J£*Ar«E'fraaMbnfli A.N \ iwmm mm i \ VI' THE OI'KMAO OF TUIKi SESSION OF 1S41-5, TO THE STUDENTS ittcmpl)i0 JtteMcctl College, NUMBER 1, 1847. BY GEORiE R. GRANT, M. D., Professor of tho Theory and Proc ike of Medicine in the Memphis Medical College, rVBJLlSHED BY TBLE CJ.J8S, ;\fr.> .'HIS, TENN.: PRINTED AT TUC DAILY ENQUIRER OFFICE. 1847. / AN AT THE OPENING OF THE SESSION OF l§4Y-8, TO THE STUDENTS OF THE Jttemplji© IlleMcal College, NOVEMBER 1, 1847. BY GEORGE R. GRANT, M. D., Professor of the Theory and Practice of Medicine in the Memphis Medical College. PUBLISHED BY THE OL.JISS. MEM?ms,°rENN.: PRINTED AT THE DAILY ENQUIRER OFFICE, 1847, a CORRESPONDENCE. Medical Hall, Mempihs, Nov. 3d, 1847. Professor Grant : Sir—We, the committee appointed by the Medical Class, to call upon you for a copy of your Introductory Lecture, for the purpose of publication, beg leave to request that you will provide us with the said copy as soon as convenient. We have the honor to be your obedient servants, J. M. ALEXANDER, La., A. J. MILLER, Texas, T. M. WARD, Miss., BENJ. T. PHIPPS, Va., THOS. W. McLEROY, Ala., IRA W. McCUTCHEN, Ga., JOHN M. JACKSON, Ky., F. M. A. ROBINSON, Tenn., JOHN B. STANFORD, Ark. Medical Hall, Memphis, Nov. 3d, 1847. Gentlemen— Your polite note of this date, asking a copy of my "Introductory Lecture for the purpose of publication," has been received. In compliance with your request, that I will provide you with "said copy as soon as convenient," I herewith send the manuscript, and with it my best wishes for your individual welfare, and that of the Medical Class of our College, whom you represent. With sentiments of the highest respect, believe me to be Yours very truly, GEO. R. GRANT. To Messrs. J. M. Alexander, and others, Committee. ADDRESS. Gentlemen of the Meoical Class : t Tennessee was just completing her fiftieth year since she had become a member of the confederated Union of States, compo- sing our free and independent Republic, when her Legislators, in their wisdom, granted the Charter for this, the first Medical school ever established within her limits. It is matter for surprise that so long a period, in her prosperous history, should have been permitted to pass by, without her seeming to bestow a solitary thought on the claims of those of her sons who were pursuing the peaceful, and quiet walks of science. It was not thus that she treated the demands of Literature. Over her extended territory, schools, and colleges, for the attain- ment of common and scholastic learning, had sprung up and flour- ished under her fostering care, with a rapidity equaled only by the thirst for knowledge which has ever characterized her gallant and generous sons. But whilst the common, the academic, and collegiate education of her children were amply provided for at home, those of them whose inclination led them to study Medi- cine,'either for the sake of the important knowledge which it im- parted, or as a means of becoming useful members of society by pursuing it as a profession, have been compelled to seek abroad, for that important information which can be imparted no where else more efficiently and faithfully, than within the precincts oif her own territorial limits. Whether the neglect to extend to the profession of medicine, the same care and encouragement which has been bestowed on common and classical learning, was attributable to our law-ma- kers, or to the apathy and indifference of the physicians themselves, G it is not our design at this time to enquire. Be this as it may, the Petition which was sent up during the sitting of the last ses- sion of the Legislature, signed by very many of our most respect- able and influential citizens, asking a Charter for a Medical Col- lege to be located at this place, was attended with no difficulty, whatever, in procuring the object sought to be obtained by the petitioners. It is true, that, penniless and almost friendless, it was sent out into the world, with nothing but a Charter to com- mence with, to be sustained entirely by individual enterprise, and to establish for itself a reputation among the old and long tried institutions of a similar kind, enriched by the Legislatures of the States, and the munificence of the cities in which they are located, or to perish in its early struggles to attain a vigorous existence. In the month of August of the past year, an announcement was made to the professional public, that a course of Medical Lec- tures would be delivered in the city of Memphis, commencing on the first Monday of November, to be continued four months. This was the first announcement of the kind, so far as we are ad- vised, that was ever made in the State. And when the time ap- proached for the opening of our untried experiment, those only who experienced it can fully appreciate the anxious solicitude felt by us who had been instrumental in perfecting an enterprize, rendered almost sacred by the amount of good, to the profession and the public, likely to accrue from it,if rightly conducted. I need not say that our most sanguine hopes were more than realized. The number of students who attended our first course of instruction in this city, last winter, has not, with but one excep- tion, been exceeded, or even equaled, by any regular school of medicine in the South or West. The class so greatly exceeded in number all our calculations, that the most lofty anticipations of the friends of the cchool were more than satisfied ; and the wis- dom and sagacity of those who had been instrumental in its es- tablishment, could no longer