ADVANTAGES OF CLINICAL TEACHING^ AN ADDRESS INTRODUCTORY TO THE REGULAR COURSE OF LECTURES AT THE BELLEVUE HOSPITAL MEDICAL COLLEGE, N. Y. DELIVERED ON THE OCCASION OF THE OPENING OF THE NEW BUILDING. SESSION OF 1 8 66-6 7. BY ALEXANDER B. MOTT, M. D., PROFESSOR OF SURGERY AND SURGICAL ANATOMY, CONSULTING SURGEON TO THE BUREAU FOR MEDICAL AND SURGICAL RELIEF OF OUT-DOOR POOR, ATTENDING SURGEON TO “ BELLEVUE ” AND “ CHARITY 11 HOSPITALS. PUBLISHED BY REQUEST. NEW YORK: 0. A. ALVOED, PRINTER, 15 VANDEWATER ST. 1868. ADVANTAGES OF CLINICAL TEACHING. AN ADDRESS INTRODUCTORY TO THE REGULAR COURSE OF LECTURES AT THE BELLEVUE HOSPITAL MEDICAL COLLEGE, N. Y. DELIVERED ON THE OCCASION OF THE OPENING OF THE NEW BUILDING. SESSION OF 1866-67. BY ALEXANDER B. MOTT, M. D., PROFESSOR OF SURGERY AND SURGICAL ANATOMY, CONSULTING SURGEON TO THE BUREAU FOR MEDICAL AND SURGICAL RELIEF OF OUT-DOOR POOR, ATTENDING SURGEON TO “ BELLEVUE ” AND “ CHARITY ” HOSPITALS. PUBLISHED BY REQUEST. NEW YORK: C. A. ALVORD, PRINTER, 15 YANDEWATER ST. 1868. ADDRESS. Mr. President, Ladies akd Gentlemen :— Humility and a just pride are contending within me as I rise to address you ; each strives for mastery as the radiant faces greeting me on all sides remind me I have been deputed to express the exultation all feel this night, because an exalted effort to push further forward the great and universal cause of Science, has been successful. My descriptive powers I fear will prove inadequate to body forth the joy which fills us now that this noble building is at length finished, and that we are here to dedicate, and to devote it to the exposition of the divine mysteries enclosed in the human frame. It is a reason for pride to be one, if the least, of that invincible band, which in the fierce and acrimo- nious contest between Prejudice and Science, has wrested victory after victory from its opponents, and which has gone slowly on, earnestly, nobly, and steadily winning for itself a pre-eminence among the learned professions. The lofty position which Medicine now holds is due principally to the vast benefits accruing from its exertions in behalf of suffering humanity, and partly to the fact, that while alleviating the physical ills of man, it strengthens the noblest and most subtle attribute of his being—the mind; for the excellent counsels, deft and tender care of the physician, frequently arrest the insensate career of brutality 4 and vice, and carry civilizing influences into the daily life of thousands. I am gratified as well as proud that medical science, with its twofold healing character, is so well represented here, and that I am permitted to pro- claim its excellence among so many worthier expo- nents of its power and magnitude, is a privilege and an honor; but above all personal satisfaction shoots up (like a gleaming rocket in a gloomy night) the proud and memorable fact that New York leads the van in the triumphal march; and that Bellevue College has sprung forth, a young giant in medical advancement, the worthy creation of the Commis- sioners of Public Charities and Corrections—and their co-operators, the Professors of Bellevue Hos- pital Medical College. Theirs was a great thought, well carried out, fully completed and teeming with benefit to numbers yet unborn; the gratitude of the nation is due to these gentlemen, the Commissioners of Public Charities, for they are unceasingly doing inestimable good. Let us not be unmindful of their labors, and not the less grateful because they are fulfilling their noble undertaking in a methodical and systematic manner. The nation’s gratitude, I repeat, is due them for their strenuous efforts to advance the science of medicine by opening their hospitals for the instruc- tion of students, and for erecting this most suitable and well-ordered building for the accommodation of those who come to New York from all the States of the Union to study our beloved profession. Perseverance and energy have here placed a com- bination of advantages within the reach of every medical student of the present day; theoretical in- 5 struction of the best stamp, and the practical teach- ings of the bed of suffering are his:—thus by- prompt illustration, rendering clear the apparently confused ideas of the lecturer, ere his words may have time to lose their impression on the mind of the eager listener. All the erudition of the comprehensive thinkers who have preceded us, and all the patient yet vigor- ous learning of the professors of to-day are made living truths, to be ineffaceably imprinted on the memory by stern practical experience. Added to the foregoing advantages is the vast in- formation to be gained by the recent establishment of the Bureau for Medical and Surgical Belief for the Out-door Poor. It is open at all times to the students of the College, and is a perpetual source of improve- ment to them. Here they find at stated hours com- petent teachers in the art of immediate prescription, and the science of mitigating every disease of the human frame. Although I can not expect the implicit confidence and veneration which are the privileges of old age, yet I think you will accept my assurance that in my day—a period comparatively recent—the study of medicine was attended by far greater difficulties, and smoothed by very many less facilities, than now ; students then had hardly any of the numerous advantages accorded to those who claim Bellevue Hospital Medical College as their Alma Mater. My late lamented father once made a similar remark to me, in regard to the increased opportuni- ties afforded the then young practitioner, and I listened with complacent indifference to his repeti- tions of the advantages I possessed over students of a still earlier date; yet such have been the rapid 6 strides in medical tuition, that it is with surprise