USA > Pennsylvania > A history of the Medical department of the University of Pennsylvania, from its foundation in 1765 > Part 10
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But with the act of calling Dr. James to the newly-created chair of Obstetrics, it must not be concealed that a grudging assent was given to the propriety of elevating the subject to a condition of independence, and that its equality with others as a branch of medical science was denied, from the fact that attendance upon the lectures of the Professor was not made
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obligatory for a degree. For three successive years it modestly remained subordinate. In 1813 it assumed its legitimate footing, when attendance upon the lectures and an examination upon it became requisite for graduation.
The following is the Resolution on the Minutes of the Board of Trustees, Oct. 11, 1813 : " Resolved, that hereafter the Professor of Midwifery shall be a member of the Medical Faculty, and that no person shall be admitted as a Candidate for the Degree of Doctor of Medicine in this University, unless he shall have regularly attended the lectures of said Professor for two years, provided, &c." On this event, Dr. Hodge, in the Life of Dr. James, thus forcibly comments :-
" This triumph of Truth and humanity over ignorance and prejudice may be considered as complete. Obstetrics was confessedly equal to the other branches of medical science, and its practitioners and teachers were authoritatively pro- nounced on a par with Surgery and the Practice of Medicine. The battle had been fairly fought and won, and Dr. James, who contributed so much to the happy issue, received now the reward so eminently due to modest worth, superior talents and attainments united with persevering industry."
At the time of his election in 1810, Dr. James had Dr. Chapman associated with him, which connection continued until the bestowal upon the Chair of its full dignity and privileges, when the latter gentleman assumed new functions in the School.
The mode of examination for Degrees, from the foundation of the Medical Department, had been to subject the student, in the first instance, to a private investigation of his qualifi- cations by the Professors, and then, by public demonstration before the Trustees, to exhibit his fitness for the honor of the Doctorate. The latter process was technically termed " defending his Thesis." The first ordeal was the most import- ant. It in reality determined the fate of the applicant, as the Professors took care not to expose incompetent persons to the mortification of failure in the public exercises, and were, moreover, well informed by it of the preparation of the candi- date for a second examination. At the examination of 1810, a modification of the first step in the proceedings was adopted,
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which has given rise to the conventional term for examination, even still employed, " The Green Box." With respect to its origin, we quote the Minutes of March 20: "This day, from certain difficulties having arisen, the Professors commenced the practice of examining the candidates behind a screen. Mr. Naudain was the first candidate examined in this manner."1 In this way the individual was only known to the Dean. The custom of examining in the "Green Box" was formally abolished by the Faculty in 1821. The examination upon the Thesis was not always satisfactory, as cases are on record of failure in this part of the exercises.
On the 1st of January, 1811, the Trustees appointed a com- mittee of their body to "revise the Bye-Laws and Ordinances that have been made in this Institution, and to report such a set of Bye-Laws and Ordinances as to them shall appear proper and consistent with the Constitution of the Seminary for the regulation thereof."
On the 21st of January the following rules were enacted with reference to the Medical Department :-
" In the Medical Department there shall be a Professorship of Anatomy; of Surgery; of the Institutes and Practice and Clinical Medicine; of Materia Medica; of Chemistry; of Na- tural History and Botany ; of Midwifery; of Natural Phi- losophy.
"The Medical Schools shall be under the immediate govern- ment of the Medical Professors, subject to the Rules and Statutes of the Board of Trustees.
" The Medical Professors shall hold meetings from time to time for the purpose of arranging and conducting the business of this department, and establishing rules and regulations for the preservation of order and decorum among the medical students, and they shall keep regular minutes of their pro- ceedings.
" All questions (those excepted which relate to the passing of a Candidate for a Medical Degree) shall be decided by a majority.
" Each student, and every other person attending a course
' Dr. Arnold Naudain, of Delaware, afterwards a distinguished citizen of that State, and Senator of the United States.
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of medical lectures, shall pay to the Treasurer of the Univer- sity four dollars at the beginning of every session, and no Professor shall deliver a Ticket of admission to his lectures, unless at the time of application thereof, the treasurer's cer- tificate of the payment of that sum be produced by the appli- cant.
