Columbia ©mtotsitp College of 3Pf)2>stctang anb Hmrgeong ILibxavy Digitized by the Internet Archive in 2011 with funding from Open Knowledge Commons http://www.archive.org/details/introductoryaddrOOmanl INTRODUCTORY ADDRESS STUDENTS IN MEDICINE COLLEGE OF PHYSICIANS AND SURGEONS UNIVERSITY OF THE STATE OP NEW-YORK, DELIVERED NOV. 6, 1839. By JAMES R. MANLEY, M.D. LECTURER ON OBSTETRICS AND THE DISEASES OF WOMEN AND CHILDREN., NEW-YORK: PUBLISHED BY THE STUDENTS. 1839. INTRODUCTORY ADDRESS STUDENTS IN MEDICINE COLLEGE OF PHYSICIANS AND SURGEONS UNIVERSITY OF THE STATE OF NEW-YORK. DELIVERED NOV. G, 1839- By JAMES R. MANLEY, M.D. IICTUB.ER ON OBSTETRICS AND THE DISEASES 01 WOMEN AND CHlLDaEN, NE W-YO RE- PUBLISHED BY THE STUDENTS 1839. V i. 1 H. LUDWIG, PRINTER, 72 Vpsev-Ptrf.pt N. Y. ■ X ':/* ' /* New- York, November II, 1839. of rhysk Sir, At a meeting of the Students of the College of Physicians and Surgeons, held on the 9th inst., the undersigned were appointed a committee to request a copy of your very able'ahd appropriate Introductory Address for publication. YV« take great pleasure in thus conveying to you the wishes of the Class, and trust that you will find it convenient to comply with their request. We are, Sir, , Yours, with much respect, A. Cooke Hull, -* N. T. LlGHTBOURNE, D. J. McGowan, C. H. OaKLE5T, Johnson Rabineau, D.VV. C.Graham, James R. Greaxen, Chairman, James S. Cooper, Secretary. y Comv:i,ttee. J To f. R. Manley, M. D„ Professor of Obstetrics, &.c» New-Yore, November 13th, 1839. Gentlemen, Your very flattering note, of yesterday's date, I have just received, and take the earliest opportunity to reply to it. You have a reasonable claim for the copy of my introductory address, and I would be unreasonable to refuse it. On former occasions the same request has been made, and I have invariably one answer, to wit : that no man has a right to publish orally, that which he would be unwilling to print. The very handsome manner in which it is solicited, would be an additional reason if any were necessary. As soon as a copy can be prepared, it shall be at your service, as the one from which I read is a first draught, and it might be difficult for the printer to decipher it. I am, with great respect, Yours, very respectfully, JAMES R. MANLEY. To Messrs. A. Cooke Hull, " (l Jf # T # LlGHTBOURNE, " " D. J. McGowan, " " C. H. Oaklev, " " Johnson Rabineau, " " D. W. C. Graham, " " James R. Greacen, Chairman. " " James S. Cooper, Secretary. ? Committee. J K AN INTRODUCTORY LECTURE. Medicine is that branch of human knowledge, which has for its object an inquiry into the nature and causes of diseases, with a view to the discovery and adaptation of appropriate remedies. Man is so complex and delicate in his structure ; the life which he is destined to lead is so marked by vicissitudes, which he can neither control nor avoid ; the dangers to which he is subjected are so imminent and yet so concealed, and his forecast of consequences is so limited and so imperfect, as to render him the subject of every noxious agent calculated not only to peril his existence, but to make him the victim of its influ- ence : that it is a matter of astonishment he lives so long, or enjoys so much. From the first convulsive struggle for breathing life, to the last faint gasp which marks him for the tomb, there is a continued strife between powers which bind him to existence, and powers which menace his destruction; and it is a law of his nature that the last must triumph. To defer or procrastinate that event to its utmost period — to 2 permit as much of enjoyment, and to enable him ta avoid as much suffering, so far as that suffering arises from physical, as distinct from moral eauses, is its peculiar province. From the necessity and extent of its application, it must embrace a wide field of observation, require an intimate knowledge of the structure and functions of the human system, both in health and disease, and a close examination of the analogies which obtain in the various departments of natural history. Almost every branch of science is pressed into its service and made to contribute to its improvement ; so that the education of the well-instructed physician includes an amount of acquirement in the various departments of natural science, which we may not expect to find in any other profession. So wide is this field of research and observation, and so various the sources from which the student must derive his information, that it has not only been found convenient, but absolutely necessary, to divide the science into distinct departments ; each of which is important in itself, while all combined are essen- tial to constitute a whole system, with which he must become familiar, before he can lay claim to the cha- racter of an intelligent and successful physician. In this school of medicine the division of the studies has been made, with special reference to the eonve- nience of its acquisition. Anatomy and Physiology, Theory and Practice of Physic, Materia Medica and Legal Medicine, Principles