SMITH 
 
 -/c -«- •>«■ ~/<r ->c ■*■ 
 
 A Discourse 
 on the -fublic Duties of Medical Men 
 
ffl-XfiVBt 
 
 Sw£ 
 
 Columbia 3lfattoergitp 
 
 intljeCttpofltogcrk 
 
 College of iPftpgiciang ano Hmrgeons 
 Hitorarp 
 
Digitized by the Internet Archive 
 
 in 2011 with funding from 
 
 Open Knowledge Commons 
 
 http://www.archive.org/details/discourseonpubliOOsmit 
 
N^^^^^^^^^^^^^iS^ 
 
 $ B&&&B^^0WF^^^0^0m 
 
 §8§P"™^ 
 
 mm 
 
 ante 
 
 m 
 
 DISCOURSE 
 
 m 
 
 
 <M) 
 
 mm 
 
 PUBLIC DUTIES OF MEDICAL MEN, 
 
 mm 
 
 mm 
 
 mm 
 mm 
 mm 
 
 mm 
 
 mm 
 mm 
 mm 
 
 mm 
 
 |||||||a|a 
 
 y^ps, 
 
 
DISCOURSE 
 
 PUBLIC DUTIES OF MEDICAL MEN, 
 
 DELIVERED AS AN 
 
 INTRODUCTORY LECTURE 
 
 COLLEGE OF PHYSICIANS AND SURGEONS 
 
 IN THE CITY OF NEW-YORK, 
 
 November 2d, 1846. 
 
 BY JOSEPH MATHER SMITH, M. D. 
 
 Professor of the Theory and Practice of Physic, and Clinical Medicine. 
 
 N E W-Y R K : 
 
 DANIEL A D E E, PRINTER, 107 FULTON-STREET. 
 
 1846. 
 
PUBLISHED BY BEQUEST 
 
 OF THE STUDENTS OF THE COLLEGE 
 
 OF PHYSICIANS AND SUBGEONS OF THE UNIVEBSITY 
 
 OF THE STATE OF NeW-YoEK. 
 
 SESSION OF 1846—7. 
 
 
DISCOURSE. 
 
 Gentlemen : 
 
 The study of medicine, next to that of Divinity, if 
 rightly directed and applied to its appropriate objects, is, 
 of all intellectual pursuits, the most widely contributive to 
 human happiness. It embraces in its scope not only the 
 structure, and laws which govern the economy of organized 
 beings, and particularly that of man, but also the history 
 and properties of the agents which are operative in pro- 
 ducing disease, and in restoring and preserving health. 
 Comprehending, in a word, the phenomena of life, and 
 whatever tends to affect the mind and body, the science of 
 medicine may be said to extend over a wider field of in- 
 quiry than any other department of human knowledge. 
 
 With this view of medical science, the elements of which 
 form the subjects of the several courses of lectures deliver- 
 ed in this branch of our State University, allow me to lead 
 your minds to the contemplation of some of the duties 
 which will necessarily devolve upon those who make the 
 practice of Physic the pursuit of their lives. In doing 
 this, I am influenced by the conviction that nothing can 
 afford to the ingenuous student a stronger incentive to in- 
 dustry, than a plain exhibition of the high responsibilities 
 the physician assumes, in entering on the practice of his 
 profession. 
 
The duties of the physician may be properly divided in- 
 to public and private. The latter, which relate to the im- 
 mediate attendance on the sick, and the alleviation and re- 
 moval of individual suffering, have so frequently been the 
 theme of discourse in books and popular lectures, that I 
 shall not defain you by attempting to repeat them. The 
 former are, for the most part, of a different kind : — they 
 concern the general health and happiness of the community 
 at large ; and it is in the performance of them, that the 
 character, talents, and acquirements of the physician, are, 
 in a degree, exposed to the observation and scrutiny of the 
 world. The nature of these public duties, and the qualifi- 
 cations necessary to discharge them satisfactorily, will af- 
 ford, it is believed, a subject sufficiently interesting to en- 
 gage your attention on the present occasion. 
 
 No physician can be qualified to perform the various du- 
 ties imposed on him by the public authorities, without an 
 extensive and particular knowledge of the several depart- 
 ments of medical science ; for it is the possession of such 
 knowledge only, that can secure to him the confidence of 
 the public, and sustain the true dignity of the profession. 
 
 Of the many subjects, an acquaintance with which is in- 
 dispensable in him, who undertakes to aid in the delibera- 
 tions of legislative bodies, respect ng the public health, there 
 are none more important than the causes of disease, and the 
 means of obviating and counteracting their effects. To 
 enable one to speak with decision and authority on such 
 subjects, it is necessary to be conversant with the varieties 
 of climate and soil, the situation and topography of coun- 
 tries, the occupations, diet, and habits and manners of the 
 people. The influence of these severally, are every where 
 known to be powerfully operative on the human constitu- 
 tion ; and their united agency is deemed, by every sound 
 
philosopher, to have been sufficiently energetic to produce 
 all the varieties of color, and configuration of body, which 
 are observed among the different races of men. 
 
 The immediate and diversified effects of climate are in- 
 teresting to every class of persons ; but to none is the study 
 of its multifarious relations so important as to the student 
 of medical science. Its direct influence in producing and 
 modifying diseases, and, its subsidiary effect, in giving energy 
 to causes which otherwise would be inactive, should be sub- 
 jects of special inquiry with every one who wishes to attain 
 that knowledge, which will qualify him to discharge his 
 public duties, and elevate him in the scale of professional 
 reputation. The glory of Hippocrates was derived not 
 more from his sagacity as a pathological observer, than 
 from his knowledge of the character of diseases, as affected 
 by the influences of air, water, and localities. 
 
 But let us take a more particular view of the services 
 which the physician may be called to render to the commu- 
 nity. 
 
 Among the subjects on which his opinion may be requir- 
 ed, are the qualities of the waters used in diet and for other 
 purposes ; the properties and effects of certain articles of 
 food ; and the best mode of preserving the health and lives 
 of persons employed in certain manufacturing and other 
 occupations. His opinion may also be demanded with re- 
 gard to the location, plan, economical arrangement, and 
 dietaries of hospitals, alms-houses, prisons, and seminaries 
 of learning. To be enabled to advise on these various sub- 
 jects, it is necessary to have a knowledge of the principles 
 of hygiene, and to be informed with regard to the effects of 
 the various systems of management pursued in the manu- 
 facturing, humane, criminal, and literary institutions of 
 different countries. 
 
