m^ NEW YORK UNIVERSITY—MEDICAL DEPARTMENT. LECTURE, INTRODUCTORY TO THE COURSE ON THE THEORY AND PRACTICE OF MEDICINE,] IN THE UNIVERSITY OF NEW YORK. BY ^^ SAMUEL HENRY DICKSON, M. D. PROFESSOR OF THE THEOR? AND PRACTICE OF MEDICINE. p/3 SESSION MDCCCXLVII—VIII. V NEW YORK: ^ JOSEPH H. JEXMXCS, PRINTER, 122 NASSAU STREET.^ 18 47. A f • I NEW YORK UNIVERSITY-MEDICAL DEPARTMENT, LECTURE, INTRODUCTORY TO THE COURSE THEORY AND PRACTICE OF MEDICINE, UNIVERSITY OF NEW YORK, SESSION MDCCCXLVII—VIII. I ! % BY SAMUEL HENRY DICKSON, M. D. PROFESSOR OF THE THEOR? AND PRACTICE OF MEDICINE. NEWoY0'RK: JOSEPH H. JENNINGS, PRINTBP fi NASSAU STREET. 1847;/, •. ' 'i fe> New York, November 4th, 1847. Professor Dickson,— Sir—At a meeting of the Students of the University Medical College, held yesterday, November 3d, II. McNeill of North Carolina being in the Chair, and O. L. Barnes of Georgia acting as Secretary, it was unan- imously Resolved, That a Committee be appointed to request of the several Professors a copy of their Introductory Lectures for publication. We, who have the honor to constitute the above Committee, would, in behalf of the Class, respectfully request a copy of your able and eloquent address, delivered on the evening of the 27th ult. With great respect and esteem, we are, yours, &c. F. A. Stanford, Georgia. Leon D'Alvear, So. America. G. T. Elliott, Jr. New York. W. W. Harper, Louisiana. W. A. Hammond, Pennsylvania. Elihu Edmundson, Tennessee. J. S. Stiger, New Jersey. A. Hallett, New Brunswick. J. R. Slaughter, Alabama. W. J. Rutherford, Jamaica. M. Whitaker, North Carolina. W. Wai.lf.n, Florida. N. A. Chapin, New Hampshire. J. T. M'Lean, Mississippi. H. Burgess, Connecticut. L. D. Sheets, Maryland. H. B. C. Harris, Virginia. G. W. Peer, Arkansas. ). W. H. Beck, Indiana. W. H. Dial, Texas. C. McKnight, Rhode Island. J. Posto.n, Kentucky. W. G. Hatch, Wisconsin. A. C. Deane, Massachusetts. J. G. Buchanan, Ohio. G. L. Jones. Vermont. R. L. Crawford, So. Carolina. w- K French. Maine. J. M. Ogden, East Canada. A. S. Petit, Illinois. E. Perry, West Canada. By order of the Committee, 0. L. Barnes, Secretary. New York, Nov. 5th, 1847. Messrs. Stanford, and others constituting the Committee of the Medical Class of New York University. Gentlemen,—I cheerfully comply with the desire, so courteously ex- pressed in your note of yesterday, for the publication of my Introductory Lecture. As soon as a copy, legible by the printer, can be prepared, it shall be placed in your hands. Accept my thanks for the very flattering manner in which you have communicated the Resolutions of the Class, and offer to them my re- spectful and cordial acknowledgments. Very sincerely, gentlemen, Y>. friend and servant, SAMUEL HENRY DICKSON r L LECTURE. In appearing before you, gentlemen, on the present occasion, I can- not but feel an oppressive degree of anxious solicitude. From my earliest days a student of medicine, I have for nearly a quarter of a century been engaged as a zealous votary and teacher of that science ; and my yearly increasing experience of its varied functions, has served to impress upon me, more and more deeply, the difficulty of attaining a knowledge of its elements, and of imparting that know- ledge to others. I have learned, too, to appreciate more accurately and profoundly, the burdensome responsibilities of the office I have so long filled ; responsibilities of the gravest import at all times—the keen sense of which is unavoidably heightened by my removal hither, into a wider and loftier sphere of action than that in which my younger life has been past. While my ambition is re-excited, and my spirit elevated by this ex- pansion of my horizon, and I find my resolution strengthened still to devote all my energies of mind and body to the cultivation and advancement of the divine art of healing, I suffer under a painful doubt of my capacity to perform adequately the duties I have taken upon me, and almost shrink when I contemplate their amount and extent. Without your earnest and persevering co-operation, without your patient attention, your favorable construction and partial interest indeed, all these, my future efforts, must necessarily result in complete failure. But in confident dependence upon a frank and cordial reception among you, a liberal appreciation of the conscientious diligence with which I shall fulfil my daily task—and beyond and above all, an humble reliance on that Supernal aid, without which all human labor is spent in vain, and worse than in vain, I enter at once, and with a predominant sentiment of hope and exulting anticipation, upon the course which is set before me. I cannot, however, be unconscious of the peculiar requisitions to which I became liable as the occupant of the place so admirably fil'ed by my lamented predecessor. " It is not given to every one to bend the bow of Ulysses;" and, although I had not the happiness to know or to hear him, yet I find in the graphic portraiture of his character, and the history of his life and his pursuits, recently drawn for us by his 6 eloquent eulogist, whose truthfulness, universally vouched for, is only equalled by their touching beauty, much to inspire me with unaffected apprehension as well as the most sincere respect. Such ability and zeal; so winning an address, tact so unfailing, and integrity so spot- less, have fairly established in your minds a standard which his succes- sor can hardly hope to reach ; not to fall far short of which indeed, will imply no slight degree of merit. To his colleagues and mine, I must not yet venture to propose my- self as his substitute socially, in the circle of which he was so long one of the brightest ornaments. Would that I could in any degree supply the loss they have suffered in this regard. For the gratify- ing compliment of their selection, and the singular disinterestedness which suggested it, and still more for the generous and fraternal welcome with which they have received me among them, I offer them thus my cordial acknowledgments, and the assurance of my recipro- cal and most grateful good will. It is reasonable to expect from any one who professes to instruct others in any art or science, that, he shall define clearly at the out- set his objects and purposes, and