Medical Education

Annual Oration 1850

By Andrew Mackie, M.D.

Mr. President and Messrs. Fellows of the Massachusetts Medical Society,

“Time, on his noiseless wing, pursues his rapid flight;” and it has fallen to our lot to live, not only at a most interesting and eventful period in the history of the world, but our lines have also verily fallen to us in pleasant places. On the midnight darkness, one star after another star has dawned in rapid succession, until the whole firmament is bespangled with brilliant glimmerings, and the way has been prepared for the great luminary to send forth the radiant blush of the morning; and, towering on high in his resplendent course, now to shine upon us in his meridian splendor. Living under the full blaze of such glowing effulgence, duties, fraught with extensive and momentous responsibilities, devolve upon us, the members of the medical profession. To our wisdom and guardianship are confided the health and lives of our fellow-beings. To our vision is unclosed every pathway which ascends the hill of science, and which leads to fields of usefulness and scenes of happiness; and, in whatsoever pursuits we may be engaged, every individual may attain to the accomplishment of his wishes. No one has an excuse to loiter in indolence, and to grovel in obscurity. “The road where honor travels lies open to all;” and, if pursued with industry and prudence, whosoever will may obtain a prize, and crown his brow with a bright and glowing chaplet of renown.

With what wonder and amazement, as we contemplate the scenes around us, do we behold and admire the high degree of perfection to which the genius of man has advanced the arts and the sciences! Well may it now be said, that the rude efforts of nature have yielded to the refining polish of art and science, and that human ingenuity and invention seem almost ready to compete with infinite wisdom and power. To us it is given to measure space by time, rather than distance; and, on this auspicious morn, when, with the man of wisdom, we can exclaim, “Lo! the winter is past, the rain is over and gone; the flowers appear on the earth; the time of the singing of birds is come, and the voice of the turtle is heard in our land;” when, with such benevolent admonitions to inspire our hearts with deep emotions of gratitude and love to the Preserver of our lives and the Giver of all good, it is our privilege, in the twinkling of a moment, to leave our places of abode; and here, in this enlightened and beneficent city, where—

here, I say, it is our privilege to assemble on this interesting anniversary, to behold each other's faces, to form and renew acquaintances, to interchange kind sympathies and friendly salutations, to strengthen mutual confidence, and inspire increased ardor; that, with renewed vigor and augmented courage, we may return to our respective spheres of activity; and there, with honor to ourselves and benefit to our friends, resume our professional labors, and in faithfulness perform the responsible duties which we may have to encounter in our pursuits.

On this particular day, no man fails to remember that—

and, as we look over this assembly, we find that several of our number, who have been accustomed to meet with us on this joyous occasion, are not here.

Their stream of life has ceased to roll, and they now sleep the sleep that knows no waking. Why this absence? Why are not all present to participate in our festivities, and to join in our salutations? Why is it that—

As in previous years, the angel of death has been amongst us, doing his accustomed work. Several of our number have fallen victims to the shafts of the fell destroyer. It has been their lot to add to the countless illustrations of the remark, that—

Human skill could not save them from death's unrelenting demands. They have finished their work upon earth; they have closed their eyes upon the busy scenes of activity; their dream of life has ended; their bodies have gone down to the silent embrace of the dark and narrow tomb;

and their spirits, in obedience to the wise and mysterious mandates from Heaven's High Chancery, have returned to their merciful Creator.

To his wise and munificent care we joyfully confide them; and, inasmuch as they have left us an example worthy, we will endeavor to imitate their illustrious virtues, and strive so to live, that, in our death and departure, we may leave much to console and encourage those who may survive us, and to whose care we may entrust the future prosperity and usefulness of the society of which we are now the living and active members.

Our sympathies would here constrain us to pause, and portray the virtues and characters of our departed friends and fellows. But that privilege we must leave for other occasions, and pass on to meet and discharge the duties which have called us now to assemble.

In my efforts this day to respond to your call, and to perform the labors which you have assigned me, you will exercise your forbearance and grant your indulgence, while I offer some reflections on the subject of medical education, in connection with the mental endowments, the mode of instruction, and the importance of sustaining the profession in its integrity, and those high literary attainments which give it character and influence, and which entitle it to confidence and respect.

