Massachusetts Medical Society: The Medical Profession and Society

The Medical Profession and Society

Annual Oration 1866

By George C. Shattuck, M.D.

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

We meet, on this our anniversary, to hold counsel on matters of interest and great importance, not to ourselves only, by any means, but to all members of the community. Accidental violence, sickness, death, are impending over all; no one knows how soon or how suddenly he may be overtaken by them. The strongest may not wisely glory in his strength and despise means and appliances of support, relief or cure. The agents of disease, decay and death beset the path of all in every period of existence. The fœtus in the womb, and the old man in his last struggle to maintain existence, are alike the subjects of our care. Strong and weak, rich and poor, high and low, have a concern in our doings and sayings as we meet here to-day, in the furtherance of the interests of the science and the art intrusted to our charge. Our responsibilities are great, and each one of us in his solitary round, as well as at these times of reunion for counsel and refreshment, must realize more or less vividly the arduousness and difficulties of his calling, as well as his need of support and encouragement.

We have this year appropriated more time to the objects which bring us together. Scientific papers and communications are encouraged by an assurance that they will not be crowded out by matters of business and routine. There is no longer one address or one speaker, in which and by whom such subjects are presented. Hours have been assigned for written communications on matters pertaining to our science and our art, and hence your attention may now with propriety be invited to some thoughts on our professional duties and relations, the subject of the annual address nineteen years ago, by one beloved and esteemed in his day, whom the present speaker must be content to follow here as elsewhere, at an humble distance.

One of our trials is that of intercourse with many who, from ignorance or wilfulness, despise our profession and treat it with disrespect and insult. We are living in an age and a community where authority is misunderstood and set at nought, where the individual feels himself called upon to treat lightly the conclusions and experience of the past, and to investigate and decide anew on most important questions and interests. Why should there be professions and societies to trammel and fetter the individual, to rob him of his liberty, and to clog and impede his efforts and aspirations? We have amongst us a sect of eclectics who are banded together to resist the profession of medicine with its colleges and societies, and to claim for each individual the right to follow his own fancies and notions, untrammelled by a regard to the rights, feelings, or interests of any associates. Our profession has existed for two thousand years, and each age has borne testimony to its efficaciousness and its value; but all this is of no account with those who prefer medical practitioners for the very reason that they do not belong to a profession. We have others among us who claim that in all this time, from absurd prejudice, the female sex has been deprived of a just right to support themselves and their husbands and children by the exercise of the art of healing. The community has been called upon to furnish means for the erection of medical colleges and hospitals, that the science and practice of medicine may be taught to women.

It is urged upon medical societies to admit amongst their members the graduates of these institutions, and complaint is made to the State legislature that the diplomas of these colleges do not command proper respect and consideration, and that male and female practitioners are not regarded nor treated with equal respect or confidence. All facilities must be granted to prove to the world that it has been all along doing great injustice to the female sex, with the idea that the organization of this sex, its physical, mental, and moral peculiarities, are not as well adapted to the acquisition of the science, and to the practice of the art of medicine, as are those of the other sex.

The fallacies that the great Creator has made all alike, and not each after its kind; that welfare and happiness are to result from the removal of all law and restraint, and every one being allowed to do what seemeth good in his own eyes; that the individual cannot trust in the solution of problems worked out in past ages, nor in any divine ordering of the world; and that his duty is to set about reforming and reconstructing everything, are not to be reasoned out of people, inasmuch as their very entertainment must proceed from an original defect of reason and judgment. They may remind us of our own defects, of the saying, humanum est errare; they may stimulate us to self-examination, and to such amendment and improvement that a good cause shall not suffer from our weakness or negligence. The fact that there are those who have no confidence in our profession, who seek relief in pain and sickness from other sources, should lead us to ask how far we are to blame for all this, what are our shortcomings and faults, and how we are to amend them? Controversy for the most part is unprofitable and to be avoided, and if we take ourselves to task we may be let alone by others. And we have an additional motive for this, when we consider what a glorious heritage is ours. We belong to a body which for more than two thousand years has been doing a work of beneficence through earnest and diligent seeking of the truth, which has existed in such various climes and countries, and has lived through the rise and fall of mighty empires and of powerful dynasties. We are associated with great and good men of all ages, whose writings are identified with the literature of the most polished languages, and their deeds with the histories of the mightiest nations. And whatever we may do in our short lives, will not die with us. We are indeed the children of a day; as individuals our strength is uncertain, so disproportionate to the work, yet each of us may do something towards increasing the store of knowledge, to be used by those who come after him. Each one may sow seed, leaving the reaping for others, so that when the places in which he has labored and with which he has been identified, shall know him no more forever, the world may be the better for his having lived in it, and succeeding generations wiser and happier for contributions, however small, preserved in the archives of the profession which lives and flourishes, whilst its individual members die and disappear. Can we not then spend our hours profitably in looking at and considering some of the objects and advantages, some of the privileges and duties pertaining to each of us as members of the medical profession and the medical society. There is, it is true, nothing new to be said on this subject, but old truths may be revived and dwelt upon, and we may inquire of the days that are past, and we may consider the sayings and doings of our fathers in such a way as to take hold of our own work more understandingly and to prosecute it more vigorously.

