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Inaugural address to the College of Physicians and Surgeons of the City of Lexington and the County of Fayette / by Charles Caldwell. Caldwell, Charles, 1772-1853. 400dpi TIFF G4 page images University of Kentucky, Electronic Information Access & Management Center Lexington, Kentucky 2002 b92-187-30608065 Electronic reproduction. 2002. (Beyond the shelf, serving historic Kentuckiana through virtual access (IMLS LG-03-02-0012-02) ; These pages may be freely searched and displayed. Permission must be received for subsequent distribution in print or electronically. Inaugural address to the College of Physicians and Surgeons of the City of Lexington and the County of Fayette / by Charles Caldwell. Caldwell, Charles, 1772-1853. J. Clarke, Lexington, Ky. : 1836. 38 p. ; 21 cm. Coleman "Delivered by appointment, February 2d, 1836." Microfilm. Atlanta, Ga. : SOLINET, 1994. 1 microfilm reel ; 35 mm. (SOLINET/ASERL Cooperative Microfilming Project (NEH PS-20317) ; SOL MN04381.01 KUK) Printing Master B92-187. IMLS This electronic text file was created by Optical Character Recognition (OCR). No corrections have been made to the OCR-ed text and no editing has been done to the content of the original document. Encoding has been done through an automated process using the recommendations for Level 1 of the TEI in Libraries Guidelines. Digital page images are linked to the text file. Medicine Philosophy. AN INAUGURAL ADDRESS TO TILE COLLEGE OF PHYSICIANS SURGEONS OF TIF. CITY OF LEXINGTON AND) THE COUNTY OF FAYETTE. i3Y CHARLES CALDWELL, M. t,2 PUEBIDENT OF THIE COntLEGx. VELIUTERED Il APPOINTMENT, FEBRUARY Id, ISM. -LEXINGTON, KY; J. Clarke Co.--Printers 1836. This page in the original text is blank. AN INAUGURAL ADDRESS TO THI COLLEGE OF PHYSICIANS SURGEONS. Of T1I! CITY OF LEXINGTON AND THIE COUNTY OF FAYETTE, BY CHARLES CALDWELL, M. D. FRESIDINT O1 TUE COLLEGE. DELIVERED BY APPOINTMENT, FEBR[TARY Wd, 183. LEXINGTON, hVY; Clarke Co.---PriDter,. 1836. This page in the original text is blank. An Inavgaural Address to the College of Physicis and Sur geons of the City of Lexington and t/le County of Fayette. By CHARLES CALDWELL, M. 1)., President of the College. Delivered by appointmenit, February 2nd, 1836. GENTLEN1E.N,-M11an. is constitutionallk a being of society. One of the master faculties of his nature is a feeling that binds him to the companionship of his race. Nor, exce t under the exercise and gratification of that feeling, is it possille for him to be either happy in L.imself or useful to others, commanding in power or distinguished in action. In plainer terms; in an isolated condition, he would be feeble. inefficient and grovel- ling, gloomy ani wretched. Every approach that has been made by him toxvirds a solitary state is in proof of this. In accordance with this view of the subject, all the products of human enterprise and industry that have improved and de- corated the earth, and contributed to the comfort and refine- ment, the dignity. grandeur and felicity of our race, have been the offspring, in some way, of the social compact. From the labours of solitary man they could never have resulted. Even among the inferior animals, it is those alone that are social-that hold constant communion with each other, and la- bour in concert, that produce great effects, make other por- tions of nature bow to their influence, . nd become in some measure the masters of their own destiny. And united la. bours, where masses combine, rarely fIil to eventuate in this. When large numbers even of the humblest and feeblest of be- ings labour long and uninterruptedly at the same work, they often render its magnitude stupendous, and its strength and perfection a theme of wonder. The pyramidsl, hose miracles of human toil and power, are mole-hills and structures of a day, compared to the coral islands, destined no doubt to be. come the basis of future continents, erected in the Pacific and Southern oceans, by societies of polypi. 2 CALD.VELL's llau. atral Address. It is also numbers associated, and acting in union, that ren- ders animals, individually weak and insignificant, powerful for evil as well as for g)ood. On this ground the bee and the silk-worm furnish us with cloice and valuable articles for use and ornament: an army ot termites is a formidable enemy, and the locust and the plmor-worm lay countries desolate. Even in the vegetable kingdom confederated multitudes give efficacy and strength. As relates to inanl.ind, I say the sameis true. Whatever may be the enterprise they iaMeditate, or the end at which they aim, union is their streregth, their buckler. and their sword. One of the reasons, ar:d not an unsubstantial one, why tribes of savages, and hordes of b1arbarians are less efficient than civilized communities, is their want of well concerted social institutions. From tle sam-- cause, the ancients were, inl many respects, much less powerful and operative, than, from their numbers, intelligenec and enterprise. they might have been. Whatever were the wvisdom and excellence of some of their general social con.-pacts, we have no ground to believe, that their more circurnscribed societies were either numerous or judiciously instituted and conducted. It is in modern times. ani among the most enlightened na- tions. that the Treat maxim, "CtJNION Is STRENGTH,"' is fully under- stood, and extensively emploved, as a rule of action. And it is no less applicable to matters of mind, than to matters of body-no less so to oonfecderacies for the advancement of knowledge, and to political combinations for the furtherance of party purposes, than to armies for the detence and the conquest of nations. Never perhaps in any other country, or at any other time, has the power of individuals confederated, active and resolute, been so forcilly and formidably manifested, as in France, during her revolutionary convulsions. Elsewhere, however, such power has been much ml ore beneficently and laudably displayed. Soon after the period of the Revival of Letters, societies for the advancement of useful knowledge began to be estab liahedoin many paits cof Europe. And, continuing down to 4 CALDWELL'S Inaugtzral Address. the present time, they have served as so many fixed centre- livtrls,to dis pIl the mists of ignorancc and superstition, eradi- cate prejudices, and thus to if',uminate the world and amend its condition. Shedding their still increasing radiance on each other, and on alt intermediate and surrounding places, they have rendered, intellectually and morally, the same ser- vices, tLat the heavenly bodlies do, in their physical capacity. They have sent forth brightness and improvement, where, without them, comparative darkness and barbarism would have brooded. On the well knowvni principle expressed in the apothegmn, "e collisione scintilla." their very controversies and contensions have been fruitful in science. The amount of knowled(ge that has been thus elicited, beyond what would have been developed in any other way, is altogether incalcula- ble. In verification of this, we need onlv look into the trans- actions of the Royal Society of London, of the Royal Acad- emy and the National Institute of France, of the literary and philosophical societies of' Dublin, Edinburgh, Vienna, Berlin, Stockholm, St. Petersburgh, and of the other great capitals of Europe, and into those of the American Philosophical Society, and of sundry other like institutioas in tie United States- we have but to look into these results of human associations, and our proofs will be ample. In those productions and their radiant sources, we shall recognise so many intellectual stars of the first magnitude, with innumerable minor ones glitter- ing around them, the whole interchanging thsir lights with each other, and pouring through all cultivated nations their united effulgence. Nor, in kindling up this illumination so mighty and glorious, has the profession of M\edicine been wanting in its contribu- tions. Far from it. Many of the most illustrious members of the foremost societies in science and letters that the world has produced, have belonged to Medicine. In truth, physicians have done much more, in the development of the science of nature, than all other characters united. By the very name he bears; nature is designated as the physician's domain. Nor is this the only meed of commendation the profession de- CAAMWELL'S hnauggral Address serves. It has not merely co-operated with other enlighten. ed bodies in the promotioa of knowledge. The numerous so- cieties, purely medical, that have been erected in Christendom, have conferred on rmlan ins a1culable benufits, by their improve- ments in science, and its judicious employment in the preven- tion and mitigation of sickness and suffering, and the preser- vation of life. This representa ion, dice any one question it, might be abun- dant y sustained, by a reference to what has been done by the diffcient Colleges ofl hy.ieians and Surgeons, and by Medical Societies under other de lominations, that have been estab- lished so numerously in every country where science is culti- vated. And, in proportion to the multiplication of such in- stitutions, and the extent of country over which they have been planted, is the amoun; of the light they have shed around them, and the good they have effected. Wherever they have appeared under sound organization, and been judiciously con- ducted, professional enterp[ise, science, and beneficence have accompanied or followed them. Under this bright arid flattering view of the subject, I cannot but hail, as an event of faii and auspicious promise, the erec. tion of the College, I have she honor to address. Not only is that event conclusive of the westerly progress of medical