DELIVERED AT THE OPENING OF THE MEDICAL DEPARTMENT, ColHIUtMAH Collcor 1NTBODT7CTOMT TO A COURSE On the Theory and Practice oLrMedicine. ..«!«' By THOMAS HENDERSON, M. D. PUOl'ESSOn OS THE theobt and practice of medicine in THE COLUMBIAN COIXEOF. WASHINGTON; PRINTED BY GALES $* SEATQN . 1825. 3&f0 Hecttttr IS DEDICATED TO THE Trustees of the Columbian College, With sentiments of profound respect And consideration, By THE AUTHOR. July 30, 1825. LECTURE, &c. Gentlemen : IN viewing the condition, moral and phy- sical, of man in a state of health, we are prone to indulge in reflections, which that aspect does not justify. Our moral character is so constituted as to require of those causes which afford us happiness, that their operations should be liable neither to interruption nor cessation. Apply this principle, this test, to man in health ; reflect on the frail tenure by which this state is preserved ; consider the evils to which he is momentarily exposed, and we shall find ever prevalent causes for humiliation. Did these considerations apply only to the physical con- formation of our frame, we might still find a refuge, and a source of exultation, in the exemption of the noble faculties, distinguishing us from the surrounding animal creation, from the operation of those causes which derange and dis- order the bodily organs. Here, too, is the pride of man abased. The mind—in the exercise of the faculties, by which we are assimilated with, and by which we aspire to a know- ledge of supreme perfection; by the powers of which we are related to the intellectual and moral world around us:— 6 thee sources of exultation become the no less fertile origin of calamity, distressing to the moral, as disease is afflicting to the physical man. Previous to entering on the immediate duties of the Chair to which we belong, the liberty is taken to refer to the gene- ral habits and collateral pursuits, attached to the study of Medicine. For indulging in the following reflections, an apo- logy is found in the interesting relation which we bear to you as your teacher ; the deep anxiety desired to be mani- fested in that rapacity ; the great importance of the subject; while we recognize some obligations to consider the follow- ing views at the opening of this department of the Medical Institution. Medicine derives its consequence, as a science, from an individual consideration, namely, its connexion with disease. It is neither the offspring of abstract intellectual inquiry, nor its legitimate object; it is derived from the necessities of our nature, and is perpetuated on the sacred principle of benevolence. The most impressive incident in its whole his- tory, may be considered the effort of uneducated, unscien- tific humanity, bending towards the relief of the first subject of disease or injury. Here the foundation of the healing art is laid; built on a corner stone which sustains it invulne- rable against the shafts of ignorance, the malevolence of misanthropic, or the effusions of satirical reproach. We maintain that the spirit of this origin pervades our science; and while obnoxious to imperfection, the characteristic of all human pursuits, it is recommended to the consideration, and important to the interests of society, in a degree unri- valled. 7 It is strikingly observable of human agency, that the exercise of its powers exhibits extremes in contrast, and that those means which, properly used, confer the greatest bene- factions on man, are susceptible of being prostituted to most destructive purposes. The grossest darkness and utter perversion of our moral nature, are exhibited under the degrading influence of reli- gious delusion and superstitious aberration. Thus it is with the abuse of the healing art; consequences resulting there- from, being as destructive in their tendencies, as they are, unfortunately for society, unappreciable and mystical. Medicine is a science. It is, therefore, to be learned ; it is to be apprehended by the mind. There is nothing in it intuitive. And it is a science of the most complicated and mixed character. We lead you to a broad philosophic view of the whole ground occupied by the term Medical Science. And what do you behold? A strait, clearly defined, unvary- ing path, in which the wayfaring man, though a fool, need not err? A pursuit terminated by the solution of a few simple problems or propositions, forcing results, with the clear and inevitable power of mathematical demonstration? A mechan- ical calling, in which the luxuries or conveniences of man, the gratifications of his caprice or pride, are involved? A high road to the accumulation of riches, or the gratification of the mercenary and avaricious purposes of the selfish heart? Let the considerations and convictions which must result from a reference to the collateral branches of science apper- taining to medicine, open your eyes to the erroneous and derogatory impression, which such views of the art are cal- culated to create. 