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Thoughts on the impolicy of multiplying schools of medicine / by Charles Caldwell.

Thoughts on the impolicy of multiplying schools of medicine / by Charles Caldwell. Caldwell, Charles, 1772-1853. 400dpi TIFF G4 page images University of Kentucky, Electronic Information Access & Management Center Lexington, Kentucky 2002 b92-217-30936341 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. Thoughts on the impolicy of multiplying schools of medicine / by Charles Caldwell. Caldwell, Charles, 1772-1853. s.n.], [S.l. : 1834 35 p. ; 22 cm. Coleman "Published by order of the Lexington Medical Society." Microfilm. Atlanta, Ga. : SOLINET, 1995. 1 microfilm reel ; 35 mm. (SOLINET/ASERL Cooperative Microfilming Project (NEH PS-20317) ; SOL MN04607.06 KUK) Printing Master B92-217. 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. Medical education Kentucky. Transylvania University. THOIJGHTS ON TILE IMPOLICY OF MULTIPLYING SCHOOLS OF MEDICINE. BY CHARLES CALDWELL, MI. D. PUBLISHED BY ORDER OF THE LEXINGTON MEDICAL SOCIETY. LEXINGTON, KENTUCKY. PRINTED BY J. CLARKE & CO.-INTELLIGENCER OFFICE. 1834. This page in the original text is blank. THOUGHTS, &c. AN invitation from the Lexington Medical Society, united to the restless and increasing desire, manifested by a few phy. sicians, to have one or two new Schools of Medicine erected in Kentucky, has elicited the following remarks on the sub- ject. It may not perhaps be unworthy of notice, that the eager- ness referred to is of recent date, and has possession chiefly of some of the junior members of the profession, who are known to be anxious to attain notoriety, by being elevated to the rank of official teachers; and who cannot conceal the fact, disguise it as they may, that they are scheming,under cover, for their own benefit, not working openly for that of the public. Most assuredly, for reasons to be rendered here- after, no motive for their conduct, founded in considerations of public good, is yet perceptible. All that appears has a leaning toward self. Nor, in the present posture of the mat- ter, is it deemed a violation of either truth or delicacy to add, that it would disclose, in those individuals.a becoming sense of the relations they bear to the object of theirambition, and to the enlightened community of the West and South, were they to wait patiently, until a few more years of study and experience should have given a fulleF measure of knowledge and maturity to themselves, before aspiring to the responsible office of publicly imparting instruction to others. It is one of the serious evils of the tirre, that boys are too solicitous to attain the standing and privileges of men, and that those who are still in the crudeness of early manhood, are equally solicitous to usurp the high places of life, not by [ 4 ] the instrumentality of their superior fitness for them, but by urging their supposed claims to them, with superior boldness and pertinacity. Let it not be imagined that we intend, by these remarks, any censure on young men for attempting to gratify a laudable ambition. Far from it. The attempt it- self is laudable, provided it be made, by a becoming use of honorable means. But those who discredit the morning of life, by unfounded pretensions, studied artifice, or presump- tuous effort, prove themselves unworthy of the stations they aspire to. Not so however with young men, who reach posts of distinction and trust, by justly deserving and honorably seeking them. Their merit is the greater, because they are young. The irregular and we might well add unnatural condi- tion of things, here complained of, is often as strikingly man- ifested in medicine, as in any of the other walks of society. Yet in no other perhaps is its impropriety so obvious, or its effects so pernicious. If ample experience, soundness of knowledge, and maturity of judgment are necessary any where, it is in the mental resources of those, who publicly minister to the health of the people. Having no settled precedents to guide them, as is the case in the other two learned professions, their dependence is on themselves. It is much to be lamented, therefore, that physicians by no means remarkable for the qualifications just enumerated should so far overrate and forget themselves, as to grasp at the post alluded to, and struggle to reach it, with a degree of vehe- mence, that would be unbecoming in those most highly qual- ified-and which indeed the qualified never exhibit. Their self-respect and consciousness of meriting it forbid them. The deportment of the deserving is modest and dignified. They wait until their own acts have rendered them conspic- uous, before they seek for factitious distinction; and then they seek it, if at all, delicately and 'inoffensively. To men of an opposite character, whose object is personal aggrandize- ment, and who cannot attain it by modesty and merit, nature having branded them with her stamp of mediocrity-to men of this cast belong the bluster and obtrusiveness, and all the [ 5 ] sinister machinations of place-hunting. If we forbear to name a few physicians, to whose conduct this picture applies, it is not because they are not known to us. Should any therefore discover their own likeness in it, they cannot charge the fault to us. We are as free to sketch a character s they are to act it. We but copy the original. It need scarcely be observed, at this enlightened period of the world, that Schools of Medicine are institutions of peculiar importance. Not only are the interests of science concern- ed in them; they involve the health, lives, prosperity, and happiness of millions, and, by the doctrines they teach, and the practices they establish, throw their influence into dis- tant ages. We feel, even now, more or less of the influ- ence of the schools of Greece. Such institutions ought not therefore to be either hastily founded, orin any way lightly act- ed onor dealt with. They should be erected only after mature deliberation, and from public motives; and those motives should be, broad necessity, or a fair prospect of correcting faults, and efecting improvements. The selfish passions of envy, resent- ment, disappointed ambition, or the desire of distinction of a few individals, should have no concern in their establishment. Nor ought mere locality to have any influence in it, except so far as it may afford advantages, not to be elsewhere so easi- ly obtained. And when a medical institution already establish- ed, has been so administered, for a series of years, as to have gained -reputation and standing, by the extensive and ac- knowledged good it has done, no measure should be adopt- ed, except from public considerations of great weight, to em- barrass its proceedings, or check its prosperity.-It is not be- lieved, that from enlightened and public spirited men, free from bias, these views will be likely to encounter any sen- rious opposition. We shall take leave of them, therefore, and offer a few others, which we trust will be found to be equally valid. Though it is known to the public, at least in a general way, what a school of medicine is,it is notwithstanding believed, that, by premising a brief description of one, we shall be [ 6] enabled to render some of our views the more intelligible and definite. It is therefore that we give it. A school of medicine is an institution, in which the knowledge of the Profession is taught in various modes. The chief of these are, public lectures, experiments, and demonstrations, an op. portunity to form an acquaintance with the standard works in medicine by reading, conversation, and public and private examinations. The school is also invested with authority to confer medical honors, under the title of degrees. That it may be fitted to communicate information, in these several ways, with benefit to its pupils and the public, and credit to itself, the institution must possess a corresponding variety of suitable means. Besides buildings adapted to its different purposes, it must have a sufficient number of well qualified Professors-men, who are not only rich in their possession of the proper kind of knowledge, bat happy in their mode of imparting it, both orally and in wvriting; add to this a library competent in size, and judiciously selected, a full suit of chemical apparatus, and an anatomical museum, with other facilities for communicating instruction in the lat- ter branch of science. With these resources, adminis- tered with sufficient ability and skill, the school must neces- sarily do much good, and acquire reputation. Without them, it cannot fail to prove discreditable in itself, degrade the profession it ought to exalt, and endanger the lives of the