[From the Memorial of the Centennial of the Yale Medical School, 1814-1914. Yale University Press, 1915.] HISTORICAL ADDRESS The Evolution of Medicine in Connecticut, with the Foundation of the Yale Medical School as its Notable Achievement. Walter Ralph Steiner, M. A., M. D. Read at the Centennial Celebration of the Yale Medical School, June the Fifteenth. 1914. HISTORICAL ADDRESS [From the Memorial of the Centennial of the Yale Medical School, 1814-1914. Yale University Press, 1915.] HISTORICAL ADDRESS The Evolution of Medicine in Connecticut, with the Foundation of the Yale Medical School as its Notable Achievement. Walter Ralph Steiner, M. A., M. D. Read at the Centennial Celebration of the Yale Medical School, June the Fifteenth, 1914. THE EVOLUTION OF MEDICINE IN CON- NECTICUT, WITH THE FOUNDATION OF THE YALE MEDICAL SCHOOL AS ITS NOTABLE ACHIEVEMENT. Walter R. Steiner, M. A. M. D., On this hundredth anniversary of the Yale Medical School, how I wish I had the pen of a Henry Bronson,1 a Gurdon W. Russell,2 or a Francis Bacon,3 so that I might successfully portray the evolution of Medicine in Connecticut, with the foundation of the Yale Medical School as its notable achievement! But these distinguished graduates are no more, and the honor is mine to do what they could have more successfully performed. In the early history of New England, the outlook for the physician was decidedly discouraging, there 1 Dr. Henry Bronson was a graduate of the Yale Medical School in 1827, and Professor of Materia Medica and Therapeutics there from 1842-1852, and again from 1853-1860. He wrote an Historical Account of the Origin of the Connecticut Medical Society. Trans. Conn. Med. Soc., 1873, p. 192, Medical History and Biography, N. H. C. Hist. Soc. Papers, New Haven, 1877, II, p. 239, and other valuable papers. 2 Dr. Gurdon W. Russell was a graduate of the Yale Medical School in 1837 and for seventy-two years a prominent physician in Hartford. He wrote Sketches of Physicians in Hartford in 1837, Hartford 1890 and Early Medicine and Early Medical Men in Connecticut, Trans. Conn. Med. Soc., 1892, p. 69. 3 Dr. Francis Bacon was a graduate of the Yale Medical School in 1853 and Professor of Surgery there from 1864-1877. He wrote a History of the Connecticut Medical Society, Trans. Conn. Med. Soc., 1892, p. 177, and Some Account of the Medical Profession in New Haven. History of the City of New Haven, New York, 1887, p. 260. 2 THE EVOLUTION OF MEDICINE being no inducements for emigration to eminent practitioners in the old world, and, to those who would take up the study of medicine here, the absence of lectures in medical schools, as well as of hospitals, presented distinct drawbacks.1 Only a favored few, on account of the expense, could embrace the opportunity for foreign study. There was, also, a dearth of drugs, the large territory to cover necessitated what was even then scant jus- tice to the individual patient and the remuneration was at best but small. Giles Firmin, of Ipswich, Massachusetts,2 had come over from England in 1632, bringing with him high ideals and a good medical education for those times. He had prepared a skeleton and had given anatomical lectures upon it at Cambridge-in fact, he was the first medical lecturer in this country-but the pinch of pover- ty could not then be remedied by him, so he despair- ingly wrote: " I am strongly sett upon to studye divinite; my studies else must be lost, for physick is but a meene help,"3 and later he did adopt this course, returned to England and died in the ministry. Of the three classes of medical practitioners- 1 Before the Revolution " it had been thought indispensably necessary to resort to foreign universities, to complete the system of medical edu- cation, and to acquire there the theory and practice of physic, which the want of regular schools and established hospitals in this country, rendered unattainable." Waterhouse, The Rise, Progress and Present State of Medicine, Boston, 1792, p. 27. 2 Dean, A Brief Memoir of Rev. Giles Firmin, One of the Ejected Ministers of 1662, N. E. Hist, and Gen. Reg., 1866, XX, pp. 47-58. Also III Mass. Hist. Coll., IV, p. 57. 3 Hutchinson, Coll, of Papers, Boston, 1769, p. 169. HISTORICAL ADDRESS 3 the priest physician, the regular physician and the empiric or charlatan-Connecticut appears to have possessed them all. The first existed for " ever since the Days of Luke, the Evangelist, Skill in Physick has been frequently professed and practiced by Persons whose more declared Business was the Study of Divinity."1 We find, consequently, many a village minister following out what Cotton Mather loved to call " the Angelical Conjunction,"2 by tending to the cure of body as well as the cure of soul. Jared Eliot of Clinton, Phineas Fisk of Had- dam, the Bulkeleys, father and son, Gershom and John, of Rocky Hill and Colchester, and Timothy Collins of Litchfield form an illustrious quintette of Connecticut's clerical physicians, who labored long and well. Although ruthless quackery, unchecked by any wise legislation, was rampant in colonial times, yet the state of medicine in Connecticut seems to be on a higher level than in the other colonies, and can probably be explained by the dignity which the distinguished John Winthrop, Jr., the Governor of Connecticut, lent to this science and art.3 For, famed by his charity, his learning and his adminis- trative abilities, he made medicine his avocation and " wherever he came, still the diseased flocked about him, as if the Healing Angel of Bethesda had appeared in the place."4 His sovereign remedy, 1 Mather, Magnalia, Hartford edition of 1853, I, p. 493. 2 Mather, loo. cit. 3 Wadsworth, Medicine in the Colonies, 1910, pp. 7-8. 4 Mather, Op. cit., p. 159. 4 THE EVOLUTION OF MEDICINE Rubila, was in many a household. In some towns its disposition was entrusted to the minister or a deacon, and, following out Wait Winthrop's instruction, it appears to have been given at the beginning of any illness.1 Its taste, however, was a slight objection to its administration, for Daven- port, the first pastor at Center Church, in New Haven, states that Governor Newman took once Rubila, but " finding himself sundrie times ready to faint away, hath not been willing to take it again, nor his wife that he should, though we per- suaded and encouraged him thereunto."2 Samuel Stone, assistant to Thomas Hooker, Hartford's first pastor, was also prescribed this powder, but unfortunately was not found " inclinable, though he was burthened in his stomach."3 It may have been the powder about which Graciana, Governor Leete's daughter, had " grown marvailous awkward and averse from taking in beer,"4 and probably was the remedy which was prescribed for Mrs. Daven- port, concerning which her husband, in the depths, wrote to Winthrop: "My wife took but halfe of one of the papers but could not beare the taste of it, and is discouraged from taking any more. I perceive that some speech from yourselfe would best satisfie her, but if God's providence puttes a barr in the way, we are called to submit thereunto."5 1 Mass. Hist. Coll., VIII, p. 429. 2 III Mass. Hist. Coll. X, p. 43. 3 III Mass. Hist. Coll. X, p. 43. 4 IV Mass. Hist. Coll. VII, p. 543. IV Mass. Hist. Coll. VII, p. 531. HISTORICAL ADDRESS 5 Before the formation of the Connecticut State Medical Society, there were no qualifications for practice except one's desire to exercise the healing art. Some, with a three months' study, had set themselves up as physicians and the public was at the mercy of the empiric or charlatan. In spite of the low medical standards, a feeling gradually became broadcast that better supervision should exist to prevent the people from being imposed upon. This feeling originated in the medical profession and was first voiced in Norwich, on September the twenty-seventh, 1763, when eleven doctors, realizing that nothing had been done " publicly to distinguish between the honest and ingenious physician and the quack or empirical pretender," memoralized the legis- lature with the request that physicians, in each county of the colony might have the liberty to meet quarterly and to choose annually a committee of three approved physicians to examine candidates for the practice of physic, and to approve by certifi- cates those found qualified. Those without such certificates, who were not already in practice, were not to be allowed to collect their fees by law.1 This pioneer attempt at medical organization in the United States, unfortunately, met defeat in 1 Summer, The Early Physicians of Connecticut, Trans. Conn. Med. Soc., 1851, pp. 50-51. See also Bacon, History of the Connecticut Medical Society, Trans. Conn. Med. Soc., 1892, pp. 183-186, and La Pierre, The Conception of Our State Society, Trans. Conn. Med. Soc., 1893, pp. 94-108. The Litchfield County Medical Association was organized in 1764. The county then was rather inaccessible so the association could not of necessity play a very important part in the foundation of the State Medical Society. Its first existing record book dates from 1808. 