Published in accord once with a resolution, passed at its meeting in June, 1859, requesting committees on scientific subjects to publish their reports before presenting them to the meeting.]

BY D. M. DAKE, M. D., PITTSBURGH, PA.

On the subject of this report much, very much, has been said and written both as to what constituted it, and the means of obtaining it; so much that it would seem that little, if any thing now could be said to make more distinct the pathway to a correct, and thorough medical education. Homoeopathy presents its pure and complete formulae by which all the objective elements of study, in this field of science and art, are to be comprehended by the human mind, and made available for the accomplishment of their legitimate and final purposes in the economy of life.

This system of rules presents to the student of medicine the human body and its functions, or vital phenomena, as the centre and radii by which to find the several arcs in the circle that surrounds said centre, that can in any way affect it for good or for evil. The centre and radii being given to find the arcs; the thinking and honest inquirer may proceed to the solution of the problem before him with the greatest certainty of reaching its logical consequences; and the result required, providing always that each process of observation and reason shall be directed by the rules of our school, or those by which Hahnemann's method of investigation was distinguished from those of other observers preceding him. The foregoing remarks apply equally to each of those branches of study a knowledge of all of which constitutes a true medical education.

Anatomy and physiology, constituting the centre and radii, of course, compose no part of the circle, nor do normal phenomena in any way indicate the existence of the circle that bounds the physician's field of inquiry. It is only when objects in the circle are brought to bear upon the centre, and leave there their legitimate impression, that we obtain a clue to the fact that such a circle has an existence. The vital mirror, reflecting the objects impinged upon it, gives the likeness of things of which the circle is composed. And it is not until each object in the circle has thus set for its likeness that our knowledge of the types which complete the circle, will be perfected. As will be seen at a glance, the circle contains all that can affect the human body and its functions, favorably, or unfavorably to its normal integrity; the likeness of each of which, as reflected in modified vital phenomena, and arranged in order around the centre gives the circle, or the great object sought. Phenomena, thus reflected from the centre, take their respective places in the circle by no arbitrary generalization of human invention, but as naturally as water seeks its level, giving the several arcs of which the circle is composed. These arcs are symmetrical, and antagonistic. That is, the causative and curative arcs occupy opposite segments of the circle, and are the natural opponents of each other, and when equally balanced, the centre is maintained in its normal integrity, to announce through symptoms the active presence of neither, but of health unimpaired.

We have in one segment of the circle, specific or dynamic causative; opposed to this, one which embraces all dynamic curatives, the Materia Medica. We have also an arc of general causatives, and opposed to it, general curatives, and lastly, mechanical causatives, and oppose to it, mechanical curatives. Facts and phenomena, at first view, seemed to indicate a chemical, and an antidotal arc, or an arc of toxical causatives and curatives, but on reflection they seem to take their place in the arcs of dynamic causatives and dynamic curatives, but should such disturbing and harmonising agents require separate arcs in the circle of sciences, in order to a clear understanding of their relations to the vital centre; let the distinction be made; for it is unimportant to my present purpose. My object is to give a distinct view of the objective elements of study, that go to make up a true medical education. One half of the circle embraces pathology, which investigates the causes; nature's symptoms and effects, or foot prints of disease; the opposite half embraces the materia medica, surgery and regulated regimen. Thus grouped into six co-ordinate branches of study, or branches sustaining to the centre and radii, equal relations; all the wide world of objects that sustain distracting, or harmonising relations to the economy exist before us, as objects of study for the physician. All other branches of study not embraced in these, we will denominate the subordinate or collateral sciences — as chemistry, botany, etc., which merely aid the student in his acquisition of medical knowledge.

Operative obstetrics finds its place, contrary to usage, in the surgical arc. Pathological anatomy in the arc of specific or dynamic causatives, giving the foot prints of disease, when the sound of its steps are no longer heard in the deserted citadel of life. Toxicology finds its place in the materia medica, etc.

The human body with its functions has constituted the point of reference, or standard of comparison by which in all past time men have sought the relations of things around, to the human economy. And they have been compelled at every step of their progress to heed physiological signs as the only language spoken by which could be communicated to the human mind the information sought.

