TIIEN AND NOW: 
A 
DISCOURSE INTRODUCTORY 
TO THE 
FORTY-THIRD COURSE OF LECTURES 
IN THE 
JEFFERSON MEDICAL COLLEGE 
• OF PHILADELPHIA. 
BY 
S. D. GROSS, M.D., 
PROFESSOR OF THE PRINCIPLES AND PRACTICE OF SURGERY. 
PHILADELPHIA: 
COLLINS, PRINTER, 705 JAYNE STREET. 
1867. CORRESPONDENCE. 
Jefferson Medical College, 
Thursday, October 11th, 1867. 
At a meeting of the Students of the College, held Tuesday evening, October 15, it was 
unanimously 
Resolved, That a Committee be appointed by the President of the meeting to wait upon 
Prof. Gross, and tender him the thanks of the Students for the profit derived from his 
Introductory Address, and to solicit the manuscript for publication 
WILLIAM EKWURZEL, President. 
Henry* W. Streeter, Secretary. 
Professor Samuel D. Gross, 
Dear Sir: It is with great pleasure that we, the undersigned Committee, convey 
to you, on behalf of the Students of the College, the high appreciation with which they 
received your Introductory Address. Desiring to preserve it for future reference, and 
also for the archives of the College, the Committee beg that you will furnish them with a 
copy of the manuscript for publication. 
With high esteem, we remain 
Your obedient servants, 
Alonzo L. Leach, N. J. R. M. Rhea, Tenn. 
M. Albert Rhoads, Penna. W. W. Grant, N. C. 
T. D. Myers, Md. J. Strawn, Cal. 
J. C. Gordon, Ohio. M. II. Cassel, Illinois. 
N. B. Spratt, Miss. S. H. Dickson, S. C. 
H. L. Law, Conn. M. D. Scanlon, N. Y. 
C. R. Mann, Georgia. H. H. Hunt, Maine. 
Jno. Kinnier Patterson, Va. J S. Lewis, Vt. 
S. L. Brooking, Mo. W. F. Vankirk, W. Va. 
L. M. Lovelace, Ky. A. Schott, Prussia. 
A. H. Scott, Ark. W. Botsford, New Brunswick. 
• H. 0. Ogle, Del. A. Maxwell, Nova Scotia. 
L. Baxter, Ind. J. M. Quilez, Cuba. 
Wm. S. S. Gay, Mass. J. Jimenez, Costa Rica. 
W. H. Underwood, Fa. 
S. E. cor. 11th and Walnut Sts., Philadelphia, 
October 18lA, 1867. 
Gentlemen : I have the honor to acknowledge the receipt of your communication of 
the 17th instant, requesting a copy of my Introductory Address. As the Address was 
prepared expressly for your benefit, I take great pleasure in placing it at your disposal ; 
and am, with best wishes for yourselves and the gentlemen whom you represent, 
Very truly, 
Your friend and obedient servant, 
S. D. GROSS. 
Messrs. Leach, Rhoads, Myers, Gordon, Spratt, and others, Committee. THEN AND NOW: A DISCOURSE. 
Two-AND-FORTY years have elapsed since this school, named 
in honor of the immortal author of the Declaration of Indepen- 
dence, was opened for the instruction of medical students; and 
how wrell it has repaid the pains, the cares, and the labors of its 
founders, its faculties, and its guardians, every one acquainted 
with the progress of medical teaching in this city is aware. That 
it had, as all similar institutions, to some extent at least, must 
have, its early struggles, its trials, and its difficulties, nay, even 
its dissensions and domestic broils, is a matter of history; how it 
triumphed over them, and eventually, at no distant day, achieved 
its proud and commanding position, is also known. From the 
time of its reorganization in 1841, the date of its permanent sta- 
bility and glory, its classes rapidly increased in numbers until 
1860, when there were assembled around us 630 pupils, repre- 
senting the different States and Territories of the Union, the 
British Provinces of North America, and several of the proud 
States of the Old World. War is hostile alike to the peace of 
nations, and to the prosperity of scientific and literary institu- 
tions, and it would indeed have been strange if the Jefferson 
Medical College had altogether escaped its late malign influences. 
The surprise is, not that it should have suffered, but that it suffered 
so little. Of the founders of the school, the original faculty 
whose names are attached to my diploma, not one is left; while 
of the faculty which came into power in 1841, and to which the 
College owes so much of its present renown, only two remain to 
adorn their chairs, and to cheer on their younger colleagues in 
their efforts to perpetuate its prosperity and to extend its useful- 
ness. Of these, one, the honored Nestor of the school, will, as 
usual, greet you with his presence this winter, and enlighten you 
with the riches of his knowledge; the other, unfortunately, is 
absent, seeking in a foreign clime the repose which he so much 
needs after the toils and fatigues of more than twenty-five years 
faithfully spent in the service of the Institution. 
My colleagues, whose representative I am on this occasion, 
have imposed upon me the agreeable duty of welcoming you to 
the Halls of my Alma Mater, and of speaking to you a few 
words of advice and comfort; of advice, as a guide to your stu- 4 
dies and to your conduct in the lecture-room; of comfort, to en- 
courage and solace you during the period of your separation from 
your homes and friends. But before I proceed to this subject, I 
desire to call your attention to another, replete, if I mistake not, 
with interest and instruction, and therefore well calculated to serve 
as an introduction to a course of medical studies. I allude to the 
changes and improvements which have taken place in medical 
science since my entrance into the profession in 1828. The 
merest glance at these topics is all that can be attempted within 
the brief space allotted to my discourse. 
The advances in our knowledge in medical science within the 
last forty years are without a parallel in any age. Never was the 
medical profession so busy and industrious, so zealous and enthu- 
siastic, so honest and exact in its views and its results, as it is at 
the present moment. It would almost seem as if the millennium 
were actually close at hand. Look where we may, progress, 
rapid and brilliant, nay, absolutely bewildering, literally stares 
us in the face, and challenges our respect and admiration. One 
is almost ready to exclaim, "Behold, all things are new I" 
The age is proud of its knowledge. It boasts of it in the pub- 
lic prints, in the workshop, in the social circle, in the street, 
everywhere, in season and out of season. It has a hundred New- 
tons, a thousand Franklins. An age which has tamed the light- 
ning, bridged the ocean with steamships, girdled the earth with 
telegraphic wires, and made everything, organic and inorganic, 
subservient to its convenience and enjoyment, has just cause to 
be proud of its achievements ; and yet it would ill become it to 
be arrogant and conceited, or unmindful of the fact that much 
of this knowledge, so much boasted of, is an inheritance, a re- 
flection of the past, a legacy transmitted from sire to son, an ac- 
cumulation of the industry, the genius, and the wisdom of other 
days, crowned with glory and sometimes even with martyrdom. 
We are too much disposed to look with contempt at the know- 
ledge of our predecessors, as if, in reality, they had worked and 
lived in vain, as if all true science had been reserved as a kind 
of special gift to the present generation. If a thick veil could be 
suspended between the past and the present, separating them com- 
pletely from each other, it would be easy to see where we should 
be. Utter darkness would cover the face of the earth. The 
giant would be a dwarf. The sun of science would be overhung 
with clouds and shadows, without one star to guide and direct us 
in our labors. All the experience of Hippocrates, of Sydenham, 
of Hunter, and of Bichat would be lost to us; the Newtonian 
system would be blotted out; civilization would be thrown back 
a thousand years; and the human mind would lapse into barba- 
rism of the worst kind. Knowledge is progressive; it marches 
by slow degrees ; the seed that is sown to-day may not germinate, 
much less fructify, for centuries. It may lie dormant in the earth 
until chance or accident brings it forth in full vigor and perfection. 
The fall of the apple had been witnessed thousands upon thou- 5 
sands of times, but it required the genius of a Newton to deduce 
from it a great law, pervading all matter, all space, from the most 
minute atom to a world, the abode of millions upon millions of 
human beings. The human body had been dissected for ages, 
but no one, until the time of Bichat, the apostle of general ana- 
tomy, had studied the tissues, and applied the knowledge thus 
acquired to the elucidation of pathology and practical medicine. 
Linnaeus, in the last century, was the first to offer a rational classi- 
fication of plants; and it was not until a much later period that 
Cuvier gave us the first idea of the nature of the vast chain 
■which connects, in one unbroken whole, the animal kingdom. 
The discovery of the cell is the work of our own day. 
We look at this curtain as it is waving faintly in the distance, 
and thank God that it cannot shut out from us one ray of light. 
The past and the present are one and indivisible. Individuals 
perish and pass away, generation succeeds generation, but mind 
and its products live forever. 
Commencing our examination with the great department of 
descriptive anatomy, it will be found that fewer additions have 
been made than in any other branch of medical study during the 
last third of a century. The treatises of Boyer, Hildenbrandt, 
and the two Cloquets, published shortly before, or soon after, the 
commencement of my pupilage, almost exhausted the subject; 
and any gaps which they left have since been thoroughly filled 
by the unrivalled, classical works of Cruveilhier and Quain; 
works which are an honor alike to their distinguished authors 
and to the nations which they respectively represent. Descrip- 
tive anatomy has, in fact, attained its ultimate limits of perfection. 
Like Alexander, the dissector may weep that there are no more 
new conquests for him. 
What is true of descriptive anatomy is equally true of surgi- 
cal, relative, regional, or topographical anatomy, founded by 
Desault and John Bell, in the latter part of the last century, and 
so thoroughly worked up in this, especially by Velpeau, Maclise, 
Malgaigne, Morton, Richet, Jarjavay, and Hyrtl. It is questionable 
whether the most painstaking man, however earnestly or zea- 
lously engaged in dissections, could add one particle of real value 
to the knowledge which now, thanks to the labors of these and 
other anatomists, exists upon this subject. The exploration has 
been most complete in every direction. 
The anatomy of the tissues, commonly known as general ana- 
tomy, or histology, first systematically studied and described by 
Bichat, at the dawn of the nineteenth century, has also nearly, if 
not entirely, attained its highest degree of perfection. Future 
observers may correct some portions of our knowledge, but it is 
not probable that any very important additions will be made to 
it, however patiently and earnestly they may prosecute their in- 
vestigations. 
When we reflect upon the vast importance of this science, and 
upon the great revolution it has effected in physiology, pathology, 6 
and practical medicine, we are struck with wonder and. amazement 
to find that it was, in great measure, the result of the labor and 
genius of a single individual, and our surprise is not a little in- 
creased when we learn that that individual perished at the early 
age of thirty years, a victim to excessive toil and boundless 
enthusiasm. 
Marie Francis Xavier Bichat, the founder of this science, was 
one of the great master spirits of his age. His gigantic mind 
grasped, with equal power, anatomy, physiology, pathology, medi- 
cine, and surgery. The fire of his composition, often, like that 
of his great prototype, John Hunter, neither elegant nor correct, 
his profound knowledge of the structure and functions of the 
human frame, and the novelty and boldness of his enunciations, 
left him without a rival. Evoking order out of chaos, he enriched 
and fertilized the commencement of the nineteenth century with 
the great variety and vast extent of his discoveries, and accom- 
plished in a few short years the work of a long lifetime. Prior 
to his time histology had no veritable existence. If it had, as some 
have alleged, been foreshadowed by the labors of Bordeu, Pinel, 
and Carmichael Smith, it lacked the proportions and finish of the 
stately science which it assumed in the hands of the illustrious 
Frenchman. 
The death of Bichat was a national calamity. Corvisart, in 
announcing the sad event to Bonaparte, then first consul, ob- 
served : " Bichat has fallen on a field of battle which numbers 
many a victim; no one has done in the same time so much and 
so well." Besides his great work on general anatomy, written and 
published within less than two years, he left a monograph on life 
and death, a system of descriptive anatomy in four volumes, and 
a number of valuable papers as contributions to the periodical 
press. He also edited, with notes and commentaries, the surgical 
tracts of Desault, and composed a small treatise on pathological 
anatomy, which was given to the world after his death. Such 
was Bichat, who, had his life been spared a few years longer, 
would have become the most illustrious physician and medical 
philosopher the* world has ever produced. 
The only work on pathological anatomy, accessible to the 
American student, in my early professional life, was that of Dr. 
Mathew Baillie, who for many years stood at the head of the 
medical profession of London, where, after a life of great useful- 
ness and honor, he died in 1824. It was comprised in a small 
octavo volume, illustrated by an atlas of plates, the former of 
which was republished in this city soon after its appearance in 
Great Britain, and served for a long time as the only guide to the 
study of morbid anatomy in this country. The work of Baillie 
was succeeded, in 1829, by the treatise of Dr. William II. Horner, 
Professor of Anatomy in the University of Pennsylvania, and this, 
in turn, by the Elements of Pathological Anatomy by the present 
incumbent of the Surgical Chair in this College. Since that time 
works, almost without number, some of them, as those of Cru- 7 
veilhier, Carswell, and Lebert, of the most magnificent and costly 
character, have appeared, and have served to elevate the study of 
morbid anatomy to the highest position among the kindred pur- 
suits. If Bonnetus and Morgagni, the founders of this science, 
could rise from the dead and witness the astounding progress which 
this department of human knowledge, so essential to a correct in- 
terpretation of the nature and seat of disease, has made within the 
last thirty years, they could not accuse their successors either of 
neglect or indifference in this respect. Although the field is still 
open, inviting further research, the clouds which so long over- 
shadowed it have been effectually dispersed, and have revealed a 
glorious sunlight, the rays of which have pierced every recess of 
the healing art with their benign and renovating influence. 
The most curious and interesting discovery in anatomy in 
modern times is that all animal and vegetable substances essen- 
tially consist of cells, of variable size, shape, and structure, and so 
minute as to be visible only with the aid of the microscope; an 
instrument first applied as an aid to anatomy by Leeuwenhoeck 
in the seventeenth century. A number of observers had long 
ago suspected the existence of such bodies, but it was*not until 
the researches of Schleiden, in 1837, and those of Schwann, a 
little later, that the fact was fully and satisfactorily established. 
This discovery, with the progress of which the name of a young 
American physician, long since deceased, Dr. Waldo J. Burnett, 
of Boston, is honorably associated, has led to vast changes in our 
anatomical and physiological knowledge, and to the adoption of 
certain views in pathology, the extent and importance of which 
no human sagacity is at present able to penetrate. The cellular 
pathology has already, under the plastic genius of Virchow, of 
Berlin, awakened a vast deal of inquiry, rapidly pushed on by 
men of the highest capacity in all parts of the civilized world. 
