No. 949.

LONDON, SATURDAY, NOVEMBER 6, 1841. [1841-42.

INTRODUCTORY ADDRESS

ON THE

OPENING OF THE MEDICAL SESSION,DELIVERED AT THE

MIDDLESEX HOSPITAL SCHOOLOF MEDICINE,

OCT. 1841,BY FRANCIS HAWKINS, M.D.

GENTLEMEN,-We are met together, at thecommencement of another medical session,attracted by the common interest which weall feel in one great object :-that object isno less than the preservation (as far as itlies within our power to preserve it) of medi-cal science ; the flame of which, it is evident,would be extinguished, if no provision weremade for the instruction of the young, andfor the continuation of a race of well-informedpractitioners of our art. It is therefore an

important object, it is an express part of ourduty, not only to receive and to carry, but totransmit and to hand down to posterity thetorch of medical science.To promote this object, to enable us to im-

part to others the results of past experienceand observation, to add strength to the obli-gation of bequeathing to those who are tocome after us the knowledge which we mayhave ourselves inherited or acquired, theseends are now generally admitted to consti-tute one great purpose and design of thehospitals of this country.

It is true that this is not their primarypurpose. The more obvious and immediatedesign of relieving their suffering inmates,was undoubtedly the first motive whichawakened the sympathies of the better partof mankind, and called forth those strenuousexertions, those munificent contributions offounders and subscribers to which (for themost part in this country at least) we owethese inestimable institutions. But thesecond purpose, which has grown out of thefirst, has become scarcely less considerable ;nay, in its ulterior effects, it is even more im-portant. For the good which a hospital caneffect, by the direct relief which it affords to

sufferers, is limited, of course, to the simplenumbers which it relieves. But the benefitswhich it may produce by sending forth skil-ful practitioners, by sending them forth, per-haps, to all parts of the world, these increase,as it were, in geometrical progression. Thecircle thus produced may extend itself inde-finitely, and, by its larger comprehension,may ultimately affect society far more thancould the central impression which origi-nated these widely-spreading effects.

I have said that this view of the secondaryuse of hospitals is now generally admitted.If formerly it was not so, this arose from anatural, though groundless, fear, that thesecond purpose might interfere with the first.But it has been found that, with proper pre-cautions, this need not be the case. Naymore, that the business of instruction mayeven be rendered conducive to the presentinterests and immediate advantage of thesick: for without the assistance of pupilsand dressers, there are many of the servicesof the hospital which could not be so efIi-ciently provided for.Thus is it in every way desirable to unite

instruction with practice. It is, in fact, notmerely allowable to the officers of a publichospital to teach the art which they professand exercise, but it becomes their boundenduty to do so. They may do this, of course,in different degrees and proportions, accord-ing to their several means and opportunitiesand abilities. But all, at least in somedegree, incur upon this head a responsibilitywhich may not be regarded lightly. It must

be, it is regarded seriously by all who desireto satisfy the reasonable expectations of

others, and, what is more, their own consci-entious sense of duty.Hoc opus, hoc studium parvi properemus et

ampli,Si pATRi: volumus, si NOBIS vivere cari.

The very walls were, on some occasion,invoked by the Roman orator to bear witnessto the truth of his discourse. On the presentoccasion, I should scarcely be using a figureof speech if I were to assert that these walls,within which I am now addressing you, cantestify to the existence and to the prevalenceof the sentiments which I have representedas now commonly entertained. For here,

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within the precincts of a hospital, with the treatment. But no where is this preferencepermission and by the aid of its enlightened of the curious and the extraordinary to thatgovernors, this school has been erected, for which is ordinary, and, therefore, practicallythe very purpose of enabling the hospital to useful, this somewhat unhealthy appetitefulfil its secondary duty, of imparting instruc- for pathological rarities, no where is this sotion to pupils. greatly stimulated, and consequently so

