Massachusetts Medical Society: The Duties, Trials, and Pleasures of the Medical Profession

The Duties, Trials, and Pleasures of the Medical Profession

Annual Oration 1852

By Henry L. Sabin, M.D.

Mr. President and Gentlemen of the Massachusetts Medical Society,

There is no more honorable employment for the time to which a professional man can be advanced, than to be invited to address his brethren. It is an elevation among equals; an honor which generous men delight to bestow, and which it is grateful to receive. There is, indeed, in such a position, less distinction between the speaker and his auditors than when the aged addresses the young, or the Professor lectures to his class. Invited to address his associates in professional studies and labors, I appear not as a teacher, but as a friend with friendly greetings. I come as a brother, not to instruct the better instructed, but to enjoy with you “the feast of reason and the flow of soul.” I come to wise men, men of experience and of professional eminence, to confer with them, and to suggest topics of reflection which are of common interest to the profession, and to the community in which we live and serve. I feel thus honored, gentlemen, in addressing you to-day. We have assembled here from all parts of the Commonwealth, from the cities, the towns, the valleys, and the mountains. We come to take each other by the hand, and to exchange words of mutual encouragement and of God-speed to all good men, and true, of the healing art.

For myself and the profession in this part of the State, I welcome, for the first time, the Massachusetts Medical Society to the green fields and groves and highland forests of Old Berkshire, in the first blush of their summer glories. I welcome you to these fruitful fields, and thriving villages, and mountain towns. I welcome you to the seats of academical and professional learning, which have been reared amid these rural scenes of beauty and of grandeur. Brethren from other States, I welcome you to a cordial and full participation in all the deliberations and festivities of this anniversary occasion.

And permit me to digress for a moment, and welcome the alumni of the Berkshire Medical Institution to this once cheerful home of our earliest medical aspirations,—to these once pleasant and oft frequented walks, these sylvan lakes and mountain glens.

Welcome also here, to drop a tear at the sad remembrance of a Day and a Jennings of our own county, who early ceased from their labors; and of the lamented Professor Wells, whose sun went down ere it was noon, full of honors in his profession.

Welcome also to the remembered kindness and hospitality of the venerable President who stands here, almost alone, as the aged elm stands in the midst of this beautiful village, a memento of by-gone days.

We have come here from our several spheres of practical life. We have turned aside, for the purposes of this meeting, from the toils and watchings and racking sympathies of a profession which is peculiarly one of labor and responsibility. I meet you, then, not as a theorist or a speculator upon the occult sciences; not to spend an hour in spooking about in dreams, among the mysteries of Mesmerism or of the Spiritual Knockings. Nor would I here discuss any of the more legitimate subjects of science pertaining to our profession. But I meet you as a practical man, having with yourselves a common experience. I come from real life to meet medical practitioners, with whom also, as with myself, “life is real, life is earnest.”

You will not, therefore, gentlemen, judge it inappropriate if I invite you to reflect upon the Duties, Trials, and Pleasures of the Medical Profession.

Yes, we have duties to perform. I need not have said this to you, because all medical men who are worthy of the confidence they claim, understand it full well. They know and feel that the very fact of our having offered our services to the public, as medical practitioners, imposes on us duties of the highest responsibility. So deeply is this felt, and so generally is it acknowledged, that with us the marvel is that it should be necessary to say this at all. Who doubts it? No intelligent man, no honorable, no fair-minded man doubts it. Yet there are craven spirits in the community, who make it their chief end to raise prejudices against the medical profession, as if doctors had really banded together to dose the people to death. This is represented as having been the great secret of the profession in all ages, to learn how most effectually to kill their patients. This impudent slander is circulated in the quack pamphlets and periodicals of the day; and vast numbers of the ignorant and the credulous believe and circulate it. It may be well, therefore, on such an occasion as this, to say frankly what we think of the duties and responsibilities of medical men.

Let it be known, then, that we have no secrets in our profession, but the secrets of one’s own knowledge; that is, the secret consciousness of knowing that of which the mass of the community and men of other professions are entirely ignorant. And this is a secret with us, not because we lock it up. It is an individual possession. We have studied and toiled for it. We cannot impart it to others, unless they will give up other pursuits, and study and labor for it, as we have done. How vain and preposterous is the slander, that we keep the knowledge of our profession a secret from the world, that we may use it for base and unworthy purposes!

