ease. From what we ourselves have seen, we know not of any recommendations we should feel less desirous of following than that contained in the following remarks: "Among the local remedies which appear to be the most generally applicable to erysipelas occurring in children, is a blister sufficiently large to extend over the diseased surface, and for a short distance beyond it, after vesication is produced the serum should be evacuated and the vesicated surface dressed with fresh lard." Now if this be not adding fuel to the flames I don't know what you would call it. Moreover, our attention has been called to an accusation of Dr. Parker, of New York, against his countryman, viz.: "That he has described sixty-eight (68) diseases, and has recommended the employment of calomel in fifty-one (51).” I have seen a great number of cases of diseases of the digestive system, treated according to the rules laid down in this book, and my experience and observation lead me to believe that the therapia is all wrong, and even the French system of Ptisans, and the like (doing little or nothing) is much less objectionable. But nevertheless, I have no doubt that one-third of the physicians in the northern part of our own State (I know not how it may be in other parts) are still practicing on this same system. I see but little difference between this class of practitioners and those fellows mis-called eclectics, homoeopathists, et id omne genus. The whole stock of information which they possess, has been drawn from Eberle's and Wood's Practices, and in the hands of such persons they must be terrible engines for mischief.

That Eberle's Practice, which used to be the great authority in this Western country, has been the cause of great mischief, I have no doubt. There is scarcely a disease treated of in the two volumes, from intermittent fever to worms, where mercury in large or small doses, or both, is not prescribed. It was his great panacea or grand catholicon, and Wood's Practice, in a less degree, is obnoxious to the same charge. Any physician who would now advocate such practice ought to be caricatured as a modern Sangrado. Said Sigmond, twenty years ago: "These practitioners [of the purging, drastic catharticising school] will tell you that they have bled, puked, and purged with calomel and antimony, blistered, perhaps, and otherwise tortured a case that required none of these means, or if it did, not at the stage when they employed them, for even that which is considered a most innocent medicine, may be the source of the utmost harm, if it be taken at an improper moment, or under unfavorable circumstances. Medicines generally, and apparently unhesitatingly prescribed, are given with safety only by those who are acquainted with their modus operandi. Thus magnesia, than which nothing can be more useful under proper regulations, and nothing is considered more simple, has been productive of fatal consequences, from the ignorance with which it has been administered, or the perseverance in taking it when it had failed in its expected influence." A striking instance of the poisonous effects of chlorate of potash, a medicine which had been supposed not only to be almost harmless by its enthusiastic exhibitor, but who thought that he had at last discovered an agent which would ward off, if not cure, that opprobium medicorum-Phthisis-by imparting that vivifying gas to enkindle the spark of life almost gone out, has, as you are all aware, lately occurred in the death of one of the brightest ornaments of our profession in the West. Now, although the postmortem examination of the body showed, perhaps, that his theory was correct, it yet showed that the human stomach is not alone a chemical laboratory or retort, but that if we wish to introduce any medicine into the system, we must be careful that we do it without disturbing or destroying the functions of any of the organs.

Believing as I have for some years, and as I still do, the doctrines of the reviewer of Forbes, as I have quoted, it necessarily follows that we must look for our principal improvements in therapeutics, to chemistry and the microscope. The first has already done wonders in this respect. The latter, by giving us a better knowledge of the phenomena and nature of inflammation, has produced an entire revolution in the treatment of it, and taught us that it is not the proper way to cure it by lowering the vitality of the system. Chemistry, by showing us what is wanting or superabundant in the body, in various diseases, has shown us how to supply the one, or safely eliminate the other.

I doubt not, as I said before, that the day is not very far distant when medicine will be one of the most certain sciences, or at least a much less uncertain science than it is at present. When, as is the case at present, not many cases will be empirically treated, but when by an analysis of all the excretions and secretions of the body, diseases will be treated on certain scientific principles. In the meantime let us be cautious in the use of all drugs of doubtful nature or value, and take for our motto, the old one, "in medio tutissimus ibis."

One thing I wish to say en passant, and this is: that for some years past I have been in the habit of letting my intelligent patients, or some of their friends, know what drugs I prescribe, as well as the effects I expected to be produced by them, and I must say that I have always found it to be the best plan; and this is the opinion of many of our most eminent physicians. The advice given by Prof. Worthington Hooker, on this subject, is good, as is also the advice of Prof. Frank Hamilton to a graduating class. He says: "Be wise and prudent, but never let policy sit above conscience. By which I mean plainly, if a rich man needs your physic give it to him and let him pay for it, but if he does not need it, tell him, like an honest man, that his money will not buy it. Despise tricks, placebos, and sugar pretenses as beneath the dignity of men. If our patrons dare not take our advice, they certainly ought to be afraid to take our medicine, and whenever you are driven to the humiliating necessity of pretending to give medicine to sane men and women, because, while they do not need it, they clamor for it, I shall advise you to abandon your profession and look out for some occupation which will give you a more respectable and a more honorable living.