be doubted. In looking over this assembly I recognise among it several of the familiar faces which I had the pleasure of meeting, almost daily, during the past first session of our College course. In ad- dition, I behold many strangers who have visited our city for the. first time, and who are about to take up their abode, for a season, among us. For what purpose, it w\v be asked, have you all for- 7 saken the pleasures and the comforts of home, with the blandish- ments which encircled you among the companions and friends of your youth, to spend, among strangers, the cold and cheerless months of winter? I am well aware that it is not to pursue pleasure, in the com- mon acceptation of the term, that you have come hither. Nei- ther is it to accumulate perishable wealth, amidst the din, the hur- ry, and the bustle of the commerce and trade of this busy mart. Nor is it to squander in idleness and ruinous dissipation your time and your means, that you have left the homes of your youth, and the friends of your love. To acquire the priceless treasures of knowledge, which are strewn along the quiet and secluded paths of science, has doubtless been—as it always should be with the disciples of the Healing Art—the motive urging so many of those, with whom we pleasantly journeyed together last winter, to return to our College, and with them so large and respectable a body of new and eager votaries. The return of those of you who were members of the last class, to spend with us your second session, as students of the Memphis Medical College, affords the most gratifying proof that you were well pleased, in the general, with the mode, and the kind of in- struction imparted to you, by the members of the present Facul- ty. And you may rest assured, gentlemen, that this demonstra- on your part, will stimulate them to labor with more zeal and ar- dor in the responsible and difficult positions assigned them. Noth- ing which they can do to promote the exalted behests of our no- ble calling, and your individual interests, shall be left undone. We will labor unceasingly to prepare you, well and truly, to dis- charge its solemn and responsible duties, and to inspire you with the noble resolve, so to qualify yourselves, that you will cordially and cheerfully lend a helping hand to elevate the character and the dignity of the profession, in the South and South-west. If we have cause to be gratified that so many of you who atten- ded our first course, have returned to prosecute your studies with us again during the ensuing winter, we ought, likewise, to consid- er it a compliment to our young and promising Institution, to see among the class many new comers ; and some of them, from remote and distant points. It is but another evidence, not to be mista- ken, that the Southern radical public are beginnin- rightly i> 8 appreciate the important and too long neglected truth, that the profession ought to be studied near by the region where it is designed to be practised. I feel no hesitancy in saying, that the student acts wisely, in selecting for his teachers those whose experience of disease has been acquired in sections of country, similar in most points of view, to that which is to be the theatre of his future operations ; and with the very same maladies with which he is to contend, in the struggle between health and disease—life and death, if, at the same time, facilities are afforded him for acquiring a thorough knowledge of the profession, in all its details. Whether or not we possess these facilities you will be able to de- cide for yourselves, when our means, and our ability for imparting instruction shall have been fully displayed before you. And, if this College shall fail to discharge the obligations which she owes to the profession, and to science, I trust you will feel it to be your duty, and your privilege to point them out to us, that we may pro- ceed to correct them if necessary. You have come hither to be taught the structure of man, in all its complicated and wonderful parts. That piece of superior mechanism which is to be the object of your special care, and the subject of your future meditations. To gain information concern- ing the manner in which the functions are performed in health, and the deviations to which they are liable, constituting disease. To obtain correct views of the causes, the symptoms, the pathol- ogy, the diagnosis, and the treatment of medical and surgical dis- eases, with the influences exercised over these by climate and lo- cality. To study the peculiarities of the diseases, and the acci- dents to which the delicate organization of woman subjects her ; and to learn the proper management of helpless infancy ; how to protect it from the influence of the physical causes ever tending towards its destruction ; with the best methods of preventing and curing the diseases of childhood. To have exhibited for your in- spection the various remedial agents which are to be the instru- ments, in your hands, to be wielded by you, for the purpose of dri- ving the enemy from the citadel which it is soon to be your duty to preserve and protect; and to be taught their therapeutic and toxical qualities ; the appropriate doses of each, with the best form; and modes f««r their administration. To have presented 9 to your view, in the Labaratory of the Chemist, imitations of ma- ay of the beautiful and sublime operations of nature, as displayed in the physical world around us ; to be taught the best methods for the analysis and synthesis of the various bodies in the universe ; to have presented