8 Go to the structure of the human body, and learn from its striking complications, from the infinitely diversified organ- ization, displayed by the knife of the anatomist. Ask at the laboratory of chemical operation, if remedies are the result of simplicity in the order of nature, or of the manifestations of art. Appeal to the tremendous casualties and demonstra- tions of disease, which attend the surgeon's duty, and you will discover " that true surgery consists not so much in the ability to perform an operation, as in knowing, in judg- ing, when it should be done." From these sources, may lessons be learned which should frighten from the path of medical pursuit, the unguarded, the heedless, or the mere mercenary calculator. It is evident that great injustice would be rendered to the art of physick, to its noble pretensions, if the branches of science just alluded to, are to be considered as those only which appertain to it. In the splendid retinue of attendant sciences are recognized natural and moral philosophy, and especially metaphysicks, or the study of the mind. We are presented, as the objects of professional conside- ration and responsibility, not only with the physical man, and the numerous list of calamities incident to that part of his nature; not confined to the maladies of ------" ghastly spasm, or racking torture, qualms, v Of heart-sick agony, all feverous kinds, Convulsions, epilepsies, fierce catarrhs, Intestine stone and ulcer, cholic pangs, pining atrophy, Marasmus, wide wasting pestilence, Dropsies and asthmas, and joint-racking rheums," Dire as is the tossing, and deep as are the groans, which, from couch to couch, are uttered, and forced by bodily 9 agony; these do not constitute the most awful subjects for our attention, nor comprehend the pursuits to which we should devote our talents. It is the mind which presents to the Physician the theatre on which to exercise his most exalted powers, his most intense and accurate judgment, his most ready and comprehensn e tact. It is here, that man is most fearfully and wonderfully made. The connexion of mind and body ; the respectively peculiar and common sources of disease; the delicacy involved, especially in the moral treatment of the derangement or disorder of reason, judgment, imagination ; the control of demoniack phrenzy ; the cheering of moping melancholy ; the direction and re- storation of moon-struck madness; the apt recognition of that rocking, vacillating intellect, which, yet in a dubious state, may be restored to the light of reason, or plunged into the darkness of derangement! What a contemplation of the object and nature of the healing art do these considerations convey! It need scarcely be observed, that the philosophy of the mind, as well as that of nature, are fully embraced in the sphere of those studies and pursuits essentially attached to medicine. While it is not admitted that medicine is so utterly re- moved from the attitude of demonstration as may be thought by many, we may be permitted here to affirm, that there is perhaps no science in which so much debateable ground is to be occupied, as in physick. Combatting a law of our na- ture, and directing her energies against the tendency to death, inherent in that nature, the condition of medical sci- ence is never to be realized, which has been suggested by the enthusiastick, but ill-judging votaries at her shrine. Diseases 10 may be cured, they may be eradicated; the hopes of philan- thropy may point to Jenner, and bid the aspiring student exult; yet, while physical agents and conformation retain their powers and susceptibilities, man will be the victim to disease and death. This character impressed on medicine by the nature of man, and morbid powers, gives to the science an aspect, which, while it invites the exercise of expanded and vigorous intellect, repels the idea that other than such should enter her classick courts. From an elevation whence she dis- penses blessings, her votaries are allured; but only by the path of learned investigation and erudite research, is her temple to be reached. No easy road is found for favorites; no royal way to her honors. The various collateral pursuits to which we have alluded, as essential to form the character of a physician, all concen- trate in one object, viz : the practice of physick. In all of them you will find able teachers in our colleagues, in the school which has been established by authority. The struc- ture of the human body in health will be minutely laid be- fore you, that you may take a correct, comparative view of it, in its morbid condition. You will be instructed in the re- sources which man calls forth for protection against destruc- tive tendencies. You will be taught to admire the wisdom, and wonder at the power of creative agency, and you will discover the innumerable points at which we are liable to disease, and exposed to death. Elsewhere, you will have the scientifick display of those means with which Providence has blessed us, for the restoration of that health and energy, the loss of which we from time to time sustain. The laboratory of the chemist will, with taste and accuracy, present those 11 analyses and combinations of nature and art, which furnish so many of the juvantia, and guard against the ladentia. While you will finally be called on to follow the knife of the Surgeon in the exposition of those awful scenes which justify him in the application of the principle, that it is better to con- tinue in life halt or maimed, than, for a part not vital, to sa- crifice life itself. If, then, the