and Practice of Surgery, Chemistry and Botany, are all taught by men alike qualified, both by the measure of their information, and their talent to communicate it; to render the several courses as instructive as they are interesting. In consequence of the resignation of the late able and intelligent Professor of Midwifery and the Dis- eases of Women and Children, the direction of this course of study, by a vote of the Trustees of this Institution has been assigned to me ; and I stand be- fore you in the character of a public lecturer for the first time. I trust, however, that I enter upon its duties with a full knowledge of the responsibilities of the charge, and a full determination to render it as easy of acquisition, and as interesting to the student as can consist with the importance of the subject and my own measure of ability. I cannot allow this occasion to pass without an acknowledgment to Dr. Delafield, who lately occu- pied this chair, for his kindness and liberality (mani- fested without permitting time for solicitation) in offering the use of his valuable museum for the illus- tration of this course of study. I beg him to accept my thanks, and on behalf of the Trustees of this School, I tender him theirs. 8 From the latitude of remark usually allowed in introductory addresses, I should feel warranted in selecting any subject connected with the course which was calculated to interest or entertain ; and those would probably create most interest in a mixed audience which admitted most scope for speculation. Such, for example, as the doctrines of Generation, Superfcetation, Foetal nutrition, &c, all of which, no matter how ably they might be discussed, are utterly destitute of any practical benefit. I have preferred, therefore, the beaten highways of acknowledged truth to the devious bye-paths of hypothetic debate ; and have chosen to present a view of the subjects which I have been appointed to teach, some of the principles upon which they rest, and the obvious duties which they require. I do not flatter myself that their novelty will entertain, still less that they will amuse ; they are too old to answer the one pur- pose, too hackneyed for the other, and too serious to be prostituted to either ; but as much is known to be true which is not properly appreciated, I presume that the few remarks which I may offer will not be without their interest. The course of instruction upon which we now en- ter not only includes the treatment of the gravid and parturient female, but the treatment of the diseases of women and children : under which head are com- prised all those diseases connected with, or in any manner dependent upon, the derangement of func- tions peculiar to the female. In this view of it, it must be confessed that its importance is much mag- nified, for it would not be difficult to shew that the fatality from this class of diseases immeasurably ex- ceeds that which follows from the diseases and acci- dents incident to the pregnant or parturient woman ; and the successful treatment of them, requires a more extensive range of observation, and a more close and intimate knowledge of the female constitution, than the art of Midwifery itself, considered apart from this relation. Every qualified Obstetrician must, from the nature of his vocation, be a well-informed physician, for, with the exceptions of manual and instrumental operations, or what is "usually styled Operative Mid- wifery, no well-founded distinction can be estab- lished between them. The education of the one ought to be the education of the other ; and where they are not, both are deficient. The study of every department of medical science is essential to both, the division into departments, as before stated, being created only to facilitate their acquisition. Midwifery is that branch of a medical education which has for its object the preservation of the health of the gravid female, her safe delivery, and perfect 10 recovery from its effects. It involves a knowledge of every branch usually taught in medical schools, and in addition, such a special and particular know- ledge of the female functions, as has made it neces- sary to consider it a separate and independent course of study. Its importance is too obvious to require a laboured recommendation; for whether considered in relation to the interest of the patient, or the repu- tation of the physician, no part of a medical educa- tion has higher claims to the attention of the student. His professional character is so intimately connected with his successful practice of this art, that he will find it is impossible to maintain the confidence of the community, if he be deficient in this single department. His professional standing in all other respects, may be as elevated as his most partial friends may desire, but failures here, in public opin- ion, admit of no apology, and are invariably followed by a retribution which will destroy all his future prospects. As a practised art, it must be almost as old as crea- tion, but there is very little in its early