The cells of the human body exist not only in the natural tissues, 
but also in abnormal growths, and one of their characteristic fea- 
tures is their wonderful power of proliferation, by virtue of which 
they multiply with extraordinary rapidity, both in health and 
disease. The doctrine of the schools now is that everything 
emanates from a cell-omnis cellula e cellula; that is, where a new 
cell is there must have been a cell previously, "just," to use the 
language of the German Professor, "as an animal can spring only 
from an animal, a plant only from a plant." These researches, 
the result of the successive improvements of the microscope, and 
of a more careful application of that wonderful instrument, which 
has endowed man almost with a new sense, have clearly demon- 
strated the cellular nature of all vital processes, vegetable and 
animal, physiological and pathological, and the unity of life in 
the elementary forms of all organized beings, if not also the unity 
of disease in all organs and tissues. 
If, at the commencement of my professional life, there was any 
one department of medical science in a more unsettled and unsatis- 
factory condition than another that department was physiology, 8 
and it cannot be denied by any one at all familiar with the subject 
that much of the uncertainty which then enshrouded it still con- 
tinues, notwithstanding the vast amount of labor, talent, and 
genius expended in the efforts to elucidate it. It is a department 
which, to borrow the language of Lord Bacon, in reference to 
medical science in general, has been more labored than advanced. 
Nor need this at all surprise us. The secrets of nature are not 
easily unlocked. She is slow in unveiling herself to the gaze 
even of the most patient, zealous, and philosophical inquirer. Her 
modesty shrinks as the maiden at the approaches of her lover. 
She loves to flirt and to coquet with her votaries, and not unfre- 
quently blinds and disappoints them upon the very threshold of 
some grand discovery. 
Our knowledge of certain portions of physiology was as perfect 
thirty years ago as it is at this moment. No real light, for exam- 
ple, has been thrown upon the mechanism of the circulation of 
the blood in the heart and large vessels as disclosed by William 
Harvey in 1629. He literally exhausted the subject. Concerning 
the circulation of the blood in the capillaries, and even of the 
structure of these tubules, our knowledge is to-day very little, 
if any, in advance of what it was a third of a century ago. Of 
the functions of digestion, respiration, calorification, and genera- 
tion, not to mention others, a similar remark may be made. 
The greatest advances that have been made in recent times in 
physiology relate to the functions of the nervous system. Within 
the last twenty years many facts have been explained that were 
formerly entirely unknown. When I attended my last course of 
lectures in this school, the brilliant discoveries of Sir Charles Bell 
and Magendie just began to attract the attention of the medical 
teachers of this country, and I well remember with what enthusi- 
asm the professor of anatomy and physiology dwelt upon the 
genius of the two men who were thus gradually opening to the 
gaze of their professional brethren a mine of incalculable riches 
to medical science. It required the labor of ages to determine 
the interesting and important fact that the two sets of nerves, 
emanating from the brain and spinal cord, are endowed with dif- 
ferent functions, one with the faculty of motion, the other with 
sensation, and yet the very arrangement of these nerves, and their 
peculiar mode of origin, would, one might now suppose, have, 
generations ago, furnished a satisfactory clue to this fact without 
any necessity for the elaborate experiments that were performed 
by the English and French philosophers. Of the nature of reflex- 
motor action, first brought under notice by Dr. Marshall Hall, and 
a knowledge of which is of such vast consequence in a practical 
point of view, nothing was known thirty-five years ago. 
In 1847, Schroeder Van-der-Kolk discovered the wonderful law, 
of so much value in the application of electricity to the cure of 
muscular paralysis, that " whenever a mixed nerve furnishes fibres 
to a group of muscles, its sensitive fibres are distributed to the 
corresponding portion of the skin." Another valuable discovery 9 
has been made by Schiff. By a series of well-conducted experi- 
ments he has proved that the "gray substance of the posterior 
fibres transmits the sensation of pain, while the white fibres are 
devoted to the transmission of tactile impressions." The know- 
ledge thus elicited enables the practitioner at once to explain, in 
any particular case, the nature and seat of what is called locomotor 
ataxy, a peculiar affection of the spinal cord, liable to occur at all 
periods of life, both as the result of disease and accident. The 
discovery of the reflex-secretory action of the nervous system, a 
discovery almost as brilliant as that of Marshall Hall, above 
alluded to, was the work of our distinguished countryman, Pro- 
fessor Campbell, formerly of Georgia, now of New Orleans, by 
whom it was originally announced, in an able and elaborate paper 
read before the American Medical Association, in 1857. 
If time permitted, reference might here very properly be 
made to many other recent discoveries in this department of 
anatomy and physiology, the value of which it is impossible even 
now to conjecture. The names of Brown-Sequard, Pannizza, 
Longet, Claude Bernard, Van Deen, Ludwig, Stilling, and Volk- 
man are indelibly identified with these important advances in 
this interesting, branch of biology. Much of what is now obscure, 
and consequently imperfectly understood, will, no doubt, ulti- 
mately be cleared up, not so much, probably, by experiments 
upon the inferior animals, at present so much the rage, as by care- 
ful clinical study, or, in more comprehensive language, by a more 
enlightened interpretation of the phenomena of morbid action, a 
method of inquiry which accomplished so much in the hands of 
Sir Charles Bell and Marshall Hall in unravelling the functions 
of the nervous system. 
It is only a short time since the vitalists and the chemists vied 
with each other for the ascendency in physiology, the former 
referring all the processes in the animal economy to the operation 
of a living sentient principle, the latter almost exclusively to the 
effects of chemical agency. Here, as in nearly all other extremes, 
the truth lies in the middle. Nevertheless, there are, even now, 
notwithstanding our increased light, some who assert that the 
human body is a mere machine, wholly independent of vitality; 
that the circulation of the blood is a mere hydraulic operation, 
explicable by the ordinary laws of physics; that the lungs are 
nothing but a furnace for the consumption of oxygen and the 
generation of carbon; that the stomach is a mere laboratory, and 
digestion a purely chemical process; in short, that the brain is a 
storehouse for the manufacture of Dutch toys and Yankee notions. 
In chemistry, how vast the changes since the time of Gay-Lus- 
sac and Thenard, the founders of modern chemistry! Forty years 
ago organic chemistry had a vague and undefined existence; its 
facts were comparatively few and undetermined. To-day it pre- 
sents a bold and majestic front, with the word "Progress" in- 
scribed upon it in large and indelible letters, its destiny being in- 
dissolubly connected with industry, agriculture, medicine, the fine 10 
arts, and humanity. It is, in fact, the great lever of human pro- 
gress. To two men, more particularly, is the world indebted for 
the salutary impulse communicated to organic chemistry within 
my time-Baron Liebig, who made the little town of Giessen for 
years a centre of intellectual attraction, and Mons. Chevreul of 
Paris, a man who has established for himself an imperishable re- 
putation as a profound thinker and an original investigator. 
My colleague, Professor Rand, has been so kind as to give me 
a synopsis of the more important improvements that have been 
made in chemistry since 1830. From this it appears that nearly 
all the apparatus now used consists of glass, cork, and caoutchouc. 
Volumetric and spectral analyses have been introduced; the former 
of marvellous rapidity and great accuracy, the latter of a delicacy 
before unthought of. By it the new metal csesium was detected 
in a mineral water of which it could not have formed more than 
the 100,000,000 part by weight. It is the agency now employed 
for studying the composition of the sun and stars. An immense 
number of new compounds have been discovered, and the syn- 
thesis of over one thousand organic compounds effected. Chemi- 
cal preparations, of uniform strength and efficiency, and of small 
bulk or slight taste, have, in many cases, replaced the cumber- 
some and uncertain Galenical preparations of the Pharmacopoeia, 
as, for example, the alkaloids and their salts, now so much used 
in the treatment of disease. Iodine and bromine, although pre- 
viously known, were not generally employed. Chloroform, dis- 
covered almost simultaneously in America and France, is of later 
date. The cause of contagion has been studied, and a rational 
system of disinfection established. 
The manufacture of matches, gun-cotton, collodion, and gutta- 
percha goods, the vulcanization of caoutchouc, and the invention of 
the telegraph and of photography are all due to the recent pro- 
gress of chemistry. The application of chemistry to agriculture 
and physiology, by Liebig, Dumas, Mulder, Lehmann, and others 
has completely changed the face of these two departments of know- 
ledge. The researches of Von Meyer, Joule, Grove, Helmholz, and 
others have established the great doctrine of the correlation of force, 
and given the mathematical relation between heat and work. The 
undulatory theory of light has been physically proved by Fizeau 
and Foucault. The inquiries of Ohm have brought the laws of 
voltaic electricity within the domain of mathematics. 
The materia medica has been purged of many of its crudities, 
and attained a more exalted position. The vast accessions which 
it has received consist, not so much in the addition of new articles, 
properly so considered, as in new combinations of many of those 
long known and accredited. Some idea of the remarkable changes 
that have been effected in this department, within the last thirty 
years, may be formed when it is stated that my learned colleague, 
the Professor of the Institutes of Medicine, has written a large 
octavo volume of upwards of seven hundred closely printed pages 
upon what are called new remedies. Every vegetable and mineral 11 
has been laid under contribution; chemistry has lent its power 
of analysis and refinement; and physicians, in quite a number of 
instances, as in the cases of Fountain and Hammond in our own 
country, have not hesitated to perform dangerous experiments 
upon their own persons to test the virtues of the new candidate 
for favor and adoption into the family of medicines. Time 
would fail me if I were to attempt even an enumeration of the 
more important additions to our modern Pharmacopoeia. The 
most valuable, unquestionably, are the preparations of iodine, 
potassium, bromine, iron, aconite, and veratrum viride, of the 
efficacy of which, in controlling morbid action, no one not fami- 
liar with their use can form any just estimate. The discovery of 
cod-liver oil has been a great boon. Employed freely in the 
earlier stages of phthisis, there is probably no remedy which ex- 
ercises so salutary an influence over that ruthless disease in ward- 
ing off the fatal issue. 
One of the most remarkable discoveries of the age is that 
medicines introduced into the subcutaneous cellular tissue act 
much more speedily and forcibly than when taken by the stomach 
or the rectum. The operation is performed with a small pocket 
syringe, the nozzle of which terminates in a very sharp point, 
so that the skin may be easily penetrated without pain. A pa- 
tient racked by sciatica, gout, or cancer is relieved in a few 
minutes by the hypodermic use of a third to a half grain of mor- 
phia. One grain of quinine thrown under the skin makes a much 
stronger impression in warding off an attack of malarial fever 
than five times that quantity introduced into the stomach. The 
probability is that we shall be able, ere long, to purge and vomit 
our patients by this simple and elegant method of medication, 
whose practical history extends back no further than 1859, when 
attention was first directed to it by Mr. Charles Hunter, in the 
London "Medical Times and Gazette" for that year. 
In no department of the healing art has there been greater pro- 
gress, with sound, healthful improvement, during the period under 
review, than in the treatment of diseases of the uterus, a class of 
affections really very little understood, even by the most enlight- 
ened practitioners, in the first third of the present century. The 
change has, indeed, been marvellous. Our knowledge of these 
disorders, so frequent in their occurrence, and in their conse- 
quences so harassing and distressing, was, until within a compara- 
tively recent period, in a great degree conjectural. The only aid 
invoked in their investigation was the sense of touch, and even 
that was often rejected by the over-sensitive female from motives 
of false delicacy. The result may easily be guessed. As was the 
diagnosis, so was the treatment; if the one was erroneous, how 
could the other be correct? It is an axiom in medicine not to 
prescribe for a malady before we have ascertained its true nature 
and seat; and although this is not always practicable, yet the rule 
is not the less true. 
The marvellous changes here referred to are all due, mainly, if 12 
not wholly, to the employment of the speculum, an instrument 
well known to the ancients, but long lost and forgotten. Delinea- 
tions of it were found upon the walls of Pompeii and Hercula- 
neum ; and Paul, of JEgineta, alludes to the d-ioptra, a form of 
speculum, as an instrument in general use in his time for examin- 
ing the vagina and uterus. Ambrose Pare has given an account 
of a uterine speculum, accompanied with several drawings, in his 
great work on Surgery, published towards the close of the six- 
teenth century. Mention of it also occurs in some of the older 
treatises on midwifery. Through false notions, however, of pro- 
fessional delicacy it had fallen into disuse until restored in 1822, 
by Professor Recamier, of the Hotel-Dieu, of Paris. In this 
country the speculum was first employed by Dr. Sharpless, of this 
city, in 1835, soon after his return from Europe, where, especially 
in the large venereal wards of Mons. Ricord, he enjoyed ample 
opportunities of witnessing its application, and of appreciating its 
great value as an aid in diagnosis.. The practice met for a while 
with much opposition and even abuse. Now every one em- 
ploys it. 
Sounding of the uterus, as a means of ascertaining the existence 
of disease in its interior, is of still more recent date, hardly thirty 
years having elapsed since attention was first directed to it by 
Mons. Lair, of Paris. When we reflect upon the great value of 
these examinations, now universally practised, it is amazing that 
they should have been so long overlooked and neglected. 
Dr. James H. Bennet, of London, nearly a quarter of a century 
ago, justly remarked that the discovery of auscultation and per- 
cussion by Avenbrugger and Laennec had hardly produced so 
great a change in thoracic pathology, great as that change has 
been, as the application of physical exploration in uterine dis- 
eases was destined to effect in this extensive and important depart- 
ment of medical science. This prediction, made in the true spirit of 
enlightened progress, was years ago amply verified. No educated 
physician now attempts to diagnosticate a disease of the uterus 
or vagina without the aid of the speculum. This instrument, so 
simple in construction, and so easy of application, has brought to 
our aid an additional sense in the investigation and treatment of 
this class of maladies. It has, in fact, produced not merely a 
change but a thorough revolution, alike honorable to the profes- 
sion and of inestimable value to poor suffering woman. 
The only monograph on female diseases, thirty-five years ago, 
accessible to the American student, was that of Dr. Dewees, even 
then far in arrear of the existing state of the science. On inflam- 
mation and ulceration of the uterus, as revealed by the speculum, 
the work was entirely silent; nor did it contain any information 
respecting the operative surgery of that important organ, a sub- 
ject so admirably handled by Sir James Y. Simpson, Dr. I. Baker 
Brown, and, above all, by our distinguished countryman Dr. J. 