A learned professor, at one of our medical colleges, says, “Within the last century, our profession has been advancing in its claims and merits beyond all precedent, and yet has declined in public estimation. Mankind appear to have but little more respect for it now, than in the days when medical science was but a jumble of superstition and empiricism, and when practitioners were banished from Rome as public pests. To make such an acknowledgment is disagreeable; but, if the contemplation of the picture should lead to an effort to correct the evil, and bring about a better state of things, the confession may prove salutary. Mortifying as this declaration is to those intimately identified with this maltreated profession, it is very true that the most learned, morally eminent and excellent, in the ranks of medical practitioners, are not placed higher, in the minds of the great public, than natural bone-setters, seventh sons, or itinerant mesmerizers. A few, indeed, in all communities appreciate a cultivated understanding, and honor talents and science; but the multitude of men and women care no more about educational qualifications, genius or experience, in a physician, than they do about the police regulations in the planet Mars. A doctor is a doctor to them the world over. The more he lowers himself to the vulgar level, the higher place he has in their estimation. The condition of the present exhibits quite as many absurdities in their vigor as environed past generations. Medicine offers finer opportunities for a hypocritical display of humanity than any which pretends to administer to the temporal wants or necessities of our nature; and hence it has been cursed, from the birth of the father of physic, with armies of knaves. But ignorance is in the majority, and with a stentorian voice hails with delight the approach of a quack, because he is not trammelled or embarrassed by the dogmas of schools. No: he is a freeman, addressing himself to those who imagine they are themselves capable of appreciating merit or detecting imposture, when the fact is they are not capable of one or the other.”— Could we say the above was an overdrawn picture of a heated imagination, rather than a candid statement of plain truth, it would be far more flattering to our wishes, and agreeable to our feelings. It does, indeed, accredit much to the industry and efforts of the members of the profession; while, on the other hand, it presents an obscurity in the perspective, enough so, seemingly, to dishearten and discourage from continued effort in attempting to achieve what our predecessors have desired, and what they have labored with assiduity to accomplish. Yet, notwithstanding all of these unpromising presages, we will not abandon the cause, but hope on, and with renewed energies attempt to wipe away its reproaches, and raise it to its own dignified elevation. The science of medicine is an exalted subject of intellectual labor; one of worth, dignity, and consideration, among every respectable class in society.

The subject of medical education is one of deep interest, not only to those in the profession, but to every member of the community. Already is it beginning to receive that attention in the different sections of our whole country, which indicates better things, and inspires a hope, that, ere long, the educational requirements may be so much advanced that none shall be admitted to practise the healing art, excepting those who shall have studied the allotted time, and who shall give evidence also that they possess those attainments in knowledge, in skill and integrity, which shall rightfully entitle them to the confidence of the profession, and of those also who may need the aid of the physician and surgeon.

When we consider in what manner multitudes are hurried into the profession, and that too so undeservedly; when we see how and where the degree of M.D. is conferred, without scarcely a pretence of merit; nay, more, when many are appending to their names this title of distinction, without even going through with a form of preparation; and when we remember how our whole land is overrun with quackery, and deluged with nostrums, both patent and not patent,— the time has most assuredly arrived for those who have been educated, who know and rightfully estimate the duties and responsibilities of the profession, to whom also is confided the guardianship of the public health, and who alone are qualified to judge in so important interests,— the time, I repeat, has fully come, when renewed and special efforts should be put forth to ascertain the extent, and arrest the progress, of so general and destructive evils.

On the subject of education, there will necessarily be entertained a great variety of opinions as to modes, while all will be of one mind in their estimation of what constitutes the information both desired and needed. Free and candid discussion, in matters of difference in opinion, is the only right way to develop the truth; and, if aught may this day be suggested which shall aid in advancing what we all so much desire, it will be an ample remuneration for every effort and for every sacrifice.

A brief reference to the process by which young men are introduced into the profession will prepare the way to demonstrate some of the objections to the present system of education, and to make some suggestions whereby it may be improved, and likewise aid in securing a profession more enlightened, and better prepared for its duties.

Without special reference to natural talents or preliminary preparation, it is too often that many commence the study of medicine, without any good and sufficient reason to expect much success or benefit in the enterprise.

Too many, like young Scroggins, enter the doctor's office to prepare themselves for our noble and responsible profession. Says the country doctor, “On my return home, after having gone the rounds, and witnessed scenes of the most thrilling interest, ongoing into my office I found a person there who had been waiting two hours on important business. This was a young man, apparently about twenty-one years of age, rather below the middling height, with bow legs, long nose, retreating chin, and not a tooth in his head. He was exceedingly bashful; and my entrance threw him into such confusion that I was compelled to busy myself about something, in order to give him time to recover himself. When I looked at him again, his face was covered with frequent flushes, and wore an expression of pain, which led me to think he was ill with the colic.

“‘Is the pain here?’ said I, applying my hand to my stomach.

“‘No.’

“‘Is it here?’ — ‘No.’

“‘Are you ill? Speak out, young man! If I can assist you in any respect, it will afford me much pleasure.’

“This encouraged him a little; and, with much stammering and blushing, he said, ‘I want of you to learn doctoring.’”

Without being able to appreciate the extent of the study and the duties of the practitioner, young men pass their season of pupilage under the direction and teaching of the nearest physician. During this period, they attend — where it can be done with the least expense, and without much reference to the advantages — two courses of medical lectures, and receive the degree of M.D.; and then, with this testimonial alone, are admitted in full fellowship into a medical society, to be entitled to all of its privileges and honors and benefits, and to help in forming the character and reputation of the profession.