But the most important effect of an improved medical education will be, to direct attention to the paramount importance of preventive measures over curative ones-in one word Hygiene.

The better-informed and more intellectual portion of the public are more acquainted with this subject than they were a few years ago, yet so far as its details in every department are concerned, much remains to be done. Although the gymnasium, boat rowing, &c., have done much to improve the physical condition of a portion of the male population, comparatively few of the female portion of the community are much better off than formerly, except that they have, to some extent, some respite, by the sewing machine, from the wearisome stitch, stitch, stitch, to which they were formerly subjected. And as to the ventilation of houses, proper food for the people, judicious dresses for women, physicians have much to do to enlighten the masses; and it is peculiarly their province to do it. But physicians can also, while instructing the people in their Hygienic relations, do much for their moral health in an incidental way. The great Dr. Rush, while visiting the sick, lecturing to medical classes, &c., thought it to be his duty also, to say nothing of his eminent services to his country "in the times that tried men's souls," to lecture against drinking intoxicating liquors,

the use of tobacco, preaching anti-slavery, &c., and the same may be said of the lamented Dr. Drake; and, in my opinion there is great need of the same exertions and labors by philanthrophic physicians now. And especially do I consider it to be the duty of physicians to do what they can to dispel that popular delusion which has recently seized all classes, I mean the doctrine that alcohol is a food as well as a medicine-yea, a medicine that will often cure Phthisis, or at least prevent it. I don't mean to say that there may not be occasionally a case of Phthisis, where alcoholic drinks may be useful, but that these are exceptional. On this subject, my experience, or belief, rather, accords with that of Dr. N. S. Davis, whose conclusions, in his report at the last meeting of the American Medical Association, are as follows:

"1st. That the development of tubercular diseases is facilitated by all those agents and influences, whether climatic or hygienic, which directly or indirectly impair or retard the metamorphosis of the organized structures and lessen the efficiency of the organized structures.

"2d. That observations and carefully devised experiments both show that the presence of alcohol in the human system, notwithstanding its temporary exhileration of the cerebral functions, positively retards both metamorphosis and elimination.

"3d. That neither the action of alcoholic stimulants on the human body, nor the actual results of experience furnish any evidence that these stimulants are capable of either preventing or retarding the development of tubercular phthisis."

There may be cases where the remedy may do some good temporarily, but I believe that they are rare. As a consequence of these prevalent notions, almost every body has been guzzling liquors of various kinds, lager beer, &c., if not something worse.

The experiments of Lallemand, Perrin, and Ducroy, communicated to the Academy of Sciences, Paris, on the action of anesthetics, show that alcohol acts in the same way as chloroform, ether, and amylene, primarily on the nervous system, and only indirectly on the respiration through the medulla oblongata. A review of their book in the Westminster Review of January last, says of this "arrester of metamorphosis," as it has been called, "that the striking accordance which has been shown to exist in every fundamental particular between alcohol and anæsthetics, the difference in their behaviour being only of a secondary character, and being obviously referrable to their chemical and physical properties, must surely be regarded as most strikingly confirmatory of the position taken up by the authors of this treatise, in antagonism to the Leibigian doctrine, that alcohol is food. For there is not a single point of difference in their actions which can justify their being placed in different categories. Their physiological effects in large doses are essentially the same. Their special affinity for the substance of the brain and the liver is a most striking point of conformity. Whether alcohol be taken into the stomach, or the vapor of ether or chloroform be inhaled, no sooner has it been received into the circulating current than it is treated as a substance altogether foreign to the body, which is to be removed by the excretory organs as rapidly as possible. Those organs continue to eliminate it until the blood has been entirely freed from it; and then, but not till then, its perverting influence upon the nervous functions ceases to be manifested. There is no more evidence of alcohol being in any way vitalized in the body, than there is in regard to ether or chloroform. If alcohol is to be still designated as food, we must extend the meaning of that term so as to make it comprehend not only ether and chloroform, but all medicines and poisons, in fact, every

thing which can be swallowed and absorbed, however foreign it may be to the normal constitution of the body, and however injurious to its functions. On the other hand, from no definition of a poison, which should include those more powerful anæsthetic agents, whose poisonous character has been unfortunately too clearly manifested in a great number of instances, can alcohol be fairly shut out.

