pursuit, explain the mysteries of minute anatomy at greater length, and with more precision, than the teachers here: but, nevertheless, I assert that ours is the better method with a view to the education of those who wish to become, not mere philosophers, but skilful and useful practitioners.

In like manner, pathology is not taught here as a separate science, but you receive your instructions in it from the lecturers on the practice of physic and surgery; who, while they explain the changes of function or structure, which constitute disease, point out also the symptoms by which the existence of these changes is indicated in the living body, and the means to be employed for the patients' relief. Thus, while you are taught pathology, you are taught also its uses and application; and these different subjects, brought under your view at the same time, serve mutually to elucidate each other; for, while pathology assists you in obtaining a knowledge of symptoms, the study of symptoms, and of the operation of remedies, contributes in no small degree to extend your knowledge of pathology."

There is much in these remarks that calls for serious consideration.

Medicine is partly made up of abstract, partly of practical science. As philosophers, we may cultivate the former-as physicians and surgeons we must apply, and should be familiar with, the latter. The mass of students are neither calculated nor intended for mere speculative men. They require that practical knowledge, without which they can neither feel nor inspire confidence, and which is indispensable for the safety of their patients, and the success of themselves.

But latterly a disposition has been shewn in some of the London schools, to erect separate chairs of physiology and pathology, and to teach them in their transcendental form-a plan which will probably be attended with ultimate mischief to the pupils, and transform them into theorists, instead of plain and sensible practitioners.

2. It would be well if students would take this hint :

"It is of great importance that you should so arrange your studies that no excessive and overpowering demand may be made on your attention at any one period. And here let me advise you to begin with a system of steady application, and to adhere to it throughout. It is not uncommon for medical students, any more than it is for other students, to engage at first with zeal in their pursuits; then, as these lose the charm of novelty, to become careless and indifferent, and, at last, when their education is drawing to a close, and it becomes a question how far they are qualified to undergo the required examinations, to endeavour to make up for the time that has been mis-spent and wasted by excessive labour, such as is incompatible with sufficient physical repose and mental relaxation. But it is not in this way that great things are to be accomplished either in our profession, or in any other. Habits of attention which are once lost are not easily regained; and no durable impressions are made upon a mind which is exercised beyond its powers."

3. Sir B. Brodie recommends devotion of the first season to anatomy. If the student has five or six years before him, he should dedicate two Winters to this department of science, before he attends the hospital.

“While engaged in attendance on the hospital, always bear in mind that there is no one of your other studies which, as to real importance, can compete with this. The lectures on anatomy, chemistry, materia medica, practice of medicine and surgery, and midwifery, are nothing in themselves. They are but the means to an end, and are valuable only because without them you would be unable to learn the symptoms and treatment of diseases in the hospital. I feel it my duty to make this observation, and to make it earnestly, because it appears to me that the truth which it inculcates is not, for the most part, sufficiently impressed on the minds of medical students. Perhaps, however, if strict justice were done to all concerned, and we were to trace this mistake to its origin, we should find that it belongs, not so much to the medical students themselves, as

to those by whom their course of education is regulated, and who, by a false estimate of the importance of lectures, and an unnecessary multiplication of the number of them which the students are required to attend, have left an altogether insufficient time for a profitable attendance on the hospital."

Probably the Apothecaries' Company require attendance on too many lectures upon Botany, and certainly on too many upon Medical Jurisprudence. In other respects, it would not be easy to find much fault with their arrangements. The fruits of their plans may be seen in the superior intelligence of the present over the former race of professional men. We allude, of course, to the mass. The character of Ollapod in Tristram Shandy would fit few now.

4. Hospital Attendance.-All that Sir Benjamin says upon this subject is excellent.

"It is not by going through the form of walking round the wards daily with the physician and surgeon that you will be enabled to avail yourselves of the opportunities of obtaining knowledge which the hospital affords. You should investigate cases for yourselves; you should converse on them with each other; you should take written notes of them in the morning, which you may transcribe in the evening; and in doing so you should make even what are regarded as the more trifling cases the subject of reflection. Some individuals are more, and others are less, endowed by nature with the power of reflection; but there are none in whom this faculty may not be improved by exercise, and whoever neglects it is unfitted for the medical profession.

You will at once be sensible of the great advantage arising from your written notes of cases. But that advantage is not limited to the period of your education. Hereafter, when these faithful records of your experience have accumulated, you will find them to be an important help in your practice; when years have rolled over you, and the multitude of intervening events has obscured the once bright inscriptions on your memory.

Feeling as I do how essential it is, both to yourselves and to the public, that your hospital studies should be well conducted, I shall proceed to offer some further observations on this subject.

