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stand the preparation when he comes after-wards to examine it. Good delineations, Ineed scarcely add, are a most useful resourceas illustrations, in cases where the real ob-jects are of such a kind as cannot be pro-cured or prepared for exhibition.The actual demonstration of the objects,

aided frequently by illustrative drawings,is then essentially required to render at-tendance on anatomical lectures profitableto the student; and it is a mode of instruc-tion that may, I am convinced, be advan-tageously carried much farther than it gene-rally is. The preparation of parts for illus-trating lectures is, for the most part, confinedto those of which the structure is visible tothe naked eye ; but, as I have already ex-plained, the principal facts relative to thetextures and to organic development can beseen only by means of the microscope, andif the student is to obtain a real, and not amere verbal knowledge of these finer pointsof anatomy, an apportunity must be affordedhim of inspecting the objects with that in-strument. Some microscopic objects whichdo not need to be highly magnified, may beshown even during lecture ; and a time maybe set apart for demonstrating those whichrequire a higher magnifying power, or nicermanipulation. An opportunity is thus af-

forded of practising the student in the useof the microscope, with which, in the presentstate of the science, no accomplished ana-tomist ought to be wholly unacquainted.

-But, Gentlemen, I hasten to a close. I

feel how much my efforts have fallen shortof the occasion, how far they have been be-low what an enlightened audience, like thepresent, was entitled to require of me ; and,permit me to say, Gentlemen, I trust yet, indue time, to prove, that they have not alto-gether done justice to myself.

I trust, however, that, from the slightsketch I have laid before you of anatomicaland physiological study, imperfect as it hasbeen, you will have been able to form someidea, at least, of the nature of our futureduties. The fulfilment of these duties will

require, on your part, all that love of know-ledge, all that persevering diligence, andthat desire to excel, which have hithertobeen so abundantly displayed by the pupilsof this institution. On my part, Gentlemen,I am sensible how much you have a right toclaim of me, but yours are claims that must

be met, not by words, but by deeds ; and allI shall say on the present occasion is, thatno effort of mine shall be wanting, no laboursshall be spared, which can tend to forwardyour instruction.

ADDRESS

INTRODUCTORY TO A COURSE OF LECTURES

ON SURGERY,DELIVERED ON MONDAY, OCT. 3, 1836,

BY MB. LAWRENCE,AT ST. BARTHOLOMEW’S HOSPITAL.

Ia the course of lectures, Gentlemen,which I commence this evening, I shall en-deavour to instruct you in the science andpractice of surgery, using that word in itsmost extended acceptation, as including aknowledge of the nature and treatment ofall the diseases which custom has assignedto the care of the surgeon, whether theyarise from injury, and other external agents,or from internal causes,-whether they areto be treated by external means, by chang-ing the diet, or other habits, or by internalremedies. I say, the diseases which customhas assigned to the care of the surgeon, be-cause, although the separation of physic andsurgery is, in many instances, convenient,and, in many respects, of public utility, thedistinction is arbitrary, and altogether de-pendent on usage. The scientific principlesare common to the two branches of the pro-fession ; the practical proceedings are en-

tirely alike, and the mode of study is thesame. The distinction, even in practice, isso vague, that whether a patient should beattended by a physician or a surgeon de-pends, in many instances, not on the.natureof the disease, nor- on that of the meanswhich are to be employed in its cure, buton the opinion which the patient may hap-pen to entertain of the talent, the knowledge,and the integrity of a particular individual.It is a question of confidence, not of noso-logy. I must, therefore, express my entireconcurrence in what, was stated by my greatpredecessor in this chair, viz., that surgeryand physic, considered as subjects of studyand scientific investigation, are one and in-divisible.

In attempting to convey to you the notionI entertain of the nature and extent of sur-

gery, and the distinction between that andthe other branches of the medical profession,I must first beg of you to discard from yourminds the limited, and, I may say, the un-worthy, notion that might arise, if you con-sidered the etymological import of the word.The Greek words cheirergon and cheirourgos,and the Latin word clairurgia, and the Eng-lish words surgeon and chirurgeon, are thesame expressions, modified according to thegenius of different languages. The Greekterms which are used are derived from cheirthe hand, and erg-on, a work. Thus, 14 surgeon"literally means work of the hand, and ’ sur-gery" means manual operations. Surgery,considered thus etymologically, might bedefined, "That part of treatment, or thera-

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peutics, which consists of manual opera- ( Considering the distinction between sur-tions ;" but it certainly creates more work gery and the other parts of medical art andfor the head than the hand. Now, certainly, science to be entirely arbitrary, I use thea surgeon very frequently employs the hand, word in its common acceptation. I con-but he finds much more serious work for the ceive it to include the following injuries ofhead. If surgery had been what the name all kinds :-The greater part, if not the

implies, a merely mechanical object, a spe- whole, of external and local diseases; thosecies of handicraft, the genius of HUNTER internal diseases which produce a change re-would not have been required to spread and cognizable externally,-for example, altera-to unfold its principles ; and such names as tions of position, of bulk, of figure, of con-those of POTT, ABERNETHY, DESSAULT, Bi- sistence ; and all cases requiring operations,CHAT, RicHTER, and SCARPA, would not have external applications, and manual proceed-delighted in its cultivation and illustration. ings of all kinds. Now, these are the sub-