history to flatter the pride of science ; there is still less to imi- tate ; and really nothing which a humane mind can contemplate with complacency. The ancient prac- titioners of this art had no principles to govern them ; nor could they have, in the absence of that elemen- 11 tary knowledge which alone can serve for its founda- tion. Of Obstetric Anatomy they were lamentably ignorant, and their Physiology was conjectural. They appear to have given attention to it, only inciden- tally, for the practice was confined almost exclusively to the female sex. They had little opportunity of improving a science to which they did not profes- sionally devote themselves; and from the time of Hippocrates to Harvey, and perhaps long anterior to it, it might with truth be said, that the curse pro- nounced upon our first mother, and entailed upon all her succeeding daughters, lost nothing of its severity or bitterness by the officious interference of the male practitioner. All Midwifery to be found in ancient authors down to the time of Ambrose Pare, (who lived nearly con- temporary with the great Harvey,) is matter of sim- ple curiosity. Old medicine, like old statute law, must of necessity become obsolete. The conditions of society, and the measure of information extant when adopted, render them of little value after the lapse of ages ; and any progressively improving art or science can be but little indebted to its first projec- tors. From Pare we may date the origin of the Obste- tric art. He brought together the detached facts and opinions which were spread over the pages of a crude- 12 medical philosophy, and presented it in the form of a distinct science : and the opportunity afforded by the institution of public hospitals and infirmaries in his time, enabled him to teach a more rational mode of treating the parturient woman, than any who had preceded him. The progress of improvement from this point, although slow, was sure, down to the time of Dr. William Hunter, and thence onward to our own day, no branch of medical education has receiv- ed Greater accessions to its store of important facts, or made more rapid advances ; till we may say, with- out danger of successful contradiction, that its princi- ples are better settled, and its practice more rational than at any previous period. On the threshold of our inquiry into the nature of our vocation, we are necessarily directed to the physical character and constitution of her who is the subject of it. The knowledge of woman, both in re- lation to her structure and her functions, is so essential to a full understanding of them, that nothing on this interesting branch can deserve the name of science which has not this for its basis ; and indeed, without it, the whole is worse than useless, and woman would be more fortunate in being favoured with our neglect than with our attention. In the history of all animal creation, if one truth can be said to be more obvious than another, it is, that the Creator has adapted laws 13 for every living being, suited to the necessities of its existence ; and surely woman cannot be the excep- tion. The laws of her being have destined her to become a mother ; and to this end, long before she has attained maturity, and even without her con- sciousness, the powers of her nature, although si- lently operating, are directed. We see that her solid (bony) structure differs from that of the man, in shape, in consistence, and in capacity ; in order to qualify her, when the time shall come, to enter upon that interesting relation, with safety to herself and security for her offspring. We observe that the dis- tinction of sex is but one of many differences which exist between them, and that on her part, when they do exist, they all concur to the same great end. Her system of nerves, of muscles, and of blood-vessels, although essentially the same, are marked by such striking peculiarities, as scarcely escape the most common observation. The cellular tissue, which composes by far the largest part of the human body, is in her more abundant than in the man, and the specific gravity of her whole person is less. Her muscles are less strong, and possess less solidity ; her nervous system is more sensitive, her circulation more rapid, and every part of her structure, from its pe- culiar nature, independent of any adventitious cause, is more distensible and yielding, in order to provide, 3 14 when the time shall arrive, for those changes which are the necessary results of gestation ; and ensure her health and safety both as the expectant and ac- tual mother. She but obeys a law of her being in this relation : and He who made her has provided her with constitutional resources suited to her condition. Dr. Adam Clarke, the learned and ingenious com- mentator, whose skill in searching out the geneolo- gies of proper names is universally acknowledged ; derives the term woman from the Saxon word womb- man, or man with the womb ; and he takes occasion to say, that in many modern languages, the term sig- nifying woman is made by