Our books are open to all who will read them. Our laboratories and lecture-rooms are open to all who will in earnest take up the study of the healing art. Our medicines are all in the market, for the benefit of those who know how to use them. The discussions of our medical societies are published to the world, while cases in the practice of our best physicians and surgeons are extensively reported to be read of all men.

It is quacks and the compounders of patent medicines that practise deception by pretending to some profound secret in their nostrums. And they who are the loudest in their complaints against us are the very dupes of the deception they complain of. They compass sea and land for a useless thing that is puffed in the newspapers, merely because it is said to possess some mysterious healing quality, unknown to anybody but the ignorant pretender.

But with regular physicians no such deception is practised. All that we know of diseases and their remedies, of medicines and their uses, is published in our books. And every new discovery, as soon as it is sufficiently tested, is heralded in our periodicals. It is a point of honor in the profession, that every regular practitioner should make known his discoveries for the benefit of all. And the physician who vends a nostrum, and practises upon the credulity of the people, by wrapping himself up in the mysterious secrecy of the knave and the quack, loses his rank in the profession. He is at once dishonored and disowned.

No, gentlemen; I say it in your presence, in the hearing of all who care to listen,—and you are my witnesses to the truth of the declaration,—that we have no secrets in our profession, and that we sanction the sale of no nostrums. Whatever knowledge we have or may attain of the science or the art of medicine, we would gladly impart to all. And, more than this, if we could dose out knowledge by grains and scruples, and put it down men's throats as we do pills and powders, we would dose our calumniators till they should cry, Quantum sufficit. Yes, we would pour it down them, till it should mingle with the circulation of the blood, from the heart to the brain, and from the brain to the extremities,—till it should operate upon the whole system, purging away from them the whims and fancies and quack medicines, under which they have so long groaned and suffered.

I say, also, that it is the duty of medical men to make themselves masters of the science of their profession. No one should enter upon the practice of the healing art, until he is thoroughly grounded in its principles,—the symptoms and diagnosis of diseases, the nature and powers of medicines, and the history of their uses and effects. We have no right to pretend to a knowledge which we do not possess. We owe it to the community, whose confidence we claim, to know what we profess to know. If all who set themselves up as physicians and surgeons would do this, and if none who are recognized as such were ever known to depart from so plain a principle, the confidence of the people in the profession might be expected to be unshaken and universal.

But there are pretenders on every side of us,—doctors in name, as well as we; and sometimes, I regret to say, they are of us,—men who disgrace the profession, and forfeit the respect of their brethren, and of all intelligent and fair-minded men, by boasting of great secrets in their practice. It is these men of marvellous cures that make the mischief. They flatter the credulous with the belief, that they can almost raise the dead by their mysterious skill; and, although the course of such men is short, and destined to end in neglect and forgetfulness, yet every dog of them must have his day; and the regular physician often suffers in his practice, simply because he will not descend to the baseness of pandering to the prejudices of the deluded. Yet, Brethren, there is no duty more plainly incumbent on a professional man, than to maintain the honor of his profession by an honorable practice of it. Our occupation involves a brotherhood of responsibilities. Its power of usefulness depends on the competency and faithfulness of its members. If one member is deficient in practical skill, or in the principles of an honorable practice, he casts discredit upon every other member within the sphere of his influence. Every physician and surgeon, therefore, is bound to possess himself of the requisite science and skill for a successful practice. He goes not forth as a mere man of business, to traffic in wares with purchasers whose “eyes are their chaps,” and where the worst of a bargain is the loss of a few dollars. No, it is not money, nor personal interest, for which he negotiates; but life and death are dependent upon his skill and assiduity. He deals not with the strong, the healthful, and the enterprising; who, if he were a merchant, would pay him his price for the comforts, conveniences, or luxuries of life. But the physician’s skill is above all price to those who need it, and cannot be estimated in dollars and cents. He is to go at the call of the sick; and his pecuniary reward is to be a secondary consideration, an afterthought, to be realized or not, as circumstances shall determine. His business, first of all, is with the victims of disease,—the halt, the maimed, the broken, the senseless, the suffering, and often with the dying.