sci- ence, and its collateral branches; it futher shows that the profession has attained already, in this highly favoured and fast-brightening region, ar, early maturity and a dignified standing. Nor, provided the institution be administered with wisdom and energy, can it fail to contribute, in an eminent degree, to the furtherance and confirmation of the rank, which westerm medicine has already acquired. It will aid in facili- tating and hasten ng, by the strength of combined numbers, what would acvance but slowly and with difficulty, and per- haps ultimately fail, under this languor and insufficiency of in- dividual enterprise. But no lasting improvement in human affairs can be the fruit of accident alone, momentary impulse, hasty conceptions, or immature counsels. It nr'ust be the product of time and re- 6 CALDWELL'S Inaugural Address. flection, judicious arrangement, and persevering labour. This is true of the issue of all enterprises, whether they be project- ed by individuals or associations. They must originate in ripe deliberations and forecast, and be conducted by svs em, else they will certainly f.il,and be productive perhaps of evil, rather than good. INor can our Cod ege exhibit an exception to the general rule. To labour successfully and (do the good it meditates, it must have in view well selected, definite, and substantial objects, and.must adopt a suitable scheme of ac- tion for their accomp is iment. And, fortunately for its pros- pects, such are the auspices, under which it is fu inded. 'I he general results at which it aims, arid an outline of its intended modes of attaining them, are brlieti sketched in tile preamble to its Constitution. The remainder of the present discourse, therefore, shall consist chiefly of thoughts and suggestions, respecting the procedure by Which thaL outline may be best filled up, and the picture finished. When contemplated in its entire character, Medicine pre- sents itself under a two-tbld aspect; that of a plysical science; and of apractical/profes.,ion. And the object of our College is its improvement in both. Nor must the moral of the pro- fession, which is its highest attribute, be nelectedor forgotten. Means for its improvement as a science rmcust be derived from two sources; the study by observation of' the structure and functions of the human body, as well in a healthy, as in a dis. eased condition, together with the causes, progress, seats and characters of disease, and of the means by which disordered action may be changed and rectified; and the study of books. And, to the formation of an enlightened and educated physi- cian, the pursuit of each course is alike indispensable. As a profession, apart from its literary and scientific char- acter, Medicine, besides judgment and skill, comprises two leading elements, manners and morals; and its cultivation in both is essential to the standing it ought to possess; and to which its votaries should be ambitious to raize it. The man- ners of a physician have also a two-fold bearing; towards his brethren of the profession, and toward the sick. In the former 7 8 CAL3WLL'S Inaugural Address. of theses relations, they constitute a portion of medical eti- quetle, and have no smr.ll influence on professional order, de- corum and harmony. Tney fall properly, therefore, under the cognisance cf the profession. But over his mere manners in the sickroom, although imnportant to his patients, as well as to himself, and over his mnanners as a man, the profession has no right of control. There are peculiar reasons, however, why the manners of a physician should be mild and affable, polished, courteous, and dignified, ev en beyond those of other cultivated men. A departure by him from this style of deportment does mischief, and is unbecom ng and often o(fensive. It approxi- mates, therefore, very c osely to a departure from rectitude. It is in medicine, lr ore especially than in any other vocation, that manners amournt to minor morals. An accomplished physician, therefore, is ar. accomplished gentleman. So far as he is defective in the latter respect, he falls below the standard of his profession. But I must dwell on this no longer. In offering to your consideration a few remarks on the other topics referred to, I shall speak of them in the order in which they have been mentioned. And first: Of the study of diseases, their causes, characters, and treatment, as they present themselves to our observation in the persons of the sick. So extensive and diversified is the field of inquiry, which this subject covers, that it will be impossible for me even to specify, much less discuss, all the numerous points it em- braces. The cause- of disease alone, with their modifications and combinations, would, if considered in detail, furnish mat. ter for a greater number of volumes, than I can devote to them even of pages. And, in this vast western region, so widely different from the regions of the east, they farm a study pecu- liarly important. Essentil as a knowledge of the causes pro- ducing our diseases is to the institution of a successful plan of treating them, it is still more essential on the score of their pre- v en tion. Difficult as the stady of medical etiology is in itself, its diffi- culty is greatly increased. in this section of the United States, 8 CALDWELL'S Inaugural Address. 9 by the rapidly changing condition of the country. The great Valley we inhabit is in a transition state. Such is the pro- gress of cultivation and improvement it it, that what existed and exerted an influence on the complaints of the last year, is materially altered during the present, and will sustain fur- ther alterations in the year that is to follow. Corresponding, therefore, to this unsettled state of things must be the changes in our diseases. Difficult, howvever, as is the task of investi- gating thoroughly, and correctly por raying western maladies, and of making known the true mode of treating them, it must be encountered and accomplished by the physicians of the 'West, else it will not he accomplished at all. Eastern physi- cians, whatever may be their pretensions and protestations on the subject; are totally incompetent to it. Of the real char- acter and mode of curing the complaints of this Valley, so different in all things from the valley of the Atlantic, they are strikingly ignorant. And they too often betray their igno- rance, by their inconsiderate efforts to appear informed. Nor can those young men, who, deluded by deceptive promises, cross the mountains to eastern schools of medicine, receive from lectures there, on the treatment of the diseases with which they are preparing to contend, a single original idea that is worthy of their attention at the time, or of' their re- membrance afterwards. All they can be amused with res- pecting it by Atlantic teaching is mere hearsay or conjecture, on the part of the teachers, and not the result of either obser- vation or study. How can the case be otherwise Not an eastern professor has ever devoted an hour to the rational and practical investigation of the character and treatment of western maladies! The reason is plain. He has never had an opportunity of thus investigating them, because he has never seen them. Under such circumstances, the pretence of enlightening young men on the subject, deserves a name, which a sentiment of delicacy toward our profession, and a feeling of respect for the audience I am addressing, withhold me from bestowing on it. Were I to pronounce it, however 10CALDWvuLL's Inaugural .iddres. unwarrantabla tasumption, it would be difficult to prove the imputation unmrrite(l. In proof of tle statement just submitted to you, I appeal to physicians who, having been educated in the East, have pursued their profession in the Western states, whether they have not been obliged to adopt a practice materially different from that inculcated in the Eastern schools Nor have I the slight- est doubt of thei. reply being jffirrnative. On the contrary, I know it wtill. Forgetting the precepts on practice received by them iil the east, those physicians have been compelled to become their. own practicul teachers, talking observation and experience for th6irguide. In further proof of the same sen- timent, let the learned professors of the eastern schools he themselves translited across the mountains, and pianted as practitioners in the Mississippi Valley-and mark the issue. And it wvill be hutnilia.tinrg to them. To become competent to the treatment of the complaints lo be encountered by them, they will be compelled to reject many of the notions they had previously tought, and learn new and more correct ones, from observation and experience, and from the practice and instruc- tion of the physilians around them-from the instruction of the same practitioners, as men, wimom they had themselves pre- tended to instruct, as pupils and boys! On the truth of this, I peril my reputation. The experiment would teach our eastern brethren two use- fiul lEssons- i.o prefer observation and experience, as sources of medical knowledge, to mere reading and theorizing; and to abstain fronm indelicate and unfounded censures of western practice in western complaints. Yet, do those gentleman openly and unblushingly persist in pretending to instruct others, on points respecting u hich they are uninstructed themselves! And, what is still more to be lamented, their pretence is received, by admiring iisteners, for wisdom and learning! It is time that this scheme of ";second- hand" teaching was brought to a close; and that it was suce ceeded by one of substantial usefulness! It will be understood that my reference is, not to the teaching of medical privcilpye 10 CALDAVELL'S Inaugural Address. but medical practice in diseases to which the teachers are