a simple feminine termin- ation of the word signifying man ; and the above ac- count, short and imperfect as it is, is in perfect accord- ance with that opinion. She is man with a womb, and therein consists all the distinction ; for whether she be considered morally, physically, or intellectually, the differences are all to be referred to this one cause ; and that she does differ in all these respects, even in- dependent of education, is pretty generally admitted. The influence of sex in determining the moral cha- racter is strikingly exemplified by a comparison of the several conditions of the male, the female, and the eunuch. The emasculated slave of the Eastern des- pot has nothing in his moral nature common to either sex. The physical courage, the intellectual vigour, 15 the noble daring, the strong passion belonging to the man ; are in him cowardice, mental imbecility, child- ish timidity, and idiot rage. Compared with woman, we find that the refinement, the ingenuousness, the excursive fancy, the child-like reliance on her protec- tor, the patient endurance under suffering, and the elasticity of temper, which all combine to render her the ornament of the social, and the delight of the do- mestic circle, are alike strange to his heart and alien to his conceptions. The outcast of humanity against his will, he is put to uses fit only for the brute. "With powers of intellect too barren to cultivate, and capacity for enjoyment but little more expanded than the child's, he basks in the sunshine of his master's favour, and is paid the wages of his meanness in sen- sual indulgences. Hybrid in body, soul, and spirit, after a short life spent in employments too disgusting to be named, to which neither man nor woman could be debased, he falls into the grave unhonoured and unwept. This is not the place nor the occasion to pursue this subject, although it is not deficient in interest to the practical physician. The necessary and re- ciprocal dependence upon each other, of the moral and physical natures, is too obvious to need illustra- tion ; and if the information to be derived from this source be properly improved it would explain some singular apparent anomalies in the pathology of 16 female complaints. I am not willing to say that our moral and intellectual powers depend essentially on organization, but I am willing to believe that the con- nection which subsists between the one and the other is so constant and invariable, as to warrant us to con- clude that they depend on each other; and the lead- ing features in the moral aspect which the female sex presents, as distinct from the male, under the same measure of culture, will go far to confirm our faith in this dependence. But to return to our immediate subject. This con- formity of the female, both in structure and function, to the great purpose of her creation, is so constant and invariable, under all circumstances and in all climates, in all healthy conditions of the subject ; as not to per- mit us to question that the whole process of repro- duction, so far as the female is concerned, from the first moment of conception to its final consummation in the birth of the offspring, is controlled by the same natural laws. And it is not unreasonable to believe, that in the primitive stages of society, very little, if any, assistance was required by the parturient mo- ther, more than could be afforded by the female attend- ant who had passed the same ordeal before her. We have the best authority for believing that, even at this day, in many parts of India, Africa, and Ame- rica, the parturient female neither wants nor needs 17 assistance. When her painful hour arrives, she se- cludes herself from her companions, or betakes her- self to some retreat sheltered from the sun and wind ; bears her agony in silence, as if impressed with its necessity, and the conviction that sympathy with her sufferings can neither prevent or mitigate them ; and after a short period returns to her family with the object of her solicitude cradled in her arms. Information derived from the Bible, the oldest au- thentic record, and our surest guide in matters of fact as well as in points of faith, permits us to conclude, that the safety of the parturient women was almost exclusively entrusted to their natural powers ; and we are assured that the Hebrew women, during the first captivity of their nation, for the most part, had no assistance even from their midwives, for it is recorded, that the midwives whom their oppressor ordered to destroy their male children, answered, that it was not their fault that they were not destroyed, for that the Hebrew women were delivered previous to their in- terference. The record is found in Exodus, chap. i. " And the king of Egypt called for the midwives, and said unto them, why have you done this thing, and have saved the men children alive 1 and the midwives said unto Pharaoh, because the Hebrew women are not as the Egyptian women, for they are lively, and are delivered ere the midwives come unto them." 18 The first recorded