I reiterate the remark made by my father so short a time since. Very few had the advantage of hospital practice even fifteen years ago. Hard study, unremitting reading, a few clinical lectures, and dissecting under difficulties, formed the principal features of a student’s life. The young doctor was obliged to seek cases in the lowest haunts of poverty and destitution to acquire experimental knowledge. The labor was great and the benefit not always recognizable before old age had stolen on: now the student may graduate an experienced physician and surgeon if he choose—although it is not an incontrovertible fact that he must inevitably become so, for even Bellevue Hospital Medical Col- lege is not a machine for producing thorough practi- tioners, warranted never to fail. While thus enlarging on this easy, or as our Eng- lish cousins have it, “royal road” to learning, and dilating on the advantages this admirable institution offers to the student and our profession, we must not forget there is another view of this pleasing picture. We have noted the lights and shades, the well- handled foreground, and the skillful manipulation of the variegated, beautifully blended tints : let us now glance at the cool middle-distance with its transpa- rent shadows; and the aerial perspective forcing in- ferior objects to retreat to the far background, but which, however, are no less important to the har- mony and perfection of the entire landscape, than the grand and striking foreground :—I mean the bene- fit which the patients necessarily derive while under treatment at the hospital. Every man speaks with caution when aware that 7 Lis views may be discussed and questioned; with even greater’ circumspection does the physician or surgeon in a hospital form his diagnosis after the surgical or medical attendant has given a case the most careful investigation and thought, before pre- scribing or operating, and before referring to the principal practitioner for counsel. He feels that his reputation is at stake ; his opin- ion once irrevocably pronounced will be debated and deliberated upon, not only by the student, but by the numerous physicians who come from far and near to attend the clinical instructions in these hospitals, and his standing may be affected by the least deviation from a clear, correct, comprehensive understanding and statement of the case. Consequently the patient is conscious of his own importance in the development of scientific truths; he feels great satisfaction in knowing that a per- sonal motive is added to that of universal benevo- lence and philanthropy for the proper treatment of his individual case, which motive is the high regard that every right-minded man must foster for his own honor, and that of his profession. The patient therefore feels a justifiable confidence in his physician ; which indeed he well merits, when we consider that duty, honor, and the charitable desire to relieve human suffering inspire him to ex- tend every benefit to, and to take every possible care of all those who within these walls seek exemption from pain. Let us contrast the meager opportunities afforded the student in former days for personal examination of disease, with the present admirable and effective system. Not many years ago, but little prior to the estab- 8 lishment of this school, the entire course of clinical instruction consisted of weekly, or at least semi- weekly, operations in the amphitheatre. There, most formidable operations were performed, or a diagnosis was made, and the patient prescribed for ; this being done a great disadvantage arose, inasmuch as the result of the treatment was rarely known; for there were then only out-door patients, and as they were not under the personal supervision of the practitioner during the progress of the disease, he was unable to witness its alleviation, and to receive the only really satisfactory assurance of the correct- ness of his treatment. Nor did the patient often return to the clinique and gratify the doctor with personal evidence of his success. Now, the patient remains under the eye of the student until a cure is effected. Are the heart and lungs under investigation ? then the chest is percussed and auscultated by the Pro- fessor in the presence of the pupil, and an opportu- nity is afforded him of making the examination for himself, with an expert teacher calling his attention to the variety of sounds indicating various descrip- tions and stages of disease. Should the valves of the heart be in an abnormal condition, he is initiated into the manner of detecting it; and by measurement, auscultation, and percussion he is able to account for the symptoms produced by hypertrophy, fatty degeneration, atrophy, and the various functional disorders of that organ, none ot which ever resist these tests. Through the medium of the stethoscope, of percussion, and other physical signs, he becomes familiarized with pleurisy, pneu- monia, and tubercular disease in its various forms • also the differences between bronchial affections and 9 pulmonary complaints, tlie location of cavities, and the almost numberless refinements in diagnosis are clearly discriminated. The female departments of the hospitals likewise present the same variety of disease, and in addition we find the important branch of obstetrics and dis- eases peculiar to women, committed to the charge of gentlemen who have devoted years to attaining proficiency in the treatment of these cases: whose care it is to make the student acquainted (in a man- ner at once delicate and inoffensive to the patient) with the nature and treatment of disease which, as a novice in the profession, he will not have an oppor- tunity of investigating for years after he has entered upon his professional career; but when the time does come when he is called