6 THE EVOLUTION OF MEDICINE the lower house of the legislature, and it was only granted to three of the petitioners to see their desires gratified twenty-nine years later. The advantages of an organization of a medical society were clearly shown during the Revolution when one was formed in the army which had tended to improve the state of medical knowledge.1 On the tenth of December, 1783, Leverett Hubbard, Eneas Munson, Samuel Nesbit, Levi Ives and Samuel Darling, all of New Haven, requested the physicians and surgeons "to meet at the Coffee House in New Haven on the first of January then ensuing, at two o'clock P. M. for the purpose of forming a county society and combining with other similar bodies to obtain from the legislature an act of incorporation the more effectually to regulate the practice of physic."2 It was, consequently, a purely voluntary and provisional organization which was dissolved when its purpose had been attained. To accomplish it, however, required eight years of struggle, during which " the eastern counties appear to have become very remiss and fallen into a lethargy,"3 yet the New Haven County Associa- tion persevered and strove by their committee to open a correspondence with other medical societies 1 Cases and Observations; by the Medical Society of New Haven County, in the State of Connecticut, New Haven, 1788, p iii. 2 Bronson, Medical History and Biography, N. H. C. Hist. Soc. Papers, New Haven, 1877, II, pp. 239-388, and Eliot, The Origin of the New Haven County Medical Association, New Haven, 1902, pp. 8-16. 3 Bronson, Historical Account of the Origin of the Connecticut Medical Society, Trans. Conn. Med. Soc., 1873, p. 198. HISTORICAL ADDRESS 7 in this country and Europe, and to send them selected papers from their files. In January, 1788, it was voted that a collection of the most interesting cases communicated to the society be made, and that they be published at the society's expense. A pub- lishing committee of five was, accordingly, appointed and in the summer of that year a pamphlet appeared, containing eighty-six pages, with the title: Cases and Observations; by the Medical Society of New Haven County, in the State of Connecticut. It was the first publication of any medical society in this country and was a very praise-worthy pro- duction, containing twenty-six papers, contributed by the society's most distinguished members. Five hundred copies were printed, and its complimentary notices by Dr. John Warren of Boston, Bishop Seabury of Connecticut (for he had been trained as a physician) and Dr. John Morgan of Philadelphia, with others from England and France,1 doubtless spurred the members to further efforts, which were successful in May, 1792, when the Connecticut State Medical Society was finally organized by a charter free from the objections of the previously rejected bill of 1787.2 It was accomplished, how- ever, only in the teeth of the most intense oppo- sition, which was demonstrated in Yale College in 1788, when it caused the seniors to debate the 1 Bronson, Medical History and Biography, N. H. Hist. Soc. Papers, New Haven, 1877, II, p. 13. 2 Bronson, Historical Account of the Origin of the Connecticut Medical Society, Trans. Conn. Med. Soc., 1873, p. 201. 8 THE EVOLUTION OF MEDICINE question " Whether it be safe to grant the proposed charter for the medical societies in Connecticut," and on the sixth day of January, in the year fol- lowing, they took up the subject again, in the form " Whether the institution of medical societies be useful."1 The keen public interest in this appears to have been developed from the fear lest chartering a medical society might create a private monopoly. After the charter was granted, as the years passed on, public opposition ceased, for the effect of the medical society upon the medical profession was mag- ical. Thomas Miner, of Middletown, in a Presidential address before the society, in 1837, has shown to what a low ebb the majority of the profession had reached in 1792.2 Though capable physicians were rare, yet trustworthy surgeons were scarcer, and a competent obstetrician was almost unknown. He says, " there was not probably a good practitioner to a county." By this professional union, however, quackery and mystery were largely banished from the profession, and the need of better facilities, in Connecticut, for medical education soon became painfully apparent. In 1800, the legislature dis- owned all pretenders as physicians by withhold- ing from them the legal power of collecting their professional debts, unless they had been legally examined and approved.3 1 The Literary Diary of Ezra Stiles, edited by Franklin Bowditch Dexter, New York, 1901, III, pp. 324 and 338. 2 Trans. Conn. Med. Soc., 1837, pp. 3-12. 3 Unfortunately this law was repealed by the legislature in June, 1842. HISTORICAL ADDRESS 9 Before the establishment of the Yale Medical School, the opportunities for the education of Con- necticut physicians were for the most part incon- siderable.1 Some, like Daniel Lathrop (Y. C. 1733) of Norwich,2 Daniel Bontecou (Y. C. 1757)3 of New Haven, or Elihu Tudor (Y. C. 1750) of East Wind- sor,4 were able to go abroad to "walk the hospitals," although they did not stay long enough for a medi- cal degree. Their number, unfortunately, was con- fined to a favored few. Others like William Tully (Y. C. 1806) of Saybrook,5 or Timothy J. Gridley Y. C. 1808) of Middletown Upper Houses or Crom- well,6 went to Dartmouth to place themselves under the able instruction of Nathan Smith, while still others, like Jonathan Knight (Y. C. 1808) of Nor- walk,7 or Elisha North of Goshen8 betook themselves to the medical school of the University of Pennsyl- vania or like Thomas A. Graham (Y. C. 1768) of West Suffield to King's College Medical School in New York City.9 But the largest percentage of them, compelled by their scant means to remain at home, bound themselves, by an apprenticeship to a neighboring physician, for a variable period. When 1 Knight, A Lecture Introductory to the Course of Instruction in the Medical Institution in Yale College, New Haven, 1838, p 7. 2 Dexter, Yale Biographies and Annals, N. Y., I, pp. 483-484. 3 Dexter, Op. cit., II, p. 451. 4 Dexter, Op. cit., II, pp. 243-245. 6 Dexter, Op. cit., VI, pp. 68-73. 6 Dexter, Op. cit., VI, pp. 193-194. 7 Dexter, Op. cit., VI, pp. 213-216. 8 Steiner, Dr. Elisha North, One of Connecticut's Most Eminent Medical Practitioners, Johns Hopkins Hosp. Bull., 1908, XIX, pp. 301-307. 9 Dexter, Op. cit., Ill, pp. 278-279. 10 THE EVOLUTION OF MEDICINE they felt competent to practice, they then were ac- customed to receive a certificate, vouching for their good character and satisfactory attainments. Some of the earliest physicians were licensed to practice by the General Assembly, and by virtue of this power were not required to pay taxes and were excused from military and other personal duties until 1740, when this law was repealed.1 Others, without any license or authority, started to practice upon their own volition and many in this group were incompetents, quacks or pretenders. Of the early teachers, it is sufficient to name Jared Eliot of Clinton, who has been considered the father of medical practice in Connecticut,2 Benjamin Gale of Killingworth, his son-in-law,3 John Barker of Franklin,4 Jared Potter of Walling- ford,5 Lemuel Hopkins,6 and Mason F. Cogswell of Hartford,7 John Osborn of Middletown,8 Elisha Tracy of Norwich,9 and Thomas Hubbard of Pom- fret (later Professor of Surgery in the Yale Medical School).10 Some of these had so many pupils that 1 Sumner, Op. cit., p. 37. 