AN 
INTRODUCTORY DISCOURSE, 
TO A 
COURSE OF LECTURES 
ON 
CLINICAL MEDICINE 
AND 
PATHOLOGICAL ANATOMY; 
DELIVERED AT THE OPENING OE THE NEW 
CLINICAL AMPHITHEATRE OF THE LOUISVILLE ITAL, 
November 5th, 1840. 
BY DANIEL DRAKE, M. D. 
PROFESSOR OF THESE BRANCHES IN THE MEDICAL INSTITUTE OF LOUISVILLE. 
PUBLISHED BY THE CLASS. 
LOUISVILLE, KY. 
FEINTED BY PRENTICE AND WEISSINGER. 
1 840. TO TH* 
MEMBERS OF THE MEDICAL CLASS: 
Gentlemen, 
In yielding to your respectful request to be furnished with 
a copy of my Introductory Lecture, for publication, I am not gov- 
erned by my own conviction of its containing any thing so now or 
striking as to merit that distinction; but by two other considerations: 
First—It may do something towards promoting the study of Patholo- 
gical Anatomy, in the West and South; and, perhaps aid you, after 
graduation, in the prosecution of Clinical Observations. Second—Its 
publication will contribute to make known the fact, that the Profes- 
sors have erected an amphitheatre, in which the examination of pa- 
tients can be conducted in a manner far more advantageous to 
students of medicine than in tho wards of the Hospital. 
Most respectfully, 
Your friend and preceptor, 
DANIEL DRAKE, M.D. 
Medical Institute of Louisville, 
December 10 th, 1840. INTRODUCTORY LECTURE. 
Young Gentlemen, 
The object of the Introductory Lecture which I am about to deliver, is to 
explain, especially to the younger members of the Class, the nature and 
importance of the branches of medical science confided to me by the 
Managers of the Institute, and to make known to you the means and fa- 
cilities which have been recently provided for their prosecution. 
By Clinical Medicine is understood the study of diseases at the bed- 
side of the sick, which may be carried on either in private practice or in 
Hospitals. Most of you have been more or less engaged in the former 
mode with your preceptors, and you are now aboijt to engage in the latter, 
which is often called Hospital medicine. I trust that none of you will 
think his previous opportunities in private practice have been such as to 
render an attention to Hospital medicine superfluous. I am aware that 
many of you have been reading with gentlemen of science and skill, for I 
have the pleasure of knowing them; but all cannot have had that ad- 
vantage, and even those who have, may still find an attention to hospital 
practice eminently beneficial. 
In private practice many restraints are imposed on physicians, and still 
more on students. Enquiries which may be freely made in hospitals are 
often inadmissible in private families ; the presence of various members of 
the family and of visitors frequently limits our physical examinations; re- 
cords of the symptoms and prescriptions from day to day are seldom kept; 
and the physician is not, in general, at liberty to expound to his pupils at 
the bedside of the patient the reasons for his prescriptions: finally, the 
student very seldom has the opportunity of making regular visits, and, for 
the most part, is taken to see cases of an advanced and dangerous charac- 
ter, when the symptoms are so numerous and complicated that he is inca- 
pable of analyzing them, and looks at them with a mixed feeling of curi- 
osity, wonder and despair. Thus, under the most favorable aspect in 
which wTecan contemplate clinical opportunities during private pupilage, 
they are exceedingly imperfect, and I ought to add, sometimes injurious. 
This last remark involves no censure of private preceptors, as I will make 
apparent to you in a moment. When the student accompanies his teacher 
to the bedside of a patient, he sees the symptoms and hears the prescrip- 
tion it is true, but very often knows little more of the case. This being 
repeated, an association of ideas is, at length, established in his mind 
between certain phenomena and certain medicines; so that when the for- ner present themselves they suggest the latter; but this is not science, 
any more than it is science, for a mariner to predict from a certain aspect 
of the sky that a storm is impending, while he is totally ignorant of the 
principles of meteorology. The symptoms of disease are but the signs 
of disordered function, and the mind should first contemplate them in their 
connexion with the organs and their actions. They must be interpreted, and 
then the reasons for the prescription become intelligible. But, as I have 
said, these explanations cannot in general be made at the bedside in pri- 
vate practice, and, therefore, many students grow up to be, what in name 
they despise, mere empirical practitioners. 