6 
 
 But it is in relation to matters connected with the ori- 
 gin, diffusion, and prophylactics of pestilential diseases, 
 that the physician is required to discharge duties of a 
 higher and more responsibta character. 
 
 Few cities in maritime situations, and, indeed, few of any 
 magnitude in the interior of countries, are exempt from 
 the occasional ravages of pestilential epidemics. The 
 frightful aspect of these diseases, and the fury with which 
 they frequently commence and pursue their career of deso- 
 lation, have, from the earliest ages, given them the first rank 
 in the list of human calamities. 
 
 In such seasons, when the popular mind is alarmed and 
 turned from its ordinary occupations, the responsibilities of 
 the physician occasion anxieties of extreme intensity ; for, 
 on him then devolves, not merely the duty of announcing 
 the appearance of the disease, but of watching and report- 
 ing its progressive extension, and of studying its origin, 
 nature, peculiarities and treatment. 
 
 To enable you to form a just idea of the circumstances, 
 in which he is required to perform such important services, 
 it will not be improper to cite a few examples of the terri- 
 ble fatality of pestilential epidemics, and of the depressing- 
 moral effects they produce on the community in which they 
 prevail. During the plague of London, in 1665, the deaths 
 were numbered at upwards of 6S,000. In 1709, the same 
 disease prevailed in Dantzic, and destroyed about 25,000 
 of its inhabitants. In the following year 30.000 perished 
 by it, in the city of Stockholm. In 1719, it ravaged Aleppo, 
 destroying in a short period 30,000 persons. Numerous in- 
 stances of epidemic plague, equally devastating, might be 
 adduced ; but it is deemed sufficient to add one or two ex- 
 amples illustrative of the mortality of yellow fever, or that 
 form of pestilence which has so frequently, within the last 
 
hundred years, visited the principal Atlantic cities of the 
 United States, and some of the larger sea-port towns of 
 southern Europe. Sir Gilbert Blane well remarks that, 
 "in respect to mortality, this epidemic takes precedence 
 even of the plague ; for, in a population of 16.000, civil 
 and military in Gibraltar in 1804, there perished 6,000 ; a 
 proportion considerably above that of the pestilence of the 
 Levant. In our own country, this disease has been scarcely 
 less malignant and fatal. Nearly 4,000 died of it in Phila- 
 delphia in 1793 ; and its prevalence in this city, and in 
 other American cities in 1795, and in subsequent years, af- 
 fords similar evidence of its extraordinary rate of mor- 
 tality. 
 
 As the plague and certain other malignant distempers, of 
 former ages, have left enduring memorials of their destruc- 
 tive energy, so will the epidemic cholera leave indelible traces 
 of its ravages in the present century. Commencing its de- 
 vastations in 1817, in the Delta of the Ganges, this fell 
 disease has over-run many of the most populous cities and 
 regions of the old and new world, destroying millions of 
 our race. 
 
 To complete the view of the terrific character of ma- 
 lignant epidemic visitations, let us contemplate their influ- 
 ence on the moral feelings. There are perhaps no circum- 
 stances which more powerfully affect the popular mind than 
 those of pestilence. The intellectual energies are paraly- 
 zed ; the depressing passions are awakened : and the com- 
 mon vocations of men are abandoned, or pursued with di- 
 minished alacrity. The history of epidemics furnishes many 
 illustrations of these remarks. Thucydides, in his admi- 
 rable account of the pestilence which ravaged Athens, du- 
 ring the invasion of Attica by the Peloponnesians and their 
 allies, says, to use the words of his translator Dr. Clifton r 
 
8 
 
 " that the most terrible circumstance of all was the depres- 
 sion of mind in those, that found themselves beginning to 
 be ill ; for, growing immediately desperate, they gave them- 
 selves over, without making any resistance." After describ- 
 ing the horrible mortality in the city generally, he remarks, 
 that " the temples, where they dwelt in tents, were also full 
 of the dead that died there ; for, oppressed to the last ex- 
 tremity by the violence of the distemper, and not knowing 
 what course to take, men grew equally careless about holy 
 and profane things. So deeply impressed were the Atheni- 
 ans with the idea that certain destruction awaited them, 
 that they yielded themselves up to desperation, and finally 
 to every licentious excess." " As to laborious works'" says, 
 Thucydides, "no man was forward to undertake anything 
 noble or laudable, not knowing whether they should live to 
 finish it ; but, what any man knew to be delightful and 
 every way conducing to pleasure, that was made both hono- 
 rable and profitable ; neither the fear of the gods, nor the 
 laws of men restrained any. For, with respect to the one, 
 they concluded from what they saw, that it was all the same, 
 whether they worshipped, or not worshipped, all men dying 
 without distinction ; and with respect to the other, no man 
 expected that his life would last till the law could punish 
 him for his misdemeanor." 
 
 To a similar state of grief and despair were the people 
 of London reduced by the plague, to which I have alluded. 
 Dr. Hodges tells us that the consternation was inexpressi- 
 ble, " The whole British nation wept for the miseries of 
 her metropolis." After narrating in detail the desolating 
 progress of the disease, he emphatically exclaims, 
 
 Quis talia fando 
 
 Temperet a lachrymis ? 
 
 The gloom and despondency which take possession of the 
 
mind in seasons of pestilence, give a new aspect to every- 
 thing connected with the present and future. Dr. Rush, 
 in his narrative of the state of his mind during the yel- 
 low fever in 1793, says, " My perception of time was new 
 to me. It was uncommonly slow. The ordinary business 
 and pursuits of men appeared to me in a light that was 
 equally new. The hearse and the grave mingled them- 
 selves with every view I took of human affairs." 
 
 Such is a feeble description of the calamities of pesti- 
 lence, the moral and physical phenomena of which are ex- 
 tremely interesting to every reflecting mind. 
 
