The Principles and Objects of the Massachusetts Medical Society

Annual Oration 1857

By M.S. Perry, M.D.

Mr. President and Gentlemen, — It is now seventy-six years since the formation of the Massachusetts Medical Society. The number of its members, at that time, was limited to seventy. It now has nine hundred and eighty-nine; and we may congratulate ourselves on its present prosperity, its efficient organization, and on the general intelligence of its Fellows. But has the Society carried out to the fullest extent the intention of its founders? Has it done all it could do to raise the standard of medical education? Has it been the means of elevating the moral condition of its members? Has it been instrumental in advancing the cause of medical science? Has it met the demands of society, or satisfied its own members by its organized efforts for their good?

These are questions which may naturally suggest themselves to the mind of every one present at our annual meetings. They are questions which, within the last few years, I have heard asked not only by junior, but by senior members of the Society, who knew little of its history, its principles, or the efforts it has made for the good of the profession. But they are questions which demand a candid reply; and I have thought I could not fill up the hour you have so kindly allotted me, more profitably than by endeavoring to answer them, and by suggesting some action on the part of the Society connected with its future prosperity and usefulness.

Before we inquire what the Society has done, let us ask, What are the principles upon which it is founded?

“Show me,” says an ancient author, “a man’s principles, and I will write his biography.” I believe that almost every man, after he has passed the meridian of life, finds his true level in society. His principles, the secret or avowed motives which have formed and moulded his character, have been tested; and he stands before the world honored and respected, or falls into his grave neglected and despised. So with a society: it must stand or fall, when its principles have had their full development. If these are true; if they have for their object the good of society, or the fullest expansion of the human intellect and character, — it will not only stand the test of time, but will command the respect of the good and wise in every civilized community.

The founders of this Society — among whom we find the names of Appleton, Danforth, Dexter, Prescott, Rand, Warren, Stockbridge, Tufts, Welch, and Holyoke — were more than ordinary men. They saw and felt the importance of united action. Individually they could do little, except by example. Collectively they could raise the standard of medical education, exercise a controlling influence over the morals of the profession, encourage medical schools, found public libraries, and disseminate valuable publications. In 1781, they applied to the Legislature for a charter, which, with the by-laws that were subsequently adopted, contain the principles which have governed the Society from that time to the present.

In the act of incorporation which passed the General Assembly in 1781, we have the four following propositions laid down: —

1. The universally acknowledged truth, that the happiness and health of society are intimately connected.

2. That a just discrimination should be made between such as are duly educated and properly qualified for the duties of the profession, and those who ignorantly and wickedly administer medicine.

3. That the President and Fellows of the Society, or such other of their Officers or Fellows as they shall appoint, shall have full power and authority to examine all candidates for the practice of physic and surgery, respecting their skill in their profession.

4. That the prerequisites to such an examination should be a good preliminary education and a good moral character. — This last proposition, which might fairly be deduced from the second, is announced in the By-laws of the Society.

A thorough, systematic medical education; an education that could stand the test of a rigid examination, and which was based upon a well-informed mind and a sound morality; and the protection of the public “from the ignorant and wicked administration of medicine” which should endanger the lives of the people, — are the principles of this Society. They are principles which have their foundation in truth; and they afford a platform broad enough and strong enough for the support of the Society against all the attacks of its enemies. What has the Society done to carry out these principles?

I. It has raised the standard of medical education.

We cannot form a just estimate of the good this Society has done, without glancing at the condition of the medical profession before its formation.

