Massachusetts Medical Society: The Duties of the Medical Profession

The Duties of the Medical Profession

Annual Oration 1867

By Horace P. Wakefield, M.D.

Mr. President, and Fellows of the Massachusetts Medical Society:

All that I am, have and hope for in. this world I owe to the Medical Profession. Whatever influence has resulted from any honor bestowed or position attained, I have endeavored to use to promote the welfare of the Massachusetts Medical Society in particular, and advance the interest of the Medical profession in general. If the success of my efforts had equalled my desires I should have felt an honest pride in the result, but must be content that some progress has been made in collecting vital statistics, without which no accurate and thorough calculations can be made of epidemics, the duration of disease or the mortality of different localities; and without which cannot be discovered those obscure causes which are silently yet surely sapping the vital powers of the human race.

But, however much I value the confidence reposed in me and the honors conferred by my fellow citizens, they are as the dust of the balance compared with that of being the mouth-piece of this Society on this festive occasion. For this I would make my most graceful bow and tender you my profoundest acknowledgments and most grateful thanks.

A few years ago, the Massachusetts Medical Society resolved, “nor will it hold itself responsible for any opinions or sentiments advanced in any future annual discourse.” It took counsel of the wise man, “The prudent man forseeth the evil and hideth himself.” If this be the acknowledged doctrine, that for whatever opinions I may advance and for whatever views I may promulgate, I, and I alone, am responsible, I accept the position and lay this down as an axiom, responsibility in toto exempts from criticism in toto.

Only once in the life of an individual is vouch safed the high honor of addressing the assembled medical profession of the Commonwealth. The living voice can vibrate on the living ear but for one short hour. To the speaker it is an hour of moment; to the listener it may seem to “creep with leaden legs.” To the one it is the hour of a life, to the other it may pass “like the idle wind.”

We have assembled on the first anniversary of a two days session of festivity. We meet at the “hub of the universe.” I welcome you, Mr. President, from the city of the east, laved by the waters of the beautiful Merrimack, consecrated by the ashes of George Whitfield, small in territory but large in resources of wealth and intellect. To you, the second officer of this Society, from another city on whose soil were left the footprints of the Indian King Philip, rich in manufactures and men, I extend the right hand of fellowship. To the assembled thousand from the sands of Cape Cod and the rocks of Cape Ann, from the Switzerland of Massachusetts where Graylock throws his shadow, from the banks of the Merrimack and the Connecticut, from the hills of Hampshire and the fertile fields of Worcester, from every town and “city set on a hill,” and every village nestling in the valleys, through the length and breadth of this glorious Commonwealth, in behalf of the Medical Society I give a joyous welcome. To all the members of this Society old and young, in full practice and in anticipation of practice, the Nestors of our profession and its tyros too, I give a merry greeting and welcome salutation. And I would kindly remember all the representatives from kindred societies of sister States. To those from the pine tree State, away towards the rising of the sun, Massachusetts's eldest daughter, “bone of our bone and flesh of our flesh;” those from the land of “granite and ice,” from the verdant slopes of the Green Mountains, from the land of “steady habits” and “wooden nutmegs,” from the garden patch of Providence Plantation, and the broad acres of the Imperial State, I extend hearty congratulations. To all brethren from far or from near who may honor us with their presence, I extend fraternal greetings. Brethren from our “erring sisters,” we would to-day be “hale fellows well met.” We have all embarked in the same craft. “Row, brothers, row, the stream's running fast;” “a long pull, a strong pull, and a pull all together,” and we'll soon be in the haven of Union.

Gentlemen, we meet under favorable auspices. The clouds of war, that for four long years hung like a pall over our beloved country, have lifted and scattered. Peace again is in our midst, and plenty through our borders. We have cause for congratulation, that we are yet one people, and by the blessing of a kind Providence we have proof that we are a “people whose God is the Lord.” By the valor of our fathers, our brothers, our sons, the ravages of war were confined to the cotton fields of the South and averted from the corn fields of the North. With grim visage and garments rolled in blood, the Destroyer has stalked through one portion of the land, while our fields, our marts, and our workshops have been unmolested and comparatively undisturbed. Our institutions have been on trial. The jurors, the true and loyal men of the nation, have returned their verdict. It was a capital trial—a question of life or death. Death to slavery, life to the nation, was the verdict. In this terrible ordeal, in this crucible heated by the wrath of men seven times hotter than it was wont to be heated, slavery was consumed; but its dying throes ushered into life a race of Freemen. “A nation was born in a day.” With this birth, like any other, come new, great and grave responsibilities. Chattels have been transformed to beings, things have been changed to men. These must be lifted from the depths of ignorance, taken by the hand and brought up to a higher level, educated for the enjoyment of life and liberty, and the pursuit of happiness, prepared for the destiny that awaits the disenthralled, and made “jewels set in ebony” to deck the crown of Him “who made of one blood all nations of the earth.” God in his omnipotent economy, who “maketh even the wrath of man to praise Him and restraineth the remainder,” has wrought out the enfranchisement of a whole race. This race, doomed by the policy of men to be the victim in this conflict, has emerged the victor. The loyal masses have conquered a peace and annihilated a rebellion. The loyal Representatives have reconstructed a government on the principles of equal rights and equal justice; and now let us, not as physicians merely, but in the higher capacity of men, unite with all in zealous effort to elevate a down-trodden and oppressed people; not merely “stand still and see the salvation of God,” but wake to renewed exertions to heal wounds, assuage resentments, and unite both the pale and dusky hue in a common brotherhood, in the bond of one common union, for the love of one common country, and the advancement of the cause of one common Lord.

