.jLvrtESS OF THE PRESIDENT. 4- BY- DR. I. N. LOVE, St. Louis. At Mississippi Valley Medical Association, Thirteenth Annual Meeting, Crab Orchard Springs, Ky., July 13, 1887. Reprint from the Weekly Med. Review, July 16, 1887. ADDRESS OF THE PRESIDENT. Pressing Present Needs of the Profession. BY DR. I. N. LOVE, ST. LOUIS. We have great reason to be proud of our profession, the world over; proud of its achievements and accomplishments, the record it has made of energy, originality, intellectu- ality, scientific development, humanity, char- ity,and at no time in its history has there been more to glory in than in the past fifty years, and no grander presentment made by any of its workers than here in our own America. The names of the elder Gross, Flint, Marion Sims, John T. Hodgen, McDowell, will not be forgotten as long as human suffering exists in the world, and be it remembered they were every one the product of this Mississippi Val- ley, and many of them from your own State of Kentucky. However, in our pride in our craft we should not lose sight of our weak points, and should take pains to fortify ourselves against them. First upon the list of wants I shall mention that of more thorough and Systematic Organization ok the Profes- sion. Of all the so-called learned professions ours is second to none in numbers, character and influence, and all that is necessary to the se- curement of that which is for our best good is for us to be alive to our interests to the ex- tent of marshalling our forces in the proper manner. In union there is strength, and the presentation of a united front on the part of a body of thinking, working, voting, studi- ous men, eighty thousand strong-men who are the trusted advisers of every family in the land, would make them invincible, and whate'er they wished within the bounds of propriety would be accomplished. At Mississippi Valley Medical Association, 13th Annual Meeting-, Crab Orchard Springs, Ky., July 13, 1887. Gentlemen of the Mississippi Valley Medical Association: It is needless for me to attempt to express my appreciation of the honor you have con- ferred upon me in electing me as your presi- dent. To say that I am proud of having been se- lected to preside over an organization repre- sentative of the medical profession of this great valley-a domain which DeTocqueville half century ago grew enthusiastic in describ- ing, and declared capable in its boundless re- sources of feeding and supporting an empire, and whose record and present condition to-day give complete justification to his most extrav- agant predictions-a section of country com- posed of the glorious States of the West and South, rapidly becoming the directing and controlling commercial, social and political power of the continent-to essay the expres- sion of my gratification and pride in the honor conferred would seem superfluous. I can only thank you. In addressing you for a few moments I have concluded to present no scientific matter, pre- ferring to leave that field entirely to you dur- ing this meeting, and promising at future meetings to do my share in that direction. I will offer to you a few thoughts, random and disjointed though they be, not in an ad- visory but a suggestive way only, upon some of the The individuals composing this mass would be improved and polished by the rubbing to- gether. In these convocations all can bring informa- tion and exchange experiences, and science will be subserved and the good of humanity advanced. Let the profession go on in the good work of crystallizing itself by organizing in every township, county, state and section in the country, and once in one or two years as may be thought best, send delegates from these va- rious local societies to the American Medical Association-our National Medical Congress. Higher Medical Education. The question of higher medical education is one that has been discussed these many years, and the discussion will probably be con- tinued for years to come, but that it will eventually be solved favorably to the profes- sion and the people there can be no doubt. In the majority of states the laws require the exhibition of a diploma before granting the right to practice, but unfortunately are silent regarding the qualifications of the dip- loma giving power. Under existing conditions in many states a company may organize, composed of quack doctors, broken down clerical mountebanks and wandering tramps, procure a charter and grind out doctors for the cross roads or the most aristocratic sections of the cities, large and small. In Minnesota, Mississippi, Alabama, and a few other states, the legislatures have wisely, I think, enacted laws requiring all practi- tioners to go before a board of examiners and give evidence of the knowledge that they pos- sess by passing a proper examination in all essential branches of medical science. Such laws are a credit to the state, a protection to the citizens, and are certainly advantageous to the properly educated and equipped physi- cian, and are disastrous only to the "diploma mill" and the charlatan. Remove from the medical diploma its power as a license to practice, and the "wild cat colleges" which live "for revenue only" will cease to be. Speaking of the medical diploma of to-day the Medical Standard pointedly presents it thus: "As enthroned in medical legislation it is a fraud and a curse; it masquerades under false pretenses and knifes every attempt at higher education. It is time that competency itself, and not its purchased and mendacious alleged certificate, were accepted as the true basis for legislative honors. With this