upon to treat similar cases, he will be able to recall and make available the teachings of his student-life, which were indelibly impressed upon his mind by actual vision and touch. The same remarks apply with more force if possi- ble to the treatment of surgical diseases. The scal- pel reveals the truth, and settles beyond doubt exceedingly difficult questions, as to the nature and cause of disease. Recognizing this as an established fact, how important it becomes that tlie surgeon should possess that knowledge which enables him to appreciate at a glance the most minute detail of a case, and which decides bis opinion in that momen- tous question:—“Shall an operation be performed or not ?” There are numerous instances in the course of a surgical practice, where an experienced eye may lead to a prompt decision, although an affirmative answer may cause the patient the loss of a limb, or bring him some other equally mortifying disfigure- ment ; again there are many cases (and these are by 10 far the more numerous), where all the skill and knowledge of the surgeon, as well as the aid he may procure through the able counsels and experience of his seniors, must be brought to bear to determine the necessity or justification of operative procedure, wherein the question of life or death is so frequently involved. How often does it occur that the urgency of the cases requires prompt action, and that the necessary time to procure counsel can not be spared ? Under such circumstances, although the casual observer can detect nothing in the manner or countenance of the surgeon indicating the consciousness of the vast responsibility resting upon him, there nevertheless exists within the mind of every well-informed opera- tor a full and just appreciation of his position. Per- haps it is for the first time he has been similarly placed, and the contending words yes or no ! stand before him in a new light, and for him alone to choose between them; he should not for a moment allow any thought of, or consideration for his future professional reputation to step in and bias his judg- ment. The foundation of all surgery is that wonderful book of Nature from which alone anatomy can be studied. A perfect knowledge of the structure of man is indispensable, and upon this superstructure is established the refinement of Surgical Anatomy. The importance of this subject can not be too strongly impressed upon my hearers, who perhaps will one day prove by practical demonstration, that it is impossible to perform (with safety to the patient) the most simple operation in surgery, without a perfect knowledge of the relative structure of the human frame. 11 Time will not permit me here to enter upon a full detail of the importance of this branch of study, and the positive refinement and precision it gives to surgery;—during the coming session, I trust I shall be able to place it before my listeners in such a light as to inspire them with a determination to become masters of that portion of surgery which, like a chart and compass in the hands of a skillful mariner, pilots him in safety through the shoals and break- ers of a stormy sea, to a well-known harbor, where he reaps his reward in the blessing of those who have intrusted their lives and happiness to his care. Yet this is not all a surgeon requires to fit him for the practice of his art,—all the senses must be so thor- oughly educated that each and every one can be im- mediately brought to bear upon the case before him; that the eye, the moment it rests upon the diseased part, can locate it and indicate its accessibility by the scalpel of the surgeon; the organ of speech elicits from the patient the important recital of his case; the ear, ever ready to detect the pulsation of an aneurism as well as the physical condition of the patient, comes to his aid, and the nasal organ can frequently confirm his diagnosis;—but the last and greatest of all qualities is the touch : the hand may be able to execute, but without the studied practiced sense of feeling, the “ tactus eruditus,” what is a surgeon but a mechanic! He must be able to decide, before an operation is performed, the different forms of disease which are presented, the location and character of tumors, and detect suppuration, pulsation, and the various forms of surgical disease which may require his interference. No opportunity should ever be lost in improving this important adjunct to the surgeon’s success; with- 12 out it lie is unfit to practice his profession, and will often find himself unwittingly sacrificing the life of his patient and his own reputation. The surgeon must also be a good physician; for many of the diseases coming under his care require medical treatment only. How much, then, are the influence and usefulness of the young medical man enhanced by the opportu- nities now offered him ? The practical instruction he has .received during his daily studies, enables him to start from the same vantage-ground which his fore- fathers in the profession gained only by years of practice. The uninitiated must not for a moment conclude from this brief sketch of the advantages presented by clinical instruction, that I have given a complete and elaborate description of what can be witnessed daily by the most casual observer. It would take hours, nay days, to give an idea of the advantages to be derived from the personal inspection and the treatment of daily bedside practice in medical and surgical cases. This practice we assume to have been brought to its highest perfection in Bellevue College; and as a father in his pride delights to bring his child before his friends, and vaunt its fail- proportions, its great achievements, and is pardoned for his parental conceit and folly, so I trust to be excused, if, sharing the pride of my colleagues in founding this