Massachusetts Medical Society: Watch and Wait

Watch and Wait

Annual Oration 1872

By Thomas N. Stone, M.D.

Give me, give me, said the dying poet Herder, to his son, as he moistened his parched and fevered lip — Give me a great thought, with which I may quicken myself. Thus the eloquent Roby was wont to introduce his lectures on the Theory and Practice of Medicine.

And, Mr. President, and Fellows of the Massachusetts Medical Society, standing where the great and the cultured of our profession have so often stood — oppressed with the immediate precedence of one, facile princeps, eloquent in word, more eloquent in work — well may your speaker to-day exclaim, with the dying poet, Give me, give me a great thought, with which I may quicken myself. But great thoughts are not of mushroom growth. They grow, as the great oaks grow, slowly beneath the nurturing sun and shower of passing years; sending their roots deep, before lifting their branches broad and high. And, alas! their quickening comes not in response to every earnest prayer. Their inspiration must come with the occasion, or exist in the man. The occasion is present, if the hour does miss its man. For the meeting of the Massachusetts Medical Society is of itself a great occasion. To other men this day may be as the common, days of the passing year; but to us it comes with the flavor of a Passover — one of those days of leisure and good fellowship a physician so often prescribes to others, but so seldom takes himself. To-day, from sea-coast and inland, from every city and village of the old Bay State, have come up hither men of honored name and an honorable profession, to greet each other as brethren.

Ours is a silent profession; but in every ward of our cities, in every village of our State, you will find its members nobly doing duty, calmly meeting responsibility, and silently laying labor and life on the altar of humanity, with a martyr’s devotion, without a martyr fame — men known perhaps only in their circuit of labor, but there loved and honored; and in many a heart and home, to which they have often come with angel aid, their memory will be fragrant long after the Master shall have called them to higher duties. While we yield to the pulpit and the bar all their advocates may claim, we still fearlessly assert that, in talent and labor, in all the studies and offices that aid or adorn society, the medical profession is their peer. And surely as one gathers here to-day at our annual feast, with men whose names are an honor to humanity, men whose countenances bear the impress of intelligent thought and earnest endeavor, he may well be pardoned if a thrill of pride comes to his heart, with the thought, I, too, am a brother. We have come up hither from our different fields of life labor, brothers by the kinship of like thoughts and toils, like joys and cares; united in the fellowship of a Society whose only fault is the common parental one, that of being too lenient in chastening her wayward children. In her name we greet you to-day, and gladly would we bring, to grace the feast, the inspiration of some great thought, to cheer and energize you mid future toil. But the eloquence of our profession lives in deeds, not words. It has the logic of labor, not the mere rhythm of sound. Its aim is the silently useful, not the loud-sounding ornamental. And, surely, when our President and Councillors drafted for your speaker a village physician from the barren shores of Cape Cod, they could hardly expect great thoughts to grow in diluvial sands. Her giant oaks, beneath which the stern old Puritans once knelt and prayed, were, like themselves, the fruitage of by-gone centuries, and the exhausted soil rears none but the stinted, gnarled dwarf. Leaving then to others, whose cultured leisure may fit them for the task, the higher mission of inspiring you with great thoughts, I come to you today with the simple message — Watch and Wait.

