A Medical Discourse, or An Historical Inquiry into the Ancient and Present State of Medicine by Peter Middleton, published in 1769, is a foundational work in the history of American medical education. Delivered as an inaugural address at the opening of the medical school in New York City, this discourse reflects the Enlightenment-era enthusiasm for reason and empirical study. Middleton, a physician and professor at King’s College, presents a comprehensive overview of medical practice from antiquity to his contemporary period, emphasizing the evolution of medical knowledge and the importance of systematic education in the field.​

The discourse begins by tracing the origins of medicine, acknowledging the contributions of ancient civilizations such as the Egyptians, Greeks, and Romans. Middleton highlights the advancements made by figures like Hippocrates and Galen, whose theories dominated medical thought for centuries. He then examines the transition from medieval to modern medicine, noting the gradual shift from reliance on ancient texts to a more empirical approach that characterizes contemporary practice. This historical perspective underscores the dynamic nature of medical science and the necessity of adapting to new discoveries and methodologies.​

A significant portion of Middleton’s address is dedicated to the state of medicine in the 18th century, particularly in the American colonies. He discusses the challenges faced by colonial physicians, including limited resources and the prevalence of traditional remedies. Despite these obstacles, Middleton praises the resilience and ingenuity of American practitioners who, through observation and experience, contributed to the development of medical knowledge. He advocates for the establishment of formal medical education to standardize and improve practice, reflecting the Enlightenment ideals of rationality and progress.​

Middleton’s Medical Discourse serves not only as a historical account but also as a call to action for the advancement of medical education and practice. By situating contemporary medicine within a broader historical context, he encourages a thoughtful and progressive approach to healthcare. His emphasis on education, empirical observation, and the integration of new knowledge remains relevant, highlighting the enduring importance of these principles in the ongoing evolution of medical science.