noble institution, I touch upon the events connected with its conception and its rapid growth; a growth surprising perhaps to many kindly listening friends. It was organized in 1860, and founded in 1861 under very inauspicious circumstances; at a time when the most sanguine member of the Faculty could 13 hardly hope for success; when our beloved Union was threatened with dissolution ; when civil war was standing even on our threshold; when our country was divided into two great halves, and a double barrier of glistening bayonets forbade the passage to either side, of those who might be in search of knowledge. The struggles and labors of those early days were soon swept from remembrance by the certainty we all felt that we could not fail! a certainty soon real- ized, as each successive day brought us new students and fresh proofs of the great need which we had at last filled in medical education. Our success as an institution was no longer a problem to be solved, when during the first session of 1861 and 1862, one hundred and one gentlemen inscribed their names as Matriculants on our books, out of which twenty-eight received their diplomas as Doctors of Medicine, and upon looking at that list we find that a majority of the States were represented, showing conclusively that though the Union might temporarily be dissevered, the medical profession was united; for during those trying times when ani- mosity and ill-feeling were rife and wrought to the highest pitch, doctors on both sides paid each other respect and consideration, and courtesies mutually extended proved clearly they never forgot that to be invariably a gentleman imbued, with kindness of heart and nobleness of character, is a primary part of a physician’s education. Having had occasion to direct surgeons of the adverse armies to perform duties in common, and watched with pleasure the necessarily rapid consultations on cases of importance, I have seen as much deference paid to each other’s opinion as would have been shown in a private con- 14 sultation in civil life in the most luxurious drawing;- room. And after the battle at Appomattox Court House (at which I was present and witnessed the signing of the articles of surrender), my duties placed me in a position enabling me to observe with satis- faction, that no class of men were more heartily welcomed, and taken by the hand with better feeling, than the surgeons of the opposing army. Having digressed, to pay a well-merited tribute to the excellence of high-minded physicians, let me now turn to what is at this moment of nearer import— Our College. Although proud of our first year’s ex- perience, we had yet to learn whether the plan of instruction, novel in its method, which we had ini- tiated and adopted, had been appreciated by the student; and whether he was sufficiently impressed with the benefits to be derived from it, to warrant him in recommending Bellevue to others and avail- ing himself of its ministrations during another session. In the Catalogue of 1862 and 1863 will be found the names of many whose faces were familiar to us, and a class numbering one hundred and eighty-three, of which forty-one became Doctors of Medicine at the close of the session. Had we not reason to congratulate ourselves that the efforts we had made were fully appreciated; certainly the list of students during the session of 1863 and 1864 was sufficient to warrant us in believ- ing that they had been, as that list numbers three hundred and seven Matriculants and ninety-four Graduates. So also did the class of 1864 and 1865, which numbered three hundred and twenty-three Matricu- lants and one hundred and eleven Graduates. 15 Our last winter’s session, during 1865 and 1866, brought us the largest class of medical students that had ever been congregated together in any one medi- cal school in this city; it numbered four hundred and seventy, and diplomas were granted to one hundred and seventy-one gentlemen, coming from twenty-nine different States, and from Canada, Nova Scotia, New Brunswick, Prince Edward’s Island, Cuba, and even Germany and Central America. Sustained by public opinion, authorized by the still increasing number of students, have we not done well in extending our labors, enlarging our means and capacities for study, by the erection of the present building ? Probably never in the history of Medical Colleges has there stood a fairer, prouder record than ours. Our Institution has been in operation only five years, but to what perfect stature has it grown ! Its infancy was passed in the dark days of our country’s trial, its short youth matured by hardship, war, and financial trouble; nevertheless, we find it to-day strong in its sturdy manhood, attained in the light of peace and plenty, in the prosperity and vigor of victory, and a once more united land. Although the seed-time did not promise a plente- ous harvest, we now find our glowing garners teem- ing with rich and shining grain; every resource of art and science has been pressed into the service of the student; his welfare, his advancement have been thoughtfully and conscientiously considered, and therefore may we not proudly assert that Belle- vue is worthy of the patronage it has received, of all the honors yet in store for it ? And may we not fondly hope for an ever-increasing sphere of its use- fulness, with abundant means to continue it? 16 Knowing what the colleges of America were be- fore this grand idea of connecting didactic and clini- cal instruction was put in practice; contrasting, as we inevitably must, the superior advantages of the students of the present over those of the past days, we will, I trust, as the pioneers of the new combina- tion, be leniently judged for any self-laudation, re- membering how incontestably superior is the modern course of medicine to