May its influence be thus indefinitely ex- likely to be indulged, as in the largest hos.tended ! May the benefits which it confers pitals. In them a restless running afterbe multiplied an hundred fold ! And may novelties is apt to supersede the steady, con-the good seed of experience which is raised stant pace of those who are toiling in theirin its wards be thus wafted to distant lands, proper road, and making therein a real pro-and take root and bear fruit wheresoever it gress. Again, where business must be con-is wafted! ducted on a very extensive scale, where muchThe business then of education may pro- must be administered by general rules, and

perly be carried on in a public hospital. Can where all things must be performed withinit be carried on with sufficient advantage in stated and often limited periods, it cannot bea hospital like ours? For, compared with expected but that some things may besome hospitals in our own country, and with roughly, not to say imperfectly, executed.many on the continent, ours may appear a Is there not danger that some degree of

small one : but, for the purposes of study apathy or of carelessness may hence be gene-and instruction, I apprehend that this is of rated in students, unless they are much uponlittle consequence. Indeed, there are reasons their guard in these respects?why, with a view to practical improvement, On the other hand, it must be granted thata hospital of moderate size may be even pre- for large results, for copious inductions, andferable to one of the largest dimensions, comprehensive generalisations, for the col-Provided it be large enough (and for this it lection of statistical returns, for laborious

clearly should be large enough) to admit investigations and comparisons, and for thecases of every description, in numbers pro- elucidation of obscure parts of pathology, forportioned to their ordinary degrees of fre- purposes like these, the larger hospitals, that,quency (their very frequency rendering those in some foreign capitals, are supported bywhich are most numerous most important), the resources, and administered by the autho-and provided that such cases be as numerous rity of the State, offer advantages that cannotas can be watched attentively and studied elsewhere be equalled. But these objects,diligently, no more can be required, nor can important as they deserve to be considered inmore be wished for students, especially for a scientific point of view, and ultimately withbeginners. If the produce of a garden be a view to the good of mankind, yet do not, itabundantly sufficient for its owner’s use, he must be admitted, immediately concern therequires not, as far as his own consumption younger students. Nor do they affect theis concerned, a larger space. Is there not vital interests of the human race so power-reason to fear that a larger space might not fully or so directly as the less ostentatious,be equally well cultivated? And thus, when but more useful, pursuits and appliances ofthe progress of civilisation has caused a the healing art, those that supply the meanscountry to be subdivided to a certain extent, of preserving life, and of rendering existencethen, for the most part, cultivation is most happy, or free, at least, from constant suf-perfect, and agricultural skill is carried to fering.its highest attainable point. For the reasons that have been mentioned,

In hospitals of the largest size there is these latter objects are likely to engage areason to fear that the mind of the youthful greater share of attention, and to be morestudent may be confused by the multiplicity deeply impressed upon the minds of studentsof objects which are at once presented to his in smaller hospitals, than in those which arenotice ; or, at least, that his attention may be too large to be closely watched and carefullydiverted from that close and patient study of superintended in every part, and in whichparticular cases on which alone his real im- some minor points of immediate utility andprovement depends. Again, there is a natu- advantage are apt to be postponed, for theral tendency in students to desert the com- sake of the larger but more distant objectsmoner cases of disease for those which are which have been before alluded to.rare and curious. And yet, since their It were little to be desired, therefore, evenfuture business and greatest happiness will if it were possible, that the hospitals andconsist in curing as much of disease as they schools of this metropolis should be in anycan, and in administering the largest possible way consolidated ; nor would any privilegesamount of relief to human suflering, the or immunities that could be conferred uponcommoner cases are to them the more valua- them, nor any appropriation of publicble, for the very reason that they are of daily wealth that could be made in their favour,occurrence : they prefer, in fact, a better nor any splendid results that might be ob-claim to the attention of a sober-minded tained by forcing them to work, as a greatstudent than cases of so rare a nature, that machine, by general rules, none of thesethe like, perhaps, may never fall beneath his advantages would afford sufficient reason for

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consigning them to the care of the general land by a natural rather than an artificialgovernment. In our soil these institutions course.

flourish best when raised and when sup- Such being the principles on which theported by voluntary charity. Let them not hospitals of this country are, for the mostbe withdrawn from the management and part, founded, I believe that the circum-superintendence of those whose liberality stance of being connected with them impartshas raised or fostered them, and whose much of its truly practical character to Bri-watchful care has made them what they tish medical education. And this brings meare. to the principal topic on which it is my dutyWe hear much in the present day of the this day to address you-the subject, namely,

spirit of centralisation; and, if we look around of medical education. We have seen that

