if^V^ A P m j, i. ANNIVERSARY DISCOURSE, BEFORE THE NEW YORK ACADEMY OF MEDICINE. DELIVERED IN CLINTON HALL, NOVEMBER 22d, 1854. IIS BY JOHN H. GRISCOM, M.D [published by order of the academy.] % ISA*'.* NEW YORK: PRINTED FOR THE ACADEMY BY R. CRAIGHEAD, 53 Veset Street. i 1855. • ANNIVERSARY DISCOURSE. Mr. President, and Fellows of the Academy of Medicine : While gratefully acknowledging myself the reci- pient of many high evidences of the regard of my esteemed associates of the Academy of Medicine,— especially of this honor, of which I most fully appre- ciate the dignity and usefulness,—I feel bowed under a sense of my unworthiness of it, and of my incapa- city to respond in a fitting manner to the high de- mands of the office. But it is with the intellectual as with the social world: when guests are bidden to a feast, the host beforehand calculates the extent of his accommoda- tions and of his means of entertainment, so that those who come at his bidding, may depend upon the re- sources of the mansion being strained to the utmost for their comfort and enjoyment, in every mode to suit the demands of their different dispositions, and even to satisfy their proclivities to criticism. Yet, " He who writes, Or makes a feast, more certainly invites His judges than his friends ; there's not a guest But will find something wanting, or ill-drest." 1 DISCOURSE. But it is a different state of things when the host and guests change places; when the host is invited to prepare afeasl, and the guests invite themselves to partake of it. In that relation do my audience and myself now stand—a compulsory, though not unwil- ling host, with a pleasant and goodly company, who, though self-invited, are wholly welcome to whatever may be found for their instruction or amusement; the host, on his part, feeling happy that his guests, though they may find but a meagrely spread table, yet are disarmed of their criticism, for they are self-invited. In considering the position which I occupy on this occasion, as in some measure the exponent of the views and sentiments of a numerous body of men, the questions naturally arise in the mind, who and what are they, to whom, and for whom, I am called to speak ? What is their character ? What the nature of their vocation ? What their relation to the people among whom they dwell ? I would not unduly magnify the character of the occupation which I have chosen for my pursuit in life ; but as one of the humblest of its followers, I may be permitted, as I sit at the feet of the Gamaliels, who in all ages, and many countries, have honored the hu- man character, and blessed and benefited the human race, as no other profession has done ; and, more practically than any other, as a class, perform the identical service, and follow more nearly in the foot- steps of our Divine Master, who when he trod our planet, sought out the sick, the injured, and the de- mented, and healed them ;—I may be permitted, as I DISCOURSE. 5 gaze at those bright examples of real, practical good to man, to utter some expression of the feelings of veneration and gratitude which fill my soul, as I con- template their devotion, their self-sacrificing spirit, the lustre of their deeds, their brilliant intellects, and lastly, the Heaven-born nature of their calling. As a traveller, reposing at evening hour, and casting his eyes upon the star-crowned heavens, finds his soul gradually filling with the glory of the scene above and around him, contemplating as they move along, the soft but brilliant light of the moon, and then in turn, the different planets, stars, and here and there a me- teor ; so may the modern devotee of the healing art find his spirit rapt in the contemplation of the glori- ous lights of his profession, which stand out on the dark page of history, made darker by the contrast, beginning with their more effulgent prototype, who with power miraculous healed all who came unto him, and would not be weary. To have a place, even the humblest, in the ranks of such a profession, with such a model, and to be furnished to any extent with an understanding for the performance of the same prac- tical duties of healing the sick, and saving life, which He performed, should satisfy the soul, hungry for earthly gratification, more than the glory of the Alex- anders, who sigh for more worlds to conquer. The question which I propose to discuss this even- ing, is the important one of the relation which exists between our profession and the public; or, in more precise terms, and rejecting all personal considera- tions, the relation between the People and the Science of Medicine. 6 DISCOURSE. There are two standpoints from which Medical Science is to be received in this relation. From the one it is seen in its therapeutic, cr curative, aspect; from the other are distinguished its prophylactic, or preventive, powers. These two great features, though united in the com- mon bonds of humanity and true science, nevertheless present some contrasts to each other. Like two pa- rents devoted to the protection and preservation of. a family, each in its own appropriate sphere performs peculiar duties, but both so mingled as to be essential to each other's perfect work. The therapeutic department sees man in his indi- vidual relation only, and embraces in its sphere of ac- tion and study, the diseases which affect him in that isolated position; while the prophylaxis of medicine comprehends him not only in his individual aspect, but also regards him in the family, in the community, and even ecumenically, and throws around him a sani- tary segis, to protect him against the influences, which, borne upward from the earth, or descending from the air, or generated within, by the operations of his own immediate organization, are constantly impinging upon him at all points. This, would shield him from the evils, which, when they do arise, it is the pro- vince of its sister branch to alleviate or cure. I need not occupy your time with more than a pass- ing notice of the first of these two branches of Medical Science. The glories which, under its name, its vo- taries have won for themselves and for humanity, the deeds of valor which in battle with death have been DISCOURSE. 7 achieved and are being achieved, in the laboratory, the chamber, the hospital, the ship, on land and on ocean, should put to blush the boasting of the sol- dier, even for honors won " in the imminent deadly breach." My immediate predecessor in this honorable post gave us an eloquent exposition of the rapid improve- ments which, in nearly every department of medicine, have been made in these latter times, with the results to the human family, of the speedier curability of dis- ease, and the greater prolongation of life. I will not dwell upon this theme, interesting as it is; but in pursuance of my immediate object, 1 may, in this con- nexion, give utterance to a sentiment from which I will further on make a pertinent deduction, that for improvements in the therapeutic branch of our favor- ite science, the profession itself is wholly responsible ; and to its members alone can the public look for con- tinued advances in the healing art. The treasures, whether of invention in what may be denominated the more mechanical, or the discoveries in the purely scientific, portions of our calling, which have from time to time been made, have been developed almost wholly by the researches and reflections of the medi- cal student; and upon him, and him alone, still rests the duty of eliminating whatever else of worth there may yet remain in the unexplored depths of nature's great laboratory, or of sounding the deep unfathomed caves of Almighty mind, and bringing thence the gems of invention which pertain to the healing art, and which are to be found only by the patient ob- 8 DISCOURSE. server, the acute reasoner, the tried and perplexed operator. Even when, as occasionally has been the case, the genius of accident has uncovered an idea or a material, to hi in it must be submitted for the deter- mination of its real significance and value; and the great public, for whose benefit the profession labors and studies, may settle down in the calm assurance that every thought, every suggestion, every invention, however sr' II its significance or claim to considera- tion, and come from what quarter it may, will receive from true science all the attention it deserves; but the daily newspaper, bo it understood, is not the pro- per ground for the discussion of such matters, nor is popular prejudice or passion their proper arbiter. J;, is true in medicine, as in other practical arts, that years and ages will ofttimes elapse between the discovery of a principle and its practical applica- tion. Thus, though Franklin (the modern Prome- theus) ascertained the identity of electricity and light- ning, and brought the bolt of Jupiter from heaven to earth, and made of it a plaything, yet half a century elapsed ere Morse made it subservient as a post-boy ; and though Page lias literally put it in harness, we must abide in patience till another Fulton shall come to apply it successfully as a motive power. So it has been, and so it will be, with improvements in the ars medendi. Thus it was with the discovery of the circulation of the blood by Harvey, centuries subsequent to the brilliant experiences of Hippocrates; thus, too, it was with the application to the treatment of disease by Sydenham, of the natural laws of health, DISCOURSE. 