They enter on the duties of the profession as symptomatists and thera- 
peutists ; when, in reality, they should be symptomatists, therapeutists 
and pathologists. Every physician who is not a pathologist is a routin- 
ist. On the other hand, although every pathologist is, as far as pathology 
goes, a man of science, he is not necessarily a good therapeutist, that is, 
practical physician. His knowledge is not sufficiently extensive. It 
comprehends pathology only, when it should embrace two other branches. 
Now itis the object and duty of a professor of Clinical medicine, to teach 
these branches in connexion. It is my function, young gentlemen, to teach 
them to you, and if I should not, I shall neither discharge the duty assigned 
me, nor fulfil the expectations under which you have done me the honor to 
become my pupils. To prophesy that I shall be successful, would be arro- 
gant : to predict that I shall fail, would be absurd. But it involves neither 
arrogance nor absurdity, to say, that nothing can be accomplished without 
a conjoint and earnest effort. A sense of duty to you, ought to stimulate 
me to such an effort—and a sense of duty to your future patients, should 
animate you to similar exertions. Time will tell to our friends and society, 
how far we have respected the obligations of conscience, benevolence and 
professional honor. 
Every co-operative effort, young gentlemen, requires a plan of opera- 
tions, and a common understanding of the means by which it shall be car- 
ried on. Ours will be the following: we shall bring from the wards of 
the Hospital a selection of such cases as seem likely to be most instructive, 
and make each case a special study. Some of them will be simple and 
easily disposed of; but others will be obscure or complicated; confused 
in their diagnosis, uncertain in their pathology, difficult in their indica- 
tions of cure—and it will be necessary, of course, to dwell patiently upon 
them. They must be kept before us for protracted observation, and made 
the subjects of deep and deliberate thinking. Our attention must be con- 
centrated, sustained and active ; the lapse of time must be disregarded; 
and every student must feel as though the development of the case de- 
pended on himself, as in battle every soldier should regard himself as the 
Achilles of the conflict. 
This attention, young gentlemen, cannot be given bv proxy, any more 
6 7 
Ot&u you cau oouruh your bodies, by employing an agent to eat your food. 
Professional acquirement, like professional honor, is strictly personal; 
and each must earn his own share. On this point let no student deceive 
himself. To borrow a further illustration from the science of war, when 
a regiment has acquired renown, every member of it participates, al- 
though every one may not have been valorous, for it is estimated in the 
aggregate; the stout in heart and the timid in heart, are grouped together, 
and the latter appropriate to themselves a portion of the fame of the for- 
mer. But this can never happen in medical classes. Your names, it is 
true, are interwoven on our matriculation book, you sit side by side in 
our amphitheatres, you nod to each other from the opposite benches, 
under a dull lecture, and pierce the depths of each others minds with 
glances from animated eyes, when new ideas are awakened in you by the 
eloquent voice of truth ; but the day will come when the wheat must be 
separated from the tares—when the magnetic wand of interrogation, ex- 
tended along your compact lines, will draw out the pure metal and leave 
the dross behind. 
But the analysis of your collective body is then only begun. You 
separate, and disperse upon various theatres of action; and are then 
called upon, single handed, to battle with the destroyer ; each one is then 
for himself, and his success will correspond to his scientific chivalry. He 
must be covered with shame or glory, according to his own achievements. 