Surgery is one branch of the medical pro- jects which are ordinarily comprised in afession : let us enquire in what it consists. course of lectures, or in treatises, on surgery.To preserve health, to remedy injury, to cure Thus, we see that surgery embraces a largeor to alleviate disease, and to apply the portion of the science and art which relatesknowledge that we possess on this subject to disease. If we divide the subject underto the elucidation of various important ques- its general name of " medicine" into twotions in legislation, in jurisprudence, in cri- parts, physic and surgery, we shall find thatminal proceedings, in police, and in other the latter is at least equal in extent and im-matters relating to the health and comfort portance to the former.of individuals and societies, are the objects I do not trouble myself with consideringof a comprehensive science, which we may what relation each of the two parts of thedesignate by the general name of medicine. medical profession bears to the other inThe science of medicine, considered thus ge- rank : that is a point of fact which involvesnerally, embraces the natural history of man, the opinion of the public, and it cannot,the enquiry into the organization of the hu- therefore, be determined by the parties in-man frame, and into its living actions. It terested. I will only observe upon this

surveys the human body under the various point, that there seem to be two kinds ofmodifications which are impressed on it by rank adjudged-the artificial, which is de-surrounding influences of all kinds. It termined by the decrees of the herald’s col-studies the nature and mode of action of lege-the natural, which is awarded by thethese influences, and hence it derives the public voice, in the remuneration of publicrules for preserving health, for alleviating services, not a private one. The criteria re-or removing disease. The practical applica- specting the latter in our own profession,tion of these rules constitutes the art of me- depend on the amount of accession to thedicine,-the " art of healing," as it is fre- stock of knowledge and of useful practicalquently called, but, as it ought more pro- improvement. I trust that the surgeon will

perly to be termed, " the art of treating dis- never be disinclined to enter the lists for theease ;" while the collection of facts, and the latter species of distinction.reasonings on which the practical proceed- It must be confessed, that in the preced-ings are grounded, constitutes the science of ing enumeration of the subject, the boun-medicine. Now, although medicine, as thus daries of surgery are not very clearlyexplained, is one subject, and although all marked: injuries, accidents, operations,-the parts are connected by numerous and these are undisputed parts of surgery ; butintimate relations, the field which it embraces when we come to distinguish between ex-is far too extensive to allow of its being cul- ternal and internal diseases, the affair istivated by one individual, either for the pur- more difficult, and really I cannot pretendpose of writing or teaching; and it has been to draw the line of demarcation. We needfound convenient for practical purposes, in not, however, give ourselves much troublemany instances, to subdivide the art into on the subject, for our patients cut the knotparticular branches. Hence have arisen the which we are unable to untie. When theyseparate callings of physician, surgeon, and are ill they do not look to nosologies, orapothecary ; and hence the distinction of phy- systems, to see whether they are sufferingsic and surgery has arisen naturally, in the under a medical or a surgical disease, theyprogress of society, like other divisions of resort to those in whose talent, knowledge,labour. It accords with the notion gene- integrity, and professional character, theyrally entertained, and well-founded, that the place the greatest reliance, without con-confinement of talent to one object is attend- sidering the distinctions under which theyed with an increase of skill and perception. practice, or the fraternity to which they be-This is true with respect to those parts of long. In the great majority of instances,our own profession which are of a mechani- medicine is practised in the country as onecal kind, and this distinctly prevails where- profession. Persons are called "surgeon-ever medicine has been cultivated as a apohecaries." General practitioner is thescience. Surgery, then, is one portion or di- title by which they are now very fitly deno-vision of medicine. minated. On the contrary, in the metropo-

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- its, and in many large towns, surgery and mentofdisease, fromthatmedical knowledgephysic are exercised by separate prac- which is an indispensable guide to the timetitioners; they are taught by distinct and mode of its application, survived theteachers, in separate courses of instruction, circumstances which gave rise to it. Itand regulations are enjoined by law for two lasted in our own country until the middledistinct species of the community, the phy- of the last century, when the Incorporationsician and the surgeon, severally governed of Barber-Surgeons was dissolved by Act ofby the College of Physicians and the Col- Parliament, in the reign of GrEORGE thelege of Surgeons. Second ; yet, however, the union still exists

. Finding this apparent contradiction, we in many parts of Europe.,are naturally led to enquire in what the dis- In order to understand whether there istinctions between physic and! surgery con- any well-regulated distinction between sur-sist ; whether in the nature of the diseases gery and physic, it is necessary that I shouldallotted to each, or the mode of treating advert briefly to medical science and prac-them ? how and when the distinction aroae’? tice. When you hear that the human bodywhether there is any difference in the mode consists of numerous separate parts, thatof learning them? these exercise distinct offices, and that theyNothing like the modern distinction was are variously acted upon by external causes

made by the ancients; we find no traces of and internal agents, you might naturallyit in the Greek, the Roman, and the Arabian suppose that any of them might be studiedwriters. Certain branches of practice were, separately ; that you might learn the natureindeed, followed separately in Egypt, where and diseases of some one or a few organsdiseases of the teeth, the eyes, and even without studying the rest. A little reflec.some internal organs, were attended to ex- tion will show you that knowledge, if itclusively by particular practitioners ; and a could be thus obtained, would be very im-similar distinction existed in Rome, where perfect. The individual organs which makedentists and oculists were numerous. But up the human body, although various inHIPPOCRATES, GALEN, and the Greek medical their structure and office, are all connectedwriters, wrote indifferently on the treatment with, and naturally dependent on, eachof fevers,-on external and internal diseases, other. They are merely subordinate partsand operations, of one machine, and they all concnr, each