Dr. Griffin, the distinguished President of Williams College, whose clarion voice formerly resounded in the temples of this city, once said to a party of students he was socially entertaining, “Young gentlemen, I am going to give you a lesson on the christian duty of laughing.” How strange that an eminent divine should feel the need of inculcating this duty on a company of young men! Yet we may discover the propriety of the lesson when we remember the tendency of the human mind to regard this world as one only of ills and woes, of sorrows and sufferings, to feel only the thorns of life, but never to see the rose blooming close by their side. Man is prone to look on the dark side. We pursue our daily tasks among the unhappy, the disconsolate and the miserable. To them, for the time being, life is only one of sadness. They can see no beauty in nature. The earth has no flowers. The sun is only a taper. The night has no stars. “Man enters the world with a cry and leaves it with a groan.” From the cradle to the coffin he is mourning for lost opportunities instead of improving present ones, sighing for broken toys instead of amusing himself with the joys of the present, trying to escape the burdens of life instead of manfully standing up and bearing them. Each one has a treasury of sorrow, and it is the only treasury that is always full. His check on this is always honored, and his draft is never protested. “The heart knoweth his own bitterness.” Every one too has a Pandora’s box well stored with the ills that may be, and into it every one is disposed to peep.

Breathing such a miasmatic atmosphere the lungs of the physician are apt to become studded with melancholic tubercles, and viewing such sights continually his eye becomes jaundiced and looks at all the brighter scenes as “through a glass darkly.” It is necessary for us to guard against this tendency—thus

“this world to scan,
A mighty maze, yet not without a plan;”

and to strive to cultivate that faculty of the mind, which

“finds tongues in trees,
Books in the running brooks,
Sermons in stones, and good in everything.”

The eye, too timorous to admit more than a single ray of hope, and that refracted by a false medium, can never take in the full light of truth and look at the dispensations of Providence, as its loving kindness has designed. There is another side to this picture. The darkest cloud, surcharged with the lightning of heaven, has a silver lining. Nay, it has a celestial brightness if we could only view it from the other side. There are family groups overwhelmed with sickness and misfortunes, in which angels might feel at home, and hearthstones around which there is more of heaven than of earth, although lights are there put out that will never be relumed on this side the river; Rachels are “weeping because their loved ones are not,” and Davids are consoling themselves by the thought “I shall go to him but he shall not return to me.” How peaceful and serene are some of these scenes of deep affliction we are called to witness! The silver lining of the cloud is now in full view, while the electricity has been silently discharged and the darkness and gloom are all gone.

Constantly moving in these scenes of sorrow it is natural that our minds should become tinged with sombre views, and hence the especial need of occasions like the present. This is the gala day of our profession. We meet when the “time of the singing of the birds is come;” when Nature is enamelling the earth with flowers, and rousing the dormant energies of all created things through her wide domain; is cheering our despondency with the glad hope that if a “man die he shall live again.”

One great advantage of this social re-union is the opportunity it affords of initiating new associations, and cementing the friendships formed in earlier days; of the interchange of the generous feelings welling up from the lower depths of our better nature, only now and then stirred to make us better physicians as well as better men. We meet to brighten the chain of friendship, eaten by the rust since we last met. We come to grasp the warm hand we have not pressed, it may be, since our academic or collegiate days; to give and receive the fraternal greetings of those we meet from day to day, or only from year to year. We come to chip off the sharp corners and rub down the rough edges of our being, notched, hacked and marred by the ills and perplexities of another year. Our hearts beat quicker, and for the time our “youth is renewed like the eagle's.” The wrinkled brow is smoothed, the pallid cheek is flushed, the heavy eye is brightened, new life is infused into our wearied, flagging spirits, and a new lease is taken for another year of the joys and pleasures of our whole being.

The scenes of joy and sorrow, of hope and fear we have passed through since our last meeting are fast receding from our memories. Our aim has been to relieve the sufferings of our fellow men and brighten the monotony and gloom of the sick room with the hopes and blessings we are enabled to convey through the ameliorating influence of the medical art. How the result has tallied with the aim, the eye of Him, “who seeth the end from the beginning,” has noted as we made our daily rounds. It has been truly said by one of our self-made men, and whose indomitable energy has proved the assertion, that success is a duty. If we are true to ourselves, true to the obligations imposed by our profession, true to the better instincts of our nature, we shall do something to verify this assertion, do more for suffering humanity, be happier in our calling, do more to relieve the ills of our patients and lighten our own burdens, than those who singly have an eye on the “almighty dollar,” and measure the value of the profession by this grovelling standard. This anniversary is a time suited as well for good resolutions in the future as for happy congratulations in the past. Let us individually and collectively resolve to do our whole duty, make ourselves more useful, prove truer to our patrons, strive to elevate the profession and advance the science of medicine, and demonstrate by our zeal and activity to our communities that they and the world are the better for our having lived in it.

The bow must be at times unstrung or it loses its elasticity. I remember the first time I ever heard Daniel Webster speak, he made this remark to the students of college: “Young gentlemen, it was not that Achilles carried the longest bow to the siege of Troy that made him formidable, but because he knew how to use it.” It is the knowing how to do, that makes the efficient physician; and the knowing how to leave off doing, that makes the happy one. Every day’s cares and duties plow a furrow in his cheek, and it is only the happy home that can fill it up. When his daily task is done, his jaded spirits are drooping, and his feet, weary with the labors of the day, are turned towards home,

“Tis sweet to know there is an eye will mark
His coming and look brighter when he comes.”