Marion Sims, whose excellent treatise is far in advance of any 
work of the kind ever published. To him, and to Dr. James II. 13 
Bennet the world owes an immense debt of gratitude; to the for- 
mer for the important services which he has rendered to the ope- 
rative surgery of the genito-urinary apparatus of the female; to 
the latter for his masterly work on inflammation of the uterus, 
originally issued in 1845, in which he was the first to make known 
to the physicians of Great Britain and the United States the diag- 
nosis and treatment of the organic diseases of the womb, until 
then very imperfectly understood, and for the most part wretchedly 
mismanaged. To my former colleagues Professor Charles D. Meigs, 
for many years one of the chief pillars of this school, Professor 
Henry Miller, the distinguished obstetrician of Kentucky, and 
Professor Gunning S. Bedford, the able teacher and writer, great 
credit is due for their exertion to popularize the use of the specu- 
lum in this country. Professor White, of Buffalo, a gentleman 
ever alive to the progress of science, and the interests of humanity, 
also deserves honorable mention in connection with this subject. 
Ovariotomy, a conquest of modern times, is an American ope- 
ration, first practised in 1809, by Dr. Ephraim McDowell, of 
Danville, Kentucky. He performed the operation altogether 
about thirteen times with a success highly flattering to his skill. 
After a Rip-van-Winkle sleep of nearly a quarter of a century, 
ovariotomy woke up one morning and found itself suddenly 
famous. Revived by Mr. Clay, of Manchester, it has, mainly 
through the influence of his labors and writings, become one of 
the most common of the capital operations, and is almost univer- 
sally acknowledged as one of the greatest triumphs of modern 
surgery. The mortality, now that the after-treatment is so well 
understood, is much less than formerly, the ratio being about one 
death in three cases and a half, thus comparing most favorably 
with the results of many of the more severe operations. 
Valuable improvement has been effected in the treatment of 
puerperal peritonitis. Instead of copious abstractions of blood 
with the lancet, thereby draining the system rapidly of its vital 
fluid at a time when it can be ill-spared, most practitioners at the 
present day place their chief reliance upon the exhibition of opium 
in large and frequently repeated doses, and upon the application 
of leeches and of stupes of turpentine and laudanum to the abdo- 
men. For the introduction of the opium treatment of this disease 
we are mainly indebted to Professor Alonzo Clark, of New York. 
The practice of midwifery, properly so called, has experienced 
many salutary changes. The use of anaesthetics, and a better 
comprehension of the powers of nature, have greatly simplified 
the duties of the accoucheur, and have furnished him with more 
enlightened views of the mechanism of parturition. The forceps, 
that " noble instrument," to use the designation of Chapman, the 
original inventor, were seldom employed thirty-five years ago, 
except in cases of very tedious labor, and even then compara- 
tively infrequently, nature being generally regarded as fully com- 
petent to the task of expelling the child without such aid. In a 
long practice of this kind, at one time quite extensive, I never 14 
had occasion to use the forceps in a solitary instance among my 
own patients, and a still-born child, from protracted retention of 
the head, was one of the rarest of occurrences. Now, almost every 
physician, young or old, ignorant or educated, applies the instru- 
ment if the labor is at all tedious. In a recent medical journal Dr. 
Hardie, of Scotland, is stated to have applied the forceps in 28 out of 
100 cases of labor simply to abbreviate anxiety and pain. Of the 
propriety of such a procedure it is not my business here to ex- 
press an opinion. The able gentlemen in charge of this depart- 
ment will, during the course of the winter, afford you all the light 
you may require upon the subject. I may, however, be pardoned 
for expressing my conviction that a more cautious reserve in the 
use of this instrument-an instrument that may be wielded for 
evil as well as for good-would conduce alike to the interests of 
humanity and the credit of obstetric practice. The advocates of the 
employment of the forceps, as a prophylactic measure, to save the 
child, and thus prevent the ill effects that might arise from delay, 
constitute, unfortunately, as it seems to me, a very numerous and 
influential class at the present day. 
Until recently, great difficulty was frequently experienced in 
effecting reduction of the umbilical cord in cases of prolapse. 
The operation is now, thanks to Professor Gaillard Thomas, of 
New York, a very easy one, all that is necessary being to place 
the parturient female upon her knees and elbows, so as to throw the 
breech beyond the level of the rest of the body, when, by a little 
manipulation, the object may promptly be attained. By a similar 
expedient Dr. E. R. Maxson, of the State of New York, has readily 
succeeded in converting shoulder into natural presentations. 
Midwifery, in the latter part of the last century, was taught by 
Smellie, of London, in four lectures at 10s. A paper lantern, 
suspended at the door, served to direct the young aspirant after 
obstetric honors to the amphitheatre of the learned professor. 
When the University of Pennsylvania was organized in 1764, no 
special provision was made for teaching this dignified and import- 
ant branch of the healing art, and it was not until 1812 that it 
was considered worthy of holding a distinct place in the curricu- 
lum of the institution, known as the mother of American Medical 
Schools. The fact is, the practice of midwifery was long regarded 
by many of the leading medical men of the country as a positive 
degradation. 
Great improvement has taken place in the physical and medical 
treatment of children. I well recollect the time when these little 
creatures were looked upon, apparently, as if they were abso- 
lutely destitute of the ordinary qualities of our nature; as if they 
were hardly human beings. Their early education was shame- 
fully mismanaged; and their diseases, generally ill-understood, 
were treated in the most harsh, cruel, and unscientific manner. 
Overdosing, ill-ventilation, and underfeeding were the order of 
the day. It often made one's heart ache to see these little starve- 
lings in their mothers' and their nurses' arms, looking like so many 15 
picked chickens, destitute of flesh and blood, fed upon calomel, 
and deprived of proper food and drink. One of the greatest dis- 
coveries of modern times is that children have stomachs! 
In surgery, in all its branches and ramifications, not only great 
advances, but vast improvements have been made; improvements 
as brilliant as they are honorable to the genius, intelligence, and 
enterprise of their authors. A mere glance at this subject must 
suffice for this occasion. 
In 1824, Civiale performed, for the first time, the operation of 
lithotripsy-improperly called lithotrity by our cousins across the 
waters-and from that period until his death, on the 13th of June 
last, he employed it upon upwards of sixteen hundred persons, with 
what result has not, thus far, transpired. Although Gruithuisen, a 
Bavarian physician, had, in 1813, called the attention of the pro- 
fession to the practicability of crushing stone in the bladder without 
a resort to the knife, yet to the French surgeon, who was for up- 
wards of a third of a century the acknowledged leader in this field 
of practice, is mainly due the merit of having brought the opera- 
tion to its present degree of perfection. This is not the place for an 
account of the manner of executing the operation, for a compara- 
tive view of its statistics, or of the estimation in which it is held 
by the profession. It is sufficient to add that its claims have 
been fully settled, and that it justly ranks among the acknow- 
ledged triumphs of surgery. 
In lithotomy, the gorget, the favorite instrument of Physick, 
Gibson, and Dudley, has been superseded by the knife, and the 
operation, as now generally performed, is, in every respect, more 
simple than it was forty years ago. 
The treatment of aneurism has been much improved, and ren- 
dered less dangerous to limb and life. The Hunterian operation, 
which, taking all the arteries together, furnished an average mor- 
tality of about one in four, is now comparatively seldom per- 
formed ; mechanical and digital compression, forced flexion, and 
other processes having taken the place of the ligature. For the 
revolution-for so it may justly be termed-which has been thus 
effected, all honor is due to the Dublin surgeons, particularly to 
Hutton and Bellingham, the latter of whom, in a short tract 
issued in 1847, was the first to point out, upon correct and scien- 
tific principles, the manner in which compression acts in curing 
the disease. 
Acupressure, devised a few years ago by Sir James Y. Simpson, 
as a substitute for the ligature, which has so long enjoyed the 
confidence of surgeons as a means for preventing and arresting 
hemorrhage, is a contrivance the precise value of which is still 
undetermined. Much has been said and written in commendation 
of it, especially by its ingenious inventor; and in a monograph 
published within the present year by Professor Pirrie and Dr. 
Keith, of Aberdeen, numerous cases are related illustrative of its 
great advantages, with an expression of the hope that it will, ere 
long, come into general use. I have myself, however, no idea 16 
that it will ever entirely, or even in any considerable degree, 
supersede the employment of the ligature. When the prejudice 
incident to the introduction of all novelties shall have subsided, 
the profession will be better able to form an unbiassed judgment 
of its real utility. 
There are, as is well known, various articles of the materia 
medica, endowed with hemostatic properties, but all these are as 
nothing compared with the wonderful effects of subsulphate of 
iron, or Monsel's salt, so-called after a chemist of Bordeaux, who 
was the first, a few years ago, to call attention to the subject. 
Having employed this substance in numerous instances, I am 
thus able to bear testimony, from personal experience, to its 
astonishing virtues. It has already saved many lives. 
The treatment of syphilitic diseases has undergone many 
changes. Mercury, formerly so generally and so copiously ad- 
ministered for the relief of primary and secondary symptoms, is 
now rarely given, except in the hard variety of chancre, in which 
the induration obstinately resists the ordinary measures, or the 
phenomena are such as to justify the belief that the virus is still 
insidiously at work. The secondary accidents, at least in my own 
hands, commonly yield to the ordinary antiphlogistic remedies. 
For the cure of the tertiary variety of the complaint the iodides, 
as they are denominated, introduced to the notice of the profession 
by Mons. Bicord, of Paris, have proved most effectual, especially 
when, as has long been my practice, they are combined with a 
minute quantity of bichloride of mercury, the very mildest and 
most innocuous of all the forms of that important salt. The in- 
oculable character of secondary syphilis, formerly so strenuously 
denied, is now generally admitted, while the duality of chancre, 
a subject of so much angry discussion during the last fifteen 
years, is still a mooted question. 
The treatment of cancer stands precisely where it did forty years 
ago. While our knowledge of the histological and microscopical 
characters of the disease has been vastly extended by modern 
research, our means of arresting and curing it are as impotent as 
ever. The treatment of cancer by the hypodermic injection of 
acetic acid, introduced a short time ago by Mr. Broadbent, of 
London, and from which so much benefit had been anticipated, 
has signally failed; and there is at present no reason to believe, 
from what is known of this horrible malady, that science, in its 
onward progress, will throw any useful light upon its mode of 
management. 
The management of fractures of the leg and thigh is much 
better understood than formerly. The treatment by adhesive 
plaster, pulley and weight, recently utilized by Dr. Swinburne 
and Dr. Buck, of New York, and now commonly known as the 
American method, is rapidly gaining confidence, and will proba- 
bly, at no distant day, meet with general approval. Its sim- 
plicity is only equalled by its efficacy. The anterior splint, 
introduced by Professor N. R. Smith, of Baltimore, deserves 17 
favorable mention in connection with the treatment of fractures 
of the lower extremity, as its merits are no longer questioned by 
any one acquainted with its character and mode of application. 
Its utility was amply tested, in numerous instances, during the 
late war, especially in the treatment of gunshot and other compli- 
cated fractures of the thigh and leg. Of the value of adhesive 
plaster, as a means of effecting extension and counter-extension 
and securing quietude to the parts, I shall have occasion to speak 
fully during the course of the winter. It is sufficient here to say 
that I was the first to describe and recommend this method of 
treatment as early as 1830, and that it is one of the greatest addi- 
tions to practical surgery of the present day. Another valuable 
improvement, in the treatment of fractures of the lower limbs, is the 
starch bandage; or, what is still better, the plaster-of-Paris band- 
age, originally used by the Moors of Spain, and reintroduced to 
the notice of the profession, in 1829, by Professor Kluge, of Berlin. 
Within the last twelve years the subject of subperiosteal resec- 
tion of entire bones, or of portions of their shafts, and even of 
joints, has attracted considerable attention, the operation being 
founded upon the well-known agency exerted by the periosteum 
in the regeneration of osseous tissue. Koehler, Troja, Weide- 
mann, and many other of the older surgeons, were well ac- 
quainted with this property of the periosteum, and numerous 
cases are referred to in their writings in which entire bones were 
reproduced after necrosis. Professor James R. Wood, of New 
York, has recorded an instance of the complete regeneration of the 
lower jaw after its removal for phosphorus disease, the periosteum 
being left intact. If we may credit the assertions of certain 
writers, as Ollier and Sedillot of France, Creus of Spain, Larghi 
of Italy, Langenbeck, Neudorfer, and Lucke of Germany, the 
procedure has already achieved wonders. I have myself, in 
all the numerous operations that I have performed during the 
last thirty years for the removal of dead bone, scrupulously re- 
spected this envelope, and I presume that there is not an enlight- 
ened surgeon anywhere who has not pursued a similar plan of 
treatment. The subject of the transplantation of the periosteum, 
so thoroughly worked up by Ollier, who lately published a large 
and costly treatise upon it, is comparatively new in this country, 
but will no doubt soon seriously engage the attention of the pro- 
fession. For my own part, I am disposed to place very little 
confidence in the merits that have been ascribed to it. 
The reduction of dislocations by manipulation, a plan of treat- 
ment popularized by Dr. Reid, of Rochester, has superseded the 
brute force by the pulley; and chloroform, the employment of 
the lancet, the hot bath, and tartar emetic. 
The treatment of diseases of the joints has experienced import- 
ant changes; pus is freely evacuated with the lancet by direct in- 
cision ; coxalgia is treated by perfect quietude of the correspond- 
ing limb, by what is, absurdly enough, styled elastic extension; 
and permanent anchylosis, even in some of its worst forms,, is. 18 
readily remediable by comparatively safe and simple measures. 
The names of Davis, Taylor, Sayre, and Bauer merit honorable 
mention in connection with these improvements. 
The wire suture, concerning which so much has been said and 
■written of late years, although a valuable addition to our arma- 
mentarium, is now less frequently used than formerly, and the 
opinion seems to be gaining ground that metal possesses little, if 
any, superiority over ordinary silk. If it is less irritating than 
silk, it has the disadvantage of being less easily removed from 
the wound. Where long retention of the suture is required, as 
in the operation for vesico-vaginal fistule, the wire suture is, in 
my opinion, justly entitled to preference. 