9 though an ocean of air, fifty miles in depth, and of ever-renewed purity, had surrounded the globe since the day when Adam first received into his nostrils the breath of life. Thus was variola the terror of man- kind till Jenner discovered the prophylactic power of kine pock. And has not modern Chemistry revolu- tionized the Materia Medica in many particulars, be- sides presenting us with innumerable additions to its armory, which a clearer and more accurate knowledge of its sister science, Physiology, enables us to apply with tenfold facility and certainty? There are those of my associates of this Academy, whose heads, in- deed, are garnished with silver, who may remember when burnt sponge was the great specific for Scrofu- lous disorders. Who hears of it now? And yet it is as potent, nay, more potent than ever,—only that the wand of the Chemist has touched the incinerated mass, and in the purple cloud which rises from the ashes we behold Iodine, and, following it, a length- ened train of valuable resources against disease. So recent was the discovery of this potent and useful element, which has done so much for sufferinsf hu- manity, that there is one among my auditory, to whose patient, the wife of a then distinguished citizen, was administered a portion of the first specimen im- ported from the country of its discovery. Scores of my auditory will long remember their thrill of delight when they witnessed the proofs of the modernly discovered truths of Physiology, as unfolded to us under the beautiful manipulations of Marshall Hall and Brown Sequard, truths which had existence 10 DISCOURSE. co-equal with life itself, but which lay concealed till now for want of a mind to search them out. A con- tinent of the most important facts, and teeming with life, which waited the birth of a medical Columbus to discover and expose to our view and possession. But it were needless, in this presence, to multiply illustrations of the happy advances which Medical Science has accomplished in the present century. It sufficeth to allude merely to the almost mathematical precision to which the art of Diagnosis has attained; to the revolution wrought by the Microscope ; to the better understanding of the pathology and treatment of several diseases, as, for example, Croup, Rheuma- tism, Phthisis, and renal disorders; to the more per- fect analysis and knowledge of the nature of the dif- ferent tissues ; to the establishment of the physiology and pathology of the Cell. Nor has Surgery lagged in the race of improve- ment. Its votaries, by the brilliancy of their achieve- ments, have earned the admiration of their fellows, and won the never-fading wreath which belongs to the victor over death and suffering. Providence would seem, indeed, to have taken the practitioners of this branch of our profession under its special care, and in reward of their heroism and boldness, made their way easier for the discharge of their delicate and trying duties, and relieved them of the drain upon their sympathies, by the gift of anaesthesia to their patients. When so many earnest and ingenious men are striving successfully for improvement, and adding to DISCOURSE. 11 the general store of knowledge and means of doing good, I trust I shall not be charged with invidious- ness, nor as slighting the merits of any other, in allud- ing to one of these instances as a prominent illustra- tion of the advance of modern art; and, in doing so, testify my acknowledgments of the honor which has been shed on American Surgery by the genius of one now a resident of this metropolis,* the details of which were, during the past year, pronounced in public in connexion with an appeal for aid in the establishment of a special hospital. When a mechanic announces an improvement in the cut-off of a steam engine, or invents a machine for making friction matches or barrel staves, and thus cheapens those articles, the journals of Art take up the~note and sing the praises of the inventor over hill and valley, and forthwith a stream of wealth flows into his willing lap. To the inventor of the Cotton Gin, which was made to save slave labor, State after State voted medals and money. Surely, then, he who makes or suggests an improvement of any kind, for the relief of the " ills which flesh is heir to," equally deserves the praise and gratitude of men. But when, as in the case alluded to, through ardent industry, in- domitable perseverance, and the application of intelli- gent genius, an opprobrium medicorum is for ever ex- punged, and one of the saddest accidents to which humanity is liable may be speedily and permanently relieved, public honors may more properly be awarded, and public gratitude freely acknowledged. * J. Marion Sims, M.D. 12 DISCOURSE. If it were a fitting act in our National Congress to award the sum of $100,000 to him who bestowed so inestimable a boon upon the whole human race, as was done by the discovery of the anaesthetic pro- perty of ether, surely one half of that amount might with equal propriety be adjudged to him, who, not by discovery, but by the steady workings of his inven- tive genius, has bestowed an equally precious boon upon one half of the race, especially when that is the better half. But in the absence of any probability of such a testimonial, the whole public of New York, professional and non-professional, should unite in a generous response to his appeal, and in a well-en- dowed special hospital, erect to him a fitting memorial of his talent and virtues, and thus show to him, while yet living, and prove to others, both now and in future, that humanity can and does appreciate the labors of those who devote their talents to her service. From the premises thus briefly stated, we arrive at a conclusion in which every honest, unprejudiced, and intelligent mind will unite, that the medical pro- fession, as a body, is justly entitled to this eulogium (in these days none too common)—that in the matter of improvement, and advance in its means of curino- disease, it has done, and is now doing its duty. But there are, perhaps, few of our money-loving and popularity-seeking, or even of our sincerely Christian and benevolent fellow-men, who can appreciate the full meaning of this little word " duty" in this connex- ion ; who are able to understand the devotedness and self-sacrificing character of our profession, even when DISCOURSE. 13 their observation is directed to our hospitals, our dis- pensaries, and other numerous medical charities. These noble institutions, they say, are evidences of a Christian era and a Christian land, while they ex- ult in being members of a community where money is so liberally supplied for their erection and support. Such indeed is truly the case; but as in their pro- menades along yon busy mart, they pass that beau- tiful greensward which, like an oasis, contrasts so strikingly with the arid, noisy pavement, and behold in the vista of the refreshing arch of elms, the grey ivy-colored walls, in quiet and unostentatious repose, and reflect that there the sick and wounded may en- ter and be healed, undisturbed by the commotion of the outer world; or as, in pursuit of wealth or plea- sure, borne by the floating palace along the skirts of yon trio of islands, which grace our eastern shore as emeralds adorn the brow of queen, from the deck they behold whole villages, larger than many cities which send their representatives to the Legisla- ture, exclusively populated with the sick and and their attendants ; or as, from the summit of some observa- tory, they look down upon this wilderness of roofs and chimneys, and see it dotted all over with Dispen- saries, Asylums, Infirmaries, and Hospitals, and ob- serve the ceaseless streams of their fellow-mortals setting towards these Bethesdas, little do they reck of the talent, the assiduity, the time, gratuitously la- vished there by the medical men, without whose aid these institutions could have no existence. As he opens the daily morning sheet, the eye of the 14 DISCOURSE. merchant or broker, after first scanning the reports of the sale of stocks, and the rates of freight, perhaps next lights upon a modest little paragraph, entitled, " Report of the Dispensaries" for the past month,— a paragraph composed almost wholly of figures (which in most instances, especially when prefixed by the magic dollar symbol—$—he fully comprehends the nature of, but), which in this instance are as mys- terious to him as the mummied bulls of Dr. Abbott's museum, and as useless, for aught that he can see, as the stock and bank reports are to the physicians whose labors are there embodied and embalmed. He may see there in the course of a year, if he will take the trouble to count up, that in one dispensary there were put up by the apothecary 104,463 prescriptions ; in another 35,340, in a third 20,000, in a fourth 10,- 000, and in a fifth an equal or greater number. But what these prescriptions are, and what they repre- sent, he knows nothing, and perhaps cares as little. Let us give a brief explanation of their meaning and value. Inspect the files of the apothecary and there maybe seen numerous little scraps of paper—perhaps the selvage of a newspaper, a corner of a leaf of an old song book, or perchance the fly-leaf of a well thumb- ed bible, which some poor widow, in some dark cellar, has suffered to be violated for the first time, in order to procure medicine for her sick child—and the cy- phers upon them, illegible to common eyes, indicate the reflections of minds, containing each a profounder knowledge of physiology and pathology, more accu- DISCOURSE 15 rate power of diagnosis, more minute chemistry, and a more varied materia medica, than were the joint possession of Hippocrates, Bichat, Lavoisier, and all the priests of Esculapius. But as in this form, all this labor, and thought, and study, are inappreciable at the stock board and on 'change, it becomes necessary to reduce them to some practical standard whereby they may be recog- nised. Let us, therefore, put it all in the shape of figures, in the denominations of federal currency, so that^ Wall-street may comprehend its value, and South-street perceive its own indebtedness. According to a table which I have compiled, chief- ly from their own published statements, there are in this city, devoted to the care of the sick poor, four general hospitals, five dispensaries, two eye and ear infirmaries, one lying-in asylum, three special hospi- tals (on Blackwell's and Randall's Islands), several orphan asylums and prison hospitals, besides other unenumerated charitable and penal establishments, where medical and surgical aid is rendered. In the institutions there enumerated, there were treated in 1853, 151,449 cases of disease, of every variety. Devoted actively to the service of these pa- tients, we find recorded the names of 169 medical men. Estimating the professional service rendered these patients at what is denominated, in the last report of one of the institutions, in true mercantile phrase, the 16 DISCOURSE. " lowest market value" * (which of necessity varies in the several institutions, in consequence of the varied character of the cases), we have an aggregate of $745,458. An analysis of the circumstances connected with these services, shows that of these 169 medical men, 36 are merely boarded and lodged at the expense of the institutions, or receive pay equivalent thereto, amounting in all to $6,552; 30 of them receive sala- ries varying from $200 to $1500, in the aggregate $20,560; while the remaining 103 receive no com- pensation whatever. In addition to this, if we estimate the amount of private gratuitous advice which every medical man renders, in the emergencies of the sick poor, at the moderate rate of $100 each per annum, the number of practitioners in this city being about 900, we have (to say nothing of bad debts) the sum of $90,000 to add to that before given, making a total of services rendered by the medical profession, in the year 1853, to the sick poor, in the city of New York of $835,458, of which there is returned $27,112. To make this subject still more distinctly appreci- able by the money changers, and especially by the ever-complaining tax-payers, let us put it in the shape in which they are most accustomed to look at pecu- niary matters, in the form of a bill, with a debit and credit item, and it will stand thus:— Report of Eastern Dispensary for 1853. DISCOURSE. 