The reasons for association in a profession and a society lie deep in our very natures. A practitioner in a part of our State where the population was sparse, was summoned from his bed on a cold stormy night of the month of December, and went for miles on horseback through cold and snow, to a patient of means and substance, who had been suffering for hours with retention of urine. Gently, promptly and efficaciously was the relief administered. As the physician was preparing to return, the patient asked, What compensation shall I make? and was told that the fee would be left to his own judgment and generosity. A well filled purse was put into his hands, and from its contents a pistareen taken, for those were the days of specie payments and Spanish coins, and when this was placed in the Doctor's hand, he kept it for a while on his palm, and as he turned it over, exclaimed, What a poor creature is man when left to himself!

Our brother was a philosopher, and took refuge in his disappointment in the contemplation of a truth, which is at the foundation of and connected with all social organization, and which, in these days of individualism, may be pondered with advantage. What would man be, what would be his position and his attainments, without the family, the State and the Church? How wonderfully are his faculties developed and strengthened by institutions which put him in relations and enable him to work in co-operation with his fellows! What wonderful bodies were those guilds which sprung into existence in the dark ages, at a period when all of man's energy and wisdom were needed for advancement and protection! Who has not gazed with admiration at the guild houses, or at the engravings and photographs of them? Who has not admired the schools, hospitals and alms houses which were thus called into existence? Each trade had its guild or association for mutual improvement in their respective arts and sciences. The strong and the weak, the high and the low, the rich and the poor, were bound together for mutual support and edification. The weakness and infirmities of man's intellectual and moral nature were acknowledged, and means taken to improve and exalt them. If we inquire what was doing for our own profession in our mother land, and about measures taken to improve it, we find an act of Parliament passed in the third year of the reign of King Henry VIII., in the year 1512, in which it is recited, “Forasmuch as the science and cunning of physic and surgery (to the perfect knowledge whereof be requisite, both great learning and ripe experience) is daily, within this realm, exercised by a great number of ignorant persons, of whom the greater part have no manner of insight in the same, nor in any other kind of learning, smiths, weavers and women boldly and accustomably taking upon themselves great cures and things of great difficulty, in the which they partly use sorcery and witchcraft, partly apply such medicines unto the disease as be very noisome, and nothing meet therefore, to the high displeasure of God, great infamy to the faculty, and the grievous hurt, damage and destruction of many of the king's liege people, more especially of them that cannot discern the uncunning from the cunning” — “Therefore, no person within the city of London, nor within seven miles of the same, shall take upon him to exercise and occupy as a physician or surgeon, except he be first examined, approved and admitted by the Bishop of London or the Dean of St. Paul's for the time being, calling to him or them four doctors of physick.”

In this recital are many points worthy of notice. The connection of medicine and theology, as shown by physicians being placed under the supervision of church rulers, may first engage our attention. This provision was wisely abrogated in the course of a very few years, and the College of Physicians became an independent body, charged with duties and responsibilities in the supervision of the practice of medicine; yet the truths at the bottom of the connection still remain, and are not enough heeded in our day. The leading motive of establishing the College was to prevent and remedy abuses, which were to the high displeasure of God; and would it not be well for us if such a motive were more active in our day and generation? Are we not wanting in a realization that our thoughts and works, both as individuals and members of societies, should be, not so much in reference to our own advancement as to the glory of our Maker and Redeemer? Do we sufficiently realize the presence of an omniscient God, constantly watching over his creatures, recognizing and compassionating their infirmities, especially interested in all attempts to succor and relieve the erring and unfortunate, and noting in his book of remembrance every kind and disinterested look, word and deed?