In the long night of ignorance and bar- in its own way, in producing one commonbarism which intervened between the down- result-the life of the individual. All thefall of the Roman Empire, and the revival of leading arrangements are calculated to giveletters in the West of Europe, learning and a character of unity to the organization andscience were confined to members of the living action of the frame. There is oneecclesiastic profession, to whom we are in- source of nutrition to the whole body, onedebted for the preservation of those imper- centre of circulation, and hence all the partsfect remains of literature and art which we are mutually dependent for the means ofstill enjoy. The practice of medicine was their nutrition and growth, and for the ma-confined to them; priests and monks were terials for their various exertions, on thethe physicians and surgeons of those times; alimentary canal and circulating system.they attended to the bodily ailments, as well There is a common point to which all sen-as to the spiritual wants of their flocks. In sations are conveyed, and from which voli-the course of time this combination of me- tion emanates-the seat of the animal pro-dical practice with ecclesiastical duties was pensities, the moral feelings, and thefound objectionable ; we may, indeed, fancy intellectual powers-the source of nervousthat it might be inconvenient to entrust the energy. The nervous system performs thecomplaints of females, for instance, to an most important offices; it assists the actionorder of men whose vocation led them to of the various separate parts, and combineslead a life of celibacy; and the rulers of the them for the general purposes of thechurch thought it necessary to adopt strong economy. It regulates the combination andmeasures, and put a stop to it by a papal succession of movements, and renders themedict, in the beginning of the 14th century, harmonious, so that, although there is a

in which they were expressly forbidden to multiplicity and intricacy of parts, they arepractise surgery, under the penalty of ex- the same ends, and the machine workscommunication. The manual proceedings silently and imperceptibly. This system isthus abandoned by the ecclesiastics, were the great instrument of co-operation andtaken up by barbers, attendants at baths, sympathy ; by means of it, the various partsitinerants, and mountebanks. In the course act together in a state of health, and suffer,of time, the care of sores, and some minor or sympathize, in disease. Hence the ex-processes, came to form, with the art of the pression of HIPPOCRATES, in reference to thebarber, the occupation of a particular class human body, labor unzas, consentientia omniaof men, who were legally incorporated in -one exertion, all parts concurring. Youthis and other countries, under the denomi- can form no adequate notion of one organ, ornation of barber-surgeons:’ This separa- system of organs, if viewed insulated fromtion of surgery, or one branch of the treat- the rest, any more than you can understand

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the action of a single wheel or lever detached the signs of treatment under the three-foldfrom a watch or a steam-engine. In the same division of hygiene, which includes diet, air,way, when an organ labours under disease, clothing, exercise, and other circumstancesit would be very improper to confine your of general management; pharmacy and surattention to the local symptoms. You must gery.consider the disturbance which diseased ac- Anatomy, physiology, morbid anatomy,tion is capable of exciting in other parts of pathology, therapeutics-these are the pri-the body, and the reciprocal influence mary divisions of your immediate medicalwhich other parts may exert over the seat of studies, all of which may be referred to onedisease. or other of these heads. When disease is

Again, although individual organs are nu- studied in this way, in reference to the

merous, the elements of organic structure whole body, it constitutes the science ofare few. The basis of parts is made of the general pathology, while a similar investi-cellular, the vascular, the nervous, and the gation, directed to a particular organ, is theabsorbent systems : the phenomena of life pathology of that organ.are alike in all their leading features. Now, the real question respecting theHence the changes of structure, and the de- distinction of physic and surgery is this :-rangements of function, which constitute After surveying the whole field of disease,disease, are essentially similar, differing in the way I have mentioned, can you seeonly in modification. Since the organic ele- any natural division into two parts ? Canments, or the materials of the frame, are the you divide them into two independentsame throughout, and since all the various halves, requiring distinct modes of studyactions are linked together in the execution and practice? Certainly not. The entireof a commou purpose, the nature, disease, structure and functions are universally andand treatment, must be everywhere essen- intimately connected; no one part is inde-tially the same. The principles of pathology pendent of the rest. The causes of unna-are the same for all parts of the body, and tural function, and those deviations thatthese, therefore, will be common to the phy- constitute disease, are often found, not insician and surgeon. There is one anatomy the part itself, but in other parts or func-and physiology, and there can be only one tions, and the means of treatment are seldompathology. We may therefore assert, that to be applied to the part actually diseased.surgery and physic, considered in regard to An example or two will render this truththeir principles, are inseparable; they are more obvious. A person is seized withdistinct in practice, but not in science. We palsy, he is unable to move the arm or legmay go further, and maintain that no part of of one side, forming the disease calledscience, however limited, can be thoroughly hemiplegia, or lateral palsy. Now, nothingunderstood, except by one who has studied is found in the paralysed limbs ; they are inthe structure and living action of the body a natural state, and would be found so bygenerally, and who has then cast his view examination on dissection. From the gene-over the whole field of disease. ral condition of the patient, we soon find