trace, as on a map or chart, the path which he intends to follow for their attainment. A better understand- ing is thus brought about from the beginning between the speaker and his hearers, and there is far less risk of disappointment on the one hand, and on the other of a wearisome expenditure of vague and undirected exertion. As the noblest offices are those of benevolence, so our divine art, all whose aims are beneficent, claims justly to rank among the most elevated of the professions. Whatever the motives of the individual, all the labors of the physician are labors of love, sancti- fied by the holiest of Samples, and full of gracious dignity. Like all other modes of human life and action, they partake of human im- perfection, and fall greatly, doubtless, beneath the high standard to which we should ever aspire; but in the effort to reach or even to ap- proach it, we shall not fail to find ourselves sustained and purified. Like Prometheus, we must contend vehemently and with indomitable tenacity against the powers of evil; like him we shall often discover our forces to be insufficient to relieve the sufferings under which we and our brethren are destined to groan ; but ihe very contest is ex- hilarating and glorious, and will not always prove unavailing. We have made, we are making progress towards our goal ; we have al- ready seized and hold firmly some gratifying trophies. In the wide application of narcotics to the removal of pain ; in the extended and still extending employment of the bark of that Peruvian tree which has long given health to the nations ; in the daily improving processes of surgery ; and, to close briefly an enumeration that might be greatly lengthened, in the soothing, gentle, and successful methods of minis- tering " to the mind diseased," which justly confer a bright immortali- ty on the names of Pinel, Conolly, Haslam and Earle, we find gifts of infinite value bestowed upon our wretched fellow men. But our best triumphs perhaps, though not so striking or brilliant as these, our best triumphs have been won in the ample field of Hygiene, to which, first and last, and chiefly, I would direct now and always 7 your earnest attention. To improve the physical condition of the masses, and thus to render more and more perfect the health of each unit of which they are composed, this is the problem most urgently pressed upon us for solution. As the density of a population increases, the artificiality of its modes of living must also increase; and in the numerous and varied contingencies with which it is surrounded, and in which, so to speak, it imbeds itself, the elements of all physical evil* discomfort, and disease must abound. These, it is obvious, as being also artificial, and many of them factitious in every sense, may be corrected, or at least modified, if they are recognized and known. It is part, and the most important part of our professional duty, to detect and expose them, and to inquire into and indicate the best means of avoidance and counteraction. Such prevention, unfortunately too little appreciated by communities, and therefore too often unnoticed and unrewarded, is the clearest among the benefits that science, skill, sagacity, and experience can avail to provide for us. How uncer- tain and difficult the treatment, the cure ; how sure and easy the avoidance of variola, of scurvy, and of those other forms of pestilence, which arising from causes now understood and evaded, have ceased to devour their ancient annual hecatombs of human victims. To remove or destroy the agents productive of one endemic, or to check the march of a single epidemic, would be a triumph far beyond all the glories of war or of literature. The study of the causes of disease, to which you will early and always devote yourselves, is necessary not only, as I have already observed, in its relation to hygiene as its absolute basis, to enable us to escape from them, or to diminish their malignant influence over us, but in order to a proper understanding of their modes of impression, their characteristic effect upon the organism. It will thus aid us in our pathological investigations, which, with all attainable aid, you will find as obscure as they are full of the profoundest interest. We must engage in them with the most untiring patience, the most inde- fatigable perseverance ; often following through the labyrinth traces as indistinct as those by which the Indian is led in the pursuit of his prey, or his cunning enemy. The external signs or symptoms of every deviation from health must be noted, compared, and collated with every coincident circumstance; the internal signs, the subjective in contradistinction to the objective phenomena, made to express themselves, asked for and sought after; and the sensations connected with symp- toms minutely inquired into, by the examination and cross-examina- tion of every patient. The physical or material changes, both as wrought upon the solids and fluids during the progress of disease, and as left stamped in their ultimate result at the time of death, must be looked for, detected, recognized, described, and delineated. From all this severe scrutiny, we must finally proceed to deduce our principles by the closest rules of logical reasoning, inferring the true character of the connection between phenomena occurring successively and co- incidently, and thus determining the nature of their relations to each other; deriving in this manner from effects a knowledge of causes, and from intelligent appreciation of causes an anticipation of effects. 