us, we see this system established or in pro- the business of education is not incompatiblegress amongst other nations. In countries with the first objects of a hospital, and thatwhere the ruling power is absolute, and it may be carried on effectively in a hospitalevery public interest becomes an affair of no larger than our own. So that, for thestate, it is natural that the maintenance and purposes of clinical instruction, it is neitherdirection of the public schools and hospitals necessary, nor in all respects desirable, toshould be wholly in the hands of Govern- adopt a system of centralisation, like thatment. Under a popular form of govern- which has been adopted in some foreignment it would seem, at first sight, that this capitals.should be less expected ; and yet it has Let us now consider what are the properbeen clearly shown by modern political characters of medical education, both gene-authors (I think by M. De Tocqueville), rally and professionally.that where the democratic power is in the I take it for granted, that the education ofascendant, there, too, the tendency to cen- any particular class should bear a certaintralisation becomes again apparent. It is relation not only to the amount of knowledgeonly under a moderate or well-balanced form required for that class, but also to the exist-cf government that men are left at liberty to ing state of general society. Now, inestablish their own charitable institutions, to order to suit the temper and feelings ofwork them out for themselves, and to distri- our own country, and to be adapted to thebute their very alms in what manner they spirit of the age we live in, I think it will

please. appear that medical education should pos-There is danger, therefore, to the liberty seas the double character of comprehensive-

which we enjoy in these respects, under our ness and of practical utility-of comprehen-own mixed form of government, from two siveness greater than at any former time, and

sources, one on either side. But we trust yet with no less devotion to its proper ob-

that Providence, which has carried us safe ]ects. , , ,.

through many dangers, will continue to steer There is scarcely any subject to which

the British bark in that secure and happy greater attention has been paid of late thanchannel which lies between the rock of ab- to that of education. Education has been

solute power on the one hand, on which our the theme of books and lectures, of conver-liberties might be wrecked, and the whirl-

sation and debate : in the library and in

pool of democracy on the other, in which popular assemblies, by the domestic fire-

they might be absorbed and swallowed up. side, and in the council-chamber, it hasy ° been discussed by philanthropists and poli-Are these remarks irrelevant? I should tical economists, by the anxious parent and

plead guilty to the charge if proposals had by the busy statesman. The great improve-not been frequently made of late to call in ments and the wide diffusion of education inthe aid of the Legislature for the regulation modern times have attracted this large shareof hospitals and of medical education, and of public attention ; and public attentionto commit the management of them to the fixed upon the subject has tended to diffuseexecutive power of the Secretary of State. education the more widely. In our daysYet experience has long since learned, and the children of the lowest orders are, in somehas expressed this truth by an apposite points, more highly educated than were thosefable, that the power of a master, called in of the independent gentry and even of thefor a special purpose, may not be so readily nobility in the 14th and 15th centuries.shaken off when that purpose has been an- The question naturally occurs (and to usswered. it is a question of the greatest interest), Has

It is far more suitable to the nature of our medical education kept pace with generalinstitutions, to their spontaneous origin and education, and with the professional trainingself-acting energy, that the sources of charity of other classes ?should not be forced or constrained, nor its I answer, fearlessly, it has. For to whomstreams confined within particular channels, should we look to decide this question?but that they should arise of themselves out Not to the gifted few who spring to emi-of the abundance of the rich, and flow as nence in every age and from every soil,they are called for by the wants of the poor ; through their own native energy, with any orthus carrying blessings and fertilising our with no cultivation ; not to them should we

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look, but rather to the general body of the self must, if the expression may be allowed,profession. For the business of education have been general practitioners.is with ordinary men ; and it is in the com- Afterwards, increasing knowledge causedparative state of the mass of mankind that the division of the art into different depart-its effects are rendered the most apparent. ments, and education was then more parti-Now, has any class of men advanced more cularly directed towards one or other ofrapidly within the last half century, than the these departments, often, it must be con-general practitioners of this country? As- fessed, by too narrow and direct a route.suredly they are not behind the age : so But this proves, not that the art should notgreat has been their progress in various parts be divided, but only that those who so nar-of knowledge, that this circumstance in part rowed education were not possessed of gene-accounts for the desire which we sometimes ral principles, nor able to take comprehen-hear expressed, that all branches of the sive views; for, in proportion as we ascendprofession should be united, and that some- to higher elevations of knowledge, we canthing like equality should be established see the more clearly that the ramifications ofbetween them. But such wishes are vain ! science are united at their source. Thus,such schemes are nugatory ! the discoveries of Hunter, developing theThe shortest theoretical answer to any general laws of life in health and disease,