His frugal meal is prepared by her “who riseth while it is yet night and giveth meat to her household,” and partaken of with a heart grateful to that Being who maketh him to differ from those to whom he has ministered. His little ones prattle around his knees, and the soothing influence of these domestic joys recuperates his fatigued energies for the labors and duties of another day. He has earned his daily bread by the sweat of his brow, he has discharged the duties of the hour, and his sleep is sweet, for his conscience is at peace with his God and all mankind.

The disagreement among members of our profession is so apparent, and become so nearly a fixed fact, that it has passed into a proverb, “Who shall decide when doctors disagree?” Whether this is in reality the case with us more than with our brethren of the other professions, or with men engaged in other pursuits of life, I will not stop to argue, but will admit there is too much reason for entertaining this opinion. We have an universal panacea for this evil that is always at hand. It is found in an old volume that all of us are prone to neglect, and the lids of which sometimes become dusty. It is a fragment of a discourse known as the Sermon on the Mount, and recorded by a tax-gatherer of Galilee: “Whatsoever ye would that men should do to you, do ye even so to them.” This is the foundation of our system of ethics—an excellent code for all of us to study—and the strict observance of which will render us more honorable members of our profession and better members of society. Be frank and freely communicate whatever by observation or study you may have acquired. Let your store of knowledge be as open to your neighbor, who may desire to draw therefrom, as to yourself. Conceal nothing from your brethren that may tend to benefit them and advance the interests of the profession. Hide not your light under a bushel, neither blow your own trumpet, lest the public may discern no euphony in the blast, and exclaim with Byron,

“Oh, Amos Cottle! Phoebus, what a name
To fill the speaking trump of future fame!”

Beware of the vices of envy and jealousy, and remember there is room enough in this world for everyone to perform his part well, and gain distinction without disparaging others. Cherish the habit of looking at the merits rather than the faults of your associates, and cultivate the Christian virtues of forbearance and forgiveness. Never try to enlarge your practice by the insinuation that your brother does not thoroughly understand his business. A reputation laid on the ruins of another is evanescent, and a character erected on such a foundation will, like the morning cloud, soon pass away. Exercise caution in cases of consultation, lest you convey the impression to the patient or his friends that all is not being done in his case that might be done. A look, a word, an insinuation, may unintentionally do a wrong to the patient, as well as lacerate the feelings and seriously affect the reputation of your brother. Make no change in your treatment for the sake of the change. I have found it very safe practice, and I believe it is eventually popular practice, to “let well enough alone.” A physician, when asked how he amassed his fortune, replied, “I made a very good living by attending to my own business, and saved money by letting other people's alone.”

Another duty of the profession, a duty we owe to ourselves and the public, is that of associating together. It is of advantage to us in various ways. The interest in our profession is improved, our knowledge is increased by the interchange of what each has acquired, our social natures are cultivated, and we are stimulated to renewed efforts to advance the cause of medical science, and show to the community that the confidence reposed in us has not been misplaced. Of thus associating together I can speak from experience. I have realized the benefits accruing from thus occasionally meeting with my associates, and learning from them what they have discovered in their experience and practice. I belong to one of the smallest District Societies in the Commonwealth, but it is a live one. It has holden meetings once in two months since its organization, for seventeen years; collected statistics of the zymoses of the district, from every member thereof in active practice, for a series of years, a report of which has been made to the parent Society at its annual meeting a number of times, and gathered statistics of the obstetrical cases occurring in the district for a term of years, a synopsis of which has been published in the Boston Medical and Surgical Journal. A thorough experiment has also been made of the veratrum viride by nearly all the members of the Society, a report of which has been published in the American Journal of the Medical Sciences. This is a specimen of what may be done by a few, “Ex uno disce omnes.” Now I will venture the assertion that every member of this District Society has had a reciprocal influence for good exerted on him directly, and that every patient and the whole community has been in directly benefited by this association.

Another duty of the profession is to do what it can to raise the standard of medical education. It has been too low; it cannot be too high. This Society was founded and incorporated for the purpose of elevating the profession and guarding the public from the impositions of the knavish and selfish. It seeks no self-aggrandizement; it has no sinister purpose. Man knows nothing except what he learns. The faculty of acquiring knowledge in different persons varies indefinitely, but the science of medicine is never acquired intuitively. A few gifted geniuses may grasp subjects by a process approximating intuition, but to most minds the acquisition of knowledge is a slow process, and the mastery of any science is only arrived at by patient toil and a systematic course of study. To prevent unfledged M.D.'s from being let loose on the community every year, although they may have been caged in the schools for the required time, and imagine that their down, like Nebuchadnezzar's, has “grown to be eagles' feathers,” let them pass the ordeal of a thorough and rigid examination, and not be admitted to the ranks of “Doctor Medicinæ” on prima facie evidence that their names have been in the office of some regular physician for the term of three years. In this way a diploma will be above the reach of many who do not deserve it, and the effect will be to make more palpable the difference between an educated member of our profession and an arrant quack.