8 The unlimited extent of such studies as these, the precision and nicety of detail demanded, would present obstacles insurmountable to ordinary minds, were we not assisted, and indeed, borne along by the division of labor, which makes every thing possible. While on the one hand, some of our brethren are carrying on their minute research- es into symptomatology, with a constancy that knows neither intermis- sion nor fatigue, and noting down for us the innumerable facts ob- served, with the plausible, but I fear somewhat delusive exactness of statistical arithmetic ; others spend their lives in the charnel-house, amid thousands and tens of thousands of the dead, whose bodies they inspect, to ascertain how and by what changes the protean forms of disease develope themselves, and interfere with the natural and vital functions. Chemists, in a hundred laboratories, analyze for us the morbid fluids ; and microscopists pore over the construction of organs, the arrangement of fibres, the motions of the living atoms, and the weaving of the tissues, from the primary cells and cysts. We enjoy great advantages from this dispersion of active and curious inquiry over the vast field of research which we are called to explore. Each mind thus employed apart, like the bee buried in the recesses of some wild flower, collects and brings up its individual stock to contri- bute to the general store of the great human hive. In the earlier stages of your progress, and for a considerable portion of your elementary course, all that is demanded from you is close ap- plication and assiduous attention. " Nothing is denied to well directed labor, nothing is attainable without it." I ask in the young no other intellectual quality besides diligence, to insure their ultimate and com- plete success. When by means of it they have laid the proper found- ation for future acquirements, they have already formed the habits which will not fail to carry them forward with steady impulse to what- ever goal may attract their steps. Whatever department of our varied and complicated art they may select for their devotion, they are des- tined to illuminate and adorn it. Look over the roll of illustrious wor- thies of our profession, and choose among them those whose fame you will emulate. Already have the coruscations of the genius which has from time to time sparkled idly among us, dazzling rather than en- lightening, faded away into the darkness which must cover every thing except imperishable and inextinguishable truth ; and no names remain which are not written on the tablet by the hand of patient labor. "The poet," says the Roman critic, "is born a poet, the orator be- comes one." We may safely affirm that no man is born a physician ; he must become one by the severe and constant application of all his mental powers; thus, and thus only. Lectures written by the learned grandfather may be read by the two succeeding generations, but they were instructive only from the lips of the first; their spirit, incapable of hereditary transmission, departed with the soul of the writer. Medical talent, or skill, or sagacity, is not likely to descend from father to son; its continuance from one genera- tion to another, with all the aids of opportunity and education, will be found, I believe, of rarer occurrence than the heirship of any other form of celebrity. Hunter and Bichat, and in our own country Lawrence, and 9 Jackson and Forry, these and such as these, are they who have won for themselves an undying renown. I do not deny them the possession of genius, but if thus endowed it is not by this quality that they have at- tained the lofty elevation assigned them ; we know them and crown them only as patient laborers, pains-taking observers, unwearied accu- mulators, accurate recorders and trustworthy reporters. This best mode of eminence and reputation is within the reach of every one of you; it is worthy of the most highly gifted among the sons of men, and should be eagerly, steadily and universally sought after. I might ex- cite you to emulation by the mention of living names, in long array, now winning honors in the same bright field; but I could not enumer- ate all who truly merit such notice, and in making a selection I should become liable to the charge of injustice or partiality. The preparation for such a course as this, however, implies no incon- siderable extent of previous attainment in general science. How can you analyze or understand the analysis of the morbid fluids without a knowledge of chemical elements, tests, agents, and re-agents 1 How arrange and employ your microscope to advantage without acquainting yourselves with the principles of optics ? Nay, how comprehend the physiological uses of parts, or even the application of the commonest surgical apparatus, without due cognizance of mechanical implements and the results of mechanical forces in action? These illustrations, which might be multiplied indefinitely, are I know trite and familiar to you all. But trite as they are, we must repeat the reference to them often, and as impressively as we can, in order that by this repetition we may prevail on you to give due weight to the injunctions thus urged upon you. By your obedience to them you are to be hereafter dis- tinguished from the empiric and charlatan—a distinction which, I would anxiously make you aware, you must win for yourselves ; it cannot be conferred upon you from any source. Aristocratical eminence, in the original meaning of the words, the true " government of the best," must always prevail in the realms of science. There exist there no leveling institutions, no equalizing ordi- nances. Superior acquirement is the only claim of rank admitted there, and that is never refused. Having endeavored to ascertain the causes of disease, investigated their nature, modes of influence and effects, and made every effort in our power to discover how best to check their production, remove them, counteract, remedy and destroy them; having inquired into the charac- ter, course, progress and results of the innumerable train of maladies to which they give rise, " whose name indeed is Legion, for they are many," we proceed to our ultimate object, and enter upon the department of therapeutics, or the application of remedial measures to the cure of dis- ease. Here again we would be almost hopeless of effecting any valu- able, well defined and permanent advancement, but for the division of labor already spoken of. While one devotes himself to surgery proper, a second gives his attention to the experimental adaptation of medicinal agents to the removal of morbid phenomena, and a third sits down to the profound investigation of principles by which we may be guided in the material, mechanical, empirical, and scientific practice of our art. All 2 10 these are usefully employed, and while pursuing each his own purpose, act as benefactors to society, and contribute largely to the available re- sources of the