ADDRESS OP THOS. M. LOG-AN, M. I). PRESIDENT OF THE DELIVERED IN ST. LOUIS (MO.), MAY 6th, 1873. ADDRESS OF THOS. M. LOGAN, M. D. V PRESIDENT <,co« s:o OF THE "• l-PtAItV, ? • • ci'D'j-A jMita! Js'ietiali®#, DELIVERED IN ST. LOUIS (MO.), MAY 6th, 1873. ADDRESS OP THOS. M. LOGAN", M. D. PRESIDENT OF THE ASSOCIATION. Gentlemen : Just two years ago there was witnessed a spec- tacle well worthy our contemplation ! It was full of signifi- cance, and stands forth, unparalleled, in the history of our divine art, from its earliest annals down to the present moment. Along the Atlantic slope of this vast continent—throughout the length and breadth of the land from Maine to Mexico— were seen, gathering together, one hundred and twenty-one living, aspiring intelligences,* moved by one thought, nerved by one impulse, animated by one hope—the good of humanity! Abandoning, for the nonce, the peaceful pursuits of their chosen vocation, relinquishing its rewards, and exposing them- selves to all the hazards incident upon velocity of locomotion, westward they steered their beneficent course, borne along the iron pathway cleaved across a continent! Annulling the opposing conditions of time and space, over three thousand miles they went—“skimming over the valleys, * These western pioneers of the Association organized themselves, in connection with the members of the Pacific Coast, into a society, at the last meeting in Phila- delphia, by the title of the “ Rocky Mountain Medical Society,” and elected Wash- ington L. Atlee, M. D., of Philadelphia, President, and John Morris, M. D., of Balti- more, Secretary, to commemorate the auspicions event. All honor to the glorious one hundred and twenty-one ! 4 thundering across the rivers, and panting up the aides or pierc- ing through the hearts of the mountains." Science having made subservient to their bidding those dynamic agencies, more potent than the Genii of Arabian fable, they accomplished in seven duys the travel that once consumed more than as many months; and thus they reached the city of the Golden Gate— the Mecca of their pilgrimuge In the same spirit and with the same purposes with which we this day come together, they mot their confreres from dif- ferent and widely distant regions. They met, not as the mere reflexes of other men’s opinions; not to promote those objects which centre in self-interest, but as the independent represent- atives of a high-toned, liberal profession, to secure the benefits which accrue from singleness of purpose and unity of action. With views as comprehensive as the wide domuin of science, they labored with the same unswerving perseverance which has characterized each and every session of this Association during its entire history. Having in four days accomplished the object of their high mission, they returned, noiselessly, like the great forces which control the universe, everyone to his allotted sphere in life, and ere the lapse of another week, all were once more seen quietly fulfilling the daily duties of their noble calling Such a spectacle of moral grandeur, 1 repeal, never before was witnessed in the history of our Association—never in the annals of medicine. Amazed aud confounded, the disloyal in our ranks looked on with staggering doubt; the faithful took part with renewed trust—trust in the power of our organiza- tion, the power of its knowledge, and the power to make that knowledge disinterestedly available to the whole profession. As in that wondrous fratno whose structure, functions, and relations compose our constant study, the sentient nerves feel keenest at the extremities, so we, the distant dwellers on the Pacific, romote from former centres—the ganglia of its gather- ings—continue still to thrill with quickening memories of the benefaction, whose magnitude and value cannot be computed. Neither has the reflex action been lost upon the Association, but permanently stirred up to deepest depths, its members flowed back, the following year, into Philadelphia, like a tidal wave of tenfold volume, in unprecedented numbers. Nor is the influence yet abated. Like yon mighty river, which sweeps with 5 ever-living, ever-moving waters along the wharves and by the busy marts of this Empire City of the West, carrying rich de- posits of fertility and plenty from State to State, in its annual overflowings, to bless the dwellers upon its shoresand throughout the vast regions of its lengthened course, so we are here to-day rejoicing in the strength of our numbers, to scatter far and wide, along the pathw’ay of humanity, the benign influences and free-will offerings of our collective counsel and experience. Herein lies the great catholic principle of our Association. Having a common heritage and a common interest as Amer. icans in each other’s welfare and advancement, we