I was very favorably impressed on reading, last year, a report and resolution, made and adopted by the Medical Association of the District of Columbia respecting the preliminary requirements of medical students; viz. “No member of this association shall receive any one into his office, as a student of medicine, without a certificate from the counsellors, that he has been examined, and found qualified to commence the study of medicine; and it shall be the duty of the counsellors, before granting such certificate, to satisfy themselves that the applicant is of good moral character; that he has received a good English education, including an intimate knowledge of the construction of language, and a correct orthography; that he is well acquainted with the elements of natural philosophy, embracing the elementary principles of mechanics, optics, acoustics, pneumatics, and hydraulics; the elementary mathematical sciences, including algebra and geometry; and that he possesses a competent knowledge of the Latin and Greek languages.” This seems to be laying the axe at the root of the tree, and checking the evil at the commencement. A system of action in conformity to this would prevent much regret and disappointment. This is one of those cases eminently calling for prophylactic treatment, where it is much easier to prevent than to remove an evil. Most assuredly, such a course can but commend itself to all interested. Far more preferable would it be to have a young man discouraged and rejected, before he may have wasted his time, and spent his money, than, at the last extremity, to reject him, or admit to the profession those who never can become good and competent practitioners, and who wish to engage in the profession simply because they have good reason to suppose that they cannot succeed satisfactorily in any thing else. The present loose practice of admitting so indiscriminately to the study of medicine all who may fancy to become doctors is the wide door wide open through which so much reproach and discredit is brought upon the profession. By having recourse to some such system as the above, a smaller number would enter on the study; and none would be encouraged to pursue it, excepting such as might give a reasonable and encouraging prospect of success. Should it be objected that this course would be conferring too much power, in answering we have to say, it is not increasing, but merely changing the time, and exercising it when it can be done most advantageously.

It is a remark made by some, and believed by quite too many, that a moderate endowment by nature is sufficient for all the purposes of the profession of medicine. This limited and mistaken view is entertained, not only by some who consider themselves candidates for its labors and honors, but by multitudes who are in confident expectation of receiving and enjoying its benefits. They alike have no adequate conception of the labors and anxieties and responsibilities of a physician's situation and duties, beyond what is seen with the eye of prejudice through a misty atmosphere. They suppose his labors to be, with a kind of nonchalance, to ride through the streets, making occasionally a pleasant and social call, and now and then to be disturbed at the season which invites to sweet and refreshing repose; and, if need be, sometimes to endure an exposure to the inclemencies of the contending elements, made furious by the raging storm. They take not into consideration, that the life and health and happiness and welfare, not only of an individual, but of whole families and the community at large, depend on the attention and skill of the attending physician. “They have never felt the high responsibility of the physician's vocation, when called upon to render some sacred service, — perhaps to enter within the precincts of the penetralia, with a grasp of the hand, and a look which seems to say, ‘I confide to your skill and knowledge my all of earth. Fail not, I beseech you, to summon all your powers, I conjure you to command all your skill, to relieve distress, to abridge agony, to augment happiness, and prolong life; and you shall have your reward.’” Neither can they ever know, until experience teaches, the many anxieties and perplexities which sometimes attend the treatment of disease, nor the mortification which the most discreet and skillful may have to encounter — and that, too, most undeservedly — through the inconsiderate and hasty judgment of those who, without knowledge and prudence, are always ready to condemn and vituperate. Neither do they know the constant solicitude which attends the first efforts of the youthful practitioner. To this plea of limited talents, some resort to conceal their own deficient qualifications, and to impose on the unsuspecting the grossest deceptions of quackery in all of its specious ostentation. Others are led to imbibe and entertain the mistake, because of the unobtrusive and unostentatious manner in which the medical man uses his knowledge, practises his skill, and discharges the round of his important duties. He is not called upon in a public manner to make a brilliant display of natural or acquired abilities. Seldom does he have occasion to become a public declaimer; yet often is he required to exhibit knowledge acquired by the most diligent study and profound research, and that, too, without the outward show which so often excites both admiration and applause. Neither at the forum, nor in the desk, nor on the rostrum, does he have an opportunity to make a brilliant exhibition of refined elocution; but in his retirement, where he studies and learns the structure and economy of the noblest work of God, and in scenes of sickness, where, all hushed in silence, interrupted only by the expressions of suffering and sympathy, he is called upon to use the knowledge and wisdom and skill of the good and learned physician to repair the ravages of disease, and to restore to a healthy action derangements occurring in the most delicate functions of the complicated mechanism of infinite wisdom, — in such scenes and conditions it is where he needs to be able to summon to his assistance the aid of the highest attainments which the best cultivated endowments of nature ever can confer and afford. The necessity of a mind capable of extensive research and comprehension is at once apparent also, when we take an extended view of the numerous subjects to be studied and understood, and the various duties the medical practitioner has to perform. Contemplate the structure and economy of man, in all his delicate and complicate mechanism; go back to primeval days, when the whole subject was enveloped in darkness and obscurity, and trace the wonderful discoveries which human genius has unfolded to the understanding and comprehension of the student; consider the mysterious process of reproduction, how the embryo is perfected and fitted to become the residence of the soul; study the intimate relationship between matter and mind; see how beautifully and aptly the numerous articles of sustenance are prepared and converted to supply the demands of nature; witness the economy of respiration, and trace the rounds of the circulation of the blood, in all of its intricate and delicate coursings and changes, in order to nourish and supply the wastes of the body; see how man is recovered from wasting sickness, and restored to invigorated health, — how he is reclaimed from the brink of the grave, again to gladden and to sympathize with his friends in their social enjoyments; nay, more, with wonder and amazement, look upon and duly appreciate what has been done and achieved in this our day by a citizen of Boston, and justly estimate the discovery which disarms the surgeon of his terror, and under the influence of which the patient can endure his operations; while, in balmy repose, his mind ranges through regions of enchanted beauty, and revels in the delights of a celestial elysium; recollect, also, how that sentence, dooming to sorrow and anguish the most delicate, beautiful, and lovely work of creating wisdom, is so far ameliorated, that the mother, comparatively without suffering, is enabled to embrace her darling offspring, and, with her heart full of love and happiness, fully to realize all of her fond anticipations. Let considerations like these be brought before the mind and understanding, and no individual can again judge so erroneously or think so meanly of what man ought to be, in his natural endowments, to fit him for the study and the practice of that profession which is so intimately connected with the life and health, and the weal and woe, of his fellow-beings.