17 January 1, 1854. The People of the City of New York , To the Medical Profession Dr. To Professional Services rendered in Public Institutions, and to the poor in private, during the year 1853, $835,458 Cr. By Cash, and entertainment, 27,112 Balance, $808,346.* To which we may add, Payment not expected. I have before observed, that in its earnest and un- ceasing efforts to improve its means of usefulness, the profession has earned, and is continuing to de- serve, the character of a good and faithful servant. In view of the facts and figures which have just been presented, it must receive the award of merit for the performance of all that is required of it on the score of Charity. And where is the profession or class, that can make such an exhibit of its deeds as this ? The public em- ploys numerous experts to administer to the instruc- tion, and to the physical and moral wants, of the needy, but where shall we look for any thus employed, who render their time, their energy, their talent, and often yield up their lives in the service, without pecuniary remuneration ? Do our judges ever sit to administer justice, or do our lawyers plead the causes of the poor without their "quidpro quo?" Do the instructors in * By the more liberal estimate which many others would make, and the addition of some Institutions not included in my statement, this amount would be raised to a full million. 2 18 DISCOURSE. our public schools spend their time in " teaching the young ideas how to shoot," without bagging a goodly share of game for themselves ? Is the armed defend- er of his country's honor or liberty satisfied with the bubble of popular applause ? Do the claims of pa- triotism suffice our legislators without their " per diem" and " mileage ?" And if we quote in the hear- ing of another learned profession, the words claimed as their commission, " Go ye to the lost sheep of the house of Israel, heal the sick, cleanse the lepers, raise the dead, cast out devils,—freely ye have re- ceived, freely give ?" will they not respond by quot- ing another text, " The laborer is worthy of his hire," and require its practical application to their calling? Can there be named any profession, high or low, feeble or strong in numbers, that gives the proportion of a thousandth part of the amount of service to Cha- rity or public weal, that is given by the Medical pro- fession annually, without fee or reward ? The glit- tering enticements of wealth, apparently so easily at- tainable in the counting-house ; the allurements of popularity held forth from the hustings or the forum; the ambition to command the applause of listening senates, or the bubble reputation at the cannon's mouth; these are all suffered to pass as the idle wind, by him who finds a luxury in doing good, be it in the gilded and satin furnished chamber of the mil- lionaire, or the stripped and impoverished cellar or attic, of the child of want and misery. But the response is upon the lip of the layman, " you receive an equivalent in enlarged experience. DISCOURSE. 19 and the hospital, and dispensary appointment gives a credit which is a passport to private success." With- out stopping to criticise this assertion, which is so amenable to criticism, by those who best understand the subject, let me simply say, that the same amount of experience would be afforded, and an equal influ- ence upon private success be exerted, if the incum- bents of these appointments were to receive a pecu- niary remuneration for their services ; in other words, if the members of the profession were to-morrow unanimously to decline these incumbencies, and the authorities were compelled to pay a pecuniary equi- valent for the required medical and surgical aid; while in either case, the experience alluded to is more, far more, for the advantage of the public than for the profession, and in the establishment of hospitals, dis- pensaries and asylums, the public receives back in this very experience, all it pays for their support, with decupled interest. In whatever light it may be viewed, therefore, the rendition of these services is simply, the contribution of the Medical Profession to the support of public charity, to the full amount mentioned ; it is so much saved to the tax payers. I would not be understood as recommending, or even suggesting, any alteration in the time-ennobled and heaven-born spirit which actuates our profession in this matter; and I am fearful that, even so far as I have gone, I have not only trespassed upon the sacred injunction of Christian charity, "Let not thy left hand know what thy right hand doeth," but that I have also violated one of the most honored rules of 20 DISCOURSE. medical ethics. If I have erred herein, the blame is exclusively my own. I have but sought to place the profession of my choice "rectus in curia," in the great assembly of the people, which contains so many who affect to believe in its hard-hearted and exacting disposition, and who flippantly charge it with inhu- manity, when it seeks the wherewithal to obtain some of the creature rest and comfort, which all value so highly, but which the physician's very duties, in a great degree, deny to him. Permit me only to add, in conclusion of this branch of my subject, that if we receive as an axiom the beau- tiful sentiment of Dr. Young :— " Who does the best his circumstance allows, Does well, acts nobly, angels could no more,—" I respectfully submit whether the Medical profes- sion is not logically entitled to a rank in animated nature, at least parallel with, if not superior to, that order of beings. Thus does the Medical profession discharge its ob- ligations to the public. If now we inquire how the public responds in the performance of its duty to the profession, the answer, it is feared, will not indicate a full reciprocity of devotion and Charity. Indeed the question, in one respect, is already answered. The fact that the community is willing to receive un- requited, at the hands of the profession, so enormous an amount towards the support of its public charities, displays a disregard of this reciprocity and of its own best interests, which strikes one with surprise ; a sur- DISCOURSE. 21 prise which would suffer no diminution, but rather be increased, were some of the facts connected with the administration of some of our medical charities ex- hibited to view. But I refrain, and will ask, in this connection, your brief attention to only one point in the mutual obligations of the public and the science of medicine. One great fact in the history of civilized society, which stands out with protuberant prominence, dis- figuring and deforming it, is the encouragement and support given to the boldest and most impudent char- . latanry. The Arabian fiction of Sinbad the Sailor, beridden by the Old Man of the Sea, who clings to his shoul- ders and sides with a pertinacity which resists every effort to dislodge him, finds a realization in the mo- dern system of Quackery astride the body of Society. The hideous old creature of the fable maintains his position by night and by day, compelling poor Sinbad, by a vigorous application of his heels to his ribs, to carry him wheresoever he pleases ; now under the trees, to pluck fruit; anon into the brook to procure drink; and even in sleep he is immovable. The parallel fails in but one point: for the conve- nience of the tyrannical rider, Sinbad was a compul- sory, Society is a willing, hobby. Perhaps a more fitting simile is found in the subsist- ing relations of the parasitical vine, which both clings to the generous surface of the forest tree, to sustain it above the earth where it would otherwise grovel, a*nd sucks from it the nourishment which it converts 22 DISCOURSE. into poison, and with which it infects whatever living thing it touches. This is one of the most lamentable as well as sur- prising facts in the history of humanity,—pervading all ranks of society, many in other respects the most intelligent and refined, being victims of the delusion equally with the coarse and ignorant. Under what- ever form the quack may put forth his pretensions, or whether he may change them as often as the moon changes, it matters not; if yesterday he was an infi- nitesimalist, to-day an eclectic, to-morrow a mesmer- ist, and anon a hybrid of some before unheard ofpro- geniture, the public takes to its arms the empiric of the grossest and most irrational theory. There is said to be a philosophical sect who be- lieve that of whatever is thought among the arts and sciences of the present day to be new, and apparently the development of modern mind, an antetype. may be found in the history of ancient days. Thus, as the light of the sun penetrates more and more deeply into the age-darkened recesses of Pompeii and Hercula- neum, the discoveries of the antiquary are found to rival many of the vaunted inventions of our own time. In our Crystal Palace (itself the very poetry of archi- tecture, but losing its originality in the preadamite creation of the stems and tracery of the Victoria Re- gia), in the Crystal Palace may have been seen an evidence of this truth, in an instrument transmitted from the Tower of London, which, though 200 years old, is the very Dromio of one whose recent invention added another star to the crown of American genius. DISCOURSE. So in spite of the boast of the devotees of modern charlatanry, of the systems pretending to be the offspring of modern science and liberalism, there is scarcely one that is not anticipated by more than centennial date, and the revival of which is but the exhumation of the mummy of long forgotten ages. The false system which attracts the gaze of the gap- ing crowd, is but the dexterous horsemanship of the Hippodrome, and finds its antecedent parallel in the Olympic games, as sung by Homer: " As when a horseman from the watery mead, (Skilled in the manage of the bounding steed,) Drives four fair coursers practised to obey, To some great city, through the public way; Safe in his art, as side by side they run, He shifts his seat, and vaults from one to one; As now to this, and now to that he flies, Admiring numbers follow with their eyes." * The amount of money expended in this city upon patented and other nostrums, to say nothing of the fees paid to the quacks themselves for what they call advice, it would be of course impossible to ascertain. We may obtain a shadow of an idea of it, by scanning the stately and elegant mansions erected by their vendors here and there in our broad avenues; and now and then an indicative item comes to light; as, for instance, I have a wealthy neighbor, a man of otherwise good intelligence, whose medical text book * Pope's Iliad XV., v. 882. 