 Now, it is in the midst of such scenes, that the physician 
 is expected to act with intelligence and deliberation. Though 
 breathing, in common with his fellow-citizens, a pestilential 
 atmosphere, and especially so in his visits to the crowded 
 hovels of poverty and tilth, no fears or anxieties should be 
 allowed to disturb his equanimity or embarrass his judg- 
 ment. His is then emphatically the post of danger, as it 
 is of duty and of honor. The public have a right to claim 
 his services ; and hence it is important that he be qualified 
 to render them Avith advantage to the community, and with 
 credit to himself and his profession. Thucydides, in his 
 history of the Athenian pestilence, called upon every phy- 
 sician to declare the origin of the distemper. During the 
 plague of London in 1665, the king "commanded the Col- 
 lege of Physicians jointly to write somewhat in English" 
 says Dr. Hodges, " that might be a general directory in this 
 calamitous exigence." 
 
 But in no pestilential period has recourse to our profes- 
 sion been more universal than during the wide-spread deso- 
 lations of the epidemic cholera. Wherever, in Europe, the 
 disease appeared, or threatened invasion, the municipal 
 authorities consulted learned physicians and medical 
 
10 
 
 associations ; and, for the most part, adopted the methods 
 suggested by them for averting or arresting its prevalence. 
 On its appearance in this city, in 1832, a medical council 
 was organized, at the head of which was placed the emi- 
 nent physician and surgeon, who now presides over this col- 
 lege ; and whose learning and practical wisdom are directed 
 to the promotion of its highest interests* 
 
 But how, it may be inquired, is the student to qualify 
 himself to serve the public under such trying circumstances ? 
 To this, it may be answered, that it is by investigating the 
 history and phenomena of epidemics. It is true, the essen- 
 tial nature of the causes of pestilence is involved in mys- 
 tery ; and the laws which govern the operation of those 
 causes are not fully ascertained. Still, the circumstances 
 in which many of them originate, and the mode in which 
 their agency is extended epidemically, are sufficiently well 
 understood to enable us to form correct opinions with re- 
 spect to their general attributes. 
 
 It is well known that few medical subjects have been 
 more fertile of controversy than the origin and mode of 
 propagation of pestilential fevers. The grand question re- 
 specting the contagiousness or non-contagiousness of these 
 fevers, though settled for the most part, on this side of the 
 Atlantic, is still agitated among the physicians of Europe. 
 As every measure designed to prevent or diminish the evils 
 of epidemics is based on the opinions formed concerning 
 the nature of their causes, and their mode of extension, it 
 may readily be conceived how important it is to under- 
 stand the merits of that controversy, in order to arrive at 
 satisfactory conclusions. Error on this subject is to be 
 deprecated not merely on account of its retarding the 
 
 * Alexander H.Stevens, M.D. 
 
11 
 
 progress of science, but for a more important reason. It 
 leads to the adoption of a system of measures which may 
 be oppressive and inefficient in its operations. 
 
 If the spread of pestilential fevers depend upon a conta- 
 gion transmitted from one individual to another, and capa- 
 ble of being transported from place to place, it is obvious 
 that the means of checking their diffusion should be found- 
 ed upon principles corresponding with the laws, which are 
 known to govern the extension of disorders confessedly 
 contagious. But if they originate from a poison, generated 
 from materials existing within the precincts of cities, and 
 totally disconnected from the living human body, a poison 
 incommunicable from one person to another, but diffused 
 through the common atmosphere and endangering all who 
 breathe it, it is equally plain that a very different system 
 of means is required to stay their prevalence and prevent 
 their recurrence. 
 
 The theory of the contagious nature of plague and yel- 
 low fever is so widely different from the doctrine of the 
 local and miasmatic origin of those diseases, that no regu- 
 lations, deduced exclusively from the one theory, can be 
 adapted to that of the other ; nor can there be any consis- 
 tency in a system of medical police which is designed to 
 meet both views of the subject. 
 
 When the Venetian Government in 1423, appointed offi- 
 cers to guard against the introduction of the plague, an 
 appointment from which originated lazarettoes and quaran- 
 tines, there was but one opinion respecting the cause of the 
 disease; and consequently no other preventive measures 
 were thought of, but those intended to exclude its reputed 
 contagion. From that period to the present day, the same 
 principles of medical police have, for the most part, pre- 
 vailed in regard to that disease in the different countries of 
 
12 
 
 Europe ; and have been implicitly adopted in this country^ 
 in relation to tne yellow fever. The correctness of those' 
 principles were long since called in question by many re- 
 spectable medical observers ; but the fears and prejudices 
 of mankind have hitherto allowed no facts, however well 
 established, and no arguments, however conclusive, to in- 
 duce them so to alter the regulations of quarantine, as to 
 make them harmonize with the doctrine of the endemic or' 
 miasmatic origin of malignant fevers. 
 
 There is a sentiment in the human mind, that strongly 
 resists innovations in institutions which have long been 
 established ; and its influence is seen to operate with most 
 energy in cases in which the proposed innovations are 
 founded on principles diametrically opposed to opinions, 
 which have received the approbation of ages. Even the 
 simplest improvements which science offers to the arts, are, 
 for the same reason, often tardily adopted. Since the re- 
 vival of letters, great and important improvements have 
 been made in the science of medicine ; improvements, 
 which have not required the sanction of the municipal au- 
 thorities, or alteration of legislative enactments to enable 
 the public to enjoy the benefits resulting from them. Had 
 such sanctions and emendations of law been necessary, be- 
 fore the world could have experienced the advantage of 
 those improvements, it is doubtful if medicine would yet 
 have emerged from the darkness of the fourteenth century. 
 Now, in common with every other department of medical 
 science, the etiology of pestilential fevers has, since the in- 
 stitution of quarantine, received large accessions of truth j 
 but it unfortunately happens that they are, in a great mea- 
 sure, practically useless, in consequence of the public au- 
 thorities refusing to adopt the system of police and hygiene, 
 which they naturally suggest. 
 
13 
 
 The only apology which can be offered in justification of 
 legislative bodies declining to alter the laws relating to 
 pestilential diseases, and particularly to quarantine, so as 
 to make them consistent with our improved knowledge of 
 the causes of those diseases, is the want of unanimity 
 among medical men. If appeals, however, were made to 
 those only, whose learning and opportunities for observation 
 have enabled them to trace the causes of malignant fevers 
 to their true sources, it is believed, there would not be found 
 sufficient discrepancy of opinion among them, to occasion 
 any embarrassment in arriving at just and satisfactory con- 
 clusions on the subject. 
 