that which was once considered perfect. I would not be thought guilty of vaunting and over-rating the present, and detracting from the labors, the merits, and the immortal fame of those who have gone before in the great work of advancing medical science; and greater, more philanthropic by far was the origination of those cliniques, which to-day we consider so wanting, than is our enlarge- ment of the nucleus into the present system of hospital instruction. Let me reverently, and with a touch of awe, mention the classic names in American medical literature: of Francis, Post, Hosack, Rush, Warren, Physick, Wistar, Godman, McNeven, Bard, Mitchell, and Mott, with a host of others, co-workers and benefactors of mankind ; the last named was the founder of clinical instruction in this country, the first named was among the earliest of those who availed of it. Francis fully recognized its value to the student, and would often recall (while conversing with me) the earlier days of his career, when, as Professor of Obstetrics, he propounded to his hearers the intri- cate diagnostic signs of disease, with no bedside to illustrate his meaning, no patient’s voice to answer those important questions, which aid so much in forming a correct opinion, and which together with 17 the physical indications (developed by the examina- tions) decide the condition of the invalid. Francis was a great man, of vast mind and intel- lect, appreciated by few, but beloved by those who knew him well; a good man, whose heart was prone to sympathize with suffering, and whose purse was ever open to appeals to his generosity—he was indeed the benefactor of the poor. Last among this galaxy of fame stands the name of one who as preceptor and guide, counselor, friend, and father, I will not here refer to; but if a son-can throw off all tender memories, all clinging associa- tions which might bias his judgment, I shall strive to do so now, and as an unprejudiced, ardent admirer of a great and unsullied life, will speak of him to whom the world accords the eagle heights of renown in surgery. Possessing not half the advantages of care and training, and impelled by none of the incentives to study which lure on even the most idle truth- seeker of the present day, what did he not accom- plish for his generation—for those who were the recipients of his individual care, and for all future ages by the advancement of the science of surgery and medicine? His marvelous perception required but a glance to penetrate disease; his almost superhuman intuition detected the surgical case at a touch; his tutored practiced mind was fertile in remedies, and most active in originating new means of surgical relief; added to all this was the hand strong and skillful, true and trenchant, swift and sure to execute the in- finite plannings of his mind. Did not this rare com- bination of qualities endow him with genius ? And is 18 not his well-merited, undying fame a grand harvest for such an intellect and such a life? Great men and great truths work with such a simple yet impressive force upon the masses, that the first thought in every mind on hearing of great deeds deftly done, is “ Why did not I think of or do that before ?” So it is with original operations : the mode of relief to the patient once made evident, all around wonder at their own obtuseness in not having con- ceived it themselves. Simplicity made the grandeur of my father’s life and practice. Of his many acts and thoughts, all calculated to advance his beloved profession, and the welfare of his fellow-beings, none perhaps will, for propagation of medical science, compete with the noble work of establishing Clinical Instruction as a part of medical education in this country. Not without effort, not without prejudice, not without incurring the charge of innovation from many of his old associates, did the young Quaker doctor, succeed in his project and hold his first Clinical “ Seance,” the first that New York had ever witnessed, and which was held in 1810, when he filled a Professorship in the Medical Department of Columbia College. He was himself an example of the gain to be derived from this source, having profited by the cliniques he had attended at Guy’s and St. Thomas’s Hospitals, London, wdiile a pupil of the great Sir Astley Cooper ; he felt the importance a similar in- struction would be in his own country, and the bless- ing it would be to professional life here, little imagining in his philanthropic zeal, that he was establishing a claim on the gratitude of, and com- manding the admiration of future ages, while work- ing out his own inevitable renown. 19 Pardon me for thus touching upon a life, and a reputation which hold so closely to my own ; it needs no eulogium from me, but I can not avoid speaking of him in connection with that enterprise which has made this College what it is; in stating the pre-eminence it has attained in affording practi- cal bedside teaching, could. I do otherwise than revert to him who in all our earlier meetings and councils was always with us, always ready to give both aid and advice ; who by his active interest forwarded our cause, and prophesied our great and now almost accomplished future. Is it necessary for me to name him ? Is his name not known and revered wherever surgery and medi- cine are taught ? Have not the votaries of medical science been proud to quote him as authority ? Yea ! and appeal to him during his lifetime as the master mind of American surgery ? The name of Valentine Mott still lives ! and will ever be remembered with honor, pride, and grati- tude by his professional brethren and a thankful public—it can never die nor be forgotten. It is neither my object, nor would it be becoming in me to pronounce too much eulogy upon so great a man ; although much has been said more eloquently