In the first instance, your attention should be directed more to the symptoms and progress of diseases than to their treatment. You should begin with those of the simplest form, as the only means of obtaining that elementary knowledge, without which you will in vain endeavour to comprehend the more complicated and difficult cases. Carrying with you into the wards of the hospital the knowledge which you have acquired in the dissecting-room, you will, in each individual case, make these inquiries :-What is the nature of the disease, considering it anatomically and physiologically, and in what organ is it situated, or has it no distinct locality? If these points can be satisfactorily determined, you will, in most instances at least, have discovered the bond of connexion between the various symptoms; your subsequent investigation of the case will be rendered more simple; and you will be enabled to form a more distinct and rational notion as to the treatment which is required, and the probability of a cure, than you could have formed otherwise. Do not be satisfied with having learned the structure and functions of the body in health, but attend the examination of those who have died of their complaints; and endeavour to associate the symptoms which existed before death with the morbid appearances observed afterwards. The more extended cultivation of morbid anatomy is one of the most peculiar features of modern times. It has laid the foundation of a more accurate system of pathology than that which existed formerly, and has led to many improvements in practice; and it is right that your minds should be impressed with a just sense of its great value and importance."

5. Morbid Anatomy not Pathology.-Sir Benjamin makes some admirable remarks upon this head.

"Morbid anatomy is not pathology, though it is an essential part of it. You

may know all that is to be known of the former, and yet your knowledge of the latter may be very limited. To be a pathologist you must study disease in the living body, even more than in the dead. Even in the instance of what we call local diseases, morbid anatomy does not teach us all that we ought to know; but there are many diseases which, as far as we can see, have no absolute locality; and what does it teach us there? In cases of hysteria, gout, fever, and in a number of others, which it would be easy to enumerate, the dissection of the dead body furnishes us with little else than negative information; and in some cases, if we trust implicitly to it, morbid anatomy will prove a deceitful guide. Thus, in a patient who has died of continued fever, you find the mucous membrane and glands of the lower portion of the small intestine ulcerated. Your first impression might be that you had discovered the original malady of which the fever was symptomatic. It is only by the investigation of the disease in the living person that you are enabled to satisfy yourselves that the ulcers were the consequence, and not the cause, of the fever. The mere morbid anatomist may suppose that in the inflammation of the oesophagus and trachea, he has discovered the essence and real scat of hydrophobia; but a more extended observation teaches you that such inflammation is but a contingency; and that, whether it exist in a greater or less degree, there will be the same fatal termination of the patient's sufferings. Then there is an extensive class of diseases in which we may say that there is actually no danger; and of these morbid anatomy can teach us nothing, although we may learn much respecting them, so as to understand their nature sufficiently well, by investigating them in other ways. We know as much of a sick headache as of pulmonary consumption; as much of psoriasis and lepra, as of small-pox and measles."

6. A Sanguine Temperament the best." The first question, then, which should present itself to you in the management of a particular case is this:-Is the disease one of which the patient may recover, or is it not? There are, indeed, too many cases in which the patient's condition is so manifestly hopeless, that it is impossible for you to overlook it. Let me, however, caution you that you do not, in any instance, arrive too hastily at this conclusion. Our knowledge is not so absolute and certain as to prevent even well-informed persons being occasionally mistaken on this point. This is true, especially with respect to the affections of internal organs. Individuals have been restored to health who were supposed to be dying of disease in the lungs or mesenteric glands. But it is also true, though to a less extent, with respect to diseases of parts which are situated externally. I know females who are now alive and well, who were supposed to labour under malignant disease of the uterus; and I could mention many cases in which patients have recovered of what had been regarded as an incurable disease of a joint. It is a good rule in the practice of our art, as in the common affairs of life, for us to look on the favourable side of the question, as far as we can, consistently with reason, do so. A sanguine mind, tempered by a good judgment, is the best for a medical practitioner. Those who from physical causes or habit are of a desponding character, will sometimes abandon a patient to a speedy death, whom another would have preserved altogether or for a considerable time."

Sir Benjamin's observations on the principles which should guide us in the treatment of disease are both philosophical and practical. We wish that our space permitted their insertion. But we cannot refrain from quoting the following observations :

So far the rules of practice seem to be sufficiently intelligible. But the great difficulty remains to be noticed :-How are you to determine what are remedies, and what are not, and the real value of the remedies which you possess? Here is the most abundant source of the errors which infest our art; from which even the most experienced and discerning practitioners are not altogether exempt; but which especially prevail among those who are deficient in

experience or good sense. It is to the almost entire ignorance of the public, and especially of the aristocratic classes, as to the evidence which is necessary to establish the efficacy or inefficacy of a particular mode of treatment, that we are to attribute the reputation which is frequently obtained by empirics and other adventurers, who pretend to practise the art, without having learned the science, of medicine.