It is the first object of the medical student that disease has taken place in the head,to make himself acquainted with the struc- and we trace that disease to his mode ofture of the human body and living action: living, or to other circumstances whichthese are the subjects of anatomy and phy- have been in operation for a length of time.siology. He is then prepared for the study The treatment founded on what we haveof diseases ; he watches the circumstances just discovered respecting the causes andunder which they arise ; he views their pro- primary seat of the malady, is directed

gress and termination, and he explores the to the head: we bleed, we employ cup-organic changes which they produce. He ping, leeches, purging, and change his diet,learns to connect these changes with ex- we employ blisters, setons, and issues, andternal appropriate signs or symbols, deriving thus we diminish or remove the paralyticfrom his comparisons the means of deter- affection, without doing any thing to themining the exact seat and nature of disease, paralysed limbs. Many are the local affec-and of predicting its course and event. tions in which we can trace no injuriousThese matters are the subject of morbid or agency on the part diseased. We find anpathological anatomy and pathology. Ana- unhealthy condition of some important organtomy is the sign of healthy structure; mor- or system, or we trace the derangement in sobid anatomy of diseased structure. Phy- many parts of the body, that we say the con-siology is occupied with the healthy func- stitution is unhealthy. We find on investi-tions ; pathology, with those changes which gation that these states of the constitution,the functions undergo in disease. The stu- with their unhealthiness, owe their origindent is now prepared to observe the effects to causes of long continuance, of a slow andof the various external agents, of outward almost imperceptible operation. We cannotapplications, of inward remedies, or of sur- cure such diseases by merely local means,gical operations, which are necessary for we must trace the mischief to its source, andremoving diseases and restoring health. apply our remedies there, or we shall neverThese are the subjects of therapeutics, or cure the patient. A person is seized with

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gout in the toe ; the attack comes on fre- gins. She has decreed - that both shouldquently in the course of the night, when obey the same pathological laws, and hasnothing can have happened to the part. We connected them by mutual influences so

find in such patients a disturbed state of the numerous, that we cannot engage in the in.

circulation, an unnatural fulness of the cir- vestigation of either without a reference to

culatory system ; we find a -disturbed con- the other. External diseases in many casesdition of the digestive organs, and of the arise from internal causes. I may mentionsecretions, and we have no hesitation in re- erysipelas, nettle-rash, and the whole tribegarding these as the internal cause3 of the of cutaneous affections, even carbuncle,outward and visible malady. We rectify gout, and oedema. In all these cases thethese disturbances of the circulation, of the external malady is merely a sign or indica.digestive organs and secretions, by change tion of more important internal mischief.of diet and internal remedies, and thus we In other instances external causes producecure the patient. We thus succeed in re- internal diseases, as in various catarrhs,storing the patient to health without making rheumatic affections, and in inflammation ofany application to the part which is appa- the chest and abdomen. Our great reliancerently the immediate seat of disease. The in all these cases is on internal treatment-same pathological views which direct our the merely local measures are comparativelytreatment in the cure of a gouty toe, also unimportant. It is in vain, then, to instituteguide us in the accomplishment of of much distinct professorships for external and in.more important object—the prevention of ternal pathology, to establish colleges offuture attacks. The state of a constitution physicians and surgeons, to call them sepa,which gives rise to gout, is the offspring of rate sciences, and direct that they should beluxuriousness and indolence,- unless, there- practised separately. Lecturers and writersfore, in addition to other means we enjoin cannot make the distinction, and thus wean alteration in diet and other habits, we find, in many instances, that the same dis-shall never accomplish that renovation of the eases are considered by the teachers, bothconstitutional powers which is implied by of physic and surgery, comprehended in thethe cure of gout, in contradistinction to the writings of both, illustrated by both on themere removal of a gouty attack. same principles, and treated by the same

The influence of disease or of injury is not means.in general confined to the spot which is the Some have assigned local diseases to theimmediate seat of suffering ; it often ex- surgeon, and general diseases to the physi.tends, and includes so many parts, that, cian. The idea seems to have prevailed,speaking loosely, we say the whole constitu- that the injuries and external affections,tion suffers. A disorder of the brain, pro- which particularly fall under the care ofduced by excessive mental exertion, by in- the surgeon, are more especially local, andtemperance, or by other causes, disturbs require more strictly local treatment than-the circulation, the digestive organs, and internal diseases which come under thethe secretions, and brings a patient into the care of the physician. Now, though thestate called fever. Inflammation of a part, latter are in many instances obscure, andfrom a wound or fracture, in like manner are, therefore, not so clearly fixed to a de-disturbs the circulation, the digestive or- finite situation, they are just as local as thegans, and the secretions, and in the same former. Surgeons have been too much inway produces fever. Now, how are cases the habit of relying on local treatment, andof this kind to be understood, or treated, by thus have themselves sanctioned this erro-those who confine their attention to some neous notion. I remember the time fmyself,one part of the constitution ? What are we when the surgeons of this hospital wouldto think of the distinctions of surgery and go round the wards, and see a hundred orphysic, when we find that the one case is more patients, and not prescribe a singlemedical and the other surgical, and particu- internal remedy. If the patient’s bowels

larly when we discover further, that if we were confined, the sister, or nurse, wouldwere ignorant of the history, and considered administer a dose of purging mixture, ormerely the general condition of the patient, electuary. If anything beyond this werewe should not, in many analogous cases, be necessary, the case was referred to a physi-able to distinguish the medical from the sur- cian. This ingenious mode of employinggical fever? two persons to do the business of one, hasThose persons who are inclined to main- passed into disuse, and I apprehend that

tain strictly the distinction between physic there are none of us so warmly the admirersand surgery, take various views of it, but of the wisdom of our ancestors, as to wish itnone will bear close examination. It has to be revived.been proposed to refer external diseases to Diseases, however, cannot be dividedthe surgeon,-internal to the physician. Un- into local and general. There are hardlyfortunately for this distinction, nature has any in which we do not find it necessaryconnected the exterior and interior of the to direct our attention beyond the part, ifhuman frame so closely, that it is difficult we consider the cause, the progress, theto say where the one ends and the other be- termination of the disease, and the object of