The perineal section, devised by Desault, and revived by Mr. 
Syme, has been proved to be the only trustworthy method of 
treatment for the relief of very tight and obstinate strictures of 
the urethra, especially when complicated with perineal fistule, 
and great local and constitutional suffering. The operation, which 
requires an accurate knowledge of the anatomy of the parts for 
its successful execution, seldom disappoints expectation, and, thus 
far, the mortality has been very slight. 
In ophthalmology vast progress, if not great improvement, has 
been made. Of the immense activity at present going on in this 
interesting department of surgery, some idea may be formed, 
when it is stated that in 1865 one hundred and thirty-seven tracts 
were published upon it, and not less than two hundred and 
twenty-four in 1866. In some of the schools, ophthalmology 
enters into the regular curriculum of a medical education. Paris, 
Berlin, and Vienna are the great centres of this kind of teaching, 
to which students from all parts of the world flock to avail them- 
selves of its supposed advantages. It is, however, worthy of 
remark that many of the operations recently introduced into this 
department are still on trial at the bar of public opinion, and that 
a long time must necessarily elapse before their actual value can 
be fully determined, notwithstanding the great attention they are 
everywhere receiving. With the advances of ophthalmology 
are honorably associated many distinguished names, but for the 
first great impulse our acknowledgments are mainly due to Von 
Graefe, the celebrated oculist of Berlin, who, as an ingenious and 
accomplished operator, enjoys an unrivalled reputation. 
Orthopoedic and conservative surgery are modern creations. 
Dr. Louis Stromeyer, of Hanover, in 1831, proved, by a series of 
well-conducted experiments upon the inferior animals, that ten- 
dons, divided subcutaneously, readily unite without the interven- 
tion of serious inflammation, and he thus founded a new depart- 
ment of surgery, known ever since as orthopoedic surgery. All the 
operations for clubfoot and analogous distortions, performed prior 
to this period, had signally failed, because they were not based 
upon correct scientific principles. 
Thirty years ago conservative surgery had hardly an existence, 
not for the want of conservative teaching and practice, but be- 19 
cause the professional mind was not prepared for its reception. 
Dr. Physick, justly styled the Father of American Surgery, was 
an eminently conservative practitioner, and he spared no efforts, 
in his lectures, to inculcate the importance of the subject. He 
was himself, however, no writer, and at that time there were 
neither clinics nor clinical reporters to disseminate his doctrines. 
Hence his teaching fell upon barren soil, and the merit of found- 
ing conservative surgery has been awarded to other laborers. 
Formerly thousands of limbs were sacrificed which would now, 
under the more rational and enlightened treatment, be preserved. 
Amputations are much less frequently performed, while resec- 
tions of the joints, the origin of which dates back to the latter 
part of the last century, are very common, especially in patho- 
logical cases; and the powers of the system to endure disease and 
operations are vastly better understood. 
Plastic surgery, founded by Taliacotius in the sixteenth cen- 
tury, has been greatly extended and improved in this, chiefly 
through the labors of Graefe, Carpue, Dieffenbach, Zeis, Serre, 
Von Ammon, Liston, Labat, and Blandin. My predecessor in 
the chair of surgery in this school, the late Dr. Thomas D. 
Mutter, performed some very creditable operations of this kind 
for the relief of the horrible deformity of the face and neck so 
often witnessed after burns and scalds; and my distinguished col- 
league, Professor Pancoast, devised, early in his professional 
career, an excellent suture for effecting accurate apposition and 
maintenance of the transplanted integuments in the construction 
of new noses. Some of the very finest noi<tes ever manufactured 
in this city were made with the aid of this suture. 
Staphyloraphy is of modern origin, having been first success- 
fully executed, in 1819, by Professor Roux, of Paris. For some 
very important improvements in the mode of performing this 
operation, claimed, singularly enough, by a distinguished foreign 
surgeon, the profession is indebted to the late Dr. J. Mason War- 
ren, who published an account of the procedure in the "American 
Journal of the Medical Sciences" for 1843. At the time of his 
lamented death, hardly two months ago, he had operated nearly 
one hundred times for cleft palate, with a degree of success highly 
honorable to his dexterity and scientific knowledge. The same 
surgeon was the first to devise an operation for closing abnormal 
openings in the hard palate, by raising a flap of muco-fibrous 
structure on each side of the fissure, and uniting them at the 
centre. 
The operation for hare-lip has been much simplified, and the 
fact established that it may often be successfully performed within 
a few days after the birth of the child. Numerous planshave 
been devised for the radical cure of hernia, but not one, so far as 
I am able to comprehend them, of an entirely unobjectionable 
character. The one now generally practised is that of Mr. Wood, 
of London, a modification of that proposed by Wutzer, of Bonn, 
in 1838. Dr. Agnew, of this city, has also of late years practised 20 
a method peculiar to himself, with what success I am not in- 
formed ; and Professor Pancoast, many years ago, effected some 
cures by the subcutaneous injection of iodine. 
Surgery shares with medicine the honor of the invention of a 
number of instruments, due to a knowledge of the science of 
physics, some of which have already rendered invaluable service 
to the diagnosis and treatment of disease. These instruments, 
which are merely natural outgrowths of the stethoscope, the off- 
spring of the fertile genius of Laennec, in the early part of the 
present century, are the ophthalmoscope, laryngoscope, and rhino- 
scope, by means of which the practitioner may explore the most 
hidden recesses of the eye, windpipe, and nose, thereby enabling 
him to extend the sphere of his observation, and to obtain more 
accurate information of the disorders of those important struc- 
tures. To Dr. Desormeaux, of Paris, we are indebted for the in- 
vention of the endoscope for inspecting the urethra and urinary 
bladder; and no doubt some ingenious physician will before long 
construct a gastroscope, an instrument, as the name implies, for 
looking into the stomach.1 In this enumeration we must not lose 
sight of the sphygmograph and the thermometer; the former for 
measuring the force and frequency of the pulse, the latter for de- 
termining the heat of the surface of the body in disease; a sub- 
ject now earnestly occupying the thoughts of numerous observers 
in different parts of the world, and destined, it is said, to throw 
much light upon the nature and treatment of morbid action, 
especially the various kinds of fevers. With the value of the 
microscope, as a mea#s of diagnosis, every one is familiar. With- 
out the aid of this instrument, the practitioner would be utterly 
at a loss to distinguish even some of the more common maladies, 
while the science of medical jurisprudence would literally be de- 
prived of its right hand. In the great work of Professor Worm- 
ley, of Columbus, Ohio, on the Micro-Chemistry of Poisons, just 
issued, it is asserted that with the aid of the microscope, applied 
in accordance with the methods therein suggested, it is compara- 
tively easy to detect, with unerring certainty, the lOO,OOOth part 
of a grain of arsenic or mercury. Another contrivance, of in- 
calculable value to the medical jurist, devised only within the 
last few years by Mr. Sorby, of England, is the spectroscope, a 
small mirror attached to the microscope, which, by reflecting the 
light as it falls upon a spot of blood, however minute, instantly 
discloses the peculiar nature of hematin. It is said that the char- 
acteristic spectrum of a single blood-disc may be thus obtained. 
Instruments, denominated atomizers, have recently been in- 
vented, and are now much used for throwing medicated and other 
fluids into the nose, throat, and air-passages for the cure of in- 
flammation and other affections. A very excellent account of 
1 Since the above was written, Dr. Milliot, of Kiew, has published an account 
of an instrument which he calls the stomatoscope, and which consists of a glass 
tube, containing a platinum wire, connected with an electric apparatus as a means 
of illuminating the oesophagus, stomach, or lower bowel. 21 
this method of treatment, interspersed with a good deal of per- 
sonal observation, will be found in an elegant little brochure, pub- 
lished during the past summer, by your teacher of clinical medi- 
cine, Dr. Da Costa. Contrivances of a similar kind, employed 
for the production of local anaesthesia, will be shown to you at 
the surgical clinic, in connection with some of the minor opera- 
tions, to which alone ether, rhigoline, and other sprays are ap- 
plicable. 
I have purposely abstained, until this moment, from mentioning, 
in connection with the more important advances in surgery, the 
grandest of them all-a boon of inestimable value to the human 
family. I need hardly say that I allude to anaesthetics. In 1846, 
the people of this continent were startled by the announcement 
that a dentist of Boston had discovered an agent which, if properly 
inhaled, was an effectual preventive of pain in surgical operations, 
however severe or protracted. The name originally given to this 
agent was " letheon," and, unfortunately, for the honor of the dis- 
coverer, its true nature was for some time kept a profound secret. 
It was soon ascertained, however, to be nothing but sulphuric 
ether, an article long known to the profession, but not as possessing 
such virtues. The first trials with this agent were made in the 
extraction of teeth, and it was not until after its success was per- 
fectly established that it was used in the more severe operations, 
the first of which, consisting of the removal of a vascular tumor 
of the neck, was performed, while the patient was under its influ- 
ence, at the Massachusetts General Hospital, on the 16th of Oc- 
tober, 1846, by the late Professor John C. Warren. 
Although the discovery of anaesthetics had been foreshadowed 
by the experiments of Beddoes and Sir Humphrey Davy, in the 
latter part of last century, to Dr. W. T. G. Morton, an ingenious 
and accomplished dentist of Boston, is unquestionably due the 
merit of having first applied sulphuric ether, now so extensively 
employed in this country, for the prevention of pain in surgical 
operations. Nitrous oxide gas, the article with which the late 
Dr. Wells, of Connecticut, performed the experiments which 
immediately preceded the discovery of Dr. Morton, is now almost 
universally employed in the extraction of teeth. The anaesthetic 
properties of chloroform were detected by Professor Simpson, of 
Edinburgh, in 1847. 
Of the vast benefits of anaesthetics in surgical practice, I shall 
frequently have occasion to speak this winter. Meanwhile, it may 
be stated that anaesthetics are employed not merely to prevent 
pain, but also as aids in determining the diagnosis of various 
affections, as, for example, in sounding for stone in the bladder ; 
in searching for the presence of foreign bodies in wounds; and 
in the reduction of dislocations and strangulated hernia. Mid- 
wifery, too, comes in for a share of the blessings of anaesthetics; 
and cases occasionally arise in which they may be advantageously 
employed in medical practice. 
Among the most remarkable changes that have taken place 22 
in the treatment of diseases within my time, changes amounting 
to a positive revolution, is the abandonment of emetics, active 
purgatives, and venesection. Until within a comparatively short 
period these agents were the great remedies for combating morbid 
action, and it is therefore not surprising that their employment 
should for a long time have been universal. To be sick, however 
slightly, and not to be freely vomited, purged, and bled was an 
anomaly; to permit a patient to die without subjecting him to 
these ordeals was a crime. If a man had a headache, an irritable 
stomach, or any disorder of the digestive organs; or if, in the 
language of the day, he was "bilious," a very common and popular 
expression, the very first medicine that was generally prescribed 
was an emetic of tartrate of antimony and potassa, followed, within 
a few hours, by an active cathartic, of which calomel, or calomel 
and jalap, formed the principal ingredients. The object of the 
emetic was to rid the stomach of bile and other impurities; of the 
cathartic, to correct the secretions, especially of the liver, and to 
effect thorough evacuation of the bowels. If there was any arterial 
excitement, and if this excitement was not subdued by these reme- 
dies, blood was next freely drawn from the arm in a full stream, 
so as to produce not only a powerfully depressing but also a de- 
cidedly spoliative effect. If the arterial action was very considera- 
ble, the lancet, instead of following, preceded the emetic and ca- 
thartic. The repetition of this course, of which this is a rapid 
outline, was of common, I might add, of constant occurrence. 
There were few patients whose ailments were at all severe or ob- 
stinate who, on their recovery, if they were so fortunate as to 
survive this practice, could not boast of at least two or three 
pretty copious bleedings, and of having swallowed twice that 
number of emetics and cathartics. This treatment prevailed both 
in city and country, though in the former, as the patients, from 
their peculiar habits and modes of life, were less able to bear very 
active depletion, its employment was less frequent. 
The abandonment of this treatment, a treatment well entitled 
to the term heroic, has for years past been complete. An emetic 
of any kind is now rarely given, no matter what may be the na- 
ture of the disease ; drastic cathartics are less frequently adminis- 
tered; and as to venesection, even in the treatment of the more 
violent and dangerous affections, as, for example, pneumonia, 
pleurisy, gout, and rheumatism, in which it is said to have once 
been so beneficial, every one looks upon it with a sort of holy 
horror. The lancet, formerly the inseparable pocket companion 
of the physician, now rests quietly in its case, incrusted with rust, 
a thing of the past, an object of curiosity and reproach. The 
divorce is complete. Young Physic boasts that he has never seen 
a lancet, and expresses surprise that such a weapon should ever 
have been in such universal use. Taking the practice of the pre- 
sent day as bis standpoint, he cannot see why such a sanguinary 
operation should ever have been necessary. He looks with dis- 
gust at the conduct of his predecessors, loudly declaims against their 23 
want of judgment, and, like the Pharisee in the Bible, devoutly 
thanks God that he is not like other men. Scrupulously abstaining 
from the spilling of blood, he entrenches himself behind his wine, 
his whisky, his brandy, his milk-punch, and his beef essence, bids 
defiance to disease, and, in the triumph of his pride, regards 
himself as the very god of physic, to whom alone are confided 
the secrets of the healing art. He parades his statistics, counts 
few, if any, losses, and is not only a benefactor to the state, but a 
positive clog to the undertaker and the resurrectionist. 
This change of practice reminds one forcibly of the story of 
Sganarel, the mock doctor, in the comedy of Moliere, who, upon 
a doubt being expressed by Geronte that the heart was on the 
right side, and the liver on the left, replied, "Yes, it was formerly 
so; but we have altered all that, and we now practise medicine 
after quite a new method." 
Whence, and wherefore are all these mighty, these astounding 
changes in our method of dealing with disease and death ? Are 
they due to some radical alteration in the condition and habits of 
man himself, to a change in the type of disease, or to the improved 
knowledge and increased wisdom of the modern physician, and to 
his more intimate acquaintance with the virtues of certain reme- 
dies ? These are momentous questions, upon the proper solution 
of which must depend much of your success, or want of success, 
as practitioners of the healing art. 