to you the elements which enter into the com- position of every tissue of your own body, with an exact analysis of its various and diversified secretions ; and to learn the art of manufacturing many of the most valuable and potent articles, now in use in the practice of medicine. And this is but a sketch —a mere outline, of the diversified subjects which must be pre- sented for your consideration and study, in order to qualify you for the faithful performance of the duties, of the high vocation, to which you are all aspiring. Seeing, then, that so much is absolutely required to make the teachings of a medical school complete, a most important ques- tion here presents itself:—Can all these interesting subjects, so essential to a finished medical education, be taught thoroughly and advantageously in the Memphis College? I answer—notwithstanding the terrors of pseudo-critics, and the accusation of arrogance and presumption—that, in my humble opinion, the demonstrative branches of the science will be taught as efficiently here as at any other place; and that, tho' the prac- tical branches may not be so fluently bolstered up by references to authorities, yet the instruction imparted will be better suited to meet the exigencies of disease as it prevails in our climate; and will prove of more essential service to southern and south- western classes, than that imparted by teachers—whatever may be their acquirements in other respects—who are practically un- acquained with the pature and treatment of the diseases of south- ern latitudes. An opinion similar to the one just uttered, was expressed by the Professor of the Institutes of Medicine in this College, in an Inaugural Dissertation, delivered at the opening of the last ses- sion, for which he is fiercely assailed, and bitterly denounced by some of the leading medical journals of New York and Philadel- phia. But these violent outbursts of vituperation and abuse, from interested journalists, will never be able to drive southern physi- cians from the maintenance of a position, in relation to sectional medicine, which is too obvious to remain any longer a matter of doubt. 10 Whether the school, which I have the honor on this occasion to represent, possesses the facilities and the means for imparting instruction, to anything like the extent enjoyed by other similar institutions of learning, has so much of vital importance involved in the issue, that it cannot be amiss, at this time, when we are about commencing a course of medical instruction, to examine the subject, in a spirit of becoming candor and fairness. That the study of Anatomy can be as advantageously prosecuted in Memphis, as anywhere else, is too self-evident to be doubted by any one at all conversant with the subject. The materiel is here, and it is exactly such as the science is studied from wher- ever it is taught—physical man about to be reduced to the ele- mentary principles of which his organism is composed. No one will be so fool-hardy as to affirm, that the South does not produce, in as perfect development, the structure and parts of our animal bodies, as are to be found anywhere else. That these perfect structures admit of being studied as thoroughly, and demonstrated as satisfactorily with us, as elsewhere, none, we presume, will call in question. And that there are individuals among us, competent to trace out and unravel every part and parcel of this most per- fect of nature's works ; giving to each its appropriate name, and possessing the ability to explain, satisfactorily, the mechanism and uses, so far as is known, of all its parts, is most certainly true. In addition to the usual method of imparting instruction in Anat- omy, this department of our school is furnished with one of the most complete private cabinets, for teaching the minute and intri- cate parts of the science, to be found anywhere in the West or South. The gentleman who fills this very important chair, in the Mem- phis school, makes his appearance here, as a public teacher, for the first time; but there are those present who have been his pri- vate pupils, in another city, where he has acquired a well-earned reputation,in this particular department. Ashe possesses every necessary requsite for the perfect teaching of Anatomy, in all its minute details, who will doubt that this part of your education cannot be as readily acquired here, as at any other school of med- icine, in the Union. Where, in this country, are the Institutes of Medicine—embra- cing, not Physiology alone, as is the case in some of the American 11 schools, but Physiology proper, General Pathology, and General Therapeutics—the comprehensive sense in which the Institutes are understood with u?—better taught than in the Memphis Med- ical College? Over many of the obscure and important func- tions of the body, the genius and talents of the teacher of this department, in our school, had shed new rays of light, years be- fore similar views were advanced in the writings of either Liebig or Carpenter. To him, likewise, is to be attributed the highly important reformation, which has been effected in the views of the profession in the South and South-west, in respect to "systems in medicine," when, "solitary and alone," he combated the errone- ous views of Broussaias, and Cooke, at a time when the peculiar doctrines of the latter, both as related to the pathology and treat- ment of disease, were as prevalent and fashionable among a very large majority of the medical men of the West, and the South, as were the falsely so called physiological