Then will be the time, young gentlemen, that fountains of bitter regret 
will burst forth from the depths of memory, to deluge your hearts and 
blight your happiness, if you have suffered the precious opportunities of 
your pupilage to pass away unheeded. Lost property, lost reputation, 
even lost purity, may be recovered, but let me tell you, lost time and op- 
portunity are gone forever; and every moment which thus flies away 
takes with it an atom of your prospects, as every emanation from the rose 
carries off a particle of its fragrance. Even the neglect of a single case 
in this clinique, may exert on your future professional destiny, an effect 
of which, as young men, you cannot form a conception. The diligent 
study of a particular form of disease within these walls, may enable 
you to combat it successfully, when you enter the chambers of afflic- 
tion, and at once establish you in the confidence of society; while a 
failure, from ignorance, to do so, might doom you to degradation. I tell 
you, young gentlemen, that you may be attentive to what is brought be- 
fore you, if you will. Did you not command your attention in making 
your way to this place? You are not machines, and compelled to move at 
the bidding of an external force! Do you not feel in yourselves a power, 
by which you can do, or refrain from doing? Are you not able to turn a 
looking eye upon what is presented, and a listening ear to what is said, or 
withdraw your attention from both, as you may choose? Mere seeing and 
hearing, let me warn you, will not answer: you must look and listen. You may see a patient before us, and hear an examination going on, and 
still leave the amphitheatre without any adequate knowledge of the case ; 
because you were neither looking nor listening. Your attention was 
taking its siesta, or admiring the idle creations of a wayward imagination, 
when it should have been sitting with its tablets in the eye and ear, re- 
cording all that might fall upon both. 
To render your clinical opportunities effectively useful, it is indispen- 
sable, young gentlemen, that you should be punctual in your attendance on 
the Hospital. A professor in the halls of the Institute often devotes sev- 
eral minutes of the opening of a lecture to examinations on the last, and 
if you are late in arriving you only lose the advantage (in the technical 
slang of the lecture-room) of being stumped ; an advantage, however, so 
great, that every student should long after it as his young heart yearns 
for the highest honors of the school; but no such recapitulations can take 
place in the clinical hall. We shall begin with the patient before us, and 
he who is not here in time, will lose all, be it much or little, that tran- 
spires before his arrival, and lose it irrecoverably—you must, then, 
move with celerity to the Hospital. When you are on your way and 
are about to cross a street, it will frequently happen, that a carriage is ap- 
proaching to traverse your path, and sometimes even a procession will be 
at hand. Now these little events will divide you into three Classes. 
1st. Some of you observing the approach of the carriage, will determine 
not to be interrupted, and, therefore, quicken your walk, and finally per- 
haps run across the street, directly in front of the horses. To these the 
obstruction will prove a stimulus, and they may reach the hall, even be- 
fore the time, and secure a front seat. 2d. Others will not quicken their 
pace, but stop on the corner till the carriage passes by. These may ar- 
rive, by the time the first patient is carried out of the clinique; 3d, and 
lastly, there will be others who, even if they see a long procession about 
to intersect their path, will make no active effort to cross before its arriv- 
al, but stand gazing, till the whole has passed ; they then move on con- 
versing with each other on what they have seen, and arrive perhaps about 
the time the last patient is brought in; but observing that the eyes of the 
Class were directed upon them, they will, the next time a similar interrup- 
tion happens, conclude not to prosecute the visit, but spend the remainder of 
the hour in a stroi! about the city. Thus they will lose a prescribing day. 
A lost elementary lecture, by industry in reading, and the aid of a fellow 
student, may be in some degree made up, but a lost prescribing day, caus- 
es a permanent deficiency in the chain of data. In the lecture rooms of 
the Institute, much of your labor is a meditation on previously acquired 
facts ; but our business here, is to observe as well as meditate; to collect 
new data, to reason upon them at the moment; and each student should take 
them in, through his own senses, as well as reason upon them with his 
own mind. 
8 Still further, you ought not to rely upon your memories, nor upon 
the hospital records, read from time to time in your presence. You 
should keep your own clinical registers. Seated as you are, there can be 
no difficulty in doing so, and you will be without excuse if you neglect it. 