 From these observations, an opinion may be formed of the 
 nature of the subjects, an acquaintance with which is neces- 
 sary, before the physician can be qualified to discharge the 
 implied obligation he takes upon himself to serve the pub- 
 lic, by pointing out the means of removing or preventing 
 the calamities of malignant epidemics. In investigating 
 these subjects no pre-conceived opinions or idolatrous at- 
 tachment to medical authorities should be allowed to in- 
 fluence his inquiries. A rigid adherence to facts, and a 
 strict observance of the rules of induction, cannot fail to 
 lead him to correct conclusions. When truth has been thus 
 attained, it is his imperative duty to urge it upon the atten- 
 tion of legislators, in order that the health laws may be 
 founded upon correct principles. Were the regulations of 
 quarantine so founded, the vexatious inconveniences, to 
 which the crews and passengers in ships recently arrived, 
 are, in many instances, subjected in this country and in 
 Europe, to say nothing of the detention of ships and their 
 cargoes, in certain cases, would not be experienced. The 
 interests of voyagers and the concerns of commerce, every 
 
14 
 
 where, with perhaps a few exceptions, demand a reform of 
 the systems of quarantine* 
 
 But further ; as it is the province of the physician to en- 
 lighten the public on the subject of the sources of pestilen- 
 tial diseases ; so it is, also, his duty to indicate other general 
 causes of disease, and to urge the adoption of means for 
 their correction. Among the causes referred to, there is 
 none more injurious to health than the use of intoxicating 
 liquors. Indeed, the amount of disease, poverty, immorality 
 and crime, produced by intemperance, vastly exceeds that 
 resulting from all other sources of physical suffering, de- 
 pravity and guilt. It was remarked, nearly two centuries 
 ago, by Lord Chief Justice Hale, that if the great enormi- 
 ties, which had come under his judication in the course of 
 twenty years, "were divided into five parts, four of them 
 
 * The great movement recently made in Europe, with a view to amend 
 the existing quarantine laws, there is reason to hope, will result in the 
 adoption of such modifications of them, as will make them accord with 
 the present state of our knowledge respecting the etiology of the plague. 
 " In 1838, a proposal was made by the French to the British Government 
 to promote the formation of a congress of delegates from the various 
 European States having ports in the Mediterranean, for the purpose of 
 agreeing upon some uniform system of quarantine regulations, to be 
 adopted by and binding upon all." For much new and valuable infor- 
 mation on this subject, reference may be had to " the Correspondence 
 respecting the Quarantine Laws, &c, presented to Parliament, 1846 ;" 
 and especially to ihs " Rapport a l'Academie Royale de Medecine sur 
 la Peste, et les Quarantaines, fait, au nom d'une commission, par M. le Dr. 
 Prus, &c, 1846," Analyses of these documents are given in the Med. 
 Chrurg. Review, No. 106. Recently, also, the quarantine laws in this 
 country have attracted attention. Able discussions of the subject are 
 published in the " Report of the special committee of the House of As- 
 sembly of the State of New-York, on the present Quarantine Laws, 
 1846 ;" and in the twentieth number of the New-York Journal of Medicine 
 and the Collateral Sciences, edited by Charles A. Lee, M.D. 
 
15 
 
 would be found to be issues and products of excessive drink- 
 ing, or of tavern and ale-house meetings." 
 
 Recognizing it as an obligation incumbent upon him, as a 
 physician and guardian of the public health, Dr. Rush, 
 years ago, widely proclaimed the mischiefs and extent of 
 this prevailing vice of our nation. But it is only of late 
 that the philanthropic of our whole country have been 
 awakened to a sense of its destructive consequences. It has 
 been remarked by a medical professor in a neighboring State 
 University, in speaking of the numerous victims of intem- 
 perance, that " well may war, pestilence and famine drop 
 for an instant their weapons of destruction, and look on 
 with astonishment and envious admiration, to behold their 
 own havoc so far outdone." 
 
 The magnitude of the evil in question, demands that 
 every medical man should gird himself to the work of pro- 
 moting the temperance reform which is now going onward 
 in the world ; and which the late lamented President of this 
 College, Dr. Watts, pronounced the greatest moral enter- 
 prise of the age. 
 
 But the public duties of physicians are not limited to the 
 objects, which have been mentioned. His services are re- 
 quired in the armies and navy of his country. In these, 
 he takes an honorable rank, corresponding with the responsi- 
 bilities which devolve upon him. 
 
 Without health, no soldiery can be eifective : and hence 
 its preservation is of the first importance to the state. The 
 strength of armies is often prostrated by disease ; and to this 
 cause is not unfrequently attributed the miscarriage of mili- 
 tary enterprises. It is well ascertained that more troops 
 perish by disease than fall by the sword ; a fact deeply in- 
 teresting to every nation engaged in war. 
 
 The diseases, from which soldiers most frequently suffer, 
 
16 
 
 in summer and autumn, are fever and dysentery. Numer- 
 ous examples illustrative of the great extent to which these 
 maladies prevail in armies, are recorded in the memoirs of 
 military medicine. We are told by Sir James McGrigor, 
 that in the peninsular army, there were admitted into the 
 British Hospitals, " during the years 1812-13, and part of 
 1814, 68,894 cases of fever, of which 6,703 died, equal to 
 9.7 per cent.; and during the same period there were admit- 
 ted into the regimental hospitals 7,526 cases of dysentery, 
 of which 4,717 died, or 62.5 per cent." It is said that we 
 ought not, during a campaign, to calculate upon less than 
 ten sick, to every one hundred fighting men. According to 
 M. Vaidy's estimate " an army of one hundred thousand 
 men may expect to have ten thousand sick during a cam- 
 paign, independent of any rencontre with the enemy ; of 
 which number five or six thousand may be medical and the 
 rest surgical cases ; but after a battle the proportion will 
 be reversed, and under the most favorable circumstances, he 
 calculates upon ten thousand or twelve thousand wounded 
 in addition to the above.' 1 The number of sick and wounded 
 among the American troops in the present Mexican cam- 
 paign, there is reason to believe, will be found to confirm 
 the correctness of the general statistical calculations of 
 Vaidy. Exposed as soldiers are to the vicissitudes of the 
 weather, and to the influence of climates, rendered un- 
 healthy by the extremes of atmospheric intemperature, and 
 noxious exhalations from the earth, their lives are constantly 
 endangered, and their constitutions, however robust, often 
 deeply impaired by privations, fatigues and irregularity of 
 habits. 
 