2 Dexter, Op. cit., I, pp. 52-56. 3 Dexter, Op. cit., I, pp. 477-480. 4 Woodward, Trans. Conn. Med. Soc., 1859, p. 31, and 1862, pp. 174- 175. 6 Dexter, Op. cit., II, pp. 668-670. 6 Steiner, Dr. Lemuel Hopkins, One of the Celebrated Hartford Wits, and a Forgotten Distinguished American Student of Tuberculosis. Johns Hopkins Hosp. Bull., 1910, XXI, pp. 16-27. 7 Dexter, Op. cit., IV, pp. 141-143. * Mathewson, Trans. Conn. Med. Soc., 1877, p. 141, and Hazen, Trans. Conn. Med. Soc., 1892, p. 549. 9 Dexter, Op. cit., I, pp. 609-610. 10 Kingsley, Yale College, New York, 1879, II, p. 76. HISTORICAL ADDRESS 11 they conducted a miniature medical school, which, in a few instances, had a great reputation in those days. In one of Lemuel Hopkins' letters to Joel Barlow he writes: " I still keep up my medical school and have now five pupils - all promising young men-with me,"1 while on another occasion he states: " I still keep a roomful of pupils."2 Earlier, in 1785, when there were but two medical schools in this country, we find Dr. Philip Turner and Dr. Philemon Tracy of Norwich, issued a pro- spectus for the delivery of a series of lectures to students on Anatomy, Physic, Surgery, etc. As an inducement they offered " the free use of a complete library of ancient and modern authors, together with the advantage of being present at capital operations, dissections, etc." They, also, state that every attention will be paid by them " to render their lectures both useful and pleasing, their con- stant endeavors will be to facilitate the instruction, direct with propriety the judgment, correct the errors and increase the knowledge of the pupils in their study."3 In Pomfret stories are still extant of the fast riding over the country of Dr. Thomas Hubbard, and his pupils, who were discourteously called " his hounds."4 The elder Dwight is generally credited with the distinction of first suggesting a medical school to 1 Todd, Life and Letters of Joel Barlow, New York, 1886, p. 112. 2 MS. letter, Conn. Hist. Soo. 3 Woodward, Trans. Conn. Med. Soc., 1862, p. 169. 4 Kingsley, loc. cit. 12 THE EVOLUTION OF MEDICINE be established in connection with Yale, but the idea really originated in the mind of his predecessor, Dr. Ezra Stiles. On December 3, 1777, about six months before he became President, he drafted a plan of a university, particularly describing the Law and Medical Lectures. This was done at the desire of the Yale Corporation, as they wished to lay it before a committee of the General Assembly of Conn- ecticut, which was appointed to consider the ex- pediency of founding these two professorships, as well as other matters. Fortunately a copy of this plan is still preserved among Dr. Stiles' papers,1 and from it we learn that the author thinks it "desirable in order to cement a seat of learning with the public that some at least of the principal Foundations should be instituted by the State, and suggests that the Professorships of Law and Physic are of ex- ceeding utility and benefit." Then he speaks of 200 physicians living in Connecticut, and adds that " to circulate and increase medical knowledge must be an object worthy the attention of every well regulated state." He would divide the medical lectures into three series, assigning to the first " the anatomy of the human body, muscular motion, the vascular system, the circulation of the blood, osteology, and in general whatever tends to give a complete idea of the animal frame the subject of diseases and health." These lectures, he thinks, might consist of extemporaneous descriptions on a skeleton and on the arterial and venous systems in 1 Stiles' MS., Yale University Library. HISTORICAL ADDRESS 13 wax, with occasional dissections and explanations of the plates and drawings in Cowper's Anatomy and Cheselden's Osteography. The second series would consist of lectures on materia medica, and for this he proposes a room furnished with drugs as in an Apothecary shop, being a good collection of simples and the capital efficacious medicines with some of the officinal prep- arations. These should not be exhibited in written lectures, after the manner of Cullen, but should be arranged by the professor so that he might go round the room and give extemporaneous lectures or descriptions of each class, until he has finished the whole arrangement and led the pupils through the whole materia medica. Connected with these lectures, he would have some on chemistry, so that the physician might know about compounding or preparing some important medicines and recommends Boerhaave's or Newman's Lectures for the prepara- tion of these talks. The last series should consist of written lectures on the nature of diseases and the art of medicine and surgery. He advises, the consultation, for this purpose, of the writings of Hippocrates, Boerhaave, Van Swieten, Sydenham and Mead. These also should be referred to the students for their private reading and study. After taking this series the student if found qualified could take the Degree of Bachellor in Physic. Then leaving college, after a year's course of clinical Lectures and the Praxis medendi with some physician in full and large 14 THE EVOLUTION OF MEDICINE practice, the student may be prepared to receive the degree of doctor of physic. The public then, he adds, would experience the benefit when the main body of Physicians in a State are thus formed for usefulness and honor. Unfortunately the com- mittee were not like minded, so the matter slumbered until the elder Dwight re-opened it soon after he became President in 1795. In 1802 Benjamin Silliman was appointed to the chair of Chemistry and Natural History, at Yale College,1 and we learn in his biography that he then expected " from the first to be ultimately connected with a medical school," at the same institution.2 For this reason, before taking up the duties of his professorship, he attended, in Philadelphia and Edinburgh, lectures upon anatomy, materia medica, botany and the theory and practice of medicine, in addition to those on chemistry and natural his- tory, his coming specialties. Four years later, at a meeting of the Yale Corporation, the Reverend Dr. Nathan Strong of Hartford introduced a reso- lution which called for the appointment of a com- mittee to inquire into the expediency of establishing a medical professorship.3 If this committee found 1 " Already in 1798 President Dwight, in the fullness of his learning and the wide reach of his intelligence, had perceived the importance of the science of Chemistry, and through his influence a vote of the Cor- poration was passed to the effect ' that a Professorship of Chemistry and Natural History be instituted in this College as soon as the funds shall be sufficiently productive to support it.' " Kingsley, Yale College, New York, 1879, I, p. 211. 2 Fisher, Life of Benjamin Silliman, New York, 1866, I, p. 161. 3 MS. Records, Yale Corporation. HISTORICAL ADDRESS 15 it expedient and practicable, they were then to devise the means of such establishment and a system of regulations which they judged adapted to the subject. The resolution was promptly passed and the Prudential Committee with Dr. Nathan Strong and Professor Benjamin Silliman were appointed as a special committee.1 It was intended to be, as Silliman subsequently states,2 the leading step towards a medical school, for the establishing of which ample authority was clearly expressed in Yale's Charter of 1745.3 The Con- necticut Medical Society had, however, been sub- sequently granted an unusual charter which gave the society the power not only to examine and license physicians, but also to confer degrees upon them. The society, acting within this power, had recently made several regulations concerning med- ical education,4 so the committee from the college recognized the importance of conferring with the society about the establishment of a medical insti- tution and addressed a letter to it, upon this subject, which was read at an adjourned convention of the 1 The Prudential Committee at that time was composed of Hon. John Treadwell of Farmington, Lieutenant Governor of the State, Rev. Dr. James Dana of New Haven and Rev. David Ely of Huntington. MSS. Records, Yale Corporation. 