the test, the competition between colleges would be, not which can produce the most graduating ma- terial at the least costand the greatest profit and in the shortest time, but which will afford that thorough instruction and sound educa- tion which shall receive the approval of the law in the acceptance of their graduates. A school which cannot live and prosper by this test has clearly no right to exist." That we have too many medical colleges, good, bad and indifferent, I think all will ad- mit, and it is to be hoped that there may be a "boiling down" accomplished, whereby the scum and the dregs may be removed. At this time every city, great and small (and even many of the smaller towns) in the land has from one to a dozen medical col- leges, many of them using every effort to in- veigle into an already over-crowded profes- sion raw material, fit or unfit, it matters not so the list of matriculants and graduates be large. To a very considerable degree the remedy lies in the hands of the body of the profes- sion which is disconnected from, and which is the great feeder of medical colleges, in that its individuals are the original preceptors of the students. This large class, forming the great majority of the profession, should se- verely discriminate in taking students into their offices. They are the profession's pro- tectors, and they should guard it against igno- rance and moral obliquity. They should receive as students only those who are likely to be a credit to them and an adornment to the profession, and see to it that they are properly entered in colleges that are properly conducted and catering to the better sentiment of the profession. In all candor I think the mania which afflicts the profession in all its ramifications should be abated-the mania for teaching medicine. In city and country alike the bent of the profes- sion appears to be in the direction of multi- plying its numbers, in spite of the fact that many already within its ranks are barely able to live. In the old world a practitioner accepts a student or apprentice only after he has given the strongest evidence of his mental and moral fitness and general attainments, in ad- dition to which the student obligates himself to pay a given and goodly sum each year for a term of five years, and that he will not after he has been licensed, engage in practice with- in a distance of ten miles. By this rule the student has to pay for that which he receives, the practitioner must needs give something tangible in return-knowl edge and the art which earns his bread-at the same time wisely protecting himself against the competition which he himself has nursed. Tn the cities, however, this mania for teach- ing and multiplication of colleges carries with it a feature which in the form of clinics and dispensaries in excess has become a crying evil. I refer to the Abuse of Medical Charities. This is a subject which is agitating all the cities of the world, and in many of them pub- lic meetings have been held by the profession to discuss some means for remedying the wrong; in all it is of very serious import to the profession and to the people-a double injury. ( In many cities, clinics, hospitals and dis- pensaries are established and being estab- lished vieing with each other in the induce- ments offered to attract patients, in taking the bread from the mouths of the tyros in the profession who have been seduced into it by the allurements of an easy entrance, as well as many of the older members who find it difficult to keep the wolf from the door; at the same time banefully affecting the sub- j ects of their indiscriminate charity by educa ting them to the point of being full-fledged paupers. Relative to this I quote the following from that bright and sterling journal the Chicago Medical Standard: "To what is practically indiscriminate alms- giving, the profession has been and is griev- ously addicted. The merchant, beloved for his charities, would be laughed at as a fool were he to give away his goods to persons in the enjoyment of good salaries, yet the physi- cian is doing this every day through his dis- pensary,hospital and church charities. As a re- sult charity has become the first refuge of the charlatan. "The poor treated free" is the motto upon the banner under which the quack marches to victory. "The result of the indiscriminate ostenta- tious rivalry in charity, is that the upright, general practitioner, overworked to secure a , bare livelihood, finds neither time nor strength . for scientific research, as his labors are too, exhaustively increased by the financial strug gle for existence. Worn out in harness he dies,and a wealth of medical lore which would have enriched the world is buried with him, and the "good, charitable doctors" cant over his remains that it was tobe regretted that such an able, honorable physician had pub- lished so little, and was such a poor business man. "At least one-half the community are prac- tically paupers as regards medical char- ities. The professional Pharisaic pseudo- philanthropy has created this large class of morally defective beings. In the interest of the profession and society, it istiniethis were ended. Let every physician bestow in secret ' his private medical charity on the deserving poor. Such charity will elevate them and ele- vate him,but let every medical pseudo-philan- thropist who acts as medical officer to any so- . called medical charity, whether it be a church i charity, a dispensary or hospital, or a college clinic, which, after rigid supervision does not - turn from its doors all able to pay, be driven from the