If there has been any material physical degeneracy of the 
human race, as it manifests itself to me in my daily intercourse 
with the people around me, I have not been able to perceive it. 
They seem to me to be as tall, as hardy, as well-proportioned, as 
healthy, as capable of enduring labor and fatigue as the people 
were forty years ago. They have not, so far as there is any out 
ward evidence of it, undergone any essential change in their 
habits or modes of life. They use similar food and drink, follow 
similar occupations, breathe a similar atmosphere, indulge in 
similar amusements. If they eat beef and mutton, terrapin, 
croquets, oysters, and chicken-salad, fortified with champagne, 
whisky, and brandy, so did the people a generation ago. If we 
go into the rural districts, we shall find the same remarks to be 
applicable. Nowhere is there any evidence whatever of deteriora- 
tion of the race. During the late war the most abundant proof 
was furnished on both sides of the line of the extraordinary power 
of endurance among the soldiers, inlhe astonishing marches which, 
on more than one occasion, were performed, feats which were never 
surpassed, if, indeed, equalled, by any armies either in ancient or 
modern times. If the races of the Old World are deteriorating in 
stature and muscle, I repeat that I know nothing to justify the 
belief that such changes are occurring among the inhabitants, na- 
tive and foreign, of this mighty continent, the best fed, the best 
clothed, the best housed people on the face of the earth. 
It has been asserted that the change in our treatment has been 
caused by a change in the type of disease. This, indeed, is the 24 
prominent doctrine of the day, endorsed by many of the most 
enlightened physicians, surgeons, and accoucheurs throughout 
the civilized world. It is based upon the assumption, at first 
sight plausible enough, that disease has lost much of its inflam- 
matory character, and that, owing to some peculiar condition of 
the system, hitherto not satisfactorily explained, it has a strong 
tendency to run into a typhoid state, thus absolutely forbidding 
the use of the lancet and other depletory measures, formerly so 
much in vogue, and imperatively demanding the employment of 
alcoholic stimulants and a generous diet. This doctrine of a 
change in the type of disease is not new. Distinct mention of it 
is made by some of the older writers. As a matured plan of treat- 
ment, however, it was originally enunciated by John Brown, of 
Edinburgh, generally known as the founder of the Brunonian 
system of medicine, a pupil and afterwards a rival of Cullen, who, 
in order, apparently, to bring discredit and contempt upon his 
master and the celebrated school of which he was the chief orna- 
ment, taught that there were two distinct classes of diseases, the 
sthenic and asthenic, the former, as the name implies, being at- 
tended with over-action, the latter and the more frequent of the 
two, with debility or exhaustion. Brown discarded active deple- 
tion altogether, and trusted wholly to opium and alcoholic stimu- 
lants, of which he himself was a habitual consumer, for the cure 
of diseases. Although he was a mere sot, and finally perished, at 
a comparatively early age, from the effects of his intemperance, 
his doctrines rapidly spread over Europe, and, for a time, com- 
pletely enchained the minds of many of the most distinguished 
physicians, especially in Italy and Germany, the field of its 
greatest and wildest luxuriance. A lull, however, at length 
ensued, and for upwards of a quarter of a century Brunonianism 
was nearly forgotten, when it was revived by the late Dr. Robert 
Bentley Todd, Professor of Physiology and Pathological Anato- 
my in King's College, London. Connected with a large hospital, 
the inmates of which were, for the most part, of a broken-down, 
dilapidated constitution, he was forced, despite the prejudices of 
his education and the habits of his early life, to abandon deple- 
tory measures, and to rely solely upon the use of stimulants, 
tonics, and a generous diet. As he was a fascinating teacher, and 
an able writer, his views rapidly spread from Europe to this 
country, where they were soon received by the great body of 
medical men as sound and reliable guides in practice. 
Todd, it will thus be perceived, went a step farther than his 
Scotch prototype; for, while the latter taught that one class of 
cases required depletion' and the other stimulants, the London 
physician abandoned himself entirely to the latter, zealously main- 
taining the doctrine of a change of type of disease, and the conse- 
quent inability of the patient to bear the loss of blood, generally 
even by cupping and leeching. That a man of the transcendent 
ability of Dr. Todd should have fallen into such an astounding 
error is not a little surprising; the circumstances can only be 25 
explained upon the assumption that he had a very limited private 
practice. This, at all events, is a reasonable construction. Seeing 
chiefly hospital patients, enfeebled by neglect, intemperance, and 
starvation, he could hardly have reached any other conclusion. 
His patients had no blood, no muscle, no life-power. Stimulants 
and tonics were necessary at the very outset of the treatment. 
The system required to be upheld; not depressed and depleted. 
The class of cases attended by Dr. Todd were such as are to be 
found in every eleemosynary institution in every crowded city in 
the world. The Philadelphia Hospital, as you will see by and 
by, is filled with them, and there is hardly, at any time, summer 
or winter, spring or autumn, an individual within its wards, what- 
ever may be the nature of his ailment, who could bear the loss of 
ten ounces of blood with impunity, or one whose condition would 
not be rendered materially worse by an active emetic or an active 
cathartic. In promulgating his doctrine, one of the most perni- 
cious in the annals of medicine, Todd forgot that there is in every 
community a class of patients the very opposite to that just referred 
to-the well-fed, the plethoric, the comparatively robust-those 
whom Brown designated as the sthenic. Will any one who knows 
anything of the nature and treatment of acute disease affirm 
that such patients would not be benefited, vastly benefited, by a 
little leaven of the " old practice," the lancet and at least an active 
cathartic ? Will any one contend that inflammation-pneumo- 
nia, pleurisy, gout, and dysentery, to which such persons are par- 
ticularly subject-is less active, less severe, less destructive than 
it was a generation ago ? I imagine not; at all events there is no 
evidence of it. Already the doctrine, with the practice based 
upon it, is tottering to the ground. Some of its ablest advocates 
have already renounced it as false and dangerous, as an ignis- 
fatuus, only calculated to mislead the thoughtless and the unwary. 
Three circumstances, so far as I am able, from much observa- 
tion and reflection, to form an opinion, lie at the foundation of 
these extraordinary changes:-a more comprehensive knowledge 
of the efficiency of certain remedies; a greater reliance upon the 
powers of nature; and the influence of fashion in shaping the con- 
duct of physicians. 
1st. Every one familiar with the progress of materia medica 
within the last quarter of a century, is aware of the valuable ad- 
ditions that have been made to the stock of our knowledge. It is 
only necessary here to refer to aconite and veratrum viride; the 
former a European, the latter an American remedy. Both of 
these articles are most powerful depressants, daily employed in 
the treatment of inflammatory affections. A few drops of either, 
repeated every hour or two, will speedily reduce the force and 
frequency of the pulse, open the pores of the skin, lessen pain, 
and relax the system. These agents, of which the teachers and 
writers of my student-days were entirely ignorant, are among the 
most potent and trustworthy antiphlogistic remedies at present 
known, and they have effectually, in the hands of most practi- 26 
tioners, usurped the place of the lancet, the emetic, and the 
cathartic. 
2dly. Experience has shown, especially since the introduction 
of homoeopathy and various kindred illusions, that Nature alone, 
without any aid whatever from medication, properly so called, is 
often competent to cure disease, particularly if very mild, and the 
patient do not, by any indiscretion, interfere with her operations. 
This fact is now so thoroughly established as not to require any 
elucidation. It is the platform of Young Physic. The older a 
practitioner grows, the less medicine he generally gives; for he 
well knows that perfect rest of mind and body, and abstinence 
from stimulating food and drink, are frequently more effective in 
arresting and dislodging morbid action than the most potent article 
of the Dispensatory. Radcliffe, in his old age, pithily said, 
" Whenl was young I had fifty remedies for every disease, now I 
have hardly one remedy for fifty diseases." Hippocrates, Galen, 
Sydenham, Boerhaave, Cullen, Hunter, Rush, were all believers in 
the healing power of Nature. A knowledge of this power, which 
deserves to be profoundly studied, is the basis of the success of 
the practice of Hahnemann and his disciples. Globules which 
can be swallowed with impunity by the ounce, cannot exert any 
positive curative agency. While they soothe the patient's mind, 
Nature does the work. 
3dly. Fashion has often much to do in moulding the practice 
of physicians. It is as much of a tyrant in our profession as it 
is in millinery, in mantua-making, and in the cut of one's coat. 
Eugenie introduced the crinoline, simply because she desired to 
conceal a temporary defect in her person-a defect of which most 
ladies who love their lords are proud-and the " skeleton" speedily 
found its way into every house in the civilized world. 
It is impossible to account for the whims and caprices of the 
human mind. Weakness is its great essential characteristic. 
There is nothing, however absurd, that it will not believe. We 
express surprise when we hear that a great medical luminary has 
succeeded in attaching his name to some particular theory or 
mode of practice, and is thus completely revolutionizing the senti- 
ments, not merely of the lesser lights of the profession, but of 
men who, in point of talent, judgment, and skill, are in all respects 
his equal. It is still more curious to find that certain diseases 
have been, at times, fashionable. When Louis XIV. suffered from 
anal fistule, that loathsome disease became at once the fashionable 
ailment of his debauched court. Dukes and duchesses, counts 
and countesses, virtuous women and courtesans, all either had 
the disease, or affected to have it. " 'Tis a distemper," says Dio- 
nis, " grown in fashion since that which the king had, and on 
which the chirurgeons were forced to perform the operation in 
order to its cure. Several of those who before that time carefully 
concealed their having it, are not now ashamed to publish it, and 
some courtiers have even chosen Versailles for the place where 
they will undergo the operation, because the king should be in- 27 
formed of all the circumstances of their indisposition. Those who 
have only a small draining run immediately, and turn up their 
posteriors to a chirurgeon for him to make incision. I have seen 
above thirty who desired to have the operation performed, and 
whose folly was so great that they seemed angry when they were 
assured that they did not at all want it." 
There are even fashionable physicians. A handsome face, bland 
manners, and an elegant dress, with a stylish carriage and groom, 
have often done more in securing practice than the most profound 
talent and attainment. When Dewees was in the heyday of his 
glory, as an obstetric practitioner, there was hardly a fashionable 
woman in Philadelphia who would consent to be delivered without 
his aid. In one instance, recorded by the distinguished accoucheur 
himself, the lady actually went nearly one month beyond the ordi- 
nary term, purposely, it may be imagined, to have the gratification 
of his attendance. 
It is within the recollection of the older members of the pro- 
fession, both in Great Britain and in this country, how fashionable 
liver complaints were forty years ago, in consequence of the 
influence of the writings of Faithorne and Johnson. All cases 
of dyspepsia, intercostal neuralgia, and chronic cough were referred 
to disorder of this organ, which, in most instances, was as innocent 
of their causation as the babe in the womb is of the sins of its 
mother. When Corvisart, physician to Napoleon, published his 
treatise on diseases of the heart, cardiac affections became at once 
exceedingly prevalent. Twenty-five years ago all the women of 
America labored under spinal irritation. Mr. Teale, of England, 
and the late Professor John K. Mitchell, of this city, had each 
published a tract upon the frequency and importance of this 
affection, and for a number of years it was the dominant complaint. 
The late Dr. Horace Green, of New York, popularized throat 
diseases, and, for a time, the tyrant, fashion, ruthlessly sacrificed 
every tonsil and uvula that had the misfortune to come in the 
way of the physician. At present, diseases of the uterus are the 
fashionable disorders. Not to have an ulcer upon the womb is to 
be beyond the pale of the sex. Every chronic complaint to which 
women are subject is at once referred to this malady, and they are 
as angry when told that there is nothing of the kind, as were the 
courtiers and others in the time of Louis XIV. when informed 
they had no fistule. Doctors and patients alike have womb on 
the brain. 
Dr. W. D. Buck, of New Hampshire, in an address before the 
Medical Society of that State, has so admirably hit off* this pro- 
clivity, that I cannot forego the pleasure of quoting some of his 
remarks. Speaking of the uterus as a harmless, inoffensive little 
organ, stowed away in a quiet place, "it furnishes," he jocosely 
says, " a capital field for surgical operations, and is nowadays 
subject to all sorts of barbarity from surgeons anxious for noto- 
riety. Had Dame Nature foreseen this, she would have made it 
iron-clad. What with burning and cauterizing, cutting and 28 
slashing, and gouging, and spitting and skewering, and pessarymg, 
the old-fashioned womb will cease to exist, except in history. The 
Transactions of the American Medical Association have figured 
one hundred and twenty-three different kinds of pessaries, em- 
bracing every variety, from a simple plug to a patent threshing- 
machine, which can only be worn with the largest hoops. They 
look like the drawings of turbine water-wheels, or a leaf from a 
work on entomology. Pessaries, I suppose, are sometimes useful, 
but there are more than there is any necessity for. I do think 
that this filling of the vagina with traps, making a Chinese toy- 
shop of it, is outrageous. Our grandmothers never knew they 
had wombs, only as they were reminded of it by the struggles of 
a healthy foetus, which, by the by, they always held on to. Now- 
adays, even our young women must have their wombs shored 
up, and if a baby accidentally gets in by the side of the machinery, 
and finds a lodgment in the uterus, it may, perchance, have a 
knitting-needle stuck in its eyes before it has any." 
Within the last few years, diseases of the larynx have been 
rapidly rising into distinction, and are likely, for a time, to exert 
an extensive influence upon the credulity of the people and the 
practice of the profession. 
What is true of diseases is equally true of medicines. I need 
only refer, as an evidence of the fact, to the mania which at 
present prevails in regard to the use of bromide of potassium, 
carbolic acid, and some other articles. I have witnessed the rise 
and downfall of a hundred panaceas. 
That this fashion in medicine had its influence in times past as 
it has in the present, no sensible man can doubt, else it would be 
impossible to account for the large evacuations formerly practised 
in the treatment of disease. The bleeding was often not only ex- 
cessive, but ill-timed and wholly improper. I quote some cases 
in illustration. A young woman, the subject of acute pleurisy, 
was bled by Professor Gregory, of Edinburgh, 230 ounces in a 
few days; and in a case referred to by Dr. Blundell, of London, 
the quantity removed within tlie same period was a gallon and a 
half. Both patients recovered. In the memoirs of the French 
Academy, examples are related of 300 ounces. The late Dr. 