In the early settlement of this State, we find the clergy among the most ardent advocates for the cultivation of medical science. Many of them were successful practitioners of medicine. The Rev. John Fisk sustained a high character as clergyman and physician in Salem in 1637. Charles Chauncy, the second president of Harvard University, was a learned divine and a successful physician. He had six sons educated to both the medical and clerical professions. Dr. Nathaniel Williams, who graduated from Harvard in 1693, was a popular teacher, clergyman, and physician. The Rev. Thomas Thacher, the first minister of the Old South Church in Boston, was a learned divine and a “beloved physician.” He wrote and published the first medical work found on record in New England. Dr. Cotton Mather first informed Dr. Boylston of the fact, that inoculation of smallpox had been successfully practised in London, and advised him to introduce it into Boston; and, when the doctor was persecuted for making the attempt, he was sustained and defended by most of the clergymen in and around Boston.

Many other names than those I have mentioned might be added to the list of those who labored, not only for the souls, but for the bodily comforts, of their fellow-men. They deserve our lasting gratitude for the efforts they made in laying deep the foundations of that general love of knowledge which characterizes the New-England mind.

Most of the leading physicians, from the settlement of Massachusetts to the time when the Society was formed, were educated in a foreign land, or gained a reputation by their experience during the revolutionary struggles. The mass of the profession were not, however, qualified for their responsible and arduous duties. Six months or a year in a physician’s office, or serving an apprenticeship in an apothecary’s shop; looking over a few anatomical plates; reading the works of Sydenham, Boerhaave, Brooks, Huxham, Munroe, Winslow, Sharp, and Smellie; and compounding a few medicines, — constituted the sum total of their medical knowledge; and yet it is quite surprising to find how many of these men, hardly educated in what at this day we should call the first rudiments of medical science, gained, by their industry and natural sagacity, an honorable reputation.

In eight years after the formation of this Society, when it had become strong in the confidence of its members, and had gained in some measure the good will of the public, it took the initiatory step towards its permanent foundation. It passed a By-law, requiring every physician, who wished to join the Society, to furnish certificates that he had studied three full years, with attendance on the practice of some competent physician; that he had, in addition to his medical acquirements, a good knowledge of Greek and Latin, the principles of geometry and experimental philosophy. He must also have practiced medicine three years, and must give satisfactory evidence to the censors that he was worthy of their confidence. Since that time, the terms of admission have been modified at various periods. In 1803, the three-years’ term of practice was abolished, and physicians were admitted upon examination by the censors, or by taking a degree of M.D. from Harvard University; and, in 1837, the Berkshire Medical School was allowed the same privilege with Harvard University. It could hardly be expected that a society as large as this should have been in operation two-thirds of a century, without committing some mistakes. I contend, however, and I think its records will show, that, in all its doings, it has never lost sight of its first great principle. It has been harmonious in its endeavors to raise the standard of medical education. Sectional interests and personal motives have been laid aside for the good of all. It may not have done, and I think has not, all it could; but its efforts have been made in the right direction, and have been guided by the highest aims for the good of the profession.

II. It has raised the standard of morality. The founders of the Society did not have regard only to the intellectual or scientific attainments of its members: they allowed no man to enter it, however great his acquirements or whatever his standing, who could not bring satisfactory testimonials of good character. These were required prior to an examination; and, if they were not furnished, he was at once rejected. The founders felt, as I presume every member now feels, that the usefulness of the Society depends as much upon the moral character of its members as upon their scientific attainments. This is the only guaranty they can give the public. In this lies its safety. In knowledge alone there is not security. The physician must be presented to them a true man, true to principle. What man of commonsense would knowingly trust his life one moment in the hands of an immoral physician? This Society has pledged itself, by its By-laws, to give no man its influence or support, without abundant proof of his good character. It has done more: it has provided a way by which he can be expelled from the Society, if he does not live up to his professions and promises; and the records of the Society show how well it has carried out this principle. The By-laws say, “Any Fellow may be expelled from the Society for any gross immorality, or for any crime of which he has been convicted. He may also be expelled or censured for presenting in his own behalf, or for another, any false certificate of character, tending to deceive the public, or the censors of the Society.” What more could this Society do to give character to its own body, or confidence to the public? It has endeavored to guard its avenues, so that no man can enter it who has not upon his forehead the stamp of an honest man; and no man can remain in it, however high his position in other respects, who is convicted of dishonesty or unprofessional conduct.