2 Fisher, Life of Benjamin Silliman, New York, 1866, I, p. 260. 3 Clap, the Annals or History of Yale College, New Haven, 1766, pp. 50 and 51. 4 October 1799 " Voted, That Doctors ./Eneas Munson, Nathaniel Dwight, James Potter, Simon Walcott, Jessie Carrington, William B. Hall, Thaddeus Clark and Jeremiah West be a Committee to take into consideration and digest some regular system of education to be pursued by Candidates for the practice of Physic and Surgery in this State; and 16 THE EVOLUTION OF MEDICINE Medical Society, at the house of Amos Ransom, in Hartford, on May 20th, 1807.1 This led to the appointment of a committee of conference and consultation on the part of both, which had frequent meetings under Presi- dent Dwight's chairmanship, in Professor Silliman's rooms, in the Lyceum.2 In the fall of that year a committee of five from the Medical Society reported in favor of a union with the college, in establishing a medical institution.3 The report was accepted by the Society, and eight were then appointed by it, to form with a committee from Yale a constitution to answer the purposes pro- report to next Convention." A Revision of the By-Laws of the Con- necticut Medical Society till October, 1802, Middletown, 1802, p. 29. May 1800 " Voted, To accept the report of the Committee appointed last October, to point out a regular system of education to be pursued by Candidates for the practice of Physic and Surgery, which is as follows, viz. That no Candidate for the practice of Physic or Surgery in this State,' shall be admitted to examination, until he shall have attained the age of twenty-one years, is of good reputation, and shall have had a Collegiate Education, and shall have studied at least two years with some respectable Physician or Surgeon; or if he has not had such preparatory education, shall have studied at least three years with such Practitioner; and shall not be licensed to practice, unless found qualified as follows, viz. A General knowledge of natural Philosophy, Chemistry and Botany, and a thorough knowledge of Materia Medica, Pharmacy, Anatomy and Physiology, Theory and Practice of Physic and Surgery." Ibid. p. 21. 1 Trans. Conn. Med. Soc., 1807, pp. 64-65. 2 Fisher, Life of Silliman, New York, 1866, I, p. 260. The committee from the Medical Society was composed of Drs. John R. Watrous, Mason F. Cogswell, John Barker, Eli Ives and Joseph Foot. Trans. Conn. Med. Soc., 1807, loc. cit. 3 This committee was composed of Drs. John Barker, Eli Ives, Thomas Goodsell, Joseph Foot and Timothy Hall. Trans. Conn. Med. Soc., 1807, p. 69. HISTORICAL ADDRESS 17 posed in the contemplated union.1 In May, 1808, the report of this committee was read, amended and adopted by the Society, and finally was sent to the clerks of the eight component county medical associations for their local societies' consideration.2 Five months later, a committee of three was chosen to confer with a committee from the Corporation of Yale College upon the articles of union as amended.3 Their report, when amended by the medical con- vention, was also adopted but, through some neglect or inadvertence, it was not laid before the Cor- poration until September, 1810.4 After an alteration in the articles as amended was proposed by the Corporation, they were adopted by the Medical Society, and a committee of three was appointed to confer with the Corporation's committee about the means of accomplishing this union and of bringing an act of incorporation before the legis- 1 The enlarged committee was composed of Drs. Timothy Hall, John Barker, John R. Watrous, William Shelton, Siah Fuller, Natheil Perry, Smith Clark and John S. Peters. Trans. Conn. Med. Soc., 1807, p. 70. 2 Trans. Conn. Med. Soc., 1808, p. 71. 3 This committee was composed of Drs. Eli Ives, Samuel Woodward and John Bester. Trans. Conn. Med. Soc., 1808, p. 73. 4 A special committee, composed of Drs. John Barker and Thomas ( Hubbard, was appointed by the State Society to wait on his Honor, the Lieut. Governor, and ascertain if anything and what was done by the Corporation respecting the Articles of Union with the Medical Institution in Yale College, transmitted by the Secretary. This committee reported that through some neglect or inadvertence they were not laid before the Corporation. Then it was voted that Drs. Barker and Goodsell be a committee to wait on Mr. Silliman and request him to lay before the Corporation in September, 1810, the Articles of Union, as amended by the Convention. Trans. Conn. Med. Soc., 1809, p. 77. 18 THE EVOLUTION OF MEDICINE lature.1 In October, 1810, this act was passed by the united efforts of the two committees, and is the basis of the present charter of the Medical School.2 It has subsequently been amended in 1821,3 re- enacted in 18254 with amendments in 1826,5 18296 and 1832,7 again re-enacted in 1834,8 with amend- 1 The committee from the medical society to consider the method to be pursued to accomplish this union was composed of Drs. John R. Wat- rous, Mason F. Cogswell and Eli Ives. Trans. Conn. Med. Soc., 1810, p. 81. The committee from the college for this purpose was composed of President Dwight and Benjamin Silliman. MS. Records, Yale Corporation. 2 Trans. Conn. Med. Soc., 1811, pp. 86-89. 3 Public Acts of Conn., 1822-1835, p. 20. This amendment refers to the proper signing of licenses and diplomas, and makes those licenses and diplomas legal, which have been heretofore otherwise countersigned. 4 Trans. Conn. Med. Soc., 1825, pp. 7-12. 5 Trans. Conn. Med. Soc., 1826, p. 9. By this amendment the agree- ment of the professors was legalized, to pay each, for five years, the annual sum of one-tenth their fees for a hospital at New Haven. This sum was not to exceed one hundred dollars a year and if the amount was less than one hundred dollars, the professors agreed to bring it up to that figure. By this amendment the old rule regarding gratuitous students was abolished. 6 Trans. Conn. Med. Soc., 1829, pp. 10-11. This amendment increased the professors to six, established as a preliminary requirement " a com- petent knowledge of the Latin language and some acquaintance with the principles of Natural Philosophy," in the addition to a good English Education. The course of study at the school was lengthened to three years for a college graduate and four for others. The attendance on only one course of lectures was required for a license but two were necessary for a degree. 7 Trans. Conn. Med. Soc., 1832, p. 11. This amendment shortened the course of study for college graduates and non-graduates to two and three years respectively. This was done as the other colleges did not adopt the recommendations of the Northampton Convention. 8 Trans. Conn. State Med. Soc., 183:4, pp. 14-16. This was re-enacted to avoid the confusing condition existing from the last three amendatory acts. The only change was that a graduating dissertation was required of every student. HISTORICAL ADDRESS 19 ments in 18561 and 1866,2 and finally re-enacted in its present form in 1879.3 By this last enactment, the mutual agreement between Yale College and the Connecticut Medical Society could be voluntarily dissolved by mutual consent, and, in May, 1884, the dissolution was accomplished after an harmonious union of nearly three-quarters of a century.4 The original act speaks of the President and Fel- lows of the Medical Society uniting with the Presi- dent and the Fellows of Yale College to form a medical seminary to be styled, The Medical Insti- tution of Yale College. 1 Trans. Conn. Med. Soc., 1856, p. 34. By this amendment no person should be recommended to a gratuitous course of lectures unless he had attended one course of lectures. 1 Trans. Conn. Med. Soc., 1866, Appendix G., pp. 106-107. The re- striction upon the number of professors was removed, provided it was more than four, the price of tickets for each branch was not to exceed $15.00, a graduation fee of $25.00 was required and two examinations (one at close of lectures and one during commencement) were now enforced. 