community, by sending among them, to take charge of their health, a tribe of superficially educated physicians. Hence, in founding an institution of the sort, the first thing to be done is, to furnish it with the requisite means to instruct. That the Medical School of Transylvania possesses the sev- eral provisions and fitnesses here enumerated, will not be denied, by those who are qualified and unprejudiced judges. In their suitableness to their several purposes, her buildings are not surpassed, by those of any similar institution in the United States; of her Faculty, as a body, the competency has never been called in question, but has been spoken of in terms of high commendation; her library, large already, and [ 7 ] yearly increasing, is one of the best selected in the country, many of its works being of uncommon value; and the chem- ical apparatus, and anatomical museum, with other provisions in the latter line, are amply sufficient for all the experiments 'and demonstrations requisite in teaching. In making these provisions, to which there is nothing comparable, west of the mountains, and which, in real usefulness to a medical class, are perhaps not surpassed -in any, and in but few instances equalled, by the means and arrangements of the Atlantic schools, near thirly-five thousanl dollars have been expended. .'But it is believed that a brief recital of what the School of Transylvania has done, will be at once its justest and highest encomium. It has been in operation. fourteen years, in which time it has instructed near three thousand pupils, from seventeen or eighteen States of the Union, and conferred degrees on about seven hundred. Nor are the practi- A BRIEF VIEW OF THE RISE AND PROGRESS OF THE MEDICAL SCHOOL OF TR ANSYLVANIA.-This institution has been in operation fourteen years, the ,ff- pound;eenth course of lectures in it being now in progress. According to its Record. book, its classes, and the degrees conferred by it, have been as follows: YEARS. NO. OF PUPILS. NO. OF DEGREES. 1819-20 37 7 1820-1 93 1 1821-2 138 37 1822-3 171 51 1823-4 200 47 1824-5 234 57 1825-6 281 65 1826-7 190 53 1827-8 152 53 1828-9 206 40 1829-30 199 81 1830-1 210 so 1831-2 215 74 1832-3 3 69 1833-4 262 TotaL 2810 699 It is believed, from this view of it, that, for its vigorous prosperity, and the rapid increasase of its classes, the Medical School of Transylvania is without a parallel. Certainly, in tho United States, there is nothing comparable to it. At the commencement of the present century, when the Medical School of Philadelphia had been in operation about forty years, it did not number more, we believe, than 200 hundred pupils. It now contains about 400-3umor says [ 8 ] tioners it has formed, whether in medicine or surgery, infe- rior to any of their age in the country. To the truth of this, experience testifies. For the last eight or nine years, it has been, in numbers, the second medical institution in the United States; and, throughout the Mississippi Val- ley, where it is best known, we believe its reputation has been equal to the first. It appears to us, therefore, that we may safely add, without rendering ourselves obnoxious to the charge of boasting, that Kentucky has just reason to be proud of the school she has founded. It has doubtless been more creditable to her, among her sister States, than any of her other seats of instruction-perhaps we might have said than all of them united. Drawing pupils, as it alone does, from every corner of the West, there is no improper assump- tion, in calling it the SCHOOL OF THE WES-T. Nor is the whole amount of its usefulness, to its parent State, yet reci- ted. By the pupils it has educated from other States, it has borught into Kentucky a large sum of money-at least from fioe to six hundred thousand dollars-perhaps more-a liberal bonus for the charter it holds. In a word, it has done its du- ty, and not only met, but greatly surpassed public expectation. These facts have never been denied; nor can they be, con- sistently with truth. Out of the foregoing view of things arise one or two ques- tions, which seem worthy of a brief and candid examination. 1. Does the public interest call for another School of Med- icine in the State of Kentucky 2. If not, is it consistent with good faith and sound policy, in the Legislature, to authorize the establishment of one a few more. In thirty-three years then, that school has added about 200 to its classes; while, in less than half the time, the school of Traneyvania hasformed a class of 262. This isthe highest eulogy the institution can receive. The most elequent and forcible language in praise of it, would be spiritless and feeble, contrasted with the power of the foregoing figures. And the same fiPres constitute the most cogent and conclusive argument, that man can urge, against an unneces- sary attempt to injure it. [ 9 ] To these questions it is believed that satisfactory answers can be given; and,when given, it is further believed, that they will render the general subject better understood, than it appears to be at present. We shall consider them in the or- der in which they are proposed. 1. Does the public interest call for another school of med- cine in the State of Kentucky T From no view of this question which we are capable of taking, and we have examined it attentively, is any reason perceived for answering it affirmatively. Nor do we believe that any exists. On the contrary, every consideration that bears on it, has a negative aspect. All the youth, desirous of medical knowledge, whether be- longing to the State of Kentucky,or coming from other States, who present themselves to the School of Transylvania, are instructed and treated generally, we believe, to their satisfac- tion. We have certainly heard of no'complaints from them, on any score, beyond what some few make of all schools, and which will be made occasionally of every school, that human wisdom can erect, or human talents and industry administer. The misfortune, in these cases, iS, that the complaints of the few, whom nothing can satisfy, are too often received, as the complaints of the many, who approve in silence. Nor is it unimportant to add, that the fault-finders are usually among the least intellectual and respectable members of the school. If they murmur or condemn, on account of not re- ceiving knowledge, the defect is in themselves-tbeir want of capacity or want of industry-or both. Boarding and subsistence arc furnished to the young gen- tlemen, in Lexington, at a cheaper rate, as is confidently be- lieved, than they can be procured, equally good, in any oth- er city of the United States. Do any of the pupils fall sickt They are faithfully attended and prescribed for, by the Fac. ulty, without charge, and affectionately nursed, by the fami- lies in which they reside. Not only are the lecture rooms spacious and convenient, but so warmed and ventilated, as to be pleasant and of a B [ 10 J suitable temperature, in all sorts of weather. Five of the Professors meet their classes, each six times in the week, and the sixth nine times, the entire Faculty delivering weekly thir- ty-nine lectures, and occasionally extra ones. This is believ- ed to be a heavier service than is rendered, by the same num- ber of Professors, in any other medical school in the Union. Besides being briefly examined several times every week, du- ring the sessions of the school, each pupil, on presenting himself for a degree, having previously attended two cours- es of lectures, and prepared and submitted to inspection a written Thesis, sustains a strict examination of an hour. The terms on which the young gentlemen procure books from the library are liberal and easy; and there is opened to them a free access to the Professors, for a solution of such difficulties as may occur to them, in their studies. It may not be amiss to observe, that matriculation and the use of the library, which,in the medical school of Philadelphia, cost the pupils fifteen dollars, are afforded to them in the school of Transylvania, for fice dollars. Nor is this all. In the library used by the Philadelphia school, there are no text books, each pupil being obliged to purchase those he wants, or do with- out them; while several hundred dollars have been expend- ed, in the purchase of text books for the Transylvania libra- ry. In fact, no exertion is spared by the Faculty of Tran- sylvania, to render the instruction imparted as rich and va- ned, and, at the same time, as inviting to the pupils as possi- ble. And, as already stated, the result is, that no physicians of their age, in the United States, have higher professional reputations, or are more successful in their practice, than those who are