profession. I would here remark, however, that this division of labor of which I speak, must not be understood as encouraging the delusive idea that any, the remotest branch of therapeutics, can be cultivated apart or sep- arate from that root through which all its vitality and luxuriance must be derived. Thus the medical purist, who cares not to understand the principles upon which external or mechanical disorders are surgically treated, refuses his aid to a parturient woman, or to a suffering infant, as objects beneath his dignified and scientific notice, and knows not how to conduct an autopsy, is a ridiculous anomaly, that our profession, growing daily wiser, refuses to tolerate, though it can hardly be as yet affirmed to be altogether expunged from existence. Equally abhorrent to common sense and sound reason are the pretensions of the exclusive bone-setter, manipulist or special operator, not to speak of the self- taught prescribers who take charge of particular diseases, tumors, can- cers, dropsy and consumption, whom I almost scorn to notice by the brief- est allusion, but whom some of our civilized and educated communities not only tolerate but fondly patronize. No single locality of morbid action can be pointed out, so totally disconnected with the rest of the organism, as to refuse to share in and sympathize with the general health or the derangements of other parts. Do not misunderstand me. I not only admit, but highly approve of the selection of certain departments of practice as matters of special study, and, if you please, of even exclusive pursuit. In dense populations we must have the surgeon thus cultivating his anatomical famaliarity with the relations of parts to each other, his manual dexterity, self-possession, promptness of decision and physical courage, or hardihood of nerve, and the obstetrician most laudably devoting his whole time and attention to a class of delicate sufferers, to whom it is impossible to refuse our lar- gest pity and sympathy ; whose faces, when in the enjoyment of their highest health and vigor, we will not " permit the winds of heaven to visit too roughly," and to whom, when in anguish and distress, we are bound to consecrate our best capacities, most intelligent sagacity and most exquisite skill. Nay more ! Of surgeons, one must give his un- remitting efforts to the care of the teeth, those strange portions of the animal economy, which commence by disturbing, deranging, annoying and convulsing us in infancy, requiring throughout our whole lives in- cessant care, yet aching often in spite of it, and finally, as life advan- ces, decaying and dying, while still strongly encased in their living and sensitive sockets, and torturing us whether we retain or part with them. Another will find abundant room for perpetual, and I fear I must add, as hitherto, unavailing investigation of the defects and disor- ders of the ear, that most complicated and most unintelligible of all structures ; and a third, like Wenzel and Alexander, spend his life in nice operations upon the eye, whose derangements not only give us in- tense pain, but shut us out from some of the principal enjoyments of existence, the varying expression of the "human face divine," and the contemplation of beauty in all its forms, animate and inanimate. But 11 if the aurist, the oculist, the obstetrician and the dentist be not thor- oughly a surgeon; if the surgeon be not an anatomist, a physiologist, pathologist and physician, let the profession denounce and the commu- nity beware of him. He is an ignorant and dangerous pretender, whose course will be marked by suffering and destruction. Equally worthy of denunciation, and on the same grounds of com- mon sense and rational principle, are the champions and followers of ex- clusive systems and plans of treatment, who represent the art or science of medicine as consisting in mechanical and uniform application of one remedy or one series of remedies alone to the cure of diseases. Here again I must guard myself from possible misapprehension. The field is so wide before us, and the paths which lead across it diverge so far from each other, that no one among us is entitled to censure his brethren for mere differences in opinion and action, however great. If, as has happened, a well-informed, educated physician, choose upon a compar- ative examination of the several systems of therapeutics, to follow with narrow tenacity any one of them, I may wonder at his error and delusion, but may not pronounce his absolute condemnation, whether % he confines himself to homoeopathy with Hahneman, abstraction with Broussais, stimulation with Brown and Thompson, or hydropathy with Priesnitz. I pass sentence only on him who, without knowing or seek- ing to know the comparative grounds of preference among these various methods, or the positive merits which entitle them to confidence, devotes himself with an inconsiderate, and therefore by no means innocent en- thusiasm, or with a deeply guilty calculation of mere selfish profit, to the unmodified and monotonous employment of any ; a course of which our country presents at this moment numerous and melancholy exam- ples. We are bound more earnestly to set ourselves in opposition to this system, because it is singularly well adapted to seduce the weak and ignorant, those whom it is our especial duty to guard and protect. It is not from any anxiety as to the permanent success of these modes of empiricism that I am thus earnest, nor any dread of the overthrow of scientific medicine. Far from it, I entertain no such idle apprehen- sions. Truth is mighty, and will prevail. Nor am I selfishly con- cerned for fear of any ultimate impairment of the standing or welfare of the profession in the struggle. Knowledge is power, and those who actually possess most of it will attain most power. This is the rule; this will inevitably be the final result. But during the transient reign of any popular delusion, much injury may be done by the predomi- nance of ignorance and error, which therefore we should hasten to overthrow or enlighten. Among the defects in the preliminary education of our classes, the most deleterious in its ultimate influence is the omission of logical teaching, of instruction in the approved and proper