such proposal appears to me to be, that it were calculated to unite medicine with sur-must be unjust either to the profession or to gery ; but it was in principle only, notthe public. To the public, if the highest necessarily in practice. Thus, also, thequalifications are to be demanded from all further observations which have since beenlegal practitioners, thereby making over the made in morbid anatomy, have tended to theprivate treatment of the poorer classes, who same result, by showing that the commence-cannot remunerate such high qualifications, ment, progress, and effects of inflammation,to the hands of unlicensed and incompetent and of other morbid states and processes,persons. To the profession it must be are both, in external and internal parts, alikeunjust, if the qualifications and attainments in essence, and conducted by nature on theof its highest orders are to be lowered to an same identical plan. The establishment,uniform standard, thereby depriving it of therefore, of such general principles, toge-much of its learning and its science, those ther with the concurrent aid of an improvedsprings which elevate its position in society, state of education, enabling all to apprehendand keep it raised above the level of a those principles the more easily, these coil-trade. curring circumstances seem to be bringingThe practical answer, however, is, that us back to the very point from which we

such schemes are quite impossible: unifor- started in the earliest times ; namely, to amity and equality are acknowledged neither reunion of all branches of the profession.by laws divine nor human. No one should But this retrograde course would, as I thinkknow this better than members of our pro- I have already shown, be erroneous as tofession, well versed in the laws of life and practice, though right and proper as to edu-in general physics: for nature herself, by cation. Of education, therefore, let theall her infinite variety, rejects uniformity as foundations be not only deep, but let them beinadmissible into the works of creation, and, also wide and ample ; for otherwise the su-by her ascending and descending scales of perstructure, which may justly be intendedorganisation, condemns equality as contrary to taper gradually to a point, yet cannot beto the designs of the great Creator. large in its dimensions, nor lofty in its height.

But these remarks apply only to the prac- Therefore, before the time of entering upontice of our art, not to the mode in which it the curriculum of professional study, theshould be learned. In practice the division mind of the student should be well trainedof labour to a convenient extent, and devo- by previous exercise of various kinds ; fortion to, and consequent eminence in, parti- otherwise, it will be impossible for him tocular pursuits, are so natural and so gene- obtain the palm of excellence in his ownrally beneficial, that whatever may be said arena, much less to conciliate the favour ofto the contrary by ambition, envy, or discon- society by the grace or dignity of his deport-tent, they must and will exist. ment.

Professional education, on the contrary The plausible position, that" study con-(upon this there is no dispute), may and centrated in one pursuit gives the fairestshould be uniform up to a certain point ; and chance of excellence in it," has been shownthis point varies according to the amount of to be quite untenable by an admirable writerknowledge possessed at different periods. on the subject of education. He observes,In the earliest times, when the knowledge that "of the intellectual powers thejudgmentwhich men possessed of the healing art was is that which takes the foremost lead in life.small, education was wholly uniform, for the How to form it to the two habits it ought tovery reason that so little was known: nor possess, of exactness and vigour, is the pro-could the art be then divided into different blem. It would be ignorant presumption sobranches. The Podalirius and Machaon of much as to hint at any routine of method bythe heroic ages, and even E- sculapius him- which these qualities may with certainty be

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imparted to every or any understanding ; times we live in gives them greater interest,still, however, we may safely lay it down and renders them even more stimulating.that they are not to be got by a gatherer of The world, like a mighty army, appears tosimples,’ but are the combined essence and have its seasons of"halting and encamping.;extracts of many different things, drawn but surely this is a stirring time : the know-from much varied reading and discipline ledge and the intellect of mankind are clearlyfirst, and observation afterwards: for, if now advancing forward. Never was greaterthere be a single intelligible point on this exertion necessary in every class, in everyhead, it is that a man who has been trained individual, lest he should fall behind, and beto think upon one subject, or for one subject distanced on the march.only, will never be a good judge even for The members of the medical professionthat one : whereas the enlargement of his have certainly not been inglorious in the ad-circle gives him both knowledge and power vance of science. When we review theirin a rapidly-increasing ratio. So much do achievements and the discoveries which theyideas act, not as solitary units, but by group- have made, who does not feel his spiriting and combinations ; and so closely do all roused, and emulation strong within him ?things that fall within the proper province of For, let us look first to the finest, the mostthe same faculty of the mind, intermix with wonderful, the most mysterious part of orga-’and support each other! Judgment lives, nised beings-the nerves: these, in all theiras it were, by comparison and discrimina- intricate but not irregular complexity, hadtion." lain for centuries open to the eyes of men,But what is the utilitarian plan, the nar- but scarcely to their understanding. They

