w l§ AN ADDRESS, DELIVERED BY DOCTOR SAMUEL GRIMES, I: Indiana Ijjetotcal CmMum, j 0l«' DELPHI, BEKORE THE eii I () i ^^ Br HELD At ' *^F 0 NEW ALBANY, MAY 20, 1852. PUBLISHED BY RESOLUTION OP THE SOCIETY tNDIANAPOLlS : DIANAroLlS JOURNAL CO'S STEAM PRINTING* EST A B Ll »H M S NT' 1855. MBKKfes*- _i^ki^! LH AN ADDRESS, DELIVERED BT DOCTOR SAMUEL GRIMES, OF DELPHI, BEFORE THE nfoiana JBriiital Conization, HELD AT NEW ALBANY, MAY 20, 1852. PUBLISHED BY RESOLUTION OF THE SOCIETY. INDIANAPOLIS : INDIANA POLI8.I OUBNALOO'8 STEAM PRINWING ESTABLISHMENT. 1855. AN ADDRESS, delivered by dr. samuel grimes, of delphi, at new albany, may 20, 1852; before the Indiana medical convention. Fellow-Members of the Indiana State Medical Convention : However much I might have coveted the honor of addressing you on the present occasion, I have felt ever since that honor was con- ferred, how little I can hope to come up to your requirements. I take, however, some consolation, by reflecting that the objects for which we are assembled, do not require either eloquent appeals or great learning for their support. Each of us must be supposed to bring with him a conviction of the importance of sound ethics for the direction of his conduct to his patients, his medical brethren, and the community at large ; and each of us, knowing his own rights, and aware how they may be infringed on, will be careful to do justice to those of others. My present duty does not require of me to engage in long and labored argument, to exclude errors in which you have not indulged, or to maintain truths of which you are already convinced. I shall not pretend to the office of a teacher.— Far be such presumption from me; when I see before me so many who are able to be my instructors on many essential points. All the privilege that I would venture to ask of you just now, is that which belongs to membership of a great family, united by com- munity of faith and identity of interests. Like other families, there may be differences of opinion among the individuals composing it, and at times, discussions partaking of some warmth. But these differences and discussions must be kept within our own limits, and not made matters of appeal to the general public. If we must, on occasions, have recourse to arbitration, let the arbiters be selected from among, and by ourselves. This brings me to consider, briefly, the means by which we can do each other justice, maintain our common rights, and extend and increase the usefulness of our noble profession. The plastic power of the political institutions of the United States is strikingly manifest in the readiness with which the different classes of citizens—professional, agricultural, commercial, and manufactur- 4 ing—imitate them in their own seperate movements, having reform and improvement in view. Thus, we see, in these classes, primary assemblies of their members discussing wants, pointing out grievances, and suggesting remedies; but afterwards delegating to a limited number authority to examine more fully and calmly the premises, and to agree on certain conclusions, which, without hav- ing the powers of law on the constituents, shall reach them with the force of a strong moral obligation, by which they consent to be bound. In most of the States, there is either a complete or an incipient organization of medical men, in the form of County or State Socie- ties, analogous to County Courts, and State Legislatures; and with- in a few years past, we have in the shape of a medical Congress, our Great National Medical Association, which holds its session an- nually. In our professional capacity and relations, we are thus pro- vided with all desirable means of legislation ; and in disputed cases, with courts of judicature at the same time. Let us then, while still retaining and exercising our rights as citizens and members of the body politic, adhere closely to that organization which will increase our just weight and influence as members of the body Medical__ Singly we have no power ; united by sound ethics, we can make ourselves heard, and all our reasonable requirements complied with, whether we address a Memorial to the Legislature, or invoke the assistance of our fellow-citizens generally, for the endowment of institutions for medical instruction, or for the treatment of the sick, or the adoption of sanitary measures for the protection of the public health. The recommendations of the profession, in its collective or asso- ciated capacity for the government of its several members, carry with them an authority little short of legal enactment. But as on other occasions, in the social compact, the greater the power, the more cautious should they who possess it be in its exercise, and the more undoubted their wisdom and purity of intention. Our readi- ness to conform to a distinct and decided recommendation of a par- ticular course of action, will depend both on our belief in its abstract propriety, and our confidence in the person or persons from whom it emanates, as well as the time taken for mature deliberation on the measures recommended. If this be a correct view, all of us must feel our responsibility • for by us, either as constituents or delegates, are the recommenda- tions made, and to no inconsiderable extent enforced. In another point of view, each of us is answerable to some extent for the wisdom and ethics of the profession at large, since the aspect under which it is regarded, and the influence conceded to it, must depend on the attainments and moral worth of the individuals of whom it is made up. No one of us can stand excused