modes of searching after truth ; the neglect of proper familiarity with discussion, investiga- tion, dialectics. No one seems to consider this an essential portion of his studies except the lawyer, present and future. The young attor-- ney is exercised in mock courts and debating societies, as the pupils of the ancient schools were exercised, and very properly, in making nice; distinctions and enforcing them upon opponents; in acutely pressing 19 the question of relevancy or irrelevancy, both as to testified fact and offered argument. He thus attains a keenness and expertness of cross- examination, and a sagacity of induction, which we find in no other profession; traits which Scott was so fond of reproducing, and exhibiting most effectively throughout his admirable romances, as in his Pleydell and others. But while I admire these characteristics in my friends at the bar and on the bench, I feel that the community is no less, nay, is even more interested that the same mental qualities should be developed and brought fully into action in the study and practice of the healing art. Need I remind you that nothing is more common than to see systems of pathology and therapeutics built up upon the most insufficient foun- dations ; principles established upon the most illogical, irrelevant and inconclusive reasoning ; and rules of conduct dogmatically laid down and insisted on which have been drawn from the most narrow and par- tial views. Read our journals, and observe the most opposite deduc- tions thrust upon us by writers who have each of them observed a sin- gle fact or a few seeming facts, and who, not possessing the skill to sepa- rate the apparent from the real, nor the patience to wait for further con- firmation of the assumed truth, rush into a hasty and blundering gen- eralization. Suppose such persons gifted with readiness of tongue and pen, zeal and plausibility, and you have founders of schools who shall betray thousands into error. Such were Brown and Rush, Broussais and Hahneman; and although we have escaped the chains which they sought to throw over us, yet we must in candor make the mortifying con- fession, that the eclectics and conservatives among us have, in the contest against any prevailing heresy, ever derived most efficient aid from the op- posite and expulsive progress of some newer and more striking delusion. Observe the headlong haste with which, every day, some recently discovered agent is taken into favor, eulogized and applied to all possi- ble forms of disease, iodine or colchicum, prussic acid or aconite, with- out caution, without selection, without discrimination. I do not allude here to the monstrous quackery which fills our newspapers and contaminates our whole tissue of domestic habits; betraying the fond mother into the reckless administration of dan- gerous and fatal drugs to her infant child, blasting the strength of manhood and the bloom of beauty, and bringing down its vic- tims into early decrepitude or a premature grave. This gross evil tends, sooner or later, to work its own cure. But how can we hope for the removal of that indifference which cares not to enquire at all, but prefers the prompt assumption ; that indolence which, content with a superficial glance will not examine closely ; that inexpertness which, however patient and conscientious, can not investigate exactly and logi- cally ; that ignorance of the art of reasoning which is incapable of weighing duly either fact or argument. We must not deceive you or ourselves. Nothing can be more obscure or difficult than the dis- covery of practical truth in medical questions of an extensive variety of aspects, that present themselves every day, and must embarrass, often and profoundly, every considerate physician. In local, municipal and general hygiene, you will be asked of the origin, propagation and prevention of disease; in medical jurisprudence the most delicate and 13 important points will be submitted to your decision, both in the civil and criminal courts. Need I remind you how often, in public investiga- tions such as these, the profession is betrayed and disgraced by the in- competence of some unready brother, all unaware even of the proper mode of conducting the inquiry in which he is engaged, and for want of the habit of reasoning, incapable even of a plausible effort to satisfy the demands made upon him. How shall a careless or uninstructed thinker penetrate the cloud of doubts which wrap so many individual instances of disease, unprepared even to follow those who offer him a clue to guide him through the labyrinth. The ingenious inferences of a Laennec, deduced from acoustic observations ; the critical acumen of Copland, collating and balancing the extensive records of curative treatment; the clear and comprehensive conclusions of a Forrey, based upon the comparative statistics of more than three fourths of the earth's surface; the sagacious and instructive reflections of a Holland, are all lost upon him, and he is doomed to blunder on from error to error, from prejudice to prejudice, in the midst of uncertainties and vacillations that render his professional life as miserable to himself as it is full of danger to others. Miserable indeed ; unless, as is often the deplorable fact, he becomes utterly blinded by his self-complacent vanity, and, while he attributes all his failures to inexorable destiny, boasts of his gratifying success. It is impossible to enquire too rigidly into the evidence brought for- ward to establish doctrines of such high import as those upon which the well being of the sick and the protection of the sound are to depend. But here, as in matters of religion, extremes are equally to be dreaded and deplored. Fanaticism must be avoided on one hand, and infidelity on the other ; and faith and reason must proceed in harmony. For my own part, I cannot but regard credulity as the worst enemy of truth in our science; yet^t has suffered greatly, also, from the scepticism which doubts too much. While I urge upon you a careful examination of testi- mony, a severe scrutiny of apparent fact, a strict adherence to the rules of logical induction, and a resolute refusal to listen to mere special plead- ing or argument, however ingenious, which is not fair, open and