Such registers will be among the most valuable documents you can carry 
home with you—transcripts from nature, and records in some degree of 
your own experience; or, at least, of your own observations. When a 
patient is cured, the minute history of the case will enable you to judge 
how far the treatment is applicable to similar cases of your own; and 
when he dies, the same history will enable you to detect the errors of 
treatment which have, perhaps, led to that melancholy event, whereby 
you w'ill avoid them in your own practice. 
On this head, 1 will only add, for the information of all who may aspire 
to the honors of the Institute, that our examinations preparatory to the 
awarding of those honors, will in future embrace a reference to the clinical 
teachings in this Hall.* 
Much of what I have said, is applicable not less to Clinical Surgery 
than Clinical medicine ; but my able coadjutor, who is about to assume the 
care of the sugical ward of the Hospital, and whose duties, not less than 
my own, will be discharged in this amphitheatre, will in his private intro- 
ductory speak for himself. 
We come now, young gentlemen, to the second division of our professor- 
hip, Pathological Anatomy. The association of this with Clinical Medi- 
cine, so far from being arbitrary, is altogether natural. Almost every sick 
person either reco/ers or dies. Under the former issue, his case is con- 
summated with his discharge from the Hospital; under the latter, by a post 
mortem inspection, which will always be made, when the body is not 
claimed by friends, and taken away for private sepulture. 
Now what is the object of a post mortem examination! It is simply to 
ascertain to what extent the healthy have been transformed into diseased 
structures ; and from these observations, to deduce the seat and the mode 
of morbid action, which constituted the disease. Of this disease, the symp- 
toms were the external manifestations, during life—the morbid appear- 
ances are the internal manifestations, revealed to us after death. We ac- 
quire an a priori knowledge of its pathology, by the symptoms—an a pos- 
teriori knowledge, by the derangements of the organization and the organ- 
ism. Thus, within the walls of a Hospital, notin the halls of our medi- 
cal schools, are the tests of doctrines brought to bear upon them. Here, 
and here only, do we see displayed the power and value of the expert- 
mentum crucis. 
The pathological anatomist sits judge over the Clinical practitioner, and 
renders a decision from which there is no appeal. The scalpel pierces the dead body, and the clouds of false doctrine and error which over-hung the 
case are dissipated, as were the sorceries of ffie great deceiver, when he was 
touched by the spear of Ithuriel. The history of no fatal case is com- 
plete until the pen of pathological anatomy inscribes upon its last page 
those facts, which either condemn or justify him who pronounced upon its 
diagnosis and conducted its treatment. Thus, the revelations made by 
this science are of the most sober and momentous character—a chapter of 
truths connected with the mortal illness of a human being—truths which 
bear directly on the character and conscience of those to whom the life of 
that fellow creature wras entrusted; and hence the clinical dissecting room 
has a character of professional seriousness, scarcely less impressive than 
that moral solemnity which should always be present within its wTalls. 
Pathological Anatomy is the new tribunal of practical medicine; and w7ell 
would it be for the interests of truth and humanity, if every culprit could 
be brought to its bar. But it does not merely applaud, acquit and con- 
demn—it likewise instructs, and the lessons it teaches can be learned from 
it alone. 
By the symptoms we conjecture the mode of morbid action, and the 
organs most affected; by the effects of our medicines these conjectures 
are strengthened into opinions; by pathological anatomy they are established 
as truths, or rejected as errors. Without the data supplied by this science, 
there can be no sound pathology, and without sound pathology, there can 
be no consistent and successful practice. Thus, although pathological anat- 
omy cannot directly teach us to prescribe, it supplies materials towards a 
system of theoretical medicine which are indispensable ; and the want of 
which materials, more than any other deficiency, has retarded the creation 
of such a system. Viewed under this aspect, Morbid Anatomy assumes an 
importance unequalled by that of any other branch of the profession, 
except healthy anatomy, which by common consent is the elementum sine 
qua non of medical science ; for it not only constitutes the lowest stratum 
of the basis, but likewise blends itself with all the materials of which the 
superstructure is composed. 