III. This society has done much, directly and indirectly, to advance medical science.

More progress has been made within the last fifty years, in placing medical science on a sure basis, than had been done before in centuries. If we take the “First Lines” of Cullen and Hunter on the blood, as containing all the important facts on medical subjects up to the end of the last century, we can form some idea of the rapid change. Since that time, the discoveries in physiology, in animal chemistry, in etiology, in the diagnosis and treatment of disease, and, above all, in pathological anatomy, have done much towards placing the science of medicine on an inductive basis; and, while we acknowledge our indebtedness to the French, Italian, German, and English physiologists and physicians for the greater portion of these discoveries, we must not do injustice to the members of this Society by excluding them from the list of active searchers after scientific truths. The Reports of this Society on vaccination, on petechial fever, on mercurial treatment in acute diseases, on the treatment of diseases of the joints by blisters, on the history and nature of secale cornutum, on phlegmasia dolens, on typhoid fever, on the history and treatment of delirium tremens, on irritable uterus, on self-limited diseases, on diseases of the knee-joint, on fractures, on the detection of deep-seated matter, and on ventilation, show that the Society has not been a silent observer of the changes that are going on in the scientific world. Then, if we take the writings and discoveries of individuals who are members of this Society, and who have received from it countenance and support, we shall, I think, furnish abundant proof that the profession connected with this Society have done something directly for the advancement of medical science. Take, for example, as the result of individual effort, Dr. Ware on croup; the operation for the closure of the hard palate, by Dr. J. Mason Warren; the introduction of fusel oil, and the revival of the operation by suction of paracentesis thoracis, by Dr. Morrill Wyman; and the excellent paper, with cases upon the success of this operation, by Dr. Bowditch; the paper on diaphragmatic hernia, and the manual on auscultation, by the same writer; the method of retaining the fragments of the patella, when fractured, by adhesive plaster above and below, by Dr. Cabot; the operation for vesico-vaginal fistula, by Dr. George Hayward; the dissertation on orthopedic surgery, by Dr. J. Henry Bigelow; the article on puerperal fever as a private pestilence; and a work on homoeopathy, by Dr. Oliver Wendell Holmes; the introduction of the inhalation of ether, not to enter into the merits of its discovery, by the surgeons of the Massachusetts General Hospital; the valuable paper on ovariotomy, by Dr. Lyman; and the noble labors of Dr. J. B. S. Jackson in the department of pathological anatomy, which have given him a European as well as an American reputation; and the “Advice to the Young Physician,” containing some of the valuable results of a long and useful life, by Dr. James Jackson; and the writings of Drs. Burnett and Dalton. It cannot be expected that I shall enumerate all that has been done by individual effort; but I have given the above list of discoveries and authors as an illustration of my proposition.

And, in this connection, I should do injustice to my own feelings if I omitted to mention the name of one whose eulogy has been pronounced, and whose biography is soon to appear; one whose name was more familiar to surgeons and physicians abroad than that of any other man connected with medical science in this country; one whose name appears on almost every page of the early Transactions of this Society, and who filled at various times all its important offices; one whose industry, energy, and zeal won for him an enviable reputation at home. I refer to the late Dr. John C. Warren. I think few of us can appreciate, at this day, the efforts he made to secure to the profession an honorable reputation. We owe him and his contemporaries a debt of gratitude which we shall never repay.

Indirectly, this Society has done something to advance medical science by the zeal with which its members have confirmed by their own observations the truths that have been discovered by others. As an illustration of this statement, I will only remind my contemporaries of the enthusiasm with which our “be loved Jackson” confirmed at the Massachusetts General Hospital the discoveries of Laennec and Louis.