It is not to make a bargain that he is called, but, if possible, to perform a cure. The patient, with a burning fever, is in no condition to negotiate; and, if anxious friends solicit the physician's aid, the idea of money is often excluded by the greatness of the benefit they hope to derive from his skill and care. It is not a bargain they propose to make, but an appeal.

The life of a husband, a wife, a child, a brother, a sister, a dear friend, is in peril; and their appeal is made with tearful earnestness to all that is manly and social and sympathizing in the physician. They feel that their sick are in his hands; and they beseech him, as a friend and a Christian, to do all that man can do to stay the hand of death, and rescue their loved ones from the power of the grave.

One has only to contemplate these circumstances and relations in all their tenderness, perils, and anxieties, to see that the duties of a physician are peculiar. They are often among the most trying and important of human responsibilities; they are the duties of a man of science and skill, who is conscious that he understands the case better than the anxious friends that are about the patient’s bed. He feels bound, therefore, to act upon his own individual responsibility. His duties are his own, as he must answer to his God; they are the duties of a man of conscience, a man of heart, and of tender sensibilities; nor do I see how it is possible for a physician to do his whole duty in these cases without Christian principle. He takes, as it were, the destiny of a fellow-being into his hands. The patient and his friends trust implicitly to his skill; they see with his eyes; and wait, with anxious suspense, the indications of his hopes and fears.

How can he take all these confiding sympathies into his keeping, without feeling that his position is intensely responsible? And when medicines fail, and he must speak the word that dashes the hopes of patient and of friends, the best of all relief to the physician is to be able to direct the dying one to the Great Physician,—to commend to God those whom his medical skill is impotent to save. A sense of religious responsibility, therefore, is nowhere more appropriate than in the practice of medicine; and there are no relations in life, perhaps, in which a physician may hope to be more useful than in mingling the instructions of religion with the intimacies and confiding sympathies of the sick and the dying. Such are the duties of the medical man. They are peculiar duties. They have their foundation, it is true, like all the duties of man to man, in the general principles of justice, humanity, and religion. These duties and their responsibilities are appropriate to none but medical men; they properly devolve upon no other men or women, and no others should assume them. If we cannot maintain this principle, and make its justice apparent to the public, our profession is not worth maintaining; it has no rights to claim, and of course no duties to discharge. On this supposition, every man would be his own doctor; medical and surgical science would be of no avail; no class of men would be responsible for the health of the community; mere mother-wit would take the place of the principles of science; and the sick and the maimed, of all diseases and hurts, would have to take their chances of life with “natural bone-setters,” and the legendary specifics of marvel-wonders and empirics. But this it is the object of the medical profession to prevent or to remedy. It embodies the science and skill which are needful—the results of the study and practice of ages—in relieving the maladies of man. On the ground of its competency, thus acquired, to do all that man can do, it claims the confidence of the public; and no one has a right to take part in these duties who does not possess a reasonable amount of the science and skill of the profession. Nor will the truly scientific physician feel that he is competent to stand alone in his practice. Cases will often occur, in which the more he knows of their difficulties and dangers, the more he will feel the need of the advice of his brethren: consultation will, accordingly, be invited in such cases. It is thus apparent that duties of medical men are not individual and solitary duties: many of them are social and fraternal. They are not the duties of a single physician or surgeon, but of the profession; and they are never properly discharged, excepting by mutual consultation and counsel. It is in this way, and not by solitary self-consequence, and the vaunting of individual skill, that the highest honor and usefulness of the profession is attained. Thus it is the duty of every medical man to identify himself with the profession by calling to his aid, in cases of great difficulty and peril, the counsel of his brethren. And he should impart to them as freely as he receives, feeling that, in honoring the profession, he honors himself; and that, in advancing the reputation of an honorable rival, he promotes his own. This is manly, generous, Christian. I would that we had no examples but of such a spirit with us. It makes us blush with shame to be told, as we sometimes are, that doctors are apt to be sensitive, jealous of each other's success, governed by a mean spirit of rivalry. Let us disdain the charge, and rise above it. Our duties call on us to mingle with sufferers; our work is in the chambers of the sick, and we share in great and tender responsibilities. We need, brethren, each other’s sympathies.

Let us then give, as we would receive, heart for heart, hand for hand. Let us acquit ourselves like men, and be strong in each other's confidence, and in the honorable discharge of the duties of our profession.—But enough of duties.