 It is to be noticed, however, that the health of an army 
 is often remarkably influenced by the morale of the troops, 
 a series of disasters depressing the mind, and thus favoring 
 
17 
 
 the action of morbific agents ; and, on the other hand, a 
 succession of victories producing mental phenomena which 
 fortify the system against the assaults of disease. The 
 latter fact is strikingly illustrated in the circumstance that 
 "after the battle of Austerlitz the French army, can- 
 toned in Bavaria, had only 100 sick in a division of 8,000 
 men." 
 
 To those intrusted with the health of soldiers, a know- 
 ledge of military hygeine and medical topography, in all 
 their details, is indispensable. The circumstances of armies, 
 in active service, are ever varying ; and consequently every- 
 thing relating to the peculiar endemic influences of different 
 localities, and to the qualities of the articles used in diet, 
 should be well understood by the medical officers. The 
 discipline and means of preserving the health of men in 
 the field are usually different from those which are proper 
 when they are in garrison. In the former situation, they 
 are subjected to the action of causes, which often vary in 
 their nature or mode of action, with every change in the 
 position of an army. In the latter, the causes of disease 
 are more uniform ; and when ascertained, admit of the ap- 
 plication of a uniform system of measures for their correc- 
 tion. In every situation the medical officers, if properly 
 qualified for their stations, may render important services 
 to their companions in arms. 
 
 The preservation of the lives and health of soldiers has 
 been esteemed an object of so much consequence as to 
 induce some governments to institute seminaries for educa- 
 ting army surgeons. As examples of this kind, may be men- 
 tioned those founded many years since at Vienna and Paus. 
 The former was called the Josephine Academy ; and was 
 " under the direction of the minister of war, out of whose 
 treasury, the salaries of the professors, and all other 
 
18 
 
 expenses were defrayed." The latter was established in 1794, 
 the French Republic finding it necessary to have medical 
 officers, specially prepared to serve in the navy and military 
 hospitals* The advantages of such institutions, and of 
 professorships for teaching military hygeine and medicine 
 in general medical schools, in countries where there are 
 large standing armies, and particularly in times of war., 
 cannot be doubted. If governments require the services of 
 medical men in their military establishments, it is proper 
 they should provide the means for educating them. 
 
 The value of the services of army physicians and 
 surgeons has been highly estimated from the earliest ages 
 of classic antiquity. Homer, in his Iliad, mentions in the 
 strongest terms of commendation the medical aid afforded 
 to the Greeks, by Podalirius and Machaon, at the siege of 
 Troy. When the latter had been wounded by Paris, he 
 represents Greece as trembling for her physician. In his 
 disabled state, at the command of Idomeneus, he is trans- 
 ported with dispatch to the fleet. 
 
 " Ascend, thy chariot, haste with speed away, 
 And great Machaon to the ships convey, 
 A wise physician skilled our wounds to heal, 
 Is more than armies to the public weal." 
 
 The distinctions conferred on military surgeons, in mo- 
 dern times, attest the value assigned to their knowledge 
 and skill. Napoleon, besides rewarding in a substantial 
 manner the services of Baron Larrey, his Surgeon in Chief, 
 honored him in his last will and testament with a bequest, 
 and pronounced him the most virtuous man he had known. 
 The laurels acquired by the surgeons of our revolutionary 
 army, still remain in freshness on their tombs. The name 
 
 * North American Med. and Surg. Journal, No. 4, p. 351, 354. 
 
-of Dr. Craik is rendered imperishable by the honor bestow- 
 ed upon him, and by the legacy left him by the illustrious 
 Commander-in-Chief. In the words of his biographer " he 
 was one, and what a proud eulogy it is, of whom the im- 
 mortal Washington was pleased to write in his will, 'my 
 compatriot in arms, my old and intimate friend. ; " 
 
 But there is another duty imposed on the physician, by 
 the public authorities. He is frequently summoned to give 
 his opinion at coroners' inquests, and in courts of justice. 
 In certain criminal cases, subjects exclusively medical, re- 
 quire to be elucidated, before a satisfactory verdict can be 
 rendered ; subjects which sometimes involve questions of the 
 most intricate and perplexing nature, and upon the correct 
 decision of which, depends the administration of justice. 
 In no public situation can a physician be placed, in which 
 his medical knowledge is so likely to be thoroughly tested 
 as in giving testimony before an enlightened court and 
 jury ; and hence, none but those who have devoted them- 
 selves to the study of juridical medicine can appear with 
 credit at a public tribunal as a medical witness. Whether 
 the subjects, on which his opinion is demanded, relate to 
 the slighter offences against the State, or to the more ag- 
 gravated ones of murder by mechanical violence or poison ; 
 or whether they respect the condition of individuals with 
 regard to sanity of intellect, the duty of the medical jurist 
 is in a high degree responsible. Erroneous opinions given 
 in such cases, may sometimes either allow the guilty to es- 
 cape retribution, or consign to death or imprisonment per- 
 sons innocent of the charges alleged against them. Can 
 any reflection occasion deeper contrition than that which 
 must arise in the mind of a conscientious physician who 
 discovers, after an innocent fellow-beino- has been ig-nomini- 
 ously deprived of life, that through his ignorance, culpable 
 
20 
 
 ignorance, he had contributed to a result so fearful ! The 
 great improvements which have been made in Medical 
 Jurisprudence within the last thirty years, have given to 
 this branch of medicine so high a degree of importance, 
 that no medical man is excusable for neglecting its study 
 In no country has it received more extensive contributions 
 than in the United States ; and I take pleasure in stating, 
 that two of the graduates of this college have given to the 
 world the most elaborate and valuable elementary work 
 which has appeared on the subject.* 
 
 In taking a general survey of the public duties of phy- 
 sicians, it may not be improper to speak of those of medi- 
 cal teachers. In truth, when regarded with attention, these 
 duties appear to be deserving of more consideration than 
 those of medical men in any other situation ; for upon the 
 proper performance of them, in a great degree depends the 
 qualifications of those, who are destined to pursue the prac- 
 tice of medicine as a profession, and consequently upon 
 whom will devolve the duty of serving the community both 
 in a public and private capacity. 
 