pretensions of Medical Science be such as have been stated, we ask what should be the preparatory education of the medical student ? Can a mind embrace, with any power, such a scope, which has not been well trained in the art of thinking ? Or can there be presented to your consi- deration a vocation which demands of the student more ex- tensive and deep acquaintance with general academick and philosophick pursuits ? The strength of judgment and polish of intellect, derived from the study of the classicks, as well as the fact that many of our finest ancient writers are still accessible, only, in their vernacular tongue1, render a tho- rough acquaintance with the Latin and Greek a most im- portant accomplishment. The illustrations of French phy- siologists and pathologists, constitute a familiar knowledge of their language a great facility to the medical student, and that remark may be extended to other European lan- guages : while the stern and invariable tendencies of ma- thematical science alone give to the medical student the fa- culty of controlling apprehension, which confines the mind to that process of investigation, result, and inference, so as to prevent his being led astray in the mazes of speculation or hypothesis. We affirm that whatever is essential to con- stitute a prompt, luminous, expanded, philosophick mind, a 12 mind fitted for close investigation, critical analysis of fact, clear and connected view of cause and effect; a mind appre- hending the relations of physical and moral nature, capable of tracing their operations, estimating their tendencies, and philosophising on their phenomena; we say all that is essen- tial to form this power of intellect, is equally so to prepare a student for the pursuit of Medical Science. Nor should we assume untenable ground in asserting that this can only be brought about in a complete course of academick and colle- giate studies. Admitting that the emergencies and exigencies of a wide- ly spread and rapidly increasing population, engrossed with the cares attendant upon the provision for their physical ne- cessities, will operate to retard the general progress of the mind, we rejoice to say, that these causes have ceased to affect the intellectual character of our country. This nation is rapidly investing herself with the splendid adornments of science. The facilities for the acquisition of knowledge are multiplying pari passu with the motives, and in no depart- ment of seience will these circumstances bear wi'h more ef- fect than on medicine. With great truth then may it be ad- vanced, that no justification can be found for the encourage- ment of a youth to engage in the study of medicine, whose mind has not been suitably enlarged and expanded by pre- paratory knowledge. These general views are submitted as such. It may be that incidental exceptions can present themselves, as justifying a departure from them, but never to a degree which shall affect their most inseparable rela- tion to the highest interests of our profession. If, indeed, there be any one thing in the system of medical education 13 in this country, important to be corrected, it is that disposi- tion which overlooks the qualifications for private pupilage; and thus undervalues and depresses the standard of general attainment. It is with these views that the trustees of the Columbian College have referred to a high standard of general know- ledge as connected with the enjoyment of the honors of the school. It is to facilitate the progress of students in sci- ence, that this liberal institution has tendered to those en- gaged in medical pursuits under its auspices, the advantages of attending to the several branches of philosophick study. It is to stimulate the exertion of pupils, that these collateral aids are gratuitously conferred; aids which we are pursuaded will be regarded by those for whose benefit they are institut- ed, as highly honorable to the Faculty of the College. We have been careful to express these views of prepara-* tory education, as essentially bearing upon the qualifica- tions requisite to give character and energy to professional talent, lest an impression, too generally entertained, and we fear sometimes justified, should be created, in reference to the medical school which is this day commenced. That to which we allude, is an idea that, in facilitating the means of obtaining publick medical instruction, the standard for professional acquirement is lowered, and unappropriate motives are presented to youth, to assume the study of me- dicine. On the contrary, in the regulations adopted by the trustees of our College, is afforded the strongest assurance that the requisitions will be of the highest character ; and the solemn 'and mutual pledge of all concerned in teaching medicine in this school, is, that, as no sacrifice of time and 14 talent shall be withheld in the courses of instruction con- nected with it; so no requisition, consistent with justice to pupils, shall be dispensed with in testing their pretensions to the honors of the College. These considerations are submitted distinctly and confi- dently, as they may prove incentives to minds suitably pre* pared to prosecute medical studies aright; and as they may prevent misapprehension on the part of those who might