The quotation respecting preliminary preparation which has been made, has very much anticipated what might be said on that department in the course of study. I can but hope it may receive an attentive consideration and cordial approbation by the whole faculty. It certainly is as much a duty to use means for preventing evils, as it is to devise appliances for remedying them. It is inconsistent to complain of trials and provocations, and not put forth an effort to remove what is unpleasant to encounter. The power and means to improve the education of the profession is very much within and under the control and direction of the Society; and, by united and persevering energies, measures may be adopted and pursued which will check the introduction of so many practitioners, deficient in both genius and knowledge. To the Society is intrusted the quo modo et quantum of instruction; and no one can object to its taking cognizance of, and deciding concerning, the preliminary preparation, any more consistently than they can object to its control over the period of pupilage, and its power to decide on the qualifications, when the student shall have completed his time, and gone through with the studies assigned. In our common schools and colleges, preparation is required and judged of by appointed agents. Some regular system is needful to sustain order, and secure the best advantages of those institutions. The whole study of literature is progressive, and in proportion to the proficiency in the present will be the success in the future. Between the preliminary and successive studies there must be necessarily blended that intimate union which can never admit of a disconnection. Each department requires careful attention in its appropriate season. The student in medicine should be familiar with both the dead and living languages; and then he will be enabled to hold free and familiar intercourse with the fathers and founders of our science, and also to enjoy an unrestrained access to the literature of modern ages. Thus qualified, he may range through and explore the expanded regions of science, and accumulate a rich supply of such knowledge as he may find needful and beneficial in practical life. He ought to commence his course of professional studies with his mind well disciplined, and its energies well concentrated. With such preparation he will be ready to investigate with system and discrimination the science of anatomy and the intricacies of physiology, and to judge between the many and too often contradictory theories of health and disease. No other study proffers so many temptations to draw off the mind from matters of fact, and to embarrass it with the wild vagaries of an excited imagination. After acquiring a thorough knowledge of the mechanism of the human body, he can no longer be guided by plain matter of fact and mathematical demonstration; but, in the mazes of hypothesis, he is left to pursue his course enlightened and guided by his own experience and observation, and such information as he may have gathered from the study of what others have learned and recorded for the benefit of themselves, their associates, and their successors. In professional life he will be called to decide and act on the impulse of the moment; and, for such emergencies, what can better prepare him than a mind early trained to habits of calmness and promptitude?

Having thus briefly noticed the subject of preliminary study, and having made reference to the great importance of beginning the course correctly, as we pass on to consider the present system of medical instruction, we shall find it faulty in some respects, and susceptible of improvement in the whole course.

The present custom of commencing the study solitary and alone in the nearest office, and perhaps for no better reason than because of its proximity, must inevitably sometimes be attended with ill success and grave disappointment. Seldom does such a situation furnish means adequate to the purposes to be obtained. Too often there may be found a deficiency in the library; there may not be convenient opportunities of practising dissections, nor the advantages of an extended museum; the teacher may become remiss in making frequent examinations, and the pupil thus lose the advantages of recitations; the important privileges of clinical instruction may be limited, and thus may be lost one of the most important opportunities to gain that kind of information which is of the greatest practical importance in pursuing the round of professional duties. Under such disadvantages, the student may pursue his course, groping in darkness, until he finds himself at some medical college. What then is his situation? Almost any thing but what it ought to be. Every thing there has to be done too much in a hurry. The whole time needs to be occupied in hearing lectures on the different subjects. There must necessarily be confusion, and there can be but little time for study. Moreover, this may all take place at the season of the year least propitious for dissections, and at a location where neither a hospital nor any other convenience for clinical instruction can be afforded and improved. He finishes his three years of study, to say nothing of his education; and, one way or another, he obtains a diploma, which to him is in an unknown tongue; and thus is he prepared to enter a medical society. In this way, often but poorly prepared for the duties and trials which await his early efforts, and having but imperfectly learned how far to confide in nature's recuperative powers, and when to interfere with his own resources, and being “armed with a diploma and the prevailing doctrines of the day,” he goes forth, full of theory and with strong confidence in his own powers, and “with sanguine expectation to vanquish every disease with more than the skill and valor of a Don Quixote.” But, alas! he goes frequently to encounter disappointment, perplexity, and chagrin, and to suffer under the severe censure and withering rebuke of his friends and his patrons.