The founder of our Holy religion came to this world healing the sick, leaving us an example of ministering to the diseased and infirm; and would we not respect our calling more, and do its work better, were we animated by the conviction of an association with that Divine Master, at whose command the blind saw, the deaf heard, the lame walked, and even the dead came to life? Would we not be more tender and faithful to our patients — would we not be more gentle, courteous and disinterested in our intercourse with each other, did we realize that this high displeasure of God, mentioned in this act of Parliament, is that most to be dreaded and most to be avoided by us, even in the minutest and apparently most insignificant actions of our lives? We cannot, indeed, boast of being exempt from the troubles and dangers of superstition. The Mesmerist and Spiritualist practitioners in our own community should remind us that our natures are as in times past. Are we not, however, more in danger of skepticism? In our hurried and bustling lives, with the claims of so many sciences and departments of knowledge appertaining exclusively to this world and this life, so pressing upon us, are we not chiefly in danger of neglecting the unseen and the eternal, and of shaping our course and directing our studies solely with reference to a world and a life abounding in sin and infirmity, and which can never satisfy either our intellectual or our moral nature? Busied as we are with man's littlenesses and infirmities, do we not especially need to be looking forward and upward? Compelled as we often are to recognize our own ignorance and insufficiency, ought we not to be seeking a light and a strength which is supernatural! Is theology, or a knowledge of God, safely to be disregarded by any of us, or can we wisely carry on a work and a conversation with which God and Heaven have nothing to do?

But we must note, also, in this act of the High Court of Parliament, recognizing our profession and setting forth its duties, that the grievous hurt, damage and destruction of the people is dwelt upon as an evil, when every man or woman is allowed, publicly, to exercise the art of healing, which is to be remedied by legislative enactment. In the original act of incorporation of our own Society, the same truth is brought forward: “Whereas it is clearly of importance that a just discrimination should be made between such as are duly educated and properly qualified for the duties of their profession, and those who may ignorantly and wickedly administer medicine, where by the health and lives of many valuable individuals may be endangered, or perhaps lost to the community.” Thus we have declarations from two legislative bodies, one convened in London, and one in Boston, the second made after an interval of two hundred years, recognizing the fact that medical societies were formed for the great benefit of the community. And certainly we can safely point to our records of doings and writings for proofs that these objects have not been lost sight of. How many histories of diseases and epidemics have been preserved, how many a one has returned to his work edified and strengthened by consultation with his brethren! We need not stop to prove that this part of the work of medical societies has been vigorously and successfully prosecuted. There is, however, another matter specified as of great importance, namely — that of securing a community against ignorant and incompetent practitioners, into the prosecution of which it is well for us to inquire. The early records of the Royal College of Physicians have been destroyed. In the year 1555, John Cains was elected its President, and held the office for seven successive years; and remarkable for many qualities and many doings, he was distinguished for the energy of his administration as executive officer of the College. We read of his admonishing, fining and imprisoning many empirics, and of his addressing an appeal to justices, mayors, sheriffs, bailiffs, constables and others, exhorting them to commit to prison offenders against the College laws, “men who were wandering about the country with changeable names and false medicines, to the great abuse and deceit of the kings people, and loss of goods and lyves of the same.” In the year 1555, Cains issued a letter under the corporate seal, reproving the University of Oxford for having conferred on Simon de Ludford, a seller of drugs, and David Lawton, a coppersmith, the degree of bachelor of medicine, both having been rejected by the censors of the College. The effect of the letter was that the Chancellor of the University ordered that, in future, candidates for a medical degree should be examined in Plato and Aristotle in philosophy, and in Hippocrates and Galen in medicine.

Our own Society has certainly constantly exercised an influence to secure time and amount of preparation in those entering the profession. Within a few years only, when Harvard University established a medical commencement at the close of the lecture term, and a practice was introduced of conferring the degree of Doctor in Medicine on bachelors of arts who had attended lectures on Anatomy and Chemistry, and whose term of professional study lacked four months of three full years, members of this Society remonstrated at any one, however superior his preliminary education and accomplishments, becoming a Doctor in Medicine without having devoted at least three years to professional study; and the practice was at once abandoned. The experience of all societies in this age, leads to the conclusion that the improvement of members and the securing good education to candidates for membership, are what can, with most certainty, be accomplished. In our own country the government makes no provision for repressing quackery, and delegates no powers to any societies for this purpose. The free and enlightened citizen must take care of himself, and is allowed every facility for trying any systems or nostrums to improve his health or cure his disease.