John W. Francis, of New York, one of the most distinguished 
physicians our country has ever produced, was bled early in life 
nearly ten quarts in a few days, for a violent attack of croup. 
Mr. Cline, of London, drew 320 ounces of blood in twenty days 
from a man in St. Thomas's Hospital, on account of a contu- 
sion of the head. Dr. Physick abstracted 90 ounces, by weight, 
from Dr. Dewees, at one bleeding, in a sudden attack of conges- 
tion of the brain, while laboring under fever. Dr. Rush, in his 
"Defence of Bloodletting," declares that it is much better not to 
bleed at all in fever, if the quantity drawn is disproportionate to 
the violence of the disease. " If," says he, " the state of the pulse 
be our guide, the continuance of the inflammatory action, after 
the loss of even 100 ounces of blood, indicates the necessity of 
more bleeding, as much as it did the first time a vein was opened." 29 
Rush and his followers bled in all classes of diseases, even in 
smallpox and the so-called malignant fevers, as well as in all 
conditions of the system, in anemia as well as in plethora. He 
bled a medical man, the subject of an attack of autumnal fever, 
which continued for thirty days, twelve times before he succeeded 
in arresting the disease. He bled one lady for a pleurisy, in her 
pregnancy, eleven times in seven days, another thirteen times, 
and a third sixteen times, while in a similar condition, and all 
three recovered, without any detriment to their children. Old 
age constituted, in the opinion of this great man, no barrier to the 
operation. He bled a lady, in the eighty-fourth year of her age, 
twice in an attack of pleurisy; and from a man, ninety years old, 
the subject,of bilious fever, he abstracted thirty-six ounces of 
blood at three bleedings, recovery following in both instances. 
" I bled," he says, " my eldest daughter when she was but six 
weeks old for convulsions brought on by an excessive dose of 
laudanum, given to her by her nurse; and I bled one of my sons 
twice, before he was two months old, for an acute fever which 
fell upon his lungs and bowels." " I have used this remedy with 
great success in every case of consumption attended with a hard 
pulse, or a pulse rendered weak by a laborious transmission of 
the blood through the lungs." In one instance, he bled fifteen 
times in six weeks, and in another, eighteen times in two weeks, 
in this state of disease, with, as he declares, the happiest effect. 
" Mr. Tracey, of Connecticut," says Dr. Rusli, " informed me, in 
the spring of 1802, that he had been bled eighty-five times in six 
months, by the order of his physician, Dr. Sheldon, in the inflam- 
matory state of this disease. He ascribed his recovery chiefly to 
this frequent use of the lancet." 
I well recollect that the first case of disease I ever saw in this 
city, after I became a pupil of the late Dr. George McClellan, the 
founder of this school, and its first Professor of Surgery, was one 
of pleurisy in a young man whom I was sent to bleed, and in 
whom the operation was afterwards repeated daily until the pain 
and fever left him. This was at that time the usual practice. Occa- 
sionally, indeed, not unfrequently, the bleeding was repeated twice 
and even thrice on the same day, generally by re-opening the 
same orifice. 
An anecdote, related to me by my colleague, the distinguished 
Professor of Medicine, will better illustrate the sanguinary prac- 
tice of former times than anything I can tell you. An old friend 
and patient of his, a gentleman of unbounded hospitality and luxu- 
rious habits, generally spent his summer months at Saratoga for 
the benefit of his health. As he labored under a chronic ophthal- 
mia, aggravated by the high living of the winter, he always 
stopped a few weeks at Philadelphia to profit by the advice of 
Dr. Physick. He was, of course, in consonance with the practice 
of the day, placed upon low diet, consisting chiefly of mush and 
milk, and, as he was quite plethoric, was further reduced by 
bleeding and purging on alternate days. One gloomy, wet, and 30 
chilly June morning, while sitting despondingly by the fire in his 
chamber, Dr. Physick made his regular call. lie did not enter, 
but stood at the door, and asked his patient how he felt. " Quite 
uncomfortable," was the reply; " my eyes are very sore." "Send 
for the bleeder, then," said the Doctor, "and lose eight or ten 
ounces of blood." "But it is my rhubarb day I" exclaimed the 
sick man, "and I have already taken my dose." "No matter," 
was the rejoinder, "you must be bled." "I be d-d if I will," 
said the patient. " If you had touched my pulse I would have 
followed any directions you might have given me; but no man 
shall prescribe for me across the room." " Good morning," said 
Dr. Physick, coldly; and they parted, never to meet again. 
Dr. Rush, meeting unexpectedly an old friend during the 
height of the yellow fever in 1798, asked him why he had not 
left town. He replied that he had sent his family away, but could 
not leave himself. " Then," said Dr. Rush, " go home and be 
bled immediately." 
The great physician had evidently studied Moli&re, in whose 
time, when the practice of bleeding was in full force, high health 
was a thing to be feared, and to be subdued with the lancet and 
" dulcifying clysters." If the person remonstrated, the reply was: 
" The method is salutary; and as one drinks for thirst to come, 
one must likewise be bled for illness to come." 
The practice of bleeding and purging in the spring, as a means 
of purifying the blood, and thus protecting the system against 
disease in the hot summer months, prevailed almost universally 
for ages, and was abandoned only when bleeding and active purg- 
ing became unfashionable in the treatment of inflammation. I 
recollect it was the custom thirty-five years ago, in the spring, 
for scores upon scores of people, especially in the rural districts, 
to go to the doctors to be bled. Sometimes non-professional men 
performed the operation on a large scale. The late Mr. Hazard, 
one of the founders of Mauch Chunk, in the early days of that 
settlement, when physicians were scarce, had quite an extensive 
practice of this kind. One day a stout, hale-looking Irishman 
came up to be bled. " Mr. Hazard, and how much do you charge 
for takin' a pint o' blood?"-the quantity usually drawn. "No- 
thing," was the reply. " Then, by St. Peter," said Pat, "you may 
take a whole quart from me." 
It was but yesterday, as it were, that cold water was scrupulously 
withheld in the treatment of fevers, especially if the patient had 
taken calomel, then so fashionable a remedy; and that an uncon- 
querable prejudice existed even against ventilation or the ingress 
of cold air into the sick chamber. Cold water, now so extensively 
employed as a local remedy in wounds and external diseases, was 
formerly looked upon either as an inert or dangerous application. 
Now, who, in looking at this practice of Rush and his contem- 
poraries, from our stand-point of conservatism, would not pro- 
nounce it to be grossly absurd, if not positively criminal? The 
modern physician, uninfluenced by prejudice, and governed by 
sound knowledge and judgment, instinctively asks himself the 31 
question: Could such a practice as this have ever been necessary? 
If we answer affirmatively, one of three things must be assumed, 
either that our predecessors were fools, that there has been a 
great change in the nature of disease, or that the march of science 
has put us in possession of remedies which have very properly 
superseded the heroic practice of former times. I have already 
expressed my disbelief in the change of type of disease, as well 
as alluded to the fact that we are acquainted with certain remedies 
of which no one had any knowledge thirty years ago. As to 
whether Rush, his disciples and his contemporaries were fools- 
reckless, ignorant men, without science or judgment-I leave 
others to determine. It is easy to see that a judicious use of 
aconite and veratrum viride in the hands of those practitioners 
would have enabled them to dispense with this frequent employ- 
ment of the lancet, and to conduct, with the aid of these active 
agents, their cases to an equally favorable issue, as is done at the 
present day. It is evident that these knights of the lancet labored 
under a most extraordinary delusion in regard to the efficacy of 
general bleeding; they bled largely in all stages of disease, and 
under all circumstances and conditions of the system, and thus 
committed the most flagrant errors. Had they limited the ope- 
ration to the incipient and gravescent stages of disease, before 
there was any serious structural change, the product of abnormal 
deposits, much less mischief would have been done, and many 
more lives saved. They forgot, as most men now forget, that 
there is a bleeding point, which, if properly interpreted, may 
often be seized with infinite advantage, especially in the treat- 
ment of acute disease of the more important organs and tissues. 
Who does not see in this excessive bleeding, and vomiting, and 
purging, and abstinence, the influence of fashion, the crinoline of 
society, the autocrat of medicine ? 
In thus assigning what I conceive to be the true causes of the 
extraordinary changes that have taken place in the treatment of 
disease and injury within the last quarter of a century, I am not 
unmindful of the fact that morbid action of every description is 
liable to be temporarily influenced by peculiar extraneous circum- 
stances. During the prevalence of severe epidemics all intercur- 
rent maladies, of whatever nature, wear, as Dr. Rush long ago 
so justly remarked, the livery of the dominant disease, thus mate- 
rially weakening the system, and proportionately interfering with 
the employment of depletory measures. At such times the sur- 
geon often finds that wounds unite with difficulty on account of 
the imperfect vitality of the plasma, and that it is not safe to per- 
form any of the more severe operations. But these changes 
always rapidly disappear with the prevailing distemper; they do 
not impress themselves permanently upon the constitution, and 
do not, therefore, lead to what are properly termed changes of type 
of disease. 
Extremes, whether in science or in politics, are dangerous, and, 
in general, short-lived, errors; and it does not require the prevision 32 
of prophecy to determine that the present mode of treatment, 
which has so completely enslaved the medical mind throughout 
the civilized world, must, in a comparatively short time, undergo 
important changes. It cannot be otherwise. The difference is 
too appalling; it is a chasm, not a bridge. Nature takes no 
leaps. In so great a problem the truth always lies in the mid- 
dle, not at the outskirts. The lancet will again come in play, 
not so extensively or indiscriminately as in former times, but 
moderately and philosophically; and the present terrible system 
of stimulation, which sends its victims daily by thousands pre- 
maturely to the grave, and which fills our land with drunken- 
ness and crime, cannot much longer maintain itself in the 
confidence and esteem of the reflecting members of a great and 
learned profession. A modified, improved, regenerated prac- 
tice, based upon common sense, and a more sound clinical obser- 
vation must take its place, and thus carry healing and blessings 
upon its wings to the nations of the earth. Those of us who have 
lived to see the workings of these two extremes, the extremes 
of excessive depletion on the one hand, and of excessive stimula- 
tion on the other, are living witnesses of the power of endurance 
of the human system, often under the most adverse circumstances. 
We can testify from personal observation, which many of the 
younger members of the profession cannot, to the fact that a man, 
burdened with disease, may live with hardly any blood in his 
body, on the one hand, and, on the other, that he need not neces- 
sarily perish when his system is saturated with alcohol. 
The last third of a century has witnessed the downfall, if not 
also the rise of a number of systems of medicine. Solidism, which 
in the hands of Boerhaave and Van Swieten, had in great degree 
been supplanted by humoralism, had still, early in my professional 
life, a firm hold upon the minds of some of our most distinguished 
teachers and writers, who could discover in the human body no- 
thing but a mass of material, acted upon and influenced mainly 
by sympathy, without any positive agency of the blood. Every- 
thing, even conception, was explained through the action of this 
mysterious power. The fact that medicines could enter the circu- 
lation, and thus affect the solids, was sternly denied. The last and 
most distinguished champions of this doctrine were Chapman 
and Caldwell, names well known to the American student. The 
researches of Andral and Gavarret, Muller, Gulliver, Jones, Gi- 
bert, and others, on the blood, effectually dispelled these antedilu- 
vian reveries, and opened a mine of knowledge, from which has 
issued a vast flood of light upon the nature and treatment of dis- 
ease. The reign of solidism is ended, and humoralism is, as it 
was a century ago, the dominant idea. A fluid so complex in its 
composition, the basis of nutrition and growth, pervading and fer- 
tilizing every atom of living matter, must necessarily be closely 
connected with many morbid changes, and must itself be a pro- 
lific inlet of disease. Indeed, there is a class of affections, univer- 
sally recognized at the present day, as dependent mainly, if not 33 
exclusively, upon a morbid condition of the blood, and hence 
denominated blood-diseases. These affections were well portrayed 
by Andral and Gavarret thirty years ago, in their work on Haema- 
tology, and they have since been more elaborately and correctly 
described by other observers. 
Broussaism is another of the idols that have been broken by 
the onward march of science. This doctrine, so called after 
Francis Joseph Victor Broussais, its founder, born at St. Malo, in 
1772, exercised a powerful influence upon the practice of medi- 
cine, in the early days of my professional life, on account of 
its extreme simplicity; for it referred almost all diseases, espe- 
cially the different forms of fevers, to inflammation of the mucous 
membrane of the alimentary canal, and the practice which he 
suggested for the cure of his patients consisted mainly in the use 
of ptisans, gum-water, a non-stimulant diet, and a few leeches to 
the abdomen. The author of this system, or the New Doctrine, 
as it was more generally termed, which aimed to revolutionize 
the practice of medicine, was a voluminous writer, and it is a sin- 
gular fact that all his more important works were translated in 
this city by gentlemen who have since, although not followers of 
his school, occupied a high position in the medical world. He 
died in 1838, and was interred, with great pomp and ceremony, at 
Pere-la-Chaise, his pupils dragging along the hearse to the grave, 
as a mark of respect and devotion to their illustrious master. 
Five years after this event a statue was erected in his memory at 
the Hopital du Val-de-Grace, of which he had long been chief 
physician and professor of military surgery, and a discourse pro- 
nounced upon his life and character, in the name of the Royal 
Academy of Medicine, by Mons. Pariset, the permanent Secre- 
tary. Whatever may have been his merits as a zealous laborer 
in the cause of medical science, it is evident that Broussais was a 
very indifferent observer, as well as a very unsound and unphilo- 
sophical practitioner; in a word, a mere medical enthusiast, 
whose doctrines are now remembered only as matters of history, 
no one attaching any importance to them. He has not one fol- 
lower at the present day, and even his name is almost forgotten. 
Cookeism not long ago wielded an extensive influence in the 
medical practice of the United States, especially in the south- 
west. Dr. John Esten Cooke, its author, taught that nearly all 
diseases had their origin in disorder of the portal circulation, and 
that all that was necessary to cure them was to administer a pill 
composed of rhubarb, aloes, and calomel; hence called the R. A. 
C. pill. Occupying the exalted position of Professor of Medicine, 
first in Transylvania University at Lexington, and afterwards in 
the University of Louisville, this doctrine was eagerly seized, 
upon by the numerous pupils who attended his lectures, and for 
nearly a quarter of a century his name was a household word 
with the physicians of the valley of the Mississippi. The R. A. 