throw our portals open wherever we are welcomed, and by the introduc- tion of new material, assimilate new elements into the common mass. Migrating over our vast territory, as our Association has done for more than a quarter of a century—holding its meetings first in the North, then in the South, next in the East, and then in the West, it acts as the irrepressible light and air of heaven, imparting its vivifj’ing influence in all directions and infusing fresh energy into the monotonous existence of the medical practitioner. But the great principle does not stop here. By the influx and efflux of travel, and all the inter- changing currents of social and professional relations, the precious germs of our discoveries are engrafted, as soon as known, upon the common stock, and the good fruit is spread abroad in all directions without stint or hindrance. In every city, county, and State, societies like ours are continually springing up, based upon the same unselfish tenets, the indi- vidual members, as well as the organizations themselves, being bound together by the adamantine chain of a professional and fraternal sympathy, which is destined to encompass the whole land wTith its ameliorative and recuperative influences. Ever- more urging a broader and more complete culture, our Associa- tion calls upon all schools and colleges in the land, and upon all who teach in and control them, to exact a high and liberal pre- liminary education; not so much in ancient classics—though the grace imparted through them adds to the dignity and influence of the physician—but in modern languages, philosophy, and every department of physics and of knowledge; and thus, by the light of general science, to illuminate the technicalities of their special pursuits. Nor has its voice been raised in vain, for every day are being witnessed the incipient symptoms of 6 a tendency to that scientific training and discipline in indue* live reasoning whereby the American mind po—esses itself of knowledge at firsthand, without the intervention of Kumpean authority. TIiiih it keeps ever before our ardent gaze the speedy advent of the time foretold by the prescient Agassiz, on the shores of the Pacific, when, instead of sending our youth abroad to be instructed in narrow specialities and the ways of fawning and servility, our home universities will rather be thronged with students from the older nations, who, with the arts and sciences on a broader plan, will be taught to think and act as freemen, as active, independent live men, adapted to the wants of a progressive, practical slate of society. If, in aught that has just been uttered, 1 have seemed to speak with the enthusiasm of the poet rather than with the soberness of the physician, I know that the reality does not justify the appearance. Of all the impressions derived from the history of our Association, the most vivid, the deepest, tho most lasting is that expressed by the indirect results of its meetings. Organized more than twenty-five years ago, when the pro- fession was in an almost chaotic t:ondition—when medical books were, compared to our times, rare and expensive, and when modes of communication were few and far between, it has proved of incalculable value, as a medium for diffusion of knowledge, for interchange of thought, experience and criticism. More directly, in the several departments of the profession at large, it has kept on duty a corps of volunteers steadily engaged in exploring and defining all the topographical bearings of the scientific field. We may fearlessly assert, that in earnest, enterprising movements of a progressive tendency— which is the distinctive characteristic of the age—no calling presents, more fully or honorably than ours, through these committees, a better measure of advancement. This is made manifest by the great variety and large scope of the reports brought before the Association, and by the discussion of them in the several and appropriate sections, during the last few years. And whereas formerly we were entirely dependent for our literature, in the various branches of the profession, upon foreign authors, we now can boast of an American supply, as various and profound in learning, as it is for the roost part correct in literary and classical elegance. In mill- 7 tary surgery, especially, the proud monuments of our achieve- ments have quickened into activity the cbirurgical world ; and the invaluable stores of operative experience and practical knowledge, derived from the recent lamentable civil conflict, elevated the claims of American surgery, both North and South, to an exalted pre-eminence. Our surgeons have legitimized certain operations (as recorded in the pages of our Transactions), notwithstanding European prejudices; w’hile religiously cultivating conservatism in the largest