It must be clear to the reader how it is that physiological signs, or symptoms, point as radii to their respective arcs in the circle as they are influenced, modified, or controlled by one or another of the wide range of causatives or curatives, as they are brought to bear upon the vital centre. By what other process of observation and study, is it made possible for the mind of man to work problems in medical science, or in the wide range of therapeutic detail.

The six co-ordinate branches of study referred to, constitute the scientific basis of therapeutic art. The physician takes his place amid the phenomena that play between the vital centre and the circle, regulating the application of forces, in the latter to the former, that he may effect the modifications of vital action requisite to health. Science answers to what is to be done? And, WHAT with? Art, to the How! The student of medicine begins his course of study with anatomy and physiology. The body is dissected; the organs, tissues, and component parts of it, with their continuities and relations to each other, are brought to view; from this point he turns his eye to the functions, positive and relative, performed by the organism; here all the phenomena that distinguish the living from the dead, are expressed through the term physiology — whose enchanting volume opens to his delighted gaze the alphabet to the language, whose study he is commencing, and he will only know the alphabet when his knowledge of these branches of study (anatomy and physiology) is complete. He is, after all this study, only just prepared to understand the statement of problems to be solved through years of close observation and attentive study, in order to that degree of medical education which constitute the standard of his age, or the generation from which he receives it. Starting here, ho receives anatomy and physiology in their normal conditions, as the centre and radii given, by which he finds the disturbing, and harmonizing rotations of all things else to it, that can, in any way, change its decrees, or modify the qualities of its action or functions. What is true in this respect of the whole is so of its parts. Not a successful step can be taken, without constant reference to the conditions and functions we would appreciate, or correct, by means of art. The fractured bone, the dislocated joint, and gaping wound, alike speak by symptoms, thereby announcing the nature of the injury sustained, and every thing that is requisite for the physician in order to find his indications of cure. And how would he find the appropriate dressings, and know the degree of force requisite to place and retain injured parts in the positions most favorable to the cure, in any given case, without accepting the parts to be treated, as the standard of comparison, by which to find and know the appropriateness of means to be employed? Splints must be fashioned after parts they are intended to fit, and the force requisite to the reduction of dislocated parts, must be determined by the resistance offered. The abnormal conditions arising from the abuse of the ordinary and general necessaries of life are given to find the use requisite to restore physiological harmony to the disordered system, as general curatives. Knowing the mechanism of labor, i.e., the parts, organs, and principles involved in the process of parturition, the points, from which to reason to the means required for the removal of obstructions, to the completion of, or by which to aid the process, are furnished. The shape, size, and relative position of maternal and fetal parts, directly involved must be accepted as the centre and radii, given to find the object sought. Thus science, instead of empiricism, becomes the basis of art, directing by principles the same in all time to a correct judgment on the fitness of means to ends, sought by the interference of art. By the same process of observation and reason, all mechanical curatives or aids to cure, must be arrived at, and when fully known we shall have the complete and perfect science and art of surgery. Knowing the pathogenesis of all drugs, and the pathology of all diseases arising from general and specific causes, what is lacking to complete the scientific basis of therapeutic art? It will be complete, when our knowledge is perfect of all diseases and all cures; and when we know the disturbing and harmonising relations of the external world to the human economy.

The distinction hitherto recognized between the direct branches of science that compose the true science of medicine, and those that are merely collateral, subordinate, or subservient to it, has never been made sufficiently clear in the literature of the old school, to bring before the student the whole field, and exhibit at one view, the relations of its various upon the human body as the central object; upon physiological phenomena, as the indicating radii, pointing to objects of al kinds in the external world that sustain to the centre disturbing or harmonizing relations; and, lastly, upon all such objects grouped into six co-ordinate branches of study Thus we have all that can cause and all that can cure united into one complete structure, as the everlasting basis of medical art chemistry composes no part of the structure. Botany enters not into its composition; though these branches of science afford important aid in the investigation of medicinal materials, they secure by their tests and descriptions, uniform articles for the materia medica. Chemistry opens the human system, and exhibits its silent depths: Where the eye, assisted to the utmost, by philosophy, has never been able to go; philosophy brings to view the combinations of atoms, separately invisible, and gives is insight into the formative processes of the tissues, imperceptible by the senses unassisted. Thus chemistry and physiology, assist in laying road and deep the foundation of physiology, whose province it is to give us the value and true signification of the normal phenomena of life.