Every age has its ruling passion, its pet pride. It may be Spartan simplicity — it may be Oriental magnificence — it may be pride of physical development — it may be the boast of progressive thought. Every age has, too, its egotism, which acknowledges no past glory, and fears no future judgment. Progress is the cry of the present age — progressive thought the pet pride of to-day. The charm of antiquity is broken. The idols of the past are prostrated and trodden by the iconoclasm of the present. No doctrine is too sacred, no dogma too hoary, for the levellers of today. Premising that antiquity is synonymous with barbarism, and that every change of base is in direct line toward the Richmond of perfection, we can hardly believe the past ever thought, though her sages and poets, her sculptors and painters, her crumbling temples and unearthed cities, proclaim a culture of external beauty, and internal thought, scarcely rivalled by the boastful present. It is really strange how those apes and savages, far up the stream of time, continue to be our schoolmasters; and equally curious how, under the “survival of the fittest,” so many barbarians still live on this old earth. Either they were the evolution of some late protoplasm — or their fathers, having reached the peak of national perfection, toppled over the other side, the trail of lost arts marking their descent. It matters little what new departure from old theories, faiths, and modes of association, is taken, in medicine, theology, politics or philosophy, they all bear the label of progressive thought. Under the winning garb of a lass with Grecian bend, this progressive thought is ringing the door-bell of our medical schools and professional institutes. In the shape of more ghostly maids and matrons, it worries the midnight dreams of our political leaders, with clamorous demands for that universal panacea — the ballot. And if woman will imitate the sun, and not the storm, she will doubtless now, as in the beginning, have her way. Every year witnesses the birth of some new theory in medicine, some grand discovery in the laws of Nature, who in her old age seems as prolific of law as a Massachusetts Legislature. New creeds, new sciences, are springing up like the old dragons’ teeth — all under this glorious reign of progressive thought. He who would keep pace with our medical literature will find little leisure for Don Quixotte or Walter Scott, for it is equally astonishing how many book-covers a grain of gold will gild, and how many books a progressive thought will fill.

But is all this boastful progressiveness of the present a real advance? What if thought, co-eternal with matter, be found to be under the same law of correlation and conservation? There is no fog so confusing as half-formed ideas enveloped in the mist of new terms, strange, outlandish technicalities, or long, learned words full of sound because empty of meaning. I once asked a professional brother who was eloquent on the infinitesimals, why his patient died if his medicine was so potent to save? He answered loftily, “Because the receptacles of life would not answer to the medicine.” It was a foreshadowing of Huxley’s nettle, and I was astonished by his explanation. It thrilled me as the good parson’s Mesopotamia did his female auditor. But whether those unanswering receptacles were located in the pons Varolii or pons Asinorum, I remain ignorant to this day.

It is strange how much our “conditions” have to do with our theories. Living on the outer edge of our continent, and on that account probably more influenced by earth’s circling whirl, and riding for twenty-five years the old bark-mill circuit of a country physician, I have become a zealous advocate of a theory which I commend to the students of “dynamic energy.” My theory is, that all active forces move in circles. Thus the stars above us and the earth beneath move in circles round the sun; and sun, earth and stars wheel in grand battalions round that infinitesimal something or nothing called the centre of the universe. The ocean’s tide is circling ever round the earth, and wind and storm travel in zones. We tremble in our cities and villages when we hear that the cholera has begun his Attila march in India, lest he circle the earth with death. Civilization seems to have obeyed this circular law. Beginning in Eastern Asia, it travelled across the old continent, and still “westward the star of empire takes its way,” now gilding the Pacific Sea, soon to shine on Japan. And who can say that some future historian may not sit beneath the shadow of Bunker’s shaft, there to muse over a dead empire? It is said revolutions never go backwards. If not, then they are under this law. For we have seen a populous nation rush from monarchy into the far-off regions of Red Republicanism, and, after a few years, in returning circuit shine out in her old position in the political heavens. This law of circular progression holds good in lesser as well as in the larger circles of motion. For nature is ever chary of her laws. With one law she rounds a dewdrop and an ocean — binding alike an atom and a universe.

Thus the law of circular motion controls the movement of mind as well as of matter — controls theories and creeds, fashions and modes of thought. “The eclipse of faith” has been ably written; the ellipse of faith remains yet for future record. For creeds and theories, dogmas and doctrines, all have their orbits, more or less elliptical. They each have their aphelion and their perihelion. And that ancient was a close observer of progressive thought, who, finding in a temple an idol thrown down in the dust, took it carefully up, and, placing it on its pedestal, did it reverence; and when asked the reason for such conduct, answered, “Men change their Gods so often, this may be worshipped again to-morrow, and I wish to forestall its favor.”