"The Medical Professors shall, each in rotation, act as Dean for one year, and it shall be the duty of the Dean to arrange and conduct the business of examining the candidates for medical degrees.
" The Professor of Natural Philosophy in the Medical De- partment shall not be considered as a member of the Faculty, nor entitled to a vote at the meetings of the Medical Pro- fessors ; nor shall he comprehend within the plan of his lec- tures any branch of natural knowledge for which there is a professorship especially appointed in the Medical department. He shall provide apparatus for his own use, and he shall have authority to make regulations for the government of his school, subject to the Rules and Statutes of the University.1
Rules for Graduation.
"1. No person shall be admitted as a Candidate for the De- gree of Doctor of Medicine until he shall have attained the age of twenty-one years, nor unless he shall have applied himself to the study of Medicine three years, two of which shall have been in this University; nor unless he shall have attended the Pennsylvania Hospital during one session at least, and also have attended the practice and been the pri- vate pupil of some respectable practitioner.
"2. No person shall be admitted as a candidate for said Degree unless he shall have regularly attended the lectures of the following Professors: of Anatomy, Surgery, Institutes,
! This Professorship was instituted at the same time as the Chair of Midwifery, as a part of the organization of the Medical Faculty. It was filled June 29, 1810, by the election of Mr. Robert Hare, who does not appear to have performed any duty, and resigned October, 1812. It was subsequently filled by the appointment of Dr. Robert M. Patterson, until the transfer of that gentleman to the Chair of Natural Philosophy and Mathematics in the Department of Arts, in 1814.
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Practice and Clinical Medicine, Materia Medica, and of Chemistry.1
"3. Each person intending to offer himself as a Candidate for the Degree of Doctor of Medicine, shall, on or before the 10th day of March of the year in which he offers himself as a Candidate, signify such intention in writing to the Dean, and shall, one week at least before the time appointed for his examination, deliver to the Dean a Thesis on some Medical Subject, which subject shall have been approved by the Pro- fessors. The Candidate shall then be examined privately by the Professors upon the various branches of Medicine, and upon his Thesis in the presence of such of the Trustees as may choose to attend, notice of the time of examination having previously been given to them. If he be found quali- fied for the Degree, he shall be so reported by the Dean to the Provost, who shall communicate such report to the Trustees, in order that if approved by them, their Mandamus may be issued for conferring the Degree, at such time as they may judge expedient.
"4. The Thesis may be published, if the Candidate desire it; the permission of the Professor by whom he was examined thereon having been first obtained, but no alteration shall be made therein after such permission shall have been given; and a copy of the Thesis shall be deposited in every case in the University Library before the degree be conferred.2
"5. Each graduate in Medicine shall pay to the Provost three dollars as an honorarium, and to the Vice-Provost two dollars as an honorarium, at the time of placing their signa- tures to the Diploma."
The fee for graduation had been regulated in 1809, by requiring of the graduate the sum of five dollars to each Pro-
1 Midwifery was omitted as a branch necessary for graduation, and did not rank on an equality with the other branches until 1813. See ante.
2 It had been enacted in 1802, " That the Dean inform each Candidate upon his application, that if it should appear upon inspection of his Thesis that he was not well acquainted with Orthography he will not be regarded as qualified for a Degree." In 1806 the candidate was relieved of the necessity of publishing his Thesis, and it was made optional with him to print it or not, as in the regulation above.
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fessor. In the arrangements subsequently made between the Trustees and the Professors, the specific fees of the Provost and Vice-Provost have been commuted for an addition to their salaries. The pecuniary understanding between the Board and the Faculty has undergone many modifications, arising from an outlay of capital in providing accommoda- tions for teaching. The whole fee for graduation was fixed at forty dollars, which continued to be the regulation until 1837, when the matriculation fee was fixed at five dollars, to be paid but once, and the fee for the diploma reduced to thirty dollars.
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CHAPTER X.