24 DISCOURSE. is the advertising columns of the penny press, and who is believed to expend about $150 per annum in quack medicines, and this chiefly for imaginary dis- orders. This man would doubtless demur strongly to being taxed a tithe of that amount to remunerate the medical staff of a dispensary or a hospital. When we come to view this matter in a philoso- phical light, and endeavor to account for the extra- ordinary depth, and breadth, and strength of this delu- sion by which society is infatuated, at first glance one is very prone to cast the stone of censure against the projectors and vendors of the nostrums. But in my judgment this would be a serious error : the fault lies rather with the public which patronizes, and not so much with the tradesman who profits by it, and who, while he chuckles over his rapidly accumulating pile, may, to some extent at least, be an innocent be- liever in the virtues of his so called specific, and even be unconscious that every article in the formula of his preparation, is described at length in the text book of every student of medicine; that, in this respect, it is is literally true, there " is nothing new under the sun." More fairly, I think, is the evil to be attributed to the gross ignorance of the public itself. Ignorance is the mother of delusion; intelligence and delusion can- not coexist. Vice and insanity, but not undiseased delusion, may be combined with education and intel- lect ; and this rule applies as well to medical, as to any other subjects. And what subject can be named upon which there is more profound popular ignorance DISCOURSE. 25 than the mechanism and physiology of the human structure ? And on what, therefore, is there more op- portunity for the successful practice of deception by the knave, or for the strengthening of delusion in the victim ? With the exception of that masterpiece of German medical transcendentalism, which has of late years taken captive so many silly men and women, and which was with such forcible truth described by a late lamented fellow of this Academy as a " deception on the part of the physician, and a delusion on the part of the patient," with this single exception, I feel disposed to exonerate, in a great measure, the practi- tioner and vendor of charlatanry and nostrums from culpability, and to attribute their prevalence and abundant support chiefly to the cause I have men- tioned. On this subject it is too true, that " Darkness covers the land, and gross darkness the people." If this is admitted as the true explanation of the cause, the remedy is clearly indicated. Instruct the people in the true nature of their own organization, familiar- ize them with the formation and operations of their own living machinery, and then and then only, will they understand the folly and danger of tampering with its delicate movements. A rational being, cognizant of the exact and sub- limely refined nature of his digestive and circulating organs and functions, would as little think of drug- ging them with any of the thousand nostrums of the day, as would a sober engineer to crowd the furnace with extra inflammable matter, when his engine is al- 26 DISCOURSE. ready driven up to its full and safe degree of steam pressure. But as to the effect of this delusion, and its conse- quent loss of valuable means upon the progress of science, and the improvement of medicine. I have before adverted to the fact, that it is necessarily to the scientifically educated members of the medical profession, and to them only, that the world can look for progress in medical and surgical art. To this duty the attention, and no inconsiderable portion of the means, of the profession, are continually addressed. Its journals are supported by itself alone; except in one of these United States (Michigan), medical schools, unlike our ward schools and Free Academy, which are sustained by the public, derive their support almost wholly from the profession. The expenses incurred by the numerous state, county, and private medical societies, which are maintained like this Academy, for public good, are defrayed to the last cent, without aid from that public whose interests are deeply involved in their continued and energetic action; while the time and talent expended in gratuitous services in medical charities, as has already been stated, redound greatly to the advantage of the public. The representatives to our great national Medical Congress receive no " per diem" or " mileage" from the public treasury, yet we may hesitate not to say, that in what relates to the welfare and progress of the human kind, the results of its three days' proceed- ings will bear a favorable comparison with the recent DISCOURSE. 27 eight months' parturition of its political sister at Wash- ington. Under this state of facts, it appears certainly due to the profession that it should receive from the pub- he, whose interests it serves, all the aid and support which is legitimately derivable from the practice of the healing art. To put money into the pockets of an empiric, although his treatment may occasionally hit right, is to support a class of men devoted exclu- sively to private gain, without the least public spirit in their calling, who have never yet given the wheel of medical science a single revolution forward, and from their ignorance could not, if they would. This position I am ready to abandon, when there shall be shown one new idea in chemistry, a single ray of light from the profound depths of physiology, one anatomical discovery, or a reliable idea before un- known in pathology or therapeutics, that has ever emanated from the head of any medical charlatan that ever lived. In fact, a truly scientific man cannot be a quack. The loss to the medical profession, therefore, by the support of charlatanry, though it has been enor- mous, is far surpassed by the loss sustained by medi- cal science and consequently by mankind, for whose use all sciences are studied and improved. Turning now our attention from the Therapeutic relations of medica] science, and taking our stand upon the point from which the Prophylactic horizon may be scanned, the relations of the people and that science are exhibited in a widely different attitude. 28 DISCOURSE. The fact which here first arrests the attention is, that whereas in the therapeutic branch, as has already been shown, the responsibility of initiating and per- fecting improvements rests solely on the profession, in the present case the onus lies upon the shoulders of the public at large. So far as the members of the profession are members of the community, they must share the responsibility of the existence of defective hygienic arrangements ; but as members of the profes- sion, they cannot justly be charged with it, except as they may be called upon as experts, to recommend sanitary measures, and take part in their execution. Let me illustrate this point. Suppose the board of trustees of a public school, or a hospital, consists of ten persons, one of whom only is a physician. All are equally responsible for the good order, economy, and effective character of the institution, and among the rest for its sanitary condition. Should the building be unfitted for its purpose, either by location, crowded apartments, want of ventilation, or any other cause, each trustee is bound to be cognizant of the fact; and although the medical member of the board, from his better knowledge of the laws of health and sickness, may be more able to appreciate the consequences, and perceive them to be inevitable—yet, as a trustee, he bears only one tenth of the responsibility; and if he has raised his warning voice against the defective circumstances, although unheeded, he is absolved from even that. But if, on the other hand, he is empow- ered by his associates to direct and perfect arrange- DISCOURSE. 29 ments for the removal of the evils, then, but only then, is the responsibility wholly his. So stands the medical profession in the community of which it forms a part in relation to the prevention of diseases. It shares the responsibility exactly in proportion to it& numbers, which in this community bears the ratio of about one to 700. Having thus shown where the burden properly be- longs, let us make a brief examination of its nature and extent. But here steps in the casuist, with the belief that disease is a visitation of God upon the people for their immorality, and that to talk of preventing its in- fliction, is to fly in the face of Providence. Although this sentiment may prevail, especially with a certain class of minds, an extended argument for its refutation would be inappropriate to this occasion. It will satisfy my own mind, at least, to state the conviction, that with regard to a great number of the diseases which afflict humanity, the rule of physical cause and effect in their production, is as clearly demonstrated and defined as the law of gravity; that the avoidance of specific disease, by human foresight and care, is not confined to the prevention of Small Pox by vaccina- tion ; to the removal of Intermittent Fever from a neighborhood by the draining of a marsh; or the prevention of Ship Fever by thoroughly cleansing and ventilating the steerage ; and that the recent Secre- tary of State of the British Empire never uttered a more pregnant truth than when, in response to an application for the appointment of a day of national 30 DISCOURSE. fasting and prayer to God for the removal of Cholera, he said: " The Maker of the universe has established cer- tain laws of nature for the planet on which we live, and the weal or woe of mankind depends upon the observance or neglect of those laws. One of these laws connects health with the absence of those gas- eous exhalations which proceed from overcrowded human beings, or from decomposing substances, whether animal or vegetable; and these same laws render sickness the almost inevitable consequence of exposure to those noxious influences. But it has at the same time pleased Providence to place it within the power of man to make such arrangements as will prevent or disperse such exhalations, so as to render them harmless, and it is the duty of man to attend to those laws of nature, and to exert the faculties which Providence has thus given to him for his welfare. The recent visitation of cholera, which has for the moment been mercifully checked, is an awful warnincr to the people of this realm that they have too much neglected their duty in this respect; and that those persons with whom it rested to purify towns and cities, and to prevent or remove the causes of disease, have not been sufficiently active in regard to such matters. Lord Palmerston would, therefore, sug- gest, that the best course which the people of this country can pursue, to deserve that the further pro- gress of the cholera should be stayed, will be to em- ploy the interval that will elapse between the present time and the beginning of next spring, in planning and DISCOURSE. 