honest, I would inculcate as well that frank and liberal readiness to concede all that is definitely proved, and to rely with confidence upon all that is reasonably sustained, without which the active business of life cannot be carried on in any one of its numerous departments. Before enter- ing into discussion it behoves "us to settle clearly the nature of the proofs requisite to establish a proposition, and not to make demands dur- ing its progress, upon the advocate of the affirmative, for unattainable or irrelevant support. We should be prepared to weigh justly the seemingly hostile contingencies adduced on both sides, nor hastily deem them incompatible. Above all, we must carefully distinguish between words and things; between actual conditions and the phrases used to denote them. The confusion which you will thus avoid, has been, I fully believe, the source of much of the vacillation, uncertainty and instability ascribed to our art as its chief defect. We employ terms to embrace too large a scope of meaning, and thus include under them opposites, or seeming opposites. Hereafter, for instance, we shall find 14 the words fever, inflammation and irritation uttered and written every < where in this indefinite way ; and when we are told that fever has been treated by one with depleting remedies, and by another with stimulants, while a third has been equally successful with the expectant method, we shall fall into childish wonder or most unphilosophical doubt, until we reflect that the term has been applied by the first to denote a dis- eased state marked by inordinate excitement, by the second to express a condition of which low or feeble action was a prominent element, and by the third a self-limiting affection, devoid of malignity and de- ficient in destructive force. It is for want of attention to these distinc- tions, that so many are led astray by the ignis fatuus of limited experi- ence, uncorrected by reading ; one of the most serious dangers which beset the course of the youthful and enthusiastic practitioner. He will find safety only in the constant and impartial study of the documents offered us by the adherents of all opposite and hostile systems, recollect- ing always that their statements are to be received correctively and for our information ; never for our absolute guidance. We have been recently startled by the views presented of the two ex- clusive systems that enjoy a temporary vogue, both in Europe and Amer- ica, Homoeopathy and Hydropathy, on the part of one of the leading spir- its of our profession in Great Britain, Dr. Forbes, the distinguished trans- lator and annotator of Laennec, and editor of the Medical Journal, for a long while the most influential and widely circulated in the English lan- guage. This gentleman, in his endeavor to seem impartial and just to the few respectable advocates of the new heresies, very nearly ran in-. to a positive denunciation of the time-honored orthodox system, which numbers upon the list of its cultivators the venerated names of Boer- haave, and Sydenham, and Cullen; while pressing his argument against exclusivism, and exhibiting to us the danger of intrusive and too heroic interference in the treatment of the sick; while urging upon his brethren due caution, as to the admission of testimony, and the hasty satisfaction with inferences not warranted, and results not made out, scarcely escaped the dismal plunge into the dark abyss of scio- lism. He recoiled, but not in time; and having made too late the amende-honorable, and explained away his seeming heresies, has failed to reinstate himself in the favorable regard of his brethren. You will find much to warn you, and something to instruct, in the perusal of his writings; which I recommend to you the more readily, because they strike at the very errors to which we are most strongly prone on this side the Atlantic, and where partial and mistaken, lean to such as are not, by any means, likely to prevail among us. Disease, in America, is marked by lineaments as broad and deeply furrowed as the features of our country itself; owing probably to the less artificial state of so- ciety here, and our strongly pronounced habits and energetic modes of life. Heroic practice, as it is styled, is more frequently required in such a community, is more efficient, produces more controllable results, is certainly better borne and safer than in older, denser, more de- pressed populations. It requires to be more or less modified in its application doubtless, to the denizens of crowded cities, the pale and languid votaries of fashion, whose shadowy and undefined maladies, 15 nervous, mimotic, dyspeptic, neuralgic, hysteric, or by whatever appel- lation we designate them, are not inappropriately treated by as unde- fined, infinitesimal, and unimpressive management. But go abroad into our illimitable forests, our ocean-like prairies, our fertile alluvial, miasmatic vallies, and along our endless ranges of mountains, with their barren, cold, rocky sides, and their rich, warm coves, and you will meet with a far different class of diseases; grim, hasty, violent, destructive. Our fevers will kill, in a large proportion of cases, if not arrested artificially; our inflammations tend rapidly to disorganization, and our profluvise to exhaustion, among the hardy and hard-living inhabitants of our wide-spread territory ; with the great majority of whom we shall not be able to avail ourselves of those all important adjuvants of a milder and less efficient system of prac- tice, to be found in a well regulated regimen, judicious nursing, and assiduous care. In our future prelections, you will be informed, that I differ widely on many points from the writer of whom I have been speaking, and that I deprecate earnestly the tendency of the doctrines which he teaches. He would lead us to trust, most delusively as I think, to the assumed property or quality in the organism of a regulated, adapted, or curative opposition to morbid action, known from the earliest times as the vis medicatrix naturae, whose very existence I regard as a fiction, and whose influences, if it exist, those movements, namely, which are ascribed to it, I shall hereafter prove to be blind, unsafe, and more frequently deleterious than