than I could express it, there is a feeling of duty, a filial desire wdiich prompts me to add my voice to do honor and justice to one who was a devoted husband, a loving father, and a good Christian. Young Gentlemen, Students of Medicine:— I can not blit believe you have come hither with a fixed determination to enter upon the study of the art of healing with the liveliest sense of its import- ance, and a just estimate of the means now afforded 20 you to obtain a mastery of your great calling. Many of you are here for the first time, perhaps undecided as to your future course, others again whose faces are familiar to me as attentive listeners during the last winter’s session, have returned I am sure more anxious than ever to perfect themselves, as probably this course closes their term of collegiate study. Upon leaving these halls the toil and labor of professional life begins. At first the graduate in medicine will have leisure to devote to his books; what he has learned from listening to lectures is only a part of his medical education, but it has taught him how to study with advantage, and as he knows that at first his practice will occupy merely a small portion of his time, he can devote many hours to fixing indelibly upon his mind the facts and illus- trations which have been presented to him during the winter. My observations have led me to think that the first-course student will be most benefited by close and faithful attendance upon the clinical instruction ; this view is so much at variance with the advice which in former years was given to the student, that it may appear bold; I am satisfied, however, that the plain and simple facts and truths presented to the mind of the uninitiated, develop in it a desire to know more and to investigate the cause of the disease and the effect of the treatment pro- posed in each case brought before him by the in- structor. Although I have enumerated some of the leading characteristics of the school you are about to attach yourselves to, and which I trust will endear itself to you and be ever hailed as your beloved Alma Mater, the advantages of clinical instruction are not con- fined to Bellevue Hospital; you have within reach 21 the Charity Hospital, the Small-Pox, and the Nursery Hospitals situated on Blackwell’s, accommodating upward of fifteen hundred patients, with all classes of disease, a large proportion being chronic, and of a character not to be seen in Bellevue : these hospi- tals are also open for clinical instruction, and through the kindness of the Commissioners of Public Chari- ties and Corrections, a steamer will convey you to them gratuitously at the appointed time. To these gentlemen you are also indebted for other valuable adjuncts which make your studies more perfect, and upon inspection of this and the adjoining building opened to-night to the public, you will be prepared to appreciate the facilities of- fered by the many improvements which the present advanced stage of medical education has prompted them and my colleagues to place at your disposal. I have already referred to the Out-door Bureau, situated in the lower part of this building; it is similar in its organization to the dispensaries located in different parts of the city, and affords the student the same facilities of seeing disease, with the advan- tage, that the case may be admitted to the wards of the hospital, and thus not lost sight of. There is yet one step needed to perfect the working of our machinery. I will here throw out the sugges- tion to connect with this department a School of Pharmacy, where the apothecary may be taught his duty, and thus not defeat (as is too often the case), by his ignorance, the purposes of the physician ; and also, what is of more importance, to provide a place where the student (who intends to practice in the country, and is dependent upon his own phar- maceutical knowledge) can receive an amount of instruction in practical manipulation in drugs 22 which will better fit him for the practice of his pro- fession. Curiosity will lead you to the “ Morgue,” a room appropriated to the reception of the bodies of persons found drowned, or dead from causes unknown, afford- ing their friends an opportunity of recognizing the deceased, without any of those loathsome surround- ings which were inevitably presented when the bodies were left on the wharves or in the streets of the city. Perhaps on first thought you will be un- able to realize the advantages offered to you in this department; among others I will mention an im- portant one. You here have an opportunity of care- fully scrutinizing the post-mortem appearances of a person who has been immersed for a greater or lesser time in water, and of becoming familiar with the contusions and abrasions occasioned by the body coming in contact with hard substances vrhile under water, contrasting them with those received prior to the immersion; thus furnishing that important knowledge upon which the testimony before a court of justice is founded, and upon which the life or liberty of a fellow-being may depend. To the public the Morgue is of great value, giving them an opportunity to reclaim the bodies of friends who have been missing. While every care is taken to afford them evidences of identity, there is nothing to offend the eye or sense of the most delicate. From the Morgue you pass into the apartments appropriated to tho Coroners: here serious questions are carefully examined, testimony received, and the causes of death by violence or otherwise are decided upon by a jury. The medical testimony is adduced from the examination of the body in an adjoining room, and a report made to the Coroner and jury. 23 What can there be of more importance to the student of medicine than the varied and intricate points connected with Medical