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the treatment; while there are, I believe, together or in succession, is often followedreally none that strictly deserve the name of by a surgical operation.general. When a part of little consequence Considering the subject historically, wein the animal economy is slightly diseased, cannot deny that surgery originally con-

no striking effect may be produced beyond sisted of those limited mechanical and sub-the part itself; but when an important or- ordinate departments which were exercisedgan is seriously disordered, many other under [the direction, and with the permis-parts feel the influence, and hence arise sion, of the physician. Such was thewhat are called general diseases. The dif- feeble infancy of our profession, in whichference, therefore, between what we call we can discern no traces of the vigour andlocal and general disease is in degree, not efficiency which characterize its maturity.in kind ; it is a mere difference of more or To carry back surgery to this state of impo-less. If we were to arrange all diseases in tency and subjection, would be impossible;one column, beginning with the most local, for we cannot arrest the onward march ofand ending with the most general, we might knowledge. The attempt would be aboutfill the interval with others which would as hopeless as that of trying to persuade aform an insensible transition between the man to put on again the leading-strings oftwo extremes. Where could we strike the infancy. Surgeons have, for a long time,line across in order to make the distinction cultivated with ardour and success thebetween physic and surgery, by an arrange- scientific foundations of the general profes-ment of diseases constructed in this way? sion. They can appeal to the rapid pro-Many are the affections which are local gress which surgery has made during theduring one part of their existence, and gene- last half-century, and to the present undi-ral in another. A person receives a slight minished reign of its progression, in proofcut, scratch, or puncture on the hand; it pro- that their claims on the good opinion andduces a little redness ; this may, perhaps, confidence of the public are not inferior tobe neglected, the inflammation extends up- those of any other branch of the profession.wards to the arm, and produces general They can point out, in medical annals, thefever. A female has a lump in the breast, names of men who stand foremost in thewhich remains for years without pain or in- rank of contributors to medical knowledge.conveniennce of any kind whatever; after a Among these, I may mention that of thetime, it increases in size, it becomes painful, illustrious Pott, who was for a long seriesthe whol constitution suffers, and disease of years a surgeon in this hospital. Heis produced in many other organs of the has always been justly regarded, both inbody. other countries and in this, as one of the

Reverting to the nature and extent of the great modern improvers of surgery. Hisduties which originally constituted the oc- works describe, in clear and elegant lan-cupation of the surgeon, under the etymolo- guage, and with sound judgment, the resultsgical import of the term, some have proposed of his own observations, and are stillto confine surgery to the cases in which perused with instruction and pleasure.operations, or other manual treatment, are They contain a luminous exposition of doc-required. Thus, it has been represented as trine and practice on many important partsthe province of the surgeon to administer to of surgery. He, however, is thrown intoexternal ailments, and among his duties has the shade by the more powerful genius, andbeen included a very important negative- the extraordinary achievements, of his co-that of prescribing no internal remedy what- temporary and rival, John Hunter, theever! This most important professional greatest man whom this country has pro-distinction would rest, not on any essential duced in medical science, (cheers) withoutdifference in the causes or nature of disease, excepting even the immortal discoverer ofor in the principles of treatment, but on the the circulation-the greatest man in theaccidental and often varying circumstances combined character of physiologist and sur-of the means by which those principles are geon, th at the whole annals of medicine canto be carried into effect. What are we to present. No other individual, either in an-do with the numerous cases, such as inflam- cient or modern times, has attempted-tomatory affections of the head, various gouty say nothing of performing—so extensive aand rheumatic disorders, in which changes range of investigations. He examined mi-of diet and internal administrations are ne- nutely the structure and function of thecessary, in conjunction with topical appli- human body ; he enquired into the organi-cations, and with the surgical proceedings of zation and living action of animals in allvenesection, cupping, leeching, blistering, their varieties, extending his researches intoand setons? How are we to dispose of the vegetable kingdom as being endowedthese affections in which those various with life, though in an inferior degree. Hemeans become necessary in conjunction or observed the phenomena, and he traced thesuccession, as in retention of urine, in stran- effects of disease in all organs and strue,

gulated hernia ? In the latter a series of tures. He brought together the lights is-manual proceedings, with external applica- suing from these various sources, and threwtions and internal remedies, employed either them in full force on one great object-tlie.