2 Trans. Conn. State Med. Soc., 1883, pp. 202, 203. The professors were now not limited, many matters were omitted from the act, being left to the college for their determination, and the union between the college and Medical Society was so fixed that it might be annulled by mutual consent, without further legislative action. 3 Trans. Conn. State Med. Soc., 1884, pp. 10, 11. Knight speaks thus of this union (A Lecture Introductory to the Course of Lectures in the Medical Institution of Yale College, New Haven, 1853, p. 13). "The result of this arrangement has been eminently happy; all unpleasant feeling was at once and forever allayed; the members of the Society be- came interested in the school; we have at all times had the benefit of their counsel and support, and it gives me pleasure to state that no instance of disagreement has ever arisen among the members of the board or between the School and State Society; on the contrary, each has regarded the other as a fellow laborer in the endeavor to promote and advance the in- terest of medical science." It is interesting to note that Nathan Smith in 1808 "thought Yale would do better without the assistance of the Medical Society." Tully, MS. Diary, 1808, Yale University. 20 THE EVOLUTION OF MEDICINE The institution was to consist of four professor- ships, viz: (1) of chemistry and pharmacy; (2) of the theory and practice of medicine; (3) of anatomy, surgery and midwifery; (4) of materia medica and botany. They were to be appointed by the Corporation of Yale College from nomina- tions made by a joint committee of an equal num- ber of persons appointed by the Medical Society and the Corporation of Yale College. A cabinet of anatomical preparations was to be provided for, as well as a collection of specimens in the materia medica, and a Botanical Garden was to be estab- lished as soon as funds were to be available for that purpose. The medical student was to attend to the study of medicine for two years with "some medical or chirurgical professor or practitioner of respectable standing," if he is a college graduate, or three years if he be not, and one course of lec- tures was required for admission to an examination for license. "A meritorious person" from each county in the state was annually to be given the privilege of attending the lectures gratis. These individuals were to be recommended by the County Societies or, in case of their failure to do so, by the Medical Convention of the State. The tuition was to be $50.00 a year. The committee of ex- amination was to consist of the medical professors and an equal number of the members of the Medical Society, appointed by the Medical Convention, and the President of the Medical Society was to be ex-officio president of the examining committee, HISTORICAL ADDRESS 21 with the privilege of a vote at all times and a casting vote in case of a tie. If the President be absent, one pro tempore could be appointed by the Medical Society's members of the examining committee. This committee had the power of examining for a license to practice physic and sur- gery, which license must be signed by the President of the Medical Society, and countersigned by the committee or a majority of the same. The emoluments from the license were to be as hereto- fore and were to accrue to the Medical Society. For the degree of M.D. the attendance on two courses of lectures was to be required and for this degree four dollars was to be paid to the President of the college, three to each of the examiners present and ten to the treasury of the Medical Society. The honorary degrees were to be conferred by the President of the college on those recommended by the Medical Society. The examinations were to be one yearly, and held at the close of the course of lectures. If the candidates were ill, they might be examined at another time. The medical students, who had attend- ed two courses of lectures, were able to attend future courses gratis, and all those licensed were to be members of the State Medical Society.1 On Nov. 20, 1810, Timothy L. Gridley (Y. C. 1808) wrote an interesting letter to his classmate, 1 These articles show the efforts of the Corporation to conciliate the jealousy of the medical society by causing the vacancies in the professor- ships of the institution to be filled by them, on the nomination of a committee, composed of an equal number of professors from the faculty 22 THE EVOLUTION OF MEDICINE Jonathan Knight, then a tutor at Yale College.1 Gridley was studying medicine at that period in Hanover, under Dr. Nathan Smith, and desired ''to obtain information respecting the establish- ment of a medical school in connection with Yale College." He had heard that "the appointment of professors was the only obstacle to the commence- ment of medical lectures" and states that he had told Dr. Smith his desire to see his teacher one of the professors there. To this Dr. Smith had re- plied that if there was a vacancy, and the Faculty of Yale College should request him to fill it, he would accept without the least hesitation. The intolerable burden he had sustained for a number of years past, which he felt unable to endure lon- ger, was one of his reasons for leaving, and we know that he had occupied there what Oliver Wendell Holmes would call not a chair but a settee, lecturing upon chemistry, anatomy, surgery and the theory and practice of physic, in addition to carry- ing on an extensive practice. Gridley then proceeded to speak of Smith's ability, "first as an original and members of the society. Again, in the appointment of the examining committee this is seen, for it was composed of four from the faculty and our from the medical society, the fifth member being the society's Presi- dent, who presided at the meetings of the committee and had a casting vote in case of a tie. The medical society also had the right to appoint yearly, through its various component county associations, two deserving indigent students from each county, who were to receive their lecture tickets gratis. 1 MS. letter, Yale University Library. Gridley was born at Cromwell. He received the degree of M.D. from Dartmouth in 1812 and practised medicine at Amherst until his death on March 10, or 11, 1852 (Dexter, Yale Biographies and Annals, VI, pp. 193, 194). HISTORICAL ADDRESS 23 and practical lecturer on surgery," and adds, " he has made many and important improvements in operative surgery, discovering the origin as well as cure of some diseases, such as necrosis of the bone." In short, Gridley rated him as the equal if not superior to any surgeon in the United States. Also, "he is a man of general information, of an easy, familiar but dignified deportment, communicative, agreeable in conversation, of equable temper and of charitable disposition. In fact, wherever he is known he is admired and beloved." Gridley thought the 60 students in Hanover would largely follow him to New Haven, and imagined the opportunity of attending Mr. Silliman's lectures would collect students from all parts of New England. In 1811 the Lieutenant Governor, Professor Silli- man and Dr. Nathan Strong were appointed a committee to act with the medical convention in establishing the chartered medical school.1 Sub- sequently, in the following year, Dr. Mason F. Cogswell of Hartford was chosen Professor of Sur- gery and Anatomy and Dr. Jonathan Knight, Assistant Professor of the same subjects.2 Many with Gridley then believed Dr. Nathan Smith was the man for the first appointment, but "the Corporation and President never countenanced the idea because they believed him an infidel and could not reconcile it with their duty to appoint any man of this description to a station in College 1 MS. Records, Yale Corporation. 2 MS. Records, Yale Corporation. 