The globe we inhabit is made up of atoms. Medical knowledge is only the collection of infinitesimal particles, gathered and transmitted from the archives and modern repositories of medical science. No man can grasp all knowledge or make all discoveries. But does the fact that the human mind is finite absolve us from the obligation to contribute our mite to the common fund? Remember the plaudit bestowed on the poor widow, recorded by the beloved physician, “She has done what she could.” How natural is it to covet eminent talents, great opportunities and commanding influence! Did we realize how hard it is, rightly to improve one talent, how difficult to make the most of small opportunities and exert a limited influence always for the greatest good of the greatest number of our fellow men, as well as the highest good of our Master's cause, methinks we should be more modest in our aspirations. Responsibilities, obligations and duties increase in a geometrical ratio with talents, opportunities and influence. When we have faithfully, scrupulously and religiously improved all committed to our care, then, but not till then, we may safely sigh for more.

We live in an active age. The world moves, and we must move with it; but if we move in one continuous round alone, we become rusty. To keep in an active, vigorous state, we must burnish up by contact with others. We should sometimes extend our vision beyond the horizon of our profession, wake up to the realization that we are men, that we have a common interest with our fellows in the affairs of life, that we have social and moral natures, that we have rights to be looked after, duties to be discharged, that we have a common interest in the politics, morals and religion of the day, and that we are in positions to exert a commanding influence and give a higher tone to the societies in which we move, instead of having all our views on these subjects manufactured for us even without our order.

A distinguished painter was once asked with what he mixed his colors to render them so beautiful, and yet so true to nature. His reply was, “Brains.” It is an irreversible law, that the dignity and success of any pursuit is in exact ratio to the brains put into it. The more brains directly or indirectly applied to the medical art, the greater will be its skill and the more potent its energy. The time is coming when a thorough knowledge of chemistry will enable the physician to grasp the poisons generated in our cellars and around our buildings, and convert them into the pabulum of the flowers of the garden and the fruits of the field. The miasmata floating in the atmosphere, from which emanate cholera, dysentery, fevers, &c., will, by the skilful manipulations of science, be made to blossom in the rose, wave in the yellow grain, or blush in the cheek of the delicious peach, apple or pear; when, by an exact comprehension of the laws of nature, those agents which are now silently at work sapping our energies and wasting our lives, will be drawn out from their hiding places to minister to our necessities and comforts, and instead Of shortening, made to prolong our existence.

We live at an era when, in spite of the machinations and absurdities of empiricism in its protean forms, the character of the scientific physician stands higher, and his influence is more potent, than at any other time within the history of medicine. To us is committed the honor, the interests and the advancement of the profession. If our predecessors have established the reputation of the profession, shall we not transmit it not only untarnished, but also with a brighter burnish, to our successors? “Freely ye have received, freely give.” If we perform faithfully all our duties as citizens, if as medical men we are scrupulously exact in discharging our duties to our patrons, and in every way exerting an influence to advance the standard and interest of our profession, we may be sure that it will continue to hold a controlling influence over the civilized world, and, in spite of all the mousing empiricisms of the age, will shine with a brighter lustre, and be honored and respected by the wise and good long after its revilers have been consigned to the tomb of the Capulets.

We have no fears for the future if the profession will strive for a higher degree of culture, for a more honorable ambition to investigate for itself the improvements and discoveries of the age, to think independently, to distinguish the chair from the wheat, and especially to unlearn and discard those principles, maxims and teachings which fail to stand the ordeal of experience, and which, having been weighed in the balance, are found wanting. While we remember our duties to the profession, let us not forget our duties to ourselves. We should be men of the highest and noblest character. If we should ever be tempted to

“Bend the pliant hinges of the knee,
That thrift may follow fawning,”

let us remember, if we would yield individually, we have no right to do an act which will bring disgrace on our profession, leave the slightest stain on our fair fame, or tend to sink us to a level with the empiric.

Of the duties we owe our patients we have a worthy example in the life of our divine Master. He went about doing good. The blind saw, the deaf heard, the lame walked, the issue of blood was dried up, the bier was touched and the dead son restored to the tender embrace of the mother. We have not the miraculous power of the great Physician, but could we realize that the lives and health of all that is dear and lovely to our patrons are committed to our care, should we not more fully exert ourselves to prepare to assume this responsibility, and having assumed it, more faithfully strive to do all in our power, that no one patient, be he high or low, rich or poor, shall suffer by our laches, and the heart of no friend shall break or bleed because the skill we possess was not exerted to the utmost in his behalf. Let us be more tender and faithful to our patients, so that when others come to render the same offices to us, that we have spent our lives in rendering to them, they may do it cheerfully and tenderly; so that we may wish to be paid in the same coin we have tendered to others. Let us remember that physicians are mortal. We are passing away. In a short time the hand, it may be, we have been instrumental in restoring to health, may perform the last sad offices for us as we close our eyes on sublunary things. Do we come up to a realization of our responsibility to those who trust their lives, and the lives of their families and households, to our care and custody? The husband and the father commits to his family physician the idol of his soul and the darlings of his heart. How momentous the deposit, how weighty the responsibility! Do we feel how much of moment, for weal or woe, is entrusted to his keeping, to whom are unbosomed all the secrets of the family circle, whispered in his ear alone, and known only to the Searcher of hearts? To none save the family physician are committed so many opportunities for good or for evil. To him the inner chambers of life are thrown open, and the deepest recesses of the soul are revealed. To his honor and integrity they are committed, trembling lest the confidence may be abused, and shuddering lest “a bird of the air shall carry the voice, and that which hath wings shall tell the matter.” Who has not seen the reluctance with which a fact has been communicated, while the patient knew the importance of its being disclosed! Who has not known how much of effort it cost the virtuous matron, and the pure maiden, to communicate with her physician? From these anxious efforts let us learn our obligations to keep locked in our bosoms the inevitable secrets of the profession, remembering that if all our acts were written in our foreheads we should never wear our hats on the backs of our heads.