ap- proach this institution under erroneous impressions. We differ from many who have written and spoken on the subject of preparatory education in their apprehension of the sentiments of a distinguished American medical professor, on this important topick. We shall be anticipated in announc- ing the name of Rush, one honored in medicine and general science as a most accomplished scholar, and pre-eminently esteemed as a teacher of our art. He has been considered as representing classical and general learning not to be neces- sary for the student of medicine. However such an opinion may have been popularly received by inexperienced young men, and however this popularity might have, during his life, shielded such a sentiment from critical consideration and merited reproach; no authority, however influential, could prevail to rescue such opinions from the stern and de- liberate animadversions of posterity. Having received in- struction from the lips of this unrivalled preceptor, having been familiar with the elevated character of his acquire- ments, and delighted with the classick spirit of his mind and conversation, we should, in common with his pupils, deeply regret to find such a reproach affixed to his fame. The views of Professor Rush were positively in favor of 15 an extensive and well-directed education, preparatory to medical pursuit. The imputation does not appertain to him, of suggesting, that mere •• English education," to use com- mon phraseology, is sufficient for the purposes and prospects of the medical student; and we deeply regret that even a single individual should have adopted that opinion, especial- ly that it should have practically influenced so many of the youth of our country. In a lecture, introductory to his course, delivered more than thirty years ago, we find the views of our writer on the subject of education preparatory to the study of medicine. Without calling to your consider- ation several minor particulars, though by no means unim- portant, in the course prescribed, we will exhibit a rapid- sketch of the system recommended by our venerable teacher: Arithmetic, Geography, the French, German, and Italian languages, Mathematicks, Natural and Moral Philosophy, embracing the evidences, doctrines, and precepts of Chris- tianity, History, Government, Poetry, Drawing, with some highly judicious observations on the importance of the habit of extempore discussion and composition. We will not apo- logize for introducing a few words on this, latter subject.— " To enable him (the pupil) to study to advantage, it will be necessary to exercise his active faculties by teaching him to think. For this purpose, he should first be employed in ex- tempore speaking, in disputing societies, and in translating passages from foreign languages. As soon as he has ac- quired a sufficient stock of ideas from books and conversa- tion, he should be obliged to exercise a talent for invention by the different species of composition. In this way, he will strengthen and fertilize his own mind more in one year 16 than he will by seven years application to such studies as afford exercise only to the memory. A young man may be- come learned by constantly sitting at the feet of a master, but he can be made wise only by the executive operations of his own mind." The study of the Latin and Greek languages were recom- mended to be prosecuted for a year or two, and at an age when the powers of the mind are enlarged, and more capa- ble in a short period of acquiring the requisite knowledge of these subjects. We do not desire to take up the question as to the time of life when the dead languages should be attended to; nor do we incline to the opinion of Professor Rush, or wish to be understood as denying its truth. The sole object is to expose the views of preparatory education as laid down in his introductory lecture—that his actual sentiments may be known and duly appreciated. Speaking of the study of modern languages, he observes, " Let not the intended votary of me- dicine be discouraged at the number of modern languages which have been mentioned as necessary or useful to a phy- sician. The same number, and sometimes more, are deem- ed necessary in many countries in Europe, to qualify a young gentleman for the profession of arms. It would be disrepu- table to our science, that a profession, the object of which is the destruction of human life, should require more attain- ments in this part of education, than that, whose only ob- ject is the preservation of life." We trust that no impression so derogatory to the charac- ter of this excellent man will be adopted, practically, by American youth, as that which we have endeavored to re- move. Far from depressing the importance of education, 17 he barely dissented from the mode pursued in attaining it; and, to render this peculiarly plausible, it did not require the ingenuity or eloquence of Rush. There was something in it adapted to the times in which he advanced his opinions. The requisition for practical talents in medicine was, at that period, so great, as scarcely to admit of the extended pro- cess of collegiate instruction : nor did the facilities for this, present in such attainable measure, as to induce that devo- tion which is now happily extending its