It will come home to the reasoning mind with all the force and clearness of an axiomatic proposition, that nothing can be known of the disturbing or harmonizing relations of agents in the external world to, independently of phenomena elicited through, the human economy. The human body announces through modified vital phenomena the influence exerted by any agent upon it; and the language of signs or symptoms is the only one spoken, by the correct rendition of which it is made possible for the mind to find the rotations sought, between causes and cures, and the human economy. Thus indicated, the pathway of the student is too plain to be mistaken; and the absurdity of adopting eclecticism as a new, true, or important doctrine, by which to find the fitness of therapeutic means, will be detected at a glance. The in flexible demands of exact and rigid scientific formulae for scientific purposes, must be heeded, and the logical mind will pronounce them just. The law of Homoeopathy will yield in nothing to those who would liberalize its formula by the adoption of a political instead of a therapeutic rule by which to select, apply, and know the appropriateness of curative means. Let us not be deceived, gentlemen, by the delusive word eclectic, for it expresses at most, in its recently popularized signification, but a political rule, and in that expresses nothing new, for no one knows better than the true and thoughtful Homoeopath the right of each, as well the duty, to select what, according to his chosen and the best means of judging, will best accomplish his object — the cure of the sick.

Nor let us be deceived by that other word benevolence in View of doctrines and laws at once inflexible and immutable. If pathogenesy and pathology are given to find one law of cure or curative indications, we must heed their pointing with strict fidelity to our chosen, logical and scientific formula, in distinction from the empirical. We should be consistent. The term “liberality,” when used for the purpose of bringing together in harmony, opposite and incompatible doctrines and systems of medicine, becomes a burlesque upon our nomenclature, and stultifies the man in our ranks who would employ it for such a purpose; though by the free use of the word he might convince the world of his goodness of heart, he would be no less sure to convince the reflecting of his logical debility, or asthenia of intellect. To try all things and hold fast that which is good, is the fundamental rule of our creed, but its teaching is not to be mistaken. It means not that haphazzard trial, whose fruits reach us upon the tongue of fitful gossip, but that which elicits the truth-telling phenomena of vital action. Universal observation confirms the truth, that the fruits of empiricism are unreliable, bearing upon a brazen face the ineffaceable word “false,” so plainly stamped, that no close observer can fail to read, heed and profit by it.

The Institute should place its protest upon every effort of its members calculated to obscure the distinctive truths and doctrines of Homoeopathy. And when any of its members are found harping upon useless adjectives, like “rational,” “eclectic,” or “conservative,” liberal,“ etc. the eye of suspicion should be fixed upon them, for it is more than presumptive evidence of their ignorance of Homoeopathy, and its clear teachings.

It is beneath the true dignity of this scientific body to behold with unconcern, influences at work calculated to tarnish the rising glory of Homoeopathy; Her intrinsic value as a system of medicine, distinguished from all others by her scientific and artistic principles and laws, has carried her through, against all opposition, to a proud position in the confidence of nearly every enlightened community in the world; and if men wish to reap the fruits of her popularity — and for this take her name — they should by no means insult her spirit, like selfish cowards bent on treason. They should not seek to disgrace her by attempts to bring about an illicit intercourse between her and any empirical monster, to secure hybrid and uncouth offspring, and as a scientific body we should offer our solemn protest against all such attempts on the part of members.

Having shown of what a Medical Education should consist, the course of observation by which the student of medicine should investigate its objective elements, the distinction necessary to be made between the direct and collateral branches of study, and, lastly, the futility of all attempts to blend in one the opposite and totally incompatible doctrines of the various schools of medicine; the method, means, and course of study and instruction requisite to a thorough ”medical education,“ next in order demand our attention.