from responsibility for joining in acclamation or loud disapproval, as the case may be, of men or o* measures, on the plea that his voice was not heard separately from that of the crowd. Nay, more, our silence may be almost as injuri- ous as our wrong votes, by our withholding our support to a good cause, and thus giving its enemies additional power of annoyance. We cannot stand excused for inaction, either on the plea of indiffer- ence, or of diffidence in our own powers. A man may not choose to lead, but if he approve of the cause, he is bound to follow him or them, who, to the best of his judgment, are its fittest exponents and advocates. Allow me to make the application of these postulates to the agita- tions, proposed reforms, and attempted revolutions in the medical profession at the piesent time. It has been said by the Roman poet and critic (Horace) that a man must be born a poet. It would seem, just now, as if a vast multitude of both men and women in our country believe themselves to be born physicians—judging from the confident and oracular manner in which they hold forth on the most difficult questions of the nature and treatment of diseases, without their being blessed with any learning or experience, or having thought it necessary to give any time to study. They talk more glibly of fever than of their farms or work-shops, or the dairy—and speak with much more confidence of their ability to rectify derangements of the living body, than they would of repairing a watch, or even making a cheese. To listen to these persons, one would be persuaded that they alone understand the arcana of disease, and the true methods of treatment, and that we doctors of the regular pro- fession are marplots and ignoramuses. They compassionate our weak reasoning powers, in our not being able, like them, to find an unerring guide in a book, in which, in one paragraph, are detailed all the symptoms of a disease, and in another, the infinitesimal doses, by subdivision and dilution for their cure, the remedies being found in the box which accompanies the book. Who, with only a moderate allowance of brains, and little moral sensibility, can resist the offer of becoming a healer of bodies on such easy terms ? Need we wonder that a person unfitted for any thing else should become a dispenser of globules, and decillionate part of a grain in solution ? A man too ignorant to be trusted with a foundered horse, or a woman afraid to prescribe for a pet lap-dog, will not hesitate to give advice as to the best course of treatment for a sick fellow being, and, what is still more curious, their advice will often be asked and followed. Emboldened by the toleration of their absurdities by some, and the direct countenance by others, these Cossacks after a while take a form of organization, and promulgate certain doctrines or cteed, and tease the Legislature of a State to give them chartered privi- leges, by which they found schools and confer degrees. Then we hear the complimentary observations and comparisons on the respective merits of what the sapient interlocutors call the new and the old school, or the new and the old method of treating diseases. There is another set again, of would-be reformers, or rather revo- lutionists, whose creed consists more in what they do not believe in regular medicine, than what they actually believe in their own systems, so called. In their extreme desire to shade their eyes from the gLre of a noon-tide sun, they fail to see an obstacle in their way, over which they stumble and seriously hurt themselves. In their dread of making blood flow from an orifice externally, for a limited time and of a limited quantify, they lose sight of the terrible effects of its internal flow, by which the organs are obstruc- ted and oppressed, and often fatally altered in texture, and paralyzed in functions. They are horrified at the very idea of venesection as a remedy, but they can look with calmness on bleeding capillaries, by which the lungs are engorged, or the air passages choked, or the brain oppressed and disorganized. These same persons prate of the poisonous effects of mineral preparations, in apparently stultified unconsciousness of the fact that by far the most numerous, the most suddenly destructive, and the least controllable poisons, are obtained from the vegetable kingdom; and that the dangers from the abuse and misuse of vegetable poisons are greater by far than that from mineral ones. Which of the two medicines, opium or calomel, has had the largest share, by its injudicious use, in injuring health and shortening life ? In the difficulty of graduating the dose or gradually increasing it, which causes the most solicitude—arsenic and corrosive sublimate on the one hand, or prussic acid and strychnia on the other ? I will ask one more question, and then dismiss this part of my subject. Who is entitled to be called eclectic, in the true and philo- sophical application of the term ? He who culls and chooses from all the remedies furnished by nature and art, for the relief and cure of disease?