In the history of the Royal College of Physicians of England, we read of various other attempts to prosecute and punish, by fine and imprisonment, those undertaking to practise medicine or surgery without a license or degree. In the reign of Queen Elizabeth, a letter was sent to the College by the Secretary of State, signifying that it was Her Majesty's pleasure that one Margaret Foenix, a poor woman, should be permitted quietly to practise her small talent, and minister to the curing of diseases and wounds, by means of certain simples, in the application whereof it was thought an especial knowledge had been given her for the benefit of the poorer sort, and chiefly for the better maintenance of her impotent husband. To this letter, answer was made by the College, “that the especial knowledge referred to was a weakness and insufficiency, rather to be pitied of all than envied of them, or maintained by others; and that, as there ought to be no one thing more allowable in his honor's eyes than the preservation of wholesome laws, and the maintenance of good and laudable orders, but, also, the greatest ornament and beauty of a commonwealth; they were of opinion that the diligent care they had, and were bound to have, over the life and health of Her Majesty's subjects, the dutiful regard they bore to the maintenance of their privileges, and the strait band of oath and conscience, were of greater weight than they could release themselves of at pleasure: and, therefore, most respectfully refused to suffer either her or any other unqualified persons to intrude themselves into so great and dangerous a vocation, not only against good order, privilege and conscience, but, also, to the evident danger of the life and health of such of Her Majesty's most loving subjects as might be abused by their notorious and wilful ignorance.” Yet, vigorous and successful as were these efforts, quackery was not abolished. Queen Elizabeth herself sought no counsel of the members of the Royal College in a serious illness, but trusted to a Spanish Jew, from whose poison she narrowly escaped. Edward VI. was a victim to an ignorant woman, in whose care he was placed by the Duke of Northumberland, who dismissed his physicians. And we have no need to ransack the records of the past for instances in which those of social position and education, as well as the vulgar and illiterate, prefer the services of boastful empirics to those of the modest and quiet physician.

We must then recognize this truth, that our government refuses to take cognizance of these matters.

Our President has no power to call on mayors, bailiffs, constables or police officers, to banish and imprison those seeking to impose on the community with offers to prevent or cure disease. Not only has every man in this community a right and a liberty to intrust his health to the ignorant and unprincipled, without let or hindrance from law or statute, but the empiric can call upon courts and officers to enforce his claims to compensation, and he finds readily, in the newspaper and magazine, the opportunity to make known his pretensions and to set forth his claims.

The question is not before us whether the community is better off for this removal of all impediments, for this granting of facilities to the practice of the art of healing by the ignorant and presumptuous. Accepting the fact, we must devote all our energies to our own improvement in skill and knowledge, and to maintain our own discipline, that the unworthy and incompetent may not belong to our Society. We surely have enough to do in improving and reforming ourselves. We must not conceal from ourselves the imperfections and deficiencies of our science and art, we may properly admit them to others without blazoning them abroad. What Hippocrates announced more than two thousand years ago, is still true, “Life is short, and the art long, the occasion fleeting, experience fallacious, and judgment difficult.” What Lord Bacon says of idols of the tribe and idols of the den, idols of the forum and idols of the theatre, needs still to be studied and pondered over.

Surely we may wisely consider what is said in the extract from Rousseau, which Louis, to whom we owe so much in the advancement of medical science, adopted as the motto of his work on Typhoid Fever, “Truth is not in my mind, but in external things; the less I put of myself in my judgments, the nearer I shall get to the truth." How much has this “self” done to mislead and to delay the progress towards truth! We must indeed admit that whilst the science and art of medicine have been cultivated for more than two thousand years, they are still imperfect. We meet here to-day for improvement, and the questions why and whence these imperfections are very pertinent.