I lay no claim to any patent right in this theory of circular progression (though I believe it as new as most original theories are), lest some of you chance to light, in your reading, upon the first chapter of a quaint old writer called The Preacher, who in a by-gone century seems to have combined the divine and the doctor — and who might prove priority of discovery in a patent case.

In the early history of our country, Medicine and Theology were wedded together, and like other once yoked companions, they have since their legal divorce kept even pace with each other in their progressive march. There must have been the “Life Stuff” of a nation in our stern old Puritan fathers; their ideas, theological and pathological, were strong, compact, granitic— fit for the foundation stones of Empire. They deemed nature depraved, morally and physically, needing aid and correction. They had firm faith in the Infinite, but none in infinitesimals. They cured diseased action in body and soul by strong, cogent opposites, not by shamming similitudes. They could in theology stand strong doctrine to the seventeenthly of a three-hours sermon. In pathology they could bear bleeding, sweating and purging, in as large doses and as oft repeated. The beloved youth of whom Jefferson was wont to tell, who died of a decline notwithstanding his attentive physician had bled him twenty-six times, was an effeminate son of the F. F.s of Virginia, not a sturdy scion of the old Puritan stock. But progressive thought has revolutionized the old Puritan ideas in theology and pathology — Nature is now exalted to the throne of Empire, and sickness and sin are both under her control. Treatment is expectant; the mission of the divine and doctor is not now to conquer, but to wait. Nature cures, and the parson and physician present nothing disagreeable except their fee. Thanks to our homœopathic brethren, that in all their attenuation of medicine they have not attenuated the fee. Had they carried their great law of divisibility into the fee, we had been routed horse and foot. But whatever our difference of opinion about the increase of power with the decrease of the dose in medicine, we all agree on these two central doctrines: —

1st. The dollar is indivisible, and the great law of divisibility comprehends it not.

2d. We must all take our bread and butter in allopathic doses.

Through what a world of fretting and frying, broiling and baking, it would have saved this nation of great eaters, if nature had consulted Hahnemann at the outset of creation. In this age of quick conclusions, when mind is teeming with new and strange theories, as did mother earth with vegetation about the carboniferous epoch, when each day brings forth some miracle-working medicine for a public eager to drink of the fountain of immortal youth — in this time, so full of forces, active and potential, exceptional laws, after-thoughts of nature (according to which, a muskrat on a windward meadow ought to soothe the commotion of a whole village, and the scent of a poppy-bed keep a city awake) — an Intelligent Conservatism is the true philosophy in medical theory and practice. By this I mean, not an indolent, sleepy carelessness, but a calm and watchful scrutiny of all pretensions. Not condemning an old truth or an old medicine, because it is old, nor fearful of the new because of its novelty; for in every theory there is a point of truth, upon which point, it is true, some rest like an inverted cone, with wide-spreading top and a very small base. And yet, an intelligent conservatism should do honor to the base point, if it reject the superstructure.

It is no easy post a conservative occupies in our onward time. ‘Tis as hard to be unfashionable in practice as in dress; to acknowledge a leaning for the old and tried, while the rage is for the new; to go plodding along with your little bug lantern, while a professional brother is filling the air and his purse by the bright corruscation of the last new rocket; to acknowledge that you see disease and its remedies as yet “through a glass darkly,” while others boast of seeing “face to face;” to watch and wait, while you feel the rush of the multitude, ever “like Paul’s Athenians seeking something new.”

When Sherman marched from Atlanta to the sea, there were ever around his army squads of mounted bummers, fighting on their own hook, making the night bright with the flames of plundered henroosts, robbing alike the Union’s friends and foes, roaming far in advance or rear, as loot or fancy might lead, while the true soldiers in the army of progress marched slowly yet steadily on. There were for them battles to be fought, rivers to be bridged, forts to be taken; they might not forsake duty for plunder. Loyal to the old flag, they bore it onward mid weary toil and battle strife, till the great work was nobly done; and to them the nation’s debt of gratitude is due. Thus ever is it with the army of medical progress. Scouting far in advance of it, and mocking often at its slow progress, are squads of wonder workers, discoverers of new laws, founders of baseless theories, vaunting peculiar dogmas — seers, inspired by their own pride or the spirit of some defunct Indian of the know-nothing tribe — shrewd Yankees, with a patent improvement on God’s air, and the waters of earthly immortality in very suspicious looking pint bottles. It is hard often to toil on slowly with the army of real progress while such cossacks make the country a desert before you. But the true physician, like the true soldier, has a higher, nobler impulse than that of plunder. There is a loyalty to duty and to truth that brings to the soul a glow and a joy the slave of lucre never knows. The sacredness of his high office will never permit him to barter honesty and honor for gold.