Well do I remember this; and if there was one circumstance more than another which impressed me, during my novitiate, with the dignity and responsibility of the profession, it was the sincerity, the care, and the truthfulness which were manifested during these investigations. From that time to the present, no sooner can Louis, Trousseau, Velpeau, Simpson, Addison, Fergusson, Stokes, or any of the distinguished physicians, surgeons, microscopists, or chemists, of Europe, announce any new discovery, than it is received here with the greatest delight, and is immediately subjected to the most rigid examination. By sending our young men abroad, by translations and reprints of foreign works, by district societies, by associations for medical observation and medical improvement, the members of this Society are indirectly doing much for the advancement of medical science.

IV. This Society has done much for the protection of the public by the prevention of disease.

It was a remark made by one of our most eminent physicians, near the close of a long and useful life, “that he could not say how much good he had done by giving medicine; but he had the satisfaction of believing, that he had done some good by his advice to his patients in regard to the means which they should take to prevent disease, and prolong their lives.”

The protection of the public health, by the exposure of quackery in all its varied and multiplied forms, is one of the active principles of the Society; and, if there is one subject more than another which has brought upon the regular members of the profession the abuse of the public, it has been their united and decided opposition to dishonesty and deception. They are accused “of being prejudiced, of being jealous, of shutting their eyes to the truth, of looking through a false medium,” &c.

And yet, if there is any subject upon which this Society can look with pride and satisfaction, it is its devotion to the public good. Let any contagious disease threaten the public, such as yellow fever, cholera, or typhus fever, and the regular physicians are at once active in suggesting the means of prevention, and in hazarding their own lives for the protection of the people. Self-sacrifice is the highest test of sincerity; and, if there is any marked line of distinction between the true and false practitioner, it is this. I do not know of a single example where an irregular practitioner was willing to sacrifice life or property for the public good. There may have been such; but none have come under my observation. No: the advocates for the dissemination of hygienic knowledge, for the protection of the insane, for the establishment of schools for idiots, or for the founding of hospitals, are found only among the true lovers of medical science.

Gentlemen, I have taken a rapid survey of the principles of this Society, and of the manner in which they have been acted upon. I now come to the more important, and perhaps not less interesting, part of my subject.

What is now the duty of the Society? Has it met the demands of the public? Have its principles been carried out to the extent possible up to this time? These are questions which demand our serious attention.

I believe this Society must renew its efforts in two directions, or it will soon lose its influence and hold upon the confidence of the community, and become a useless, if not a lifeless, institution. It must raise the standard of medical education higher than it is at present, and send among the enlightened portion of the people correct notions in regard to what is true and false in the practice of medicine.

The standard of medical education is not high enough. It does not satisfy the members of this Society. It is not, as it should be, in advance of public opinion. It does not keep pace with the progress of medical science. Let us compare this standard with the highest standard in other countries.

“In Austria, the prerequisite to a medical is a liberal education. Five years are there required for the study of medicine. The course of studies and the routine of subjects are well arranged; and the student is obliged strictly to adhere to them, in the manner and according to the orders marked out to him by the board of medical directors. Students wishing to take out the degree of doctor of surgery are obliged, in addition, to attend the surgical clinique, and lectures upon the practice of surgery, during the fifth year; and, as these lectures often take place at the same hour with ophthalmic cliniques, the pupils are compelled to attend the latter in the first part of the sixth year. Those who wish to become master-accoucheurs are required to attend two additional months in the obstetric clinique. During the course of these medical terms, they are examined every six months by one of the professors, in order to ascertain what proficiency they have made; and no one can obtain the degree of doctor of medicine or surgery who has not a certificate that he has been through, and is well acquainted with, all the required studies.”

The requirements in Prussia are much the same as in Austria.