educated in the SCHOOL OF THE WEST. These several statements are matters of record. It does not ap- pear therefore, that either the interest of Kentucky, or that of the western States generally, calls, at present, for the establishment of another medical institution. To say the least of it, the work necessary for the completion of the en- terprise would be superfluous, and the requisite funds ex- pended to no purpose of public usefulness. [ 11) Is it alleged that the erection of a rival school would render the Professors of Transylvania more faithful and strenuous in the discharge of their duties To make the most of this, it is but a conjecture; and it is believed to be a mistaken one. The Professors are and always have been urged to their du- ty, by their knowledge of its importance, by a settled per- suasion that the faithful performance of it would redound to their honor and advantage, and secure to them the approba- tion of their own consciences, and by their sense of the deep responsibility it imposes. A dread of being surpassed by oth- ers has had no place among their motives. It is believed that were they the only public medical instructors west of the mountains, they would act precisely as they do now. This belief is sustained by their strict devotedness to their duties, when they had no western rivals. We say "western rivals;" for they have always had, in the schools east of the moun- tains, rivals sufficient to urge them to their duty, were such an incentive necessary. They well know, that if their lec- tures fall below the lectures delivered in the schools of the east, the young men of the west will repair to those schools to receive instruction. Hence they give their whole time to their classes, during the sessions of the school, and much of the intervals to the improvement of their lectures; and were they surrounded by rival institutions, they could do no more. That competition is useful in many things, is not denied. But it will appear hereafter,that, in the present case, any further western competition, instituted immediately, would be a source of mischief. We are no general defenders of what are called monopolies; but the reverse. Neither can we however unite with those, who denounce them altogether. Though wrong and injurious in most cases,they are useful and necessary in some. The copy-right of a literary work, and the patent-right for a work of art are monopolies, while they last. But they are absolutely necessary to the encourage- ment of genius. An incorporated company to construct a a turnpike or rail-road, or to form a canal, is a monopoly. Yet it is often essential to the public welfare. Nor are there [ 12] wanting other enterprises of great usefulness, that would not be embarked in, except under the sanction of special privi- leges. All that has been said and written about monopolies in teaching medicine is mere cant. With as much proprie- ty might invectives be uttered against the exclusive posses- sion, which a man claims in the affections of his wife, or a woman in those of her husband. No monopoly, in the ex- ceptionable meaning of the terms is wished for, in the busi- ness of medical instruction. The desire is to save that bu. siness from degradation. And it requires but little penetra- tion to foresee, that if such an arrangement be not maintain. ed, as to secure a comfortable subsistence to those who en- gage in it, it will never be conducted by competent men. It will pass into the hands of sciolists and smatterers, and be- come an object of disrepute.-Admitting it proved, then, as we trust it has been, that the public interest does not re- quire another school of medicine, in the State of Kentucky. 2. Is it consistent with good faith and sound policy, in the Legislature, to authorize the establishment of one This question divides itself into two branches, to each of which, as appears to us, the answer should be negative. For the following reasons, we consider the faith of Kentucky virtually pledged, not to countenance the erection of an- other medical school, except at the call of actual necessity, or to attain some object of great utility. The school of Transylvania being a State institution, the Trustees are State officers. Their legal acts therefore, as such, are binding on the State. On the invitation of those officers, in their corporate capacity, three physicians aban- doned their business and establishments, in three distant States, one in Pennsylvania, another in Virginia, and the third in Tennessee, and repaired to Transylvania, to become Professors in it, and stake their reputations and fortunes, and the subsistence of their families on its prosperity. A fourth physician removed, on the same ground, and under similar circumstances, from a remote part of the State of Kentucky. Of the six medical Professors then, in the school of Transyl- [ 13] vania, four came to it at heavy pecuniary sacrifices, on the invitation of the State, and, as they firmly believed, on its virtually pledgedfaith, that, as long as they should continue to perform their duties, as teachers, to public satisfaction, nothing would be unnecessanly done by legislative authority, to injure the institution, and perhaps ruin them. To strength- en the case, they came without fixed salaries, depending en- tirely on the income from the institution, to reward them for their first sacrifice, and subsequent labours. Had they been salary officers, whose pay would continue, though the school might dwindle, the whole complexion and nature of their engagement with the State, and their relation to it, would have been different. Under such circumstances, the erection of another similar institution, however prejudicial to the Profession and the public, would have been no material vio. lation of faith toward them. But, in the existing condition of things, the reverse is deemed true. Suppose the four Professors from a distance, or either of them, had been told, that, in from two or three, to six or seven years, from the time of their election, the State would, without any reason founded in public necessity or public good, but merely to gratify a few disappointed or discontent- ed and aspiring physicians, authorize the erection of a rival institution, within seventy miles of Lexington, would they, at the hazard of all they were worth, have accepted the in- vitation to become teachers No certainly. The proffered honour, connected with probable ruin, would not have re- ceived from them a second thought. Thefirst would have been to reject; and it would have beenfinal. And if a rival institution be now erected, to divide the interests and patron- age of the State, and the profits of teaching, it does not re- quire a spirit of prophecy to foretell, that no physician of standing will ever hereafter quit his distant home and thriv- ing establishment, to unite his fate with the fortunes of Tran- sylvania. Vacant chairs must, in time to come, be filled from Lexington, or some adjacent place. There being no longer presented even a probable reward to balance a certain [ 14] sacrifice, ageneral selection from the States will be precluded, and none but adventurers without character, can be drawn from a distance. It is not our intention, in these remarks, to underrate, or in any way disparage the talents or attain- ments of the physicians of Lexington, or of any portion of the neighbouring country. Far from it. We know the re- spectability and worth of many of them, and cherish a due regard for their characters. It will not however be denied, that the wider the sphere, from which Professors may be drawn, to fill vacancies, the greater must be the probability of procuring able ones. Nor is the converse of this less true, but stands as an axiom, which no one will dispute. Under this head another consideration might be urged with no little propriety and force. One of the original foun- ders of the Transylvania school of medicine came to it from a distance, and is still in it. He resorted to it on an expe- riment deemed by every one uncertain and hazardous. The current of opinion was decidedly against the probability of success. Ile joined his colleagues, and commenced his la- bours, with a very small class, and corresponding profits. For several years, the remuneration received by him was decidedly below the labours encountered, and the expenses incurred. But did he evade his duties or falter in his exer- tions Let those answer the question, who are familiar with the origin and progress of the institution. In the course of time, and by the labours of the Faculty, the school having attained its present standing, is it consistent with the prin- ciples of either generosity or justice, to diminish its classes, lop its honours, and