As the fundamental branch, healthy Anatomy must be your first study; 
but it is not necessary that your knowledge of it should be very great, be- 
fore you commence the study of morbid anatomy; for you wrilt find that every 
post mortem inspection, will enlarge your acquaintance with the normal 
state of the organs, although its object is to trace out the abnormal. You 
will realize even more than this. The memory of mere natural structure 
fades away more rapidly than any other memory of the medical mind. 
Physiology, to some extent, contributes to the permanence of our anatomi- 
cal knowledge, for when function and its law's are associated with organi- 
zation, the anatomical descriptions abide with us much longer; but, it is 
not till we see the organs in desolation, and compare their ruins with the 
fair forms and delicate textures, which they displayed in the days of their 
10 11 
prosperity, that the latter becomes indelibly impressed. This contrast is, 
indeed, the mordant which fixes both in the mind, and enables it to send 
forth deep and brilliant dyes of elegant scholarship. 
Every pathological dissection is, then, a precious stu ’y of general and 
special anatomy, and the youngest member of the class, who seeks only 
to advance himself in the knowledge of structure, not less than the oldest 
who labors on the web of pathology, should give a willing and undivided 
attention to all the post mortem examinations which may be performed 
within these walls. 
Nor can you study this science successfully in books alone young 
gentlemen; not even in that of my learned colleague, although the best, as I 
firmly believe, for students of medicine, that was ever published in any 
country. Paradoxical as you may esteem it, I affirm that it is even easier 
to study healthy, than morbid anatomy, in books ; for description can make 
the former more intelligible than the latter. To be understood, abnormal 
and morbid structure must be seen. Who, that has not seen a patholo- 
gical structure, till he meets with it in one of his own dead patients, 
is prepared to report it? And who acquires a knowledge of morbid ap- 
pearances, out of a hospital! Can any one pretend, that in this or any 
other country, such knowledge can be acquired in private practice? It 
cannot; and yet, it is greatly needed in private practice. Not merely 
required by the demands which medical science makes on all its votaries, 
to contribute new means for its advancement—demands which every high- 
minded young man prepares himself to meet—but society itself will make 
special calls upon you—calls that will place you under the heaviest re- 
sponsibility. 
In the first place, notwithstanding the popular prejudice which so de- 
plorably limits the cultivation of morbid anatomy, in private practice, 
there will often arise a panic in the public mind, under the onset of a new 
and strange epidemic, that will lead to a common consent and an ex- 
pressed wish, that you should make post mortem inspections, for the 
purpose of devising a more effective plan of treatment. Secondly: Every 
now and then you will be called upon to inspect the body of some favorite 
child, or some distinguished man, who has died of an uncommon disease; 
or of one of the members of a family in which a dangerous hereditary 
tendency is supposed to lurk. Finally, you will be frequently called upon 
by coroners and other legal officers, to examine the bodies of persons found 
dead under suspicious circumstances, as from diseases supposed to have 
been induced by poison, or violence, and concerning which you will be 
required to testify in court. 
Look at the responsible position in which these calls will place you. In 
the first case, if you incorrectly observe or interpret the morbid appear- 
ances, and frame a method of treatment on observations thus inaccurately 
made, the lives of thousands may be sacrificed. In the second place, if 12 
you make ignorant, or even awkward reports, on the lesions of structure 
found in individuals whose rank in families or society leads to the publica- 
tion, by conversation or otherwise, of what you say, it will inevitably in- 
jure your professional standing. In the third place, should you make an 
erroneous report, in a case of medical jurisprudence, you may bring dis- 
grace and punishment, even death itself, upon an innocent person—the 
bare anticipation of which should fill every honorable and conscientious 
mind with dread; while the realization of such a mistake, would rend your 
hearts with emotions of grief, reproach and horror. 