 In every country where literature and science receive the 
 fostering care of the government, legislators have seen the 
 wisdom of establishing seminaries for educating youth in 
 the elements of medicine ; and, as the interests of the pub- 
 lic are closely connected with the prosperity of such insti- 
 tutions, they have generally received the approbation and 
 support of the people. When regularly organized, and 
 provided with the means of carrying into effect, a system of 
 medical education, the public may reasonably expect that 
 their welfare will be promoted by sustaining them, especially 
 if the persons who assume the responsibilities of instructors 
 
 * T. Romeyn Beck, M.D., and John B. Beck, M.D. 
 
21 
 
 be qualified for their stations. It is obvious, that no one 
 is fitted for a preceptor, who is not himself a proficient in 
 the art or science he professes to teach. An acquaintance 
 with the elements and doctrines of the several branches of 
 medicine, a talent for accurate observation and analytical 
 research, a discriminating mind, a facility in communica- 
 ting knowledge, and studious habits, are among the more 
 important and essential qualifications of the medical 
 teacher. To these, should be united a deep sense of the re- 
 sponsibility of his office and an exemplary moral deport- 
 ment. 
 
 Teachers of theoretical and practical medicine are per- 
 haps more prone to adhere pertinaciously to opinions they 
 have long entertained, than professors in any other depart- 
 ment of philosophy. They are too frequently disposed to 
 rest their hopes of fame upon the establishment of theories 
 which new and accumulating facts are daily proving to be 
 visionary. This disposition to adhere to doctrines, which 
 have been often revolved in the mind, is, by no means, un- 
 natural. It is frequently the attendant of old age, and of 
 ardent and opinionated temperaments. Sometimes it re- 
 sults from a perverse unwillingness to yield, when refuted 
 by the plainest and most conclusive arguments. Such a 
 disposition, from whatever cause it may spring, should be 
 avoided or controlled by every votary of science. The 
 teacher of medicine should carefully avoid its influence ; 
 for, medicine, perhaps above every other, is a progressive 
 science. Its thories are often nothing but ingenious hypo- 
 theses, which serve no other purpose than to bind together 
 a series of facts, and which by the observation or discovery 
 of new facts are rendered nugatory. Theories, however, 
 are sometimes usefully employed in scientific researches ; 
 but they should never be allowed to impede our progress in 
 
22 
 
 the pursuit of inductive truth. The late Dr. Win. Hunter 
 remarks, in his introductory lecture to anatomy, that " In 
 our branch, those teachers who study to captivate young 
 minds with ingenious speculations, will not leave a reputa- 
 tion behind them, that will outlive them half a century. 
 When they cease from their labors, their labors will be 
 buried along with them." 
 
 Boerhaave, after completing his mechanical and humoral 
 theory, in forming which he freely availed himself of the 
 labors of his predecessors, admitted no material changes in 
 it. He devoted his attention chiefly to the physical quali- 
 ties of the body, neglecting, for the most part, the pheno- 
 mena, which depend upon the vital properties. Had he al- 
 lowed himself to investigate dispassionately, the opinions 
 of his contemporaries, Stahl and Hoffmann, the first of 
 whom led the way in the study of the vital powers, and 
 the second to the functions of the nervous system, he might 
 have so modified his system of pathology as to give it a 
 degree of perfection, that would perhaps have secured for it 
 a longer duration of authority in the schools, and left less 
 room for succeeding pathologists to distinguish themselves 
 by overthrowing his doctrines, and establishing others in 
 their place. In this respect Boerhaave affords a striking 
 instance of an ingenuous and noble mind, adhering to a 
 favorite system, even when the light of truth had shone 
 with sufficient brightness to show its defects* 
 
 * It is due, however, to the fame of this illustrious physician, to state, 
 as it is remarked by Dr. Good, that " his mind in the latter part of his 
 life, was so fallyopen to the merits of this (Hoffmannian) hypothesis, that 
 he admitted the agency of ,the nervous power, though a doctrine that 
 struck at the i-oot of his own system ; of which we have a clear proof in 
 the change which occurs in the fourth edition of his aphorisms, and par- 
 ticularly aphorism 755, wharehe lays down the proximate cause of inter- 
 mittant fever." — (Study of Medicine, VoL 2- p. 34J 
 
23 
 
 There are examples of distinguished teachers abandon- 
 ing their favorite theories, when, either from their own in- 
 quiries, or the arguments of others, they have been proved 
 to be erroneous. The late Dr. Armstrong publicly re- 
 nounced his opinion of the specific contagiousness of typhus 
 fever. His biographer, remarks that, " it has been object- 
 ed to him, that he is inconsistent with himself; that the 
 opinions towards the close of his life are opposed to those 
 which he published at the outset of his career. I admit," 
 he continues, "the fact, and claim from it, an acknowledg- 
 ment from candid minds, of the integrity of his own/' Dr. 
 Rush, though inflexible with regard to most of his medical 
 opinions, greatly increased the lustre of his fame by chang- 
 ing his views respecting the causes and mode of propagation 
 of yellow fever. He says that " the candor of Sydenham dis- 
 covers itself by the readiness with which he acknowledges 
 his having mistaken a nervous fever for a bastard peripneu- 
 mony ;" and he adds that " such instances of magnanimity 
 are very rare in all sciences ; and from the influence which 
 they have upon both interest and reputation, are less com- 
 mon among physicians, than men of other professions.''* 
 
 When teachers of medicine confine their theories to sub- 
 jects which have no direct bearing on practice, their ambi- 
 tious efforts to sustain them, are, in some degree, excusable. 
 But when from such theories are deduced principles and 
 rules for our guidance in the cure of diseases, the interests 
 of humanity require that they be decried and exploded. 
 Some of the theoretical systems and vagaries which have 
 risen and flourished in our own times are clearly charge- 
 able, in their practical application, with evils of this kind. 
 I allude more especially to the doctrines of Homoeopathy 
 
 * Memoir of the Life and Medical opinions of John Armstrong, M.D., 
 &c, by Francis Boott, M.D. 
 