reduce its income, without even the sem- blance of a public reason, to gratify the ambition and per- baps the resentment of physicians, who performed not a solitarv act in erecting it The school of Transylvania has given the tone to medical. teaching in the west, and render- ed it fashionable, and an object of desire. Is it honorable or manly then, in individuals, who have had no hand in pro- ducing this condition of things, to avail themselves of it, for their own personal benefit alone, and to the injury of those I 5 3 to whom the public are indebted for it Would it not be much more to their credit, as well as ultimately to their benefit, to devote their time to increasing their stores of knowledge, and accomplishing themselves in the modes of communicating it, that they might become well qualified to fill the vacancies that time must necessarily create in the school Were these questions submitted to a court of hon- our and conscience, the reply to them would not be doubtful. And we hold the people of the west and south to be such a court. Another, and perhaps a simpler and clearer view of this subject may be presented. The Trustees of Transylvania University, we repeat, called from a distance four of the present Professors, to the chairs they occupy in the Medical department. Suppose these Trustees had themselves the authority to found another medical school, would it be con- sistent with good faith in them to do so, to the injury or ruin of faithful and competent officers of their own creation, with- out an absolute necessity for the act, or some certain and important public benefit to be derived from it Certainly it would not. Such a measure would be a palpable infraction of a solemn compact, unless a condition to that effect had been originally expressed. But, the Trustees being the representatives of the Legislature, in this matter, their of cial acts are binding on the State. For the foregoing reasons, we are compelled to believe, that between the State of Kentucky and those Professors of the medical school of Transylvania, who were called from remote places, a sacred compact exists, the tenor of which is, that, as long as the latter shall acquit themselves of their duty, to the reasonable satisfaction of all who have an in- terest in it, the former will not causelessly and seriously injure them. Should they fail in their duty, from incapacity or oth- erwise, the remedy is plain. Let them be dismissed, and their places filled with abler incumbents. But even under these circumstances, no good reason is perceived, why the school should be crippled, by the establishment of another. [ 16] One medical school is not only enough for Kentucky now, but will continue so, for a century to come-perhaps much longer. When the pupils of the west shall have become too numerous for the two schools now existing in it, additional ones will be erected by other States, to supply the demand. It is the interest of Kentucky therefore to unite her means and energies, not divide them. The former measure will strengthen, while the latter would enfeeble her. As respects the policy of erecting another medical school in the State, we are strangers to any thing calculated to recommend it. In our opinion, it is exclusively unwise. That it would lower the tone of medical education, and the general standard of the Profession throughout the State, cannot be doubted, by any one, who has a competent knowl- edge of the subject. This it would do by rendering medi- cine comparatively a trivial pursuit, lessening its honours and emoluments, and ultimately consigning it to an inferior class of men. Talk as we may of disinterested benevo- lence, patriotism, philanthropy, and an abstract love of scib ence, it is only talk. That profession, which insures the highest reward, and the most distinguished reputation, to those engaged in it, commands the highest talents, and, from the constitution of human nature, will continue to do so. The well known fact, that young men, who are most abun- dantly gifted, generally resort to the bar, is proof of this. Reduce the medical profession so low, in all respects, as to bring it within the reach of the feeble minded, and it will be soon overcrowded with smatterers in knowledge, and the common handicraft trades will be preferred to it. To teach medicine by lectures, in such a way, as to em brace and present all the necessary views and expositions in it, and keep pace with the rapid advance of the science, is an arduous task. It furnishes employment sufficient for any individual, whatever may be his industry, the strength and readiness of his talents, or the measure of his attainments. To learn to teach it perfectly, far from being, as some seem to think it, the pastime of a few years, spent lightly, or in L 17 i the bustle of business, is the work of a lifetime, devoted to study. A more palpable mistake cannot be made, than to imagine, that, because a physician has acquired standing avid popularity as a practitioner, and written a few respectable essays, he is therefore competent to the business of teaching. He who believes and asserts this has but a very limited knowledge of the extent and depth of the science of medi- cine, and of the difficulty of framing and maturing a con- densed system of instruction in it. Merely to write essays, and practice medicine successfully, are comparatively light and circumscribed efforts, and do not, of themselves, evince either great depth of research, strength of thought, variety and richness of attainment, a wide compass of mind, or high powers of combination and arrangement. But, to no incon- siderable extent, these qualifications are essential in a medi- cal teacher. So is a general and-familiar acquaintance with the literature of the Profession; an attainment not to be made, but by a protracted course of laborious reading-an attainment, we might truly add, neither accomplished nor conceived of by some individuals, who are vehemently grasp- ing at appointments in schools of medicine. It is the record- ed opinion of one of the most distinguished Professors of Europe, that to prepare an able course of medical lectures, re- quires the steady labour of twenty years. But for such exertion and perseverance, a teacher is entitled to at least a comforta- ble subsistence. And if he does not receive it, he must in- termit his official toils, and devote a portion of his time to some other pursuit, that may add to his income. This will necessarily restrict his medical researches, and detract from bis efficiency and success as an instructor. But neither will the profits of a small school of medicine support a family in comfort, nor its honours satisfy the ambi- tion of a highminded and well qualified Professor, who is conscious of his powers. A teacher of this description, therefore, will either neglect the business of the institution, or abandon it, and some inferior incumbent will succeed him. And thus will the establishment deteriorate and lese char. C [ 18] acter. It may be received as a maxim, that a medical school discouragingly limited in its classes, will be correspondingly limited, not to say actually superficial in its teaching, and cannot therefore be the parent of accomplished physicians. Experience as well as principle testifies to this, Throughout the world, inferior schools, of every description, are places of inferior instruction, and, on the immutable law of like producing like, their pupils are of the same order. They are nurseries of smatterers, as certainly as a poor and ill cultivated soil produces scanty crops of deteriorated grain. Nor can it ever be otherwise, while the present relation of cause and effect shall continue. Added to its other defects, a lowly institution has nothing in it to awaken emulation or excite to enterprise. Every thing seen, or heard, or felt in it has the character of mediocrity. or is perhaps beneath it. The entire scene therefore is uninviting and uninspiring. A dead calm overspreads it, under which neither can the fa- culties of the mind be actively developed, nor knowledge rapidly acquired. 