Do not flatter yourselves, that because the prejudices of society oppose 
your practising post mortem examinations, it will, therefore, tolerate your 
ignorance of morbid appearances; for no such consistency exists. Society 
may withhold the straw, but will still require the brick. It assumes that 
you have the requisite knowledge, all its opposition notwithstanding; and 
it you have not, you must expect its condemnation. 
Add these considerations, young gentlemen, to that which I presented 
as the greatest the indispensable necessity of pathological anatomy to the 
formation of systems of pathological science, and then recede it you can 
from the conclusion, that the branch which I am now commending to your 
notice is of surpassing importance. 
lou may say, however, that you know many popular physicians who 
are ignorant of it, which l grant; but do you know any scientific physician, 
in whose mind there exists so extended a blank! I hope, young gentle- 
men, you will all be popular—but I hope still more ardently, that you will 
all be scientific. You should recoil from the thought of popularity without 
skill. Science, humanity, and courteousness, are the three great elements 
of sound and desirable popularity, but the greatest of the three is science. 
Clinical Medicine and Pathological Anatomy are sciences of observa- 
tion. The first requisite for accurate observation is active attention, on 
which I have already sufficiently dwelt. 
The second is an unbiased mind. In coming to the bedside or to the dis- 
secting table, you must leave your'lprepossessions and prejudices behind. 
If you do not, you are liable to see things under a modified aspect. This 
is particularly the case whenever we are engaged in minute inspections. 
A previous expectation, or even a wish, may so engraft itself upon our 
faculties of observation as to mystify them. I will give you a familiar 
illustration. When I came to this city a year ago, a drought prevailed 
every where, except in the Medical Institute, and no water flowed along 
the streets, which as you know are nearly level. As it is natural that 
the water falling upon or discharged into them, should flow' towards the 
river, and especially as I had lived in a city where such was the case, I 
presumed that the water from Chesnut street flowed off to the north ; and 
as I passed and repassed between the Institute and the Hospital, I saw most 
satisfactorily, that the cross streets declined from that scientific avenue to 13 
the river. But soon afterwards there fell a copious rain, and to my sur- 
prise I remarked the water flowing to the south, across Chesnut street 
from Walnut; when I immediately satisfied myselfi, that the streets dipped 
in that direction. 
In the third place, every case and every dissection will offer to your ob- 
servation many things in common, while each will present something pe- 
culiar. This classification, if such it may be called, should be borne in 
mind, and while you observe the former, you must scrutinize the latter. 
The symptoms which are diagnostic of the case, and the lesions of struc- 
ture which rendered it fatal, should have in your minds a special assign- 
ment ; as, in the mind of my friend, the professor of Materia Medica, and 
other distinguished botanists, a few of the characters of each species of 
plants have a special lodgment, and serve to distinguish it from all 
others, with many of wThichit may have numerous characters in common. 
In the fourth place, although I have said that Clinical Medicine and 
Pathological Anatomy are matters of observation, I must add, that medicine, 
in the full acceptation of the term, is a science of reflection not less than of 
observation; and, that while you should engage in the latter without any spe- 
cial or favourite theory, which through thick and thin you are determined 
to support, it will be your duty not merely to collect facts, but to refer 
them to principles which they are fitted to sustain. In this way you not 
only secure them, but make them immediately useful. They are the ali- 
ment of the mind; but they can impart no nourishment till they are dis- 
tributed and deposited. If merely lodged in your intellectual stomachs, 
they will no more promote the growth of your mental faculties, than food 
would nourish your organs if it remained in your corporeal stomachs, in- 
stead of taking the course of the circulation. And, as the digestive or- 
gans when engorged cannot reacton the load, and by decomposing pre- 
pare it for distribution, so if the receiving faculties of the mind collect 
without handing over to the distributing, they will soon become oppressed, 
and the whole mental economy be disturbed. 