C. pill slew its thousands of victims, and caused the destruction 
of innumerable lips, cheeks, teeth, and jaw-bones,, the result of 34 
the horrible ptyalism so common in those days. T recollect the 
case of a young lady, the subject of an atrocious neuralgia, 
brought on by injury inflicted upon the nerves at the bend of the 
arm in venesection, who, in the course of three months under the 
direction of one of the disciples of Cooke, had swallowed 155 of 
these pills with no other effect, apparently, than a very pallid 
face and a worn-out stomach. During the prevalence of the 
Asiatic cholera at Lexington Cooke recommended and prescribed 
calomel in enormous quantities. I have it upon the most reliable 
authority that a specimen dose, weighing one ounce and two 
drachms, ordered for one of his patients, is still preserved in the 
chemical laboratory of Professor Peter of that city. His colleague, 
Dr. Dudley, on the contrary, was a great advocate for the use of 
emetics, especially in chronic scrofulous affections of the joints, 
spine, and eye, in which he not unfrequently gave daily tartrate of 
antimony and potassa in emetic doses for weeks and even months 
together, with bran gruel as the principal article of diet. 
Dr. Cooke was born at Boston, Massachusetts, in March, 1783, 
during a visit made to that city by his parents, who were residents 
of the Island of St. George's, one of the Bermudas. He died in 
October, 1853, at the .age of seventy years. One of his former 
colleagues, Professor Lunsford P. Yandell, who had known him 
long and intimately, thus speaks of him in a recent communica- 
tion to me: " Dr. Cooke was one of the most scrupulously truth- 
ful, honest, brave, and true-hearted men I ever knew; a man of 
the greatest strength and depth of conviction. What he believed 
he believed entirely. He was a sincere Christian, and most exem- 
plary in all the relations of life." Dr. Cooke was the author of a 
work on Therapeutics, in two volumes, long since out of print. 
He was an acute reasoner, and a man of great intelligence, but 
a poor lecturer. 
The numerical method, introduced by Louis, of Paris, thirty- 
five years ago, was warmly embraced by many of the leading 
physicians of Europe and America, as likely, if carefully and 
systematically pursued, to be productive of much practical bene- 
fit, in testing and determining various methods of treatment in 
particular classes of diseases; but no good seems to have resulted 
from its adoption, and for the last ten years the subject has appa- 
rently been entirely lost sight of. The author of the system still 
lives; the system is defunct. 
There were many things believed in medicine in former times 
that are utterly discredited in the present. It is only necessary 
here to refer to what were called crises in febrile diseases, a doc- 
trine firmly maintained by the ancients and even by many of the 
moderns. These crises, which were supposed to be characterized 
by certain prominent changes in the nature of the malady, oc- 
curred, according to Hippocrates, on the 3d, 5th, 7th, 9th, 11th, 
14th, 17th, 21st, 27th, and 34th days; Galen, on the contrary, 
regarded the 7th, 14th, 21st, and 28th days as the critical days. 
Cullen was led to believe that there were no critical days beyond 35 
the 20th, which he considered as the true critical one. All this 
nonsense, concerning which a great deal used to be said, even by 
apparently sensible physicians, when I entered the profession, is 
now thoroughly exploded. 
The day of polypharmacy and of large doses is passed, never, 
it is fondly hoped, to return. The practice, in this respect, is 
totally changed. Physicians not only give medicine in much 
smaller quantities, but much less frequently, and the consequence 
is that their patients recover much more rapidly, and with much 
less damage from the prostrating effects of disease and injury. 
The art of prescribing is much more simple; diagnosis is more 
thoroughly understood; and the practitioner has learned to place 
more confidence in the resources of nature. 
These changes and revolutions in the practice of medicine, this 
upheaval of old systems, occurring within so short a period, are 
well calculated to startle the sober-minded and reflecting physi- 
cian, and to engender a spirit of skepticism in regard to the cer- 
tainty of the healing art. Men indulging in hasty generalization 
would hardly fail to arrive at any other conclusion. Those of a 
calmer judgment, on the contrary, will reason differently, and, 
despite these changes, retain an unshaken faith in the value of 
medicine. It is easy for them to see that these changes are es- 
sentially due to the influence of the writings and teachings of a 
few brilliant men, who, from time to time, rise in the profession, 
and who, by their dazzling genius or pernicious example, mislead 
and misguide its less thinking and less enlightened members. 
Observation is confessedly a difficult art. "In medicine," says a 
distinguished author, " there are various circumstances which ren- 
der it less easy to ascertain the facts than in most other cases. These 
depend partly on the nature of the subject, and partly on the 
situation and character of the observer. It was the shrewd re- 
mark of a learned professor that in medicine there were more 
false facts than false opinions. On all topics, either historical, 
scientific, or literary, mankind possess -a strong avidity for the 
marvellous. From the constitution of the human mind, the love 
of novelty is one great principle by which the attention is excited 
and the intellectual powers are called into action." Physicians, 
like other men, naturally love change, and it is not casting any 
imputation upon the character of the profession to assert that few 
of its members are capable of close analysis, of calm investiga- 
tion, or of strict philosophical induction. It is much easier to 
jump at than to reason out conclusions; much easier to theorize 
correctly than to observe correctly. The anecdote of Charles II. 
and the Royal Society of London, familiar to every student of 
history, furnishes a striking illustration of the truth and force of 
this remark. The monarch, soon after the incorporation of this 
learned body, requested of them to know why it was that a live 
fish thrown into a basin of water did not affect the weight of the 
vessel and the fluid, whereas a dead one would precisely in pro- 
portion to its own weight. After much discussion, and the pre- 36 
sentation of a number of elaborate essays explanatory of the cir- 
cumstance, a member, more skilled than the rest in the Baconian 
philosophy, rose, and inquired whether there really existed such 
a difference as that alluded to ? Great excitement thereupon en- 
sued, and some even asserted that to doubt his majesty's word 
was not only an insult to his dignity, but treason to the state. 
The question, however, after due investigation with a live and a 
dead fish, was finally decided in the negative, the king having 
merely desired to hoax the philosophers. 
Many years ago it became my duty to examine the body of a 
woman, who, the night previously, had, as was supposed, been 
killed by her lover. Her countenance exhibited a congested, 
livid appearance, and there was a well-marked indentation on the 
right side of the larynx as if it might have been made with a 
thumb nail. When the trial came on a number of witnesses, some 
of them of great respectability and intelligence, testified that the 
face looked perfectly natural, and that the abrasion in question 
was situated on the left side instead of on the right, as I had de- 
scribed it. The prisoner was convicted wholly upon circumstan- 
tial evidence, but the day before his execution he confessed he 
had choked the woman to death with his hand. 
These cases are types of a thousand others of daily occurrence, 
and they serve to remind one of the man, who, seeing a donkey 
for the first time, exclaimed that he had found " the father of all 
the rabbits." 
Much of the healthful progress of the medical science of the 
present day is due, first, to a better acquaintance on the part of 
the physician with the nature of disease; secondly, to the know- 
ledge that very frequently little or no medication is required to 
afford relief; and, lastly, to the fact that every case of morbid 
action must be managed upon its own merits, or, in other and 
more comprehensive language, that, wrhile there are certain gen- 
eral principles which should not be disregarded, every case must 
be treated according to the peculiar features by which it is dis- 
tinguished. 
Disease is not, as it was formerly imagined to be, a special 
entity, a particular essence, a something vague, intangible, mys- 
terious, but simply a departure from the normal standard, a change 
in or of a part brought about by a perverted action of its circu- 
lation, innervation, and nutrition. Nearly every disease, whatever 
its name or site, is essentially an inflammation. Even in what 
are called the neuroses, or nervous affections, inflammation gen- 
erally plays a conspicuous part. 
Another well established fact is that disease is materially modi- 
fied by structure and function; a discovery mainly due, at first, 
to the labors of Bichat, and afterwards to the careful study of 
pathological anatomy and clinical observation. 
These two propositions, thus briefly stated, comprise the germs 
of a revelation in medicine of the most stupendous character; a 
revelation which has swept away with one fell swoop the whole 37 
system of nosology, and has done more than all that preceded it 
in laying its foundation, broad and deep, as a grand science, to be 
viewed and studied as an object of natural history, in the same 
manner and upon the same principle precisely as an animal, a 
plant or a mineral is viewed and studied, apart from all hypo- 
thesis and speculation, as something tangible and existent, not 
vague and undefined, without form or substance. 
The fact that nature is often capable of curing disease is now 
universally admitted, and has led to many most salutary changes 
in the practice of medicine. This doctrine is not, as has already 
been stated, new ; but for the diffusion of a general knowledge 
of it the world is mainly indebted to two men, the late Sir John 
Forbes, of London, and Dr. Jacob Bigelow, of Boston. Similar 
views have long been ably advocated by the learned professors 
of physiology and medicine in this Institution. 
That every case of disease, whatever its origin, location, symp- 
toms or complications, should be treated upon its own merits, or 
according to the peculiar features by which it is characterized, 
must be evident at first sight; but, unfortunately, this principle 
is seldom recognized at the bedside, and the consequence, as may 
well be imagined, is often most pernicious. The universal em- 
ployment of this or that treatment, in consonance with the fashion 
of the day, cannot be too pointedly condemned. 
Among the singular delusions which have crept into medicine 
during the present century, and which have served to confound 
the judgment even of many educated and otherwise enlightened 
men, it will suffice to enumerate homoeopathy, Thompsonianism- 
better known as " Lobelia and No. 6"-hydropathy, the grape and 
whey cure, isopathy, electro-pathy, clairvoyance, Baunscheitis- 
muS, negropathy, and other sects too numerous and absurd to be 
mentioned. The fate of some of these is already sealed, and the 
downfall of some of the others it is easy to foresee. No system 
that is not founded upon common sense can long withstand the 
scrutiny of the public, however greedily it may seize upon any 
novelty that promises relief from pain and suffering. 
The establishment of colleges for the education of female physi- 
cians is another feature peculiar-to the present age. Whether 
such institutions are really needed, I leave to others to decide. 
My own opinion has always been that medicine is not an appro- 
priate sphere for woman, unless she confine her attention solely 
to the practice of obstetrics, in which she might, doubtless, often 
be of great service. There must necessarily be a vast amount of 
ordinary business for which females are wholly unfitted by edu- 
cation and habit, not less than by their natural sense of delicacy 
and refinement. 
Asiatic cholera was not known in this country until 1832. 
Since that time it has made several visitations, and in some dis- 
tricts literally decimated the population. To the catalogue of 
maladies, already sufficiently extensive at the period adverted to, 
have been added Bright's disease, diphtheria, pyemia, osteo-mye- 38 
litis, leucocythemia, pelvic cellulitis, and pelvic hematocele, trichi- 
niasis, uremia, aphasia, Addison's disease, locomotor ataxy, and 
cerebro-spinal meningitis, the latter of which is probably simply 
the " spotted fever," which prevailed so extensively in the early 
part of the present century in New England, and which has been 
so graphically described by Gallup and by Miner and Tully. 
Forty years ago there were few American physicians, even in 
some of the larger towns, who did not, when occasion required, 
extract teeth, using generally for this purpose the pullikin instead 
of the forceps now so universally employed. In 1820 the number 
of practicing dentists in the United States was only 30; in 1850 
it had increased to 3000, and at present it is fully 5000. Dental 
colleges, supplied with all the means and appliances for the de- 
livery of efficient courses of instruction, exist in various parts of 
the continent, and America may justly claim the proud pre-emi- 
nence of having the best educated and most scientific dentists in 
the world. 
Great improvement has been effected in the construction of sur- 
gical instruments, apparatus, and appliances. Our pocket and 
operating cases possess a degree of neatness and compactness un- 
known in former times, while the delicacy and finish of many of 
the instruments are in striking contrast with the awkward and 
clumsy character which distinguished them a third of a century 
ago. For these important changes the profession is mainly in- 
debted to Messrs. CharrUre, of Paris, and Weiss, of London, two 
manufacturers of unrivalled excellence in their day, whose pupils 
are to be found in all parts of the civilized world. As beautiful 
and perfect instruments are now made in Philadelphia, New York, 
and Boston, as in any of the great cities of Europe. 
Medical colleges have multiplied in a ratio altogether dispro- 
portionate to the wants and requirements of the country. If the 
number now in existence were reduced to one-fourth, no one can 
doubt that it would be a great gain to the interests of the profession 
and of humanity. Many of these institutions are, from their un- 
favorable situation, destitute of anatomical and clinical facilities, 
upon which so much stress is justly placed in a course of medical 
education. Even the best and 'most favored schools are far from 
what they ought to be-as great seminaries of medical science. 
Hardly any change in the curriculum of instruction has occurred 
in any of them since my entrance into the profession. The 
number and character of the chairs, the length of the session, the 
period of study, and the preliminary education of the student 
are, in most of the colleges, the same as formerly. The principal 
improvement has been in the addition of clinical teaching, ren- 
dered indispensably necessary by the demands of the age. It 
will be a proud and happy day for medicine and humanity when 
the principal medical institutions of the United States, adopting 
the suggestions offered by the recent medical teachers' convention 
at Cincinnati, shall be placed upon the same footing in regard to the 
amount and character of their instruction, and the requirements 39 
of their pupils. The only difficulty now in the way is the want 
of concert of action, which, however, will no doubt eventually-■ 
probably at no distant day-be brought about. 
The improvement in medical literature has kept strict pace with 
the improvement of medical science. I can speak here only of 
what has taken place in our own country. Thirty-five years ago, 
American medical literature was not only very meagre, but it 
could hardly be said to have had an existence. We had not yet 
answered the sneering remark of Sidney Smith: "In the four 
quarters of the globe, who reads an American book, or goes to 
an American play, or looks at an American picture or statue ? 