31 ■executing measures by which those portions of their towns and cities, which are inhabited by tjic poorest classes, and which, from the nature of things, must most need purification and improvement, may be freed from those causes and sources of contagion, which, if allowed to remain, will infallibly breed pes- tilence, and be fruitful in death, in spite of all the prayers and fastings of an united but inactive nation. When man has done his utmost for his own safety, then is the time to invoke the blessing of Heaven to give effect to his exertions."* If this doctrine of the punitive character of disease were true, there is certainly a very great dispropor- tion observable in the degree of sin committed, and of disease inflicted, upon different individuals and communities; the destitute, badly fed, poorly clothed and lodged, virtuous though poor, being punished severely and often; while the well-housed, sumptu- ously-fed, and comfortably-clothed, though they may be great sinners, obtain comparative immunity. But though abundant observation and well-esta- blished laws have determined this question, and though in most of the arrangements instituted by the State for the protection and benefit of its people, in other important relations, the prophylactic principle is fully recognised and enforced, yet in its application to the Public Health, it is greatly neglected. For * It is said of a popular but somewhat eccentric divine, not a hundred miles from Glasgow, and living in a collier district severely visited with the pestilence, that he lately prayed to heaven " to stop the cholera, as it was -doing no good." 32 DISCOURSE. example, one of the mottoes of the statesman is, ^In peace prepare for wrar," and millions are expended annually to preserve peace. We believe the safety and perpetuity of the republic rests in the intelligence of the people, and hence the expenditure of countless sums and sleepless care, for the universal diffusion of school education. Is the community startled some morning by the exposure of an,enormous pecuniary fraud, forthwith every financial concern in the coun- try institutes an examination of its affairs, and hastens to put additional checks upon its issues. But how few and inadequate the statutes, and how slight the general regard for the preservation of the Public Health, though as certainly as that the " price of liberty is eternal vigilance," the price of health is continual obedience to nature's laws of purity, tem- perance, and free air. The neglect of that which, in the shape of preven- tion, would cost but a penny, soon requires the ex- penditure of a pound, for treatment; the neglected ounce of precaution, often swells to the ton weight of pestilence and death. In this most vital of all their earthly interests, the great mass of the people seem given up to ignorance and imbecility. With almost every other question of civic economy, we find the public more or less familiar, in principle and detail. For the melioration of prison discipline, for improving the condition of the general poor, for the aid of outcast children, public sympathies are continually on the alert, and the purse of generous citizenship easily accessible. DISCOURSE. 33 But where is the association which undertakes to en- lighten the people on matters of Hygiene, and charges itself with the distribution of tracts on its numerous kindred topics? And who stands in his place in the legislature, whether of state or city, furnished with the needful information, and filled with the true pro- phylactic ardor, to suggest and urge enactments for the removal of the oppressive burdens under which vast numbers of the community, and especially of the poor, are weighed down to, and prematurely into, the earth ? But I wish not to forestall your judgment, and will ask your attention to a few facts, before suggesting any remedies for the evils under notice. Let us look first at the results of defective sanitary laws and ar- rangements, then glance at the causes /of the great amount of our sickness and mortality, and finally con- sider the means for their removal. In the year 1853, there occurred in this city 22,702 deaths, of which 19,475 were from disease alone, i.e. exclusive of those from casualties of all kinds. But with a statement of the number of deaths, a mere fraction of the truth, in relation to the welfare of the people, is told. For every death, it is esti- mated that there are 28 cases of sickness, of an ave- rage duration of three weeks. By a comparison of the known results of sickness and death which has been made in Lancashire, England (within whose bounds are Liverpool and Manchester), in Boston, N. E., together with such data as I have been able to obtain for this city, this estimate appears to be correct, and 3 34 DISCOURSE. we are thus enabled to approximate the loss sustained in this city by the pressure of disease and mortality. By multiplying the 22,702 deaths by 28, we have 635,656 as the number of cases of sickness which occurred during the year, and which, at three weeks duration each, gives an aggregate of time lost in 1853 by the inhabitants of New York of 36,672 years; equal to the loss of the entire lifetime of 1467 individuals, assuming the average age of our population to be 25 years, which is a liberal esti- mate. To compute the pecuniary losses incurred by this destruction of life and health, would seem an impos- sibility ; but if we estimate the mere loss of time and the actual expenses of medicine, nursing, extra food, &c, at $1 per day, it will amount to $6,692,640. These calculations and statements may seem to some like the wild imaginings of the enthusiast, but they are based on reliable data. The number of deaths is indisputable, and strong confirmation of the truth of the deduction therefrom, is found in the fact, that the names of nearly one quarter this number of cases of sickness are actually recorded on the books of our medical charities. But who shall estimate the social and moral losses to the human family from this terrible amount of disease and suffering ? Who can picture the anguish and woe which desolate the hearts of our people ? But it forms no part of my design to dwell upon this aspect of the subject, and were I to attempt it, I should fail to do it justice. DISCOURSE. 35 It is to another point that I would especially direct attention at this time. An examination of the mortality returns of this city for the last year, reveals the fact that 13,194, or a proportion to the whole of 58.1 per cent.,* were the result of diseases, whose causes are more or less within our control; in other words, that under the most favorable circumstances of life, those diseases, and consequently the deaths from them, might have been avoided. I would not be understood as asserting that this proportion of the sickness and mortality of 1853, by proper attention to the laws of health by those who suffered, would certainly have been prevented ; for hereditary taints, individual peculiarities, unavoidable exposures, and other malign influences, too often wholly overbalance the most rigid observance of the hygienic rules which should govern every one. But it cannot be successfully disputed that the dis- regard of these laws, arising from ignorance of them in most individuals, and the neglect of them in the legislation and administration of government, contri- bute very largely to the fatality to which this city, in common with other communities, is prone. Lest these views of the power possessed by man, to guard himself against the ravages of disease and death, may by some be deemed hypothetical, let me specify some of the instances wherein, by an avoid- * Excluding the deaths from casualties, this proportion would be 67.74 per cent. 36 DISCOURSE. ance of the causes of disease, much of the mortality of 1853 might have been prevented. There were 29 deaths from Intermittent Fever, the origin and mode of prevention of which are almost mathematically demonstrable. Cholera Infantum de- stroyed 922 lives, of which it is safe to say 900, under different relations of life, might have been saved. Small Pox gave 681 to the grave, and from the known ratio of the mortality of this disease, nearly 7000 more were rescued from it, only to carry its footprints indelibly impressed upon their features through life ; all of which could have been avoided by a universal enforcement of a prophylactic measure, as well known as it is simple and efficacious. Scro- fula, in its Protean forms of consumption, marasmus, hydrocephalus, inanition, &c, the direct effect, in a great majority of cases, of foul air, bad diet, filth, and impurity, destroyed nearly 5000. The number re- ported as destroyed by Delirium Tremens and Intem- perance is only 171, doubtless far short of the truth, which is concealed for the sake of surviving relatives. From incautious exposure to the Sun, whose rays were given to bless and keep alive, 260 fell. Of nearly 5000 more destroyed by Fever in different forms, Abdominal Affections, Scurvy, Erysipelas, Cutaneous Disorders, Pulmonary Affections, Dentition, &c, though it may not be proper to say of them, that the diseases could in every instance have been prevented, yet it can be said of them, that from the well known condi- tion in which the victims lived, a large proportion of DISCOURSE. 