case of the death of a parturient woman may be found in the 35th chapter of Genesis, and is presumed to have occurred as a consequence of great fatigue in the progress of a tedious journey, since no other cause can be inferred from the text. Another may be found in 4th chap. 1st book of Sam- uel, and it occurred under circumstances of peculiar anxiety and mental distress. At the time of the last event the world was 3000 years old : generation after generation, for all that period, had been born and consigned to the tomb, before Midwifery was culti- vated even as an art, and the inference is a very natu- ral one, viz. that the process of parturition needed little of its assistance ; for if it had, it is scarcely pos- sible to suppose that it would have remained so long neglected. The above remarks, with the accompanying facts, will serve to establish the great principle which ought always to have a controlling influence over the opinions and conduct of all Obstetric practitioners ; but it must be confessed, that it presents only the bright side of the picture ; and it is but reasonable to suppose, that many perishedunder circumstances in which the ignorance or the incapacity of their female attendants could render no assistance. Nature does much ; we have seen that she provides for emergencies long before they happen, and that 19 every appointment of her ordering is of the most bene- ficent kind ; but however ample the provision, we must bear in mind that it is always of a general cha- racter, and has respect to the subject in her natural condition only. Deformity, disease, violence, acci- dents, and all the other ills that " flesh is heir to," are as much the inheritance of the female as of the male sex ; and it is to them, and not to the intrinsic difficulties which occasionally attend her condition as nurse or mother, that we are to attribute the evils she may suffer, or the dangers against which it is our business to protect her. These are the causes which have given, and will continue to give to Obstetrics the dignity of a science, because these are the causes which render the con- dition of our female patients perilous as well as pain- ful. Besides, the female is the subject of a function which has a controlling influence over her entire sys- tem ; its organ is the centre of more sympathies and associated actions than any other, or perhaps all others combined; and these sympathies vary in number and degree in such a manner as to defy a reference to any general rule. At one time this organ is per- fectly passive, at another, particularly sensitive and active ; and these various states, in so far as we can judge, are accompanied by no premonitions by which to calculate their consequences. It varies in size, it 20 differs in capacity, and it occasionally contains within its cavity a cause of sensation and of irritation to her whole system, which renders her liable to diseases and accidents from which our sex is totally exempt. In the gravid uterus the system is called upon not only to repair its own waste, according to the ordinary laws of life, but to support and maintain within itself an embryo being, which possesses nothing indepen- dent of her for its sustenance, but the principle of life. All its nourishment, however obtained, whether by imbibition, digestion, or the transfusion of her own vital circulation, must be derived from her. Her own system of nerves and blood-vessels, her whole digestive apparatus, nay, her absorbent and even muscular system, in so far as the muscles of the trunk and lower extremities are implicated in the process of gestation or parturition, are subjected to new and unwonted sources of irritation by mechani- cal pressure and distension; so that, but for the known modification of the ordinary physical laws which govern and control healthy actions, it would scarcely be possible to suppose that she could continue in a state of health. The diseases of early life, so trifling in amount as scarcely to claim attention, may be, and frequently are, so serious in their consequences, as to render gestation a source of anxiety, and parturiency preg- 21 tiant with danger. A chilblain on the heel, a wound upon the toe, the injury from a tight shoe, and above all, and more important than any, the discipline of a fashionable boarding-school, the very means taken to make the child a perfect woman in figure and prcn portion, may in certain conditions of the system in younger life, be sources of incalculable mischief when the child becomes a worn an $ and that woman a mo- ther. Derangements of the functions peculiar to the fe- male may so impair the health, as to render gestation a disease and immature delivery inevitable. Malcon- formation in the one case, haemorrhage in another ; awkward presentations in a third ; misplaced attach* ment of the connecting medium between the mother and the child ; convulsions* and various other causes which I need not here enumerate, as they will all claim our attention during the progress of this course, may place the lives of