The Aim and Purpose of the Medical Man. The Annual Address to the Graduating Class of the Kentucky School of Med- icine, delivered June 22, 1886. BV , j Prof. J. B. MARVIN, M. D., Professor of Principles and Practice of Medicine and Clinical Medicine in the Kentucky School of Medicine. PRINTED BY JOHN P. MORTON & CO. LOUISVILLE, KY. THE AIM AND PURPOSE OF THE MEDICAL MAN. BY PROFESSOR J. B. MARVIN, M. D. Gentlemen Graduates, Ladies and Gentlemen : To “rejoice with those who do rejoice” may be equally a duty and a privilege. We esteem it a privilege to rejoice with you on this occa- sion, and right heartily do we congratulate you on this successful ending of your college career. The cordial and pleasant relation of pupils and teachers now terminates, and you pass from the narrow confines of the lecture hall and enter the great contest with disease and death. We welcome you as younger brothers and fellow- laborers in the great work of gathering the knowledge that is power and the wisdom that is life. The field of labor is vast, coextensive with humanity; the laborers are many, yet no worthy hand is unwelcome; no effort to be spared; the conflict is fierce and unremitting; hydra heads ever spring afresh, and the sword for no moment can be sheathed. While we have testified to your zeal and industry as stu- dents, and our belief in your fitness to cope with disease, as witnesseth these presents you have just received, remember your real ex- 2 THE AIM AND PURPOSE OF animation now begins, and it will last for life. Your examiners will be your patients and their friends. Thrice happy are ye, if ye as suc- cessfully pass this green-room. The accusation of talking platitudes is so freely leveled at com- mencement orators that the unfortunate indi- vidual occupying the position I do, to-day, has come to think he is expected to play the part of the king’s jester, for the amusement of the frivolous and to moralize for the benefit of all. “A Philistine talking in utilities,” as Matthew Arnold would characterize him. The greatest truths of necessity become trite by frequent repetition. Facts can never be in- validated by being trite. It is much to be doubted if love-making has been much changed or even improved since Adam, under the fig trees of Eden, first breathed in the receptive ears of Eve his heart’s desires; yet who has not, or at least earnestly desires at some time, to try his hand on this theme? Rash the in- dividual who doubts the originality and ab- sorbing interest of this ever new, trite old story. I shall not attempt the first function of the jester, neither shall I apologize for talking platitudes, if thereby I shall help you in any measure more adequately to realize the nobility, magnitude and responsibility of the office you THE MEDICAL MAN. 3 have undertaken. The aim and purpose of the medical man, and his relation to the public at large, surely concerns us all; those who have just entered its ranks, those upon whom has been imposed the burden of teaching,and those who have nearly finished their active career, and are looking forward to the time to “seek the chimney nook of ease, and there with sober thought to ruminate on what they have seen and heard and wrought.” We trust, gentlemen, you have “counted the cost” before choosing your profession. There are no great prizes in medicine, and your recompense, as weighed in the common balance, will be small enough. As a money-making concern, medicine is relative- ly a poor speculation as compared with business or some of the other learned professions. Still it is generally true that, “He that will work, likewise shall he eat,” and for every steady worker who wisely and patiently pursues his course there is probably a more sure prospect of earning a living—a competence rather than wealth—than any other occupation presents. By a system of advertisement more or less cleverly vailed, some acquire a large practice and realize a fortune, but they sell their birth- right for a mess of pottage and make an ex- cellent bargain; for a doubtful reputation is 4 THE AIM AND PURPOSE OF given in exchange for actual wealth. You are not tradesmen, and if, under the disguise of a profession, you practice a trade you can not claim to be even honest tradesmen. You are trading under false pretenses. The honorable practitioner must have “clean hands (antisep- tically, as well as ethically) and a pure heart.” Pride, a horse, and a conscience, are three things, it has been said a poor man can not afford to keep. I trust all of you have, and will never part with, the first and third, and will acquire, as soon as you need it and can afford it, the second. Medicine is not a gift with which some persons are endowed by na- ture; she is a jealous mistress, and requires of her votaries a natural bent of intellect and special training to fit them to become masters. The expert can not impart to you that deeper insight into disease he has gained only by long training. He may open the door into the laboratory of nature, but he can not invite you to cross the threshold and enter with him. Knowledge will not come without an effort. Like the dove to the ark, it may come to the windows of your mind, but you must reach out your hand and pull it in, or it will fly away again. If medicine is allotted a place among the progressive sciences, it must be studied in THE MEDICAL MAN. 5 the same way as any other branch of science —by observation and experiment. The scien- tific investigation of disease is peculiarly the province of the doctor; the very nature of these investigations requires a medical train- ing. We commit violence whenever we at- tempt to divorce the scientific investigation of disease from the practical treatment and relief of suffering. We need more original investi- gators and thinkers—men not only to observe, but to think and draw logical inferences. “ For one person who can think, there are at least one hundred who can observe. An accurate observer is no doubt rare, but an accurate thinker is rarer.” We would have you en- lightened physicians, seeking correct diagnosis and knowledge of disease, by calling to your aid all the methods known to modern scientific research. A correct diagnosis is necessary for a