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art and science of surgery. Such was his general pathology. He taught us to extendconception of the nature of our profession, our views beyond the narrow limits of localand the means by which it ought to be cul- causes and treatment ; he pointed out thetivated and improved. Many have ad- more general influence to which the diseasesvanced the art, but John Hunter gave a of parts owe their origin ; and hence he de-new form to the science of surgery. The duced the general modes of treating thosephysiological principles of our profession, diseases. He saw clearly that there ispreviously uninvestigated or unknown, only one kind of pathology, that there is nowere created, or at least brought to light, distinction in the source, nature, and treat.by his genius. Thus, he stands pre-eminent, ment, between surgical and medical diseasse,both among ancients and moderns, for ori- and, consequently, that the treatment of sur.ginal research and striking discoveries in gical affections requires all the aid of gene.the principles of medical science. This, ral pathology and therapeutics. He hashowever, is not the whole of his claim to the hence been sometimes regarded as an in.admiration and gratitude of his countrymen. truder on the territory of physic,, and he hasHe conceived the grand design of examin- been accused of wishing to make the surgeoning by dissection and experiment the struc- a physician. If it be intended to charge himture and living action of animals throughout with wishing that we should add to our sur,the whole range of creation. That he had gical knowledge that of medicine, the aceu.proceeded far in the accomplishment of this sation is just, and, in my opinion, does himHerculean undertaking, is rendered clear the greatest hononr. By thus exciting sur-by the writings he has left behind, both geons to the study of medical science gene.printed and in manuscript, and by the un- rally, he has, at the same time, conferred aquestionable testimony of his museum. That great benefit on the public, and added to thepart of the latter which is called the " phy- respectability of our own profession.siological" series, embraces all structures Fellow labourers in the same cause haveand organs, and it is arranged in each sub- not been wanting in France, Italy, anddivision, in an ascending scale, from the Germany. It is sufficient for me to mentionmost simple to the most complex. It is, Jean Louis Petit, of the French Academy oftherefore, an epitome of general anatomy Surgeons ; Dessault, Richter, Bichat, andand physiology, an exhibition of the pliilo- Scarpa. The two latter have been mostsophy of life, and discloses the ground on conspicuous among the cultivators of ana-which all divisions in natural history must tomy and physiology since the time ofbe founded, affording the basis of scientific Hunter. "

zoology. This collection is not only the Here allow me to digress for a moment,pride and boast of the College of Surgeons, and direct your attention to the mode byto whose care it has been judiciously con- which these great men have signalized them-fided by the legislature as a distinguished selves, by which they have achieved thoseornament to the metropolis, but the internal important public services which have con-treasure is so completely unrivalled, that it ferred on them imperishable renown. Theyexalts over the whole world the scientific have been called men of genius, but theycharacter of the country which gave birth to might more properly be denominated menits author. In estimating the public ser- of industry. They may have possessedvices of such a man as John Hunter, we superior natural endowments, but they haveare not to regard merely the direct acces- surpassed the rest of mankind more remark-sions to knowledge which Bowed from his ably in industry, activity, and perseveringindividual exertions, but we must consider labour. We should have supposed that Mr.the influence he exerted on the minds of Hunter’s time must have been entirely oc-those around him, the effect of his writings, cupied by his physiological researches andand example in encouraging others to enter private practice, but he has left behind himon the delightful paths of science which he a museum which can hardly, in point oflaid open to view. Hence new eras in the mechanical labour, be considered the productprogress of intellect are derived from the of one man. The writings of Bichat arelife of such a man. The lectures and writ- not more remarkable for the ingenious viewsings of John Hunter produced a powerful they disclose than for the immense extenteffect on the kindred genius of his own of anatomical and physiological researchcountryman—I mean the founder of this they embrace into all parts of the animalSchool, 1B11’. Abernethy (Applause)-to whom structure on which they are grounded, andwe may justly ascribe the great merit of hav- yet he died at the age of 30. It is in the

ing, by his lectures and writings, excited power of us all to imitate these great menand exemplified a more scientific investiga- in their judicious employment of time, thattion of the treatment of surgical cases. He stuff of which life is made up. There islearned from Mr. Hunter, of whom he was a none of us, however humble our talent, whodevoted admirer, to bring the light of phy- may not signalize himself by similar exer- .siology to hear on surgery, because he was tions, who may not make some addition toone of the first in this country to vindicate the stock of knowledge by dint of closethe natural rank of surgery as a branch of application and patient research.

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The attempt to reduce surgery to its and the female breast, and the amputationancient limits, to the art of bleeding and of limbs for diseases of the joints, were oper-tooth-drawing, which constituted the vener- ations of constant occurrence, whereas theyable encyclopaedia at the time of the barber- are now comparatively rare. Prepare your-surgeons, comes too late by a century or selves, however, by careful study, for thetwo, and if it could succeed it would be no performance of operations ; learn to executeless detrimental to the public than dis- them, at all events effectually and safelyrhonourable to our profession. In those and, if possible, dexterously and quickly;more serious cases in which local injury or but do not take pleasure in making an oper-disease is attended with more or less general ative display. Remember the just and hu-derangement, such as in compound fracture mane sentiment of Mr. Hunter :-" Anattended with fever, in injuries of the head, operation by which we mutilate a patientand of the nervous system, in erysipelas whom we cannot cure, is a confession of the’supervening on local injury or disease, in re- imperfection of our art." ,

tention of urine, in strangulated hernias, it is We are now prepared to answer the ques-obviously the interest of a patient to be tion respecting the mode of learning. The-attended by a person who understands the obvious inference from the remarks I have.case in all its branches. The surgeon who presented to your consideration is, that theknows only the local, and the physician who education of a physician and a surgeon mustunderstands only the general treatment, are be essentially the same. Anatomy and phy--each but half informed, and the two together siology, morbid anatomy, and pathology,deserve less confidence than one who under- must be studied by both. An acquaintancestands the entire case. The confidence with the general principles of treatment or’

which ignorant persons are disposed to therapeutics, is equally necessary in both

place on what they call a combination of instances. The principal difference is, that-talent is fallacious, if that combination is to to these common branches of knowledge theconsist of a surgeon who knows nothing of surgeon must add the acquisition of the ma--the general, and a physician who under- nual and operative part of the profession.’’’stands nothing of the local management. He must study medicine generally, as theIn most of these cases the local means are of physician does, and he must, moreover, qua-little consequence, while the fate of the lify himself for duties which are strictlypatient depends upon general measures, so surgical. The object of the remarks whichthat the surgeon who is ignorant of the latter I have now been making refers to the study,is incompetent to his profession. and not to the practice, of our profession ;Allow me to embrace this opportunity of and my particular design is to impress on