The English and the French philosophers call our attention to causes in our very nature and constitution, which we must bear in mind ourselves, and which we must point out to any who honestly ask a solution of doubts insinuated and instilled by the opponents of our profession. And these difficulties are from intellectual and moral defects, which are so inherent in our nature that we never can expect perfection for our science and art. No one can deny or doubt that we have made and are making great advances, but the horizon opens before us as we go on, and the extent of the field becomes even more apparent than our progress. The importance of a knowledge of the secretions and excretions has always been insisted on by writers and teachers. The empiric has boasted how much he can find out of the nature and course of a disease by a glance at the urine. How much has chemistry taught us of the composition of the secretions, as well as of the organs and tissues of the human body. We know the elements of the various articles used to build up our frames. We can trace elements going into the system by the stomach or the lungs, and going out of them by the kidneys, the skin or the bowels. But what a problem thus comes before us in each patient! A scientific knowledge of a case involves our ascertaining the capabilities of all the emunctories of the body, and how these organs act under varying circumstances. The kidneys are charged with freeing the economy of effete or superfluous nitrogenous matter, but the lungs, the bowels, the stomach, excrete this same matter, and the proportionate activity of each in each patient is a problem which we can never hope to solve. The counsel of the family physician is much preferred, for he is supposed to know the constitution and idiosyncrasies of the patient. He may know that some articles of food are more easily assimilated, that such a cathartic is to be preferred to any other, that one emunctory is more weak or more easily deranged, or the art of more readily exciting another. This man is very easily salivated, another is distressed or disturbed by opium, one suffers from exposure to cold, another is never well in hot weather. Empirically we know of one that animal food is more easily assimilated; of another, that he cannot eat mutton. To one, strawberries are poisonous; another has vertigo after eating corned beef. Now the chemical examination of tissues, food and excrement has been carried far enough to show us there must be a reason for this, and to point out in what direction to seek for it. But the practicing physician cannot get hold of all the excreta of each patient, and subject them to a chemical analysis so as to formularize the food, the medicine, or the regimen for each case. Whilst we can get hold of the urine for one or another or for several days, yet, varying as this fluid does in connection with varieties of food, temperature, exercise, clothing, moral emotions, how can we expect to subject the whole of this fluid, even passed during one protracted illness, to the chemical and microscopical examination necessary to ascertain definitely the condition and working of the excreting organs? How do the common articles of food — beef, mutton, poultry, milk, wine, beer — vary beyond our power of exact appreciation, and so as not to be recorded in mathematical terms? We cannot appreciate ourselves with perfect exactness, we cannot set down for the information of others, all the ingesta nor the excreta of the economy. And how many of the mental and moral phenomena which have important influence on the final result, escape us? How much is unknown in the single case of disease; and when we would get general laws from collections of individual cases, how different in certainty and exactness are these results from those of the solution of a mathematical problem! We must admit to ourselves, we must acknowledge to others on proper occasions, the imperfections of our science. And how powerless often is our art to arrest disease and alleviate suffering! Yet these considerations urged against us by those who would do away with our profession, should only stimulate us to a more faithful study of our science, a more careful practice of our art. We have a great task before us in the cultivation of our science, in the advancement of our art, and we need the combined and well regulated harmonious efforts of a great many to carry us on successfully in our under taking. We have so extensive a field with such minutiæ of detail, that the individual feels painfully his inadequacy to explore and to make them known. And, even, if by the labors of many we must stop far short of perfection, we can attain results of inestimable value to those for whom we labor. The obstacles we have in our natures can thus only, to any degree, be surmounted. The idols of the den of Lord Bacon, the selfishness dwelt upon by Rousseau and Louis, may be hopefully combated by associated labor and efforts. The school and the college are essential to education, and what true professional man does not recognize that education is the work of every day of the longest life! Michael Angelo was in his eightieth year, the term old master had long been applied to him, when questioned as to his presence amongst and interest in the labors of his predecessors, he exclaimed, “I must still go to school that I may learn.” Harvey had made his immortal discovery, had reaped the reward of fame and position and wealth, when he devoted a large portion of his fortune to erecting a building for the College of Physicians, and to the endowment of lectureships; thus emphatically manifesting, at the close of a long, active and successful career, his sense of the great importance of education and improvement to be effected by the advancement of the College of which he had long been a member. It is true that even thus the obstacles and difficulties in the way of progress are often made very prominent. The many laborers come together with such differences of views and results, that ill disposed lookers on will here find matter to urge against our profession. The very last year we listened to a very able exposition of a truth, on which Hippocrates thought it necessary to dwell in his day, and which has been lost sight of and revived repeatedly in the intervening ages. The vis medicatrix naturæ should be acknowledged and respected by every practising physician; great evils result from a disregard of this truth; and yet the virtues of drugs and minerals should also be well known and acknowledged. Our brother, who addressed us last year, is known and appreciated by a large circle of friends and patients for his skilful use of the various articles of the materia medica, but many who read or listened to his eloquent vindication of the restorative powers of nature, to his pungent warnings of the great evils resulting from a deficient appreciation of these curative efforts, and who knew him chiefly from these, naturally believed that he did not recognize the power of art and science to control and shorten disease, to alleviate pain and suffering, to delay a progress to death and destruction.

Six years ago the same subject was brought before us by one who never treats any subject but to instruct and to interest, and of whose achievements in poetry and literature we have reason to be proud; and subsequently it was thought best to pass a resolution that a statement that the Society does not hold itself responsible for any opinions or sentiments advanced in annual discourses, be appended to each published address. And the title of the very last address, “Disease a Part of the Plan of Creation,” was startling to many of us who hold to what our Bible tells us of the creation, that God saw everything that he had made and behold it was very good, and who attribute to the Devil and evil spirits, to man's disobedience and the fruit of the forbidden tree, an agency in the introduction and perpetuation of disease, death and all our woes into a world made so fair. Yet, under this title, certain truths are set forth of the limits of human powers in dealing with disease, pestilence and death, about which are mysteries unfathomable to mortal ken; of the Divinity which shapes all our ends, and of our relations to that Being which we all recognize, and which distinguish us widely from the empiric who pretends to understand and to teach and to be able to do all things. And may we not get an argument to show and prove the objects and benefits of our profession and our Society, from the apprehensions and criticisms provoked by our annual addresses?