24 THE EVOLUTION OF MEDICINE whatever might be his talents, reputation and learning."1 Fortunately, Dr. Smith's sentiments shortly thereafter underwent an entire alteration, and he "fully renounced his infidelity in repeated conversations with intimate friends and to his class, to whom he spoke in such terms of his past and present views as drew tears from both speaker and hearers."2 Dr. Cogswell, who had ever been loathe to accept the professorship, believed with President Dwight that the appointment ought to be reconsidered, to which view both Dr. Ives and Professor Silliman concurred. Consequently Dr. Cogswell opened a correspondence with Dr. Smith upon this subject, and learned from it that Smith would be happy to fill any place in the institution for which he might be thought qualified. He also stated that he considered "New Haven as a place more favorably situated for a medical school than any other in New England."3 The appointee to the other position, Dr. Jonathan Knight, had been encouraged to give up his tutorship at Yale, in 1811, by Professor Silliman and go to the Uni- versity of Pennsylvania for medical study. In the year following Silliman wrote him, unofficially and as a friend, "that there was an increasing proba- bility of a certain arrangement taking place, and speaks of the Corporation appropriating $200 for expenses for anatomical preparations to be procured 1 MS. letter, Silliman to Knight, Yale University Library. 2 MS. letter, Silliman to Knight, Yale University Library. 3 MS. letter, Yale University Library. HISTORICAL ADDRESS 25 by him.1 Three weeks later, Silliman writes that Knight's chance for the appointment is better than that of any one else2 and suggests that he buy three skeletons for the anatomical department. In March of that year, the school was organized by the appointment of the following professors, although it were not made public until commence- ment. Nathan Smith, Professor of the Theory and Practice of Physic, Surgery and Obstetrics; Aeneas Munson, Professor of Materia Medica and Botany; Eli Ives, Adjunct Professor of Materia Medica and Botany; Benjamin Silliman, Professor of Chem- istry, Minerolgy and Geology; and Jonathan Knight, Professor of Anatomy and Physiology.3 In the fall of 1812 thirty-seven students were as- sembled for instruction, on the opening of the school,4 and in 1814 the first class of three members was graduated with the degree of doctor of medi- cine.5 A building, which is now the main building 1 MS. letter, Yale University Library and Prudential Committee MS. Records. "Voted that Doctor Jonathan Knight Jun., lately a tutor at this college and now resident in Philadelphia, be authorized to procure for the medical institution established here, anatomical preparations, to the amount of two hundred dolors with the advise of Doctor Casper Wistar." 2 MS. letter, Yale University Library. 3 MSS. Records, Yale Corporation and Smith, Life of Nathan Smith, New Haven, Yale University Press, 1914, p. 91. 4 Dexter, Sketch of the History of Yale University, New York, 1887, p. 51. 5 Triennial Catalogue, 1910, p. 253. In August, 1813, "the Corpora- tion authorized the Prudential Committee to procure a Bell for the Medical Institution and Tables and seats for the Lecture Rooms and Dining Hall, also to enlarge the laboratory and to do any other things which appear of indispensable necessity to the organization of the Medical Institution." 26 THE EVOLUTION OF MEDICINE of the Sheffield Scientific School, was rented from its owner, James Hillhouse, who had built it as a hotel.1 In 1814, it was bought for $12,500,2 when the legislature, largely through the efforts of Dr. Nathan Smith, made the school a grant of $20,000. Within its walls, there were the lecture rooms, sleeping accommodations and study rooms, while in the basement commons were instituted. Aca- demic customs were then introduced, for each morning and evening the medical class would as- semble for prayers, at which the different profes- sors officiated, and the rigid rules which governed the Academical Department were here enforced. The innovation, however, met with the most in- different success and was discontinued in 1824.3 A botanical garden, as contemplated in the articles of incorporation, was soon established on grounds adjacent to the medical school building and was maintained at the expense of Dr. Eli Ives. Air. Frederick Pursh, a well known botanist, was en- 1 Kingsley, Yale College, New York, 1879, II, pp. 64-65. 2 Dexter, Yale Biographies and Annals, New Haven, VI, p. 728. 3 When the subject of the organization of the Medical College was under discussion in the Corporation, I was present and heard from the Hon. Chauncey Goodrich the following observations, succeeded by a dis- tinct proposition. "The Medical class," he remarked, "having a building devoted to their use and many of them having their rooms there, they constitute in fact a peculiar family, and they ought to have a family con- stitution. There must therefore be prayers as in the college proper." The proposition was accepted with little discussion, and without inquiring for my opinion. Not being a member of the Corporation, I could not volunteer in the discussion. I did not, however, believe it to be a wise measure, although proposed by a very wise and good man. A transient collection of students, most of them without previous discipline, afforded HISTORICAL ADDRESS 27 gaged as the Curator of the Garden, but was after- wards kept from accepting it by a more important appointment. Later, Dr. M. C. Leavenworth (M. D. 1817) was employed to make a collection of indigenous plants for this garden, which was soon believed to be the best in this country. Unfor- tunately, as no endowment was forthcoming, the undertaking was eventually abandoned.1 One more step in the development of the Yale Medical School deserves recognition. In 1826 a General Hospital Society was incorporated to raise funds for a Hospital at New Haven. As an "auxil- iary to the Medical Institution, this Hospital was considered very important, as without an estab- lishment of this kind, it is impossible to communi- cate medical instruction in the most advantageous manner."2 Hence, we find the professors in the but slight prospect of a reverent and attentive audience; but the attempt succeeded better than I expected, and some special religious meetings were held in the Medical College on Sabbath evenings. Commons were also instituted in the Medical College as a family; but the experiment was unfortunate. . . . Neither did the inhabiting of the building by the students produce a happy result. They were, in their habits, too familiar, sometimes noisy and rude, and of course the studious individuals were annoyed by their more restless companions. Silliman's remarks on the Medical Institution of Yale College in Fisher, Life of Benjamin Silliman, New York, 1866, I, pp. 262-262. 1 Baldwin, Annals of Yale College, New Haven, 1831, pp. 263-264 and Bronson, Biographical Sketch of Prof. Eli Ives, M.D., Trans. Conn. Med. Soc., 1867, pp. 311-320. A Sketch of Dr. M. C. Leavenworth by Dr. P. G. Rockwell can be found in Trans. Conn. Med. Soc., 1866, pp. 269-272. 2 Jewett, Semi-Centennial History of the General Hospital Society of Connecticut, New Haven, 1876, p. 29. In Tully's MS. diary he writes in 1808, when a student at Hanover, under Nathan Smith. "The fact is a Student cannot be benefited by practice, at any Medical College, unless he has the advantage of attending a Hospital." 28 THE EVOLUTION OF MEDICINE medical school enthusiastically pledged their pro- fessional services to the Hospital and generously, also, gave to it 10% of their incomes from the Medical Institution for five years, in case, in each instance, the sum did not exceed $100 a year, but, provided it was less than this stated amount, then they promised to increase it to that figure.1 The State Medical Society was equally eager to aid in the erection of this hospital, and appropriated for this purpose the yearly amount payable for degrees and also voted that this hospital be so located as best to subserve the interests of the Medical School. The first faculty was composed of a remarkable set of men, whose like we rarely meet. At the head of the list stands Aeneas Munson, who was considered at the time of his appointment to the chair of Materia Medica and Botany as the Nestor of the Medical Profession in Connecticut, not only on account of his age, but also on account of his in- tellectual attainments. He was then in his seventy- ninth year, so he was not expected to perform any duties, but his pre-eminence in chemistry, mineral- ogy, materia medica and botany increased by his appointment the standing of the original faculty. He was also supposed to be an experimental alchemist, and possibly was the physician whom President Stiles refers to in his diary as conversing upon this subject until Stiles told him it was a vain and illusory pursuit.2 His humor, quaint, dry and 1 Jewett, loc. cit. and Trans. Conn. Med. Soo., 1865, p. 90. Of the ten corporators, five were Professors in the Yale Medical School. 