—or he, who, influenced by a preconceived hypothesis, and only looking at one side of the. question, determinately abjures, at once and forever, the use of a large and important class of remedies ? But, my brethren, obvious as are the inconsistencies, ignorance, and blunders of most of the agitators, and would-be reformers, out of the regular profession, a suspicion must cross our minds, that in too many instances, the line between them and ourselves is not so broadly drawn as it ought to be. Have we not reason to fear that timidity, good nature, or false policy, may have caused some of us to lend too ready an ear to the various medical heresies of the day, and thus indirectly, but surely, give them countenance, or worse still, partially to adopt some of them ? This is an indefensible course of conduct. We are not called upon to quarrel with a friend or patient, who adopts an absurd creed, whether it be in religion or medicine, but we are not justified by any consid- eration of kindness, or love of conciliation, to appear, by the most remote implication, to be a convert to any such absurdity. Before we blame with asperity the wrong bias of a portion of the community towards medical heresies and quackery, we of the pro- fession, ought to have the consciousness that we are clearly distin- guishable from the whole tribe of pretenders by our superior attainments, not only in medicine, but in general literature and science, as well as by our greater readiness of resource at a time of difficulty and danger in a sick room. The mere fact of our holding a diploma in Latin, while others put up with one in English, and of our believing in one doctrine, while they are clamorous in favor of another, will give us no valid claim on the world for higher profes- sional rank, and greater skill in practice. We must rest our claims on something more substantive and appreciable than this. We may dwell with allowable pride on the antiquity, and learning, and signal philanthropy of the great family, with Hippocrates at their head, to which we belong. But the pride of ancestry becomes ridiculous if it is not sustained by contemporary merit. To be received in the great brotherhood and decorated with the order of merit, we ought to be able to show that we underwent early preparation, by a good academic or collegiate education, and early training afterwards, by elementary medical instruction, in the office of an experienced phy- sician, before we were enrolled and became regular and faithful attendants ia a Medical School of repute and competent organi- zation. s Some, perhaps many of us, will confess with regret, that we have not been able to comply with these requisites, in all their particulars. But surely, this does not imply that we should withhold our advice and assistance, in order to remove the obstacles from the path of those coming after us, which embarrassed and impeded our own course. The times are more propitious to the zealous student now, than they were in our early days, and consequently there is less excuse now than then for neglect, on the part of a parent, to procure for his son a good preparatory education, and on that of a physician, to impart to his pupil suitable elementary instruction in medicine.— Nor need any of us stand excused from the discharge of his duty to his pupil, if he receive any such in his office, by the plea of his own defective attainments. However limited may be our reading and knowledge of medical literature, we can still point out to the young student a good book on each of the different branches of medicine, and early familiarize him with the qualities of drugs, and, to a cer- tain extent their pharmaceutical combinations—while we give him opportunities of ascertaining their therapeutical value. Though ourselves not learned in Climatology, we can, without difficulty, put him in the way of observing and recording the characters of the successive seasons, and the modifications caused by the particular localities in which we reside. Though ignorant of Greek, thanks to the Sydenham Society, we can put into his hands a good translation of the admirable essay of Hippocrates on Air, Water, and Places, and read with our student, the interesting and instructive volume on the climate of our own great valley, by Dr. Drake. So in Botany, even if we are not able ourselves to teach, we might, without much difficulty, set an example to our students of learning its elements, and exhort them to prosecute their inquiries in this direction, combining with them the study of vegetable physiology. Continually surrounded by the productions of nature, the country student has stronger incitements, and at the same time, greater facilities, to become acquainted with Natural History than the resi- dent of a city. In pursuing the course here recommended, we shall discharge not only our duty to our students, but, also, to the several Medical Col- leges to which they will resort after leaving us, for on the proper elementary instruction which these young men have received at our hands, will mainly depend their successful indoctrination in the higher principles and rational practice of Medicine by the professors in the schools. These gentleman are continually embarrassed in 9 their teaching, by not knowing what foundation has been laid by the private teachers, or by those who ought to have been such ; nor how far they may take for granted an acquaintance with elementary truths on the part of their youthful auditors. One professor, for fear of going beyond the apprehension of his class, contents himself with uttering the merest common places ; another aims to bring up his hearers to his own elevated standard. If it be said that the first is the most popular lecturer, does not the fact show the unprepared- ness of the students for a course of instructiou such as they ought to receive, and such as an able and conscientious professor ought to be able to give. The dignity, learning, elevated standing, and successful teaching of the Faculties of our Medical Colleges cannot be matters of indif- ference to us. They are, in one sense, our representatives, in another our