en- "irc strangers. And if I speak wvith severity, my words are directed against the pretension ; not against those who ar. wan- lonly concerned ini It. Teachers who thus expose themselves, -are to be rearded ".mnore in pity thian in anger." Suppose western professors, who had never been east of the mountains, were to attempt, in their lectures, to teach the nature and treatment of the comiplaints of Philadelphia, Balti- more, and -New York, and to censure the practice of the phy- sicians of those cities-with what feelings, and in what tone would their eastern brethren reply to them The answer is plain. Tlley wvould either maintain a contemptuous silence; or their reply would be in the languaige of derision and rebuke. "Confine yourselves, gentlemnen, to your own side .of the mountains; and treat in youir lectures of things you under- stand; we can take care of ourselves and our patients, with- out your instruction!" Such would be the tone and spirit of their answer. Nor would the sneer be undeserved. And such is the answer to them, which, at the present period, our self-respect, concurring with truth and reason, instinctively dictates. Let us listen to the admonition then, and yield it obedience. But to return and more directly pursue my sub- ject. To the physicians of the Vest, I say, it belongs, no less on the score of personal and sectional pride, than on that of pub- lic duty, to vindicate their own characters, as men of obser- vation and industry, as well as of ability and standing in their profession, by giving correct accounts, descriptive, philosophi- cal, and therapeutical, of western complaints. And on you, as a portion of the tphysicians referred to, it' is incumbent to set an example of knowledge, enterprise, and labour, in this im- portant undertaking. Having deliberately pledged yourselves to that effect, in the adoption of the Constitution of the Col- lege, your course in relation to it is no longer optional. You must faithfully acquit yourselves of the special obligation thus contracted, or submit to the discreditable charge of indolence, 3 1 1 12 CALD1V ELL`! Inaugural Address. incompetence, or delinquency-or of the three united. Nor will the charge be disreputable only. It will be also injurious; because it will deprive ycu, not unjustly, of some amount of public confidence. He that is notoriously faithless in one thing, has a stain on 'his character, and is sure to be suspected of faithlessness in others. In your engagements, then, as members of the College, as in all other engagements, truth, punctuality, and a fulfilmnnt of the trust reposed in you, are the only means, by which you can usefully serve the institu- tion and the community, and secure yourselves from imputa- tions that must injure 3 ou. I have borne on this point the more earnestly, because it is that, in relation to which mem- bers of literary and scien-ific societies are most frequently wanting in duty. The prevailing diseases of this Valley, like those of other places, arise and receive their characters and modifications chiefly from two sources; the influences of the atmosphere; and the modes of life of the inhabitants; the latter including diet and drink, clothing, exercise, amusements, and habitual pursuits. And I need hardly add, that, in these respects, the people of the Mississippi Valley differ materially from those of all other sections of the United States. In the production cf disease, the atmosphere acts through a two-fold channel; its sen. ible, and its insensible qualities. The former of these are heat, cold, moisture, dryness, weight, and the transitions from one condition to another. As participa- ting extensively in tihe causation of disease, the influence of such conditions and changes must be attentively studied, by those who would attain to a knowledge of the subject. These agents again are subject to modifications from other causes. Prevailing winds affect materially the condition of the atmosphere, as respects its humidity, as well as its temperature, and its vicissitudes f'om one degree of temperature aud hu- midity to another. So do the clearing and cultivation of a country. By the latter causes, the climates of the older States of the Union have be en strikingly changed; and so have CALDWELL'S Inaugural Address. the characters of their prevailing complaints. And even in the Western States, young as they are, the effects of the same causes are already perceptible. Neither the climate nor the diseases of certain portions of this great Valley are the same now that they were forty years ago. The felling of our forests, and the advancement of agriculture act on a two- fold principle in changing our atmosphere, and the characters of our diseases. They give a freer passage to winds, whether hot or cold, moist or dry, and, by admitting the sunbeams to a less obstructed action on the surface of the earth, are in- strumental in augmenting the amount of evaporation. In con- sequence of this augmented ascent of moisture from the ground, the whole of which does not appear to descend again in dew or rain on the same spots, many superficial springs, which once contributed to water the country, have been supposed to have disappeared. An opinion, however, seems to be gaining ground, that they are not dried up, but have only changed their places of eruption from the surface. Hence, many of those natural fountains exist now, in places where they are believed not to have existed at the time of the first settlement of the country. There is no danger, therefore, of Kentucky being about to be drained of her waters, and reduced to a de- sert, according to the ominous prediction of the A bbe Correa, whose stock of language was far more abundant than his stock of science. An interesting question here presents itself. What, in their form, violence, and mortality, were the complaints of the early settlers of the West, compared to those which we now experience Unless the subject be soon investigated, a satis- factory answer to this question can never be rendered; be- cause the materials to frame it will be lost. The question might be proposed in a more general shape. What changes are produced in prevailing diseases, by the progress of agricul- ture, arts, and manufactures, united to an increase of luxury and refinement, indolence and ease Nor does any other re- gion afford such facilities for examining and solving this prob- 1 3 CALUWEfALS Inauour al Address. lem, as the Mississippi Valley. The question, therefore, ought not to be neglected. These several matters offer to the Col- lege so many topics of useful inquiry. Among the sensible qualities of the atmosphere may be further included the inflUence of electricity and light. And there is good reason te believe, that, in the production and modification of disease, those agents are far from being neu- tral. As relates to light, its influence on the action of organ- ized' beings, both anima, and vegetable, is matter of certainty. And electricity is far too powerful and active to be accounted neutral. There isground of probability, that the pitting of small- pox is owing in rome cegree to the influence of light. Dr. Luzenburg, of New Orleans, assures us, that, when he keeps his patient in darkness, curing the eruptive fever and the filling of the pock, the face is never disfigured by the complaint. The subject is emirnently worthy of further investigation. I have seen a few of Dr. Luzenburg's patients, from whose faces the light had been arefully excluded; and it was evident that the pitting, it any, would be exceedingly slight. By inquirers Into th e causes of health and sickness, there- fore, the action of those elements should be strictly inves- tigated. In a word; tha.t it may be able to form a proper esti- mate of the influences of the sensible qualities of the atmos- phere, in producing disease, and controlling its character, the College should keep a ccmplete register of the weather, with a corresponding register f prevailing complaints. In doing this it must employ the necessary instruments, especially the ther- mometer, barometer,pluviorneter, hygrometer, and electrome- ter. It must also register the courses and characters of winds, and the number of cloudy and sunshiny days, for the determi- nation of the quantity cf light enjoyed, independently of the amount of rain. Nor sh-)uld the influence of moon-light nights be unexamined. There is some reason to believe that lunar light is not altogether inefficient in its bearing on health. Though the eudiomneter does not test the sensible qualities of the atmosphere, it imay be associated with the instruments 14 CALTIiFWLL'S lflug'ural Addrass. already enumerated. It should make a part of the apparatus of every scientific body. In the production and modification of disease, the insensible qualities of the atmosphere are mnore powerful and deleterious than the sensible. Unfortlunately, however, our acquaintance with then is exceedingly limited. We have no test by which to determine their nature or character. Their very existence is revealed to us only by the complaints they produce. For want of better and more definite names, we call them consti- tutions of the atmosphere-meaning by the phrase some secret atniosphericat distemperature. They are no doubt formed by an impregnation of the atmosphere with different kinds of del- eterious gases, which may all be indicated by the term Mnalaria; but from what particular sources those gases arise, we do not in all cases know. That some of them result from the disso- lution of animal and vegetable substances, is not questionable. And that the others emanate from the earth, as the result of some agency not known to us, seems most probable. To those morbific conditions of the atmosphere called con- stitutions, are