Extremists in a profession so decidedly practical as ours are ever dangerous guides. Yet while the great principles that underlie all true medical science remain ever the same, the fashions of medical practice change almost as often as the shape of a lady’s bonnet. Some of us, whose heads are frosty, and some perhaps whose locks, like “evergreens upon a wintry hill,” show a vain yearning for the summer gone, have lived to see the teachings of our masters proscribed and ridiculed. If we have kept the theories of our early days, it has been at the risk of our popularity; for bleeding and purging and all our old heroics have been banished by the fashions of the present, the turgid face and swollen veins calling vainly for their old depletion. If we have not thrown our “medicine to the fishes,” we have emptied our apothecary shops into our groceries, where the poppy and the grain have flourished together. For while physicians have halted between infinitesimal doses and no medicine, never was the public so alternately stuffed and purged with vile decoctions, as in this boasted interregnum of medicine. While our professional teachers and editors have decried all medicine, quacks have quoted their sayings to prove to the public how useless the medical faculty — how great their own discoveries. While we have retired from the field of active operation, trusting to nature’s vaunted powers, the most powerful medicines have been drunk as water. Every telegraph post in New-England proclaims the virtue of some new health restorer; every grocery is glutted with drugs; every family has its apothecary shop. Our children are peppered with Humphrey’s pellets by day and soothed by Winslow’s syrup of morphine at night. And many a physician has often sighed that he could not add another Beatitude, saying, “Blessed is that M. D. whose minister has no favorite nostrum to mingle with his spiritual commendations.” The great law of specifics has condensed the whole science of medicine to a book of directions and a box of pellets; though, as a score of specifics are given for each symptom, they might as well have been placed, like Lord Dexter’s punctuation points, at the end of the pickle and let each patient suit, himself in selection.

It may be asked, Are Doctors to be blamed for all this legion of nostrums, which like the frogs of Egypt have entered into our bed chambers and into our kneading troughs? We hope not — for surely we have burdens enough without these. But our theological fathers were wont to say, “God or the devil will always occupy the field.” And has not the learned Bowditch shown us, in the last Report of the Board of Health, that as all men love stimuli, it is better to fill them with good Lager than to poison them with strong adulterated liquors?

But, notwithstanding the boast of progress, how far have we advanced towards Cure — the great aim of all medicines — the real test of medical progress? That we know more of the nature and progress of disease than our fathers, we gladly own. That surgery has advanced, and histology and pathology have shed new light around the pathway of the physician, we gratefully acknowledge. But can we cure phthisis more easily now than when the good Dr. Firman prescribed his syrup of maiden hair? Despite our clinics, our chemistry, our new medicine and our no medicine, do not one third of the adults of this learned Athena die of phthisis? And as I listened to the learned paper on tuberculosis at our last meeting, embracing all our advance in that direction, I was reminded how often, while flourishing stethoscope and pleximeter over the chest of some fair but doomed patient, I had had my scientific discussion on the same subject cut short by the anxious question, Doctor, can you cure? asked with trembling lip and tearful eye. Alas! we still strive to dam a river whose springs are above our climbing, far up in the mountains of the unknown. And I fear we shall have to own with Cotting, that disease was in the plan of creation; and it makes little difference with the fact, whether we believe with our theological fathers that fault lay in the loins of Adam, or accept the new gospel of wrong in our first protoplasm.