and fullest application of the term. The same remark applies with equal force to civil practice. I would specially instance ovariotomy. Persistently denounced as “a surgical temerity,” by some European surgeons, one of our members,* in Philadelphia, alone, has recorded 264 ovariotomies, with a success of about 70 per cent. Even in the young city of my adoption, contain- ing between 16,000 and 17,000 inhabitants, twof successful trophies have been added, within the last eighteen months, to this triumph of chirurgical science. The recognition of all this, as the fruit of our labors, may be tardily or unwillingly admitted by those whose prejudices and long settled habits are not easily overcome, and who have, more than once, declared our Association to be a failure. But. sustained by an enlightened public sentiment, and encouraged by the great body of the profession, the American Medical Association has lived to manhood, and will still live, not only for the maturing of its great fundamental object—reform in medical education—but also for the extension of its basis of operations, and the furtherance of those means and instrumentalities, needed in the advancement of the race towards the ultimate accomplish- ment of its high destiny. My faith, at least, is high and remains unshaken; and for all that has been done by the eminent in talent, learning, and science, I have a heart that overflows with admiration and with gratitude. While for all that is now doing let us have the soul to realize the magnitude of our objects and the import of our aims. Let me ask who that ever attended the annual meetings would not be willing to acknowledge that he did return home a wiser and a better man? Who will dare deny that the status L. Atlee, M.D. fOne by J. H. Wythe, D.D.M.D., and another by G. G. Tyrrell, L.R.C.S.I. and K. and Q.C.P.I. 8 of the profession is prettily above what it was twenty- five years ago, when (as quoted by my immediate prede- cessor) the first President declared that “ the profession to which we belong, once venerated on account of its antiquity, its varied and profound science, its elegant literature, its polite accomplishments, its virtues, has become corrupt and degenerate, to the forfeiture of its social position, and with it of the homage it formerly recoived spontaneously and universally." Would not the impartial observer now, in the face of the sublime record to which 1 have just ad verted, rather, with the far-seeing wisdom and stirring words of the same gifted Chapman, hail this organization as an instrumentality coming “ forward in the majesty of its might to vindicate its rights and redress its wrongs," and concur with him that, “confiding in our resources, we shall through them maintain the struggle till conducted to victory and triumph?" But, gentlemen, if the estimate I have rendered of what our Association has done be at all true—if it has made better physicians of us and raised the dignity of the profession—if it be at ull true that tbe infusion of clear and inductive thinking, and the importation of scientific method and scholastic art. have done so much to advance American medicino towards that exalted station among its cognute sciences, to which it is so justly entitled—then so much the weigh ter are our present responsibilities; so much too louder is the call upon us to sustain our lofty character and position, by increasing the expansive circle of our usefulness, and by extending the runge of our scientific resources. The most formidable impediments which here beset our progress, it is easy to perceive, all resolve themselves clearly into one—defective medical education. We see it in the edu- cators, with a few honorable exceptions, persistently traveling in the same deep ruts of the old, narrow road; we see it in the professorships, too often conferred on those who have never bestowed a single thought to the training of the intelligence; we see it in the low standard of fitness for the doctorate; we see it in an inverse ratio of poverty of results to the largeness of the field of operations; and especially do we feel and see it by the display of powers never before suspected, developed late in life, and under embarrassing deficiencies. So long as this state of things obtains, our medical education will con- 9 tinue to be all but a confessed and palpable failure. In vain may the cry of “Reform! reform!” be rung with its many changes round the circle of our schools, from Maine to Louisiana, and be re-echoed from our colleges in California and Oregon, so long as it is proclaimed in high places of the profession, that the exigencies of the times and the require- ments of humanity exact such a constant supply of medical force, as will hardly permit the acquisition of any greater de- gree of knowledge and attainments