referable all our endemic and epidemic diseases. These, as you know, consist of bilious fever in the numerous and diversified shapes it puts on, cholera, influenza, scarlatina, hooping-cough, measles, and a few others. And you further know, that such complaints are not always uniform in their appearance. They are in no small degree, modified in their symptoms, as well as in their general type, obstinacy, violence, and dangerous tendency, by seasons of the year, states of the weather, topographical influences, and the pur- suits and modes of living of those whom they attack. Since the days of Hippocrates, and no doubt at a much earlier period, the study of endemics and epidemics, both scientifically and practically- with a reference to these influences, has been a favorite pursuit with some of the brightest ornaments of the medical profession, and the most distinguished benefactors of our race. Nor would I feel myself justified in declining to recommend it to the special attention of the members of the 115 CALDWEIL'S Inaugural Address. College. A subject mcre interesting, or of higher importance can hardly be presented to them. Add to the influences on endemics and epidemics just alluded to, those of the progress of cultivation, wvealth, refinement, and luxury, including in the account the corresponding differehces requisite in the treat- ment of them, and our acquaintance with them will be ample. Subjoin a correct view of the differences between the same epidemics in the Mississippi Valley and in the Atlantic States and elsewhere, and our knowledge of then will be sufficient- ly complete for all the purposes of theory and practice. Such are the imperfect suggestions, which the short time I have had to prepare myself on the subject, in the midst of many engrossing engagements, has enabled me to make, res- pecting our inquires into the causes, varieties, and appropri- ate treatment of our prevailing complaints. Nor is the best mode of guarding againsti attacks of them, when they do pre- vail, a less important theme of research. But on that topic a want of time forbids me to dilate. The study of the actual seats of disease, and of the condi- tion of the organ or organs in which they are located, is an- other subject of vital inlterest in the science of Medicine. Without a knowledge of these points, diseases are not under. stood, and cannot therefore be either correctly described, or rationally and successfully treated. This inquiry involves the study of morbid anatomy, and that imposes the necessity of post-mortem examinations. In cases where any doubt exists as to the locality, nature, and character of a malady, this form of research should never be neglected. Physically speaking, it is the only way te profit by mortality, and to derive from the dead a remedy for the living. By no other process can the secret workings of a disease be revealed. Be it then a constant and favourite object of the College, to make and en- courage post-mortem inspections, on all suitable occasions, and to remove, as far a.3 poss:ble, the prejudice and opposition, that have hitherto existed toward a practice, so wise, humane, beneficent and useful. Ti e benefit that must restlt from this 16 CALDWELL'S Inaugural Address. course, if skilfully pursued, and steadily persevered in, is be- yond computation. To profit to the full extent, by these forms of research, each individual should keep a record of his observations. This practice will be beneficial in sundry points of view. Facts will be examined moie carefully, ascertained more accurate- ly, and collected more abundantly; and, when collected, they will never be forgotton; or if they should be, the remembrance of them can be easily revived. One of the most instructive volumes a physician can peruse, is his own common place- book, of a few years standing-provided it has been industri- ously and skilfully kept. Nor should he rest content with merely collecting matter, and putting it rudely on record. Still further benefit will result from his writing portions of it carefully out, and preparing them for the press. Nor will the public alone be the gainers by this. In point of mental improvement, the writer himself wilt profit much more than any of his readers. "Qui docet discit"-he who teaches, learns -is a maxim as important as it is true, and should never be forgotten, by those who are ambitious of science and letters. I do not say that no physician ever understands a subject well, until he has written on it, or prepared himself to write. But I do say, that, provided he writes carefully and accurately, he understands, it much better afterwards, than he did before. His individual ideas respecting it, if not more numerous, are clearer and better defined; he knows much better which of them are strictly appropriate to it and which not, and his en- tire view of it is broader, fuller, and more mature. His know- ledge of it is purified, select and embodied, and possesses shape, solidity and value. Hence the soundness of the re- mark, that, "while reading makes a man learned, and conver- sationfluent and ready, writing makes him accurate and defi- nite" in the communication of his thoughts. That the College may fully attain, therefore, the objects it contemplates, it will be indispensable that its members accustom themselves to com position, and commit their productions to the press, in the form 1 7 CALDWELL' X Inaugural Address. of Transaction.,e or in some of the Medical Journals of the country. In no other way can it rise to the summit either of reputation or usefulness, at which it should ainm. To accomplish its entire destiny, the institution must go still farther. Its attention must not be confined exclusively to the diseases of our co intry. It will be necessary for it to embrace in its researches a field both wider, fuller, and of great- er variety. The antiquities of the West, those mouldering relics of an extinguished race, have a claim on its regard. So have our minerals, plants, and aninials, as belonging to sciences collateral to medicine. The formation of cabinets of these productions would contribute -to the gratification of enlight- ened curiosity, as well as to the advancement of useful know- ledge. Added to the i-ational pleasure accompanying themn, such pursuits would enrich and liberalize the minds of the in- quirers, and aid in developing the resources of the West. Nor is this all. The development of our medical statistics might occupy advantasjeously a portion of the time of the members of the College. How dio the healthfulness and lon- gevity of the West and South compare with those of the East and North What is the comparative proportions of births to deaths, in these two sections of the Union And what the comparative numbers of octogenarians, nonagena- rians, and centenarians in a given amount' of population What is the comparative health of infants and children, in the North and in the South, and what the comparative facility of rearing them As closely connected with this inquiry, what is the relative size of native familes in the two regions Finally, is it true, that, under suitable circumspection and care, and including the entire compass of the year, health in general is more secure in the Eastern and Northern, than in the Western and Southern States However incredulous our transmon- tane fellow-citizens may be on the subject, I have long been persuaded, that this latte: question must be answered in the negative.-The most effectual means of protecting the health eof emigrants from one section of the United States to another, IS0 C.LIJDWILL'. Insaia-ural .Address. alli of securingr to theni a seasoning free from danger, is a topic that has never received the attention it deserves. As a matter ol science, no less than of philanthropy, it should be no longer neglected. And whether the migration be from cast and north to south and west, or in the opposite direction, I sasOAIz,, sir kness is equally to be looked for, and guarded a ga i nst. Trhe subject is, therelore, a comprehensive one. Thus far I have contined iny remarks to what may be termn- ed the study of the BOOK OF 'NATURE-a volume, which, when correctly interpreted, never misleads. With this alone, how- ever, phiyvicians must not remain content. They must study also books from tile ecss, especially recent productions of mnerit, and tile wvorls of the modern Fathers of Medicine. They will thus imurprove, at the same time, in medical literature; tand medical science. There is a fact suggested to me by these remarks to which I refer with no little reluctance; but, being, a fact, ifeel it my duty to refer to it. The physicians of the Arest read less than they ought to do, and much less thain tiley might do. There is no physician, whatever may be the extent of his practice, who may not redeem a portion of time for the perusal of books pertaining to his profession. In half the number of hours, that most physicians spend in idlenless and unimproving conversation, they might accumulate, by readinlg, a large and valuable amount of medical know- led(ge. Trhe burdensorme expense of a library is rendered, by many practitionlers. as a reason hy tlcy are destitute of one, and therefore do not read. Under this disadvantage the members of our Collece (1o not labour. The library of the Medical I)epart ment of Transylva nia is accessible to them; aud it is one of the choicest and best ini the United States. There is also a substitute for a library, to which every physician in the \West may resort. I allude to -Medical Journals, Reviews, and other Periodicals. By reading regularly one or two of these publications, the practitioner may do much toward keeping pace with the p)rogress of his profession. And the neg'lect of physicians on this point is a matter of equal