24 
 
 and the fictions of Mesmerism. To those who have en- 
 riched their minds with the treasures of classical medical 
 literature, and made observation and experience the basis 
 of their reasoning and practice in medicine, the infinitesi- 
 mal therapeutic appliances of the former, and the chimeras 
 and prestiges of the latter, betray an utter disregard of 
 sound experimental truth, and a blind or wilful devotion 
 to visionary hypotheses. 
 
 I would not be understood as intimating that the princi- 
 ples of medicine are altogether unsettled and constantly 
 changing, and, therefore, should be distrusted. It is against 
 the seductions of speculation, and the trammels of exclu- 
 sive theories only, that medical teachers should cautiously 
 guard themselves. There are great and fundamental truths 
 which have long been established, and which constitute the 
 guides of rational practice. These truths, it is the province 
 of the medical instructor to expound and illustrate. It is 
 his duty rather to exhibit the structure and functions of the 
 body, the phenomena of health and disease, and the effects 
 of remedial agents as ascertained by experience, than to ex- 
 pend his labor in attempts to elucidate final causes, or to 
 determine the manner in which pathological and curative 
 effects are produced. Still these latter phenomena are le- 
 gitimate subjects of investigation, and should be studied 
 with all the cautions inculcated by the Baconian philoso- 
 phy,— always bearing in mind the sentiment of a biogra- 
 pher* of Bichafc, that "the philosopher should confine 
 himself to the study and observation of the sensible pheno- 
 mena which the structure and functions of organized 
 matter exhibit, without endeavoring to penetrate further; 
 —beyond, an immense abyss commences,- — we should take 
 
 Bichat 
 
 Scipio Pinel. See Beclard's Additions to the General Anatomy of 
 lat. 
 
25 
 
 care, lest we fall into it." In the present state of our 
 knowledge, medicine can receive no solid accessions from 
 theoretical systems. It is justly remarked by Reveille- 
 Parise, that " the eclectic school is the positive school of 
 our art, the realism of medicine." 
 
 But public medical instruction is not confined to collegi- 
 ate institutions. In many instances, the business of teach- 
 ing incidentally attaches to the medical officers of general 
 hospitals, and particularly of metropolitan hospitals. These 
 establishments, though sustained by the bounty of the pub- 
 lic, could have no existence, or rather would fail to fulfil 
 their benevolent ends, were it not for physicians and 
 surgeons. It is true, the chief occupation of medical 
 men in hospitals, is to cure and alleviate disease ; but in 
 connection with this service it is their duty, as opportuni- 
 ties may offer under certain regulations, to give lessons in 
 clinical medicine, to exhibit to the student the veritable 
 forms, symptoms and phases of disease, to practically illus- 
 trate the methods of diagnosis, to show the processes of 
 operative surgery, and to teach, by example, the art of pre- 
 scribing the therapeutic and regimenal treatment. In 
 performing these duties, medical men assume a double re- 
 sponsibility ; first, that connected with the welfare of the 
 patients committed to their care ; and secondly, that rela- 
 ting to the consequences which may, in private practice, 
 result from the instruction given to those, who follow them 
 in their visits to the bed-side. 
 
 In glancing at the duties of hospital physicians and 
 surgeons, we must not omit to notice the obligations resting 
 on those, who have in charge asylums for the insane. It is 
 in these institutions, that physicians are called to exercise 
 their skill, in the treatment of a class of affections which, 
 in many points, essentially differ from those admitted into 
 
26 
 
 ordinary hospitals, and to manage which, requires a kind of 
 knowledge not cultivated by the profession generally. So 
 important is this department of medicine regarded by the 
 professional gentlemen at the head of the lunatic establish- 
 ments in this country, that in order to its improvement, 
 they have recently formed themselves into a body, styled 
 " The Association of Medical Superintendants of Ameri- 
 can Institutions for the Insane." In this Association they 
 hope to be enabled to accumulate an amount of experience, 
 which will tend to improve the methods of treating the 
 most formidable of human maladies. Their purpose is 
 worthy of all praise ; and we cannot doubt that their la- 
 bors will result in the enlargement of their qualifications 
 to manage the thousand varied forms of moral and intellec- 
 tual insanity, — 
 
 " To minister to a mind diseased ; 
 Pluck from the memory a rooted sorrow, 
 Raze out the written troubles of the brain, 
 A id with some sweet oblivious antidote 
 Cleanse the stuffed bosom of that perilous stuff 
 Which weighs upon the heart." 
 
 Besides the various public duties of physicians, which 
 have been mentioned, there are others of a more general 
 nature. The character of a nation principally depends 
 upon the attention it gives to the promotion of letters, 
 science, and the arts ; and as the learned professions em- 
 brace a large proportion of those, who are devoted to the 
 advancement of knowledge, it is obvious that upon them 
 chiefly devolves the obligation to support and elevate -the 
 literary and scientific character of their country. Of these 
 professions, that of medicine is the one, from which are ex- 
 pected the largest additions to the natural sciences. Medi- 
 cal men are among the chief laborers in these departments' 
 
27 
 
 of research ; and hence it is incumbent on them to give 
 demonstrations of zeal and diligence in their pursuit. In 
 which, indeed, of these branches of study, have not medical 
 men been always and every where actively and successfully 
 engaged ? Witness, for example, their efficient participa- 
 tion in the recent laborious surveys of the natural history 
 of this country, conducted under the authority and auspi- 
 ces of the State governments : and may I not specify, in 
 particular, the extensive contributions made to botanical 
 science, by one of my learned friends and colleagues in this 
 institution ?* 
 
 The duty to which I now refer, though common to the 
 physicians of every country, is perhaps especially impera- 
 tive on those of America, on account of the assertion long 
 since made that the climate and soil, and also the animal 
 and vegetable productions of this continent are inferior to 
 those of Europe. This assertion, being unsupported by 
 facts, would never have required an elaborate refutation, 
 had it proceeded from persons of less distinction than Buf- 
 fon, Robertson, and the Abbe Raynell. The mere authority 
 of such names has had the effect to impress on the minds 
 •of Europeans a belief of its truth. The simple denial 
 of it on our part, has not been sufficient to rebut the asper- 
 sion. Positive proofs have been, and perhaps are still re- 
 quired to show its falsity. Among those who have suc- 
 cessfully defended our country, against the charge of infe- 
 riority, none have offered stronger facts, or more convincing- 
 arguments than physicians. The late Dr. Williamson has 
 clearly and satisfactorily shown that "there is not any vice 
 cf the climate, or combination of elements which prevents 
 ihe expansion of animated nature, and causes man and 
 
 * John Torrey, M.D. LL.D. 
 