auxiliaries ; and whatever affects their reputation must re-act on the entire body of the profession. We cannot, therefore, be suppo- sed to look with indifference on the organization of these colleges, nor be expected to give any countenance to those, with the entire competency of whose Faculties we are not fully satisfied. A new Medical school, cannot, like a new store, or a new manufactory, or a new line of stages, be patronized, merely because it is new, and to encourage trade and reduce prices by competition. Nor can persona) regards nor sectional pride furnish an apology for our sending our students, or otherwise give our countenance to a school formed in haste out of incongruous materials, as if in a spirit of mere business speculation. The medical profession at large, must divide the re- sponsibility with the Medical Schools, for the attainments and fitness of the graduates sent out annually from these latter, as candidates for practice and public patronage. If we send to the Medical Col- leges crude materials, it cannot be expected that they should at once be fashioned into shape and harmonious proportions. If we send to them ignorant minds, we have no right to suppose that these will be instructed and taught the principles of medical logic and philosophy in the course of a few months. I repeat that we have a large share of responsibility for the man- ner in which medical education is conducted. We send our students to be educated, we influence them in their selection of the school to which they go. We, therefore, mistake greatly our position, if we think that we can assume the office of judges and critics of Medica) Schools without our participating in their cares and difficulties, an4 giving our counsel for their protection and guidance, when they com« 2 10 tip to what we believe to be a good standard of teaching. The best assistance we can give them, is to send them students properly pre- pared to avail themselves of the higher course of instruction which the professors are ready to go through with. The best counsel we can offer to the professors, is for them to abide by their own con- victions of duty in keeping up an elevated standard of medical attainments for their students, and taking adequate time for impart- ing their knowledge to these latter. Not only are there more branches of medicine to be taught now, but each branch is much richer in details than formerly ; and hence it is clear that more time is required to teach them than formerly was requisite. It may be asked whether we are ourselves, either by education or subsequent reading competent judges, in the premises, of what is necessary on the score of Medical Education ? It may be that many of us are not, in this sense competent, but the very consciousness of deficiencies, and experience of what we have suffered in consequence, may naturally impel us to seek reform, and create a desire that others coming after us should enjoy advantages of which we were deprived. % We may, however, all of us, in this age of periodical literature and abundant publications, readily procure the desired information on many subjects of immediate interest. The calls on our time and attention in the cares of practice, and especially country practice, must always prevent our being regular and systematic readers, but if we are bent on turning all the odd hours to account, and have a good medical journal, and the best monograph at our elbow, we shall be able to keep up, to a respectable extent, with the progress of our science, at least so far as to appreciate its extent and chief bear- ings, and the improvements in practice. In this way we can do jus- tice to ourselves, and to our students, and confer, if need be, under- standing^ with our brethren, the members of the Faculty of Medi- cal colleges. In order to give effect to our wishes and intentions on all that relates to the improvement and elevation of our profession, we must act through our State Society organization. Indiana, in this respect, will not, I hope, be backward in rivalling her sister States—some of which, as Pennsylvania, New York, and Tennessee, furnish in their transactions, commendable examples for imitation. For this purpose it is all important that the County Societies should be well organized—as on their efficiency will depend the weight and charac- ter of the State Society. From each of them we may expect an 11 account of the medical topography of the county, and of the dis- eases to which it is subject in successive seasons, together with those of an evidently endenmic nature. Clearness and brevity should be consulted in these descjiptions and histories, if it is desired to render them acceptable to hearers or readers, and creditable to their authors. I would recommend our Society to petition the State Legislature for an act requiring a registration of births, deaths, and marriages, so that we may be furnished with valuable vital statistics, and which will serve as a basis for many exceedingly interesting inquiries both of medical and general value. As far as it lies in our power, we shall, it is to be hoped, be, all of us, willing to give weight and efficiency to the recommendations of the National Medical Association, to which we are already indebted for an excellent Code of Ethics, and for various Reports on the Liter- ature and Practice of Medicine, and the means of elevating the standard of Medical Education. If the State and County Societies act in unison with the National Association or Congress, the best results will follow, not only to our profession, but to the nation at large. r >-■