Death of Dr. Rush-His services to the Medical School and his doctrines-
Election of Dr. Barton to the Chair of Practice, and of Dr. Chapman to that of Materia Medica-Death of Dr. Barton-Sketch of his life and labors as a teacher and naturalist-Election of Dr. Chapman to the Pro- fessorship of Practice, and Dr. Dorsey to that of Materia Medica.
THE University sustained a loss in the death of Dr. Rush, which happened on the 13th of April, 1813. It is a difficult task, after the lapse of more than half a century, to enter fully into an estimate of the qualities of this brilliant teacher of the medical sciences. We receive the impression of his ardor and enthusiasm from his early letters, when he first entered the portals of the temple of science, and we must appeal to the records of his life for the character he bore and the influence he exercised, when, in the position of priest, he ministered at its altar. For forty-four years he continued to expound the science of Medicine to admiring listeners, attracted by the polish of his language, the smoothness of his diction, and the clearness of his expositions. As age ad- vanced, he truly became the "old man eloquent," and had the satisfaction of witnessing the progressive increase of the class in attendance upon his lectures, from the small number with which he began his career to over four hundred at its close.1 He died with the satisfaction of knowing that the popularity that had been attendant upon his labors, and which had contributed so much to the success of the Univer- sity, had not ceased nor waned, for his eye was not dimmed, nor was his mental energy abated.
On the death of Dr. Rush the following Resolutions were passed by the Faculty, April 28, 1813 :-
" The Medical Professors having convened for the purpose
See Appendix F.
1783 ** 1813
BENJAMIN RUSH, M.D. Physician to the Hospital 1783-1813
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of uniting in a testimonial of respect to the memory of their late colleague, Dr. Benjamin Rush, Prof. of the Institutes and Practice of Medicine, and feeling sensibly the afflictive dispensation of Providence, which has removed from the Medical School one of its earliest and ablest supporters, Resolved, that the Secretary be directed to record their high estimation of the talents, learning, and eloquence of their late colleague, and of his unwearied diligence and zeal in the dis- charge of every official duty.
" That the Professors cherish a lively recollection of his laborious exertions in the promotion of medical science, exertions which have conduced greatly to the reputation and interests of the University, and have conferred important benefits upon mankind."
To trace the course of medical science through its phases of doctrines and opinions, from the commencement of the eighteenth century, when a remarkable impulse was given to it, to the time when Dr. Rush terminated his labors, would be an agreeable and instructive task. It would present the account of the contest between the lingering power of scholasticism, monkish credulity, bigotry, and dogmatism, and the teachings of experiment, observation, and reason.1 In Medicine, as in other sciences, the victory declared itself upon the side of humanity. There had previously been a fearful struggle, when death and the dungeon were the awards for the temerity of proclaiming God's own natural revelations, and of reading, by means he had bestowed, the truths of science; yet, through such a terrible ordeal had science passed, and placed its heel on superstition.
The difficulty is great of being entirely freed from illusive dogmas and long-continued prejudices, which have become a part of the mind itself, and tinctured its mode of operation and expression. This has been the case with Medicine. The metaphysical connection between the soul and body
1 The reader may be referred to two interesting and instructive works for information upon this subject : the "Life of Cullen," by Dr. Thomson, previously referred to, and the "Brief Retrospect of the Eighteenth Cen- tury," by S. Miller, D. D., vol. i. The article, "Medicine," in it, was written by the late Edward Miller, M. D., of New York.
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hung like an incubus upon all endeavors to ascertain the nature of the vital processes, and gave a bias to every effort to determine the secret of their production. For centuries the agency of the rational soul was the phantom of medical philosophers, who deviated from the natural history arrange- ment of the vital actions devised by Aristotle, and, not con- tent to study them in their manifestations to the senses, plunged headlong into the pit of blind, conjectural subtleties connected with causation. The idea that a vital principle existed, and modified the structural operations of the body, was obscurely seen by Van Helmont and Paracelsus, and to their imagination became a presiding deity, or demon. The rational soul, the anima of Stahl, was but another form of the same fancy, which figured, even in the middle of the eighteenth century, in the explanation of the vital processes by so accurate and meritorious an observer as Prof. Whytt.1 That Stahl himself had little faith in his own enunciation, and that he made it in deference to the authority of the school- men, he admits, when he informs us that the "introduction of the rational soul into his medical theory was not at all necessary to its vitality, and assigns as a reason for having recourse to that principle, his fear of being suspected to maintain that certain corporeal actions could be performed without an agent."2 To this ancient delusion Des Cartes administered the coup de grace by denying the existence and co-operation of a sentient soul in the production of the animal functions, and showing that the vital processes may be exe- cuted independently of mental co-operation. The teachings of Hoffman and Boerhaave were in accordance with the Car- tesian philosophy; when the last shadow of pagan theism and clerical superstition vanished from sight forever.