row scheme of mere professional education? were like the characters of an unknown lan-z The physician that is to be, as soon as he guage, of which there was no interpreter.can wield a spade, is to have his garden, in Small, at least, was the portion of this deli-imitation of the great Sir Charles Linnaeus, cate machinery (that part only which belongsand vex the ground with his botanical ar- to some of the special senses), which couldrangements. The culture of opium and for a long time be traced or comprehended.rhubarb will be his first step to the prescrip- But how much further has the 19th centurytion of them !" penetrated into this beautiful but difficultWith respect to such exclusive systems, it subject! It has attached theirproper mean-

is well observed by the writer whom I am ing to parts which were before wholly un-now quoting-" Of the professions, the me- intelligible, and has discovered lucid orderdical owes the most to physical science. where confusion only seemed to reign. InThe physician, however, can receive from it what school should this interesting branch ofonly part of his facts, his data, the dead physiology be regarded with greater intereststock, as it were, of his knowledge. To be than in this ? Where should the progressable to reason upon them, which is his best which has been made in it excite a greaterskill, he must have resorted to other and spirit of emulation? for it is inseparably con-very different studies." nected with a name which once belonged toOn the other hand, it is fairly admitted by us. Even yet, though his presence be lost

the same author, and pointedly stated by to us,-to us and to our school the namehim, that general education is to be con- of Bell belongs.sidered as auxiliary to that which fits him But if much has been accomplished in thisfor his particular station and duties in life. department, how much remains to invite our"’ No doubt," he observes, " it is a most sub- further inquiries ! If it has been delightfulstantial object with every man to be master to see how one line of a compound nerveof his profession. Competence of ability in serves to excite instinctive motion, or to con-it is his strict duty, and eminence in it his vey to the muscles the mandates of the will,best ambition. He stipulates for so much : while another line of the same nerve is sub-he has taken charge of a post, and has no servient to sensation, would it not be furtheroption but to be upon it, properly armed and interesting to discover where and in whataccoutred. Since his profession sets him in manner these functions are originated andthe eye of the public, every deficiency in it regulated in the nervous centres? how thecarries a more certain and a worse disgrace telegraphic signals of sensation are reflectedthan a failure in other duties ; and this mea- back to the spinal axis, and enabled to callsure of disgrace is right, because over and forth automatic motions ; to distinguish withabove the ordinary motives of right conduct greater clearness what parts of the cerebrum,there is the responsibility of a positive obliga- cerebellum, and spinal column, are the organstion, and the censure of public opinion to of different functions ; to observe how theenforce it." systems of organic and of animal life are

The remarks which I have quoted are so mutually connected ; to trace the influencejust and sensible, and at the same time so of the nerves on the vital motions of theclearly and forcibly expressed, that they are heart, and on those of the respiratory organs,well calculated to engage the attention of and the effects which they produce on theall, and to stimulate even the most sluggish circulation in the capillary vessels; thedisposition. But the active spirit of the manner also in which they promote and re-

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-gulate the various secretions and all the appear to have been in some instances de.necessary operations of organic life ? tected and made evident to our senses : for

If these, and many m,ore such questions, us these last pursuits may well possessappear to be difficult, let the progress which peculiar interest, since the labours of Kier-has been already made increase the ardour nan, which have accomplished much andof our researches; let them not, at least, be promise more, have been in part conducteddeemed inscrutable, when so great an insight here, and have been illustrated and assistedhas been of late obtained into the workings by our morbid examinations.of this wonderful machinery. If such and so varied has been the infor-

In former times the laws of chemistry mation obtained by these different methods ofseemed almost opposed to those of life, and interrogating nature, may we not expectchemical affinities and vital affinities were that more will be elicited by a combined usespoken of as incompatible ; but modern in- of them all ? by the mutual aid and co-opera-genuity has shown how beautifully they are tion of the injecting syringe, the microscope,subservient to the assimilating and secerning and the apparatus for chemical analysis ?processes, to the right composition and re- Retrospectslikethese,andopeningprospects