both the mother and child at haz- ard, and call for the exercise of a judgment to avert the dangers, which no moderate measure of acquire- ment can furnish. In one word, diseases in all their forms may supervene during the progress of gesta- tion, or even after a happy delivery, calculated to put in requisition all the resources of the best informed physician ; and it is in these and similar cases, and they are by no means uncommon, that all the science 4 22 and adroitness of the most skilful Obstetrician are required to be exercised. There are conditions for which unassisted nature has made no provision, and when they do occur, many of them must suggest their own rules of action even to the most intelligent and most experienced. For a large proportion of them, however, rules of practice have been adopted, sanctioned by reason and con- firmed by successful experience. What those rules of action are ; what are the reasons for their adoption ; and what the probability of success in case they are adopted ; must ever remain secrets to the ignorant practitioner. The language even of facts in Medi- cine or Midwifery, is as unintelligible to him who is ignorant of their application, as the language of music to the deaf, or of colour to him who cannot see. If he be not instructed in the principles of the science, the language addressed to his outward ears by his attendant counsel, will be as barren of conse- quence as if addressed to an idiot. Conscience, there- fore, as well as common sense, counsels every man who presumes to practice our profession, to qualify himself for its duties, before he enters upon their ex- ercise, and it is to this great purpose all medical education is directed. We have seen that the great principle which ought to control the practice of the Obstetric art, has its 23 foundation in a law of being. Not so with those which are subordinate. These must be derived from study, and a thorough knowledge of the structure and functions of the female, if they be necessary, (a truth which none will deny,) can only be acquired by a diligent application of the means which all well- regulated schools of medicine have provided. They have been already stated, and it is therefore unne- cessary to repeat them. Obstetrics, considered both as an art and a science, and they are so closely con- nected that their union is indissoluble, ranks second to none in the w T hole armoury of humanity for the mitigation of human suffering or the preservation of human life. The appliances of art here have kept pace with the improvement of science ; and he who presumes to practice it without a knowledge of both, or a reference to either, as unfortunately is some- times a fact, stands justly chargeable with the conse- quences, not only of all the errors which he commits, but with the disasters which, through his ignorance, he is unable to avert ; his ignorance assumes the character of crime, because the most expansive cha- rity cannot furnish an apology. But such is the folly of human judgment; the per- verseness of professional vanity, and the imposture of professional cunning, that, notwithstanding the in- structions which nature teaches, and the rules which 24 circumstances prescribe ; the patient parturient female, fully confiding in the resources of our art, often be- comes the victim of a mistaken or vicious practice. There are those, whose reliance on the resources of nature are so entire, that they anticipate no difficulty until danger presses, and when it does press, they are left without the expedients which a proper forecast would have enabled them to exercise. There are others who think, or appear to think, that such reli- ance impeaches the character of the science ; and that to wait on nature, whose operations are often- times tedious, is a duty too degrading for their measure of acquirement ; and there are others again, and I blush to name them, who, without any reason derived from the nature of the case, use the instru- ments of their art, with as little ceremony, I had almost said, as they would use a lancet. To these three classes of practitioners the malpractice in this part of our profession is justly attributable. The circumstances under which the first two classes pre- sent themselves, admit some hope of amendment, but the last, none. To the first, it is only necessary to say, inform yourselves. The want of that necessary education which is the ground-work of Midwifery, is one which we might as well expect nature to supply, as to expect it to be supplied without a diligent application to those 25 branches of the science which alone will teach it. The knowledge of physical conformation, of healthy function, and pathological condition, are all essen- tial to form estimates of consequences in cases of difficulty ; and it is on these, and these only, that the practitioner must rely for that measure of intelli- gence, which will enable him to anticipate them. Experience may do something, but experience itself can teach little, when the pupil is deficient in that elementary