When the optician, in constructing an optical instrument, arranges his lenses and reflectors in a new order, his knowledge of the principles of optics enables him to predict the effect which will be produced, so that, except as to some minor circumstances, he can be scarcely said to be making an experiment. But there is no reason to believe that in the study of those varied and complicated phænomena, which are the subject of Physiology and Pathology, we shall ever arrive at that point which has been long since attained in Optics, and some other branches of Natural Philosophy; and at all events, we are far distant from it at the present moment. Few greater benefits have been conferred on mankind than that, for which we are indebted to Ambrose Parey-the application of a ligature to a bleeding artery: but no knowledge which he possessed would have enabled him to say more than that it would be probably successful; and it was left for after-ages to demonstrate the principle on which it acts, and to explain the circumstances which may cause its failure. John Hunter, as you will hereafter learn, was led by his knowledge of the animal economy to propose a new method of treating aneurysm; and it is impossible to estimate the number of lives which have been preserved by this discovery; yet it was but an experiment, of which even his philosophic mind could not, with certainty, predict the result. It must, however, be admitted that science pointed out the road to these inventions. But this cannot be said of the great majority of the remedies which you will see employed. Nothing that could be known beforehand would lead you to expect that Ipecacuanha would operate as an emetic; or that Opium would occasion sleep; that Quinine or Arsenic would cure the ague; that Inflammation of the Iris would yield to Mercury; or the gout to Colchicum. The invention of these, and of a multitude of other remedies, is of accidental origin; we are indebted for our knowledge of them, for the most part, to the observations of ignorant persons, accumulated during a long series of ages; and the office of men of science is little else than to study their effects minutely, and to learn the right application of them. But even in doing this, the greatest caution and, I may say, scepticism is necessary to prevent you being continually guilty of mistakes. I have already told you how many diseases, if left to themselves, admit of a spontaneous cure. We see the surface of the body, and we know by certain outward signs a good deal of what takes place within; but there is much of which we know nothing, so that it is impossible for us to take cognizance of all the circumstances which may occur to modify the course,and alter the termination of a disease. If we trust implicitly to the instinct which inclines us to believe that when one event follows another, the first is the cause, and the second the effect, we shall be frequently directed wrong. The fact of a patient having recovered under a particular mode of treatment, goes but a little way towards establishing its value; nor is anything sufficient for this purpose, short of the same result being obtained in many similar cases, in which there was otherwise little prospect of recovery. It is the disposition of every one of us to admit the efficacy of the remedies which we employ on insufficient evidence; and unless we, whose duty it is to understand these subjects, are on our guard against this not unnatural prejudice, we have little right to blame the credulity of those whose minds are not turned to these inquiries, when a corresponding error of judgment leads them to believe in the absurdities of metallic tractors, animal magnetism, and homœopathy?"

Sir Benjamin Brodie concludes with some observations which the experience of most men confirms :

Although many years have since clapsed, it seems to me but as yesterday, when I was, as you are now, a young adventurer in this great Metropolis; and I well remember how often, in the intervals of my occupations, I have contemplated, with something like dismay, the prospect which lay before me. My own feelings, at that time, explain to me what may possibly be yours at the present period. Yet you have undertaken nothing which energy and perseverance, and upright and honorable conduct, will not enable you to accomplish. It cannot, indeed, be predicated of any individual to what exact extent he may attain professional success, for that must depend partly on his physical powers, partly on the situation in which he is placed, and on other contingencies: but having had no small experience in the history of those who have been medical students, I venture to assert that no one who uses the means proper for the purpose, will fail to succeed sufficiently to gratify a reasonable ambition. You have entered on pursuits of the highest interest, in which you will have the no small satisfaction of knowing that you never acquire any real advantage for yourselves which is not the consequence of your having benefited others. It is true that you have years of constant exertion before you; but you will eventually learn how preferable such a situation is to that of those individuals who, born to what are called the advantages of fortune, but neglecting the duties of their station, believe that they can direct their minds to no more worthy object than the multiplication of their selfish enjoyments. It will not be your lot, as it is often theirs, to suffer the miseries of ennui, or to be satiated and disappointed with life at an early period; nor will you have to regret, as you advance in age, that you have lived unprofitable members of society."

The lecture will be read with as much pleasure and as much instruction, as were experienced by those who heard it. The good sense and good feeling of its author are exhibited in every page, and the student who lays some of its lessons to heart, will never repent his perusal of it.

A CLINICAL LECTURE ON THE PRIMARY TREATMENT OF INJURIES, deliVERED AT THE NEW YORK HOSPITAL, Nov. 22, 1837. BY ALEXANDER H. STEVENS, M.D.

This is a well conceived and well-written lecture. It takes up the subject of "shock" or constitutional irritation after injuries," examines it methodically, and dwells on the treatment of the particular symptoms or phenomena which characterise it.

There is a question which has long been agitated and is not yet satisfactorily settled. Should a person labouring under the shock of an injury be bled? The arguments for bleeding are thus stated by Boyer in his Chapter on Injuries of the Head.

"What we have chiefly to fear after a violent percussion of the head are, sanguineous congestion, rupture of vessels, extravasation of blood, and inflammation. The most powerful means of preventing these consequences is to diminish the quantity of blood by bleeding. At the moment, therefore, when we are called to a person who has fallen or received a blow upon his head, and who has symptoms of concussion, we should bleed largely from the arm, and repeat the operation several times within twenty-four hours. If the symptoms are not relieved, a vein in the foot, or even the jugular vein should be opened. At the same time leeches should be applied to the temples. It is impossible to say how much blood should be taken away in such a case. Few cases require so large and repeated bleedings as injuries of the head. Experience has shown that bleeding is the most efficacious remedy that can be employed, and the writings of the best observers abound with cases illustrating its advantages. All writers