'Even its competition, if it engages in any, is petty and undignified, peevish and unprofitable. Is there, in its neighbourhood, a rival institution Instead of attempting to gain an ascendency, by rising itself, it makes an effort to do it, by traducing the other, and pulling it down. In fact, it is too apt to be as deficient in moral as in intcl- lectual qualities. How different is this from the condition of a school, where the classes are full, fhc teachers able, and the means abun- dant. All here is animation and excitement, competition and enterprise. The spirit and enthusiasm of the instruc- tor, being infused into the pupils, awaken their ambition, and produce in them a settled resolution to excel. The springs of emulation moreover are numerbus. The pupils are ambitious to equal and surpass, not only one another, but their predecessors in the school, whose reputation is held up to them, as an example of generous rivalry, and to rise, in their attainment and character, to the high standard of the school itself. Nor is this all. To no small extents pu- [ 19 ] pils imitate their preceptors. The industry of the latter therefore renders the former industrious. And, as industry and exercise develope talents and enrich them in knowledge, able and distinguished teachers never fail to impart more or less of a similar cast to those they instruct. The love of knowledge, the laborious habits, and the high bearing of Professors, entering into their pupils, are often more usefiul to them in life, than all the information, scientific and prac- tical, they impart to them by their lectures. They induce them to engage and persevere in the important work of in- quiry and self-instruction, which alone can confer on them permanent distinction. Men of humble qualifications howe- ver can never prove sources of inspiration to the pupils they teach. They are much more likely to deaden their ambi- tion, than to quicken it. But talents and knowledge are the stock in trade of those who possess them. If they are high and valuable, they will not be sold but for a high price. Institutions therefore that offer low profits, must be content with inferior capacities in those who conduct them. Hence, if the reward for medical teaching in Kentucky be diminished, the standard of instruc- tion, and of course that of the institutions, in which it is imparted will be lowered, and the professional character of the State will sink. This is as certain as any other event, depending on an established law of nature. Nor can the creation of another medical school, if it in any measure succeed in attracting pupils, fail to produce the mischief in- dicated. The State-will be a "house divided against itself," and must suffer accordingly. The issue will be a civil war in the Profession, with all its bitterness and pernicious ef- fects. The elements of strife are already collecting, and, should matters go on, in the same spirit in which they have begun, an explosion is inevitable. No instance can be ad- duced, where medicine has been benefited, by the clashing and bickering of two of, three litle rival schools, in the same city, or the same State. It is not true, that either the sci- ence or the profession has profited by such collision, in ( 20]3 Philadelphia, New York, or Baltimore; and that they have suffered by it, in New England, no one informed on the sub- ject denies. A conflict of the kind always co-operates with other causes, in bringing medicine into disrepute. It aids in perpetuating the trite and vulgar, but reproachful jeer, that "Doctors will differ." Nor is this all that may be said on the subject. A leading reason, why the Old Philadelphia school be- came so famous, was, that it existed more than half a cen- tury, without a rival. Owing to this, its emoluments be- came a price for the best talents, and its honotirs an object of the loftiest ambition. Able men therefore occupied its chairs. Would this have been the case, had it been, from an early period, one of a cluster of petty institutions No; never. Nor will any one versed either in the history of medical schools, or the knowledge of human nature, gain- say this reply. Strong and high-minded men do not con- tend merely for the sake of contention, and to bring them- selves into notice. They can gain distinction in a more agreeable and honorable way. Had the honours and profits of medical teaching, in the Atlantic States, been equally divided, ever since the close of the revolutionary war, between ten schools in New Eng- land, two in Philadelphia, two in New York, two in Balti- more, one in Washington, one in Virginia, and one in Charles- ton, (the number that has recently existed) the whole con- cern would have been so puny and sterile, that the schools of Europe would have held it in scorn. The medical rivalship existing in Philadelphia now, can do no material injury; and may possibly do good. The reason is plain. Near six hundred pupils assemble annually in that city-a number sufficient for two highly respectable schools. Very different however is the case in Kentucky. It will appear presently, that, in the entire Mississippi Valley, there are not more pupils than enough to form two moderate schools. But two schools exist already. Erect a third, to [21 ] divide the interest still further, and the whole will be un- worthy of the attention of competent teachers. Another consideration presents itself worthy of notice. The competition between two rival schools, each affording a liberal income, may be fair and honourable. The profes- sors, not compelled to scvffe for bread, may vie for fame, by endeavouring to surpass each other, in attainment, teaching, writing, and the general promotion of science and literature. Tlhe flourishing condition of one of the schools, is compati- b,le with a like condition of the other. The interest of eith- er is not to destroy the other, but to'exceed it in splendour and renown. Hence their rivalry may be useful. Far different is- the case with two or three little schools, where the Professors are literally struggling for a meager subsistence. Between such institutions, as already intimat. ed, no honourable rivalship has ever existed; nor is it to be believed that it ever can, while man retains his present char- acter. The contest is a war of extermination. The exis- tence of one school is incompatible with the prosperity of the rest. The object therefore being to destroy, other and nobler ends are neglected; and defamation, intrigue, and all the craft of petty warfare, are called into action. History and our knowledge of human nature concur in assuring us that this is true. Add to these views, the well known fact, that small schools are unable, from a want of funds, to procure the requisite means of instruction, and their useless ness, not to say their mischievous tendency is manifest. Within the last fifteen or twenty years, there has broken out, in the United States, a perfect medical-school mania. And, in almost every instance, the malady has appeared first, and raged with most violence, among noisy and conceited young physicians, who are anxious to advance their fortune, by cabal and bustle, rather than by steady habits and labori- ous practice. Its effect has been to give us about twenty institutions of the kind, where reason, experience, and example concur in showing, thatfour would be sufficient. It is a truth generally recognised, and which no one thorough- ( 22 ] ly versed in the knowledge of the subject will deny, that one school of medicine is enough for a population of from four to five millions. In no country, we believe, except our own, is the proportion higher, and, in most places not so high. And, even among ourselves, the school of Philadel- phia once served our purpose, and served it amply, when we had five millions of inhabitants. In Great Britain, contain- ing a population of more than twenty millions, there are but four medical schools. In France, with a population of thirty- three or four millions, there are not more than three schools. Yet in no other countries is the standard of the profession of medicine so high, as in Great Britain and France. The reason is plain. It is there taught and led only by men of high distinction-some of them ranking with the first men of the age. The reason of this again is equally plain. The teachers are well paid and highly honoured, by the great schools, to which they devote nearly the whole of their time. Instead of anxiously scuffling for a bare living, they proudly vie with each other for fame and public usefulness-to shed a lustre and bestow a blessing on their countries, by the pupils they instruct, and to perpetuate their own names, by the works they compose. But, we repeat, 4hat, in the United States, with a popula- tion of fourteen millions, we have already twenty medical schools-one for every seven or eight hundred thousand in. habitants-and still a fiery thirst for more. The consequence is, that, in certain sections of our country, medical education is declining, and some of the instructors nearly starving. We could name places, where it is much easier for a young man to be made a doctor now, than it was thirty years ago; and, we might add, in perfect consistency with truth. much easier than it is for him to be converted into a good shoemaker or carpenter. And all this is the mischievous and degrading, but natural