How is it in France? The course of medical study at Paris occupies four years. Before commencing the study of medicine, the candidate must be a bachelor of science, or be prepared to pass an examination in the studies required for that degree. Four times a year, he is obliged to inscribe his name on the books; thus giving evidence that he is present during the whole year. He is required to perform a great amount of dissecting; and, during at least a year, he must serve as externe in a hospital. After a certain number of inscriptions, he is allowed a ticket to the Lying-in Hospital, and can enter, whenever notified, for practical instruction. At the School of Medicine, two courses are given annually by different sets of professors; and, in addition to these, two other courses of clinical lectures are given in the great hospitals by other professors, — one corps lecturing in winter, and the other in summer. Besides the regularly established courses, there are numerous clinical lectures given by hospital-physicians who are not professors, such as Ricord, Cazenave, &c. Courses are also given, under the sanction of the Faculty, at a series of amphitheatres attached to the dissecting-rooms, where great pains are taken to illustrate the subjects taught. The student must pass an examination at the end of each year; and, if he does not show a proper degree of proficiency, he is not allowed to continue his studies. Having completed his course, he must prepare a thesis, and place printed copies of it in the hands of the professors. He passes through five examinations: at some of these, questions are given him in writing; and he is allowed to retire to an adjoining room for twenty minutes, and prepare a reply. One of the five examinations takes place in one of the hospitals, where he is required to make a diagnosis and prognosis, and state the treatment he would advise. The greatest importance here, as in England and Germany, is attached to clinical instruction.

In Great Britain and Ireland, there are eight universities which grant medical degrees. The general outline of instruction and the requirements at each of these are nearly the same. They require, as a prerequisite to a medical examination, that the candidate should have a good knowledge of the Latin language; should study four years. Six months of each year must be spent in some one of the universities. He must furnish evidence that he has studied anatomy, chemistry, materia medica, and pharmacy, the institutes of medicine, practice of medicine, surgery, midwifery, and the diseases peculiar to women and children, general pathology and practical anatomy, under professors of medicine, in some of the universities, during courses of six months. He must study clinical medicine under a professor of medicine, in one of the hospitals, for six months. He must also study clinical surgery, medical jurisprudence, botany, natural history, including zoology, during a course of at least six months. He must have attended for at least six months, by apprenticeship or otherwise, the compounding and dispensing of drugs at the laboratory of a hospital dispensary, with a member of a surgical college or faculty, a licentiate of the London or Dublin apothecaries, or a professional druggist or chemist. He must also have attended the out-practice of a hospital, or the practice of a surgeon or physician, for at least six months.

After all these requirements have been fully complied with, the candidate is subjected to a private examination; and, if he is unfit for a degree, he must study another year. If he passes this examination, he must write a thesis in Latin or English, and defend it before the Senatus Academicus.

It will be seen, by this brief outline of the requirements imposed by the highest standard of medical education in the enlightened nations of Europe, that it is far higher than with us. The preliminary education is more thorough, the time required for the study of medicine longer, there is more method in the arrangement of the studies, clinical observation is considered more important, and the examinations are more rigid. I have omitted to speak of that class of practitioners that are found in almost every village on the Continent, who are permitted, in the absence of the well-educated physician, to prescribe. For example, in Austria there is a class of practitioners (abundant specimens of which can be seen all over this country) “who are obliged by law to shave for a couple of kratzers, to exhibit the basin and striped pole, and to keep open a barber's shop. . . . These practitioners are not allowed to sell medicines; but to them are committed all the minor surgical operations, such as usually fall to the lot of apothecaries in this country. They cannot prescribe medicines, except a few simples, unless in cases of imminent danger, and when a physician or surgeon is not at hand.” This class, in their acquirements, falls far below any regular practitioner in this country.