ranks of reputable medical men. A number of years of official connection with the various eleemosynary institu- tions of a large city has convinced me that possibly, organized systems of charity are objectionable in that they discourage individual charity by remov- ing the opportunity of its exhibition and en- courage pauperism by being too indiscrim- inate in relieving the recipient of the feel- ing of personal obligation for favors received. The question may well be asked whether any other class of workers are actively engaged in efforts to increase their numbers by "giving away without money and without price" the secrets and knowledge of their calling, and at the same time educating their clientelle in the direction of demanding and accepting service without compensation therefor. Add to this the fact that sanitary science, preventive medicine and all that the terms imply are the direct result of the noble, gen- erous, heroic work of the medical profession in all the years gone by, and I think we are safe in concluding that the time is drawing near when it will be necessary to call a halt in these efforts to attract recruits and at the same time diminish the proper compensation of the workers in the profession by reckless and misdirected benevolence. Do not misunderstand me, I would not that the profession be less generous and self-sacri- ficing, but more just to itself. Let us ask re- garding those whom we take into our ranks. Are they well equipped for the service? In their entirety are they men? manly men?; If so they will not want to sneak into the pro- fession through a crack in the door and then go dodging through their professional lives for the reason that they are not able to present a clean bill of entry. The man who accepts something for nothing as a rule loses his independence and his manhood, whether he be a patient, a medical student or what* not. I have no more respect for a medical stu- dent who is not willing to give hard years of earnest work to the securement of a knowl- edge of his profession than I have for a man who fancies that he has been "called" to preach the gospel of "the Man of Sorrow who was acquainted with grief," and yet who in the very beginning of his career sinks his man- hood by accepting an education paid for by the female members of some struggling con- gregation who raise the money through "sew- ing bees" and the sale of fancy work and brie a-brac, said money being thus diverted from worthy seamstresses who are honestly struggling to make a living and solve the problem of existence for themselves and de- pendents. Both characters I have presented are a dis- grace to the calling they have chosen. This question of charity in our profession is an ever present one. Not a day passes but that we are called upon to visit those from whom the simple "God bless you" is all that we will ever receiver But that is a fee that indeed enriches us. The work of a physician is of a character, if properly exercised, to make him a nobler and a better man each day he lives, full of sympathy for the suffering, words of cheer for the sorrowing, charity for the unfortunate and the sinning,a work which of necessity de- velops a man's sensibilities,and finer feelings, which intensifies his emotional nature in one direction and curbs it in another. Let us not attempt to check this elevating and ennobling tendency. The doctor who can go from house to house and say to the patient "your money or your life," I had almost said in ad- vance, please, has a thoroughly dollar-and- cents idea of his calling to say the least, and is not a member of whom we should feel proud, even though he become prominent as a very rich man, but he is a benefit to the profession in that he educates his patients in the direction of paying their bills. His great- est damage is to himself. It is the too numerous organized charities against which I have been inveighing. Let us not cease our individual charities. Let us not attempt to close our hearts against our generous,our better impulses,but let us be carefully judicious in our distribution of gra- tuitous work, and guard ourselves against the' formation business habits in con- nection with those who are able to pay for service received. Here comes in the advan- tage to the profession, if its workers have struggled long and hard for their knowledge and privilege to practice, they are much more likely to feel that they are giving good value in rendering service and ready to demand proper pay from those able to give it. May we not hope that sooner or later the millenium of the profession will have arrived when there will be no branches, no sects, no dogmas, but all will be satisfied to train under the banner of the grand old pro- fession, which is broad enough and generous enough to permit its devotees to select any remedy they please, in any dose they please, according to any theory they please, and only commands them to serve humanity and work generously for the good of the profession under no other name than that of "Physi- cian." I am strongly of the opinion that the decline of homeopathy and other "isms" in the profession which is now well un- der way is largely due to the dignified ignor- ing of them on the part of the regular pro- fession during these latter years. Evidences of their diminishment and even- tual absorption by the parent body are upon all sides, among which may be mentioned the renouncement and denouncement on the part of their leading medical journals and prac- titioners of their infinitesimal theories, and the relinquishment of labels or terms sug- gestive of creed or dogma. In