We come together here differing much in the faculties bestowed by nature, in the opportunities of education and observation enjoyed by each one. Each one of us singly cannot appropriate nor express all truth. The anniversary orator has but a short hour in which to tell his tale of what he has thought or seen. He must confine himself within narrow limits. He has some truth or some view to which he would call attention, and if he does this impressively and forcibly have we any right to ask more of him? If all saw the same objects, if all looked from the same point of view, why should we come together in a society? And yet so are we constituted, so powerful is self love, that the forcible expression of truths not within our range of vision often annoys and disturbs us. Thus, whilst in a Society like this we may expect a correction of intellectual errors such as Lord Bacon would connect with the idol of the den, we must also look out for moral improvement, and see to it that the self love is mortified which forbids our acknowledgment of truths, and inspires a repugnance to views, seemingly contradictory of our own. Great attention is certainly paid to education in this our day and generation; but are not efforts too exclusively directed to those faculties called intellectual? Is the regulation and control of passions, appetites, affections, instincts, sufficiently appreciated? The Founder of our holy religion tells us that He is the Truth which is to set us free. He speaks of Himself as the light to which men will not come because their deeds are evil. We do not find scientific records in the Holy Bible. Geology, physiology, pathology are not taught there, and those who look upon the intellect as the only part of man for education and development, who regard the acquisition of knowledge as the one object of the school and the college, despise and neglect a religion whose earliest records tell of the fall of the race, from attempts to know what had not been revealed, and what was not intended to be known; which sets forth mysteries, bids us walk by faith and not by sight, and whose great apostle, versed as he was in all the knowledge of his day, speaks of knowledge as worthless without charity, and sets before us for imitation, and by way of exhortation, no profound study or protracted intellectual strivings, but a diligent labor for years to beat down his body and bring it into subjection. In the records of our science and art, in the lives of its professors and practitioners, what proofs do we not find of abortive attempts to advance science or to cure disease in consequence of selfishness, self love and vain glory! Had a pure love of truth, had a singlehearted desire to cure disease and alleviate suffering, been always the animating motive, had self love and self advancement been always kept in subordination, how much greater would have been our knowledge, how much more highly would our profession have been appreciated by those to whom it ministers! Did we excel in charity and disinterestedness the ignorant and unscrupulous charlatan as decidedly as we do in skill and in knowledge, would not our superiority be more readily and universally acknowledged? There are those who think that the great advance in our science, the great acquisitions in its domain, are not accompanied by a corresponding appreciation and respect in the community. There are those who say that a larger proportion of the community resort to irregular practitioners than even in the early days of this Society. Whilst our stores of knowledge are increased and increasing, whilst we can recognize and avoid erroneous views and pernicious, unwise, practices of our predecessors, is there not danger of a skepticism and distrust inconsistent with proper activity and perseverance in the use of means of cure? Surely faith and confidence are essential to the successful prosecution of our art, and we cannot inspire our patients with what we have not ourselves. Thus humility, reverence, hope, trust, are virtues to be cultivated in ourselves to the great benefit of our patients, to the commendation of our profession, to the advancement of our science and our art. At the same time I would not depreciate our duties of intellectual cultivation, of storing our minds with knowledge, nor the great advantages of our Society in these respects.

Many of us live where the newest books and journals are not easily had; many of us are so occupied in the practice of the profession, the strength of many is so exhausted by a daily round of visits and advice, that they cannot learn what is being done or thought by the many laborers in many distant fields. But we all come here for a holiday. Our offices and our patients are left behind. Our hours are uninterrupted, and we can listen to the history of what has been seen, done or heard by others without interruption and with quiet minds. And surely provision is made for increase of knowledge, for intellectual cultivation, in visits to hospitals and museums, in scientific papers and essays, in discussions and conference. Each one of us has something to learn from the others. He who toils in obscurity and retirement comes in contact with those to whom the professional writings, sayings and doings of all the countries of Europe, as well as of our own large cities, are well known; and the city practitioner, with extensive reading and observation, may learn much of the country practitioner, who thinks more deeply and digests more thoroughly amidst scenes of quiet and repose. Both city and country have advantages peculiar to each for the development of certain faculties, for the increase of knowledge, and those living in the one can profit much by intercourse with those living in the other. The idols of the den of the country, the idols of the forum of the city, may both be dethroned with great advantage to those subject to such dominion. And, whilst thus our science and knowledge may be advanced, surely we have an opportunity to practise ourselves in arts, which are very necessary in the exercise of our calling. It is not the clergyman only who is called upon to make himself all things to all men. If we would cure diseases of the body we must adapt ourselves to the infirmities even of our patients. We must cultivate manners and address to recommend our science, and in intercourse with each other we may be exercising ourselves in ways that will profit us when we deal with our patients. Courtesy of demeanor and gentleness of bearing are requisite to maintain as well as to establish pleasant and profitable relations to professional brethren and patients alike.