It cannot be expected that we can equal at once the highest standard of European medical education. Our republican institutions, our want of government patronage, and our sectional prejudices, will prevent, for the present at least, any concentrated national effort to effect this object. We cannot have any maximum or minimum standard. It must be one. It must be American. It cannot be European. But it can and it must be raised, or we must consent to stand on the same platform with homœopathists, eclectics, Thompsonians, spiritualists, and graduates from female medical colleges, and force our way as best we can into public favor. Public opinion and private ambition have advanced far beyond the requirements of this Society. Young men now, who seek or who expect to take the high places in the profession, are not content to stand on the platform we have erected for them. They take their degrees here, and then spend a year or two in England, France, or Germany, in finishing their education; while the unfortunate young man who has been enticed into the profession by its easy access, and who has just money enough to push himself within the requirements of this Society, stands but a poor chance by the side of his more enlightened competitor. Some peculiar local circumstances, or a mind stimulated by ambition to extraordinary efforts, can alone save him from sinking into a lower social and professional scale.

This want of a higher standard of medical education is felt throughout the whole profession in this country. Every report which has emanated from the American Medical Association is full of recommendations and appeals to raise this standard; and almost all of the introductory and valedictory addresses delivered yearly at our medical colleges contain some eloquent passages upon the importance of educating the profession more thoroughly and systematically.

At the first meeting of the American Medical Association, in their report on medical education, we have these words: “In whatever aspect the enterprise be viewed, the mind is finally arrested by the apparently radical source of all the evils and deficiencies in the profession; viz., the imperfect education of a large part of the profession. The serious consideration of all physicians should be called to this evil; and they should be urged, by all their wishes and hopes for a better state of things, by all their aspirations for the progress and perfection of the science, and by a motive still more exalted, — their conscientious interest for the welfare of their patients, — to direct their energies towards its removal.

In its report on the same subject in 1850, in speaking of the preliminary education of the profession, it says, “Neither public nor private teachers can deny that many of their pupils come to them imperfectly and insufficiently prepared. Aside from the deficiencies which immature age almost necessarily implies, it cannot be gainsaid, that a considerable number of medical students in this country enter upon their professional education with a limited amount of preliminary training.”

In the report of the Association, published in their Transactions at their last meeting in 1856, we have these words: “No one will deny that the standard of medical education in the United States is too low; that the license to practise is granted on the faith of attainments far too limited for the good of the profession or the public. But how to prevent this, in a country where laws are made by uncultivated and untutored minds, is the great and insurmountable difficulty.”

It is not necessary for me to accumulate evidence to prove that a higher standard of medical education than the present is necessary. The enlightened members of the profession call for it; the public demand it. But how this is to be done is a difficult question. It cannot be done by sending out able reports upon the subject. These may prepare the way. It must be done by the united and decided action of some corporate body, which has the power to admit members into its fellowship if worthy, and reject them if not. The medical schools say it cannot be done by them. They are too numerous; the competition is too great between them; the professors are too dependent upon the students for a support. If Harvard Medical College raises its standard, the student can go into some other State, and graduate where it is low. There must be an agreement between all the schools, if they accomplish this change. Upon this we can found no reasonable hope. The change cannot be effected by the American Medical Association. This body has not the power: it can do no more than it has done. It has shown, by its able reports, the importance of a change; and, if it ceases to exist hereafter as a national association, it will deserve our gratitude for what it has already done towards effecting the great objects for which it was organized. But how can this change be brought about? Where shall it begin? Gentlemen, let it commence in this Society. Let the Massachusetts Medical Society have the honor of setting the example, and other State societies will soon follow. Let it carry out the great principle, upon which it was founded, to its fullest extent; and it will receive, as it did when it was formed, the united support of every enlightened citizen of this Commonwealth. It will be seen, by the requirements for membership to this Society, that it has not advanced one iota for the last half-century; while the science of medicine has kept pace with kindred sciences, and has advanced step by step, until it has placed itself on a solid foundation. This should not be. It must, in its demands, keep up with the progress of medical knowledge, or all its adhesive properties will not save it from entire decay. Great changes cannot be made suddenly, without some danger. But there are two which I think it can make, and in my opinion must make: —

1. It can require four years' study from those who are not graduates from some college, one year of which should be spent in the study of those subjects intimately connected with medical science, such as botany, comparative anatomy, vegetable physiology, &c.