37 the deaths might have been avoided had different con- ditions surrounded them. And now, multiply as before, all these by 28, which represents the ratio between death and sickness, and the amount of suffering, destitution, and pecuniary loss, which would have been avoided by a knowledge of, and simple obedience to, the laws which God has given for our preservation, is like the number and dis- tances of the stars, inappreciable in their magnitude. With this brief and imperfect sketch of what man suffers by his own ignorance and carelessness, let us pass to a consideration of some of the causes of these destructive evils ; and if the plain unvarnished state- ment which has been given of the results of disobe- dience of Hygienic Law startles and astonishes, an exposure of the facts and circumstances which fill the background of the mournful picture would, had I the power to paint them as my own eyes have often be- held them, bring a shudder to the sensitive heart, and cause the spirit to sink with shame that such things are permitted in the midst of the nineteenth century of the Christian era. The sanitary relations of the population of a large city, and, indeed, of any place, are divisible into two general classes ; the first refers to its external, or out- door influences; the second, to its internal, or domi- ciliary life. The external relations are to the soil and its emanations; to the water for drinking and culinary purposes; to the atmosphere, as influenced by gene- ral circumstances, such as proximity to bodies of water, salt or fresh; exposure to, or protection against, i * 38 DISCOURSE. winds ; temperature; climate; moisture ; access of light; vegetation, &c. These are all influenced by natural laws. On the other hand, the intra-domiciliary life em- braces the air as affected by respiration and combus- tion, diet, clothing, condition of person, numbers in proportion to space, absence or presence of animal and vegetable effluvia, &c. Now, if we turn our attention to the first of these two points, as they affect this metropolis, we have but to repeat what has been said already a thousand times, and with unquestionable truth, that in point of geographical position, geological formation, variety of surface, equanimity of climate, and freedom from neighboring contaminating influences, the island upon which it is built commands a position unequalled for salubrity by any other on the globe; and for what nature may have denied it for city purposes, in the matter of fresh water, art has more than compensated. In itself and its surroundings, everything is provo- cative only of health and longevity. It is not to this division of sanitary influences, therefore, that we can look for an explanation of the great amount of extra mortality of its inhabitants, and for this we have but one other resource, viz.: its intra-domiciliary life, and here, indeed, we shall find it. But what power shall lift the veil which hides these scenes from public view ? What pencil shall depict in their true colors those circumstances of city life which forerun this awful desolation in those domi- cils, wrhere, DISCOURSE. 39 u Deep, as in a murky cave's recess, Laved by oblivion's listless stream, and fenced ****** * * from all obtrusion Of busy noon-tide beam, Death, The pale monarch, sits In unsubstantial majesty ?" The essay has often been attempted by abler pens than this, but the subject has not as yet attracted, as it should, the attention of the philanthropist, the legis- lator, or the citizen. Perhaps one reason for this disregard or indifference is to be found in the very darkness of the scenes which are attempted to be portrayed. The refined and polished citizen, living in comparatively pure air, and nourished to rtundity, willingly imagines the pictures of squalor, filth, foul air, intemperance, and disease, to be overdrawn ; he thinks the painter of such scenes to be " An artist at creating self alarms, Rich in expedients of inquietude, And prone to paint them dreadful." He would fain believe that " Fear shakes pencil, fancy loves excess, Dark ignorance is lavish of her shades, And these the formidable picture draw." Yet ever and anon from out his dark abodes in the cellars, the blind courts, the filthy alleys, and the sky- reaching attics, death issues, bearing in his blighting hand, more swift and wide-spread destruction in the form of cholera, typhus, and variola; and then the 40 DISCOURSE. enginery of authority, stimulated by fear of life and pecuniary disaster, is put into spasmodic operation ; and after the loss of a few thousand lives, the enemy is driven back to his customary haunts, and there left undisturbed to recruit himself for another desolat- ing, open war, which sooner or later he is sure to wage. Beyond the efforts heretofore put forth, there ap- pears but one resort by which the stern realities alluded to, can be so exposed as to attract their de- served attention, and that is a creation of fiction, which requires the aid of a Dickens, a Beecher Stowe, or more properly of its own inventor, Le Sage, to give it its true effect. Would that I could invoke the faculty of Asmodeus, and carry you from steeple to turret, and from tower to flag-staff, and thence point you to the deep artifi- cial recesses which lie upon and beneath the surface of this little spot of earth, and show you where and how two thirds of a million of human beings pack themselves. I would not, however, as did Asmodeus, unroof the buildings, for that would at once relieve them of their principal cause of disease, by emptying them of their foul air; it would ventilate them, and thus remove their poisonous influences. I would but make them transparent, for, contrary to a frequently found idea, glass is impervious to air. On such an aerial journey we might see, that though the pure air we were inhaling at those heights, is pressing with a force of 14 pounds to the square inch DISCOURSE. 41 to get into their dwellings, the inhabitants pertina- ciously close every crevice through which it might enter ; we would obtain a clearer view of the manner in which they pile themselves, tier upon tier, from two to seven deep in their narrow boxes called houses; and how, not satisfied with this, 20,000 of them dig holes in the ground, and there pass portions of the day and all the night; how on their journeyings to and fro they stow themselves in carriages, cars, and cabins, whose every window and door they close ; how on the sabbaths they assemble to worship God in tem- ples adorned with all that money and art can sup- ply, but from which every draught of heaven's fresh air is excluded, even though the weaker ones occasion- ally faint for the want of it; how even their tender off- spring, who require oxygen for growth as well as for life, are packed by thousands in school edifices, where their delicate brains are kept at high pressure, while both brains and bodies pine for air ; how in their prisons they condemn the inmates to double punishment, to wear the chain and inhale their own foul gases ; how even the sailor, who when on deck enjoys an atmo- sphere the beau-ideal of purity and freshness, when off duty, is thrust into a little cavern below, almost her- metically sealed; how sea-going passengers hither- ward are treated even worse than this ; how in almost every position, wdiether at work or at rest, in school or in church, at home or on travel, by day and by niffht, waking or sleeping, man, in his civilized state, repu- diates the great gift of Providence, free air, by which he would be made healthy, long-lived, and happy, pre- 42 DISCOURSE. fers to wallow in his own emanations, and literally " to die a thousand deaths in dying one." Before we left our elevated points of observation, perhaps a special evidence of his blindness would be furnished us by a repetition of the disaster which but lately fell upon the great heart of the city like a thun- derbolt at sunny noon; a terrific shriek from yonder school-house gives token of some dreadful event; under that single roof are crowded 1840 delicate chil- dren ; towards the close of their six hours' mental la- bors, when the whole atmosphere within has become vitiated, and carbonic-acid has usurped the place of oxygen, a number of them retire with two of their teachers into a little corner room ; one of the teach- ers feeling chilly for want of the natural fuel which would warm her blood, shuts every avenue against it from without, and opens the register for artificial heat; soon her weakened frame, deprived of its natu- ral stimulus, yields to the pressure of the impure air, and she swoons; the frightened children rush from the room, "fire" is cried,the alarm spreads, 500precipitate themselves upon the stairway to the street, it yields be- fore them, and in a twinkling 42 of the innocents are suddenly and totally deprived of the air, which before they were receiving in rapidly diminishing quantities. You will tell me this was not a legitimate result from the asserted cause ; that it was an accident im- possible to foresee, and unavoidable. In one sense, it was so, in another it was not. The commencement of that disaster, the mustard seed from which sprang this tree so full of death and woe, was the total absence DISCOURSE. 43 of ventilation. The same cause will ever produce the same effect in some form or other ; and the authorities of those schools may strengthen their stairways with iron, may secure their floors with gratings, may bar their windows, and protect the pupils in every way possible in their imagination; but in modes which they dream not of, the same results will sooner or later ensue ; it has been so from the beginning, it will be so to the end : death may not come again to these little ones in so obvious and precipitate a manner, but come it must, and if not thus, come it will in " con- sumption's ghastly form," in dropsical brains, in burn- ing fevers, or in some other of its hundred avenues of approach, until they perform their first duty to all concerned, and furnish for the children's lungs an in- cessant and ample supply of oxygen as heaven sends it.* * By the following letter from Dr. Hibbard, a member of the Board of Education, it will be seen that this "fainting fit" cost the city nearly $8000, and that without in any degree remedying the cause of the catastrophe, or avoiding it in the other school houses. No. 67 Seventh-street. Nov. 3d, 1854. John H. Griscom, M. D. Dear Sir: As one of the numerous auditory of your valuable (because practical) " Oration" before the Academy of Medicine last evening—permit me to say I was not only pleased but instructed. On the subject of Ventilation, and particularly those portions that applied to our Ward Schools, your remarks were full of interest—not only to myself but to others present, members of the standing com- mittee of the Board of Education on that subject, who had just 44 DISCOURSE. On the 25th of April last, 10 or 11 men were sud- denly deprived of life by the falling of a wall during the conflagration of a building at 231 Broadway. A come off a tour of duty to one of our new school-ho uses, where we flatter ourselves we have secured a free, sure, and healthful ventilation, not only for this one, but for every school-house hereafter to be built. The sad disaster at the Greenwich Avenue School (to which you made allusion) forms an epoch in the history of our schools long to be remembered and much to be regretted, from the loss of human life and the sufferings of so many innocent and confiding children, sacrificed for lack of sufficient and proper ventilation. A vast amount of public money has been expended in consequence ; and even here it is singularly remarkable that the real cause of the calamity has been overlooked, and the money spent in securing a safe retreat from fire, rather than in a supply of fresh air, which in this instance was so much needed, and the only cause of this calamity. Thousands of dollars have been expended in erecting fire-proof stair-ways, appending iron net-work to the well holes of stairs, and in putting up iron railings to banisters, &c, while the only remedy, " ventilation," has been overlooked. Your remarks will go far to- wards producing a safe and efficient remedy. The sums of money expended in this way to cure the evil by preventing a recurrence are, as nearly as I can astertain, as follows:— School No. 41. In Greenwich Avenue, including expenses incident to the calamity, . . $0,809.35 " 40. In 20th Street, 18th Ward, in securing their stairs by iron net-work, . 