Another duty of the physician is to cultivate hope in his patients as one of the surest remedies at his command. The intimate connection between the body and the mind is more apparent in sickness than in health. Whatever tends to keep the mind in an equable, placid condition, will react on the body, and have a decided influence in restoring that to its normal condition. Every prescription should be written, and every remedy administered, by the hand of hope. The patient, as he lies prostrated in body and enfeebled in mind, needs the stimulus which this Heaven-born messenger alone can impart. It is not sufficient that the sick man's attention should be directed to the flowery fields of convalescence away in the dim distance. In the monotony of his confinement he tires and grows weary by delay. He needs that his physician should, in the different stages of his disease, day by day, direct his attention to the favorable symptoms and the encouraging points he may recognize, and thus give variety and fruition to his hopes now, instead of deferring them to some undefined time to come. The one gives him pleasure at once and is something tangible, while the other is only moonshine, bottled for some dark, murky, cloudy night, away down the vista of some uncertain future. Wake this echo in his soul, inspire this confidence, and you will bring into action a power more wonderful than was Aladdin's lamp in working miracles of beauty and majesty, and more potent than the magician’s wand in calling spirits from the vasty deep.

To cure disease is regarded by many as the main duty of the physician. The truism, “An ounce of prevention is worth a pound of cure,” is recognized by all. Now have we not an obligation on us, possessing opportunities for learning what are the causes at work undermining the public health and shortening life, to point them out and show to our friends and patrons how they may be avoided! This I regard a duty imposed on us by our act of incorporation. If we have rights granted and privileges conferred, are not duties also imposed on us? If ever public hygiene is to be investigated, it must be commenced by the physician. Man, like a machine, wears out more rapidly if he constantly produces friction by running athwart nature's laws than when in harmony with them. Professional duty requires us to investigate this subject of health and make known how it suffers from inattention to hygienic laws, and how it may be improved by a strict observance of them. A more careful collection of statistics would, I have no doubt, prove that here in Massachusetts a large part of the sickness might be avoided by the dissemination of sanitary knowledge, and a large ratio of the deaths might be averted by the observance of the laws of health. The diffusion of statistical and sanitary knowledge would show the condition in which men, women and children suffer most, and the circumstances under which they attain the greatest health and the highest vital power. These investigations would warn and instruct the masses in regard to the dangers to be avoided and the influences to be cherished, in order to enjoy the best health and preserve the greatest working power.

The friends of education and agriculture have collected statistics, circulated information, and waked an interest in the State that has done much towards the rapid progress of these sciences. The one tends to expand the intellect both of parent and child, the other to increase the value of domestic animals and the products of the soil. Now cannot the physician do something to induce the people to adopt such precautionary measures in care and self-management as will tend to the greater expansion of human life? Will not the profession direct the attention of the people to the intimate relation that exists between the health of the masses and the prosperity of the State? The question of our Lord, “How much, then, is a man better than a sheep?” is in point. The wealth of every State depends upon the productive power of the individuals composing that State. Sickness, disease and premature death tend to diminish its wealth and power, by converting producers into consumers. The productions of Massachusetts in 1855 were a little short of three hundred millions of dollars. In 1865 they were over five hundred millions. Here was an increase of more than “two hundred millions of dollars in ten years, and at a time when the State was under the severe strain of war, and when a large portion of her working classes were being converted into consumers. Now every dollar of this capital is interested in this subject, for it has been accumulated by, and its productiveness depends on, the healthy brains and hardy muscles of the people. Whatever renders the one less active, or the other less enduring, is so much loss to the wealth and capital. If human life be expansible, and facts, under the eye of every careful observer, prove that it is, a part of this loss can be avoided. Can we, under these circumstances, afford to neglect these means, and lose the opportunity of increasing our health, comfort, wealth and vital power? Does any one say this prolongation of life and eradication of disease is taking the bread from our own mouths? Be it so. Is the profession so selfish, because its daily bread is obtained by the “ills that flesh is heir to,” that it will not act for their prevention? Is the physician so sordid, in that he lives because others die, that he will not tell his fellow man how death may be avoided for a time at least? I have more confidence in the profession than to admit or believe it. When the time shall arrive that the “infant of days “shall apply to the child of a hundred years, and the man at the age of Methusaleh shall be only in the prime of life, then may the “Ethiopian change his skin,” “the leopard his spots,” and the physician his calling, or else retire from practice, enjoying his “otium cum dignitate” in a green old age among the coming centuries.