influence, not only in our science, but on every other. The precepts of the American Sydenham are not to be considered as oracular. His labors are the legitimate ob- jects of liberal criticism. It is the duty of those who have succeeded him to point out his errors, that they may not be perpetuated by the fascinations of his eloquence, or thecap- tivation of his writings. They will bear the test of the critick's scrutiny ; and, in some instances, require the cor- rection of unprejudiced judgment. But we fearlessly avow the declaration, that of all sentiments, no one could be found in more decided opposition to the principles of Rush, or the spirit of his writings, than that which would depress the estimate of an extensive preparatory education for the study of medicine. We would not hesitate to risk the fate and progress of medicine in the hands of those who have taken, as their guide, the system of instruction advised by Rush. It would be a source of exultation, could we in- dulge the hope that such is the case with the generality of medical students. The progressive course of education will be suggested in these lectures; and you will there find the idea met, at every 3 18 step.with most decided reprobation,that a diplomatickhonour is the signal for the cessation of your professional studies. Pupils may view that attainment as a declaration that they are henceforth to depend, not on others for instruction, but on a diligent and persevering improvement of their own ta- lents. The relation of preceptor and pupil ceases ; and the latter is introduced to a theatre where he will unceasingly find motives and causes for a persevering prosecution of his studies. There is a kind of medical consultation too little resorted to ; we mean a daily and habitual reference to those authorities, which are constantly within the practitioner's reach. Never is he so little alone, as when entirely alone in his library. The treasures of accumulated wisdom surround him on every side; and invite to a removal of his doubts and difficulties, as well as to confirm him in those principles which he is hourly called on to apply. Our remarks do not refer to the text books which are so rapidly multiplying around us—but to those elaborate works on the general principles of medicine, which, duly studied, will convey an enlarged, confident, and practical influence to your charac- ters as practitioners; and enable you to meet the ever v rying exigencies of professional life with unhesitating judgment, peculiarly resulting from such pursuits; and most happily favorable to form an imposing character as a physician. Such results must obtain, where the mind is accustomed to consult with Celsus, Sydenham, Cullen, Van Swieten, Rush, and a host of others. Let it never be supposed that a text book is intended to be relied on, beyond the walls of a school, or the mere incidental reference of a practitioner. While we have often regretted to observe the neglect of preparato- 19 ry, it has not less frequently been a subject of observation, that progressive education has been disregarded. We are, therefore, particularly desirous to impress this important subject on the minds of those, who are, or may be, the pupils of this school. Unceasing demands will, by the rapid and diversified changes and improvements in our science, engross your attention; and we trust it will never be forgotten, that the physician who considers himself so wise as to require no further improvement from study, is utterly at variance with that which is due to himself and society. It is confidently hoped, whatever relative considerations may move the pupils of this school to the progressive course and habit of study now alluded to, an appeal from the claims of learning, intrin- sically viewed, will not be deemed intrusive; and that sci- entifick attainments will be prosecuted as carrying with them their own reward. Thus estimated, knowledge accumulates sources of intellectual delight and edification, " with which the stranger intermeddleth not." And however they may be considered as those of abstraction, they are positive in their character, elevating in their nature, and continually bearing on the most important relations of professional life and social happiness. Thus engaging you on the double ground of duty and pleasure, we are satisfied that our appeal will not be vain. While we have been directing the views of students of our art, and endeavoring to lay before them that course which will render them active agents in promoting the great cause of benevolence and science ; the neglect of which will involve results not less fearful than obvious; it is our duty, my cox- leagues, to reflect well, as we have done, on the influence our 20 instructions and example may exercise over the pupils who shall attend our courses. Acknowledging with suitable feel- ings of gratitude and respect, the honors which have been conferred on us by the prosperous institution under the aus- pices of which we act, we are not allowed to exempt our official duties from that which accompanies, inevitably, the discharge of such relations, viz. responsibility and care. Those who are engaged in such pursuits can alone estimate their comparative pleasures and pains. Not disavowing personal feelings, which are