Many Things Remain to Be Done

Annual Oration 1879

By George W. Garland, M.D.

Mr. President, Fellows and Gentlemen:

The research and investigations of the medical men of Massachusetts, together with the deliberations of the Massachusetts Medical Society as reported at its anniversary meetings, have not only been of great importance to the Medical Profession of this country, but their character has been such as to attract the attention of medical men and medical societies of other lands.

No State among the communities of the world should offer superior advantages for acquiring a medical education than Massachusetts, for no other State is better calculated by its geographical position, and by its bracing climate, for the production of a vigorous and intellectual race of men and women, and no other State has traditions that can more fully inspire to bravery and patriotism, as well as to research in art, science and literature than those possessed by Massachusetts, to which her sons and daughters point with pride and satisfaction. Plymouth Rock rests on her bosom; Bunker Hill with all its memories is hers; Harvard with its centuries of history is hers; and as she wheels through time and space she revolves around her own Hub, holding to view her own escutcheon literally covered with names as indelible as her own rock bound coast. High and prominent among these, written in letters of living light, stand out many names of medical men contemporary with her long list of worthies, to describe whose merits and worth, the pen should be dipped in the mellow brilliance of a morning sun-beam, and the language should be the promptings of our own poet’s brightest dreams.

To-day we are assembled to add another link to the bright chain which binds us to the past, and I take pleasure in stating that we look with entire confidence into the ever turning face of the future. The leading medical men of the past have one by one gone to their rest, with duties done and destinies fulfilled, while others have been, and are coming forward, bearing the rich treasures of past experiences and discoveries, with continually increasing facilities for acquiring a knowledge of the science of medicine.

We commit our trust to the willing hands of our young men, fully believing that a glorious future awaits them. With such a blaze of light as now illumines their path-way from the collateral sciences, and with such an ample literature as is placed in their hands, what may we not expect of them! There never was an age when the human mind seemed to run riot amid abstract principles, speculations, and untiring research, so completely as at the present time, and of all the subjects upon which human thought has been let loose, and toward the perfection of which human energies and intellect have been praiseworthily employed, no one is of more importance to the well-being of mankind than that which engages the attention of medical investigators; and no greater advancement has been made in any branch of science or literature than in the Science of Medicine during the last fifty years. No fruit of richer culture has been gathered from other fields than from ours. Yet, as in other fields, we have fallow lands, which are now being furrowed, and our young men have put their hands to the plough, now running deep and fast, looking straight forward—never back.

In his excellent oration of one year ago, Dr. Minot, after alluding to the activity and prosperity of this Society at that time, and after speaking of the advance which had been made in medical education, especially in the last few years, said, “Much remains still to be done.” This sentence was penned by one who knew whereof he wrote, and was then, and is now, not only true as regards the Harvard Medical School, and this Society, but true in all departments of our profession. Innovations and discoveries in medicine and surgery are being made from year to year; and although much has been done during the year now closing, I can say with the same force of truth, “Many things remain to be done.” Multa supersunt agenda, should be plainly written across the noble brow of this Society, for so it will be in all coming time.

There is a broad, open road to where we now stand as a Society, and still “path-finders” are pressing on, spotting trees as they pass, and this Society is ready to open up a highway before them, helping to clear away the rubbish of error, and to aid in uprooting that stronger growth, force of habits in thinking and doing.

Fellows—The rising sun of our prosperity is high in the heavens; but is there no danger? There never was a greater untruth uttered than the saying, “When a man has once got his name up, he can lie in bed till noon.” No, nothing but untiring industry will enable us to advance, or even to maintain the high position we now occupy. As well might we expect a church of Christ to succeed in its work, where the pastor and deacons absent themselves from the house of God, as for a society to prosper with inefficient officers at its head. Let us then, in the future as in the past, place able, active men at the front, and workers all along the line. There are men in all professions, who, having met with a certain amount of success, so far as collecting dollars and cents is reckoned success, seem determined to rest on their lees. They secure a certain amount of popularity, which flatters them, and being looked up to, and quoted by a few as authority, they immediately imagine themselves possessed of all wisdom and knowledge, and, evading study, they settle down into a routine life, self-sufficient, self-satisfied, and cultivate only one desire, which is to secure quietness of mind, banishing from them all study and investigation requiring mental effort. This is a most fatal mistake for a physician to make, as no other profession more strongly demands that the brain should be kept in an active working condition.