beneficial. We will not deny that in a certain proportion of cases, disease sub- sides spontaneously, unaffected, as far as we can judge, by the treat- ment instituted; nor secondly, that it sometimes subsides in spite of the treatment; nor thirdly, that consequently in a certain proportion of cases it would be better to avoid all active interference, especially by the administration of drugs. Thus much we may safely admit, as confirmed by the experience of every physician. But we are led to the farther inquiry, how we are to distinguish between cases in which this agreeable termination will take place, and others of a contrasted tendency. Of some maladies we know well that they are self-limit- ing ; and in the case of these, the simple question is submitted to the practitioner, whether or not the transient storm can be borne harm- lessly. If he decide in the negative, he will surely be bound to in- terfere, either with a view to diminish its violence, or to sustain the constitution under its fury. If in the affirmative, he is content, as in the majority of cases of rubeola and parotitis, to play the part of a mere spectator, or guardian ; or if doubtful, he will follow a cautious, palliative course. Yet even here, if we had remedies in our hands known to be sate and relevant, we would never hesitate to employ them to relieve suf- fering, and restore at once the suspended capacity for action and en- joyment. In the mildest form of Intermittent fever, once thought indeed highly beneficial or sanitary, we exhibit the requisite dose of quinine, to cut it short. We habitually endeavor to jugulate or arrest a common cold by anodynes and diaphoretics, rather than undergo 16 the inconvenience of its ordinary course. No one will bear a pa- roxysm of asthma, though confident of its subsidence in a few hours, if he knows, or thinks he knows, any specific by which he can remove it; no, nor in modern days, will we tolerate the most salubrious fit of gout, without an effort at its suppression. It is our ignorance of the appropriate counter-agent, our unpreparedness to act with definite purpose, that induces us, in any instance, to remain passive under the inflictions of disease. The reasonings and inferences of the writer cited above, do not then, if admitted in all their rational extent, in any measure strike at allopathy, as it is termed, nor even at the most heroic and energetic administration of remedies,—drugs, if you will,— but only at the system of blind interference or promiscuous perturba- tion ; a system which, although followed, alas ! by too many physi- cians, has not among medical writers, so far as I know, a single ad- vocate or defender. In following up our course of therapeutical studies, we shall be somewhat consoled to find that the uncertainty of beneficial adaptation of remedies, on which so much stress is laid, is, at least, partially compensated by an equal uncertainty of their evil operation under all ordinary contingencies. Thus, when we admit the truth of Forbes' second proposition or inference generally, that diseases sometimes spontaneously subside, or as he unscientifically and illogically phrases it, " are cured by nature" in spite of the treatment, which opposes, instead of assisting, the cure ; we must not assume, as he does, not- withstanding his suggestion of philosophical caution, in particular cases without proof, the fact of opposition. This may be, and doubtless often is deceptive, and we are led astray by our assumptions. There are some local congestions looking very like inflammations, which yield promptly to stimulants, disappearing not in spite, but^because of their action. There are neurotic affections, closely simulating the phleg- masiae, which subside not under depletion, but the opposite course. Is it not fair to infer that in some, at least, of the instances in which the apparent paradox has presented itself, it is explicable by our igno- rance ? In the deplorable necessity of guessing, we are not always destined to guess wrong. A seeming inflammation may have been more truly a mere congestion; a simulated phlegmasia may have been a real neurosis. How decide the question in any case, so positively as to affirm that all-powerful Nature had to contend both with disease and remedy, unless we can show their concurrence in her overthrow, and the modes and circumstances attending it? If then we have a reasonable hope of benefit, to set off against the fear of injury, in the more obscure and uncertain class of attacks, and there is no added risk in such as are malignant and desperate of them- selves, and not manageable by the hypothetical vis medicatrix, our prospect is surely encouraging, provided we exert all due caution in graduating prudently the force of our remedial applications, and watch assiduously their effects upon the constitution. The chances being clearly in our favor, I am led to a conclusion directly the re- verse of the sceptical and expectant maintained by Forbes, and avow myself decidedly the advocate of an efficient active allopathy, rational 17 and eclectic. Though far from optimism, I anticipate notable and steady progress to be made by means of perpetual effort, repeated and varied experiment, ceaseless interference; guided and restrained by the ever-present considerations of prudence and discretion. Thus only can we propose to narrow the too extended domains of ignorance and evil; thus only can we expect to make advances or gain triumphs in the endless battle-strife of existence. In this, our great professional contest, I look for aid from every quarter. Medicine has leaned too confidingly upon many of the con- nate sciences; each has proved itself in turn a broken reed, and pierced her. Mechanics, at one period, reigned supreme, and we spent our days in calculating forces, and weights, and measures ; che- mistry at another—and we saw every where acids and alkalies, acri- monies, fermentations and putrefactions; physiology at another, and we explained all phenomena by irritability and sympathy. But, now ! she sits as a queen upon her throne, depending upon no one, but re- ceiving tribute from all. This is her proper station. Excepting only man's moral and eternal well being, there is nothing so highly worthy attention as