We are aware that scarcely anything will be found more difficult of accomplishment than a revolution in the long established methods of thinking and doing things, among men. That few change their notions after forty years of age, has passed into an aphorism, so nearly an axiom, that rare exceptions only oppose the general rule. That the controlling influence over human affairs is ordinarily exerted by men over forty, is, therefore. a discouraging circumstance, and yet all experience goes to show that the few who step forward as rare exceptions to the general conservative rule, with truth and right on their side, have, in all ages of the world, found their way to the conservative masses, bearing the seed of revolution and reform before the steady and mighty trade-winds of human thought, and successfully planted them in the cold soil of conservatism, to spring up and bear fruit in due time. “Truth is mighty, and it will prevail;” “Knowledge is power;” “Time corrects the caprices of human opinion and confirms the decisions of nature.” These are the elements that propel the car of progress, and smoothe its way to the culminating achievements of genius, and truth-armed effort. Then why should we fear to call in question the adaptedness of means to the ends sought, by the methods and course of instruction pursued in the schools? Why should we, in this, ape our allopathic cousins? Is it because there is no better plan or order of instruction than that handed down through successive generations, and ergo, fashionable? We should do our own thinking, and accept nothing because old, reject nothing simply because new, but busily seek after truth. Reformers should refuse to split rails twenty-four feet long, simply because their fathers have done so, and adopt whatever is better.

That the present system of teaching in our medical institutions is defective, and wofully inefficient, is most keenly felt by all who reflect, and who have the honor and utility of the profession at heart; and who will undertake to sustain the negative of this proposition in the unmistakable light of facts? Look at the array of young physicians sent out annually from the colleges to assume a position between the living and the dead, to guard the dearest earthly interests of the suffering and afflicted of mankind,

And health bring back when organs truant prove,

And life's warm currents from their channels more.

How many of that number reach that post of trust and duty, with head and heart prepared for the work? You will answer, and rightly, not one in one thousand. And why? Simply because “the dead tell no tales,” and the darkness of the grave hides from the scrutiny of mankind the work of doctors. For these evils there is a remedy; and their correction is the only salvation left for the profession, and guarranty of safety for suffering humanity. It becomes us as members of the American Institute of Homoeopathy to think and apply our energies diligently to elevate the standard of “medical education,” and redeem the profession from the too well deserved sneers of enlightened manhood. The student leaving school with his mind prepared for the work, turns his thoughts to the medical profession. In the library before him, he finds works on all the various branches of study that make up a medical education. To master a knowledge of their contents appears to him a great undertaking, and so it will be found, a work he will never accomplish; nor need he, for in so doing it would require the remnant of life to unlearn the errors imbibed; but he may accomplish vastly more; he may become a true medical philosopher, to look forth upon the phenomenal in his field of inquiry, as into a volume in the type of his own language, as the handwriting of an author whose infinite iiberality allows, yea, invites him to transcribe its unalterable truths so far forth as they can be made subservient to the true interests of humanity. To accomplish this mastery over the elements of medicine, there is but one course for the student to pursue. He must study nature; like a child in the lap of its mother, he must listen to her language whose enunciation, at every step, will become more and yet more distinct, comprehensible and instructive, until he may talk with her as friend to friend. Thus will he learn to read phenomena as the language of nature, and treasure up the lessons of wisdom and knowledge she is ever ready to impart, to those who ask aright the information sought.

Once in the right path, to grapple facts and phenomena, to aggregate, sift, coordinate, and generalize, becomes a comparatively pleasant and easy work. Books will aid the student, and chiefly in acquiring skill in grappling facts and phenomena. As books are the repository of a world's cumulative facts, forms of expression, and nomenclature, the student must read, and thus obtain a tangible mode of expression of his own, and be enabled to appreciate the thoughts of others. By observation, and by faith in the honesty and ability of other observers, the student acquires facts as the basis of all his reasoning. To enable the student to go on with his work readily and understandingly, is the great object of teaching. The student should become an independent thinker, and his course of study should enable him to cut from his mooorings in the harbor of authority, that with chart and compass he may make the voyage of professional life alone, prepared at every turn, and in every storm, to know his work and do it well. That his studies may be directed to the best advantage, the method, the means, and the course or order of study should be a matter of the deepest solicitude with his teacher, who should never be unmindful of the fact, that useless forms murder the spirit of any enterprise as surely in science as in religion. Yet without method, but little can be accomplished in any undertaking, especially in attempts to discipline the mind and its various faculties in order to careful observation, quick perception, ready reason, and deliberate action; requirements so necessary to the physician.