The medical profession has also its trials. What profession has not? What good work was ever undertaken by men that did not encounter obstacles? Who ever undertook to do his duty in any sphere that did not meet with trials? It is no strange thing, then, that has happened to us: it is common to all professions and employments. But as the duties of the profession are peculiar, so are its trials peculiar; and they are many. Is not their name Legion? To some doctors, in certain states of mind, their troubles seem absolutely innumerable. Yet they are not great troubles; many of them are mere annoyances, vexations, and inconveniences, that tease and fret a man,—all the detail of making pills and apportioning medicines, small business and vexatious. And then to be called up o’ nights, time after time, in all weathers and seasons, to ride many miles over rough roads (as we have to do in the country), and find, after all, that nothing is the matter, is an annoyance. One is apt to think he had better have hardened his heart, and slept a balmy sleep that night. Yet he could not have known that it was the mere whim of his patient, if he had not gone at the midnight cry. And sabbath-day calls often make the doctor feel that there is no day of rest for him. These, and a thousand others of the same kind in the experience of physicians, are teasing, vexatious; and they hurt us, as eels are hurt by being skinned alive, until, as the old woman said, “They get used to it.” But there are greater trials than these in the practice of medicine. To some of these I have already referred, when speaking of the mischief done to our profession by quacks, and by men of mystery and of marvellous cures in the profession itself. Who that has seen many years of practice has not been sorely tried with the interference of empiricism and popular delusion? Money-making nostrums—like “Dead Shot,” to kill worms, that kill children instead—stand sadly in the way of the all-pervading influence of our profession.

Then comes the “Indian Doctor,” wrapped in mystery, with a miserably-imitated, broken French accent; born in Paris; stolen from his mother by a tribe of Indians, when he was a little child; and brought on foot, across the Atlantic Ocean, and educated in a college near the “Lake of the Woods.” And here he is, with a constellation of stars in the roof of his mouth, by which he can diagnose all diseases, and cure all human ills,—any thing and every thing; the more improbable, the better for his purpose. It enlists the credulity of thousands. They throng him with their money in advance, on promise of a certain cure. They submit to his incantations, take his root-syrup, and almost worship the “lying wonder,” till he passes off in a drunken revel. One trial is past, but another cometh. A wonderful discovery has been made by one Thomson: the physiologists of all ages have been wrong, and all the doctors are deceiving the people, and killing them with poticary. “Heat is life, and cold is death” says the Thomsonian; and it stands to reason. Does not a man feel warm when he is alive? and is not a dead body cold? So, great masses of the people believe it; just as if a man might not be burned to death as well as frozen to death. What, then, is the remedy for all diseases? It is at hand. You must sweat out the “marcury” that is in the patient, clear his stomach with lobelia, and steam to life; and, to make it doubly sure, give him “red pepper pills, No. 6.” Is not this a trial,—to see human life thus trifled with, and sacrificed to ignorance and stupidity?

But there is another trial. A dream has been told in Germany, and wafted across the waters. It finds here a genial soil; and Homœopathy is proclaimed as a remedy for all diseases,—a catholicon, a panacea. It is a new word; and, surely, it must mean something. It announces a universal principle. This, too, must mean something. “Similia similibus curantur.” How intelligible! How profound! It is hardly possible to give it in good English; but it means, “The hair of the same dog will cure the bite.” Or, if it were not contrary to Scripture, it might mean, that, if you would cast out devils, you must call on Beelzebub, the prince of devils. Surely it is a wonderful thing, this Homoeopathy. And then its infinitesimal doses are all a mystery, invisible, intangible, the quintessence of nothing! We know not what it is, nor what it does. But surpassing wonders are told of it. People get well under its application,—especially when there is nothing ails them. And so we have wrought among us cures more marvellous, and just as true, as that related in the old nursery-tale, which was got up to make children wonder and laugh, —

“There was a man in our town,
And he was wondrous wise:
He jumped into a bramble-bush,
And scratched out both his eyes.
And, when he saw his eyes were out,
With all his might and main,
He jumped into another bush,
And scratched them in again.”