There is one other matter to which we can only allude, and by way of bringing more vividly before us the importance of the objects of our Society. We must all deplore the deficiency in education and culture of many entering the profession, and the great difficulty of applying an effectual remedy to what we acknowledge as a great evil. We are citizens of a vast country, but the management of educational interests does not devolve upon the general government. Each of our numerous State legislatures can grant acts of incorporation to individuals associating themselves to teach, examine, and furnish diplomas to medical students, and thus we have a great many medical schools which are not endowed, and are dependent for support upon students. In our community the imperfectly educated easily find patronage and gain a living, and there is a very mistaken idea that preliminary education and culture are not necessary to a successful practitioner. Thus many incompetent and unworthy persons become students and are received as doctors in medicine. At the same time there are many with natural aptness, and desirous of education, who cannot pay for it. Many who need medical advice cannot make any pecuniary compensation, and in this country medical men and medical professors must supply these wants. The reasons are sufficiently obvious, why, in many of the most enlightened countries, medical students are educated by the government, and not allowed to practice medicine till after having profited by advantages in able and learned professors, well furnished museums and libraries, large and well appointed hospitals, till having spent several years in these studies and passed through several examinations. Recognizing thus the evils in deficient education and culture, the medical societies have a greater responsibility in imposing terms of admission to their ranks, and in supplying means of culture and improvement. Medical teachers have their infirmities and imperfections, but they are not responsible for these evils to the degree in which they are blamed. They should have the credit of trying to prevent and diminish them. It is only exceptionably that they secure a pecuniary compensation proportionate to their labors. They must contribute liberally to medical education, and their offices are to be held only as involving a competition calling out the exercise of all their faculties and making large demands on time and strength. In comparison with the old countries of Europe ours is still new, and much must be done to place our higher educational institutions entirely on a level with those of the large cities of England, France and Germany. Then ample endowments by the government securing an entire independence of students, the regulations and laws enforced by competent authority, both on those belonging to the profession and those wishing to enter it, are advantages which we must acknowledge and earnestly desire to have. Whilst in our community we can boast of a system of common schools wisely and liberally provided, our legislature has given nothing to medical schools, at the same time that it has contributed liberally to foster and support a female medical college. Private munificence is the only source of the scanty endowment of medical colleges; and with just pride may we refer to a physician, to Dr. Ezekiel Hersey, as the first to call attention to the necessity and importance of such endowments. Several years elapsed after his legacy was received by Harvard College, and the words and example were unheeded, till Dr. John Warren, by his personal exertions and influence, started the medical department of Harvard University.

Medical education is very expensive. Hospitals, museums and libraries, are costly. The number of sciences connected with medicine involves the necessity of a large corps of professors. The scholarships and fellowships of the old world by which years can be devoted to study and scientific pursuits, with exemption from the cares, of life, are beginning to be appreciated here, and we may hope that means for establishing them will be supplied. The resources of medical schools are being largely increased, and by members of the profession. The late Dr. John C. Warren labored at establishing and increasing a museum, and has provided means to go on with the work. Citizens of Boston have lately contributed to remove the debt incurred in erecting the present Massachusetts Medical College, and, as this is being outgrown by the school, may we not hope that those will be found appreciating the importance of a high and extended medical education, who will contribute liberally to supply the necessary appurtenances. The fact that members of this Society and professors of the College have bestowed, freely, of all they had to such a cause, should stimulate others. The period of three years assigned in this country as the term of medical pupilage is manifestly too short, and in those countries where it is extended to five and six years there is an endowment of the school, so that the student is not taxed for its support. We should note, also, how liberally medical societies in those countries are provided with libraries, museums and lectureships, to carry on the work.

And we should regard the obligation of a life spent in cultivating and developing our faculties, in storing our minds with knowledge, as a compensation for certain disadvantages. Medical men know that the same talents, the same labor devoted to other pursuits, have larger pecuniary rewards, than in their own profession. The merchant, the trader, the manufacturer, are more in the way of accumulating wealth — the politician of securing fame; yet wealth, position, reputation, powerful incentives to activity as they are to those who want them, are snares to the possessor, temptations to ease and self-indulgence. They are to be acquired by the physician only after years of unremitting toil and self-denial, and whilst they fall to the lot of very few, the true satisfaction and delight in training and disciplining the faculties, in establishing a rule and dominion over the appetites and passions, in acquiring knowledge, is the heritage of all who will strive for it; and we must admit that he who goes on day by day adding to his knowledge by careful observation, developing his faculties of reasoning as well as of perception, freeing himself from the dominion of the idols which would enslave his intellect, and from the demon of selfishness which would blind his eyes and harden his heart, who thus, with increasing years, becomes a wiser and a kindlier as well as a more learned man, has a happier life in obscurity and even amidst toil and suffering, than he who uses his profession simply for self-advancement, and acquires wealth and reputation, which are only of this world and must be left behind when summoned to depart. We begin life with a vivid appreciation of the evils about us, with a spirit and determination to overcome them, and we often err sadly in unauthorized and ill-advised attempts to reform and set right. But as we grow older we become conservative, and we are tempted to acquiesce in what is wrong in ourselves and about us, and regarding our ease and comfort, to cease from a work which can only be accomplished by constant watchfulness over ourselves and unwearied labor. Thus do we need to remind each other that there is a warfare from which there is no discharge; there is a conflict with sin and infirmity from which there is no rest but in the grave.