The practice of medicine and surgery is a work which cannot be slighted with impunity; it is no truer that poverty overtakes laziness, than that dulness and professional stupidity will meet detection. Nothing but faithful study, and a daily application in practice, of the lessons given us along the road of our advancing science, will sustain us. This tendency to rest and ease, which follows us all, has become a fixed habit with too many. During forty years practice I have met many cases of this sort. I will speak of one whom I have known for years, whose library never contained over three books; whose medicine case (for he keeps his own medicines) is an old style cupboard of three shelves, each equally confused; whose medicine bags contain a tooth-key, a bit of gum opium and gum camphor, various packages of ipecac, rhubarb, soda, &c. &c., all redolent with that professional odor, the mingling of musk and assafœtida. The opium and camphor are dispensed in shavings cut from each with a jack-knife, not by weight or measure, but by a my-trick system usually safe. In sitting against time he is quite successful in the practice of obstetrics, and here are his forceps [forceps exhibited]. The bilge water of Noah’s ark had a corroding effect on surgical instruments.

In later years there has been a waking up, a moving among the dry bones; the community at large are learning in various ways that improvements and discoveries are constantly being made in medicine and surgery, not dreamed of years ago, of which we cannot afford to be ignorant.

Retrospective surveys of medicine have been made almost annually, but the necessity for this has been substantially removed for the present by the publication, by Henry C. Lea, of papers written on the history of “A Century of American Medicine”; by the late Dr. E. H. Clarke, of Boston, on “Practical Medicine”; by Dr. Henry J. Bigelow, of Boston, on the History of the Discovery of Modern Anæsthesia; by Dr. Samuel D. Gross, of Philadelphia, on Surgery; by T. G. Thomas, of New York, on Obstetrics and Gynecology; and by J . S. Billings, Librarian to the National Medical Library, Washington, D. C., on the “Medical Literature and Institutions of America.” These papers trace the several branches with great fidelity, are a treasure to the Medical Profession of our country, and must be of value in the future, for by studying the past we may gather fresh zeal for the great unfinished work that lies before us, and may learn among other things whether this Society has answered its own expectations and ends, and how it has performed its duty to itself, and the profession of the State, and whether it can vindicate all its acts during its prolonged existence.

As we turn our eyes back over the early history of the Medical Men of Massachusetts, we see here and there one who stood high above the common mass of physicians, like a city set on a hill which cannot be hid; whose names are still venerated. Why is it thus? Why are their names cherished, and their ashes, and the places where they lie, held sacred? Because while they lived they did something to elevate the standard of Medicine; while they lived they did something to ameliorate the condition of their fellow beings, and to improve the health and happiness of mankind; and it is be coming in us to-day to remember the great and good of the past. The future is hidden from mortal eyes, except as we may reason from the known to the unknown, and infer what is to be from what has been. From what is known and from what has been we can safely infer, yes, safely foretell, that the Harvard Medical School is to become one of the leading Medical Schools of the world, where the highest education can be secured, and that the Massachusetts Medical Society in all the future will occupy that proud position, among the Medical Societies of the world, which it has held for so many years; and yet there are many things which remain to be done, and without any attempt at well turned sentences, I desire to speak of a few things of the many which remain unfinished.

It is a matter for regret that this Society has not long since taken steps to use its influence in securing the universal establishment of the metric system of weights and measures in this State, a subject which has been brought from time to time to its notice, which was so forcibly presented one year ago by Dr. Edward Wigglesworth, and which with the instructions contained in the numerous circulars furnished each member, cannot have failed to interest, if not convince us all of its special advantages over the old system. Permit me to make a few quotations. Charles Sumner said of the metric system, “It was born of philosophy rather than chance;” that “it possesses universality, uniformity, precision, significance, brevity, and completeness.” Dr. Wigglesworth says, “Every one should do all in his power to further its introduction, since it possesses such great merits in general; because of ifs safety, due to its uniformity and simplicity; because it is international, and because of its great convenience.” Dr. T. B. Curtis said two years ago, “there can be but little doubt that we shall in time generally recognize the great merits of the metric system, and it may perhaps prove easier, if we are going to undertake any change in our system of weights and measures, to make it completely and once for all.” Dr. Curtis believes “that the adoption by the medical profession of the metric system would be a most desirable consummation.” It may not be known to all the Fellows of this Society that the Pennsylvania State Medical Society voted, in 1877, to recommend the use of the metric system to the members of that Society, and to the public schools, to urge medical students to make exclusive use of it, and that in all communications thereafter made to that Society, the metric system alone should be used. The American Medical Association voted to recommend to all physicians the use of the metric system in their practice, and in their writings and teachings.