than such as will enable the new-fledged graduate to turn them promptly to clinical purposes. With an apparently reckless inconsiderateness of what might entail a waste of professional intellect, that may possibly be equivalent to the daily loss of threescore and ten years of progress, it has been deliberately argued, in the pres- ence of the assembled Association, that profundity of learning is not essential for the discharge of the physician’s function, and that practically the more the sphere of his scientific re- sources is expanded, so much the less ability does he seem to exhibit in the use of therapeutics. German}* has been in- stanced to substantiate this hypothesis—Germany, where the crowning glory of modern medicine is found, not only in its minute and exact knowledge of general, special, and compara- tive anatomy and physiology—not only in those peculiarities of the therapeutics of to-day, that one of the freshest and most advanced thinkers of the age has termed Restorative Medicine, in contradistinction to destructive and depressing medication—but rather in “ that purer jewel of her crown,” unblemished by the slightest taint of selfishness—Preventive Medicine; Germany, where cellular pathology is sweeping into oblivion a long catalogue of torturing and depressing agents, and where an amount of research in the natural history of diseases, while putting to shame our own shortcomings, is urging us, in com- mon with the prosecutors of our science everywhere, to more determined efforts in this respect—there, in that “ vater-land,” its therapeutics have been signalized as “ something hardly better than nihilism,” and the practice of physic not much more than a “ meditation on death.” Now, while I admit that there may be some apparent reasons—apparent only on the surface, however—for the im- pression thus intended to be conveyed, that the advances in our science have led to skepticism in regard to the remedial 10 powers of medicine as an art, and eapecially as to the romodial powers of drugs, at the same time I must he permitted to outer my protest, boldly, ugainst the false position which medicine is thus made to assume in her scientific character. The caution and care, the scientific spirit, and the truly scientific method observed and exercised by the leuding minds of our profession, nowadays, are due, in a great measure, to the uncertainty and want of precision in the therapeutic means we possess. Science, being organised knowledge, rejects all probabilities, and in her researches after truth, has found that a large number of acute diseases, occurring in previously sound persons, have a tend- ency to terminate in the restoration of health, even though no drug be given. This is fact—not skeplicism, but knowledge. Again, accumulated observations have established the fact thut certain acute diseases run a definite course, and end sponta- neously at a certain period from their onset. Conclusions, therefore, drawn from the formerly supposed indefinite dura- tion of these diseases, as to the efficacy of drugs to cut short- their duration, are thus proved to be founded on tulse premises, and consequently are not trustworthy. From these and simi- lar advances in our knowledge, the physician, of expanded mind, instead of being overwhelmed by tho effect of such dis- coveries, or regarding them as sapping the foundation of his faith, looks abroad with a clearer vision, and, embracing in the sweep of his glance all that has led up to, and all that flows from these revelations of science, he comes to entertain a more restricted, and therefore more correct appreciation of the action of drugs. Now, the expression of this scrupulous con- sideration is taken as evidence of skepticism by those who jump at conclusions confusedly, clumsily and erroneously. It is precisely on such garbled interpretations of w bat science lias ascertained, that empirics, mingling u crude smattering of knowledge with a cloudy muss of ignorance, have erected their crazy structures of infinitesimal nonsense. .Most emphatically do I condemn such false conclusions, and repudiate the unmerited imputation of skepticism that has been cast upon the great masters of our profession, who, I bold, are not less firm believers than myself as to the value of our present modes of treatment. It is true that with those who understand the real nature of disease—the lesions pre- senting and the mode in which they have been produced—in 11 short, pathology; we find belief in the efficacy of the so-called active (perturbative?) treatment, less strong than in those who are not so well informed—whose faith is without knowledge. But this doubt can do no harm so long as it is entertained by a cultivated intelligence, possessed of the proper kind of knowl- edge. The danger lies in the effect