2. It can appoint at its annual meeting an independent committee, selected from among its most intelligent members, who shall quarterly or semiannually, at such places as they may select, examine every physician, whether a graduate or not, who applies for admission into the Society. If the candidate is found deficient in any one of the required studies, he should be rejected until he can pass such examination.

This committee would, of course, take the place of the present censors; and I might, if I had time, give you strong reasons for this change: but they will readily suggest themselves to the mind of any one who will give the subject a moment's reflection.

It will at once be asked how these changes can be made, when, according to the present act of incorporation, any man who has a degree of M.D. from the Harvard or Berkshire Medical Schools can become a Fellow of the Society, without passing through the formalities of an examination. It cannot be done without an alteration of the charter, and an entire separation from these schools. This must be done, or you cannot move one step. There never was a greater mistake made by this Society (and I say this with all deference to those who brought about this coalition) than that of admitting graduates from these schools into their fellowship, without an examination. The moment this privilege was granted, a blow was levelled at its independence, from which it can never recover until it has retraced its steps. It opened the door for men to enter who could practise upon the principles of any new doctrine; could slander the members of the Society as much as they pleased, and set at defiance its power. Let us examine the operation of this alliance for one moment. Let us take, for example, the requirements of Harvard Medical College, and their practice of giving degrees, and compare them with the requirements of this Society. And, in doing this, I am not disposed to find any fault with the College; for I think its requirements are as great, and the examinations as rigid, as at any school in the United States; and I think, if sustained by the opinion of the profession at large, the professors would gladly raise the standard of their requirements. But what says Harvard Medical College? If the candidate for an examination has not received a university education, he shall satisfy the Faculty of Medicine in respect to his knowledge of the Latin language and experimental philosophy. What says this Society? The candidate for fellowship to this Society “shall have such acquaintance with the Latin language as is necessary for a good medical and surgical education, and shall have acquired the principles of geometry and experimental philosophy.” And then, in a note explanatory of what it means, it says, “It is understood that he be able to translate the Select Orations of Cicero, the Æneid of Virgil, or the medical writings of Celsus, and the formulæ? of the Pharmacopœia of the United States; and that he have a knowledge of Euclid, Pierce’s or Loomis’s Elements of Geometry; also of Golding Bird's or Olmsted's Natural Philosophy, or the Cambridge Course of Physics.” Harvard Medical College says it cannot go behind its charter, and must examine any man who presents himself with the proper certificates; and I understand, that in the examinations of candidates, if they pass in five or six of the required studies, and fail in one or two, they are allowed to have their degrees. What says this Society? “The censors should satisfy themselves, by examining applicants, that they have pursued a course of study fully equal to that prescribed by this Society.”

A man presents himself to the faculty of Harvard Medical College with his certificates, and passes an examination. He tells them that he intends to practise homœopathy or Thompsonism, or any ism of the day; and they cannot refuse him a degree; and, if he applies to this Society for membership, he must be admitted. What says this Society? In a recent act, it sustained the censors of the Suffolk District, when they rejected a man because he acknowledged that he was opposed to the principles of this Society, but sought admission into its ranks on the ground that it would secure him the confidence of the community.

This Society may send out as many reports as it pleases, and advise its members to hold no communion with pretenders. The mischief is done when they are admitted into the Society. Expel them, and you raise the cry of persecution. Call them irregular practitioners, and they show you their diplomas. This Society is alone responsible for its connection with the medical schools. When it was proposed to have graduates from the medical schools enter the Society without an examination, the Society had the power to accept or reject the proposal. If you will examine the reports and records of the Society, you will find that the alliance was not formed without decided opposition. The Society is alone responsible, if it allows this state of things to continue. But, if the schools and this Society hold the same relationship hereafter that they do at present, these conflicting elements must, in some way, be harmonized. The only way to protect this Society is to divorce it from the schools, to raise its standard of requirements, to examine every candidate in all branches of medical science, and to infuse into its ranks the spirit of united and determined action. I believe this course would be better for the schools. It would stimulate them to greater exertion, and inspire them with a spirit of pride and emulation.