proper and successful treatment of disease; the more we know of the cause and nature of disease, the more effective will be our methods for its prevention and cure. No amount of reasoning or theorizing can take the place of correct observation of facts. The dogma that the physician, like the poet, is born not made, contains but half a truth, and, like all proverbs, expresses only one particular attitude of the 6 THE AIM AMD PURPOSE OE mind, for the exact opposite of every proverb can be readily found. There must of neces- sity be two classes of workers. One, and by far the smaller class, are the original thinkers and investigators, who discover the hidden secrets of nature; the other class are dissemi- nators, who render practicable and available the works of the discoverers. If you have not the genius, “which is but a burning thirst for excellence,” to be an original investigator, see to it, that you are at least honest and faithful disseminators. To possess any value, your work must be undertaken in a scientific spirit and with a definite object in view. In no department of science is there so much imperfect observation, hasty generalization and fallacious reasoning as there is in medicine. This is due in part, no doubt, to the large num- ber of workers in medicine, many of whom are but poorly equipped, having failed to utilize the mental training afforded by a proper course of study. Most men require to learn “ to see with their eyes, and to hear with their ears, and to understand with their hearts.” The bad may not be out of proportion to the good; it would be much less if we could eliminate three great evils that are rife in the profession: Lack of independence in study, lack of wise discrimina- tion, and lack of intellectual truthfulness. We have labored to make you think for yourselves, to be able to give a reason for your faith. Use your text-books and notes simply as a means to an end. Be no man’s servile imitator. Strive after thoroughness and keenness in observation; analyze the process by which each fact is' reached; assimilate what you study. You may not be a genius; your armamentarium may be small, but it will be brightly polished, and ready for instant use. The independent scholar has learned to think accurately and readily. Having laid a firm foundation, the superstruct- ure will be solid and permanent. The doctor, of all men, should avoid the extremes of cred- ulity and skepticism. Hold all your theories subject to correction. Holding to an exclusive dogma will dwarf your faculties and blind your mind to the highest truth. The weakening of faith in a theory is frequently the evidence that you have acquired fresh and valuable knowl- edge. Cultivate that kind of doubt which Goethe calls “ the active skepticism whose whole aim is to conquer itself,” and not “that other sort which is born of flippancy and igno- rance, and whose aim is only to perpetuate itself as an excuse for idleness and indifference.” It has been said the doctor is judge, jury, and THE MEDICAL MAN. 7 8 THE AIM AND PURPOSE OF sheriff; hence the great necessity for wise dis- crimination in studying the causes and course of disease, and in choosing remedies for its relief. The biting sarcasm of a Voltaire,“men who know little, putting drugs of which they know less, into bodies about which they know nothing,” would never have been hurled at the profession if there had been more discrimina- tion on the part of the doctors, as well as by M. Voltaire. By intellectual truthfulness is meant that special and characteristic attitude of the mind which makes it incapable of en- tertaining at the same time, two contradictory opinions. If we look into our minds and criti- cise our thoughts, how few of us have resolu- tion enough to make a distinction between things of which we know nothing and those we really understand, and to exclude the latter from the narrow circle of our accepted con- victions. At least two qualifications are neces- sary to success—a clear conception of the aim and purpose of your life, and the will and power to live up to it; in a word, scientific earnest- ness. Second, intellectual truthfulness and independence. A well-trained and well-regu- lated mind is necessary to secure and make available for our great purpose in life truth, and truth only. I commend to you the eloquent THE MEDICAL MAN. 9 words of Fichte: “To this I am called; to bear witness to the truth. My life, my fortunes are of but little moment; the results of my life are of infinite moment. I am a priest of Truth; I am in her pay. I have bound myself to do all things, to venture all things, to suffer all things for her.” There are two radically different interpreta- tions of the relation of the medical man to the public. I have already foreshadowed what I believe to be the proper position of the doctor. No higher function can be assigned him than an attempt to elicit the different baneful in- fluences which promote disease and then en- deavor to remove them. In preventing disease he becomes the custodian of the public health. It is necessary to lay a foundation in a knowl edge of anatomy and physiology, then to study diseases and discover, if possible, their causes, then endeavor to remove them, and finally make use of the best remedies we have to re- lieve our patients of the ailments which we can not prevent. We are thus pursuing a strictly scientific method. There is much to do outside of and prior to administering drugs for the re- lief of symptoms. Efficient treatment can only follow an adoption of this method. If the prescribing a medicine always implied 10 THE AIM AND PURPOSE OE a knowledge of its action and a proper occa- sion for its use, nothing could be more condu- cive to the death of all forms of quackery, which consists in physic-giving and nothing else. Take away the quacks’ pills, powders, and potions, and there is absolutely nothing left. Take away our pharmacopeia, and there is a large basis of science and art still left for the benefit of mankind. The other, and more popular view, makes the medical man alto- gether subservient to the will of the public. The public comes into contact with the doctor onjyat one point, that is treatment. They care nothing for