I would not intimate that any sane man practices according to the preposterous theory of Hahnemann. But there is so much mystery in the name and the principle of Homœopathy, that it awakens the curiosity of patients of the fanciful and the nervous class, and serves as a shield for all kinds of practice. The principle is followed only in name; and it is well known, Mr. President, that many who practise under this name are sailing under false colors. They look one way, and row another: they steal the thunder of Homœopathy, but practise Allopathy. To honorable men in the profession, this is a trial of patience and faith. But they must bide their day, when this, like other fancies and dreams, must yield to the settled principles of science and of common sense. It is indeed a beautiful imagination, a transcendental wonder, which is here presented as a principle. It should not surprise us that theorizing men and fanciful women are allured by it, and that lawyers and ministers and merchants, and many of the fashionable and the wealthy, already know more about medicine than all the doctors. Why, they had the headache, or a cold, and they took something, they know not what, and felt better! And a great principle was announced,—“Similia similibus curantur.” This, as it is itself unintelligible, means what any one imagines it to mean. So it covers all cases. It tells the whole story, and casts into the shade all science and knowledge, besides, pertaining to medicine and its practice. And men of science and of conscience in the profession must look on, and see the delusion, and treat it as a dream, in the face of its refined and respectable admirers and patrons.

Is not this a trial? Nor is this alone. Hydropathy, and a host of other newly discovered principles of cure, throng the pathway of the regular physician, as if all the sons and daughters of the fabled god of medicine had risen up from the oblivion of past ages to stay the progress of medical science, and allure us back to barbarism, or to act over again the dim and shadowy scenes of ancient fable. But these are phantoms that will disappear. They are spirits from the vasty deep, the ghosts of exploded errors, that have troubled the world in all ages. They are short-lived, in the light of true science. And it is the province of our profession to live them down in the future, as it has done in the past. But there are yet sorer trials than these in the medical profession. They are less imposing often, but more personal. They embitter and disturb the relation of the doctor to some whom he strives to benefit. Patients are sometimes ungrateful. There are among them some who fear not God nor regard man. Yet they are afraid of death; and, when they are sick, they have none to whom they can go but the doctor. They make him a god in their distress, and demand their life at his hand. They appeal to his tenderest sympathies. But, when health is restored, all this is forgotten, and the man whom your skill and watching have rescued from the grave is your enemy. He is found perhaps among the lowest and meanest of the calumniators of the profession. He can conceive of no motive for your care of him in his sickness, but to get his money; and this he withholds, if possible. Whether this is the result of ignorance, stupidity, or the malign influence of quacks and meddlers, it is a trial to a benevolent physician, who is conscious that he deserves other returns than these from those he has labored to serve and to save. Mere antagonism and ingratitude, however, from heartless patients are not the worst of our trials. There is a disposition too prevalent in the community to attribute every failure of complete success in medical treatment to mal-practice, as if the physician had power over all the elements of nature, to eradicate all diseases, and were bound to let no man die. This disposition is especially noticeable in respect to the practice of surgery. What is a broken bone but a thing to be cured? The doctor is called to set it. He is expected to mend it as he would mend the broken spoke of a cart-wheel, by driving it into its place, and nailing it there. No allowance is made for the state of the patient, his physical weakness, the general concussion of the system, and the inflammation that ensues. Surely there is no difficulty in setting a bone. But the skilful surgeon, when he arrives, finds he has not a mere mechanical structure to repair, but a living man, bruised and broken and debilitated. To reduce the fracture at once would cost him his life. The surgeon wisely judges that life is more than limb. His skill is therefore exerted to save him alive. He waits for the proper time to reduce the fracture. And then, against weakness and pain and inflammation and exhaustion, and all the dangers of overtaxing an enfeebled constitution, he applies all the power that his patient can bear. The tone of his system is gradually restored, and in due time he rises up from his bed of pain, a well man. The patient and his surgeon rejoice together that he is alive. But the broken leg is not in all respects as it was. It is shorter than the other. The living man limps, it may be, and walks with a cane; and there are meddlers about him, and bonesetters, and quacks, and self-constituted doctors; “wiser in their own conceit than seven men that can render a reason;” and mean and craven spirits in the profession itself,—they pity the poor man with a shortened leg. Oh, yes! their compassion is awakened; they whisper in his ear, all in confidence, it is true, that the doctor ought to have known better than this. They pronounce it a botch, a failure, and assure him that the doctor was responsible to make the limb every whit as good as it was before, and, if necessary, to stretch it a little longer. They flatter him with the suggestion of a legal remedy. One and another suggest the paltry sum of three and five thousand dollars as damages. How humbling to the profession that such suggestions should emanate from their own number! Wise counsel is given, and to your amazement you are under prosecution for mal-practice. Enormous damages are claimed, and you have no alternative but to stand trial, or suffer your reputation to be blasted, and your name to be disgraced. You owe it to yourself, you owe it to the profession, to meet your assailants. And for the first time in your life you must be taken from your family, summon your witnesses, and go to court in self-defence. To a sensitive man it is martyrdom; but it is worse than martyrdom to suffer your good name to be destroyed without a defence. This is not only prosecution, but persecution. And thanks to the enlightened jurisprudence of our country, that we are even able to escape from the fangs of these dastardly, stupid, and malignant combinations. Yet we do escape. We are nobly defended by enlightened and sympathizing lawyers, and protected by learned judges; and you, brethren, are our witnesses. If you approve, no fair-minded jury or learned court will condemn. This worst of our trials, therefore, this conflict with unreasonable men, is not without its victory and its triumph; and we come out of the cloud with a clearer field than if no storm had assailed us. The profession is honored in its own defence of its principles and its practice.—I will say no more of trials.