properly entertained, it gives us great satisfaction to declare, it is our privilege and duty to do so, that general considerations are abundantly pre- ponderant in our plans—so much so, as to allow us a fair claim to the liberal estimation of an enlightened profession and community. A full and deliberate view of the subject having deter- mined the Trustees of the Columbian College to establish a Medical Department under their authority, and having occu- pied the ground which the rising influence of metropolitan character has opened in this city, and constituted us their functionaries for this purpose ; it becomes us thus publicly to renew a pledge, virtually implied, to devote our talents, with unvarying ardour, to consummate the legitimate objects of the Seminary. While we are not elevated by indulging in premature expectations, we are not to be discouraged by the scanty materials with which our superstructure is com- menced. Persevering devotion to lawful and laudable pur- suits, is never without its recompense from a community liberal and discriminating as is that in which our lots are cast. And, on a full view of the whole ground, there is every reason to anticipate that the Washihgton Medical Schooi SI will grow with the growth, and strengthen with the strength, of this metropolis. Associated as we are in the formation of a Medical School, and engaged in the cares and anxieties attendant on such an undertaking, it is natural that classick recollections should refer us to the Alma Mater whence we derived those instructions, which it is our purpose to perpetuate in this city ; and that the retrospect should be most grateful, as it bears us, in spirit, to hours, when we dwelt on the bold and vigorous flighfof the genius of Rush; on the refined and clas- sical instructions of Barton ; on the philosophick intellec- tual demonstrations of Wistar ; and the clear and apt illus- trations of Woodhouse. We desire not to omit a testimonial of veneration and respect towards the surviving guide of our early pursuits, and feel persuaded that we could not refer to him in a manner more congenial to his feelings, than by naming Professor Physick as the associate of these departed medical sages. Animated by a reference to these illustrious examples, supported by the high authority whence we derive our com- mission, and encouraged by the interesting motives which you, Gentlemen Students, excite in our minds, we appear as pioneers to open the field of medical instruction in this city. Emanating from a source laudable as legitimate, occupying ground fairly and allowedly open, we are met by the abund- ant admission of the propriety of our enterprise, and with the welcome of all intelligent and liberal minds. And in allusion to those motives which belong to the rela- tion of teacher and pupil in medicine, we inquire, have they been duly estimated? Are not those on the part of the pre- ceptor, set down to the account of formality, or to feelings, 22 if possible, of a still less generous order? We have often referred to this subject, when beholding a room crowded with intelligent youths, ardently pressing into our profession, perhaps, in very many instances, with entirely inadequate views. Have you, gentlemen, thought well on this interest- ing matter? Doubtless you have formed, with the ardor belonging to your age, expectations and hopes with which we desire not to interfere: it may be that you have derived them from the principles of benevolence, of laudable ambition, or from the prospect of accumulating wealth. This, gentle- men, is well, and God speed ye; but, mayhap, ye have not looked at the path which leads to these goals. Think ye it is a path of pleasantness? Yes, if to grapple with disease* to meet, at every step, the agonies of the suffering,* to look on the dying, while acknowledging the impotence of the art, when your every feeling would hope for its efficiency—if this be pleasantness, ye shall have it abundantly ; but, if, added to this, it be considered that all the melancholy reality of the scenes through which you will go, is thrown upon your capa- city and ability to prevent or relieve it; and that this capa- city is to arise, in a great measure, from the fidelity and other qualifications of your teachers; and if the nature of these qualifications be impressed, as it is on us, by that re- flection which twenty years' journeying in the way upon which you are soon to enter, is calculated to excite, judge, gentlemen, what are our motives and feelings. Tempered by these considerations, but not discouraged, we would have you enter on the dark and difficult path of medical pursuit, with other than the lurid glimmerings of irregular and empirical knowledge. We would have you 23 light the lamp of learning brightly at our altar, and feed it richly, as you travel onward, with the precious oil of study and observation. Then shall ye rise above the blind gropings of hesitancy and ignorance, and pursue the enlightened step- pings of intelligence and usefulness. And if, on us, a greater happiness can be conferred than to contribute to your educa- tion, that happiness will result from seeing you shining lights in a profession which, as to its influence in the dispen- sation of blessings to our race, yields only to religion.