And finally, my brethren, I cannot close this address in a better way, than by repeating the words of the immortal Sydenham, at the commencement of the preface to his first book.

"He who sets himself to the work of curing men, would do well to ponder again and again these four things:

"1st. That he must, himself, some day, render an account to the Supreme Judge, of the lives of the sick committed to his care.

"2d. That whatsoever of art or of science he has by the divine blessing attained to, is to be directed in the main, to the glory of God in the highest, and to the welfare of the human race; for it were an unworthy thing that these celestial gifts should be made to serve avarice or ambition. Moreover

"3d. That he has taken upon himself the charge of no ignoble or contemptible creature; for that we may estimate the worth of the human race, the only begotten Son of God became man, and thus enriched by His own dignity, His nature we assumed.

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Finally, that he is himself not exempted from the common lot, but is subject to the same calamities and sorrows as are others, so that being himself a fellow sufferer, he may the more diligently, and with a more tender affection, succor those who are sick."

REPORT OF.

COMMITTEE ON MEDICAL EDUCATION, 1861.

BY JAS. F. HIBBERD, M. D., RICHMOND, IND.

The discussion of Medical Education naturally involves the consideration of three major points: 1st. The person to be educated. 2d. The knowledge he must acquire. 3d. The method of acquiring that knowledge. First. The person to be educated.

No man is born a physician, consequently whenever one is met with we know he has been the subject of a special training. We often hear of, and sometimes see, juveniles who are adepts in divers occult arts and handicrafts, prodigies, in fact, in music, mechanics, sculpture or painting; but no one ever heard of a person possessed of a congenital knowledge of the anatomy of the brain, the physiology of the liver, or the art of amputating a limb. These are not matters that come to one intuitively, but, if at all, by patient, persevering study and labor.

A physician, therefore, is an artificial creation, not a natural production. But it does not follow that every individual of the human family is equally valuable as raw material from which to manufacture physicians. There is no doubt but that some persons have a cast, both of body and mind, that

qualifies them in an especial manner to receive the doctrines of medical science, and to apply them practically as an art.

In this, medicine is not singular, for every profession bears the same relation to the people.

Perhaps the great difficulty upon this point in all professions is, that we lack the means of being able to judge accurately who, among men, are best suited to any particular calling until they are tried.

In medicine, errors in this behalf would mostly be avoided if no man were admitted to become its disciple who had not what is known under the appellation of a liberal education, and then be required to understand every step of his progress, as thoroughly as he did when engaged in his preliminary studies.

A young man desiring to become a civil engineer would not be allowed to commence its study until fully familiar with common arithmetic. Every humane consideration demands that young men undergoing an education to authorize them to take charge of the sick, should be selected with greater care, and have had a more rigid preparatory training than for any other service among a civilized people.

Let not the celebrated Ambrose Pare, or John Hunter, or others of their kind, be cited as evidence of the incorrectness of these views, and that a liberal education is not a necessary preliminary to the highest attainments in medical science, and the greatest practical skill. Genius and preëminent talent make and follow their own rules and regulations, and, whether eccentric or otherwise, are not to be taken as paradigms for the average of mankind. The rule is as given above, and the illustrious examples against it named, had such special mental adaptation as made them an exception to the necessity of such rigid previous training as is common to the ordinary students of medicine.

Second. The knowledge to be acquired.

At first sight this would seem to be very easily named. The student should acquire a thorough knowledge of anatomy, histology, physiology, pathology, pathological anatomy, materia medica, medical chemistry, pharmacy, therapeutics, clinical medicine, surgery, and obstetrics, medical jurisprudence, hygiene, and medical history and bibliography. And if we attach the proper signification to these terms, the list includes all subjects that need be taught to a person for the special training required to make a physician. Whatever else ought to be acquired should be accomplished during the preparatory studies.

But we must understand these terms to mean the most advanced position that the branch of medical science named, has attained in the hands of its most successful cultivators at the period when the student is imbibing his professional knowledge.

Medical science, as a whole, and in all its parts is progressive, is in process of rapid development, and it will not do for the student of 1861 to learn no more than was taught in 1850, and the best works of that year will not do for text-books for the learner this year.

The name of any given department of medical science is the same to-day that it was ten years back, but the facts to be taught therein are very different.

Third. The method of acquiring that knowledge.

However important the other points presented may be considered, this is in no wise less so. Much of the discussion of medical education has been in respect to the manner in which it could be best inculcated, and still there is not unanimity in relation thereto.

Your committee, after looking over the matter with some care, is of the