Pardon me, gentlemen, if I detain you a few moments longer to speak of pleasures which far counterbalance all these troubles. The study of the science of medicine is itself a pleasure. It is the science of nature and of man. It is not a mere abstract speculation, with which the mind may be entertained and amused, with no material profit. We trace the delicate, curious, and complicated structure of the human system in all its wonderful unity and variety. We contemplate it in its normal and abnormal states, its aliment, the means of its strengthening and growth, and the causes of wasting and decay. The chemistry of life, and the powers of the vegetable, animal, and mineral kingdoms to contribute to its sustenance in health, and to its relief in sickness,—who would not delight to range over such a field for the mere purposes of knowledge? To a mind properly trained, no novel is so enchanting, no romance so enticing, as this study. We have here presented the wonders of God's hand, as they are in nature. But medicine is not a study only: it is also a practice. We pursue it, not simply for the pleasure of knowing its principles, but for the sake of applying those principles to the art of healing. The life of man, in his present state, is a dying life. His sin has brought disease and infirmities upon him. This curiously wrought form, “this harp of a thousand strings,” is subject to derangement. To meet these is the object of our profession. Such is the field of its usefulness. The power to do good to our fellow-men, and the heart to do it, is a source of the purest pleasure to the benevolent mind. To see the suffering of the sick and the wounded is itself no source of pleasure; but to relieve that suffering, and raise them up from sickness to health and conscious enjoyment, is happiness. The social pleasures also of the medical profession are great. There is happiness in mingling with the sympathies and affections of the families of the sick. The whole circle of endearment and love is often drawn with the tenderest solicitude around the bed of the sufferer; and the physician is there, not a stranger, but to be admitted to all the intimacies of the scene, to take part in their fears and hopes, and to give direction to all their endeavors to comfort and to save. If the hand of death is too strong to be resisted, and the patient dies, they honor his skill and assiduity, and freely admit him to share in their sorrows, and to weep with them that weep. And they hail him as a partner of their joys and thanksgivings when health returns. Ties of friendship and confidence are thus cemented between physicians, and the families they serve; for patients are not always ungrateful. It is not the rule, but the exception, for the doctor to be hated and maligned by those whom he has used his best endeavor to benefit. Far different are the returns he receives from the mass of his employers. The best of his pay, for his toil and watching, is often derived from the affectionate confidence of the poor, whose thanks are better than money to one who can afford to act the good Samaritan over them without pecuniary reward.

On the whole, Mr. President, we are engaged in a noble calling. We cannot, it is true, claim the exemption of those “who are not troubled like other men,” and “whose eyes stand out with fatness.” But we shall avoid also the curse of such, if we are faithful to our whole duty as medical practitioners. The power of usefulness possessed by our profession is second to that of no other; and the pleasures that mingle with its toils and watchings and sorrows are perhaps as great as are to be found in any other sphere of human responsibility and labor.

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