of doubt upon ignorance— upon the unscientific,—doubt of truth and belief in error; doubt in opposition to knowledge, which may prevent the saving of life; and belief, without reason or justification, which, embodied in practice, may kill. Let me explain by a borrowed illustra- tion from high authority*, whose arguments I have just been adapting to my purpose : “ I was one of three who met in consultation concerning a case of apoplexy.” (The case was one of degenerative changes—retrograde metamorphosis of the arteries. One had become so rotten that its wall had given way, its contents had escaped, a clot had formed, and by its mechanical efiects had given rise to the symptoms. The heart shared in the degen- erative changes. The bleeding had stopped.) “ In the opinion of one of my' colleagues and myself, the only' treatment to be adopted was as follows: To place the patient in the recumbent position, with head and shoulders raised; to enforce absolute rest; to keep the bowels so far loose as to prevent excitement and straining; to apply cooling substances to the head in the event of any heat of the part occurring ; to support the patient with light nutritive food, having regard to his habits. The third gentleman protested against the modern system of doing nothing; he was anxious to bleed, to purge, to blister; and when opposed, was not sparing of the term skeptic, etc. * * * Now, the difference in opinion in this case was not due to skepticism on the one side, and justifiable faith, /. e., faith justified by7 knowledge, on the other, but to knowledge on the one side, and absence of knowledge on the other.” Imbued with the conviction that the beginning of wisdom is the knowledge of ignorance, and conscious of the difficulties, which, on every hand, beset him, the scientific physician ex- plores cautiously, doubts judiciously and determines slowly. But while he rejects the hastily conceived and immature specu- lations of the self-satisfied empiric, he does not stand idly by, and let disease run its course unmodified. Knowing that the * Sir William .Tenner, Hart., M.D.D.C.L.,F.R.S. 12 Creator has established certain relation)* between cause and effect, and that all the phenomena which we witness around us are the result of certain antecedents and not of chance, he seeks to fathom the causes of diseases, and by his knowledge of their course, and of the dangers which threaten the life of the patient, at each stage of their progress, he interferes to prevent, to control and to counteract an}’ untoward conse- quences. and by the judicious employment of all the rational means at his command, among which pure air, food and stimu- lants are included, ho saves the patient from death. Now, I deny that this treatment can be regarded as nil or expectant; it is positive, nay, active. Believing, as I do. that medicine is destined, if her votaries only prove true to their allegiance, to reach that “ Ultima Thule" in its history, w’hen the stigma of uncertain shall be wiped away from its deductions, and it shall take its rank among the exact sciences. I cannot hut think, that so long as it may well be doubted if any fact or principle yet obtained in regard to therapeutic agency, in resisting morbific influences, can claim the rigidity and the universality of a positive law,* so long must scientific medicine continue her unwearied efforts after truth, through the realms of physical research—so long widen perpetually her range, through the vast compass of sub- jects with which it is linked, by the progress of science and the fluctuations of human requirements. A little reflection will show how the profession, which has always assiduously pur- sued natural knowledge, cannot separate itself from the indi- rect any more than from the direct influence of science. As a branch of natural science, consisting of an investigation of es- tablished laws, medicine must he studied with the same care and caution as other departments of science. There is this difference, it is true, that while the natural philosopher cau bring mathematics to his assistance, and the chemist can re- • *• Pbyaiology sod pathology afford little or no aaumtanre in tka adaptation of medicinal a|enM to particular disease*. nor explain the mode of tbeir opera!ioo , e. g„ lark, in tbe cnre of an ague. No mean*, yet recognised. inform u* whether ill operation ta to neutraiiM tbe mortjir miasm, or merely to protect tbe body again*! it* further notion* influence, while Nature'* reaonrce* repair tbe injury done. “Certain it ia, that the atmosphere and •aturated water* of tbe Cinchona foreat* do not exempt tbeir human inhabitant* from ague. Tbe *ame remark appliea to eeery article in tbe long catalogue of therapeutical agents, a* regard* the maiadie* in wbieh experience baa proved tbeir efleary.’’—4**«