This is not the time or place for the discussion of this important subject, which is already so well understood by quite a large number of this Society, and most approved by those who have made it a study, but you will permit me to say, it should be made a matter of interest to each one of us; one which our old habits of thinking shall not debar us from investigating individually, so that the entire weight of this influential body may be thrown in the right direction and in its favor.

If the dignity of a man’s character adds weight to his words, how great must be the weight of this Society on all matters upon which it may decide to exert its influence. In front before me are those “on whose forms age sits gracefully,” and whose silver locks are marks of well-spent years filled with experiences in the practice of our noble profession; just behind them manhood in its prime is seen, while our young men fill up the back-ground; all in social contact, and all alike enjoying the inestimable advantages of association. Could all the members of this Society be governed and guided by one motive, strict professional fellowship; by one object, medical improvement; each and all moved by that high sense of honor and integrity which govern the good and great for whom ethical codes are unnecessary, no earthly power, nor all the powers of darkness could for one moment stand in the way of the perpetual advancement of each and all. But we regret that our Councillors have felt the necessity of a code of ethics for this Society; and a committee was appointed two years ago to make a draft to be presented one year later to the Councillors for their consideration. Although the draft gave evidence of labor and study in its development, it was not accepted. It is to be hoped that if we are to be governed by a written law of our own, it will be as brief as may be, yet broad enough in its provisions to embrace all the relations of medical men in the State to each other; the relations between all general and regular practitioners and specialists of all classes, together with all surgeons and physicians of state and city hospitals designed for general and special practice. It is well understood by members of this Society that matters have not always run smoothly between country practitioners and city physicians and surgeons. Patients are flocking to the city of Boston and the smaller cities of the Commonwealth, for medical, surgical and special treatment; and while it is impossible that no disagreement of opinion should occur, still neither distance nor position should grant the least license for giving, by word or expression to, or before, a patient, what would have a tendency to injure the reputation of the family physician; and it should be remembered that the opinion and treatment of a former attendant are often wilfully or ignorantly misrepresented by the patient and friends. The members of the Massachusetts Medical Society should aid the medical institutions of the State, and encourage special study and practice which have done so much in advancing medical science, and in turn receive that patient courtesy which is their due.

I refer with pleasure to the great work carried on by members of this Society and others in the broad field of Sanitary and Hygienic study; to their assiduity and success in searching out the causes of, and in averting, disease; to their faithful investigation regarding the influence of climate as cause and prevention of disease; the nature of endemic and epidemic diseases; the prevention and counteraction of the causes of fever; the sources of infection and their modes of communication and the agencies which offer protection; the causes and removal of pestilences; the influence of regimen and diet in protecting the individual from disease; in fact men are searching for all the means within the reach of art and science, for the prevention of disease and the preservation of health. This field is unbounded and ripe for the harvest, and although the laborers are not few, there is a great work yet to be done; no department of sanitary work is finished; even here at home, in Massachusetts and New England, protection is insufficient and incomplete. As vegetation can be found in all latitudes and altitudes, from the sea-weed to the lichen upon the mountain-top, sending forth their exhalations, so endemic and epidemic influences, by whatever name they are known, from the yellow scourge of the South to the influenza of the North, are met in various degrees of severity, largely if not wholly dependent on local causes. As a single tub of stagnant water can satisfactorily stock a country village with mosquitoes, so a neglected sewer or drain will furnish a supply of filth fever for an entire neighborhood; and as the thistle down lifts its ripe seed from the receptacle and bears it through the air to curse other soils, so the atmosphere lifts chemical poisons and the germs of disease from beds of filth and pollution, diffusing them in endless variety through the different strata of air, changing too often the breath of life to the breath of death. Where the germ springs to life, sanitary work, to be successful, must also begin. Turn the tub upside down. Stamp out the thistle-bed of infection, and the work is done; all other efforts are only beating the air.