doctrines of the former, in the North, and the East. The instruction which you will re- ceive from this department, on the subjects of General Patholo- gy, and General Therapeutics, will be more valuable and attrac- tive to you, from the fact that it is based upon a practical experi- ence, acquired by several years of close observation of disease, as it prevails in the Southern States. The beautiful, the attractive, and highly useful science of Chem- istry, can be illustrated as faithfully and as fully, and can be taught as ably and as successfully in Memphis, as anywhere else. Nature is ever faithful in her responses. Represent her correct- ly, and she never deceives. If her secret and silent operations are accurately and truly imitated, the results are invariably the same, under the equator or at the poles. To do this, however, a suitable apparatus is necessary. That apparatus we possess, at least one that is entirely sufficient to teach the science as exten- sively as it is usually taught in the best schools, either literary or medical, of the West or South. That my colleague, whose duty it is to teach this fascinating science, is every way competent after many years experience as an instructor, you, who had the pleasure of listening to him last winter, and of witnessing his suc- cessful experiments, can bear full testimony; and to jours can be added the written declarations of many of the first men of the South, who have, at different times, attended courses of popular 12 lectures delivered by him, but a few years since, in some of our principal cities. That we have fewer Surgical diseases to treat, and fewer to present for your inspection, than are to be found in the wards of the large hospitals of some of our populous cities, is certainiy true. But the advantages to be derived from the study of Surgery, as practically taught at these places, are more specious than solid. For any one to say that the practice of operative Surgery cannot be taught as well in one place as in another, would justly expose him who would make the assertion, to well merited ridicule. Yet it is different with the constitutional treatment, often required in surgical diseases. This is very much modified by climate and locality, and should never be lost sight of in the management of surgical cases. The influence exerted on patients by the contam- inated atmosphere of hospitals, is frequently exemplified by erysi- pelatious inflammation supervening after almost every operation, even the most trifling, in these localities, at different periods. The principles of treatment, it must be apparent, therefore, differ in different localities, and even in the same locality at different times. These piinciples I know our Professor of this department has stu- died well and faithfully; and he will use his best endeavors to impart them to you during the ensuing, as he did throughout the last course of instruction. But, in addition to these principles of treatment, much of practical surgery can he taught you, by per- forming in your presence, after the most approved modern meth- ods, the various operations on the subject, which you will be like- ly to have to perform on the living. The various rollers, banda- ges, and splints, employed in the dressing of wounds, fractures, and other injuries, will be displayed before you, and the appro- priate methods of applying them, with all other matters necessa- ry to make you accomplished Surgeons, will be, I have every rea- son to believe, correctly taught and enforced. Every means will be used, likewise, to bring before you as many operations as the casualities of the season and the city will admit, that when you shall leave the halls where this instruction is to be imparted, you will be as well qualified to discharge the duties of the Surgeon, as though you had studied the art in those cities from whence long catalogues of "operations performed," are annually sent out with medical announcements, to swell their importance, and in- crease the size of their classes. 13 To duly qualify you for the important post which you will doubtless be called on to occupy as Obstetricians, when you shall have taken upon yourselves the responsibilities of the profession, every preparation, both natural and artificial, necessary for your instruction, will be called into requisition. The very same con- trivances which are in use to demonstrate and teach this branch of a medical education, wherever it is taught as it should be, we possess. To those of you who listened to the instruction communicated from this department of our college course, during the last ses- sion, I can safely appeal to sustain me in the assertion, that it was taught in a manner not only acceptable and satisfactory, but rare- ly excelled, even by those who have the reputation of being the best teachers of this particular branch, in the United States. We possess as ample means for imparting correct instruction in all that relates to the theory and practice of this branch of the science as any other school of medicine in our country. So, if any of you shall prove deficient in a complete and perfect knowledge of all that is essentially necessary to be known rela- ting to it, the fault will undoubtedly be your own. The various and multiplied articles contained in the Materia Medica, are as much at our command,, and as easily within our reach, as they are elsewhere. During our course, last winter, the professor of this department was supplied, from two of the largest and best conducted drug establishments in this city, with every specimen of medicine deemed necessary to be exhibited to the inspection of the class. The history, properties, action, uses, dose, &c, &c, of each, was ably and fluently descanted on; and its therapeutical application to disease, in its different forms and grades, very satisfactorily pointed out. During the past summer this department received an acces- sion, in the form of a donation, of a large number of specimens of the choicest articles of the materia medica, put up in Phila- delphia, expressly for the purpose of teaching this branch of the profession. These specimens, added to those already belonging to the college, will make the facilities for imparting instruction, from this chair, very complete. Need I say that it will also be satisfactory? 