sur- 4 9 CALDWELL'S Inauural Address. prise and regret. No practitioner, who values as he ought to (1o his professiond stading, should fail to avail himself of these abundant sources of knowledge. Being repositories of the most important disc )veries and improvements in the pro- fession, they should be resorted to, as the best substitutes for a library. Permit nie to lnention in this place, in terms which it amply deserves. a w3rk of peculiar ability and merit, the circulation of which ameng the physicians of the West would be a subject of rejoicilig to me. I allude to the 4"AMiERICAN CYCLOPEDIA OF PRACTICAL iMEDiCINE ANTD SURGERY,0 NOW ISSUING. PERIODICALLY FROI TllE PlhLADELPI3A PRESS. The true art of deriv'ing knowledge from books is too sel- dom practised by read 5rs, and is not perhaps very generally understood. To read and to learn are far from being neces- sarily synonymous terms. That a book may prove a source of learning and knowledge, it must be studied.y4.And to study is the same as to analyze, examine and compare with nature. The physician who does not read in this manner, may almost as well not read at all. "Studium sine calamo, somnium est," said one of the moost industrious and sagacious of inquirers. To study uithout s.pen in your hand, is but to dream. And there is much truti in th2 assertion. Why a pen in hand The answer is easy. To note such thoughts and passages, and to make such extracts, as may be most worthy of remembrance, and best suited to the attain- ment of any object, the cader may have in view, or to the il- lustration of any topic ho may be engaged in investigating. In doing this, the attention is at once excited and fixed. The matter is therefore more fully comprehended, better selected and assorted, and mnuch longer retained. Nor is this all. Such a digest or analysis is easily prepared, as may be fit for the pages of some Periodical. In this way the judicious and in- dustrious reader may instruct the public as well as himself. A procedure of tihe kind. by the members of the College, may be rendered exceedingly useful to the other physicians of the West and South, who find it impracticable to procure libraries. !20 CALDWELL'S Inau itral Ade ess. And the Transylvania Journal of Medicine may serve as the medium of their communication with their brethren. By pur- suing a course of this sort, and publishing occasionally what they collect by observation and experience, as well as by reading, they may render themselves, as other like institutions have done, a radiating centre of useful knowledge, for the in- struction of the less favoured portion of the profession. I should hold myself guilty of a neglect of duty, if I were not to refer to another source of knowledge, which I deem of surpassing interest and importance. And whatever emotions, the announcement may awaken in the minds of some of my audience, whether of surprise. disapprobation, disrespect, or merriment, be it understood that I allude to the study of Phre- nology. I say "study," serious study; not mere play, fire-sido prattle, or superficial reading about it, embracing a few ill-de- fined thoughts to-day, to be misapplied or forgotton to-rnor- row. I mean sober and persevering investigation, until the science is mastered. Phrenology is a legitimate branch of Medicine, and belongs therefore especially to the province of the physician. Nor do I hesitate to add, that it is so essential a branch, that, at the present day, and in the existing condition of physiological science, no physician is thoroughly educated without a know- ledge of it. The truth of this appears sufficiently from the definition of the term, which means an account of the struc- ture andfunctions of the brain. And if a physician is justly deemed defective in his education, from his want of an ac- quaintance with the anatomy and physiology of the stomach or lungs, he is still more so from an ignorance of those of the brain, the latter beingf the master viscus of the sVstem. To understand the pathology of mental derangement, without a previous knowledge of Phrenology, is impossible. The reason is plain. Pathology is nothing but diseased physiology. Phrenology, as already stated, includes, as one of its elements, the healthy physiology of the brain, and can alone lead to an acquaintance with the entire pathology of that viscus. And 21 CAL.DWYLL'S Inautural Adldrr"ss. mental derangement is -.nothing but the product of a patholoil- cal condition of the brain. As easilvy therefore, can the dis- eased functions of the lungs be understood, without a know- ledge of their healthy fhnctions, as the diseased functions of the brain, without a knowledge of its functions in health. But there exist other reasons, not to be disregarded, why physicians should study Phrenology. The science is spreading rapidly, both in Europe and the United States, and becoming fashionable and popula, For physicians to be strangers to it, therefore, will degradle and injure them. It -will convict them of ignorance in a b1ranch of their profession, which men of other vocations understand. "MAlen," did I say aye, and women too; for, in sone places, women are takincga lead in Phrenology, and pu;blislhing valuable and interesting -works on it. And it becomes physicians to be extremely careful, not to forfeit, on either ntell ctual or moral ground, the esteem of females. A forfeiture es the kind can never fail to injure themn seriously in their pcofessional prospects. In a word; the time s not far distant, when it will be as disgraceful and prejudicial to physicians, to be ignorant of Phrenology, as of any other branch of physiology or anato- my. Let me earnestly and gravely, then, recommend the study of it to every votary of medicine, who values his stand- ingin science, and is ambitious to keep pace with the march of his profession. Another branch of knowledge of great importance, yet much neglected, is Mled.ial Jurisprudence. I need not say, that, on a competent acquaintance with it, and its judicious application, depend in many cases, life, liberty, property, repu- tation, civil and polbtical rights and immunities, the peace and happiness of fambiies, and all else that renders human exis- tence desirable. This truth is too certain already to require confirmation. It is submitted to the members of the College therefore, whether it is not incumbent on them to study it themselves, and encourage, as far as practicable, the study of it by others. Like Phrenology, it is becoming a subject of much more attention, than it was even a few years ago. 22 CALDWELL:S In Ugit7a 1 Address. 23 Comparative anatomy and physiology make another subject of curious and interesting research, as well as a source of use- fuil knowledge. They throw on human anatomy and physiolo- gy, especially on the latter, light which cannot be derived from any other quarter. The study and promotion of this branch of knowledge, therefore, constitute an object highly worthy of the attention of our institution. But the entire duty of the College is not yet delineated. To improve the social condition of Medicine including its courtesies, no less than the intellectual, falls within our lro- vince. This too is a matter of interest and importance, as well to the public, as to the Profession itself. As heretofore stated, the strength and influence of men, whether in classes, or as a common body, depend on their union and harmonV wvith each other. This is as true of physicians as of the rest of mankind. And they are certainly, ais hysicians, more isolated and anti-social', than any other class of cultivated men. Assuredly they are much more so, than either lawyers or the Clergy. And hence, as a class, they have much less influ- ence. Without pretending to compute the proportional difference in numbers with any decree of exactness, I presume the United States contain five physicians for every lawyer, and ten at least for every clergyman. The physicians moreover, are as well gifted by nature, and as fully educated, as the mem- bers of the other two professions. Yet the lawyers and cler- gy govern the country. As a class, physicians have neither standing nor weight. As s , they are scarcely even spoken of or known. They are recognised only in their individual capacity, and possess alone individual influence. The words Bar and Clergy mean aggregate bodies in a confederate con- dition, and are therefore terms representative of power. And though physicians generally are sometimes designated by the term Faculty, neither standing nor influence is associated with the name. For this state of things there must be a strong reason. And it is alss a plain one. Lawyers and clergymen CALDWI LL's Inaug ural Address. act in bodies, an(" under compacts implied or expressed; while physicians act individually, without union or concert. In their power and influence, therefore, the former resemble well- disciplined veterans; the latter, new recruits, or militiamen, without discipline. True; from the natu e of their calling, and the established and necessary mode of pursuing it, lawyers and clergymen, especially the former,mast act more in concert than physicians, whose vocation is comparatively isolated and solitary. For this the only remedy within the power of physicians appears to be, the exercise of s rict courtesy and kind feelings towards each other as individuals, and the formation of special socie- ties, to draw themselves more frequently and cordially to- gether for common and friendly purposes, cultivate mutual acquaintance and companionship, and thus create in the Pro- fession some degree of consolidation, and render it instinct with a spirit of unity. By such a course may medical know- ledge and power be greatly augmented in our country, and the influence of the Profession be made much