result of an undue multiplication of petty estab. lishments, misnamed schools of medicine. Shall the same miserable state of things be introduced in- to the Mississippi Valley, destined to be the grandest coun- [ 231 try on earth-And for what-the promotion of science or the public good Far from it-but merely to feed the cu- pidity, and gratify the overweening vanity of a few turbu- lent demagogues in medicine-men who feel conscious, that they can attain their end in no other way, than by heralding their own inflated pretensions, and practising deception on the public mind. God forbid, that the science of medicine, exalted in itself, and adorned by many of the brightest names on the records of fame, should be so prostituted, as to be made to pander to such ignoble purposes! When the time shall arrive, that intriguing physicians, destitute of suitable qualifications, can obtain professorships, by the same sort of trickery, that is employed to raise demagogues in politics to places of trust, adieu to all that is praisewor- thy in the Profession! And that time will arrive, should schools of medicine be so multiplied, as to offer neither profit nor honour to men of ability. We are aware that we may be charged with making our calculation, on the present occasion, on mercenary princi- ples; and that an attempt may be made, on that ground, to throw odium on us, and excite prejudice against the views we have presented. It may be said that we allege that nothing great and useful can be done, on the score of instruc- tion, without money. We do allege this openly, and chal- lenge refutation. And, in so doing, we only say what all experience proses, and all men of sense and candour ac- knowledge. We simply contend that the labourer is worthy of his hire. The more work he does, and the better he does it, the higher wages he deserves and must receive. Those who oppose these views, and assert that men will submit, or ought to submit to severe and protracted intellectual toil, and incur heavy responsibilities, from motives of a public nature, regardless, in a great measure, of personal interest, are either uninformed or insincere. They either know noth- ing of human nature, and the usages of the world, or they aim at gaining favour and ultimate profit, by a deceptive profession of disinterestedness. ( 24 ] There is yet another view of this subject worthy of notice. For the last eight or nine years, the medical school of Tran- sylvania has drawn a fourth part of her pupils from the At- lantic States. The reason is obvious. She has had size and reputation. In the moral and intellectual, no less than in the physical world, things attract in proportion to their mag- nitude and solidity. Young men are naturally and justly am- bitious to be educated in a distinguished institution. The motive leading them to this, no one can mistake. The fame of their Alma Mater is a source not only of pride, but also of profit to them. It gives them character, and aids not a lit- tle in introducing them into business. Hence, we say, a large number of pupils from beyond the mountains, have resorted to the medical school of Transylvania. Instead of two hundred pupils and upwards, suppose her classes reduced to a little more than one hundred, by a rival school of about the same size. Would the young men of the Atlantic States resort for their education to either institution No certainly. They would view and treat such dwarfish establishments with scorn and neglect, and go elsewhere for instruction. Nor is this all; nor even the worst and most mortifying result. The high minded young men, of the Mis- siZsippi Valley, who possess the necessary means, indignant at the degraded condition of the western schools, and resolv- ed not to sink along with them, would pass the mountains, and be educated in the east. Thus would the west not only lose the honour and advantage of imparting instruction to the youth of the east; she would have the privilege of in- structing but a remnant of her own. And Kentucky, no longer receiving large sums of money, for educating the sons of both adjacent and remote States, would be drained of no small amount, by the distant education of her own sons. Such would be the inevitable consequence of erecting too many medical schools in the west. Were it not an invidious and repulsive task, we could name a section of the United States, great and distinguished in other respects, where a su- 25 ] perabundant number of small medical institutions has pro. duced the effect just specified, to an injurious extent. The entire Valley of the Mississippi does not, at present, furnish more than three hundred pupils to schools of Medi- cine. That number, equally divided, is barely sufficient for two institutions, worthy of the attention of well qualified Professors. If it be sub-divided into three or four schools) medical teaching will be surrendered to incompetent men) and the Profession will lose cast. In from ten to fifteen years more, it is probable that three respectable schools may be sustained in the West. When the Mississippi Valley shall furnish from fre to six hundred medical pupils, another institution to educate them may be erectedwithout perhaps materially injuring the Profession. But it is repeated, that, even then, one will be enough for the State of Kentucky. Why is college learning at so humble and unpromising an ebb in this State Because there are too many colleges in it-or chartered institutions under that name. The number is six or seven-fold greater than it ought to be. In con6e- quence of this unwise division of the means and pupils of the State, all its college establishments are feeble-deficient in funds, libraries, and apparatus, with two few teachers, and proportionally fewer students. If competition between ri- val medical colleges would produce such splendid resultds, as some people seem to anticipate from it, why is it so useless between literary ones Let those, who, by their unfounded representations, have furnished ground for proposing this question, Answer it; we cannot. Were the high education of the State conducted by one University, and a sufficient number of academies and grammar schools, as nurseries, all teaching on a uniform plan, the issue would be brilliant. Education in Kentucky would be equal to that in any other portion of the Union. But, frittered down, as the means of the people are, into so many disjointed fragments, it is impos- sible for literature to be effectively promoted by them. Cut up the medical means and energies of the State, and the re- sult will be similar. Kentucky schools of medicine will D [ 28 ] become but another name for objects of derision. Nothing would be so gratifying to the medical college of a neighbour- ing State, as to see the pupils that now resort to Transylva- nia, thus divided, and marshalled under the banners of con- flicting institutions. "Divide and conquer," was the war- maxim of Philip. In like manner, let the strong and dis- tinguished school of Transylvania be partitioned into two or three feeble ones without character, and the school of Cincin- nati will take an ascendency over the whole. It is not unimportant to observe, that the literary colleges in Kentucky, are not recognized, as on an equality with col- leges of the same sort, in the Atlantic States. Hence the ad eundem courtesy is not extended to them. Why Be- cause they are comparatively small and feeble institutions; and their excess in number is the cause of this. As respects the medical school of Transylvania, the case is different. It is recognised by the schools of the east, as on a par with themselves. But, partition it, and let two or three petty schools be formed out of its fragments; and neither of them will be accredited cast of the mountains. Thus will Kentucky be dishonoured in all her literary and scientific institutions. We shall only add, under this head, that it would be infinitely more creditable to the State, as well as more advantageous to medical science in the West, to erase the school of Transylvania altogether, and erect on its ruins another of equal distinction, than to partition it into two or three. In the former case, one entire institution would still flourish, and shed a lustre on its native Valley; in the latter, the fragments of one, useless and pitiful in themselves, would be disreputable to all concerned in them, and must ultimately wither and die under the dissatisfaction and neglect of the public. It is contended, we are told, that another school of medi- cine should be established in Kentucky, because that of Tran- sylvania is not sufficiently religious. This charge and objection, though too futile and offensive to deserve an answer, shall receive one. It is