anatomy or physiology and path- ology. They want the so-called practical man, not the person who has his eye at the end of the microscope, or is experimenting on the lower animals, or is continually fishing in the secretions of the sick. They care nothing for your science or even advice, but want some- thing to ease pain, give sleep, or whip a jaded appetite. According to this view the beginning and end of the medical man’s calling is to obey the patient's behests by the mere offering of drugs for the removal of ills which the patient has portrayed for himself; hence the popular voice must be regarded as the dictator of the profession. It is so in other trades —the grocer THE MEDICAL MAN. 11 does not dictate to the public what they shall eat or drink, but supplies the peculiar article which the present taste or fashion demands. It is not a matter for surprise that this method has many followers, when we remember how lucrative it is and how futile it is to offer to our patients improved methods of living, or to try and prevent disease. Drug-giving had its origin in superstition, and is at present largely a matter of blind em- piricism. Any system which has for its foun- dation drug-giving and treatment of symptoms is erroneous, narrow, and savors of quackery. Do not misunderstand me. I have no patience with therapeutic nihilism. I believe medicine is eminently the healing art, and if I had no faith in drugs I would not stay in the profession an hour. While you should be familiar with the causes and natural history of disease as far as possible, still it is not your business to stand by the bedside and do nothing. Despair never yet saved a life or helped a sufferer. Human nature requires something to be done on which to rest, and it may be legitimate to administer a drug to act on the patient’s mind, but it is im- proper to give him medicine simply for the sake of his friends, when there is no probability of its having any directly curative effect. I 12 THE AIM AHD PURPOSE OE protest against the idea that diseases are so many entities, whose symptoms are to be re- moved by drugs. The wide-spread heresy that, since it has pleased the Almighty to visit His children with various ailments, so He has pro- vided in the herbs of the field some remedy for their cure, is both absurd and untrue. We need to take our huge Materia Medica and purge it of the worthless articles, and preserv- ing those which time has proved valuable, en- deavor to discover the true nature of their action and gain a better knowledge of how to use them. Every physician worthy of the name is actu- ated by a higher motive than “mere greed after the hidden things of the life of the flesh.” There is a double interest to him in every case he treats; the human interest in the patient, and the scientific interest in the disease. You can not solve the problem of the sick- room in the majority of your cases by the stethoscope or thermometer, but by sympathy and knowledge you may impart the stimulus of hope, the sedative of confidence, or by divert- ing the attention from absorbing and depress- ing influences, restore the enfeebled and ex- hausted vital powers. Do not judge the sick by the same standard as the well. “Invest THE MEDICAL MAN. 13 suffering with the reverence that is due to its sad mystery. It has its roots deep sown be- neath the surface of our life, and reaches, in each one, the inner depths of calm or storm, in a region into which you can not pass except by tender sympathy and thoughtful care.” You will learn that pain is not the worst of evils, nor death the greatest of calamities. To you, as to no other men, the darkest side of human nature is ever open. Mingled with much that is mean and pitiful, you will witness scenes of heroic courage and devoted affection well cal- culated to raise your opinion of mankind. The gratitude and affection of those to whom you have been useful will cause you to feel in some degree the happiness of the patriarch of old, “The blessing of him that was ready to perish came upon me, and I caused the widow’s heart to sing for joy.” Such is to be your work in the years the distance hides. There will be much to try and vex you. Your life at best will be one of anxiety, toil, and self-abnegation. Failures must come, but remember our failures are obtrusive, while our greatest triumphs are often imperceptible. “ Nature effected the cure,” we may with truth often say, but it is certain nature would often effect a death but for the guiding influences of medical treatment. There 14 THE AIM AND PURPOSE OF is reward in the consciousness that life and ease and health follow your daily path. You can prolong life, comfort an aching heart, soothe many a weary mind, and bring joy and glad- ness into many a home in a way that no other body of men can. The good we can do by our science and art is as extensive as humanity, and is capable of conferring the greatest bless- ing on mankind. Inequality in the mental and physical abilities of man is the appointment of God. It is not given to all to make discoveries in science, or effect advances in our art, but each may do something, and it should be con- sidered an imperative duty so to live that those who us may be the better for our labors. “ The honors of a name ’tis just to guard ; They are a trust but lent us, which we take, And should in reverence to the donor’s fame With care transmit them down to other hands.” Your Alma Mater looks to you to keep her name unsullied, to carry on high the traditions of her past, to keep the torch she hands you brightly burning, to lighten the dark places of human life. Though life is still the great mys- tery, and life as we see it here is ever passing into death; though the storm clouds gather, and the sky is dark, yet slowly coming nearer THE MEDICAL MAN. 15 there is light. We and our successors may see it only in glimpses, few and faint, but it will come; and you “ may lessen the present gloom and hasten the dawn, which, now flushing only here and there a mountain peak, shall surely broaden into perfect day.” Gentlemen, may you win “ honor, love, obedi- ence, and troops of friends.” Wishing you length of days and happiness equal to your deserts, I bid you farewell.