. newal of the blood. Much more, however, like these, seem to invite ns on to further dis-must yet be observed of the decay and re- coveries : yet it must be owned that neitherpairs, the building up and decomposition of nature nor fortune will suffer all to be dis-the frame. We must learn the manner in coverers. But all may be practically useful:which aliment is formed and nutrition car- and its aptitude to make them so is, as Iried on ; how ingesta, as they are called, of have already hinted, the peculiar praise ofevery kind, and superfluous parts of the body British medical education. This quality ititself are assimilated and reduced into one owes, in part, to the circumstance that thehomogeneous fluid ; how even inorganic sub- teachers in our schools are themselves prac-stances are taken into or formed in the tical men, engaged, or intending to engage,blood, and play an important part in the in the active duties of their profession.preservation of its vital properties ; how all Whatever may be the merit of schools, con-the different secretions, acid, alkaline, neu- structed differently in this respect, as to the-tral, saccharine, are produced in or educed oretical views, and as to extreme minutenessout of a single flitid; how poisons may be of teaching, yet hear the opinion upon thisabsorbed, and, after lurking in the blood for subject of one who has had great experiencea considerable time, may on a sudden cor- in such matters, and is himself one of therupt the whole, or, after certain definite most distinguished ornaments of our profes-periods, may produce their specific effects sion, Sir Benjamin Brodie:-" I assert," hein every part of the body. These, and says, in a printed essay, " that ours is themany other pursuits and objects of ani- better method with a view to the educationmal chemistry, are of the very highest of those who wish to become not mere phi-physiological and pathological interest. In losophers, but skilful and useful practi-our own country the name of Prout may tioners."well excite and animate to continued la- According to this practical method (pro-bour in this prolific field. How greatly nounced by so good a judge the better nae-

also has chemistry enriched the treasury, or thod), are all those subjects taught in ourrather strengthened the armoury of medicine, school which belong to the professional partby eliciting and concentrating the active of medical education. Anatomy, physio-

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principles of mineral and of vegetable logy, pathology, are taught, not merely as in-nature. But how many are the combina- teresting branches of knowledge (althoughtions of nature’s alchemy which have never for their own sake they well deserve to beyet been explored or analysed ! How many studied), but their utility is here shown,salutary medicines may still lie concealed their indispensable utility to the physicianand folded up in plants that have not been and the surgeon, as the foundation of all me-examined by pharmaceutical chemistry ! dical knowledge, the very grammar and ru-Not curious only, but highly instructive are diments of the whole science of medicine.

the displays which the microscope has made Here, too, while the student may be charmedof the secret nooks and recesses of the cir- by the beautiful order and arrangements ofculation in the capillary vessels, and of its botany, or astonished by the marvels of che-altered states and disturbances by congestion mistry, that rapidly advancing science,and inflammation. Is there not reason to which is daily adding mathematical exact-hope that views more wonderful still may be ness to changes wonderful as the fableddisclosed by the same means? and that thus illusions of magic, while he may derivewe may be enabled to see almost to the very the utmost gratification from these sciences,points of contact, as it were, of the fluids and he will be perpetually reminded, by the lec-solids, to the extreme points, where an inti- turer on materia medica and therapeutics, ofmate union is formed between them. Still their practical bearing, and of the assistancemore, perhaps, is pathology indebted to the which they should be made to render to thepatient art of minute injection, by means of healing art.which the earliest germs of incipient disease The lectures on the practice of medicine

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and of surgery have no other object in view some further consideration ; because, at firstthan to enable the student to learn the busi- sight, it might appear to be perfectly rightness of his profession, not in the lecture-room, and natural that the discoverer of an improve-where this is impossible, but where alone he ment in practice should be allowed to derivecan do so, in the wards of the hospital, from it all the advantage that he can for him-The art of midwifery is here taught in such a self: and the custom of granting patents

truly practical manner, as that the pupil may appears to add legal sanction to this notion ;with confidence enter upon this interesting nevertheless it is repudiated by the betterbut highly responsible branch of practice ; members of our order as totally at varianceand for his right instruction and improve- with its first principles, its honour, and itsment in it the Middlesex Hospital offers benevolent character.peculiar advantages : it offers, besides, for his Nor do these higher notions depend uponimitation, the bright example and useful conventional rules and mere professional eti-career of one to whom our school is greatly quette ; but I apprehend that, however theyindebted, one whom, I believe, I may justly may seem to be opposed to the natural rightscall its founder. of property, they may be traced to our posi-