information which is essential to under- stand her lessons. The number of those, who, while they claim to be well instructed in their profession, continue to teach and practice, on the assumption that Art is omnipo- tent, and that the whole of midwifery consists in the art of delivery, we have a right to believe are few, in this country; but in Germany they abound. From the statistics of several Hospitals in the north of Europe, lately published, we learn, that in one in- stance, as many as one in five parturient women were delivered by instrumental assistance ; — in another, the proportion is one in nine — in another, one in fifteen — making the average proportion, when com- pared with the practice of the London and Dublin lying-in wards, as ten to one; so that while the proportion of instrumental deliveries in the last men- tioned places is as one to one hundred, the proportion 26 in the German Hospitals is 10 per cent, of the whole number. This disparity cannot arise either from accident or ignorance, but must find its explanation in the cause above stated. It is not my duty, and certainly it is not my design, to censure with unmerited severity, these palpable per- versions of the resources of our Art, but we may say, without hesitancy, that such an excessive proportion of instrumental deliveries, has heretofore been unknown, in any age or country. It is a remarkable fact, that this practice obtains in the same section of the world, where the doctrines of Homoeopathic medicine pre- vail. If they are inconsistent with themselves, however, it is no more than would be expected, as both are inconsistent with nature : they are at- tempts to be " wise above what is written," and the results of a knowledge derived from an experience so limited, as not to deserve the name: instrumental practice in Midwifery, and Homoeopathic medicines for recovery, would appear to leave nothing which a sound philosophy can either approve or applaud. The cure of this Obstetric heresy, if it admits a cure, must be left to time and to experience : the unfortu- nate results which must attend this practice, cannot fail to correct it. Of that class of practitioners here and elsewhere, 27 who causelessly use the instruments of our Art, we cannot speak in respectful terms, and do justice to our subject. Both reason and conscience unite to reprobate a practice which has nothing which even appears to palliate it : they may be, and without doubt are, more proper subjects for moral reform than for medical instruction. With such men I trust none of you can hold communion. He, who, in the character of an Accoucheur, can, without a distinct reference to the patient's relief, add one pang to the sufferings of the parturient fe- male, which, so far as we know, the Author of her being has intended for a memento of her mortality, cannot — ought not to claim any rank in our pro- fession : the retribution for his offences may be slow, but it must be certain ; and, come when it may, in the conflict with conscience, he must become the victim of a bitter remorse. Before I close, I would address one word to those of my audience who are candidates for the honours of the medical profession. From the few remarks which I have had the honour to submit, you may form a tolerably correct idea of your vocation ; you can estimate its importance, and you may judge of the extent of acquirement necessary to fulfil its duties. In the course of your future practice, you will be ,21 called to employ all the talents which you may pos* sess, and all the experience which yon can borrow ;■ and find, at last> that the sum total of both is insuffi-' cient for the occasional exigencies in which you may be called to act, as others have found before you. You will be placed in circumstances, in which your feelings and your duty may seriously conflict, and the practice of Midwifery frequently presents such occasions. If you would have that confidence, without which you can never inspire any in your patients ; for none will willingly trust those who will not trust them- selves ; if you would be armed for all emergencies, qualify yourselves by diligent application to study. A Sophomore physician is a dangerous man. The means placed at your disposal are ample, and yott will be left without apology, if you neglect them. Remember that ignorance, in its medical sense, is crime, when opportunity for information has been afforded, because its consequences frequently admit of no reparation ; whereas in all' other professions and employments, mistakes may be corrected : this single consideration should give to the practice of our profession, a moral sanction, stronger than any which human law can prescribe. COLUMBIA UNIVERSITY LIBRARIES This book is due on the date indicated below, or at the expiration of a definite period after the date of borrowing, as provided by the library rules or by special arrangement v/ith the Librarian in charge. DATE BORROWED DATE DUE DATE BORROWED DATE DUE ht\ :';&{ r\\ IIV/A ■ Mt,K - C28 (747; MICO 1 Ui ■" vi |0 ce- -in o M-$7rt fifdid