2. This Society should carry its principle of protecting the public from the prevalence of false notions further than it has.

There is not, I presume, an honest or intelligent physician in this Society, aside from his own interest, who does not often sicken at the thought of the imposition that is practised upon the people at this time. The literature of the day, and the public press, would seem at times to be all on the side of quackery. Occasionally, however, he finds in some periodical a paragraph which gives him a ray of hope. It quite cheers him on his way, and sends a thrill of comfort to his soul. It runs thus: “In our advocacy of liberal thought, and in our exhortation for reform, we must not forget that science is unchanged and everlasting; that the discoveries of Hippocrates were as real, and remain as true to this day, as the discoveries of Euclid. There is progress in medical science; but it is found only among the body of honest and well-informed physicians: it does not overthrow what is true in the past. When I go to a new school of medicine in case of sickness, I shall take with me Seba Smith and S. E. Coules, in place of Euclid and Newton; and bow before Mormon plates, instead of turning to the Four Gospels.” What is true in science is unchangeable; what is true in principle is everlasting. Spread among the people a knowledge of what is true and what is false, after having gained their confidence in your intelligence and honesty, and you lay the axe to the root of all that gives vitality to falsehood and deception.

If this Society will appoint annually, from among its most scientific and enlightened members, a committee, whose duty it shall be to report upon all subjects brought to their notice connected with the public health, and let these reports be sent throughout the Commonwealth, it will do more to arrest the progress of false notions of practice than it can do in any other way.

Let such an article as that which appeared in the “Medical and Surgical Journal” of May 7, upon the antiphlogistic salts of Dr. Coggswell, be sent throughout the State, and the learned doctor would soon be obliged to call upon his inventive genius for a “new panacea” for the people.

When homœopathy first made its appearance among us, if the Society had appointed an intelligent committee to investigate its merits, and the results of that investigation had been made public, I think we should hear little at this time of its pretended success.

And if this Society should now direct its attention to the examination of that new doctrine which passes under the name of Spiritualism, but which should rather be called Materialism, I believe it would do good service. Hundreds of individuals are prescribed for daily in the city of Boston by the media; and hardly a day passes that I do not hear of some new convert.

How much of truth there may be in this new doctrine it is impossible for me to say; but I am convinced, from what I have seen, that there is so much error and deception in its various manifestations, that its tendency is to subvert the principles of the Christian religion, and arrest the progress of scientific investigations. It seeks inspiration from departed spirits, and sets at defiance the accredited truths of philosophy. Such, however, are its pretended claims, that it should be subjected to a most rigid examination. I know that one gentleman in this Society, — now, I am happy to say, its President, — whose clear head and logical powers inspire us with the greatest confidence, has investigated this subject, and has given his impressions to the world. But if this Society, through a large committee, would continue these investigations, and send out its report with authority, it would produce a still greater effect.

Gentlemen, I have, in the hour that is allowed for this portion of our annual meeting, given you a brief sketch of the principles of this Society, of the manner in which these principles have been carried out; and have stated, in as distinct a manner as possible, what I consider the duty of this Society to be at the present time. In what I have said, I may not have brought my ideas before you in as clear a light as they have in the course of my examinations been presented to my own mind: but I am strong in my convictions, that this Society has its foundations in truth; that its efforts have been made in the right direction; and that if it will continue to extend these principles from time to time, as science advances and public opinion demands, it will stand through all the changes of time, “through good report and through evil report,” a noble monument to the sagacity of its founders, and a lasting honor to those who now sustain it.

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