Let us now pass to other views. The clinical division of my chair 
does not embrace Surgery, but the anatomical division is as closely 
allied to that science as to physic ; and contemplated in its connexion with 
that very important practical branch of the profession, it acquires anew 
interest. No one can be acquainted either with the institutes or practice 
of Surgery without a knowledge of pathological anatomy: no one can 
trace lines of distinction between these two branches, so much is common 
to both. It is not the function of the pathological anatomist to dress a 
wound or splint a fractured limb ; to tie an aneurismal artery ; to re- 
move a cataract, or open the iris ; to extract the sequestrum of a necrosed 
bone, or extirpate a tumour; but it is the function of the pathological 
anatomist to note the lesions of structure which render these and other 
operations necessary. Thus morbid anatomy is connected on the one hand with the diseased actions, which fix the attention of the physician, and 
on the other, with the diseased structures which demand the attention of 
the surgeon; and while you are employed in its study, you are preparing 
yourselves for the duties of both of these. 
Further, our science lends a helping hand to the chair of obstetrics. 
What are the various deformities of the pelvis, and the organic derange- 
ments of the ovaries and cervix uteri, but cases in pathological anatomy'! 
And are not the congenital delects of the foetus—the imperforate sphincters, 
the club-feet—the cleft lip and palate—the capsular cataracts and the 
spina bifidas, equally the objects of that science! 
Again. Morbid anatomy claims an affinity with Materia Medica. It 
detects those permanent derangements in the structure of organs, as the 
heart, the lungs, and the bowels, which not only render medicines una- 
vailing, but admonish the practitioner, to administer those of a debilitating 
character, with a sparing hand, in as much as lost strength, with visceral 
derangement, is with difficulty recovered. 
Once more. The teacher of the Institutes cannot dispense with the aid of 
Pathological anatomy. The facts which it supplies are indispensable to 
the general views in the philosophy of medicine, which itishis duty to put 
forth, while many of the functions have been illustrated, chiefly by noting 
the lesion which they suffer from lesion of the organs. 
Lastly. It contributes to Animal Chemistry a variety of new products 
for analysis, such as altered secretions, cretaceous deposits, biliary con- 
cretions, urinary calculi, and the heterologous tumors, thus enriching 
that science with new conquests, and, in turn, borrowing from it the 
means of advancing its own researches. 
Thus, there is not a division of the science of medicine, to which patho- 
logical anatomy is not allied—not one to which it does not lend a helping 
hand, though in very different degrees—scarcely one which does not, in 
turn, contribute to its advancement. 
Such a branch of science, young gentlemen, must be worthy of your 
profoundest attention. You should not regard its study as optional. A 
proper estimate of its rank and value will leave you no such option; but 
impose its study as a bounden duty. Such is now the judgment passed 
upon it by the most enlightened members of the profession, both in the 
old and new world. What is it so much as pathological anatomy, that 
draws students from all parts of Europe and the United States, to Paris! 
What but this gives more than half their value to hospitals, as auxilia- 
ries of medical schools! And how great are the benefits which these pub- 
lic charities confer on students of medicine and surgery! What a Senate 
house is to the ambitious young statesmen, the Hospital is to the young 
physician and the young surgeon. It is as the herbarium to the student of 
botany—the hall of justice to the student of law—the observatory to the 
youthful astronomer. 
14 15 
I am happy to tell you, gentlemen, that the Faculty of the Institute, 
have been and still are, deeply impressed with these great truths; and are 
determined to render the public charity, near which we are now assembled, 
subservient in the highest possible degree to the interests of the school. 
In this object, the Mayor and City Council, and the Managers of the Insti- 
tute, concur and co-operate with the Faculty. Under an arrangement be- 
tween the first and last, the professors have erected the amphitheatre in 
which we are now assembled, and this day solemnly dedicate to the study 
of Clinical Medicine, Pathological Anatomy, and Operative Surgery. 
