THE NEW ERA IN MEDICINE AND ITS DEMANDS UPON THE PROFESSION AND THE COLLEGE.*

ΟΝ

N the 8th of October, thirty years ago, I entered the lower lecture-room of the College building for the first time as a medical student, and listened to the Introductory Lecture. It was given by that phenomenal encyclopædia of knowledge, Robley Dunglison, for so many years the Dean and Professor of Physiology in this School. Time has gradually obliterated its then deep impressions, and now three memories alone remain to me. The first is the place where I sat; the second the precept, which has so often since then recurred to my mind in solving the medical problems which have presented themselves to me, that I must not confound the post hoc and the propter hoc, the sequence with the consequence; and the third was the gracious welcome which that fluent master of English gave to us, the incoming class.

It is my pleasant duty to-night to repeat, after a lapse of so many years, at least the same cordial welcome then extended to me a welcome to you all, from North and from South, from the Atlantic and the Pacific, and even from far-distant foreign shores. Nor is this welcome a merely formal one; it is heartfelt and true. Not only for myself, but on behalf of my colleagues of the Faculty, do I welcome you, as kindly and as earnestly as I possibly can, to the

* Introductory Address at the opening of the Sixty-sixth Annual Session of the Jefferson Medical College. Reprinted from the Times and Register, October 18, 1890.

arduous study upon which some of you are about to enter; a welcome, quite as cordial, I also extend to those who have already trodden the thorny path of the first or second year of study, and who have now a better capacity to appreciate what they learn, and a better appreciation of the earnest efforts that will be made by every teacher of the school from the oldest of the Faculty to the latest acquisition among the assistants in the laboratories.

The welcome thus extended is saddened, however, by mournful memories. It is with feelings of deep respect and admiration that I refer, as is proper, to the teacher whose honored place I occupy, whose premature and unexpected death robbed the Jefferson College of one of its brightest ornaments; a man illustrious by his name, and not less honored for his own eminently useful scientific achievements. The warmth of admiration and affection which the older students among you bestowed upon the late Samuel W. Gross was not ill bestowed, but was well deserved. Professionally he knew but one thing-Surgery. Even from his very entrance on his profession, this was his chosen department, and to it he devoted laborious days and studious nights. As a teacher he was incisive, progressive, well read, versatile, and accomplished. He was no uncertain and hesitating teacher, but gave you, in his own clear-cut and positive way, the best results of the foremost minds of the profession, both of this country and of Europe. Many of you can testify to his devotion to his subject, his students, and his Alma Mater. He sympathized with your joys, and helped you over the rough places with the utmost gladness. Few schools have had two such ornaments in one family as the elder and the younger Gross; and in the midst of all the pleasure and hilarity of the opening of the session, it is meet and proper that we should pause a moment to lay a flower on the bier of each. A moment ago I referred to the time when I myself began the study of medicine. You can scarcely appreciate what

the study of medicine then meant, as compared with what it means to-day. About the time that I began, the custom had just ceased for each member of the Faculty to deliver an Introductory Lecture to his course each year. The session began on the second Monday in October, and the entire first week was given up by the Faculty to the daily Introductories, and by the students to more or less of revelry, as might become both their consciences and their purses. In the next week we settled down to greater or less regularity of life. The session continued until the end of February, and not a few men of the first year, like Charles Lamb, made up for coming late by going early. Examination over, the iron gate that used to guard the Tenth Street entrance to the College swung heavily to, and was not opened again until the next October.

There were no laboratories. Apart from the seven classical branches there was absolutely no official instruction. No man was required to study physical diagnosis, or minor surgery, or chemistry, or the microscope, either in histology or morbid anatomy; and perhaps not a score of men in any graduating class had ever seen a muscular-fibre cell, or striped muscular tissue, or a nerve-cell, or a nerve-tubule. The fortunate few who, in the offices of private preceptors, had a chance to give a wondering look from time to time through a microscope; to examine the urine for tube-casts, or for any crystalline element, were equally small in number. Nor were there more who were ever taught to test the urine for albumin. The only histological reagents were acetic acid for clearing up a specimen, and carmine to color it, and the handheld razor was the only microtome. There was no laboratory of physiology, no teaching of pathological anatomy, no instruction in pharmacy. Nor could any man properly write his first prescription, unless he had been privately taught by his quiz master or his preceptor. The only clinical instruction was in medicine and surgery, neither obstetrics, gynæcol

ogy, nor any of the specialties being recognized. Indeed, a specialist was looked at askance as a very questionable sort of doctor.

The seven months intervening between February and October were presumably spent with one's preceptor at home. How much each student would learn in that time I leave you to judge as leniently as possible. During the spring and fall, however, there were open a few private lectures from voluntary associations of teachers, some of whom, now occupying honored places, I see about me. But these advantages were limited almost exclusively to the students who lived in the city. The examinations were easy, and for the disabled students an "omnibus" "omnibus" was prepared to carry them to, if not through, the perils of the "Green room."

Contrast this with the opportunities that you have to-day. Every student has now the opportunity to become versed in bandaging, the application of fracture dressings, and the performance of all the ordinary surgical operations on the cadaver. All of you will have had some practice and careful clinical instruction in physical diagnosis. All of you will have attended lectures on pathology and have made a more or less careful personal study of both normal and diseased structures with the microscope. All of you will have passed through the laboratories of physiology, of materia medica, of experimental therapeutics, of pharmacy, of chemistry, and have studied especially the chemistry of the urine and other secretions and excretions of the body. All of you will have had careful instruction in practical obstetrics, in obstetrical examinations, and in gynæcological operations. All of you will also have had instruction in diseases of the eye, the ear, the throat, the nose, in electricity, toxicology, orthopædics, diseases of the skin, diseases of children, and insanity, not one of which was officially taught in this or in any other medical college when I was a student.

This immense change smacks almost of revolution. But

there is need of a new and fresh overturning. The last few years have seen such rapid movement and progress in every department of medicine that we stand practically in a "New Era in Medicine," and the new era makes new demands both upon medical colleges and the medical profession to which, if we be blind, we shall be derelict in our duty, both to ourselves and the public.

Let us for a moment take a bird's eye view of these changes. First of all, a wholly new department of medical scienceBacteriology has been created. Rejected at first by most, and only doubtfully and hesitatingly believed in by many, except some prophets of the dawn endowed with finer vision than the rest, it has achieved within the last ten years a positive and now practically unquestioned place in medical science. Its revelation of the causes of many diseases and its explanation of their phenomena are as startling as they are well substantiated. That suppuration and erysipelas, tetanus and leprosy, consumption and cholera are parasitic diseases due to the invasion of the body by various forms of micro-organisms is a discovery of the first importance, and much too near for us to appreciate as yet its far-reaching influence. Bacteriology has but begun its infant career. must speedily grow into one of the most weighty of the scientific departments of medicine, and bids fair to revolutionize our practice as much as it has our theories.

It

The old Materia Medica and Therapeutics have been rewritten within the last few years in the Pharmacology of the present day. The actual daily use of medicine has been marvelously changed of late by experiments made to discover the real physiological and therapeutical action of remedies; their effects upon the heart, the arteries, the brain, the respiration, the kidneys; their medicinal and their toxic doses and effects; and from these facts to deduce a right and rational use of drugs. Besides this the extraordinary number of new drugs and the numberless new methods of their