325.00 Free Academy, do. do. . . 255.43 " 44. In North Moore Street, 5th Ward, includ- ed in the estimate for the building,cannot be accurately ascertained, but from the magnitude of the work, is set down at 500.00 DISCOURSE. 45 coroner's jury of 12 intelligent citizens, in their ver- dict, used this graphic language :— " The whole building was a complete death trap, and could scarce- ly have been more dangerous had it been constructed for the express purpose of sacrificing human life. It was moreover deceptive in ap- pearance, and on that account doubly dangerous in case of fire." Alas! if coroners' inquests were to be held on all the corpses that are made such in the showy but de- ceptive domiciliary and academical death traps in this city, there would remain but little time for the living to attend to any other business. You may find them on every street, nay ! on almost every block—traps into which victims are attracted by the thousands, and from which they are carried, after a short detention, by the hundreds, and to which the language of the verdict I have quoted will apply with pointed literalness. And yet they stand, unceas- ingly decoying the ignorant and the defenceless ; they are rapidly increasing in number, and we heed them not, nor give warning to the victims. School No. 29. In Greenwich Street, 1st Ward, included in the appropriation for raising the build- ing, is estimated by comparison, at 400.00 $7,789.78 It may not be out of place in this connexion to relate the fact, that one of our school-houses was on fire (from the hot air furnace) during school time, yet the children were all safely removed without accident of any kind, although the house was partially unroofed, and the whole damage was over $700. Very respectfully, your friend, Wm. Hibbard. 46 DISCOURSE. Do you ask for a prohibitory liquor law ? Very good. But would that have rescued from the grave the 13,734 children who in 1853 went down to it ere they saw their tenth year ? The bottle was not put to their lips, but they died, when the stimulus of a lit- tle oxygen would have saved them, and have prevent- ed the sickness of ten times the number. If society has a right to protect itself against the destructive influences of the groggeiy, so has it against the tenfold more deadly, and the thousand-fold more prevalent, destructiveness of the poisoned air of the tenant house, and of the unventilated church or school edifice. Let us have not only a law which shall put it out of the power of the dram-seller to poison his individual neighbors at three cents a glass, but one also, which will prevent the landlord's poisoning scores of fami- lies for five dollars a month. Man, with regard to the pathogenetic as well as sanitary influences which surround him, is presented to us in two general conditions. The first embraces all the circumstances to which he is exposed in a state of nature; the second, those in his artificial or civil- ized life. Of the first condition, a type is seen in the N. A. Indian, whose home and whose larder are the forest and prairie. The second finds a representative in the denizen of the polished city, such as our own metropolis. As the individual approaches either of these extremes, he becomes more and more subject to its peculiar hygienic influences, but their health-pre- serving powers are in inverse ratio to each other. DISCOURSE. 47 Thus the Indian, the more of an Indian he is, the greater the probability of his freedom from disease ; while the citizen, the more closely he follows the re- quirements and practices of his artificial mode of life, is more and more liable to disease and premature death. In alluding thus to the habits and circumstances of city life, I speak of them as they are, and not as they might be, under proper governmental and family ar- rangements. Now what are the most striking differences between these two extremes of earth's inhabitants ? They are briefly such as these : The one shuns companionship, except to a very limited extent; the other lives continually in a crowd. This, lives free to range over earth and lake, un- confined by aught save his buffalo robe and bower of leaves ; that, shuts himself within brick walb, and under roof of metal or slate. The one breathes the air in all its pristine purity; the other shuts it out as if it were poisonous, and real- ly makes it so within. From the presence of one, the excretions of the lungs and person are left free to escape and never return to him; by the other, they are retained, reab- sorbed, and reinhaled. One covers his body with garments which leave every function free and unrestrained ; the other is so encased, that his motions and functions are greatly restricted. One treads the virgin green-sward of hill and val- ley ; the other, pavements of stone and brick, while 48 DISCOURSE. the forest glade and purling brook are strangers to him. The food of the latter is brought to him by steam- boat and rail car, and his cook from France or Ire- land ; the food of the former is brought by his own bow or rifle, and is served up " au natureV by him- self. One is " monarch of all he surveys;" the other rents a floor 12 feet by 15, or at most a house 25 by 50, with a patch of grass 7 by 10. The most dense native population is perhaps one to the square mile of the earth's surface ; in some places in New York, its inhabitants are about one to the square yard. With such hygienic differences, is it a marvel that the one lives to old age and then dies a natural death, while the other is a continual prey to a multitude of diseases, and the victim of a premature grave ? Now a civilized life is not necessarily provocative of disease. Though a man shut himself in a cell, he need not inhale his own effluvia, and one may live and work at the bottom of the bay with his head en- cased in a helmet, provided in either case it is kept well ventilated. And all that is required of us, who live in houses, to prevent the corrupting influences upon our systems of the foul air of our own making (which is the most potent and common of all the dis- ease-producing agencies we know of, and as powerful as all the others combined), is to cause its removal from us instantly as it is produced, and the inhalation of nothing but pure air. DISCOURSE. 49 I am thus introduced to the last point of my posi- tion—the remedies for, or rather the preventives of, these evils. The suggestions I would offer are three in number. The first is, the universal introduction of Human Mechanism and Physiology, as a subject of study in schools, especially the public schools. For the professional part of my audience, nor any others who possess a knowledge of the subject named, is any enforcement by argument or illustration of the propriety of this suggestion necessary. The value of this knowledge, as the basis of all hope for the perma- nent improvement of the sanitary condition of the people, and of the laboring classes in particular, is self-evident. To the people themselves, outside of our profession, it is not so plain ; and with the strong disposition manifest in the public mind to examine the facts and rationale of almost every branch of science and art, even if only for the delight afforded by th« acquisition of knowledge, it is a marvel that the struc- ture, functions, and properties of his own frame, have been passed over by man in general, almost unno- ticed. Astronomy, Geology, Mythology, and other occult sciences pertaining to inaccessible objects,. and of a thousand times less practical importance,, have absorbed his time and attention to the exclusion ofhimself. The argument in favor of the universal introduc- tion of this study into the upper classes of schools, has been presented so often and so ably as to relieve me from the necessity of occupying time with it on the present occasion. Those who may desire to read 4 50 DISCOURSE. one of the most eloquent productions on the subject, I would refer to the Sixth Annual Report of the Massa- chusetts Board of Education, in 1843, by Horace Mann. But when we ask ourselves why it is that, notwith- standing the repeated and earnest appeals on its be- half, there is still so great neglect of the subject, as a branch of popular instruction, we are puzzled for a reply. I apprehend, however, that the obstacles to so desirable a consummation, will be found few and removable. They doubtless consist principally of these two, viz. the want of a proper class book, and the want of competent teachers. The text books which have been made for school purposes on this subject, are not sufficiently clear and plain in their language and illustrations; while they are generally too much burdened with technicalities, their illustra- tions are anything but illuminations ; these latter serve but to render the darkness of the subject visi- ble, and strengthen the ideal mystery in which, to the common mind, it is veiled. Let our Board of Education offer a suitable prize for the best work of the subject, adapted to school purposes, and in a year we should probably be sup- plied with it. With regard to the second difficulty, it also may be overcome by making application in the right quarter. To be a successful teacher, one must be a proficient in the branch to be taught, and on this subject of physiology there is but one source from which the re- quisite numbers and proficiency can be obtained; and DISCOURSE. 