untrue; and those who urge it, know this. [ 27 ) There are few if any medical schools in the United States, that have a greater proportion of their chairs filled with professors of religion, than that of Transylvania. And those professors belong to different religious persuasions. Nor is this all. It is confidently believed, that in no other school of medicine that can be named, are equal pains taken to inculcate on the pupils moral and religious truths and observances, as in that which is thus maliciously slandered. In almost every class, that has repaired to it, since the foundation of the school, there have beeirone,two, or more clergymen. With the consent and approbation of the Professors, if not at the request of some of them, those gentlemen have often preached to their fellow pupils; and, when travelling clergymen of note have arrived in Lexing- ton, during the sessions of the school, they have usually done the same, by special invitation. For the last three or four winters, the present one included, religious discourses, mixed with lessons on practical morality, intended particu- larly for the medical and law classes, have been delivered al- most every Sunday evening. Nor is all yet told. Places of public worship in Lexington are numerous. In them, as many of the pupils as are so inclined, attend the stated ex- ercises of the Sabbath; on which occasions the pews are liberally opened for their accothmodation; and many of them are kindly urged to this duty, by the families,in which they live. Such is the course pursued, for the religious interests of the medical pupils of Transylvania. while those of most other medical schools are allowed to pick up religion as they can-or neglect it if they will. It has been often asserted, and, as far as we know, never publicly contradicted, that Louisville and Cincitnati are more easy of access to the medical pupils of the West, than Lexington. The reason assigned is, that the two former cit- ies, situated on the river, arc accessible by water, while the latter, being remote from it, is not. That this opinion should be entertained by any one at all acquainted with the subject, is matter of surprise. f has 28) pso the slightestfoundation in truth. It is easy to show, arid, should the question be further agitated, with a view to in. jure Transylvania, we are prepared to show, that, to a very large majority of the medical pupils, who are now educated in the West, Lexington is easier of access, than either Lou- isville or Cincinnati. The pupils can reach it from their homes, in a shorter time, more comfortably, at less expense, and without incurring half the risk from accident and sick- ness. To prove all this hereafter, should it become necessa- ry, we shall derive our testimony chiefly from three sources; the geography and bearings of the States that send medical pupils to the western schools; the low stage of water in the Ohio, and the difficulty and comparative danger of naviga- ting it in the autumn, the time at which the classes assemble; and actual experience, whose evidence never deceives. It is a well known fact, that those young gentlemen, both of the present and of former classes in Transylvariia, who have ex- perienced the most tedious, uncomfortable and costly jour- nies, and who have been latest in reaching Lexington, have come by water. And, when examined and understood, the nature of the case shows that it must be so. It has been industriously attempted to palm on the country another belief, which it may be proper to notice. The pub- lic are gravely told, that Louisville and Cincinnati are pref- erable to Lexington, as seats for schools of medicines because they have hospitals, in the wards of which a class can be prof- itably instructed, by an attendance on clinical practice. When we take into view the ground on which this represen- tation is made, and the purpose intended to be subserved by it, we have no hesitation in pronouncing it an error in itself, and a palpable delusion practised on those who are unac- quainted with the subject. That a small resident class may be benefitted by this form of instruction, is true. But that a large winter class, assem- bled to attend lectures for only four months can, is not true. Nor do we hesitate to add, that those who assert the contrary of this, do it from ignorance, or a wish to deceive. On this [ 29 ] point we speak from experience. We have ourselves made one of a large class, that attempted this scheme of instruc- tion, in the wards of the Pennsylvania hospital, which are much more spacious, and better fitted for the purpose, than those of the Louisville and Cincinnati hospitals. And what was the issue Nothing but this. We abandoned the matter, in the second or third week, as a mere annoyance, and a waste of time; and so did every other pupil of standing in the class. When the prescribing physician was walking his rounds, followed by a train of a hundred students, or more, the sick-rooms were converted into so many Babels. All was confusion and indistinct sound. Every young man pressing and scuffling to see and hear something useful, often to the serious annoyance and injury of the sick, precluded the pos- sibility of learning any thing, and converted the entire scene into a farce. And such will be always the case, under such circumstances. Add to this, that young men, attending six or seven lectures every day, have no time to spend in the wards of hospitals. Nor, if they had, will they find there the sort of cases, which they will be called on to treat in private practice. In fact, in whatever light it may be view- ed, hospital practice, held out, as a lure to attract a large winter class, is a dishonorable hoax, to gratify the cupidity of those who practise it. What is the evidence of Dr. Drake on this subject Subs stantially the same with what we have detailed. Three or four winters ago, he tried clinical teaching, in the Cincin- nati hospital. And what was the result Precisely what the nature of the case rendered inevitable. The Professor found himself engaged in a form of teaching, where, from an entire want of accommodation and means, it was impossible for him to impart to his pupils any valuable measure of in- struction. He therefore abandoned the enterprise, and vir- tually pronounced it useless, in a pamphlet which he publish- ed a few months afterwards. The following is the Doctor's own account of his failure, together with the cause of it. "The lectures commenced, (November, 1831) and the first [30 ] three weeks were sufficient to establish the unpleasant fact, that clinical medicine could not be sustained. The wards of the hospital were too small to admit the entire class"-Yes truly; "too small" to admit the half-perhaps even the third of it. Yet the class was small. But Dr. Drake assigns also another reason for his failure, not much less formidable. "The Trustees (of the institution) uneducated and super- stitious men, instead of promoting post mortem examinations, sought rather to prevent them."-In fine; the notion, that a large class, by crowding into the wards of a hospital, can learn any thing useful, by an examination of the sick, is lu- dicrous. Hence, from a consciousness of this, Dr. Rush adopted the practice of taking notes of cases in the Penn- sylvania hospital himself, reporting them to his class, in his lecture room, and from those notes delivering his clinical lecture. And he might just as well have founded that lec- ture on a case in his private practiCe-much better indeed, because he could -have made in that way a much more judi- cious selection. Yet we are still assured that hospital prac- tice is of great importance to a winter class. But, by whom is the assurance given by physicians of responsibility, who have themselves witnessed it No, truly; but by those who are totally ignorant of it-who, we believe, never visited the wards of a hospital-and, we regret to add, who make the assertion, to serve their own personal purposes, regardless alike of public good, and public harm. For the truth of this statement, respecting the entire use- lessness of hospital practice, to a large winter elass, whose time is absorbed in their attention to lectures, we appeal to every intelligent and honorable physician, who has been himself personally concerned in the experiment. Once more. We are confidently told, that large cities are necessarily the best seats for schools of medicines be- cause they afford the greatest facilities for improvement in anatomy-in other and plainer terms, because subjects for dissection can be procured in them most readily, and in the greatest number. E 31 ) This assertion is unfounded, and betrays, in those who make it, an entire ignorance of the past history, and