observing, thot the mere performance of your minds the propriety, or rather the ne-operations is the least important part of the cessity, of studying medicine generally. Thesnrgeon’s duty, even in cases ivhich require various parts elucidate each other so mate-them. To judge whether a disease is cur- rially, that he who confines his attention toable by other means, to see when an opera" one, cannot understand even that properly.tion becomes advisable, and to determine I do not intend, by any means, that everywhen it is necessary, to prepare the patient member of the profession should practicebefore-hand, and to manage him well after- all parts. I am well aware that the field ofwards,are points of equal, and often of much medicine is too extensive for one person to

superior importance. Do not understand cultivate the whole. With a view to further

by this that I mean to speak lightly of oper- improvement, there can be no doubt that antions. On the contrary, it is necessary that individual who has received a general me-you should carefully cultivate that part of dical education may improve a particularyour profession; but I wish to warn you department, if his attention be entirely de-against assigning the first degree of import- voted to it. Thus, circumstances of taste,ance to a branch of surgery which you will of confidence, age, and station, may lead toseldom be called upon to execute. It is a some divisions of practice, with advantagemistake to suppose that, under any circum- to the public, and benefit to science. This

stances, a surgeon is principally employed is a point, however, which must depend onin operating. The great boast at the pre- the particular views and tastes of indivi-sent day is, that the number of operations duals, and, in some respects, on the notionshas greatly diminished. I am confident, of patients, who are disposed to have a voicecomparing the present time with what took in such a case.

place when I entered the profession, that In pointing out to you the course you arethere are not so many operations performed to pursue in your medical studies, I mustnow as there were then, by one-half or two- first direct your attention to anatomy andthirds, and the difference has arisen from the physiology; for a knowledge of the struc- _

improved knowledge of the nature and treat- ture and functions of the human body is thement of diseases, resulting from the anato- basis of all rational medicine. Doctrines,mical, pathological, and physiological re- systems, and theories which will not bearsearches of surgeons. (Applause.) At the examination by these lights, are only to beperiod I allude to, the removal of the testicle regarded as random guess-work, or idle

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dreams. No one would attempt to repair a not from lectures or from writings, but byclock or watch, or any piece of machinery, studying the book of nature. You must visitunless he understood its construction, unless the sick chamber of an hospital, and observehe knew what we may call its anatomy and disease for yourselves. Lectures and booksphysiology, that is, the materials which are auxiliaries, and often useful ones, butcompose it, and the configuration, adjust- they are of secondary importance comparedment, motion, and’ action of the various with the actual observation of disease. Toparts ; yet you constantly meet with persons know disease, then, you must see and closelywho attempt to rectify the disorders of the examine patients ; you must watch the ori-human frame, not only with an imperfect gin and progress of altered function duringidea of its construction, but almost an ab- life, and you must explore, after death, thesolute ignorance of it. No person who changes produced in organization. Hereaspires to a scientific knowledge of the pro- your knowledge of anatomy and physiologyfession should neglect the sciences of ana- will be of essential service to you. Howtomy and physiology, because they afford can you appreciate the ei?-ects of disease,the foundation and criteria of all medical unless you are acquainted with healthydoctrines. structure ? How can you refer to alteredBut a correct anatomical knowledge is function, or to the symptoms that organic

More especially necessary to the surgeon in changes produce, especially in internal parts,the execution of his ordinary duties ; with- unless you know the healthy functions ?out it he cannot determine the seat of dis- The wards of an hospital are the best schoolease ; he cannot distinguish between affec- of surgery ; and clinical instruction, undertions of contiguous parts ; he cannot under- competent teachers, is the best mode ofstand the form, nature, and appropriate learning.treatment of injuries, such as fractures, dis- You will perhaps enquire, whether it ialocations, wounds of blood-vessels, and other necessary to attend lectures and read bookssoft parts ; nor can he proceed to perform before you see patients? I advise you to

the operations of surgery without danger to resort, as early as possible, to nature, to thathis patient, and equal risk to his own repu- source from whence the great masters havetation. If you enquire how much knowledge derived their knowledge, and from whichof anatomy is necessary to the surgeon, the lecturers and writers must draw their ia-answer is short-as much as he can get. formation. Thb facts which are thus pre-But the study of anatomy must be general sented to your own senses make a stronger-it must embrace all parts of the body; impression than any description even by theunless you know of any part which is out of ablest lecturer or writer, while the know-the reach of accident, and exempt from at- ledge thus gained from nature can always betacks of disease,-any organ which can never depended upon, and is never forgotten. Be-be the subject of operation. tween him who has merely read or heard,