more available in benefitting the community. Let us fancy to ourselves the formation, in each State in the Union, of a Society or College in chief of Physicians and Surgeons, with a competent number of subordinate or colla- teral ones, all educatect physicians being members of them, and the whole ia active correspondenee with one another. Add to this a great Central College for the Nation, composed of deputies from thie State institutions, to meet at given pe- riods, as a body of reporters, and an Amphictionic Council, to manage the rmedical concerns of the Union. Of such a confederacy the power would be immense, and might be turn- ed to purposes the mose salutary and glorious. It might be made to confer on Medi2ine, in the United States, an amount of grandeur and ii-fluence, and rear it to a pitch of useful- ness and splendouv, wl ich have never belonged to it in any other country. Ats one of its high benefactions, it might re- duce the professior. to conmparative harmony, by suppressing 24 CALhVFELL'S Inaugural Address. tile jealousies and cavillings, denunciations and calumnies, among its members, that have disgraced and degraded it, and taken from it the influence it might otherwise have wielded. But this is not all. By an interchange of communications, wide and varied far beyond any thing of the sort that had pre- viously existed, it would, if such an event be possible, embody the whole medical knowledge of the Union in a common stock. Thus might there be brought against disease, in every quarter, the entire skill and healing power of a Na-tional Faculty. And thus might a light be sent forth to other nations, useful to them, and a source of professional glory to ourselves. By the weight of such an organization of Colleges, empiri- cism-n would be crushed; and enlightened practice alone would prevail. Even schools of medicine would soon feel its influ- ence, and be compelled to adopt such measures, and pursue such courses, as would no longer dishonor themselves and in- jure the Profession. No more artful and electioneering pro- ductions would issue from any of them, to palm on the easy credulity of the public, shams for realities, and fictions for facts. Nor would any Schools or their Professors be suffered, with impunity, to misrepresent and calumniate others, for their own benefit. In a word; the qualifications for medical teach- ing, then, would be talents and attainments, personal dignity, and moral standing, and a happy facility in communicating instruction; not the bluster of the pretender, the extravagant assumption of the self-eulogist, or the intrigues of the dema- gogue. Toward the production of this great national arrangement in medicine, our College can, in a direct manner, contribute but little. It may, however, by the adoption and judicious employment of suitable measures, become instrumental in the establishment of other medical associations in Kentucky, cor- respond with them, and thus both confer and receive by the intercourse, high and lasting professional benefits. It occurs to me that a scheme of this kind conducted with judgment, and aided by an efficient individual correspondence, would '2 2 CALDWh LL'S Inau-ural Address. be better calculated than perhaps any other, to elicit and em- body information. on tile diseases and medical statistics of the Commonwealth. NTor can I doubt that all the physicians of the State, anxious to io good, and zealous for the improve- ment of themselves and their profession, would heartily concur iII it. As it is the pu pose 4f the College to incorporate in its by- laws, all it may deemn requisite respecting medical etiquette and decorum, my remarks on that subject shall be brief and few. Etiquette and decorum are but other names for courtesy and good breeding, Keith the requisite admixture of special falshion in them. And they are most successfully cultivated bv intercourse anid socihty. Companionship and intimacy be- tween persons engaged in the same pursuits, rarely fail to be- get mutual kindness and esteem, accompanied by a recipro- cation of good offlces. By meeting frequently in societies, therefore, exchanc-ing, thoughts and civilities, and giving utterance to feeling resoectingr matters of common interest, physicians will contract for each other professional and per- sonal regards, whichv wil! do much in producing and maintaining between them those kitnd and respectful observances, which, decorum requires, and ws hich usually mark the intercourse of cultivated minds. In a word; did physicians mingle together as habitually and Famiiiarly, as lawyers always do, and as clergymnen do, when circumstances permit them, they would live in equal harmony; and the jealousies and strifes that de- grade the Profession, and detract fiomn its usefulness, would be no longer spoken of in terms of reproach. Independent- ly then of their rules ard regulations to that effect, -'Medical Associations, from their natural influence, tend to the preven- tion of professional dis ourtesies, animosities, and wrongs. Between the many hundred members of the College of Phy- sicians, and of the Medico-Chirurgical Society, of London, individual hostilities are rarely heard of, and acts of medical discourtesy and injustice are unknown; while personal friend- ships are numerous and warm. 26d CALDWELL'. Inaugural Addresi. But the noblest end at which Colleges of Physicians and Surgeons can aim, and at which they should never cease to aim, until it is accomplished, is yet to be mentioned. It is the purification of the Profession from all unworthy motives and practices, the expulsion from it of all that i, mean, sordid and sinister, the advancement and security of its morality and honour, and the maintenance of its dignity. Medicine is a lofty and liberal calling, the fairest, foremost, and most efficient handmaid of benevolence and philanthropy; not a trickish, grovelling, money-making scheme of barter and traffic. Its true end is to minister to humanity and public good, not to personal cupidity and selfishness-to preserve life, restore health, and relieve the sufferings of the sick and the distresses of their friends; not to gratify the acquisitiveness, and fill the coffers of the covetous and the uncharitable. As respects every new case of disease a practitioner is called to attend, let his calculation be, how much good he can do, and how much credit he can add to his profession; not what amount of pecuniary profit he can make by the job. The physician who cannot, especially on pressing and perilous emergencies, for- get himself, both as to danger and all other personal and sel- fish considerations, in the interest he feels in the condition of the sirck, the honour of medicine, and the public welfare, is unworthy of his vocation, and xvill never rise in it to enviable eminence. He may prove a successful trader in it, but nothing more. Ile will never be deco;ated with its honours while living, nor have his memory embalmed by either its regrets or its praises when dead. Like the ingrate who is heartlessly indif- ferent to his country. and whom the poet has deservedly given to infamy, the sordid trafficker in medicine, "Living shall forfeit fair renown, And doubly dying shall go down To the vile earth from which he sprung, Unwept, unhoaored, and unsuing." In making these remarks, let me not be misunderstood. I do not mean that the practitioner of medicine is not to be rewarded 5 27 CALDWELL'S Inaugnral Address. for his services. Far from it. Provided he be able, and faithful to his trust, no Maan is more worthy of a liberal reward. His education has been expensive to him, both in time and money; his professional labours are severe and burdensome, and his fatigues and exposures great and dangerous; and. in value, the survices he renders are unsurpassed. To these elements of his merit, therefore, his compensations should cor- respond. But they should be required and made, with liberal views, and on honorable grounds. Hence they should never be exacted in cases v here payment would create distress; nor, except in cases of marked injustice, through the medium of law. The widow, tl,2 orphan, and the honest and industri- ous poor should never Le made to feel them. Physicians, moreover. should have a mutual and fair under- standing in relation to the rate of their charges. And from that rate, except unde: peculiar and palpable circumstances, no one should deviate. In a special manner, no one should undercharge, for tne sake of acquiring popularity and business, and thus treacherously sapping the interest of his profession- al brethren. No man cmin be more contemptible, than he who higgles in a cheack-shop in medicine. The modes in .which our profession is demoralized and dis- honored by its members, are numerous. A want of time, however, forbids me to do more than make a passing refer- ence to a few of them. The first of thkLin I shall notice is the practice of dealing in secrets and ncstiums. Under whatever form, in whatever manner this dev!ie m,,y be employed. it is quackery, and should be frowned on an i denounced by the members of the College. Nor should any companionship, social or profession- al, be held with those by whom it is pursued. It is the product of ignorance, heartless illiberality or fraudulent artifice. In the two former cases, it is contemptible, and, in the latter, no better than deliberate swindling. It is much worse; for, in addition to feloniously taking possession of money, it discour- ages knowledge and impedes its progress, inculcates falsehood 28 CALLWvELLi Is litLUgPLul Addi'CESS. 29 and perpetuates prejudice. Nor is this all. Admitting that a physician has really made a valuable discovery in the treat- ment of disease; is he justifiable in concealing it, for his own exclusive pecuniary