28 
 
 beast to degenerate." It is undeniable that a country 
 overspread with forests, the growth of a thousand years, 
 and untouched by the plough and the spade, is not in a 
 condition to favor the development of the higher intellec- 
 tual and moral powers. But this fact is no proof that its 
 climate is radically vicious. The atmosphere of America 
 is essentially the same in its constitution as that of Europe. 
 The sun shines as resplendently in our western skies, as he 
 does in those of France, Italy, and Greece ; and when the 
 American soil shall be further subdued by agricultural in- 
 dustry, may we not expect an amelioration of climate? 
 Already in this respect, has a remarkable change been ef- 
 fected ; and there is reason to believe, that, at a period not 
 very distant, the United States, in some parts at least, will 
 possess an atmosphere as pure and invigorating, as exists in 
 the most favored regions of the earth. It cannot be con- 
 ceded that the climate of our country has at any time pre- 
 vented the expansion of the human mind. In its primitive 
 state, it may have had such a tendency ; but that tendency 
 has been rendered inoperative by circumstances of a moral 
 and political nature, circumstances sufficiently powerful to 
 overcome greater evils than the depressing climatic in- 
 fluences of an uncultivated country. 
 
 Temperate climates are peculiarly favorable to the de- 
 velopment of the physical and intellectual constitution of 
 man. That portion of the eastern continent, which lies 
 between the twenty-third and sixtieth degrees of north 
 latitude, embraces all the countries, in which our species 
 have attained the highest degree of perfection. With this 
 fact before us, what may we not hope for in the correspond- 
 ing latitudes of North America? The United States on 
 the western continent, and Portugal, Spain, Italy, Greece, 
 together with a part of France, Germany, Egypt, and 
 
29 
 
 Arabia lie within the same parallels : and consequently under 
 similar circumstances, we should expect man to become as 
 highly improved and polished in the one as in the other. A 
 comparison of places equally distant from the equator on 
 the two continents would not in the present age, be humilia- 
 ting to our country. Rome once the seat of universal em- 
 pire, is nearly in the same latitude with Boston ; but though 
 possessing a milder physical elimate, and superior in adven- 
 titious splendor, has produced few statesmen or philosophers 
 equal to Franklin. If we trace the lines of latitude, which 
 intersect Greece, through our own country, we shall find 
 them to pass through Virginia, the birth-place of Washing- 
 ington, in whom were united the moral daring and personal 
 courage of Philip and Alexander, the patriotism of Epam- 
 inondas, the legislative wisdom of Solon, and the sublime 
 moral sense of Plato. Such comparative remarks might 
 be extended to almost every elimate of our republic, and 
 in no instance should we have reason to blush. " If genius, 
 industry, erudition, and the liberal arts are begotten and 
 nourished in a temperate climate and a pure atmosphere," 
 says Dr. Williamson, " America has much to expect, for 
 the climate will ever be temperate, and the atmosphere 
 pure, through the greater part of the continent." 
 
 The Americans, I am aware, have been accused of too 
 much self-flattery ; and a British medical journalist has 
 hinted the impolicy of praising ourselves so immeasurably, 
 as we thereby leave no room for others to perform that 
 friendly office for us, on proper occasions. The accusation 
 perhaps is just ; but when we reflect that it is only within 
 a few years that our moral and political institutions, our 
 arts, literature, and sciences have been deemed worthy of 
 serious examination, and much less of comparison with 
 those of Europe, we shall find just ground of apology for 
 
30 
 
 the alleged impropriety. It is by no means wonderful that 
 in defending ourselves against the imputation of degeneracy, 
 we may have been urged by the taunts of Europeans to 
 rate our attainments in knowledge and moral excellence, 
 more highly than sober reflection would justify. Happily 
 the period has arrived in which more friendly feelings are 
 reciprocally manifested, and in which the scientific, medi- 
 cal, theological, and literary productions of our country- 
 men mingle with those of Europe, and every where receive, 
 according to their merit the respect due them in the great 
 community of philosophy and letters. 
 
 -Gentlemen, Graduates, and Students of Medicine : 
 
 In thus bringing before you some of the public duties 
 of physicians, it has been my purpose to show that the 
 science of medicine, so far from being limited in its appli- 
 tion to private or clinical practice, has bearings on objects 
 intimately connected with the prosperity, happiness, and 
 character of your country. A 5 ' science with relations so 
 various and important, affords, it is believed, ample room 
 for the exercise of the highest order of intellect. Emi- 
 nence, founded on positive merit, is, in few vocations, 
 more universal and durable than in the profession of 
 medicine. The desire to rise to an equality with, or 
 superior to others is a feeling common to noble minds, and 
 which, if duly cherished, doubles the power of the under- 
 standing, and sustains it in its highest efforts. Let ambi- 
 tion, therefore, regulated by principles of virtue and honor, 
 exert within you its stirring influence, ever remembering, 
 that united with talent and industry, it is the means of 
 mighty achievement, — it is the source of immortal re- 
 nown. 
 
COLUMBIA \ 
 
 exmW b °° k is du e c 
 expiration of a deficit 
 
 « Provided by £?2 
 
 lenient with tL e U 
 
 ; Y ^IBKAKY 
 
 [fate of borrows 
 — ~* **ry or W r, • *' 
 •^n in charge. y SpeciaJ ar- 
 
 _ 1 DATE DUE I „ T ^^^ = == 
 
 ^ " ~~~l^i±__DATE DUE 
 
 C28 (239)MI00 
 
n