I trust, Gentlemen, you will never be and one who has seen, there is the same dif-anxious to discover with how small a share ference, in point of knowledge, as there isof scientific knowledge you may be able to between the person who has merely perusedcarry on the trade of surgery. Your more the description of foreign countries, and onehonourable aim will be to make yourselves who has visited them. When you haveaccurate anatomists, as a first step towards begun to observe disease for yourselves, youbecoming good surgeons. The health, the may resort, with advantage, to lectures andlives, the limbs of our fellow-creatures, are books, which will be of service to teach youentrusted to our care, with a confidence in how and what to observe; in pointing outour knowledge, skill, and humanity ; and what might escape your attention ; in eluci-our utmost exertions, our most anxious toil dating what might be obscure ; in rectifyingafter knowledge, will not do more than erroneous conclusions ; and in impressingenable us to undertake this responsibility, the results of observation more strongly onWhat kind of feeling, what conscience can the memory.that man possess, who cn plunge an instru- Proceeding in natural order, you will firstment into the human body without knowing attend to external diseases, and then to thosewhat he may divide or injure,-who will of internal organs. In the former the origin,undertake to perform surgical operations the progress, the termination of disease, andwithout that full and accurate knowledge of the effects of treatment, are obvious to theanatomy which will enable him to meet senses. Here the evidence is before you,every emergency ? How could he bear his and you must apply the principles you deriveown feelings if serious deformity, or loss of from that source, by analogy and deduction,life, should be the consequence of his igno- to the more obscure affections of internalranee or rashness ? organs. Hence, a physician should beginThe knowledge of anatomy, however, will by studying surgery ; and he who has made

not make you acquainted with disease ; you himself a good surgeon, has done much to-may understand the structure and functions wards becoming a good physician. But doof a part perfectly, and yet not know its not understand that I mean to represent thatdiseases. How are these to be learned ? the study of surgery, in the ordinary accept-

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ation of the term, will-enable you- to prac-tise physic. The internal diseases, a know-ledge of which, and of their treatment, con-stitute together the duties of a physician,are a more arduous branch of the profes-sion ; they require greater attention, andyou should study them in all possible cases.

I should not recommend you, in the out-set of surgical study, to trouble yourselvesmuch with reading books. For the mere

beginner, it will be suflicielli, perhaps, tomake use of the elementary works of Mr.Samuel Coaper, I mean, his " First Lineson the Practice of .Surgery," and his 11 Sur-gical Diction,try." The latter book isalmost a surgical library in itself, and itsnumerous reference3 wil! show you thesource to which you may apply for furtherinformation on various points. To theseyou may soon adtl the works of Mr. Pott, andthose of Mr. Abernethy, especially his workon the " C institutional Origin, and Treat-ment of Local Diseases;" the work of Dr.Hamilton on the Administration of Pur-gative Medicines;" and, when some know-ledge has been gained in your pro:e.-sion,the works of Mr. Hunter may be revertedto; they are not suited, however, to the be-ginuer. To a person who wishes to possessa thorough scientific knowledge of his pro-fession, an acquaintance with the Latin,French, and German languages is necessary,oii account of the numerous valuable i::etswhich are to be found in those languages.I would, however, in respect to the subjectof books, again urge the advice alreadygiven, of consulting the great volume ofnature. Jucut integris accelerare rivis. The

draught of the pure spring will be alwaysrefreshing and invigorating. Seeing andexamining disease, obse--N-in,r the effectsof treatment, refflecting on the facts thuspresented to your own senses, and there-by appropriating knowledge by your ownmental exertions, will be a much moreuseful, as well as a more interesting, em-ployment than. reading.You will understand from the observ-

ations that I have now had the honour ofaddressing to you, that, in selecting themedical profession, you have set yourselvesno very easy task. The most comprehen-sive mind, and the greatest industry, wouldfind occupation for many years in acquiringthe whole circle of medical science. Youwill have occasion to lament that you can.not devote a longer time to those prelimin-ary studies which are necessary as a pre-paration for the active duties of )our pro-fession, and you will see the necessity ofimproving, with the utmost diligence, thoseopportunities of gaining improvement whichyou now possess, aud which you will neverbe able to recall.

Let me observe at the same time, thatamong all the various objects which canengage the human mind, there is no better I

exercise of the intellectual faculties, no moreattractive wnd interesting pursuit, than thestudy of the medical profession, while its

practice has the most salutary, moral ten-dency—that of repressing selfishness, and ofcalling forth and strengthening all thebenevolent and social feelings. Our first

object is to learn the construction of ourown frame, the means by which we live andmove and have our being. The nature and

operation of tho?e influences by whichhealth is interrupted and restored, by whichdisease and suffering are averted, are laidopen to our observation. Chemistry, naturalphilosophy, and natural history, are aizx-iliary sciences more or less directly con-nected with the immediate objects of ourpursuit. Thus we are led to the contempla-tion and study of nature, and to the investi-gation of truth. We are not called upon to

uphold doctrines or systems, or to defendany particular set of opinions. We have nointerests at variance with those of the com-

munity. In our professional -intercoursewith our fellow-creatures, we are knownalso as the instruments of good in restoringor securing health—the greatest of blessings ;the removing or palliating suffering—one ofthe greatest of evils; in consoling and .en-couraging our patients and friends;_ in pro-tracting the approach of taat awful momentfrom which we all shrink back with instinc-tive dread—the termination of existence.The happiness or misery of life,-the veryquestion of life or death, often hangs on ourdecision. Consider the responsibility at-

tached to those determinations which involve athe life of a beloved wife or husband; onwhich it will depend whether parents shalllose children, or whether children shallsustain the loss of a father or mother!

I trust, Gentlemen, you will enter uponyour studies in a frame of mind suited tothese serious duties ; that you will improvewith the utmost diligence every opportunityof gaining that knowledge and experiencewhich will enable you to sustain worthilythese great, these responsible duties. You

will thus render yourselves respectedmembers of an honourable profession, andyou will prepare for yourselves in decliningyears the first of all blessings, that of look-ing back on labours devoted to the goodof others, the highest of all rewards, thatof an approving conscience.

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