To remedy these imperfections, we would recommend the establishing of public medical schools. Let them be so arranged that the student may there commence, pursue, and finish his whole term of pupilage. If discreetly managed, they cannot fail to furnish advantages and offer inducements, so as almost, if not entirely, to monopolize the whole number of students; and but a few young men will be left elsewhere to obtain their education. The system of public school instruction has been adopted by the profession of divinity and of law, and for the education of school teachers and mechanics and farmers; and experience has already demonstrated its superior advantages. Medical schools should be established on principles similar to those of the other professions. We should be gratified to have our medical schools remodelled, and that with many important changes. We make no objections to those persons who now hold the high and responsible offices of professors and teachers in our colleges. For their qualifications we have the highest regards, and in their abilities the most unlimited confidence. As men of letters, we entertain for them the highest respect; and, as physicians and surgeons, we esteem them an honor to our country, and are proud to boast of their superiority in the science of therapeutics. Not to the officers, but to the present system of instruction, we make our objections; and, at the same time, we most confidently believe, that, if the teachers themselves will give the subject a candid and deliberate consideration, we shall have their approbation and concurrent assistance in effecting a reform. We would have our medical schools established on a liberal foundation and generously endowed, so that they should afford every desirable privilege, and be accessible to all classes in the community. There should be a well-selected library, and every kind of apparatus needful in a course of instruction. There should be a large and well-selected museum, and opportunities for dissections furnished most liberally. In connection also, let there be a hospital, or some other institution affording every desirable facility and advantage for clinical instruction. Let there be provided teachers competent to their important and arduous duties. Let the students also be divided into classes, and the classes be so arranged as to divide the students according to their advancement in their studies. Thus each class might pursue its appropriate studies, and have ample time to attend on such courses of lectures as might be delivered for their special benefit. The present arrangement of having so many different courses of lectures crowded into so little time fails to give both the lecturer and the student the advantages which the importance of the whole subject demands. Far more profitable and much more pleasant would it be to have the lectures delivered, one or two courses at a time, and in immediate connection with the subject or subjects which at the same period might be receiving the attention of the class. Thus each department in study, and each course of lectures, might be kept more distinct, and relieved from the confusion which results from dividing the attention, and crowding into the mind simultaneously too many subjects for consideration and memory. Another advantage at a public institution is gained by having there much to excite the ambition, and to stimulate to energetic performance, which cannot be found in a private study. Every person who is conversant with the energies and dispositions of mankind must acknowledge, that competition is needed to arouse the mental energies to make great attainments. It is true that reason and a sense of duty ought to be sufficient incentives, and perhaps in a very few instances they may answer; but they fail in the generality to produce the effects desired. What leads the daring soldier on to face scenes of danger, carnage, and death? What supports and nerves with vigor the statesman, in all of his unremitted labor and untiring effort? Banish from their eager gaze the laurels of renown and distinction; and the former will quail before scenes of blood and slaughter, and the latter will give preference to scenes of tranquillity, and the peaceful enjoyments of quiet life. So also, if, in the perspective, the medical student shall behold within his attainment such laurels and wreaths of honor as are woven for the brow of the great and good physician, the solitude of the midnight study will lose its gloom, and the early dawn of the morning will bear testimony to his early and cheerfully renewed labors in qualifying himself for the duties of his profession, and reception of its honors. In a public school also, we have concentrated the united energies of different minds, in toiling to develop the truth, and unfold the mysteries of science to the understanding and comprehension. Each student might become an important assistant to his fellow, by throwing some rays of light where darkness might perplex and conceal from individual effort.

Having thus established a medical school, with all of its multifarious privileges and advantages, instead of assigning any given time for the course of pupilage, let every student be required there to remain and pursue his studies, until he shall have made such advances and attainments in the object of his pursuits as shall entitle him to the honors, and qualify him for the labors, of the profession. Such a course might disappoint the raised expectation of many. In an instance like this, however, we would make the sacrifice of a lesser for a greater good. Many, with such restrictions, would be discouraged from commencing the study of medicine and surgery; and, consequently, there would be fewer aspirants to the practice of a profession on whose duties many enter prematurely. It is a well-known matter of fact, that, under the present system of education, time has an undue influence in deciding on the claims of the student. In many instances, there are those who receive testimonials, and go to assume the duties of a physician, who have no just demand for the former, nor qualifications for the latter. This is an evil much to be deprecated, and deserves special efforts to reform.

To the present arrangement, requiring every student to attend two courses of lectures, one of which must be at the institution which confers the degree, we have objections. It savors too much of an illiberal and monopolizing spirit of selfishness. The conferring of the honors of a literary institution ought ever to be placed on the broadest foundation, and to be given to those, and those only, who, from whatever source they may have gained knowledge, have yet made such attainments as shall entitle them to the honors to be conferred. Every medical institution should possess within its own resources whatever is necessary, that a student might there commence, pursue, and complete a good and finished education. That such colleges might be established, and that also in our own country, we have no valid reason to question. We have whatever is necessary for so magnificent an undertaking. We have wealth, talents, education, and enterprise. Nothing is wanting but to devise the plan, and go forward in its accomplishment, and our schools need not be second to any in the enlightened world. A mistaken apprehension seems now to pervade our whole policy. Instead of a concentrated effort to make the present number of schools better, there seems to be a spirit of rivalry, and a disposition to increase the number. Medical colleges are being multiplied in every direction. This is a sad evil, one to be greatly deprecated, and ought by every high-minded man to be promptly denounced. Already we have a greater number than can be adequately supported, and therefore more than is needed. The result is, that but few possess the standing, and afford the privileges, which ought there to be found and enjoyed. Many, like the valley flower, have come up in a night; and the morning has overshadowed them with darkness. They have a name, but are devoid of character and privileges. In their extremity, lest the last flickering ray of hope should expire in the socket, they, to augment their funds, or to assume appearances of prosperity, annually graduate their classes of doctors, who, “like the frogs in Egypt, overrun our fair heritage; they come up into our houses and bed chambers and beds, into the houses of servants and the people, into our ovens and kneading-troughs;” and, when the plague shall be stayed and the evil removed, we need a seer to prophesy: human vision cannot foresee, nor how, can finite wisdom seem able to devise. Such a condition of affairs brings reproach upon the profession, and is an admonition to societies to be more guarded in the admission of members, and also so to raise their requirements that their honors and privileges shall be accessible to none but men of genius and erudition.