Usage enjoins upon us each year to call over the names of those departed since the last meeting, and to consider their examples. And if I may be allowed here to refer to one who, sixty years ago, held the important office of Treasurer of this Society, who, during many subsequent years, did so much to promote its interests in various offices of trust and responsibility, as well as in his daily walk and conversation, and who, lingering amongst us, an object of respect and veneration, has passed the bounds within which the praise of man is of any account, I would speak of him as one whose claims to respect and admiration were won quite as much by an unvarying courtesy and respect to the rights and feelings of others, as by the possession or exercise of what may be strictly called the intellectual faculties. His powers of observation and reasoning, his sound judgment in matters of science and in the ordinary affairs of life, enabled him to be a safe and wise counsellor, and his scrupulous regard to the rights of others inspired a trust and confidence which was never abused. It is hard to realize that his presence at our last anniversary was, probably, his last appearance at any of our meetings. He has been long spared as a beacon light in the path of duty, and he will never be forgotten by those who have looked up to him as their teacher, or walked with him as an associate and a friend.

And of those who, during the year, have actually passed the bourne whence no traveller returns, much might be said to encourage and edify their surviving associates. We are told that the average of life is less in the medical than in other professions; yet, of the eighteen gone from us during the year, one had attained the age of eighty-one years, and one of eighty-five. Both retained the esteem of the community, the love of their profession and a certain degree of activity to the last. The name of Dr. Green will long be remembered at Worcester, and that of Dr. Thompson at Charlestown. The latter served the community, acceptably, in various offices without neglecting his professional duties; and the same may be said of Dr. Huntington, of Lowell, who was the Lieutenant Governor of the commonwealth for one year, the Mayor of the city where he resided for eight years, an active member of the school committee for several years, and holding other offices of trust and responsibility during a professional life of forty years. He was the President of this Society for two years, and of the District Medical Society for several years. A kind and sympathizing neighbor, he was especially attentive to the poor and needy. Dr. Abraham Gould, of Lynn, died at the same age, on the verge of three score years and ten.

In several of the important and populous towns of our commonwealth, public manifestations of grief and respect have been called out by the death of one of our fellows. At New Bedford, Dr. Lyman Bartlett, beloved and respected by associates and patients, died at the age of fifty-eight. From Boston we miss Dr. Moriarty; from Roxbury, Dr. Charles M. Windship; from Georgetown, Dr. Moody; from Hingham, Dr. Fiske; from Cambridge, Dr. Foster; from Newton Corner, Dr. Bigelow. And testimony comes from all these places of appreciation of the good qualities and faithful services of our brethren who, after longer or shorter periods of service, have passed to their rest and their account.

But, Mr. President, there is a provision of our forefathers which I should be sorry not to notice and respect. An address at a certain hour was appointed, but the speaker was not trusted to ramble at will; by the assignment of the hour he was reminded that there is a time for all things, that discussions, dissertations and orations, are not addressed to unlimited capacities, and that the very appeal to intellectual and emotional activity must be followed by refreshment and repose. Thus man's complex nature, his mind and his body, were recognized. The doctrine of the correlation of forces was respected, though not known under this name. The laws of the construction and disintegration of tissue were not set forth as they are traced out by the physiologists and chemists of the last few years, nor were the early members of this Society able to scan as closely the processes by which the blood is formed from the food and the tissues from the blood. They knew less than we of the passage of the cholesterine and phosphates, resulting from disintegration of nervous tissue, to the receptacles for their detention before being expelled from the body. But they did recognize a truth which, with all the lights of modern science, was not sufficiently appreciated by some of their successors, who, perhaps, however, would plead that to the arrangement of protracted sessions without a sufficient and comfortable dinner, their poverty and not their will consented. This year, gentlemen, the Committee of Arrangements recognize and provide for all the wants of our nature, and he who addresses you can only conclude with an expression of the hope that he may not have wearied you beyond that point where restoration and repair are attended only by pleasurable sensations.

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