2 Stiles, Op. Cit., Ill, p. 345. HISTORICAL ADDRESS 29 frequently biting, he considered his infirmity and re- gretted it, but "could not help it." Many examples of it still remain, but one specimen will suffice.1 Bronson relates he was once dining with the Yale Corporation at commencement dinner, when Presi- dent Dwight, who was a good trencherman, remarked, preparatory to some observation on diet: "You observe, gentlemen, that I eat a great deal of bread with my meat." "Yes," said the doctor instantly "and we notice that you eat much meat with your bread." He continued as Connecticut's grand old man in medicine until his death on June 16, 1826, at the age of 92 years.2 The second member, Nathan Smith, outshines in reputation all the rest and his name looms up larger as the years go by.3 He was the only one of the faculty not of Connecticut birth, but the wisdom of his importation from Dartmouth will never be doubted for he still sheds lustre upon the school's origin. Born as the second son of John and Elizabeth Smith at Rehoboth, Massachusetts, in 1762, he early emigrated with them to Vermont, where he spent the first years of his life as a farmer and as a district school teacher, until a sudden call to assist a doctor at an operation awoke his medical talents. After a brief period of preliminary education, he studied under this physician, Dr. Josiah Goodhue,4 and then 1 Bronson, Medical History and Biography, N. H. Hist. Doc. Papers, New Haven, 1877, II, p. 2 Dexter, Yale Biographies and Annals, II, pp. 311-313, and Thacher, American Medical Biography, 1828, I, pp. 401-403. 3 Smith, Life of Nathan Smith, New Haven, Yale University Press, 1914. 4 Smith, Life of Nathan Smith, p. 5. 30 THE EVOLUTION OF MEDICINE practiced for two years at Cornish, New Hampshire. His insufficient training caused him, at the end of that time, to go to the Harvard Medical School, where he received, in 1790, the degree of Bachelor of Medicine. Soon after this, realizing his own struggle for an education, he conceived the idea of a medical school at Dartmouth to train better those in New England who wished to follow out a medical career. In August, 1796, he made a written applica- tion to the trustees of this college, asking in it their encouragement and approbation of a plan he had devised to establish a Professorship of the Theory and Practice of Medicine. Although the plan was ap- proved by the President and encouraged by some of the trustees, it was then voted to postpone final action for a year.1 Undaunted, Dr. Smith decided to go abroad for further study at the University of Edinburgh, borrowing some money for this purpose from friends. Accordingly, he sailed from Boston in December, 1796, leaving his wife and son, to attend for three months the lectures of Monro Secundus on Anatomy and Surgery, and Black on Chemistry. His letters home speak of the "prospect of accomplishing my purpose to my mind."2 Leaving Edinburgh, he spent three more months in the London Hospital and returned to Boston early in September, 1797. He came back to find the trustees had decided to accept his plan 1 Hubbard, Dartmouth Medical College and Nathan Smith. An His- torical Discourse, Washington, 1880, p. 12. 2 Smith, Life of Nathan Smith, pp. 19-20. HISTORICAL ADDRESS 31 for establishing a medical department and finally had the satisfaction of seeing a building erected for the school. During this time, in the summer months, he also received a number of students at Windsor, adjoining Cornish, where he gave them private instruction in medicine. In 1804, we learn from a letter to his friend, George C. Shattuck, that he had then nine such pupils. The trustees voted him, in that year, a salary of two hundred dollars on condition of his moving to Hanover, which he did in the spring of 1805. In spite of the weight of business and with very ill health, he persevered with success, "being banded about from one part of the country to the other,"1 until, on May 4th, 1810, he determined to leave Hanover, as political parties were "so near a balance" he could expect nothing from either and thought the grant for a medical building might be repealed.2 He did not definitely know where to settle, but looked longingly towards Boston, until an offer from Yale College turned his direction towards New Haven, where he came in 1813. Here he spent the last sixteen years of his life, busily engaged in teaching, practicing and writing. He was original in his views and methods, unex- haustible in resources, sound in judgment and overflowing with strong common sense.3 He could 1 Smith, Life of Nathan Smith, p 66. 2 Smith, Life of Nathan Smith, p. 52. 3 Bronson, Biographical Sketch of Prof. Eli Ives, M.D., Trans. Conn. Med. Soc., 1867, p. 314. 32 THE EVOLUTION OF MEDICINE assimilate and store away easily whatever he read, being able to recall it, as well as appropriate data from his own experience, whenever necessary. His keen sense of observation was also commented upon by his associate, Jonathan Knight, his undaunted moral courage, as well as his kindness, assiduity and delicacy in the treatment of his patients.1 His affection for his family and friends was also a notable trait of his character, as seen especially in his recently published life. His wide range of personal acquaintances and friends made him the best known man in medicine and surgery in New England. In his lectures, there was no vain show of learning or any attempt at brilliancy, no as- sumption of dignity or superiority, but as hearers, both friends and students, found him then a man of true erudition and a manifest master of his pro- fession.2 His lectures were, generally, entirely ex- temporaneous and delivered in as plain and simple a style as possible.3 The better the students knew him, the more did they admire and revere him. In personal characteristics, he was of medium height, rather thin and spare. His dress was quite plain, very heedlessly chosen and carelessly put on.4 During this period he was instrumental in founding, with President Allen, the Bowdoin Medical School 1 Knight, Eulogium Pronounced at the Funeral of Nathan Smith, New Haven, 1829, pp. 16-19. 2 Smith, Life of Nathan Smith, p. 113. 3 Tully, MS. Diary, 1808, Yale University Library and Smith's Life of Nathan Smith, pp. 53 and 94. 4 Tully, MS. Diary, 1808, Yale University Library. HISTORICAL ADDRESS 33 and lectured there for five years, being assisted at times only in chemistry, anatomy and surgery.1 He was also active with his son in establishing the medical school of the University of Vermont, where he gave four courses of lectures on Medicine and Surgery, thus being active in the foundation of four medical schools, which, with Harvard, he thought would "be as much as New England will bear," and the passing years have borne out the wisdom of this statement.2 His reputation was so well established when he came to New Haven that patients flocked to him from all parts of the country, as his ledgers attest, and he not only treated the best families in New Haven, but was called to visit professionally almost every town in Connecticut, as well as many places in other neighboring states. He was a pioneer in a number of operations and the success which at- tended his medical and surgical treatment was extraordinary. His writings are few, but they proclaim him now to have been far ahead of his times. The assertion that he has done more for the improve- ment of physic and surgery in New England than any other man, will by no one (even at this late day) be deemed invidious.3 His essays on "The Treatment of Typhus Fever " and on the " Pa- 1 Allen, An Address Occasioned by the Death of Nathan Smith, Brunswick, 1829, pp. 15-16. 2 Smith, Life of Nathan Smith, p. 122. 3 Knight, Eulogium Pronounced at the Funeral of Nathan Smith, p. 15. 