Objections exist not only to the manner of commencing and conducting the season of pupilage, but to that also in which it is finished. Every innovation is by no means an improvement. The present mode of conferring degrees seems to prevent or to destroy the purposes of the design. Before the physician has passed the very threshold of his professional career, he has conferred on him the highest titles of distinction and honor, rather as a certificate of qualification than as a testimonial of more than ordinary attainments in his pursuits. As we have before said, man needs much to excite and stimulate to activity and enterprise; and, when you remove from his ambitious gaze the high honors of distinction and pre-eminence, you remove the incentives to extra effort; and nothing remains to call into action his mightiest resources, but a dispassionate sense of duty, and the quiet satisfaction of having done all things well. In the other professions, the titles of honor are conferred on the few, who, by persevering industry and marked attainments in literature, qualify themselves for more than ordinary achievements. In like manner, in the medical course, it would be much more consistent to revert to the bygone practice of conferring the degree of M.B. as an evidence that the pupil has completed his course of study with honor to himself, and with a reasonable claim to the confidence and patronage of the community; and to hold in reserve the honorary title of M.D. for those alone who, by extra labor and superior attainments in literature and professional skill, shall deserve well, and merit more than ordinary distinction. Thus, through his course, not only the promptings of reason and philanthropy, but the high honors of the profession, would stand out in bold relief to stimulate his energies, and crown his industrious efforts with palms of distinction, and meads of praise.

Another objectionable innovation is the change to the present mode of admitting Fellows into the Medical Society. The presentation of a medical degree alone is not a sufficient barrier to keep the door properly guarded, and to exclude all who are not deserving the situation and honor. The reputation of a Medical Society ever ought to be of that high order, that its testimonials of membership in good standing should afford all of its members an honorable and plenary recommendation, whenever and wheresover a testimonial of professional qualification and integrity may be found necessary. To effect such a purpose, though apparently difficult to be accomplished, should be ever kept in view, and labored for with unremitting perseverance. The Society ever ought to have a veto power over the colleges, and rely on their own resources and decisions for their own reputation. No individual should ever be admitted a member, until he shall have been faithfully and thoroughly examined by a Board of examiners of their own appointment, and found, in the estimation of said Board, to possess the required knowledge and proper attainments. It is too apparent, that many receive the honors of our medical colleges who are but poorly qualified for admission into our medical societies. This may be thought a presumptuous and preposterous affirmation. Let facts speak for themselves, and let the truth be acknowledged, though it may raise many unexpected blushes. When we consider the high and irreproachable character which many of our colleges sustain, and the reputation for knowledge, skill, wisdom, and integrity, which so eminently belongs to the professors, at a hasty glance it may seem paradoxical and disrespectful to even suggest the calling in question the merits and validity of a medical degree conferred by them. We have no wish to cast a reflection upon our colleges or the professors, nor to undervalue their authority, nor detract from their reputation; but, when we make an impartial estimate of the attainments of some who bear about their honors, stubborn facts present themselves in formidable array, and demonstrate the truth of the old adage, that, if these be thy sons,

From some inexplicable cause, — it may be an overflowing spirit of benevolence, and a superabundance of sympathy for the more unfortunate, — degrees meritorious and degrees honorary are conferred to supply some deficiency; and thus we have many recipients of unmerited favors, peregrinating the length and breadth of the land, braying out their knowledge, and erecting their hypertrophied ears, with wonder and astonishment, because the people do not receive them with greetings into their houses, and reward them according to the character of their diplomas, but abandon them by the wayside, to receive according to their demerits, and feed on husks and thistles. Such a condition of affairs ought to be a sufficient admonition to faithfulness and caution in the admission of Fellows. There exists no necessity for hurrying applicants into Fellowship. Let the good old ways be sought out and returned to, and let us walk therein. Let the bygone practice be revived, when candidates were received on probation, and an opportunity was given them to demonstrate their qualifications, and to show their plenary claims to the privilege and honor of membership. Many, with fair promise at the commencement of the professional course, fail to fulfil the fond anticipations which had been reasonably formed in the perspective, and therefore prove a reproach rather than an honor in their station. The renewal of this obsolete practice can be attended with no objections. It extends to every one all of the advantages of the Society, and throws around the youthful members of the profession, in a special manner, its influence; and therefore, while it encourages and stimulates to a high and honorable course, at the same time it may restrain from the commission of such deeds as might blast his reputation. Such influence the youthful practitioner needs. Under the restraining influence of early instruction, he may be kept and guided through the season of pupilage; but, when the expanded theatre of active life is unfolded to his ambitious eye, and when temptations to pursue a wayward course clustre around him with all their alluring influences, then he needs every inducement which the honors of the profession and the principles of integrity can furnish to aid him in pursuing the pathway which leads to usefulness and honor. By reviving the probationary system of admission, much reproach might be avoided, and the society be relieved from many occurrences, both unpleasant and detrimental to all interested.