They have thus opened a way for the advantages of the Hospital to flow 
out upon you in a more copious current than could otherwise have issued 
from that fountain. It is not my intention to speak inviduously; but jus- 
tice to ourselves requires me to say, that the arrangements which we have 
now consummated do not exist in most of the schools of the U. States 
which are connected with Hospitals, while many have no Hospital at all; 
and that although some of these institutions contain more patients, not one, 
of which I have any knowledge, has adopted a more excellent method of 
rendering its sick and its dea d available to the improvement of the pupils by 
whom it may be visited. 
The erection and opening of this Hall may, indeed, without ostentation, 
be regarded as an era in the history of medical instruction in the West. 
It completes the circle of opportunities, and prepares the way for making 
those opportunities as precious and productive to the student, as those 
afforded in any other city of the Union. Henceforth, there will exist no 
difference between your young alma mater, and the oldest schools of the na- 
tion, but what is found in the men who administer here, compared with those 
of the more ancient seminaries. Of my learned colleagues I need say no- 
thing, as so many of you have already attended on their teachings. I am 
bound, however, to declare, that but for the activity and enterprise of our 
distinguished professor of the Institutes, this amphitheatre might not, by 
this time, have had an existence. I regret that an abler man than myself 
is not to be the chief minister at its altar. But institutions are perennial, 
while men decay, and are succeeded by others. I am, at most, but a pioneer, 
and at the longest, must soon give place to some one more worthy of the 
high and respectable station which I now occupy. I hope, young gentle- 
men, that you enter heartily with me into these views of the future. It is 
noble to combine the future with the present, and live and labour for both. 
Benevolence unites them into one. Ambition overlooks neither, and aime at 
both. Thus it is, that high conceptions of patriotic duty are formed, and effec- 
tive efforts generated. Comprehensive views beget exalted aspirations, and 
these, in turn, prompt to great exertion. In minds thus tempered, the selfish 
and social become blended; and the interests which are personal, unite them- 
selves with those which are public. 
It is glorious to live with the age to which we belong, and for the ages that 
are to follow—to identify ourselves with communities of fellow-travellers. labouring to do good—who thirst after knowledge—who are ascending to fame 
in generous emulation—or, in the fulness of time, descending to the grave 
in Christian companionship. 
But, perhaps, you cannot see in the future all that will be unfolded to you by 
a more ample experience. As we advance in life the prospect before us widens, 
and many objects become visible, which had been previously unobserved. Thus, 
when the traveller descends our fairest of rivers, in its slate of depression, ho 
sees little else than the margin of its banks, and the tops of the hills which lie 
beyond ; but when he makes successive voyages, as the spring floods gradually 
rise, he sees from higher points of observation many additional objects; till at 
length, when the swollen tide has raised him to its greatest elevation, he be- 
holds extended plains on either side, which smile in cultivated beauty, and ex- 
cite surprise and admiration. 
It is delightful to contemplate the full and final establishment of an Institu. 
tion of science and humanity, on such a spot, and under such influences, as 
must of necessity render it prosperous and permanent. lake all young semi- 
naries, ours may experience those little reverses which develope energy and 
impart firmness of character; but onward and upward will be its career. 
Other schools may flourish, and new ones start into existence—for the mighty 
West is prolific ; but the Institute must continue to advance; for it occupies 
itself on the means of its own advancement, and wastes not its energies in 
retarding others. When years have rolled away, many of will return: 
some of us will then be in the grave; but you will find your alma mater still 
prosperous. Another cycle will be completed, and a few of you, whitened with 
the snows of many winters and bowed down by toil for the welfare of society, 
will revisit her ; but those from whom you are now to take lessons, will be 
hushed in death, and new—I trust more eloquent—voices will echo through 
her halls. Your aged hearts will then mournfully ask, where are they whose 
accents fell upon the ear, in the joyous days of our youth? But your moments 
of anguish will be short, for a throng of happy pupils will surround and 
greet, and honor you as elder brethren ; and your pulses will then beat high 
at the noble and cheering sight of a great medical University—ample in its re- 
sources, profound in its teachings, and exalted in fame—from which the out- 
pourings of science and humanity will flow in copious streams, among the un- 
told millions of your native land.