We have alluded to the foreign origin of the physicians who first settled in the colonies, and to the education of those who, at an early period, went abroad to the University of Leyden, where Boerhaave was the presiding genius. He was the dictator of medical opinions, not only on the Continent,
' The Works of Robert Whytt, M. D., Professor of Medicine in the University of Edinburgh. 1768. Quarto, pp. 140 and seq.
2 Thomson's Life of Cullen, vol. i
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but in England, and hence their transfer across the Atlantic. We have the authority of Dr. Rush for stating that, until the period of the institution of the Medical School, the system of Boerhaave governed the practice of every physician in Phila- delphia.1
Boerhaave was a vigorous reformer, and did yeoman's ser- vice in exploding the fallacies of dogmas. He was versed in the mathematical sciences and natural philosophy, and although too strongly mechanical in his notions, saw clearly the importance of bringing to bear upon medical inquiry a correlation of the sciences. The whole system which he in- culcated may be judged of from the creed which he uttered- "Let anatomy faithfully describe the parts and structure of the body; let the mathematician apply his particular science to the solids; let hydrostatics explain the laws of fluids in general, and hydraulics their actions as they move through given channels ; and lastly, let the chemist add to all this whatever his art, when fairly and carefully applied, has been able to discover; and then, if I am not mistaken, we shall have a complete account of medical physiology." But Boer- haave had not disabused himself of the belief in the animal spirits as a motor force, and although inferring that each motor nerve had a separate origin, and hence an office, he did not, in his physiological system, take very enlarged or correct views of the vital properties of organized beings, or of the dependence of their properties on the state of the nerves.
When Cullen came into estimation as a teacher, he reigned supreme both in Great Britain and America. His views and opinions superseded those of Boerhaave, and were without challenge until the rise of the Brunonian system, a compe- titor for credence. From his immediate connection with Cullen as a pupil, Dr. Rush, as we have seen, returned to America imbued with his doctrines, and warm in admira- tion of his mental qualities. But extensive observation, reading, and reflection, had taught, in subsequent years, the enthusiastic student that the line of speculation was not ex- hausted; and from a vast experience in the maladies of a new
1 Rush's Works, vol. iv. p. 375.
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world, materials for thought were presented to him which were not dreamed of in Cullen's philosophy.
That Dr. Rush aspired to be the founder of a system of medicine we are informed upon the undoubted authority of his biographer, Dr. Ramsay, who says: "In the autumn of 1789 I visited Dr. Rush, and was received by him in his study. He observed that he was preparing for his next course of lectures in self-defence; that the system of Cullen was tottering; that Dr. John Brown had brought forward some new and luminous principles of medicine, but they were mixed with others which were extravagant; that he saw a gleam of light before him, leading to a more simple and con- sistent system of medicine than the world had yet seen, and pointed out some of its leading features."1
The system to which reference is made in the preceding statement is that which has been familiarly known as the " Unity of Disease." With reference to this we may perti- nently quote the comments of one who, of late years, has written the Life of Dr. Rush, with the spirit of an ardent admirer, but whose medical intelligence led him to criticize the doctrine of the master. " This wonderful vision may be thus explained. Excitement or Life is a unit, and this can be accurately divided into healthy and morbid only; hence there can be but one disease, that is, morbid excitement. This position involves a huge universality, which very few minds, who have seen diseases, can at all comprehend; nor have we ever been persuaded that Dr. Rush himself had well- defined ideas thereof. We have always thought him most wonderfully entangled in the web of his honest sophistry."2
Attractive and plausible as have been the systems of medi- cal philosophy presented to the world, as generalizations they all partake of the deductive method of investigation, which assumes first principles of too limited a scope to admit
' An Eulogium upon Benjamin Rush, M. D., Professor, &c., University of Pennsylvania, by David Ramsay, M. D., Member of the South Carolina Medical Society, 1813. In this book is an admirable summary of the doc- trines of Rush.