his physical condition ; no duty so imperative as that of providing him relief from personal suffering. Evil is his inevitable portion here ; what office so glorious and delightful as to remedy and palliate it! If of sound mind and body, no external contingencies, local, social, or political, affect him so closely that he cannot enjoy his share of comfort or happiness; but without health he is inevitably wretched. " How small, of all that human hearts endure, The part that kings and laws can cause or cure," exclaims the poet. It is true, nevertheless, that kings and laws do much good and much evil, though indirectly; and our modern literature is ennobled by its repeated and earnest "efforts to draw attention to the fact. It is, I con- tend, chiefly in their hygienic, not by their political bearings, properly so considered, that governments and their institutions, legislative and social, influence the well being of communities and subjects. If our social institutions are not amended, if war and diplomacy go on as hitherto to absorb all the attention, and consume all the expenditures of governments, to the neglect of the subsistence and comfortable do- mestic condition of the masses, there is great danger that the entire fabric of European civilization will tumble into ruin. Ireland, Spam, and France, already present frightful spectacles; and if we may believe the universal testimony of novelists, statisticians, and philoso- phers, the greatest nations of the eastern hemisphere are already at- tacked by the incipient movements of incurable decline and atrophy. We exist of necessity as a profession ; and our benevolent duties must continue to be performed under all circumstances, propitious or un- friendly Differences must arise and exist permanently as to the modes of their performance, and schools will grow up among the advocates of these separate opinions. But such diversity of sentiment need not run into hostile creeds, need not interfere with our fraternal relations. Urn- 3 18 ted by the ties of philanthropy, and laboring in the same spirit and with the same purpose of doing good, we must bear and forbear with each other, and in turn give and receive instruction. Men may be distinguished as possessing two kinds of talent, the syn- thetic and analytic ; or as they may otherwise be denoted, the inven- tive and the critical. From the one set of minds we receive impulse; they urge forward and impress the movements of the age in which they live j while the others afford us the requisite guidance, restraint and modifi- cation. Truth rarely lies in extremes, and yet no principles can be fully examined or even clearly understood, except through a sort of pro- gress of exhaustion, and by extending them as far as they can be car- ried out, or made to apply. Although myself, by constitution and habit, as well as upon rational grounds an eclectic, and belonging to no sect or school whatever, I ac- knowledge a certain deference and respect for all inventors, all founders of sects and schools. From every one of these we may, nay, we must learn something valuable—they cannot fail to discover, or prove, or dis- prove some doctrine, or dogma, or principle, by the earnest zeal, the ve- hement assiduity with which they press their claims to the merit of originality, or repel some rival claim, or defend an alleged innovation. It is the province of the eclectic, standing aloof from the contest, to trace the course of the discussion, hear both sides, weigh well the ar- gument and, finally, record the result. However unwillingly on the part of the disputants, he is ultimately to be received as umpire; with whatever reluctance on the part of the discoverer, it is he who is to pronounce upon the value of the discovery. The laurels then must be fairly divided ; and while the more brill- iant destiny is undeniably his who enjoys the happiness of having in- vented or suggested an additional means of alleviating the sufferings of our race, yet it would be unjust to declare the position,of the eclectic in any substantial point of view inferior. Most discoveries in therapeu- tics are empirical or the result of accident; few are made under the direction of any known or recognized law. It must be distinctly stated, however, and well understood, that such fortunate accidents are not likely to happen to any but those who search for new truth with per- severing zeal and acute intelligence. Real progress does not consist in mere movement, but movement in the right direction. The advocate may, by his ingenious and well-wrought plea, inform and instruct the judge whom he addresses; yet having attentively heard others in their turn and impartially acquainted himself with the adverse views, the latter may reciprocally instruct and enlighten each of the advocates, by collating and bringing into harmony the scattered truths, which as pre- sented in opposition seemed hostile and imcompatible. The names of Sydenham, Cullen, Abercrombie and Andral are as illustrious and im- perishable as those of Stoll, Brown, Hahneman, or Broussais. But I fear to fatigue you at this our first meeting, and will conclude. During the hoars which we are to pass together here, I shall ask of you, and you will for your own sakes grant me, a patient hearing. Our progress will at first, perhaps, be slow ; the elements of primary inquiry may seem unconnected, the discussion of them may appear desultory 19 and less replete with interest than you had anticipated. But as we go on, we shall proceed to the application of the facts and principles grad- ually accumulated and established; and our investigations will assume a character of greater animation, excitement and immediate utility. I shall rather aim at stimulating than satiating your appetite for knowl- edge ; rather point out subjects for your spontaneous study than indoc- trinate you with the results of my own; rather urge you to effect some- thing by thinking for yourselves than to be content with the possession of themhoughts of others. On my part, I promise to leave no effort unattempted to prepare my- self for the duties which await me; and if I fail in their performance it shall not be for the want of that diligence which I have so earnestly in- culcated upon you. • r"t<" ' *y.' 0 x