To the elder physician who has left his first love in following the expectant fashion of to-day in acute disease, the question of loss or gain is often an anxious one. Perhaps ‘tis owing to early education; but often, when he sees disease rout so easily and successively the new recruits and light troops sent out to watch and amuse the enemy, he wishes he had at an early hour of the battle swept the field with his old red-coated continentals. If I mistake not, the signs of the times show that medicine has touched its aphelion and is on the returning arc of its circle. Expectant treatment is yielding to rational treatment. The golden mean is sought after. Students are autocratically warned to remember the emetic dose of sulphate of zinc. Williams, the highest English authority, is in favor of large blisters. Even some of our franker homœopathic brethren acknowledge with a sigh that in this costive age slight purgatives are sometimes necessary. And surely, after the essay on venesection given here at our last meeting, we who have kept our lancets like proscribed gods in secret places, may not fear to acknowledge our ancient veneration.

Medicine is becoming a more positive something. Mere scientific speculations are yielding to the common sense of home thought; and it is to be hoped that Medicine, which has for the last decade shared the fortunes of Ginx’s baby, will be saved from his watery grave by being restored to its lawful guardians.

A wise and intelligent conservatism will winnow the grain from the chaff of mere empiricism, and carefully glean from the fields of science and experience whatever may add to our power of preventing or curing disease. There is surely pressing upon us a responsibility which will not permit us to be idle. Anxious eyes are ever turned towards us with deep questionings the trembling lip may never utter. Treasures are committed to our care, whose value no jewels of the mine can even symbolize.

But the progressive thought of to-day not only meets us as physicians, it comes to us as men, with the hopes and aspirations of men. It enters the temple of mind, and essays to quench the fires we have deemed eternal that burn on its inner altar.

Where rises the river Nile? has been the enigma of past centuries. Whence that broad stream, with its foaming cataracts, its mighty current, its fertilizing waters? Springs it from the desert sands, or is there behind the sandy vail some lofty mountain from whose secret springs issue forth these teeming floods! But the desert sand gave back no reply, and to the challenge of science the river was as silent as the stony sphinx upon its sandy shore.

Where rises the broad river of life, with its myriad branches, its seething cataracts, its ever flowing waters? Springs it from the desert of nonentity, to sparkle for a summer’s day and then be absorbed again by the same arid sands? Or is it the river symbolled in apocalyptic vision, proceeding out of the throne of God, grandly sweeping through this vale of time, to mingle its waters with the waves of an eternal future? These are questions that have come to every thoughtful man since earth’s earliest seer asked, “If a man die, shall he live again?”

No man, surely, can belong to our profession, listen to humanity’s first wailing cry, and catch its last half-uttered prayer, without conning often in the inner chambers of his soul the solemn question —Whence and Whither? But when progressive thought summons the Invisible to her microscopic bar, and because He answers not by the Urim and Thummim of the youngest and most uncertain of sciences, declares He is not, and matter is alone eternal — well may we watch and wait, ere we give up the hopes that seem ingrained in our holiest, noblest thoughts at the dictum of the seers of to-day. When it is proved that the involution of nothing produces the evolution of something, then, and not till then, may modern Athena inscribe Nihil on the altar of the “unknown God,” at whose shrine the ancient ignorantly worshipped. But while each improvement of microscope or spectroscope reveals to us new worlds of beings and more infinite divisibility of matter, who shall say that to our present scanning there lies no beyond? Behind the lens, behind the eye, man feels the true ego sits, seeing, comparing, judging all, within the field of enlarged vision, yet itself unseen. And thus behind his microscopic protoplasm, behind the bright cloud of the spectroscope, sits in calm serenity the Invisible Controller of the atom and the universe.