The present and universal method of teaching is by lectures, delivered from five to seven each day, and each an hour long. In this mode, the rapid succession of ideas presented, precludes the possibility of retaining the matter, even by the most retentive memory. In attempts to retain the nomenclature, the ideas are lost, and vice versa. In this way both the names and the thoughts they convey are lost, or exist in the mind in unintelligible confusion. Time is not allowed for the digestion of what little is retained, and in a few days an almost universal and complete intellectual indigestion seizes the class, home sickness follows in many instances, and in most, the choice passage in the course of each professor, is the last made by the students, from the chair to the door. However efficient, as a means of instruction for the advanced student, lectures may prove, they can never be made of much utility to the newly-initiated of a class. A more familiar method of teaching should take the place of lectures; one, more likely to elicit a feeling of interest, rouse the thoughts, fix the attention, and hold the mind in active contact with the teacher, and subject of instruction. This may be done as in any literary college, the method and course of instruction in which it would be well to imitate. There should be two courses of instruction, the preparatory and final. In the preparatory, the subservient and collateral branches of science should be taught, and on the same plan of instruction as that adopted in academics and colleges generally. There should be regular recitations before the teachers of the several departments. In this way each student would imbibe a feeling of individual responsibility ample to fix the attention, which is the basis of memory, and secure a thoughtful frame of mind, the great secret of successful teaching and study; while formal lectures murder feelings of interest by holding the class at arm's length from the teacher and his subject.

The direct or co-ordinate branches of science that compose the immediate basis of therapeutic art, together with the rules of art, should be taught in a final course, and where ample means are in requisition for the demonstration of both the sciences and the arts. There may be a primary or preparatory school in every town, village, or city throughout the country, not so with the final course institutions for teaching, which could flourish only in large cities and in connection with hospitals. In New York and Philadelphia, schools or colleges for teaching the final course might be well sustained, if backed by from twenty to fifty preparatory schools, located in various parts of the United States and the Canadas.

In the preparatory schools should be taught Botany, Chemistry, Anatomy, Physiology, and the History of Medicine. With a thorough knowledge of these, the mind would be prepared to enter upon the final course of study, and appreciate the teachings of those higher branches which link them to their final purposes, the prevention and cure of disease. In most of our schools, as now organized and conducted, the student is seldom brought in contact with the sick, that he may witness the phenomena of disease, sees but few operations upon the living body, has very meagre opportunities for the observation of symptoms and conditions that point to rules of practice, or indications of cure, and direct the judgment of the physician or surgeon where, and for what, to medicate or operate. Nothing can supply the deficiency. Actual contact with disease whose phenomena and treatment are c' early pointed out by competent teachers only can answer the purpose. Such facilities for the study of the higher branches can be furnished only in connection with hospitals, and, though in a more limited way, in private practice. If the student would make the best use of the advantages furnished in institutions of the kind, his mind should be thoroughly prepared, by the preliminary course, to enter upon the study of materia medica, pathology, obstetrics, surgery in all its departments, and the institutes and practice of medicine. Facilities for teaching and demonstrating the preparatory department exist everywhere, and may be obtained at small expense; and to establish schools throughout the country in every important village and inland city, would be a trifling work, requiring no chartered privileges for its success. It may be made an individual enterprise, and if properly conducted, its influence upon medical education would soon be made apparent.

The final department, or central colleges, would be fully sustained, and so amply as to secure the best of teachers or professors, and the best means of instruction. And as a result, our entire country would be supplied with thoroughly educated physicians, alike an ornament and a benefit to society. As the schools are now conducted, students are sent out by thousands, not one in ten of whom is qualified to take a position in the world, honorable to himself or useful to society. The fact is humiliating, that in nearly every neighbourhood they come in contact with half a dozen observing old ladies, vastly their superiors in skill, and in every thing but the use of a few big words, almost, and in many instances quite, as meaningless to the M.D. as to his more unpretending auditors.