During the last few years, members of this Society have made numerous contributions to medical science and literature, which for patient research, prolonged investigation and clearness of statement, richly deserve commendatory mention before this Society, and grateful acknowledgments from the general public. It was my intention at one time to refer in detail to the innovations and discoveries which have been made of late, but after collecting a large amount of material I reluctantly decided not to use it, as to do justice to each production would extend my paper to an inconvenient length. Let any one make out a schedule, even, of the original work which has been done in Massachusetts during the last seven years, and he will be greatly and most agreeably surprised at its amount and variety, and will be made proud of the record Massachusetts is making for herself, and the high position she is taking or occupies among the State Societies of our country in medical research.

When the Faculty of the Harvard Medical School were discussing the “New Departure;” of instituting an increased and more systematic course of instruction on the part of its professors, and a corresponding increase of qualifications, requirements, study, &c., on the part of students, many feared that the existence of cheaper and less exacting schools might cause young men to avoid the advanced regulations, and that the attempt might in consequence be a failure, however desirable such a change might seem. Long before the first three years of great anxiety were completed, those who were familiar with the working of the new regulations became convinced that whether successful financially or not, a higher key-note had been touched, and the school would never fall from the true pitch to play the old tune again; and it gives me true pleasure to-day to mention the really wonderful and cheering success the change has produced, and I refer to it at this time to say, that we may congratulate ourselves as well as the School on the advantage to us of the “New Departure,” for the work of all Medical Societies and Medical Journals is in fact, or should be, a continuation of medical instruction. This we have enjoyed in a larger degree during the last few years than ever before. The papers read before us, and very much of the published matters in the Boston Medical and Surgical Journal, have been as instructive to medical men as the Harvard lectures and demonstrations, or those of any other school, have been to students, and the articles published on “recent discoveries” and on the progress of the several branches of medical science have been of infinite value to their constant readers, each department being really worth the annual price of the Journal. And I would earnestly recommend a substantial support on the part of this Society, that the Journal may be able to carry out further plans for its improvement in the future. This is due to ourselves as well as the Journal.

Now that this Society, the Harvard Medical School, and the Boston Journal are in a more prosperous and satisfactory condition than ever before, it seems to me that now is a favorable time for the Harvard Faculty, and each and every member of the Massachusetts Medical Society, to further consider the unsatisfactory accommodations at North Grove street, and for this Society. The School has outgrown the one by its increase of numbers and demands, and the Society is of that age and condition to require a home of its own. We are excluded from the Lowell Institute, a hall dear to Boston, whose walls have echoed to the voice of eloquence from poets, sages and patriots. It was a landmark in the history of Massachusetts, but it was not well suited to the wants and taste of this Society, and it has occurred to me that when the desired and needed change is made and made it will be—and a building adapted to the wants of the school is constructed, a hall sufficiently large to seat this Society might be built over the several rooms, for the use of the School on special occasions, and for the annual and semi-annual use of the Massachusetts Medical Society, the bright, cheerful walls of which might be graced by objects which would remind us of the fact that we are members of a profession of more consequence than any other to the well-being of humanity; a place we could call our own with feelings of gratification, and occupy with enjoyment, and in which medical gentlemen from other States and from other countries who visit us could be comfortably seated.

When Harvard University shall erect a building such as it needs for its own use, this Society will put its hand down deep enough into its pocket to crown it with a hall, designed by its taste and wants. Now, gentlemen, this is not that form of charity which requires us to cast our bread upon the waters and to await a reward, but it is like dropping a quarter into the hand of a faithful waiter whose return brings you a full plate. “The liberal soul shall be made fat,” is the word of wisdom. No earnest attempt has ever been made by the Harvard Faculty, or by this Society, to make an improvement, or to accomplish an end, in which they have been unsuccessful. A few years ago we were in debt; by a well-directed effort we are now in funds. Persistent effort is all that is needed. See what has been recently done here in Boston, by a few energetic young men, in securing a Medical Library and a building to shelter and protect it, with its auditorium and conveniences before unknown and unheard of. No fiat went forth, but it sprang up, a sort of first fruit of energy; a fruit that takes its nourishment from manly zeal and manly enterprise. “Go thou and do likewise.” If the improvements or changes spoken of are needed, or desirable even, in heaven’s name why not make them? It is our own fault that we have not a hall of our own. It is our own fault that we are dependent while we possess the means of independence.