actual condition of medical schools, not only abroad, but in our own country. London is the largest city in Europe, containing a million and a half of inhabitants. Yet, to procure a sub- ject for dissection there, is uncommonly difficult and expen- sive, and often exceedingly dangerous. Hence the atrocious practice of assassinating individuals, and selling their bodies to surgeons and pupils. Edinburgh contains a population of more than a hundred thousand. Yet so difficult is it to pro- cure subjects there, that the Professor of anatomy imports 4hemfrom Paris. And, for a large portion of his demonstra- tions, during his lectures, he has sometimes had but a single body. Here again the want of anatomical facilities has led to as- sassination. In what small town has this ever been the case- In none. Of the procurement of subjects in Dublin, we are not so fully informed. We know however that it is difficult and expensive. New York is the largest city in the United States. Yet has the Professor of anatomy there been compelled to bring his subjects from Baltimore. This fact we received from himself but eighteen months ago. We were also informed of strong suspicions being entertained, thatfoul deeds had been attempt- ed, if not perpetrated. in New York, to create facilities, in ana- tomical pursuits. It is only in large cities, that such atrocities are dreamt of. Paris is about half the size of London, and furnishes sub- jects in abundance. Philadelphia and Baltimore united would be less than Dublin, and would not be near equal to thefifth part of London. Notwithstanding this, either of the two American cities furnishes more facilities in the procure- ment of subjects, than London, Dublin, and Edinburgh com- bined. It is not true then, that cities afford pupils opportu- nities for improvement in anatomy, in proportion to their size. The advantages they offer, in this respect, depend chiefly on the liberality of the sentiments and usages that prevail in them. Provided the arrangements of the school ( 32 ] are judicious, and the disposition of the inhabitants friendly, experience proves, that, in towns of a moderate size, subjects amply sufficient for the purposes of demonstration, can be readily procured. We could name a place, containing not more than three thousand inhabitants, where facilities of the kind were abundant. If it be true, that a large school of medicine can be sus- tained only in a large city, or that the size of the school materially depends on that of the city, in which it is located, why have the schools of Leyden, Gottingen, and Hall6 been always larger and more celebrated than those of Viennat Amsterdam, or Berlin and, why, until the present century, have the schools of Montpellier and Edinburgh, been larger than those of Paris and London Why, again, in our own country, is the school of Boston sometimes inferior in num- bers to that of New Haven, and those of other small New England towns, and the school of New York always vastly inferior to that of Philadelphia Why, in a particular man- ner, for the last eight or ten years, has the school of Tran- sylvania been the second in size, in the United States- much larger than those of New York and Baltimore, Charles- ton and Cincinnati We call on the eulogizers of large towns and cities to answer these questions and statements, on the ground they have assumed. And, if they cannot do it, we advise them, in credit to themselves, to abandon their ground, by an ac- knowledgment of their error-or, at least, to be silent, and expose themselves no further, by writing or talking on mat- ters, of which they are uninformed. But we are not yet done with this subject. Serious rea- sons can be rendered, why, as a place of instruction for youth, a large city is inferior to a small one. 1. Subsistence in it is much more expensive. Pupils can live in Lexington at half the cost of similar fare and accom- modations, in any of the large Atlantic cities-and we be- lieve at considerably less. The same is true, in no small de- gree, as relates to Louisville and Cincinnati, or any other [ 33 ) very active seat of commerce that can be named. The rates of living in them are at least fifty per "eat hig.her tian in Lexington. To young men cf limited means, ihis is a consideration of no small weight. 2. The shows and amusements of large cities occasion much waste of time and money. This is true especially as relates to youth, fresh from the country, new to the world, and, for the first timne, removed from the guidance and care of their parents and guardians. From this cause, not only is the present time which should be devoted to study mis-sptnt by them; habits of idleness and dissipation are contracted, which often last for life and produce ruin. It is not long since a gentleman, who had himself tried it, assured us, that he had found it impossible to be a student in Louirville. Nor did he hesitate to assert his belief, that it would be difficult, if not impracticable, to find a young man, who could study closely there. One of the Professors of the medical school of New York gave us similar information, last summer, with regard to that city. He frankly acknow- ledged, that the numerous scenes of seduction and dissipation, and the general distracting character of the place, were eminently injurious to the youth who resorted to it. foi their education. While an emporium of commerce and trade is the best place, in which to practise a profession, we appre- hend it is, for the mass of young men, among the worst, in which to acquire a knowledge of it. 3. The incentives to vice of all sorts, are more numerous and powerful in large cities, than in small ones. This is more especially the case in places that are constantly crowd- ed with strangers, or which constitute thoroughfares for travellers of every description. We need scarcely add, that the two latter conditions are peculiarly true of Louisville and Cincinnati. Those cites have usually a heavy stranger- population throughout the year; and. during the winter and spring, they are. by far, the greatest travelling thoroughfares in the Mississippi Valley. These things are favoirable to those places, as emporiums of commerce, and contribute E [ 34 ] much to their growth and prosperity, in that respect. But we have yet to be convinced that they are not prejudicial to them, as situations for medical schools. To these compari- sons between Louisville, Cincinnati, and Lexington, we have adverted with no little reluctance and regret. Nor would we have done it at all, had it not been, that they have been, for years, reiterated in conversation and letters, and indeli- cately bandied in pamphlets and newspapers. The public will bear us witness therefore, that we have not been the aggressors. Neither however have we felt at liberty to re- main any longer silent, under such repeated misrepresenta- tions, intended to injure the school of Transylvania. Let not the foes of the medical school of Transylvania imagine, that any portion of this paper is intended for them. Far from it. As no motives of reason or public usefulness led them to assume their hostile attitude, neither is it proba- ble that they would induce them to resign it. Few and fee- ble, as they are, moreover, we are alike regardless of their friendship and enmity. Were we conscious of entertaining thefaintest desire to propitiate their feelings or change their conduct, we would instantly extinguish it, as unworthy to be cherished. As they have caused the tree to fall, with regard to themselves, so let it lie; and they ale welcome to all the fruit they can pluck from its boughs. It will turn to bitter- ness with them. No; our appeal is to the great and enlight- ened community of the west and south, whose views, and wishes, as relates to medical schools, are directed to the re- lief of human misery, and the good of their country. Our object is to inform them correctly of the true interests of those institutions, with that of the science they teach, and the Profession they sustain; confident that, when thus in- formed, they will act as becomes them. In a special man- ner, we address ourselves to the many hundred grateful and high-minded sons of Transylvania, who are scattered through- out the Mississippi Valley,. and flourishing elsewhere. Nor will they be deaf to the call, or indifferent to the ground of it. Added to the strong and sacred motive of filial affection [ 35 ] and gratitude, which honorable men never disregard, a sense of their own reputation and interest will induce them to make a common cause with their ALMA MATER. Enlightened as they are, they have not now to learn, that whatever injures the standing of the mother, falls like a blight on that of her dhildren.