34 THE EVOLUTION OF MEDICINE thology and Treatment of Necrosis" have become classic. In the former he considered the disease as originating from a specific cause, and being self limited in duration and never aborted. He also recognized the rarety of a second attack, and advocated a rational method of treatment which was popular until the last decade. This essay, published in 1824, is, says Welch, "like a fresh breeze from the sea amid the dreary and stifling writings of most of his contemporaries."1 His essay on Necrosis introduced better methods of treatment, anticipating those of our modern period. We regret that a Surgery, which he planned to con- sist of two hundred pages, and to publish in 1823, was delayed in its completion by articles he prom- ised for his son's journal, the Philadelphia Mon- thly Journal of Medicine and Surgery, as well as various essays.2 He refers to the work again in a letter to his friend, George C. Shattuck, on Dec. 8, 1827, and states he expected "to get through it the next summer,"3 but it was incomplete at his death. Eli Ives, a worthy pupil of a learned teacher, Aeneas Munson, was one of the moving spirits, on the part of the medical society, at the founda- tion of this school.4 He was a graduate of Yale, 1 Welch, The Relation of Yale to Medicine, Yale Med. J., 1901, viii, p. 127. 2 Smith, Life of Nathan Smith, p. 122. 3 Smith, Life of Nathan Smith, p. 137. 4 Bronson, Biographical Sketch of Prof. Eli Ives, M.D., Trans. Conn. Med. Soc., 1867, pp. 311-320, and Dexter, Yale Biographies and Annals, IV, pp. 358-362. HISTORICAL ADDRESS 35 in the class of 1799, and later a student of medicine at the University of Pennsylvania. On the open- ing of the school, he became the assistant to Mun- son in the department of materia medica and botany and so continued until 1820, when he succeeded to the chair, the latter having been made Professor of the Institutes of Medicine. This position he held until 1829, the time of Nathan Smith's death, when he was appointed Professor of the theory and prac- tice of medicine and occupied this chair a period of thirty-eight years. At the end of his time, he resumed his first professorship for one year and then became an emeritus Professor for eight years longer. He was, consequently, connected with the Yale Medical School, in some capacity, for forty- seven years. His knowledge of botany was most profound and was accountable for the success of this study at the school. He was also an acute and original observer, who inspired the affection of his students. Benjamin Silliman's career lay mostly outside of the medical school, for his academic work gave him the reputation of being one of the foremost scientists of this country. He taught chemistry at the school for forty-one years and continued as an emeritus professor for ten years longer, being the last survivor of the original faculty.1 Jonathan Knight, the beloved physician, was the last member of this eminent group of men. He was graduated from the Academical Department in 1808 1 Fisher, Op. cit. 36 THE EVOLUTION OF MEDICINE and shortly thereafter made a tutor.1 While filling this office, he resigned to study medicine at the University of Pennsylvania and took the chair of Anatomy and Physiology upon the opening of this school. In 1838 he succeeded Dr. Thomas Hubbard to the chair of surgery and kept this position until May 1864, being associated actively with the school for fifty-one years. Courtly, even majestic in figure, he combined all the graces of a gentleman of the old school with an authoritative and convincing manner. After Nathan Smith, he was easily the foremost surgeon in Connecticut until his death. "Conscientious, perhaps in all that time he never did an unnecessary or premature operation" is the tribute paid him by his pupil and successor, Dr. Francis Bacon, while Dr. W. H. Welch declares that he "probably never had his superior in any medical school in this country as a finished lecturer." I have thus tried to show the successive steps in the evolution of medicine in Connecticut from its low colonial standards to the foundation of the Yale Medical School. The first era of improvement began, as we have seen, with the advent into the 1 Kingsley, Yale Book, New York, 1879, II, pp. 72-73; Hooker, Bio- graphical Sketch of Jonathan Knight, M.D., Trans. Conn. Med. Soc., 1865, pp. 147-151; Bacon, The Beloved Physician. A Discourse Delivered in First Church in New Haven at the Interment of Jonathan Knight, M.D., New Haven, 1864. In this pamphlet is also found Dr. Francis Bacon's remarks commemorative of Professor Knight Addressed to the Students of Medicine in Yale College, on September 19, 1864; and Dexter, Yale Biographies and Annals, VII, pp. 213-216. Professor Knight's two intro- ductory lectures, published in 1838 and 1853, have been invaluable in the preparation of this paper on account of both going into the early history of the medical school. HISTORICAL ADDRESS 37 state of John Winthrop, Jr., the Governor from 1657-1676, who lent to medicine a dignity and a love of its science and art which was of lasting benefit. Subsequently the gradual realization of the importance of some regulation concerning the right to practice led eleven Norwich physicians to memoralize the legislature for the enactment of a law of this nature. Unfortunately, it failed to pass. Then a fuller sense of the importance of medical union led some New Haven physicians to band themselves together for mutual improvement and to raise the standard of medicine in the state by the formation of a state society. In their efforts to accomplish this latter object, they published the first transactions of any medical society in the United States. The organization of the State Medi- cal Society was the next step, which soon caused its members to realize their own educational short- comings and to appreciate the crying necessity of better facilities for the study of medicine in this state. And finally came the foundation of the Yale Medical School, which was due in the evolution of medicine in Connecticut to no private enterprise, but arose from mutual efforts for medical improve- ment on the part of Yale College and the Connecti- cut Medical Society. "Even if there were no other claims, this origin," says Dr. Welch, "should en- title the Yale Medical School for all time to the fostering care and support of its parent."-its surviving parent, Yale University.1 1 Welch, Op. cit. I have introduced the word surviving for if Yale is the alma mater of her medical graduates, the Connecticut State Medical Society is just as surely their almus pater. 38 THE EVOLUTION OF MEDICINE Time fails me to speak of the school's trials and successes. She has ever been at the forefront of medical progress in the effort to raise the standard of medical education from the time she introduced, at the behest of the Northampton Convention, entrance requirements and lengthened her course of study. She also early introduced recitations and from 1867 has given laboratory instruction in the necessary branches. Early in the adminis- tration of the second Dwight, she almost reached the point of dissolution, but fortunately, through his generosity and co-operation, she weathered the storm, with the assistance of her former dean, Herbert E. Smith. Now her continued existence is again and probably finally threatened. With- out the raising of a sufficient endowment, it is hard to see how she can survive, yet it was with a heroism which demands recognition that her professors, living and dead, have labored on in the face of the most discouraging circumstances, with insufficient salaries, but with a self-sacrificing, enthusiastic devo- tion to equip thoroughly her graduates. The dead are mute witnesses, but the living have testified, still testify, and will testify how her graduates have come into their midst and brought skill, solace and conscientious care to them. I know of no greater opportunity to him that hath of this world's goods than that of assuming the role of a Joshua and of bringing the school out of the wilderness of its increasing financial difficulties into the promised land of a plenteous endowment and a HISTORICAL ADDRESS 39 closer affiliation with the New Haven Hospital. This remuneration is hers by right of such an hon- orable heritage that to-day "her children rise up and call her blessed."