The members of the Massachusetts Medical Society have been asked by the Joint Committee of the Corporation and Overseers of Harvard College to give their opinion on the question of admitting women to the Medical School, and I presume the Committee has in keeping our several replies to the questions asked, and nothing I can say will be of the slightest value or weight at this time; but I may be permitted to say in explanation of my own answer, that my opinion is, that if women are to be admitted to medical schools, and are to be recognized as physicians, there can be no more impropriety or objection to co-education than there is in co-practice, or co-consultation in all classes of cases and diseases subsequent to graduation. In my judgment, if the same qualifications for admission are required as for graduation, and are strictly adhered to in all cases, there can be no valid, no earthly reason for excluding a human being from a medical school, or from this Society, whether male or female, white or black. After Harvard has done its duty, its whole duty to a student, and has conferred a diploma upon that student, this Society should receive him or her with open arms, and not till then, and should aid each one as a parent would a child.

Just here I wish to say a word. As the Faculty of the School are considering the question of an increase of the term of Study, and of requiring higher qualifications for admission, it should be kept in mind that no man lives, who after graduation and one year of practice, has felt that his preliminary education was needlessly good, or that his medical preparation was too prolonged or too carefully attended to. And it should also be remembered how many of us have had a life-long regret that our early education was so neglected, and our medical studies were so desultory and without exactness as to be of little use to us in commencing practice. As we would say of the flag of our Union, let it go up higher and higher, over our glorious land, where the nations of earth can see its ample folds float out on the breeze of heaven, so let the standard of education in Massachusetts go up higher and higher, until the best intellects of the world shall seek her shores and her privileges.

It is well known to those who have been requested to read papers during the first day, and the first half of the second day, of our annual meetings, that they have spoken to thin houses. Not a baker’s dozen of the four hundred regular physicians of Boston come in here to listen to those who have occupied their spare time for months, it may be, in searching up the literature of certain diseases and conditions, and have come here prepared to discuss matters of vital importance to the profession. This meeting is never full until just before dinner, as if the good things to eat are the all in all which bring us together. This is all wrong. Common courtesy, if nothing more, dictates a different course toward those gentlemen who, at great pains, are yearly preparing papers for this Society. These papers have been productive of good, and if they are to be continued hereafter, as we hope they will be, let the authors have a full attendance to cheer them on.

I would suggest that it might be better to discontinue the first day of our annual meeting hereafter, and instead, to hold a semi-annual meeting in October, when we could devote one day and evening wholly to the reading and discussion of papers, and any and all matters that might come up before the Society.

As the Massachusetts Medical Society does not hold itself responsible for any opinions advanced by its orators, I am relieved of the fear of future punishment for anything I have said, and I feel a comfortable confidence that I shall receive your lenient judgment.

Those larger lights which have gone out since our last meeting, whose glowing intellects, like the zodiacal light of the departed sun, still brighten a broad horizon before us, to whom age and youth alike do homage, are now fresh in our recollections. To-day let us how in humble, silent submission to the will of God, as words are impotent to frame a just tribute to their memories.

Twenty-five years ago, to-day the number of members of this Society who graduated before 1840 was quite large, composed of hale, vigorous looking men. One year ago to-day, when those who graduated before 1840 were requested to pass over the rostrum and into Music Hall, I with a few other stooping, grey-haired men responded, and my seat was within three of the head of the table. Then and there I was more than ever before impressed with the serious truth that we are all rapidly passing away. Twenty-five years from to-day will there be one left of that diminishing number?

This is our day, and it behooves us to ask ourselves, here and now, are we doing all we can? Have we been and are we true to ourselves? Have we been true to those who have placed their lives in our hands? Have we been and are we true to the Creator of heaven and earth, and the Giver of life? Are we doing all we can to advance our noble science? Whatever may be the record of the past, let us henceforth do all we can to improve those high, moral and intellectual faculties with which an All-wise Providence, who seeth not as man seeth, hath endowed us.

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