51 here is presented a mode in which the public may re- deem some of the heavy obligations under which it lies to our profession; at the same time there may be brought into exercise some of its undeveloped capa- city for public usefulness. To every school, especially every public school in this city, state, and UnitedStates, there should be attached a medical man as one of its corps of tutors, who, by spending a few hours a week in instructing its classes in this interesting branch of science, would exert an influence for good in the mat- ter of individual and public health, in the protection of the people against the nuisance and danger of char- latanry, and, indeed, in stimulating the profession it- self to higher acquisition for the discharge of its ordi- nary duties, which would soon be felt over the length and breadth of the land, and with increasing power as generation succeeded generation. The people would learn for themselves and teach their children the great value—the absolute necessity —if they would maintain health, of cleanliness, temper- ance, and pure air; they would know the reasons for these requirements ; they would be convinced that it is as incumbent upon them to return thanks to God for the air they inhale eighteen times a minute, as for the food they eat three times a day, for, without the former, the latter would be useless. They would learn why purity of atmosphere is of more importance than palatableness and purity of food; and to beware, lest, when on retiring to their nocturnal slumbers, in committing their lives to the keeping of Providence, they do not at the same time 52 DISCOURSE. commit a mockery of heaven, by excluding from their chambers the pure air which it supplies for the very object of their supplication. They would also learn, that in these days of dollar clocks, and when even urchins carry watches, church bells are supererogatory, and the steeples should be appropriated to their only practicable purpose—that of ventilating shafts—for which they are so highly available. The next proposition I would submit is, the esta- blishment of a voluntary association, composed jointly of laymen and physicians, to be called, or, at least, to perform the services implied by the name of, a Hygio- logical Society. Its objects of inquiry and action would comprise the entire field of the preservation of public and private health, in all its varied and multi- tudinous relations. I believe that on no subject would sound and autho- ritative information be sought for with more avidity. By no other means could more practical general good be bestowed; by none could more lives be saved and prolonged, than by such a society, energetically con- ducted. The argument for the formation of such an associ- ation exists in the fact, that there are numbers of able men who have devoted much time to the study of Hygiene, who have done much, and are prepared to do more, to enlighten the public mind, but whose labors are rendered comparatively useless for want of union and concentration. Their individual efforts, dispersed through cphe- DISCOURSE. 53 moral publications, are productive of but feeble effects, when, by combination and a common channel through which to pour the results of their investigations and studies, the good would be effected for which they now vainly pray and labor. Such a society would study out the true method of city sewerage, generally heretofore committed to most unscientific hands, and from which, valuable as it is when rightly conducted, there is great reason to apprehend serious evils. It would infuse into the public mind, into our legislative bodies, and our magistracy, a more intelligent regard for the proper construction of private and public edifices of every description ; it would point out where and why cer- tain diseases prevail, and how they might be avoided; it would obtain an influence in the proper regula- tion of health measures and the enactment of sani- tary laws, which would be of incalculable benefit to the commercial prosperity of this and other cities, and the happiness and comfort of their every inhabit- ant. It could do much by exerting its influence in the right direction to secure that great desideratum, a sanitary survey of the State, and obtain through the census avast amount of important medical statis- tics, now almost wholly lost; it could materially aid in perfecting and establishing a complete system of registration of births, deaths, and marriages, now en- tirely neglected for want of proper intelligence and energy in the right quarter : In a word, it would take under its keeping and guidance the sanitary interests 54 DISCOURSE. of the whole people, in all their aspects and relations, and as a medium of communication between the people and the profession, would exert a powerful influence for the good of both. My third and last suggestion relates to a Health Police. Since it is manifest that the aid of law must be invoked for the suppression and prevention of disease-producing circumstances, it would appear at first blush that for an intelligent and satisfactory per- formance of this important and very nice duty, some degree of medical knowledge were requisite. In many instances it requires no little scientific acumen to determine what really constitutes a nuisance. Even for the mere purposes of inspection of the domicils, workshops, manufactories, and places of congregation of every kind, it were but common sense to acknowledge the necessity of a certain de- gree of familiarity with the laws of health and the causes of disease, to say nothing of the many other more delicate and responsible duties implied in the name of a preventive sanitary police. No argument can be needed to enforce so self-evi- dent a proposition, as that a health officer should possess a medical education; and yet will it be be- lieved, that the commercial metropolis of the western world, with a population rapidly approaching a mil- lion, has a sanitary police which would not only fail to be recognised as such by its name, but among the 29 persons constituting it, there is (and that only by chance) but one medical man, and he with no concern in its practical prophylactic duties. With DISCOURSE. 55 this exception, from head to foot, not a member of it probably would be able to distinguish incipient small- pox from mosquito bites ; and if told it were the for- mer, would most probably give it a wide berth, rather than personally attack so formidable an adversary. The citizens of New York little know what is lost by this misorganization of its internal health depart- ment. Gross evils have long existed, and are on the increase, which must inevitably impair still more its character for salubrity; evils which lie far deeper beneath the surface than its bone-boiling establish- ments or its unswept streets ; deep ulcerous spots unceasingly pouring forth influences which keep the whole city continually on the qui vive for outbreaks of pestilence, but which, if cauterized and purified by rigid scientific penetration, strengthened by the strong arm of law, would not only save annually thousands of lives, but would place the sanitary reputation of the metropolis on a par with its commercial and political renown. It is not enough that the sexton's weekly returns of the causes of death are summed up and given to us in annual tables by the yard in length, which a little arithmetic will accomplish. We need to know the causes of the diseases, where they are, what they spring from, and how to avoid them; information which can only be obtained and properly disseminated by men of good medical education, and possessing the proper taste and energy for such work. These criticisms are not particularly intended for the present incumbents of the department. On the 56 DISCOURSE. contrary, considering their non-technical acquire- ments, its affairs, during the past two years, have been conducted with more than ordinary energy and efficiency. My aim is only to draw public attention to the inappropriateness of laymen for what is really professional duty, and that of the highest consequence to the public welfare ; a work, whose magnitude, im- portance, and requisition of professional ability, wherein none1 but a technical expert can tell what is to be done, and how to do it, bears a proportion to that which has heretofore been done, similar to what is exhibited between piloting a ferry-boat across the Hudson and guiding a steamer across the Atlantic. Mr President, and Ladies and Gentlemen,— When one sits down to prepare, to order, a dis- course for an occasion like the present, various and conflicting standards for the adjustment of its length are presented. At one time the orator may deter- mine to apply the minute rule, and, in mercy to his auditors, abbreviate it in proportion to his modesty ; or, otherwise, lengthen it by his cacoethes scribendi, or his supposed power to charm the ears of his auditory, and thus demonstrate the dimensions of his own. Or the subject may seem to him to demand its fullest ex- position, and he may mercilessly inflict a great length of detail. Again, he may be like that remarkable Scotchman, Hugh Miller, who, in his interesting auto- biography, tells us that his extempore stories in his pedestrian excursions, were usually co-extensive with the journeys he performed; " they became ten, fifteen, DISCOURSE. 57 or twenty miles long, and were determined by the milestones." In this evening's intercourse with you, I have felt myself somewhat embarrassed by all of these modes of admeasurement. My subject is well nigh inex- haustible, but not so your patience. In all decency, I must not inflict upon you another moment's deten- tion, yet it would give me pleasure to walk with you a few miles further, on what / find a most agreeable journey. But the last milestone is in sight, and our rambles must be brought to a close. I conclude, in full con- fidence in the ability and disposition of our profession to advance with time in knowledge and means of use- fulness. It is making rapid strides towards the de- sired degree of perfection. We start on our career with the light of previous days glowing upon our path. The child takes up the thread where it was dropped by the parent, and carries it forward to his successors. Knowledge, in its progress from generation to gene- ration, obeys the laws of falling bodies, their velocity increasing with the square of the distance. The nineteenth century is showering its light upon the science of medicine with the same profusion as upon the principles of political government, of whose im- provements we are in this blessed land enjoying the fruition. How great, then, is our responsibility? If in its progress towards its establishment and perfection, true science meets with an occasional traitorous or Know-Nothing interruption, its votaries will still move forward on the great errand of human 58 DISCOURSE. health and life, enlarging its borders, and strengthen- ing its stakes, feeling that upon their energy in the prosecution of improvement, and the enlightenment of the public, depend in a great measure the health, the strength, the longevity, the mental, moral, and physical condition of communities, as well as of indi- viduals, and upon them depend the welfare of the state, and even the stability of the government itself. A republic of imbeciles, of dwarfs, either of body or spirit, of a people wasted by disease and deprived of the natural provocatives of health, is as impracticable as a heaven of profligates and demons; and without sound bodies, sound minds are impossible. Fellows of the Academy of Medicine—Firm in our principles as based on true science ; faithful in their application to the relief of suffering and the preserva- tion of life ; true to that charity " which seeketh not its own," let us even be mindful that " Rugged strength and radiant beauty, These were one in nature's plan; Ardent toil and heavenward duty, These will form the perfect man."