What does the world yet owe to American physicians and sur- 
geons ?" If the celebrated Edinburgh Reviewer-who paid one 
of our countrymen, Daniel Webster, the high compliment of say- 
ing that he was a steam-engine in trousers-could rise from the 
dead, and walk into our bookstores and into our academies of fine 
arts, he would, if he could divest himself of prejudice, behold 
books, and pictures, and statues, the production of American ge- 
nius, many of which would do honor to any country. The works 
of Rush, Wistar, Dorsey, Coxe, Thacher, Chapman, Beck, Dewees, 
Gibson, Hare, and Eberle, constituted the chief bulk of our native 
authors at the period in question. The college text-books were, 
for the most part, foreign works, many of them edited, with notes 
and emendations, or notes and additions, as the phrase then went, 
by American physicians, usually teachers in medical schools; for, 
unless the editor occupied some distinguished position, no pub- 
lisher was likely to undertake the reprint, as there was a great risk 
of failure. In a word, a responsible endorser was necessary. Now 
and then, a translation of a French or German work by an Ameri- 
can appeared. I, myself, performed some labor of this kind early 
in my professional life, and there are still living among us a num- 
ber of distinguished men who busied themselves in a similar 
manner, rendering thus, at a period when it was much needed, an 
important service to the profession. 
The native works which now grace the libraries of our physi- 
cians, and which have contributed so much to exalt the character 
of the medical literature of the country, have been of later growth. 
Commencing with the " Human Physiology" of Professor Dun- 
glison, a treatise of vast labor and ability, issued in 1830, and 
worthy, in point of erudition, systematic arrangement, and elegance 
of diction, to rank with the immortal " Elementa Physiologiae 
Corporis Humani" of Haller, published two-thirds of a century 
earlier, there followed in succession, though by no means rapidly, 
the works of Silliman the elder, Bigelow, Horner, Hosack, Wood, 
Paine, Dickson, Pancoast, N. R. Smith, Morton, Meigs, Bell, Ger- 
hard, Draper, Drake, Condie, Bartlet, La Roche, Henry H. Smith, 
Bedford, Hamilton, Stille, Hodge, the two Flints, Dalton, Richard- 
son, Bumstead, Leidy, Maxson, Da Costa, Wormly, Warren, with 
many others which my limits will not permit me even to enume- 
rate. Many of these works are productions of the highest order of 40 
excellence. The treatise on the Practice of Medicine, by Dr. 
Wood, formerly Professor of Medicine in the University of Penn- 
sylvania, has been not only largely circulated at home, but used 
extensively as a text-book in some of the British schools; the 
Elements of Medical Jurisprudence of Dr. Beck, repeatedly re- 
printed in England, as well as translated into the German lan- 
guage, is one of the most erudite and elaborate works that have 
ever appeared upon the subject; and The Medical Dictionary 
of Professor Dunglison is without a rival in any country, as the 
offspring of a single individual. These works, while they shed 
imperishable lustre upon the American nation, have made for- 
eigners familiar with our ability as observers, our acuteness as 
diagnosticians, and our skill as practitioners, and have procured 
for us a distinguished rank as scientific and literary men. Foreign 
medical works, although many are still republished, as, indeed, 
they ought to be, have almost ceased to appear with that curious 
caudal appendage, the name of an American editor; and compa- 
ratively few of them are now employed as text-books in our 
medical colleges. 
Our periodical literature is not only highly respectable, but it 
compares most favorably with that of Europe; less solid than that 
of Great Britain, but quite equal, in the aggregate, to that of 
France, Belgium, Germany, and Italy. The stately quarterly, the 
"American Journal of the Medical Sciences," edited by Dr. Hays, 
of this city, is unquestionably the ablest work of the kind in the 
world. As critics, we are inferior to the English, if not also to 
the writers of continental Europe, but the time is not distant when 
we shall redeem ourselves in this respect; for what, it may be 
asked, is there that the American mind cannot accomplish if it 
sets about it ? 
I have, thus far, in accordance with the design of this discourse, 
spoken of matters and things in general-of the glorious progress 
and present condition of our profession as an art and a science; 
let me now, in conclusion, offer a few words personal to your- 
selves. 
It would be absurd in me to ask, what has brought you here ? 
The place in which we are assembled is a sufficient answer. The 
object is to prosecute your studies under new auspices; to avail 
yourselves of new means and opportunities for extending and 
perfecting the knowledge you have brought with you. Many of 
you never were in a medical college before, never performed a 
dissection, never witnessed a chemical experiment, never saw a 
great surgical operation, never even listened to a medical lecture. 
You suddenly enter, as it were, upon a new life. Hitherto your 
studies were carried on under serious difficulties. The office of a 
private physician, with here and there an exception, offers few 
facilities for the acquisition of a knowledge of a science so vast 
and so diversified in its character as that of medicine. In a well- 
conducted course of lectures, more may be learned in a single 
month than in three years, as ordinarily spent, in private read- 41 
ing; for there are a thousand things in anatomy, chemistry, ma- 
teria medica, surgery, midwifery, and medicine, which can be 
taught only by an appeal to demonstration, such as no private 
teacher can supply. In the new life into which you now pass, 
the professor reads and thinks for you; your business is to listen, 
to see, to receive, to digest; in a word, to be crammed with 
knowledge. 
To-morrow, bright and early, you will buckle on your armor 
of industry; throw your knapsack across your shoulders, and 
begin your work right earnestly, like men determined to surmount 
obstacles, clear away rubbish, and fulfil their great mission, as 
honest, diligent students. The road will, at first, be somewhat 
difficult; there will be frequent need of the spade and the pick- 
axe ; but your progress will gradually become more and more 
easy, and thus, step by step, with patience and perseverance, you 
will steadily mount up higher and higher along the steep hill of 
Science, until, at length standing upon its lofty summit, you may 
calmly and leisurely survey the majestic scenery around and 
beneath you, and take a longer breath in the consciousness of 
having done your duty. We too-I mean your teachers-men 
who, like yourselves, once sat upon hard, backless benches, in 
quest of knowledge-we too will be students ; we will accompany 
you in all your journeyings; point out, with lamp in hand, your 
way; assist in removing obstacles; encourage you by our pre- 
sence ; and thus, workers and laborers together, share your toils 
and pleasures. 
The studies of the medical pupil are of a most singularly diver- 
sified character, far more so than those of any other profession; and 
hence, unless they are systematically pursued, his progress, despite 
the best endeavors of his teachers, will be painfully slow and diffi- 
cult. You must, therefore, spare no effort to make a fair begin- 
ning. With this end in view, I would earnestly advise you, 
before you come here in the morning, to clear out the bins of 
your brains. If you will carefully examine this organ you will 
find that it is composed of many compartments, with a wonderful 
faculty of accommodation. These compartments, I shall, for the 
sake of illustration, denominate bins, of which one should be ex- 
clusively devoted to anatomy and physiology; another to chem- 
istry and materia medica; a third to midwifery ; a fourth to 
medicine; one to surgery; and, lastly, another to miscellaneous 
matters, picked up here and there in your walks to and from the 
College, and in your intercourse with your friends and acquain- 
tances. Unless your studies are conducted upon some such plan 
as this, in the most orderly and systematic manner, you will have 
the mortification to find, at the close of the session, that you have 
made no substantial progress, and that, what little knowledge you 
have attained, is, practically, of no avail. Keep your bins, then, 
clean and separate, not mixing and jumbling up their contents, 
so that, when you wish to get at them, you will be obliged to 
toil and dig anew. 42 
Although it will be the duty of each of my colleagues to in- 
form you of the best method of studying his own particular de- 
partment, yet, I cannot refrain from referring, in general terms, 
to the subjects which should more especially engage your atten- 
tion during the first session of your attendance. 
Anatomy is justly regarded as the corner-stone of the grand 
edifice of medicine. To it, therefore, you should devote much 
close study-not learning from books, but from nature-tracing 
out, with scalpel in hand, every important structure, and thus 
thoroughly photographing it upon the mind, so that, to use an 
Irish bull, with your eyes shut, you may see it as clearly as if it 
were reflected from the surface of a broad mirror. In carrying 
on your dissections, you will often be ready to exclaim with Galen, 
pausing in the midst of an autopsy, " It is not a lecture on anato- 
my I am delivering, it is a hyhin in honor of the Creator!" 
Chemistry, one of the elementary branches, can only, as your 
able professor himself will inform you, be learned in the labora- 
tory, just as anatomy can only be learned in the dissecting room, 
or operative surgery upon the cadaver; but you will, neverthe- 
less, find a great deal of nice picking in a well-conducted course 
of lectures, such as you will be sure to obtain in this school. 
You will be daily reminded, in the presence of my excellent col- 
league, of the story of the Englishman, who, looking with sur- 
prise and disgust at a Scotchman eating a singed sheep's head, 
was asked what he thought of that dish ? " Dish, sir; do you 
call that a dish ?" " Dish, or no dish," rejoined the Caledonian, 
" there is a deal o' fine confused feedin' aboot it, let me tell you." 
While chemistry is the most abstruse and difficult of studies, it is 
at the same time the most sublime and captivating, one which is 
better calculated to establish a closer relation between man and his 
Creator than perhaps any other, inasmuch as it associates him more 
intimately with the various works of His hands. To give you an 
idea of the importance of a knowledge of this science, in the practice 
of medicine, it is only necessary to point to the examination of the 
animal fluids, as the blood, urine, and semen; the analysis of 
poisons, in cases of suspected crime; and the avoidance of incom- 
patibles in the daily prescriptions of the physician. 
In studying materia medica you will learn how greatly our 
science is indebted to the vegetable and mineral kingdoms for the 
supply of our remedial agents. Flora, which ravishes the senses 
with the beauty and variety of her products, and scents the air 
with the fragrance of her blossoms, furnishes man with the bark 
for the cure of fever, opium for the relief of pain, aconite and vera- 
trum viride for the subduction of arterial excitement, and the 
juice of the grape for the support of the system when exhausted 
by disease and injury. The earth supplies him with alkalies and 
acids; the sea with chlorine, iodine, and bromine; the air with 
oxygen and electricity. 
Under the guidance of your able teacher you will learn what 
estimate to place upon the more important articles of the materia 43 
medica, how to combine and prescribe medicines to the greatest 
advantage, and how to prepare food and drink for the sick. You 
will find, as you proceed in your studies, what a vast amount of 
farrago underlies this department of medical science, and how 
much need there is of winnowing the wheat from the chaff. 
Of the fifteen hundred articles to be found in what are called 
w'ell-regulated drug stores in this city, hardly three hundred, as 
I was recently informed by a highly intelligent apothecary, are 
ever employed. The rest lie idle in their bottles and drawers. 
From thirty-five to fifty is probably the highest number pre- 
scribed from one year's end to the other by physicians of the 
largest practice. 
Midwifery holds out every incentive that can rouse the ener- 
gies, or excite the ambition, of the student. Woman, the noblest 
work of God, and her tender offspring, are the objects with which 
this department of medical science busies itself. Your professor 
will conduct you over a course of study of the most delightful 
and absorbing interest. He will unfold to you the secrets of 
conception, describe the sufferings incident to the pregnant state, 
and initiate you into the mysteries of the lying-in chamber, point- 
ing out the various presentations, the mechanism of labor, the 
use and abuse of instruments, and the proper method of carrying 
his sacred charge safely through her trials and difficulties. In 
studying this vast subject, so replete in objects of the dearest 
interest to the human race and the welfare of society, you will 
not be troubled with any doctrines of a change of type. The 
process of conception and the nature of parturition are the same 
they were forty years ago. Here, at all events, there has been 
no improvement. Good Old Dame Nature permits no encroach- 
ments upon her prerogatives. 
Medicine and surgery are so closely allied, so intimately inter- 
woven, that they constantly trench the one upon the other. They 
are, in fact, one and indivisible, recognizing the same pathology, 
the same treatment. You may be good physicians without being 
good surgeons; but you cannot be good surgeons unless you are 
good physicians. The teachers who preside over these two de- 
partments will spare no pains to qualify you for the arduous and 
responsible duties of practitioners, the great aim and object of all 
your studies and inquiries. Clinical instruction will constitute a 
special object of attention. Every opportunity will be seized to 
illustrate the principles enunciated in the didactic course. The 
subject of diagnosis will claim more than ordinary consideration. 
The object will be to teach you how to observe at the bedside, 
how to investigate cases, how to connect symptoms with patho- 
logical changes, how to form a correct prognosis, and, finally, how 
to prescribe with judgment and advantage for the sick. The 
clinics of this Institution have long been distinguished for the 
great extent and variety of their material, and you cannot fail, if 
you be at all attentive, to be greatly benefited by them. 
I have said nothing here of the study of physiology, hygiene, 44 
and medical jurisprudence. Your acquaintance with anatomy, 
chemistry, and the practice of medicine, will furnish you a ready 
key to these interesting and seductive branches of medical science. 
Thus, gentlemen, you see what is before you. Work steadily, 
arduously, systematically, but work also rationally, as it respects 
your health and comfort. We hear much of the midnight lamp. 
Upon this point you need not be particularly ambitious. As a 
general rule, the midnight lamp is a very bad lamp, emitting a 
lurid light and foul vapors, prejudicial to sight and health; not at 
all promotive of advancement in knowledge and wisdom. Sleep 
is essential to health and comfort, and I perfectly agree with 
Sancho Panza that it was a blessed invention. The Sabbath, too, 
was a great invention ; a great blessing alike to man and animal. 
Thank God for it, and see that you spend it wisely; partly at 
church, partly in wood and field, in wholesome exercise, and 
in the contemplation of Nature, partly in writing to the dear ones 
at home. Be strong in your resolve to withstand temptation. Do 
not disregard the admonitions of parental affection and friendship. 
The last words of a fond and doting mother, whispered into your 
ear, as she sobbingly pressed your hand, and imprinted her last 
kiss, were, " My son, shun the ways of the evil-doer, and neglect 
not the church and your BibleI" Cities are sink-holes of iniquity ; 
vice and temptation meet one everywhere, often in their most 
alluring forms, alike in the retired alley and in the most crowded 
thoroughfare; and happy, thrice happy, is he who can success- 
fully resist their blandishments. You need not be anchorites; 
youth is the season of hilarity and gayety; a certain amount of 
relaxation and amusement is indispensable to a student. " All 
work and no play make Jack a dull boy." A mind that is con- 
stantly exercised is like a tool that is never ground, or a bow that 
is incessantly bent. It is blunted by labor, and, if it be not occa- 
sionally unstrung, becomes unfit for the discharge of its multifa- 
rious functions. A sound, hearty, wholesome laugh is medicine 
for the soul, and is one of the peculiar prerogatives of our nature. 
A student who never rests is like a camel that lies down at night 
under his weary burden.