Allusion is had to no particular school nor class of physicians; it is a failing of all, and a fault of ours, as medical reformers. We are aping, and thereby popularizing, the antiquated method of the old school, with no higher or better reason than that it is old and fashionable. This should not be. It behooves us as medical reformers to seek diligently for ways and means by which to elevate the standard of “medical education,” and give to suffering humanity thoroughly educated physicians. In no other way can we recall and deserve the confidence of mankind and make the profession truly honored and honorable with the well-informed. Each of us, and every physician, should make the future, no less than the present, of the profession, his own, and see to it, that when finally called from his field of labor by the “pale messenger,” whose superior tactics he can no longer resist, others may be prepared to take his place, and discharge its duties with increased ability and improved skill. In this way the profession may compel the respect of the laity, deserve their support, and drive from the field the fearful number of ignorant, yet too often successful, competitors of the men of learning and merit. We have a system of medicine which, rightly understood and skilfully applied, must secure confidence: of this we have ample proof in every day's report, and all we need to work a speedy revolution in the practice of medicine throughout the world, is well educated physicians. The prejudices of mankind give way before the fearful tread of the “king of terrors,” and when they witness the successful management of the physician, in the averted step of the dreaded foe, insanity may, but nothing short can, stay their confidence in the better way and in the man of improved skill. This fact, with the knowledge that Homoeopathy offers to the world the only true and enduring philosophy, and use of curative means, gives us a deep, broad, and everlasting foundation of hope, that should inspire our thoughts, nerve our efforts and sustain us, even in the discharge of our duties to this, and ages approaching us in the vast future.

We should cast off the useless forms, that murder the spirit of our enterprise, and like the primitive christians, who saw in their mild and better way, the moral and physical regeneration of our race, start forth with burning, yet doubly rational zeal, work for the physical redemption of diseased and afflicted mankind; a redemption, not only from disease, but the heavy yoke and the bloody and disgusting rites and ceremonies of the old dispensation, imposed by a benighted and bigoted priesthood. Let us feel, practice and teach truth, and we have nothing to fear for our cause, not even the in consistencies of the few who would retain circumcision, and a few other of the vagaries of a system and dispensation they profess to have discarded, in their adoption of Homoeopathy. Let us go to work and reform our method and course of instruction, educate our students thoroughly, make each an independent thinker, a true medical philosopher, and our literature will no longer be tainted with the expressed willingness of our physicians to have called. in consultation this, that, or the other allopathic doctor, in any case, over any patient however known to literary fame or obscure in social life, Let the student be educated to know the powers, properties and modes of action of all therapeutic means, specific, general and mechanical, and to observe and appreciate the value of morbid phenomena. Let him be taught that all drugs exert upon the system two, and opposite influences as indicated by the phenomena of their action; that the paramount influence excited must indicate the law by which to apply them for curative purposes; and that that law finds its adequate expression through the phrase ”Similia similibus curantur“Then will we have a class of physicians who would as soon ask in the aid of a jackass to tune a piano or play a church organ, as seek the advice of an allopathic physician with regard to the dispensation of drugs for the cure of their patients. None would be found harping on a “compromise” between systems, “liberality” of views on self-evident propositions; “eclecticism,” as one of the fundamental laws of medical creed; or “tolerance” of antiquated error and discarded vagaries of empirical medicine. We will not stop to point out all the advantages that would flow from a more efficient mode of teaching than that now employed. They are many, and obvious. They would urge every physician past that contemptible half-way house where so many now stop to accommodate themselves to the ignorance and caprices of those who “believe a little in all systems,” to the high and ultimate aims of the profession, rightly understood and faithfully developed in practice. It would make the principles of our science, and the law of our art, the physician's guide, instead of the good opinion of allopathic neighbors on the one hand, and on the other, the ignorance and blind desires of those who invoke his aid in the hour of need. No longer the slaves of passion, but relying upon the omnipotence of truth, nothing could interrupt our march against the long-fortified temple of antiquated medicine.

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