There is a radical defect in female education. In the earlier history of our country the female portion of the community was known as women and girls. These are fast disappearing at the present day, and their places are supplied by ladies and misses. Instead of being clothed warmly in the products of then own wheels and looms, instead of partaking of the frugal meal of “Johnny cake” cooked by their own hands, they are “clothed in purple and fine linen, and fare sumptuously every day.” Then they took lessons on the washtub, now on the piano. Then they were taught to finger the spinning-wheel, now they learn to thumb the guitar. The music of the piano is captivating to the young man, but it needs the accompaniment of the washtub to hold him in charmed captivity after the days of wooing are ended. The sylvan notes of the guitar are charming to the ear of the ardent youth, but the sound from the sharp whirring of the spinning-wheel is far more enchanting to the husband and more soothing to the crying baby. The one charms the ear and tickles the fancy, while the other spins a silver thread that is imperceptibly woven around both performer and listener, that is frailer than gossamer, and yet, when united with the tie that binds two hearts in one, forms a two-fold cord that can never be broken. The female is educated with no special object to arrest her attention and absorb her energies. The result is, she captivates by her frivolous accomplishments, and because she must fail to perform, as she ought, the duties of wife, mother and mistress of her household, she makes her husband, her children and herself unhappy, or she is pressed on through her studies at school, in music and the et-ceteras of a finished education, at such a speed that, by the time her education is finished, she is finished with it. She is decked, nurtured and educated on such a high pressure principle, that by the time she ought to be putting on the blush of womanhood she is putting on the flush of the hectic. In the anxiety that the gem should be studded with brilliants, the casket is broken and the gem is lost. Let the medical profession call the attention of parents to the injury done to their daughters and coming generations by the violation of the laws of their physical being, and something will be effected towards maintaining the “Mens sana in corpore sano.”

Another duty of the profession is to warn the community against the errors of the day. There is not a more crying evil, not to say damning sin, than that of criminal abortion. It is one of those crimes so delicate that it must not be discussed, and yet not so delicate but that it can be committed, and by those even who unblushingly make pretensions to both decency and morality. There are thousands of women among the refined, as well as among the ignorant, led by the erroneous view that children are incumbrances and nuisances, whose end is physical and moral ruin. A dark cloud hangs over these family circles, and the shadow of night broods over these hearthstones. I believe it is the duty of the profession to set then- faces like a flint against this heaven-daring sin. Although every one who broaches this subject will have occasion, like Paul, when brought before Nero, to exclaim, “No man stood with me,” yet the extent and enormity of it need to be unmasked and revealed. “Verbum sat sapientiæ.”

Another duty of the profession is to see that the community is disabused of the gross fallacy, that alcoholic stimulants are beneficial to persons in a state of health. I have much respect for great names, but I never saw or heard a name great enough to convince me that alcohol is a healthy diet, or that any person in the normal state needs this artificial stimulus. The fact that it may and does do good in a depressed state of the system from disease' or accident, makes it clear to my mind that when these do not obtain, it is injurious. The use of it is a fruitful source of disease, death, pauperism and crime. No one, I think, who would go with me my daily round through the institution with which I am connected, see the squalid poverty and loathsome disease there congregated, and then calculate the expense entailed on the Commonwealth, would deny that untold evils—physical, social, mental and moral—are necessarily connected with the use of alcoholic stimulants. Probably no class of men know the evils resulting from the use of intoxicating liquors better than physicians. Knowing these evils, and in a situation to exert an influence to prevent their extension, I think it is the duty of every one of us, both by precept and example, to do what we can to stay their ravages. I would use alcohol when indicated as I would arsenic and strychnine, but I consider neither of them safe articles of diet. It appears, from statistics obtained by the Board of State Charities, that a large majority of the cases of pauperism, crime and insanity is caused by intemperance. Let the physician take a decided stand to stem the coming tide and make an effort to win the young from these enticing paths, and the blessings of many ready to perish will be his, and the proud consciousness of having done a duty and discharged an obligation will be his also. I do not suppose all will take the same view that I do of this subject. I do not ask or expect it. Whether we regard alcohol as a food or as a drink, whether we prefer prohibition or license, let us all agree to differ, and agree to unite in one combined effort to eradicate this prolific and frightful cause of unnecessary sickness and premature death from our beloved Commonwealth.

“For ye have the poor with you always, and whensoever ye will ye may do them good.” Here is a wide field for the exercise of our charity, a broad domain for the cultivation of our benevolence, but there is need of a wise discrimination in the dispensation thereof. Who has not felt that a richer fee was received than was ever laid in his palm, when the poor widow, with an empty hand but with an overflowing heart, called down the blessings of heaven for his kindness and efforts for her and hers? There is no better investment than that made in the prayers of the unfortunate, and in the gratitude of him ready to perish. Riches may take to themselves wings and fly away, the golden fee may remain till death, but will not pay for a safe ferriage over the Styx, nor pass current at the gate of heaven, while prayers and gratitude will plead “like angels trumpet tongued” for our admission to the holy city. Every visit given to the unfortunate poor plucks a grey hair from our head; every act of kindness shown to the virtuous in tears dries up one of our own, and every heart made glad by our sympathy obliterates one furrow from our wrinkled brow. While I would do with cheerfulness all in my power for the unfortunate and honest poor, words would fail to express my contempt for those who, having “wasted their substance in riotous living,” squandered their earnings on “wine and women,” left their families to the charity of a cold world, or the provision of a public almshouse, and on the approach of sickness induced by their own vicious indulgences, with brazen effrontery claim, and with unblushing impudence demand, the services of the physician at any and all times gratuitously on account of their poverty. While I would urge on the profession to do all in its power to mitigate the sufferings and cure the diseases of the poor, I would enjoin it as a duty to discountenance this unwarrantable demand. If we would take a decided stand that under no circumstances would we allow our services to be demanded by these contemptible scapegraces, we should show that we had some self-respect, take one step towards arresting them in their wasteful career of debauchery and crime, and do something towards abating this intolerable nuisance.