2 Life of Benjamin Rush, M. D., by Samuel Jackson, M. D., late of Northumberland .- American Medical Biography, edited by Dr. Gross.
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so wide an application as has been made of them. The ani- mal economy cannot be regarded as obedient to one single law of government, by which the vital operations of its parts and organs can be all accounted for; and the day has passed when even brilliant discovery in one track of research can carry captive the entire mind of the profession. The mine to be explored of obscure organic operations admits of more than one approach, and to detect and make apparent latent truths requires access by numerous avenues. Modern re- search, by employing every available means and vastly improved appliances, has demonstrated that the forces that are active in controlling and regulating the animal organism are numerous and wide-spread. Haller, Hunter, and Bichat led the way in basing pathology upon physiological know- ledge, by which alone practical medicine can be successfully directed; and exhibited clearly that observation, experience, and inductive reasoning are the sure methods of obtaining right principles. Without these, as has been remarked by Dr. Rush, " medicine is an humble art, and a degrading occu- pation."
From his valuable labors as an observer and the historian of disease, Dr. Rush must pass to posterity with honor and admiration irrespective of his theoretical opinions. The account of the Yellow Fever of 1793, and of the succeeding years, would perpetuate his name, had he written none of his other numerous communications, literary and scientific.1
Upon the death of Dr. Rush, the Chair of Practice was filled by the appointment of Dr. Benjamin Smith Barton, July 14, 1813. By this transfer, the Chair of Materia Medica becoming vacant, was filled August 3d following, by Dr. Chap- man, who had previously assisted Dr. James in the office of Lecturer on Obstetrics.
Dr. Barton carried into his new position in the Faculty the prestige of an extended reputation as a teacher of Materia Medica and the Natural Sciences, as well as the advantage of
1 For a list of the papers written by Dr. Rush, consult the Life of Dr. Rush by Dr. Ramsay ; also Jackson's Life of Rush.
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having been a private practitioner, and one of the physicians of the Pennsylvania Hospital. He did not live to determine to what eminence he might have attained in the Chair of Practice, as, after one course of lectures had been delivered, and as the other was about to commence, death terminated his career on the 19th of December, 1815.
It has always been a matter of question whether Dr. Bar- ton would have distinguished himself as a teacher of purely practical medicine, as he had done in the chair which afforded the opportunity of indulging in the especial bent of his genius. His reputation rests upon his success as a naturalist, and cul- tivator of the branches of knowledge depending upon the natural sciences for their elucidation.
He was born in the city of Lancaster, Pennsylvania, in 1766, the son of an Episcopal clergyman there settled. His mother was the sister of the celebrated David Rittenhouse. Upon the death of his father he was transferred to the charge of the Rev. Dr. Andrews, afterwards Provost of the Univer- sity of Pennsylvania, who then resided at York. He studied medicine under the direction of Dr. Shippen, at the period when the University had superseded the College, and in 1786 embarked for Europe to continue his studies. He was a stu- dent of the University of Edinburgh for two years, but did not graduate at that Institution, determining, from personal reasons, to obtain his diploma at the University of Gottingen.
The predilection of Dr. Barton for Natural History, and more especially for Botany, evinced itself very early. He manifested very soon in life a taste for drawing, and "in the execution of his designs with the pencil, at an immature age, he discovered that taste and genius in the art which he after- wards cultivated with much success." It is said that his knowledge of drawing was acquired from the instruction of Major André, who was a prisoner of war at Lancaster. "This talent was often rendered subservient to his pursuits in Natu- ral History and Botany, branches of science which are greatly assisted in their acquisition by the investigator having him- self a facility in copying the subjects appertaining to them." It was Dr. Barton's opinion that "no man could become a. wise, discriminating, and eminent botanist without possessing
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