Finally, the lectures on forensic medicine tive duties, as men and Christians. As such,are designed not to gratify curiosity only, but we are bound to do all the good we fairlyto mature the judgment and perfect the can to all our fellow-creatures. And thisknowledge of the student for the most trying duty is incumbent upon all. But whatand difficult situations in which a medical should we say of the divine who knew (if forpractitioner can be placed. an instant we may be allowed to imagineThus the education which we here profess such a thing) a secret road to salvation, and

to give is practical in all its bearings. The would not earnestly point it out to all ? Andgeneral education of the student is not, of what shall we say of the professor of thecourse, directly within our control. But it healing art who boasts that he can cure dis-has been shown (satisfactorily I trust, al- ease, and will not freely tell us how ? Bythough in a general manner, and without the general voice of the profession such adescending into particulars,) that it should be man is branded as a pretender, or driven

comprehensive, in order to suit the spirit of from our ranks as a traitor to our cause.the present age, and to form a proper basis It can scarcely be doubted that if thefor the professional knowledge which must inventor of vaccination had chosen to keepbe reared upon it. his discovery a secret, he might have realised

There is nothing but the diligent accumu- by it greater wealth, than the gratitude of alation of general and professional knowledge, nation at length bestowed upon him. But

according to our abilities and our opportu- would the name of Jenner be loved andnities, which can lead to conscientious and venerated as now it is ?honourable practice: for nothing else can Assuredly the high tone adopted by ourcreate a perfect independence, and therefore profession upon this subject redounds to itsfoster a strong abhorrence, of all the arts of credit, and tends to raise its estimation inpuffing and of quackery, whether evinced in society.false pretensions or in the profession of secret Having thus considered the manner inremedies. It is in these two forms, namely, which medicine in all its branches should bethat of boastful pretensions and that of pro- studied, and the spirit in which it should befessing some secret method of curing disease, practised, I would address a very few words,that quackery is most commonly met with. on parting, to my younger hearers, on theAnd it is met with, unhappily, both within advantages that may be expected from it.the profession and without. But whosoever I would say to those who are about to em-pretends to skill or knowledge which he does bark on their professional course, your hap-not in his conscience believe that he pos- piness depends not so much on the prosperitysesses, is not a follower of Hippocrates, but of your voyage as on the nature of yourof Paracelsus, the prince of quacks; and objects and the elevation of your views. Youafter the example of that arch-pretender, the stand on the brink of a smiling ocean, theputting forth of false pretensions is generally waters of which, if you be attentive to yourcoupled with the still more mean and vulgar course, may waft you on to fame and fortune.art, of depreciating or traducing others. But But the tide of human affairs is treacherous,let him who is tempted to proclaim himself and the time when you may arrive at thoseby interested boasting, be aware that, how- rewards is uncertain. It may be late, itever he may deceive for a moment, and profit may be never. All that we can say is, thattemporarily by his deceit, in the end he is those who use the means of success will, inalmost certain to be exposed, and to be left the long run, succeed.without credit for truth or honesty, and with But what if you change the nature of yourthe discredit also of contemptible ignorance. adventure? What if you seek, not fame andFor who shall give him credit for the posses- fortune only, but the rewards of a good con-sion of genuine goods who has stooped to set science. If you seek to benefit others, tooff fictitious wares? extend science, to perfect your art, you will,The subject of secret remedies may require as far as your own conscience and inward

176

satisfaction are concerned, be sure of a re-turn. And this return is of such a naturethat it cannot be wrecked. Then, when" your ventures are not in one bottom

trusted," " the better part of your affections"may " be with your hopes abroad," and yetyou may say, with Shakspeare’s Antonio,your merchandise will never make you sad! /Then, whatever fame or fortune you acquirewill be doubly enjoyed, as superadded to

your principal store : and you will have,besides, the solid satisfaction of knowingthat they have been obtained by no art savethat of doing good.

Let me now take leave of you for the pre-sent, by wishing you an improving andprofitable, and then it will be a happyseason. Be diligent, and you will improve :improve and, satisfied with your own exer-tions, you will be happy.