It is the duty of our profession to discountenance quackery in its multifarious forms in every judicious and honorable way. The question arises, what is judicious and honorable? In the discussions on one of the earliest tariffs, John Randolph said, “I would go a mile to kick a sheep.” That probably expressed the feelings of Mr. Randolph concerning the duty on wool; but the tariff passed, Mr. Randolph and the sheep to the contrary notwithstanding. I suppose no one can have more supreme contempt for the empiric than I have. Language fails to furnish a term debased enough to convey the true idea of a quack. I wish some lexicographer would coin some Saxon word that was mean enough to do it to a T; and yet I would not go half so far to rail at an empiric as would the distinguished Virginian to boot the wool. I would treat him as I was taught to treat a falsehood. If in the way, kick it out of your path, never turning to the right nor to the left to follow it. To-day quackery is in my way, a legitimate, subject for discussion, but I intend to handle it gingerly. The best prescription for empiricism is, “Let it alone severely.” It can bear any other treatment better than this. These parasites of the medical profession, these hangers-on, have been known from its earliest history. Each did run well, each flourished for a time, then dropped off, and new ones are constantly appearing. They are a kind of excrescence on the body medical, which flourish and increase under active treatment, but will die out and fall off if you let them alone; a kind of wart, which, if you apply caustic, will enlarge itself and irritate the body to which it is attached, but which, if you give it the expectant treatment, will eradicate itself. They are a kind of non-cancerous affection, at first irritating and teasing, given, it may be, for some good yet unrevealed purpose, but when meddled with may prove infinitely worse than we are aware of, and the active treatment of which is far more dangerous than the affection itself. I repeat, let them alone and that severely. This may be given in heroic doses, and you will ere long see the good effects of your treatment. You can never raise the empiric to an honorable level, and the attempt will only draw you down to a dishonorable one. “Can a man take fire into his bosom and his clothes not be burned?”

But do you ask, can we do nothing to abate this nuisance? I answer, Yes. Never give any countenance by recognizing it as in any way connected with the profession. Never suffer your name to be used to “crack up” any empirical remedy. You may be importuned to fix your signature to some panacea, the ingredients of which may be good in themselves, and your name may be appended without due reflection, while your influence will be paraded before the public to bolster up a nostrum and give currency to some form of quackery you most cordially despise. They “steal the livery of heaven to serve the Devil in.” Remember, that he who passes the counterfeit money, he who aids and abets, is as guilty as the man that makes the dies, stamps the bills, or forges the sign manual of the cashier. Recollect, a note, entirely worthless to the maker and everybody else with only his name on it, may pass current and stand at par with a good endorser. Charles Lamb said of one kind of quackery, “It is neither new nor wonderful. It is as old as the deluge, and, in my opinion, it kills more than it cures.” This last remark, I believe, is applicable to all of them. The public have a taste for being humbugged. They like to be drugged with nostrums, and all the better that they are sugar-coated. Everybody loves honey. You can't catch flies with vinegar, and the empiric knows it as well as any one. They judge more from the post hoc than the propter hoc. They take empiricism as they do the smallpox, in the natural way. Empirics of all kinds have a holy horror for all the regular faculty, and yet they are continually seeking to associate with us, unite with us, walk into the affections of our patients, worm into the good graces of our patrons, steal our thunder, and lay hold even of the skirts of our diplomas, which I would leave to them as Joseph his garment with Mrs. Potiphar, provided they would only cease this everlasting species of coquetry.

A man of decided convictions is a power, place him where you will. It matters not whether the convictions be right or wrong, they may be as erroneous as honest, and yet the power is there for good or for evil. Decision of purpose is an essential element in the character of an efficient physician. A positive mind will make its mark in our profession, and it will make it so it can be seen and felt too, if the attempt be made to erase it. It needs culture in most minds, but the culture is richly worth the labor it costs. The tuition comes high, but it is a paying investment. Enigmatical as it may seem, a negative man will ever say Yes, while it takes the positive man to say No. It is a little Saxon word, hard to be uttered, negative in its meaning, but positive in its effects. It is a very unpopular word, grates on the ear to which it is addressed, but it is as essential in the vocabulary of the physician as is the scalpel in his dressing-case. It cuts fore and aft like a two-edged sword, but, like the knife of the surgeon of two hundred years ago anointed with the sympathetic salve, it heals the wound it makes. I believe that the essential, prime moving cause in the restoration to health from any and all diseases, is the vis medicatrix naturæ. When this constitutional power is gone, everything else is of no avail. It makes no difference whether the disease is self-limited or unlimited; whether disease is a part of the plan of creation, is caused by a violation of some law of our being, or is attributable to

“Man's first disobedience and the fruit
Of that forbidden tree, whose mortal taste
Brought death into the world and all our woe;”

whether the currents or the counter-currents of medicine are the stronger; whether more good and less evil, or more evil and less good, comes from medication; it matters not, when this power is gone. And while I believe most fully in this curative power of Nature, I am just as thoroughly convinced of the beneficial effects of the assistance rendered this process by the skill of our profession. While I believe that many diseases are self-limited, and that many would and do recover without the intervention of medicine, I am as fully persuaded that medicine at times, heroically administered even, is advantageous, and have as full faith in the adjuncts employed to arrest diseases as I have in Nature's primary tendency to repel it. It is for this reason, that it requires more decision not to do than to do, that I would have a positive physician. The desire of the patient for medical treatment is so strong, and the belief in the propriety of constantly swallowing drugs is so universal, that it requires a will to resist the demand, and a knowledge positive in regard to what Nature can do and what assistance must be afforded. It is not sufficient that a patient lives through an attack of disease, it is necessary also that he should get well, free from all vestiges of the complaint and its sequelæ.