14 The class of last winter, in consequence of an attack which was made on your professor of this department, by an indi- vidual connected with another school of medicine, on account of his age and inexperience, through the pages cf an eastern medical periodical, after listening to his instruction for two months, held a meeting, at which was passed resolutions highly compli- mentary of his talents and ability as a teacher, which were pub- lished in the pages of the same journal, through which the attack had been made. It is consolatory to know, that, if age does not always bring wisdom, nor experience knowledge, young men are often found in our profession, whose superior talents eminent- ly qualify them for distinguished stations, long before their lock9 are whitened with the frosts of age. The present Professor of Materia Medica, in this school, is among that number, and I re- joice that this occasion enables me, thus publicly, to do justice to his talents. How you will be instructed in the Theory and Practice of Med- icine, a most important part of your education, is not for me to say. If a practice of twenty years, in different sections of the South, is of any value in familiarizing the mind with the causes, the pathology, and the treatment of the diseases peculiar to, and mod- ified by a southern climate, something, at least, may be claimed on the score of experience, as preparatory to the teaching of this branch, by the present incumbent. The infoimation thus acqui- red, in relation to the diseases of southern latitudes, and malarious regions, he hopes to be able to turn to good account, in the eluci- dation of the special pathology and treatment, of the diseases which you will be called on to contend with, in the strife waged against frail humanity, by the noxious physical agencies to which it is exposed. And where, I would respectfully ask, are you, who are to succeed us in our god-like calling, so likely to receive the instruction necessary to qualify you to enter, with confidence and success, on the discbarge of the sacred duties which you are preparing yourselves shortly to assume, as from those who have studied their lessons in the best of all schools—the school of ex- perience. It is only in the study of nature, as she displays herself in dif- ferent situations, and under ever varying circumstances, that her operations can be rightly appreciated and understood. He who 15 witnesses these, in the production of the causes of disease, in the lower latitudes, and in sections of country fertilized by the alluvi- al deposites of centuries—abounding in vegetable wealth, and ve- getable and animal remains—dotted over with lakes and marshes— and traversed by turbid and sluggish streams, will witness morbid developments, the production of these combined causes, on the human constitution, which will be sought for in vain in dense and crowded cities, or amidst the sterile granite hills of the higher latitudes. If it be true, as it most undoubtedly is, that, under the same circumstances, "similar causes invariably produce similar effects," throughout the whole of nature's vast domain, it follows, as a mat- ter of course, that the causes of disease being different, in differ- ent situations, the effects of these causes, that is disease itself, must be as dissimilar as are the essential phenomena with which it stands related. He whose knowledge of disease has been acquired in northern latitudes, will, therefore, witness manifestations connected with it, very different from those observed in southern regions; and he must, from the very nature of things, be, at least, as incompetent to communicate the instruction to others, which is indispensably necessary to qualify them to treat the morbid developments, con- sequent on natural causes, peculiar only to southern sections, as would the teacher, whose practical knowledge of disease has been obtained in the latter places, be to impart correct practical prin- ciples relating to the treatment of the diseases of the higher lati- tudes. Indeed, I think it may be confidently, and fearlessly as- serted, that the southerner would make a safer teacher for north- ern classes, than the physician of the North, destitute of the prac- tical experience only to be acquired by a close and attentive ob- servation of disease, as it prevails among us, would be for the in- struction of southern students. The reason for this is very obvi- ous. The open inflammatory affections of the higher latitudes, the result of exposure to cold alone, are treated and subdued on the plainest practical precepts, known to the profession; whilst the diseases of malarious southern regions, are modified by that agent, to an extent, and in a manner, too complex to be under- stood by the delineations of them contained in the writings of any