One is sometimes, amid the mysteries of nature and the mysticisms of science, tempted to exclaim, with the authoress of Amber Gods, “How magnificent it would be if every atom of creation sprang up and said its one word of abracadabra, the secret of its existence, and fell silent again!” But knowledge comes slowly to human vision, and there may be a Fiat which prescribes its limit, saying “thus far and no farther.” With all our boasting we have not yet reached the essence of the material, which lie on the outer circle of the vast territory of the immaterial. We see only the symptoms of fever, we are as ignorant of the electric fluid itself as Thales, who believed a spirit was concealed in the amber. We may weigh the stars by attraction, but neither scale nor spectroscope has revealed to us attraction itself. The ancient astronomer, with unassisted vision, counted the larger stars of night, but beyond his ken lay worlds of light the telescope has since revealed to us; and who shall say that the telescope has yet reached the ultima thule of creative skill? That beyond, there are no islands of light, no continent beyond, waiting its future Columbus? Man stands the central recognizer of creation’s wondrous series. Before and behind him lie infinite studies. The advance thinkers and discoverers of to-day must prove that they have reached the hidden springs of all vital and mental force, and that behind them all is empty void, ere they can show that mind is but the effect of material organization, and “thought-force is but the converted energy of burning carbon.” The question is not, Does thought have mechanism? but, Does mechanism have thought? The test is not tracing evolution back to protoplasm, but in proving that there is nothing beyond; that the utmost tenuity of matter is not the outer boundary of spirit. The dispute is not concerning protoplasm; but whence is protoplasm, with its power of alimentation, contractility, and reproduction; created or self-created; and is not evolution always preceded by involution? Let those who laugh at the miracles of a supernatural gospel explain the wonders of the natural, ere they claim preference. For in this infinite series they suppose “whatever link you strike, tenth or ten thousandth, breaks the chain alike.”

Is it asserted that this topic is not germane to this occasion? To this I reply, that he who has no religious faith is not fit for a physician. He may make a good gardener on a mere scientific basis; may add beauty to a rose, or size and weight to a cabbage-head. But he who stands by the bed where nature fails and earth fades — who has daily to deal with minds, with aspirations after a higher life, which cherish an intuition of a nobler existence as the impress of Deity upon the soul within, clinging to the hope of immortality as the only hope that spans the dark vale — must have, to fit him for his sacred calling, beneath all his professional theories, the faith that takes hold on eternity and on God. For if he is unworthy the name of a physician who ruthlessly wrenches away the last hope his patient has of this life, how much more unworthy is he who quenches the last ray of an immortal faith! You and I have often watched that gradual disrobing of the spirit, which New-England’s most beautiful, most terrible minister of death brings. Month by month, week after week, the outer garments one after another are laid aside, till the soul robed in white seems to stand looking out of her bright windows, watching for the messenger. We have listened at the doors of the beautiful workhouse of mind; we have seen the lights fade and go out and the curtains fall at its windows; we have heard the wheel stop at its cistern; we looked, the house before us was dark, silent, tenantless; we heard no whisper of the departing, no rustle of angel pinions, as the occupants passed out from that domed factory of thought. But went they not? Have all the hopes and loves that throbbed within, all the thought that weighed the stars in balances, and calculated the comet’s speed — which clomb nature’s loftiest heights, and sounded her lowest depths, searching after a creator God — have they all become a thing of naught; the dull clod that gave all being, returning senseless to its native earth? Where is the warrant of science for this execution of man’s immortal hope? Let her revelation of authority be as clear as the sun light it is to quench forever — let our advanced thinkers, the new priests of science who essay to blot a Creator out of existence, first show us a power, “which commandeth the Sun, and it riseth not, and sealeth up the stars; which alone spreadeth out the heavens, and treadeth upon the waves of the sea; which maketh Arcturus, Orion, and Pleiades and the chambers of the south; which doeth great things past finding out, yea and wonders without number.”

Till then, brethren, with a wise and watchful conservatism we can afford to wait; for dark will be the millennium of that science which blots out faith in God and immortality, giving us the revelation of a nettle’s sting for the teachings of the God-man, shutting forever from us the many mansions of a Father’s house whose far off lights now seem to glitter above us with inviting ray.

Then indeed will the old fables become a terrible reality; for then shall the sun in his daily circle look down on Tantalus with the forbidden waters of immortality mocking his fevered lips, and the silent stars of that night with pitying eye will see Prometheus chained to his native rock with the vulture’s beak of a blasted hope rending his aching, throbbing heart.

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