My theory is, that the less medicine one takes and gets well of his disease—not lives through it merely—the better it is; but when Nature fails to cure, or shows unmistakable symptoms of failure, I would come to her assistance right early, and prescribe heroically if need be, with the firm conviction that the remedy capable of injury if misapplied is equally capable of benefit when judiciously and skilfully directed. The physician that can watch his patient, stand by and see that no harm comes to him from interference with Nature unnecessarily, will be ready to come to her assistance as soon as she gives the grand hailing sign of distress. By so doing he will combine and unite the expectant with the heroic practice, with benefit to his patient and with credit to himself. At one time he can exercise a “masterly inactivity,” and at another, he, like Gen. Grant, can “fight it out on this line if it takes all summer.”

In the officious intermeddling of friends this ability to say No is of great moment. While I would patiently consider all idiosyncrasies, attentively listen to all suggestions, and carefully weigh all peculiarities, and while I would humor them when I knew I could do it with no detriment to the patient, I would, so long as the responsibility was on me—for no one could share if he would, and no one would if there was any to share if he could—kindly, but firmly, say there must be no interference by friends, when there can be no division of responsibility.

One duty still remains. The lesson, “He saved others, himself he cannot save,” is again before us. The proof that man is mortal, and our art is imperfect, stands out in bold relief. Twenty of our associates “have gone the way of all the earth, and the places that once knew them shall know them no more forever.” Of these much might be said in the way of eulogy, and written for the encouragement of those who yet linger on the shores of mortality. They have gone only a little in advance. Every rolling year adds to their list and diminishes our own. Soon some one will perform the last rites for us, that we are now doing for our loved and lost. In a little while the whole of the present catalogue will be registered on the other side of the river.

Dr. Augustus A. Gould, who occupied your Chair, Mr. President, at the last annual meeting of this Society, and presided so acceptably over our deliberations, is no more. He was summoned by an inscrutable Providence in the vigor of his manhood, in the midst of his usefulness, rich in experience, while diffusing his knowledge for the good of our profession and of his fellow men, at a time when to human ken his life and his influence were the most needed. If prayers could have shielded him from the fatal shaft, if love could have saved him from the unerring aim of the insatiate archer, another’s lips in the coming future might have spoken his tribute and pronounced his eulogy.

Dr. Charles H. Stedman, careful in examination, keen in analysis, a strict observer of nature, hesitating to interfere with her processes yet bold in emergencies, and ever ready with a helping hand when she needed assistance, has paid the final debt. By his urbanity and kindness he endeared himself to all, woke an echo in the souls of his intimate friends that cannot sleep again, and touched a chord that will never cease to vibrate till long after the hand that struck it shall have mouldered back to dust.

Dr. William E. Townsend, the skilful, honorable and attentive physician,

“Whose very foot had music in't .
As he came up the stair,”

has passed on to that country from whose bourne no traveller returns. His sun went down ere it was noon. His kind offices and faithful services will be held in grateful remembrance by his surviving friends till they meet him in that better land, where no one shall say, “I am sick;” where the “wicked cease from troubling and the weary are at rest.”

Dr. Reuben D. Mussey, a distinguished honorary member of our Society, having lived and had his being for eighty-six years, has gone home to be at rest. The speaker knew him while attending lectures at the Medical School in Dartmouth College. An earnest student, an original thinker, an interesting lecturer, a skilful practitioner, a bold operator, he won the affections of his students, gained the confidence of his patients, and showed to the world what a vast amount of labor and of good too can be accomplished by industry, energy and perseverance. He made no pretensions to genius, but he improved the powers bestowed by his Creator to the best advantage, and made his mark higher on the temple of fame than those who rely more on powers innate than on powers acquired and disciplined. None met him but to bless, none knew him but to love. As if in answer to united prayer, “serus in cœlum redeas” he lingered long on earth, an ornament to his profession, a blessing to the world, a noble specimen of the gentlemen of a past generation, and an example of the humble Christian eminently worthy of emulation.

The names of Bates, Brewster, Bullard, Clark, Fales, Sir Charles Hastings, Hayward, Hoyt, Kittredge, McCullum, Page, Skelton, Snow, Warren, White and Whiting will long be cherished and revered by those to whom they ministered, and with whom they lived. Some have gone in the dew of their youth, just entering on the great theatre of life, ardent and buoyant; others in the noontime of life, in the midst of their usefulness, with harness all on, their bones full of marrow and then- hearts full of hope; while others, “full of years and full of honors,” have been gathered “like a shock of corn fully ripe for the harvest.” We would strew their graves with the cypress and with the laurel, drop a tear of affection and hold their names in grateful remembrance. Emulating their virtues, let us all so act that our daily lives may leave behind us a fragrance ever sweet and ever during, that our good deeds may erect a monument for us more lasting than granite, and that our names may be embalmed in the memories of all with whom we have lived and moved. As we contemplate this change, let us view it not in sadness and gloom, not in despondency and sorrow; and when we are summoned may we close our eyes on the scenes of earth

“Like one who wraps the drapery of his couch
About him, and lies down to pleasant dreams;”

conscious that we have acted well the part assigned us here below, joyful in the hope that a blessed immortality and a happy re-union with all the wise and good who have passed on before, await us above, and confident in the belief that he who is faithful in a very little shall receive the plaudit, “Well done, good and faithful servant, enter thou into the joy of thy Lord.”

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