Another feature in the character of a physician, and one which should ever be very prominent, is strict integrity. It may be said, that a physician can be a skilful practitioner, even without this important trait of character. Be it so: nevertheless, he must be made an exception to a governing principle, and fail to be as useful as he might have been, and have to depend on others to give that character to the profession which will secure the confidence and respect of an intelligent people. In the discharge of his professional avocations, the medical man has to deal with all classes in society, and to sustain himself in all of the varied emergencies: he needs to be governed and guided by most unwavering principles of uprightness. Is he a man of highly responsible character, duly estimating his situation and its responsibilities? — he will spare no pains to obtain a thorough education, and thereby prepare and hold himself in readiness to respond to whatever emergencies he may encounter. Great and manifold obligations rest upon him. To his care are confided interests of the greatest magnitude. On his doing right or doing wrong depend the life and health of the diseased, the happiness or unhappiness of many, and the social enjoyments among relatives and friends. Nothing can be substituted for knowledge, skill, and faithfulness, in the treatment of disease, where life is at stake. In vain are the pleas of good intentions; and miserable must be the reflections of him who, without adequate knowledge, shall fail to perform his duty. Whether injury results from over-doing or not doing, the results may be equally pernicious, and alike fatal; and therefore a just cause of reproach and censure in either case. An overdose of strychnia may destroy life immediately; and, on the other hand, the withholding of a few grains of ipecac or rhubarb may prove equally as disastrous, though not so rapidly. In all of his situations and pursuits, he will find that his usefulness and happiness depend upon his knowledge and competency to perform rightly his varied duties. Often will he fail, through the imbecilities of remedies and other uncontrollable causes, to withstand the onward strides of disease, and save his patient from death. In his disappointments and regrets, great will be the consoling reflection, that he has been faithful to his trust, and, notwithstanding he has been unsuccessful, yet in his treatment he has pursued a course in strict conformity to the best instructions which knowledge and skill can afford. In justice also to himself, that he may have confidence in his own abilities, and thereby be relieved from undue perplexity and painful solicitude in the treatment of disease, which to the most enlightened is greatly embarrassed by contradictory theories and hypothetical chimeras, he needs to bring to the work a mind richly stored with knowledge, and guided by wisdom. Integrity also must be the governing principle of action in sustaining that degree of mutual friendship and liberality which is so much needed to maintain salutary and harmonious intercourse amongst the members of the profession, in their deportment one towards another. Every medical man can but highly appreciate, when it can be done properly, the privilege of calling to his counsel and assistance the knowledge and experience of his Fellows, to relieve from doubt, and to divide the responsibilities, in cases of great interest and important results.

To knowledge and integrity let there be added refinement, modesty, kindness, benevolence, and sympathy, and the physician will be prepared to do his work with credit to himself, and honor to the profession; and to be rewarded with the gratitude and affection and esteem of those who have received good at his hand, and also by the commendation of a conscience void of offence.

Besides what we have already noticed, there are other causes which operate to impede the onward progress of our profession, and to detract from its deserved reputation. Among those, there is perhaps no one more formidable and pernicious than the seeming necessity of some species of charlatanism to satisfy the caprices and prejudices of many in the community. What attaches importance to this malady is the stubborn fact, that this belief is entertained in every grade in society. A species of hallucination seems to pervade indiscriminately the learned and the unlearned, the rulers and the ruled. Daily observation demonstrates how ready all classes are to be duped by the wiles of the deceitful; and almost every returning year gives renewed evidence of the mistaken apprehension of our legislators, who, by their enactments, instead of sustaining and fostering the interests and prosperity of one of their chartered institutions, seem to show a disposition to prostrate to one common level the learned and the unlearned, and equally to appreciate the skill of the man of letters, and the impositions of the most blustering mountebank. Dr. Curtis, in his communication on the Public Hygiene of Massachusetts, says, “We have legislated, usque ad nauseam, on almost every thing but that which concerns us most, namely, the surest sources of health and life, and consequent happiness and prosperity. By legislation we have protected the beasts of the field, the fowls of the air, and the fish of the sea; by legislation we have encouraged the arts and sciences, except those which would most directly enable us to live long, useful, and happy; by legislation we have granted privileges to the manufacturer, developed the resources of the agriculturist, and, directly or indirectly, offered rewards for the best cattle, the fleetest horses, and the fattest hogs; have extended inducements for best building, greatest crops, and most improved implements, all of which is most praise worthy: but we have neglected to use the means for securing attainable longevity and exalted happiness, as well as some of the most prolific sources of State-wealth.”