benefit, and the relief of those alone who become his patients Assuredly hie is not. I1 its true spirit and bearing, medicine is a social profession-an institution of benevolence and conscience, rather tian of self. The concealment referred to, therefore, is a conpiracy withl disease; if not to aid it, at least to connive at its ravages, and give them scope, when they might be mitigated or arrested. And that is crim- inal. Hie who deliberately conceals a remedy or mode of treatment, that might prevent death, is but little better, if better at all, than an accessory to homicide. As such he de- serves reprobation, not to say some form of punishment by law. Felons have been transported, and have even expired on the gibbet, for crimes much less inhuman and prejudicial to society. One of the most mischievous and reprehensible practices of our government, is its giving countenance and aid to nostrum-mongers and impostors, by granting them pa- tents for the preparation and sale of their concoctions and mixtures. As wvell might it give public sanction to any other form of outrace on mnorality and trutlh. Insomerespects at least the granting of authority to counterfeit bank notes would be less pernicious. That would neitherdestroy huiman life directly, nor render remediable complaints incurable; while patent com- pounds frequently do both. This desecration of govermental au- thority should be condemned and protested against, not only by all educated physicians, but by every enlightened individu.al in the nation. The Medical associations of the United States in particular, and our College as one of them, ought not to regard such an evil with indifierence. To deprive quackery in this form of the countenance of government would do something toward its entire extinction. As a matter related to this subjuct, permit me to observe, that the establishment of a medical test in Kenlucky, would be a measure creditablel to the Commonwealth, and of deep CALDWELL'X Inaugural Addresx. interest to the healthand lives of its inhabitants. I allude to the passage of a law for the prevention and suppression of empiricism, so far as that can be effected, by compelling every one pretending to medicine to acquit himself satisfactorily un- der a strict examination, before he can be admitted to the priv- ileges of practice. In niost, if not all the other Western states, a law of the sort already exists. Its usefulness more- over, in those placcs, in guarding the sick from pretenders and impostors, is universally acknowledged. And our increasing swarms of stearr-docto: s, vegetable-mediciners, bone-setters, and other craft alike in :nfamy, render a provision of the kind as necessary in Kentucky, as in any other community. Would it not be well, tLerefore, so far to agitate the question, as to effect a call of a convention of the physicians of the State, to deliberate on it, and if deemed advisable, to submit its views of it to the legislature, in the form of a memorial In such a movement, I carnLot doubt, that the College whould do its duty with fidelity anda zeal. It was my design to nvite the attention of the College to certain sinister and unseemly practices, too often pursued for the procurement of business, even by physicians who call themselves educat',d. But a want of time forbids my treating the subject in detail. I can only refer to it in a few general remarks. The means usually e nployed, by the practitioners alluded to, are misrepresentation and calummy, artifice and treach- ery-all designed to injure their rivals, and benefit themselves. And they are shaped, arid applied, according to the ends their employers have in view. Is there in vogue any form of treating diseases, somewhat new, respecting which the public have scruples, or which they are induced 'o suppose may be pushed to excess The medical intriguer lays his account and arranges his means, to fasten such treatment ca his rival-to fasten it, I mean, in uspicion and reports To make plain my meaning. During part of the lifetime of the late Dr. Rush, the lancet, an reported to be wieldel by him, was a weapon of terror; so CALDINVELLs Inaugural Address. i and during another part of it, calomd and/jalal2. On the re- putedly excessive and destructive ernployment of these remne- dies, the low and malignant calumniators of the time affixe(d their accusations. And by thus bearing false witness against their neighbor, they brought guilt on thenmselves, without dim- ming the lustre, or affecting the elevated standing of the ac- cused. So lofty was the sphere, in which their intended victimn moved, and so puny and feeble their own arms, that they could not bring their poisoned weapons to their mark. Had Profes- sor Rush and his pupils done, by bleeding and purging, but a part of the mischief that was scandalously charged on them, the guil- lotine of faction, and the sword of Napoleon, would scarcely have been as fruitful in their ministry to the grave. But the charge was unfounded. Though erroneous and fanciful in many of his theoretical notions, Dr. Rush was one of the ablest and most successful practitioners of the age. And by vile attempts to sully, by calumnies, the well-earned fame of that distin- guished teacher and accomplished gentleman, many an igno- minious reviler rose to a point of notoriety, which, from the feebleness of his powers, he could never have attained in an honorable way. It is thus that Thersites lies embalmed in his own calumnies. The chief theme of the slanderous imputations of the pre- sent day, is the excessive use of calomel. Too many physi- cians resort to unfounded representations on this topic, to in- jure competitors, conciliate public favor to themselves, and procure business. And their procedure is usually as treach- erous as it is unmanly. While they denounce the bold use of calomel in others, they pursue it themselves-thus skulking under the cover of deception and hypocrisy. I could name ha- bitual railers against the employment of that remedy, who ad- minister it frequently in their own practice, in doses of front thirty to one hundred grains !-and at times in still larger ones! I conscientiously believe, that there is not a clamorous coin- demner of calomel in the country, who does not administer it in much larger doses, than he is willing to acknowledge. Hie CALDWEVELL'S Inaugural Address. plays the hypocrite, for his own benefit-the public wefare, being a secondary object. In truth, I have never known either a practised and public fault-finder, or a secret whisper- er of evil things against a rival, who was himself an honest and a trust-worthy man. I do not say that calornel may not, like other medicinal substances, be given in excessive quantities. Perhaps it is thus given occasionalv. But 1 feel convinced, that where that remedy is e7hibited in inordinate and injurious doses once, it is maliciously reported to be thus administered, one thousand times! Unfortunately the public mind is steeped in prejudice against this article. Hence, as already stated, prac- titioners given to i-atrigie and hypocrisy avail themselves of that prejudice to injure their rivals. Nor is this all. The well known dread of calomel, which so generally prevails, in- duces honest and hih minded practitioners to conceal, from motives of caution. the amount of the remedy, which they often administer. I could name physicians of this description, who reside in the east, as well as in the west. It is not true, therefore, that the administration of calomel in large doses is peculiar to the Mississippi Valley. The practice prevails, in a higher or lower degree, with enlightened physicians, where- ever high grades of biliou3 diseases prevail. Nor do I hesitate to add, that, notwithstanding the dread of it which many en- tertain, and the condemnatory clamour maintained against it, caloinel, when skilfully administered, is the mildest and safest of all the powerful remed; es belonging to the Materia Medica. There is no other, whose lose can be increased so far beyond what is customary, with so little risk, and often with so much benefit. The apprehension of its doing mischief arises from the fallacious hypothesis, that it enters the system, mingles with the blood ar d other humours, and settles in the bones! Be that idle notic n done away, and the fear of colomel will soon cease to annoy the practitioner and injure the sick. Calomel in substance never goes beyond the alimentary canal. On the mucous lining, of ihat tube its immediate action is ex- 317 CALDW ELL'i Inaugural Address. pended, its influence on other parts of the system being alto- gether sympathetic. And instead of irritating the alimentary canal. it often soothes it, and acts as an anodyne. This effect I have often witnessed, in cases of great uneasiness and dis- tress. In truth it is a common effect of fall doses of calornel, in diseases of gastric irritation. While small doses often in- crease the irritation, full ones relieve it. As an evidence that calomel does not enter the blood and circulate through the system, it is frequently, when administered in quantities un- necessarily large, discharged from the bowels, in a visible form by its own action. But I can dwell on this subject no longer. Nor is it necessary that I should. I am sure the College is sufficiently alive to the delicate and tender observance, that every physician should entertain and practice, toward the re- putation of a professional brother. Nor will it fail to regard with marked disapprobation all breaches of such observance, wherever they may occur. Let it not be inferred from the foregoing remarks, that I am advocating the "heroic" employment of calomel. I am neither defending nor condemning it. The ordeal of general expe- rience can alone test its value-not the arguments, whether