Jurisprudence, and how much more intricate does it become when, as an expert, he is called to express an opinion as to the cause of death, and is able to recall some similar case which occurred during his student-life at this College. The next room will no doubt from its name strike you as a most valuable aid to medical learning—it is the Post-Mortem Room. Here, under the eye of the Professor, examinations are made and the correctness of diagnoses verified. Pathological specimens withou tnumber are exhibited, and you become familiar with the causes of death and the appearance of normal and abnormal parts. Ascending to the floor above, you find the museum, where are carefully preserved the important specimens resulting from operations performed in the hospital as well as the pathological specimens found in the cases examined after death, with a large variety of beautifully prepared exemplifications of diseases of the skin, &c.; added to these are the private collec- tions of the Professors of this College. I can not leave this room without recalling an event which brings sadness to my heart; it wras destined to contain a collection of pathological specimens which was not equaled in this or any other country, the work of over fifty years’ professional life of one I have already referred to, besides a large portion of my own comparatively small collection. Fire, that almost resistless enemy, laid waste much of it; but I am happy to say all was not destroyed, there still remains a nucleus around which will gather little by little the particles which eventually make a whole, 24 and that museum may yet be worthy the name it bears. The multiplicity of advantages afforded by Bellevue College are such as to compel me to occupy a few moments more and call your attention to the accom- modations for the pursuit of the study of Practical Anatomy. I think I may boldly say they are unsur- passed in the world. This department is presided over at all times by an accomplished and zealous Demonstrator and his assistant, prepared to initiate you into the most intricate labyrinths and most inti- mate acquaintance with the wonderful machinery comprising the human fabric. Let me here pause for a moment and endeavor to impress you, not only with the importance of this branch of medical studies, which is the foundation of all positive knowledge in the medical and surgical treatment of disease, and without which no man can practice his profession understandingly, but with the fact, too often overlooked, that we are in search of this information through the medium of a deceased fellow-being, and that all due respect should be shown to the mortal remains; no unnecessary waste should be indulged in, and as every portion contains parts worthy of being carefully studied, your dissec- tions should be conducted with a view of acquiring knowledge and not satisfying idle curiosity. Remember that the stern but silent monitor who lies before you, is an emblem of what you must inevitably become, and therefore let the words of Cicero be ever present in your mind, “ In eadem re utilitas et turpitudo esse non potest.” There still remains one department to which I have not alluded—that of Practical Chemistry. In the 25 rooms appropriated to this invaluable and indispen- sable branch of medical education, are to be found all the necessary appliances for the investigation of disease or cause of death, which through the secre- tions or otherwise can be detected by careful analysis. The importance of this knowledge can be only real- ized when, in the course of daily practice, cases present themselves which are involved in obscurity; in addition to which advantages, it gives weight to the testimony of the medical witness in enabling him to assert, that the investigations upon which his opinions are based were made by himself, and that his is positive and not hearsay testimony. The march of intellectual progress in the acquisi- tion of physical science is exhibited in the regular advance and appreciation of clinical studies, as triumphantly and as convincingly as in any other department of knowledge. If the words of Abernethy be true, “ that a hos- pital is the only proper college in which to rear a genuine disciple of Esculapius,” then, indeed, by repairing to this Institution in its several departments, do you come to a befitting college in the great Em- pire city, where a corresponding greatness marks its prominent institutions of science, of letters, and all that can benefit humanity; furnishing the amplest provision for the acquisition of knowledge in almost every department. Upon this I advance the truth, that nowhere else in the land are you furnished with the materials of illustrating your noble art, of having subjected to the eye and brought within the grasp of the hand, a greater variety of more important instances of indi- vidual suffering demanding your remedial relief, and taxing your professional capacity. 