Says Dr. Ware, “There are many persons, who, from their natural temperament, and there are many others, who, under the influence of disease, cannot be satisfied with the steady, sincere, and unpretending management which the self-respect of the regular practitioner obliges him to adopt. They require to be encouraged by hopes which are to prove fallacious, by promises which are to be broken; to be soothed and kept patient by a thousand flattering arts, which those who understand disease, and can really foresee its course, and who feel bound to honesty of purpose and deportment, cannot employ. Hence a resort to quackery is almost essential to this class of patients. Happy it doubtless is to many of them, that they can have recourse to those whose ignorance or whose conscience does not prevent them from pretending to knowledge which they do not possess, or from professing to accomplish that which we know to be impossible.” How to dispose of hindrances of such a character seems to baffle the understanding and wisdom of all. To brand them with the epithet of humbug, without apparent satisfactory reason, seems to add to their influence, and to lessen confidence in the regular practitioner. Many confidently believe, that they have been cured of diseases by taking the medicines and following the directions of these pretenders. Most undoubtedly, in some instances, the sick have received benefit. By indulging their caprices, access may perhaps be found to their understanding and judgment, and they may be made to apprehend the truth in its own light. Many diseases require chiefly cathartic medicines; and, so far as the various patent medicines and quack-nostrums are of that character, their administration may produce the effect desired. The Thompsonian form of medication will sometimes cure as well as kill; but, in most cases, a milder treatment will have quite as salutary an operation. The liberal use of cold water, judiciously and opportunely applied, is a valuable remedy in some cases, but will not always drown the disease, without drowning the patient also. The homoeopathist will also be successful, not because of his visionary theory and infinitesimal doses, but because there is no diseased action in the case beyond what will yield to the recuperative efforts of nature, assisted alone by strict diet and regimen. Much of the treatment, and many of the remedies, which are used hap-hazard in the various forms of quackery, in the hands of an educated and skilful physician, are found to be valuable, efficient, and useful medicines.

In the practice of medicine, that department which most requires knowledge, discrimination, and judgment, is concealed from the view of the unlearned. The application of the remedies appears to them to be the most difficult and important part in the treatment of disease. Hence, the bland promises in a label, and the syren song of the arch-deceiver, have their captivating power; and, while they hurry their victim to the grave, they at the same time inspire him with the delusive hope, that all is well; that health will again be restored; and that he will be enabled to realize the fulfilment of his fond expectations, and enjoy his anticipated happiness. This malcondition of our profession can best be remedied by an improvement in the system of education and an honorable deportment among all engaged in so important trusts. We need to be able to demonstrate to the whole public, that we are governed and sustained in our professional pursuits by a high degree of erudition and moral principle; while also it is needful to disabuse the minds of those who are shrouded in the misty atmosphere of quackery, and who are suffering in their interests, their health, and their lives, having been made the dupes of error and prejudice. Let it be so plain that the wayfaring man may clearly see a difference between the learned physician and the illiterate impostor; that different diseases require different medication; that one theory and the same treatment are not adapted to every species of derangement in the functions of the various organs. Let every regular practitioner aspire to such elevated attainments as shall leave no occasion for any one to ask, “What do ye more than others?” Let it also be very satisfactorily manifest, that the regularly educated physician has no fellowship with quackery in any of its multiplied fascinations; and that “practice, without the guide of science, is downright jargon and empiricism.”

I have thus ventured to suggest some modifications in the subject of medical education. Perhaps some may think them to be ill timed and preposterous on my part. With becoming deference to the opinions and practices of this Society, I have presented them for consideration, to be received or rejected according to their merits or demerits. I have neither wish nor design to appear before you this day in the spirit of radicalism, and a desire to raise a controversy, or to commence a reform, merely for the sake of a change. To the interests and prosperity of this Society I am most ardently attached; and for the course and conduct of its members, both the dead and the living, I entertain the greatest respect. To those who laid its foundation, and to those also who have watched over and guided its interests, until it has attained to its present dignified position, are due the highest veneration and most profound gratitude, not from medical men only, but from every member of the community. Nor do its prospects for improvement, honor, and usefulness, in the perspective, become less promising when we contemplate its present condition. Among those who are devoted to its welfare and prosperity are numbered many, who, for talents, enterprise, integrity, knowledge, and skill, are deservedly entitled to rank with the first intellects of the age. The peace and harmony which ever have existed, and still continue to pervade its every interest, the high attainments in erudition and the intelligence of its members, and the fixed determination to stand aloof from every species of charlatanism and to rely on its own resources, promise a brilliant career in ages to come.

It is not our business this day to found, to establish, or to create a Society. To us the task is assigned to maintain, to preserve, to perpetuate and perfect. Do not imagine this is a light duty; that it may be accomplished by the aid of passive virtues. Upon every work of man's hand, inevitable destiny writes the words, “This, too, shall pass away.” It is only at the price of perpetual vigilance that our institution can be maintained and prospered. Principles, like to those which founded it, must be sustained if we would preserve the Society. Occupying, as we the members of this Society now do, an elevated position, let us so live and act, that we may, so far as in us lies, transmit to our successors, unimpaired, the rich blessings and privileges which we have inherited. Before us lies a boundless and exulting future. Here, upon this narrow shoal and bank of the present time, we may stand, and, with proud consciousness, welcome the succeeding generations to a Society governed by wholesome laws, and sustained by a learned and honorable Fellowship. May we so live and so sustain our reputation, that, when those who follow us, in their turn, come to pass away from the active scenes of professional life, when they come to welcome, as we are now doing, the generation who shall succeed them, it may be with the same pride and hope which now burn in our bosoms, and with no mournful recollections drawn from a comparison of their present with their past; but may they welcome their successors to a Society which Massachusetts shall still be proud to own and honor, and on which kindred societies shall look with a spirit of emulation!

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