[EXPOSITION OF A METHOD EMPLOYED FOR THECURE OF CONSUMPTION,

BY FRICTIONS WITH

OLEUM ANIMALE F&OElig;TIDUM,

CONNECTED, AS REGARDS THE PRINCIPLES, WITHTHE " LARD-CURE" AND " INHALATIONS."

By ULRIC PALMEDO, M.D., of Berlin.*

* Continued from p. 118.

WE shall now pass in review the most frequentand important circumstances and remedieswhich have a direct and topical influence onthe lungs, and by means of which a cure, or,at least, amelioration, has been observed inconsumption.

]. That climate exercises a distinguishedinfluence on the frequency as likewise on thecourse of this disease, is a fact which is esta-blished beyond all doubt. Even in ancienttimes some countries were known as themost proper residence where consumptivepatients had a prospect of prolonging life, ifnot of an entire recovery of health. Accord-ins to the testimony of Plinv and Celsus. theRomans sent persons of consumptive tendency Ito Egypt; where even now, according to

Savary, this disease is said not to exist. In Iour times several parts of Italy enjoy a well-earned fame in this respect; for instance,

I

Pisa, Rome, Messina, and Naples. Thetwo former rank nearly equal. For patientsso far gone as to be compelled to keep theirroom, a residence at the Lung Arno at Pisa,is by far the most propitious which Italy canboast, and has a European celebrity. Napleshas not proved quite so favourable for con-sumptive individuals; its climate is some-what of a more exciting character ; it is,moreover, too much exposed to winds.Nice, sheltered from the north-winds by ahigh chain of mountains, has, on account of

its warm but generally rather dry and ex-citing climate, proved very convenient forpersons affected with bronchitis chronica,bronchorrhoea, and asthma humidum, butless so in cases of true tubercular phthisis,although it formerly possessed a celebrity towhich it was not entitled. (Lasnyer, Surles Climats d’Italie, etc.," in Nouvelle Bibl.M&eacute;dicale, Juillet, 1829. J. Clark, "TheInfluence of Climate in Chronic Diseases ofthe Chest and Digestive Organs," secondedition, London, 1830.) In the west andsouth-west of France there are several placesvery healthy for consumptive persons, andamongst them the southern coast of Br&eacute;tagne,and Pau at the foot of the Pyrenean moun-tains, are particularly to be distinguished.The south-east coast of France is decidedlyprejudicial, on account of the sudden changesof temperature and the violent cold winds,particularly the mistral, which prevail there.Hieres and its vicinity may, however, be ex-cepted ; being protected by a connection ofhills from the north-east winds, it has thefinest climate scarcely inferior to that of theabove-mentioned places in Italy ; Marseilles,Aix, and Montpellier, are much spoken offor their salubrity, though they are, in fact,undeserving of it. Consumptive diseases areprevalent in these towns, and in the hospitalsof Montpellier, according to Fournier andMurat (" Topographie M&eacute;dic. de la Ville deMontpellier," 1810), one-third of the deathsare caused by phthisis pulmonalis. In

Spain, the province of Valentia is said to beadvantageous to this class of patients. In

England, Torquay, Dawlish, and Exmouthin Devonshire, as also Penzance in Corn-wall, are distinguished on the south-westcoast; and on the southern coast, U ndercliff inthe Isle of Wight, and Hastings on the coastof Sussex. In Ireland, the bay of Cork andMallow are advantageously situated. In thenorthern part of the Atlantic, Madeira hasobtained a great renown, and is become thesubject of several monographies by Gourlay,Heineke, and Henton. Copland prefers itas a residence for phthisical persons to allthe places of southern Europe : a Madeirahouse was, therefore, established at Bristol.After Madeira may be classed the CanaryIslands, the Azores, the Bermudas, andBahama Islands.The beneficial influence of the climate of

these places shows itself in the unfrequentoccurrence of this malady amongst the inhabit-ants, as well as in the remarkable ameliora-tion of the evil developed in those personsthat flock thither from the north. Youngpeople who, under rougher climates, werethreatened with the approach of consump-tion, frequently there get rid of this tendency;and in others the disease itself, though faradvanced, is often retarded for a time, andsometimes for years. Instances are notscarce of English patients in the last stageof the disease having taken up their residence