the city of St. Louis at this time there can hardly be found a half dozen practition- ers presenting tangible evidence of any pecu- liar tenet or article of faith. I cite the fol- lowing from the "New York Medical Times" the leading and best so called Homeopathic medical journal in America, viz: "In the nature of things there can be but one system of medicine recognized by science. Either Homeopathy must absorb the Old School, or be absorbed by it." (January, 1887, page 308). "The doctor of the future will surely rec- ognize no sect in medicine." (Ibid). "If the public only knew how these so- called 'high dilutions' are made, we doubt whether they would be tolerated for a mo- ment. In most cases it wouldjonly be necessary to describe this process to stamp out any tend- ency to a belief in such transcendentalism." (Italics mine). (April, 1*886, page 18). "Our old school brethren have this advant- age over our new school friends, that no matter what their practice, in name at least they are non-sectarian and they can gradually, as they are doing now, absorb the truths of all schools without eating any very large amount of crow." (June, 1886, page 83). These quotations and the facts previously referred to clearly indicate the tendencies of the day. Apropos to the points here made I re- member a remark offered nearly twenty years ago by the late Dr. Jno. T. Hodgen, in re- sponse to an extravagant denunciation of homeopathy, to this effect." Life is too short to indulge in the arraignment and condemna- tion of all those who do not happen to look at things as we do. Hahnemann's ideas were mostly absurd, it is true, from the standpoint of logic and common sense, but that they have accomplished much good in having ren- dered our medication less heroic, and in hav- ing taught us to rely more upon nature will be admitted. Had these notions been re- ceived silently or permitted to rest upon their merits, and the exponents of them not an- tagonized and persecuted they would have died "a horning." In marked contrast to this calm and thoughtful course of my preceptor was that of one of my earliest teachers in medicine who used to occupy a considerable part of his lecture hour in hurling anethemas and bil- lingsgate at the heads of his erring homeo- pathic brethren. Let us not waste our time and talents in showing up the weakness of our fellows, let us be as charitably and kindly disposed to- ward our weary and worn co workers as we are toward the idiosyncracies of our sick and suffering patients. Of all men doctors should be most lenient toward errors and blunders, for none know better than they how thor- oughly matter has power over the mind which it environs. However, let us no longer carelessly accept the title of "Allopaths" given us by our opponents, but announce if called upon, that we are "physicians," and that our title permits us to choose from the entire world of medicine any means or rem- edy that will help our patients. That we will weigh in the balance all that is pre sented to us and hold fast to that which is good. Let us then, one and all, determine to be considerate and tolerant of the rights of others, grant to every man the same privilege that we ask for ourselves, that of having an opinion and acting in accordance with it. Let us remember that all the quacks are not in the irregular ranks of the profession, and whether they be or not let us deal gently and kindly with them and win them over into the straight and narrow path of pro- fessional rectitude. In this connection, permit me again to quote from that fair, honest and liberal expo- nent of Homeopathy, the New York Medical Times (April, 1886, page 18) as follows : "There are so many facts in science which appeal to the intelligence of every reasoning man. So many avenues of thought open and constantly opening as the darkness which hid them from sight rolls away before the light of science, that there must be room for all to work without jealousy or discord, each bringing his quota of knowledge to be tried in the furnace of practical experience and each recognizing the other as a fellow worker in the ranks of a great profession. We cannot check the progress of truth or force its reception. The mind will some day, as light gradually dawns upon it, be wide open to receive it and incorporate it with its own life and work. Intolerance, exclusiveness or angry discus- sion will neither help nor retard. w All that we can do is to live earnest, con- scientious and honest lives, ever striving to do good and intelligent work in that great field of labor where there is room for all." Let not the criticisms I have expressed impress you that I for one moment think the profession is, on the whole, retrograding- decidedly the reverse. The progress is on- ward and upward, and I never meet with ag- gregated numbers of my co-workers but that I feel greater pride than ever that I have been permitted to enter the ranks. A grander, nobler, more self-sacrificing body of men never lived, and all that is needed for them to thoroughly love one another is for them to meet together often and know each other better. Gentlemen, as the days come and go and the years pass, I feel that doctors are fortu- nate in their calling. Above the strife, the slavery of their work, the insufficient remu- meration, the sometimes cold and cruel thank- lessness of their patrons there stands out the fact that they are elevated, refined and no- bilitated by their duties and association with the sad and unfortunate, and if they be true to themselves it follows as the night follows the day they cannot be false to any man.