favourable or unfavourable, of any individual. To that test let it be brought-and be dealt by fairly. My only object at pre- sent is, to express my abhorrence of the unmanly and immoral practices of those, who, by artful insinuations, and ground- less statements in relation to it, endeavor to benefit themselves, to theprejudice of others. Such conduct is ignominious in itself, and treasonable towards the profession. But it is not alone physicians, in their individual capacities. that deliberately violate the morals of medicine, and contrib- ute, by their misconduct, t) bring reproach on the profession. However reprehensible and much to be regretted the fact mar be, it is notwithstanding true, that, on the same point, associa- tions of physicians, under the title of "Medical Schools and Colleges," are, on some occasions, equally guilty. And when they thus forget themselves and their high vocation, and be- 33 CA LJ1"W;LL': InTaug ural Address. come deaf to the calls of morality and honor, the mischief of their example goes beyond computation. Nor is any rebuke which indignation can frame, nor any condemnation that lan- guage can express, too deep for their demerits. By the influ- ence of their sinister practices, they poison medicine at its fountain head, and render its entire current impure! My al- lusion is to the numerous electioneering artifices, which some of those institutions eml loy, and the misrepresentations they send abroad, to acquire popularity, attract pupils, and fill up their classes--and, as far as they can, to prejudice other schools. To dwell on all these abuses is notmy intention. Were time even at my 'omma md, the task would be too offensive for the occasion. On one breach of morality, however, habitually committed by some Schools of Medicine, I deem it a duty, to offer thus publicly a Jew observations, and to speak of it in the terms of condemnation it merits. My allusion is to the deception practised on p:upils, by groundless representa- tions of the great advantages they are to derive, from an at- tendance on "Clinical Lectures" in Hospitals and Infirmaries. That benefit may accrue from such lectures, to afew pupils, during the summe: season, when they have no other engrossing and oppressive engagements, and when they have, therefore, leisure and opportunity to devote to the subject a sufficient degree of attention and time, is true. But, that a large win- ter class (say two hundred and fifty, or even a smaller number) required to attend daily six or seven professional lectures, and permitted to visit the Hospital or Infirmary but twiie a week, and then allowed to remain in it, in a dense jostling crowd, only for an hour or two-that a class of such a kind, and under such circumstances, can profit by the sort of lec- tures delivered to them, eonsisting of half-heard hints and re- marks on dozens of cases in rapid succession, is not true. Nor do those who proclaim the benefits of the mummery believe in its usefulness. They know the scheme to be but an empty parade, designed as an aid in forming classes, not in instructing them. Yet they persist n eulogizing it, because it deeoys into 34 CALDWELL'S Inaugural Address. 35 their toils a few more pupils, than they could entrap without it. But do they augment by the practice their reputation for candour and fair-dealing, as well as their classes I put the question, let those whom they deceive unite with the con- sciences of the deceivers in framing a reply. In plain terms; there is not, in the United States, a Hospital or Infirmary, an attendance on the practice of which is worth a cent apiece to the members of a large winter class! On the contrary, such attendance is but a waste of time; an assertion confirmed by the experience of thousands, and not invalidated by the experience of one! The following is an account of Clinicul in1struction in the Pennsylvania Hospital, and the Philadelphia Alms-House, by far the best institutions of the kind in America, recently given by a physician of standing who has been a witness of it for the last fifteen years. "' What is it then, that constitutes the clinical instruction of most of those who annually leave our grandest schools armed wvith their diploma Some forty tours, performed at intervals of three or ftur days, throughout the wards of some great hospital, the attending physician or surgeon in the centre, and fifty or one hundred students crowding round him, on the level floor. They approach a bed. The medical attendant then, perhaps, may ofTer some remarks, though this is far from being universally the case, and when it does occur, afew of those who happen to be nearest perceive his meaning and ob- serve the case. The middle of the crowd may seize some general principle, or treasure up some fact that the lecturer delivers; its application to the case beforethem being, like the patient, placedl bteyond dteir ken. Those of the outer circle occupy the time in converse upon other topics. The crowd moves on, but still some remain to tease the patient with ill- directed queries." AND THUS ENDS THE FARCE-AND THE CER- TAIN FALLS! A few years ago, Professor Drake made an experiment an clinical teaching, in the Cincinnati Hospital, with.a very limi- ted class; that mode of instruction having been previously eu- 3C ALPTRYiL Inaugural Addren. logized in hlo moderate terms. He soon, howver, Tthet wiih such stubborn obstacles. as induced hits to abatndon the enter- prise, as either impracticable in its nature, or useless inits issue. Yet still is it used as a stated lure, to seduce pupils to the schools of that city. Even in Paris, the great emporium of clinical teaching, ex- perience confirms the tri .th of these remarks. In the Hotel Dieu, where a class of from tro to three hundred pupils follows -the celebrated teacher Chomel, the crowd around him renders his clinique comparatively nninstructive. In L'Hopital la Piti6, on the contrary, where the class is small, and nmple opportu- nity is afforded for an examination of the patienlts, and for hearing the lectorer, t le Clinique of Louis is of great value. Hence those young men who resort to the Parisian School, for a name, attend the Hotel Dieu; while those whose object is profitable instruction. pass daily several hours in the wards of la Pitid. Anl this they continue throughout the year. On this mockery of instruction, as practised in the United States, I attendee mysef when a pupil, for a few weeks, in the Pennsylvania Ho-pital. Like other uninformed young men, I commenced tile couise with eagerness, and full of hope, because I had been deluded bv its unmerited praises. Finding in it, however, nothilno but a scene of idle parade and solemn emptiness, I turned frem it in disaust, and abandoned it for- ever. And so did ex:ery other pupil whose object was in- struction; because he could appropriate the hospital hours more profitably to some other mnode of obtaining knowledge. To pass these censu'.es on Schools of Medicine is painful to me. It is painful, howVever, chiefly, because the censures are just. The abuses exist, their character is dishonorable, and their influence and example an unqualified evil, and a reproach to science. Such are sume of the subjeCts that call fur our investiga- tion of them, and some of the modes of inquiry, by Whicm nAdical science may Lte improved by us; and such a fewof (hle immoralities and aswas of the Profession, which r1.ed refor- 36 CALLJWELLS Iatuigural Addieg.;. 37 nation. Nor can I believe that the College will be either in- sensible to the, or inacive under a view of them. Tn, aix- ing tbwir names to its Constitution, thie Members of the inasi- tution, as heretofore intimated, have solemnly pledged theic faithful adherence to it, in all its requirements. From their obligations thus contracted, therefore, they may not, I say, depart, without a serious violation of duty. And those obli- gations expressly bind them to promote, as far as may be in their power, whatever they may deem uscFul and honorable to the Profession, and to prevent and suLjjress, to the same extent, what may prove injurious or discrcdlitable to it. By virtue of their pledges thus deliberately given, Medical science and Medical morality have new and more powerful claims on the members of the College. Strong and sacred, moreover, as are the claims of the former of these, those of the latter are immeasurably more so. It is the moral of life that renders it honorable, and constitutes the chief element of its value. What then is medical morality, that by clearly understand- ing it, we may more correctly appreciate it, and more invio- ably observe it It is, the morality common to human nature, more scrupulously and feelingly practised toward each other, by those, whom the habits and sympathies of the same pursuit have associated and formed into a band of brothers. Within this sphere it enjoins benevolence, charity, courtesy, forbear- ance, and justice to all, and forbids whatever may injure or offend. Medical morality is but another name for brotherly love and kindness in medicine, concentrating and mellowing the sterner virtues, heightening their activity, and directing their course. It is the morality of the New Testament dif- fused through the Profession, rendering it instinct with its ben- eficent spirit. And that morality is summed up in the golden precept, "Do UNTO OTHERS, AS YOU WOULD THAT THEY SHOULD D- TO YOU." Be this the practical motto of our College, and harmony and decorum will characterize its meetings and movements, high s8 CALD-WXLLS Inaugural Address. standing and reputatio l may be attained by it, and abundant good will result from its establishment. Let the same be ob- served as the motto cf physicians in general, and a new era of usefulness and gloiy will open on Medicine.