26 I can not leave this subject without paying a well- merited tribute to woman. To her indefatigable industry and untiring energy belong the establish- ment of many charitable institutions; by her exertions they are sustained, and economically and judiciously managed. I may cite, in proof, the “Nursery and Child’s Hospital,” “The Infants’ Home,” “Lying-in Hospital,” “ Orphans’ ” and “ Half Orphans’ Asy- lum,” “Woman’s Hospital,” and others. She is the prime mover in all the well-conducted private chari- ties which abound in this city; and, lending her presence to illumine the pain-stricken couch, softens ‘the sufferer’s agony by tender nursing. It has been said by an eminent obstetrician, that “ Home is woman’s place, except when, like the star of day, she issues forth to the world to exhibit her beauty and her grace, and to scatter her smiles upon all who are worthy to receive so rich a boon; then she goes back to her home as the sun sinks in the west, and the memory of her presence is like the sun- light that lingers long behind a bright departed day.” This is a pretty picture of woman in her happiest and most peaceful sphere, when life is smiling and undimmed by the black clouds which sooner or later gather around; when these burst pitilessly over us, as in the last four or five years, woman remembers that she has more exalted duties than those which bind her to the narrow but sacred home-circle; then unlike the warlike Joan d’Arc, who armed herself to deal death around, woman draws near even to the ghastly field of battle, urged by a lofty sense of duty, and with undaunted brow but gentle hand she tends the dying soldier, uttering holy words of comfort to 27 soothe the expiring patriot—expiring suddenly and violently, away from friends apd home. I do not adduce a solitary case; we have innumer- able instances of her high courage and unshrinking devotion in moments of trial and peril. Look back a few months, and those who have seen Northern and Southern women, contentious factions alike forgotten in the common impulse to do good, ministering to the sick and wounded soldier in the hospitals, will bear testimony to the excellence, valor, and value of woman, who from a noble sense of duty exiles herself from her cherished home, and volun- tarily deprives herself of all that augments her natural charms and sweet attractions ; and then her duty bravely done, her part fitly enacted, she modest- ly retires to her home, like the sun sinking slowly but grandly in the west. Among so many noble women it may seem almost invidious to name one—yet there is one who sings the soul-stirring song of good deeds to suffering mankind ; whose thrilling notes awake an enthusi- astic refrain in the great heart of civilized human- ity ; whose name stands foremost on the list of those who have well-striven to lighten the misery and the ills of others—I allude to the heroic Miss Dix. Unlike their worthy sister, it is not always the lot of the weaker sex simply to assuage the sorrow of others;—she must herself suffer. No matter how low the object of her affections may have fallen—does she desert him ? No ! How often in the public thoroughfares do we behold a reeling, imbruted sot, receive well-merited contempt from every shuddering passer-by. One alone, his wife, clings to him; though it may be he has made her homeless, abandoned her to penury— 28 perhaps starvation and rags, she still upholds the repulsive wretch with, tenderness, humility, and a disregard of vile personal abuse, even blows, with godlike forgiveness and devotion deserving a better recipient of such mercy, love, and charity—the first principles of our beautiful creed. Should death at length relieve her of the cause of much undeserved anguish, resentment finds no place in her pitying breast; and at the last dread moment we find her weeping penitential, it may be remorse, ful, self-accusatory tears for the dishonored dead. Who can doubt woman’s goodness or usefulness ! With a soul more keenly alive to the kindlier emotions of the heart than our rude sex can vaunt, is she not our most cheering, charming companion in adversity as well as prosperity, an admirable blend- ing of truth and fidelity, of affection, simplicity, frankness, and integrity ? I tremble as I breathe the revered name of Mother! She commands our most sacred respect when we behold her surrounded by her little ones, inculcating in them an earnest love of virtue and fear of God. Her modest, gentle, and religious example develops all that is best in us; her precepts and teachings tend to eradicate all that is vile. He who does not reverence the tender influence of a mother is not imbued with the finer, nobler feel- ings which accord respect and consideration to his fellow-beings, nor the love and gratitude he owes his mother. He who has never known the blessings of a home, made fair and pleasant by a mother and sisters’ affec- tion, is to be commiserated—for, “ Their looks of love, ah, who could see, Nor think great Sire of Love on Thee?” 29 The Father of Medicine, the stern Hippocrates, asked, “ What is Woman?” and answered the ques- tion himself in one word, “ Disease.” But is that all that she is ? No! She forms the strongest link in the social compact, and her import- ance and power you will sooner or later feel most keenly; therefore, despite the sententious dictum of the scornful philosopher, you must not, young gentlemen, regard woman solely in a medical point of view. Remember she is your best friend and co-operator in the sick-room ; the bright light of your home; your solace and comfort in moments of care and misfortune, and when, “ The day of your destiny’s over, And the star of your fate hath declined, Her soft heart will refuse to discover The faults which so many can find." Poets have paid so many beautiful tributes to the exquisite worth of woman, that my poor language pales before their metaphor; but none more truly than Scott has portrayed her few foibles and great virtues. I mean in the trite lines which all know, ending, “ When pain and sickness wring the brow A ministering angel thou.” The mighty giant Science, in his early manhood has founded a fit abode for his old age; he has placed his gentle sister, Mercy, within it, and together they will make their home, Bellevue, the resort and refuge of suffering but grateful masses, and the admiration of the learned as well as of the benevolent. In bidding you adieu, I feel tempted to quote some 30 words of Bishop Heber, substituting, however, the name of “ Bellevue ” for that of “ Bombay.” “Thy towers, Bellevue, gleam bright they say, Across the dark blue sea ; But never hearts were half so gay As this night meet in thee.”