with the laws of her economy, yet that innu- merable circumstances arise which interfere with this process and demand the assistance of the well instructed and skilful accoucheur; and the more civilized and refined society becomes, the more frequently is such assistance demanded. A knowledge then, of Obstetrics, is essential for the medical practitioner. But how can this knowledge be attained ? Is the physician to forsake the halls of science and the libraries of the learned? is he to abandon as useless all the lights which the anatomist and physiologist can display? must he follow the Empiric in his dark and dangerous course, and, without any previous knowledge of the structure or functions of the econo- my, attend upon the suffering female in the most trying and dangerous moments of her existence, and thus learn the practice of midwifery, at the expense of the happiness and lives of hun- dreds of his fellow creatures, estimating the extent and accuracy of his knowledge by the amount of his experience ? In other words, is Obstetrics to be regarded by you, gentlemen, simply as an art, that is, a mere congregation of facts fortuitously acquired; or as a science, deriving its fundamental principles from Anatomy and Physiology—from the structure and func- tions of the female organs, supported and enlarged by a careful observation of facts, derived from a well regulated experience, and the whole analyzed and arranged by the exercise of a dis- criminating and jealous judgment? 14 To you, who have any knowledge whatever of medical science, it need not be demonstrated, that no man can be a safe practitioner of Midwifery who is ignorant of the form, the com- position, the relative position and connections of the female organs, and of their bony encasement,the pelvis, of the actions and functions of the uterus and its appendages, by which the child is supported until maturity, and then expelled;—and who knows not the powers by which this expulsion is effected, how they operate, the nature and character of the resistances to be overcome, and the various difficulties and dangers to which the mother and child are liable during this action and re-action of antagonizing powers. All this, and more than all this, he must know before he can become even a profitable spectator of the process of labour. On further investigation it will be discerned that the almost innumerable facts collected by accurate observers respecting the physiological and pathological states of the female, at all the important epochs of her life, and especially at those connected with her parturient state, have been carefully analyzed by the cultivators of obstetrics,—their similarity and dissimilarity ac- curately noticed, and the whole systematized with as much, if not with far more precision, than that which characterizes any other branch of medicine. There is nothing which can be affirmed of the Practice of Medicine, or of Surgery, which is not equally applicable to Obstetrics: like them, it demands im- peratively an extensive and a classical education, a knowledge of philosophy in all its various branches, physical, moral, and intellectual, that its principles may be understood, and like them also, the practice of midwifery cannot be safely conducted by any one who is not familiar with the general principles of 15 these collateral sciences. It has been truly observed; that medicine brings all other sciences into requisition. It is based on them all. It is the apex of that glorious pyramid of science which has been erected by the efforts of the human mind during the successive ages of the world. Obstetrics, then, is a science. It constitutes one of the bright galaxy which, in the aggregate is designated as the science of medicine. But, gentlemen, I am not sa- tisfied with simply vindicating its title to be regarded as a science. If you will receive the testimony of one who has been a student and practitioner of medicine for more than twenty years, and who, in private and public institutions, has attended to the several branches of the healing art, there is no department of the profession more difficult in the acquisition or in the practical application of its principles than that of Ob- stetrics. It demands a mind well educated, richly furnished with all that philosophy can supply, capable of nice discrimi- nation, governed by a sound judgment, cautious, prudent, cir- cumspect, yet bold, self-possessed, energetic and capable, in moments of sudden alarm and danger, of rapid and decided action. You will discern that these peculiar and high charac- teristics of the mind, however important they may be to the Physician and especially to the Surgeon, are still more essential to the Obstetrician, for in no department of the profession is diagnosis more difficult, and in none must remedial agents be resorted to with more promptness and decision. I may add, that in none will you witness more splendid triumphs of science, or realize more fully the benefits conferred by our profession on suffering humanity. 