author, with which I am acquainted, from whence, mostly, 16 teachers beyond these pestiferous regions, derive all their knowl- edge of our diseases. In the present state of the science, it be- trays ignorance to assert, as has recently been done, that "the principles of pathology are of universal application, and can never become sectionaV And when the phenomena of the nervous sys- tem—its physiological and pathological conditions—become bet- ter known and understood than they are at present, with the mod- ifying circumstances exercised over it by climate and locality, the fallacy of the assertion will be rendered still more apparent and absurd. No fact, in medicine, is now better understood, among the in- telligent members of the profession at the South, than this, that the inflammatory affections produced by atmospheric vicissitudes, require, with us, a treatment essentially different from that so successfully pursued, and recommended, by northern teachers of Practical Medicine—and all others who adopt their plan—in re- gions of country not pervaded by the influence of malaria. This element, which gives a peculiarity to almost every ailment, "which flesh is heir to," amongst us, so completely usurps the control of the pathological indications—or principles if you like—as to re- quire a modification in the treatment, "of universal application," where this element is superadded. In sections of country where maleria is never present, the nervous system does not acquire that peculiar diathesis, which is the result of its influence on the hu- man constitution, where it is generated and abounds; consequent- ly, these pathological and theiapeutical principles cannot be uni- versal, whether this agent be present, or whether it be absent. That there is such a thing as sectional medicine, or disease mo- dified by circumstances connected with climate and locality, so as to give it certain peculiarities which cause it to differ, in many of its leading phenomena, from disease bearing the same name, in other places, where these characteristics belonging to climate and locality are absent, is, I conceive, no longer debatable ground. The arguments and proofs brought forward in its support, by my learned colleague, in his Inaugural Discourse, delivered in the hear- ing of those of you who were here at the opening of the last ses- sion of our college course, has, in my humble opinion, set this matter at rest. Any further remarks from me, therefore, in rela- 17 tion to this topic, would only be a waste of our time, and a tax on your patience. If the preceding statements respecting our facilities, and our ability to impart instruction, in the practical as well as demonstra- tive branches, be true, it follows, that you have not acted unwisely in selecting, for your teachers, those whose knowledge of disease has been obtained in southern localities. That the public will have cause to repose entire confidence in your skill, when you shall have passed through our College course, and deservedly ob- tained its highest honors, is what your teachers have a right to expect. The fact that you have been taught near home, by those who have seen much of the very diseases with which you will have to contend, should, as we doubt not it will, be your*passport to public favor and confidence. Strive then, gentlemen, to qual- ^ ify yourselves, by diligent application and study, well and truly to discharge the highly responsible duties which await you. The standing of the Memphis Medical College; our characters as teach- ers; and your own" reputation, depend upon the improvement which you may make of the salutary lessons, to be imparted to you during the present course of lectures. It is greatly to be regretted, that Clinical Medicine, and Clinical Instruction, have not received a greater share of the atterttion of public teachers, in the United States. A standing objection, urg- ed in certain quarters against medical schools out of the large cities, is, that they are not provided with extensive Hospital ar- rangerhents, for clinical teaching. And yet the clinical instruc- tion, afforded by the much vaunted advantages of Philadelphia, for imparting this kind of knowledge, is very greatly overrated, as all are aware who are familiar with the facts. In an Inaugural Address,* delivered on the 2d of February, 1830, to the Collegeof Physicians and Surgeons of the city of Lexington, and the county of Fayette, in Kentucky, by Dr. Caldwell, President of the College, the following very just remarks are employed in dis- discussing this subject: "There is not, in the United States, a Hospital or Infirmary, an attendance on the practice of which is worth a cent apiece to the members of a large winter class! On the contrary, such attendance is but a waste of time; an assertion confirmed by the experience of thousands, and not invalidated by • Transylvania Journal of Medicine, Vol. 9, page 289. IS the experience of one! The following is an account of clinical instruction in the Pennsylvania Hospital, and the Philadelphia Almshouse, by far the best institutions of the kind in America, recently given by a physician of standing, who has been a wit- ness of it for the last fifteen years. "What is it then, that constitutes tfce clinical instruction of most of those who annually leave our grandest schools, armed with their diploma? Some forty tours, Performed at intervals of three or four days, throughout the wards'of some great hospital, the attending physician or surgeon in th# centre, and fifty or one hundred students crowding round him,