16 There are still other considerations of high import, which enhance very greatly the dignity of medicine in gene- ral, and of Obstetrics more particularly. I allude especially to the high tone of moral, and even religious sentiments which its exercise most imperiously demands. You all know the importance of Medical Ethics; that the code of morals which governs the intercourse of man with man, is enforced with pe- culiar strictness on the members of the Medical profession: and justly so. The physician enters into the privacy of fami- lies, and penetrates even to the most retired chamber: he be- holds the human character disrobed by the rude hands of men- tal and corporeal suffering, of all the coloring and drapery thrown around it by the forms of society, and thus becomes the depository of facts which involve the happiness of indivi- duals, and of society. He must, therefore, be above suspi- cion. Ignorance may be excused, cupidity even may be tole- rated—but the physician who violates confidence, who dis- plays to the gaze and ridicule of the world, the vices, weak- nesses, or even the personal defects of his patients, will not be tolerated. Whatever may be his talents, his attainments, and his reputation, this destitution of honorable feeling, this want of true moral sensibility, will destroy his influence, and de- grade him as a man, and a physician. The practitioner of medicine, must therefore, not only possess these qualities, but he must bring them continually into active exercise. All personal considerations are to be sacrificed for the benefit of his patients. He must sympathise with their sufferings; and, when they become impatient, or irritable, from the influence of pain and disease, he must be patient and forbearing; disre- 17 garding his own sensations of fatigue and exhaustion, and continually practising that charity, " which endureth all things." There is not, I firmly believe, any profession, or business in life, in which the moral sensibilities of our nature, are more constantly called into exercise, or where there is a greater manifestation of pure morality, than in the profession of medicine. And however recreant some physicians have proved, we may appeal with a just and laudable pride, to the great mass of the Profession in confirmation of the truth of this assertion. If the intellectual excellence of the science of medicine, be thus dignified, and rendered more valuable by its moral ten- dencies, Obstetrics must, in an especial manner, partake of this elevation, and thus exert a wider and more effective influence. The reason is apparent. It regards the female sex, with all its characteristic delicacy, and moral sensibilities. The Accoucheur is an attendant at those moments when pain and agony are so intense, that all the anxieties of the patient are concentrated upon herself; his presence is disre- garded; reserve is banished; the most secret sentiments of the mind, and the most delicate feelings of the heart, are revealed; and thus a confidence absolutely unlimited, is involuntarily and unexpectedly placed on her medical attendant. Woe to that man who shall violate such confidence, even in the slightest degree. At such periods, there is special need for all those excellen- cies of character, to which we have alluded—great and imperious demands are made on the health and strength, c 18 as wen as on the patience, perseverance, and charity ol irib practitioner. His comfort and convenience must now be forgotten; and whatever be his privations, however exhausted by watchfulness and anxiety, he must bestow unremitted attention on his suffering, but most interesting patient. It is therefore, generally conceded, that the practice of Midwifery demands, not only more of the time, health, and strength of the physician, but involves a higher responsibility, and a greater exercise of the disinterested virtues of the heart; while it is intimately associated with all that is delicate, all that is excellent in the female character. Such is the nature of the science of Obstetrics, and such are the individuals, who first taught its principles in our coun- try, and maintained, for a long series of years, by their pre- cepts and example, its importance and dignity. Far be it from me, to detract in the least from their reputations; or, to undervalue in any degree, the excellencies of our science. I would rather magnify them, and thus present noble ob- jects for your ambition, and my own. Sensible as I am of my deficiencies, overwhelmed as I may be, under a sense of my responsibilities, and in view of the difficulties of my station, I will not despair of rendering myself useful to you, by inculcating the principles of Obstetric science, and continually displaying its intimate connection with the welfare of society, and with the happiness of the most inte- resting and lovely portion of the human family. In this arduous labor, gentlemen, may I not expect your co-operation? May I not hope, that you will feel, and esti- mate rightly, the responsibilities of your station; and, so far 19 from being discouraged by the difficulties presented—that you will meet them, with all the generous ardor and boldness of youthful spirits; that you will lay surely and deeply, the foun- dations of the science, and erect the superstructure with care and diligence; and above all, allow me to hope, that you will never forget that science, morals and religion, are naturally, and indissolubly connected! NATIONAL LIBRARY OF MEDICINE NLfl DlDbflM3D 1 >J*f W* "; y"± }*++■*' ' arc. *iir v 17 •* ^%4 t *r#!