H^jbLu. (s.vr.) MnilntB' Cnronum*. AN ETHIC ADDRESS, DELIVERED BEFORE THE DISTRICT MEDICAL SOCIETY, FOR THE COUNTY OF BURLINGTON, JANUARY 10,1854. BY IS S. W. BUTLER, M. D., PRESIDENT OF THE SOCIETY. PUBLISHED BY'ORDER OFTHE SOCIETY- r V A 'sift '«*,' BURLINGTON i PRINTED BY JOHN R0DGER3. 1854. DOCTORS' COMMONS.* Gentlemen op the Medical Society :— A time-honored custom which I should be loth to violate, makes it my duty, before retiring from the Presidency of this Society, to read an essay on some subject connected with Medical Science. To some of you, who could draw from years of experience and obser- vation, facts that have been long stored up in the mind, and many times ruminated upon, this would be a very easy task; but to one, who like myself, has only just entered within the portals of this temple, whose mind is in a state of transition from the chaos of medical theories and opinions with which it was so industriously stored in our schools, to the " fulness of the stature" of one, who, from experience and observa- tion, has some established principles and opinions of his own, which he may embody in an essay, without fear of rendering their author obnox- ious to the charge of presumption,—it is quite a different thing. In this dilemma, I have chosen for discussion, the topic already an- nounced. To the ear it may sound rather unique, but upon it, I shall endeavor to found some remarks, which I hope, may prove mutually beneficial. Among the many vicissitudes of my somewhat eventful life, it has been my lot to travel in the wilds of the far west, unprotected and alone, without chart, compass, or guide. On entering a vast forest, whose tower- ing trees and rank foliage, almost shut from me " the eye of day"—with, sometimes, not even a bridle-way to shew that human beings had ever trod the ground before me—or, on emerging from such a forest, upon the borders of a prairie, whose expanse— " As green, as wide, and as wild as the sea," has stretched away until it became blended with the horizon—I have #An Ethic Address, read by S. W. Butler, M. D., before the District Medical Society for the County of Burlington, January 10,1854—and published by order of the Society. 4 paused an instant to reconnoitre my position, and fix indellibly in my mind the points of the compass, the bearing of my place of destination, and to observe any landmarks which might serve to guide me in my jour- ney. This done, I have gone fearlessly forward, nor do I remember ever to have been led astray, Just so, having entered the temple of medical science, I would pause on the threshold—would look around, and scan its fair proportions—ex* amine the foundations of its massive pillars—survey the span, and calcu- late the power of the lofty arches that support its stately and magnificent domes—glance at the interminable length of its "long drawn aisles"— and intently regard the fountains and exotics which sparkle in, and adorn its spacious court-yard. But I would do more : I would look aloft, con- sider well the object and aims of my life—my position, and the opportu- nities it gives me for exerting an influence for good, or for evil. I would earnestly scrutinize that narrow way which ascends before me by no winding path, to the very goal of my existence, and with a steady eye on that, I must fix indellibly in my mind some principles of moral conduct, founded on the revelation of the Divine Will, and which, once determined upon, must not be swerved from, "though the heavens fall." But we have here indicated the work of a life-time, if we have not en- croached on the employment of Eternity! It is to be observed that while the eternal and immutable principles of Truth lie at the basis of the whole, there are certain foundation stones upon which this noble edifice is reared; while, in the popular estimation at least, we ourselves, and each worshipper in the temple, constitute inte- gral parts of that foundation and of the structure itself. Now, it is an established principle in Architecture, that in proportion as the materials of a structure are compact and firm, will be its strength, and the degree of confidence placed in its durability. If, therefore, in the public estimation, we, individually and collectively, are held responsible for the amount of confidence which the science of medicine inspires, we must not, cannot lightly estimate this responsi- bility. It becomes our bounden duty to adopt any practical measure that may be devised, by which these integral parts may be fused into one whole; for this once dope in a manner apparent to the popular view,— inasmuch as they hold us to be its representatives,^—our science must ne- cessarily, command the full confidence of the public, That it does not command the respect it did, in the days of SydenT ham, Fothergill, and Friend, we think is a position that will hardly be questioned, notwithstanding that as a science, it is very far in advance of 5 the position it then held. And more, I have- evidence that within the short period of fifty years, children were instructed to pay marked respect in public, to even a dissipated family physician. This is far from being the case now. Whence this change in public sentiment? It is not without a cause :—where does it lie ? The science itself is very far in advance of its position fifty years ago, and is therefore deserving of far more respect, to which its representatives are most surely entitled. Why do they not receive it ? Philosophical and political reasons, and conven- tional customs may reasonably be adduced as causes, yet we believe there are others within ourselves, and for which we are, in a degree responsible, and which may and ought to be removed. The cause, and the remedy for this condition of things may be stated under the following heads:— 1. Defective medical acquirements, including their antecedent causes. 2. The fact that Quackery, in its various forms,—in part by its attain- ments, but principally by its pretensions, and the collusion with it, of those who pass as scientific physicians,—is leveling upwards, and claiming, and receiving a portion of that respect which is due the scientific physician alone : and, 3. Want of union and harmony among scientific physicians, We have not time in this essay to discuss the positions assumed under the first two heads, but must confine our remarks to a few considerations suggested under the last. Leaving out of view, expressions having reference to that religion of the heart, upon which all our hopes for the future must be founded, I hardly know of two words that fall more heavily upon my ear, than those, so frequently in the mouths of the multitude, and so eagerly caught up, and reechoed by the press,—"Doctors disagree." The saying has become a proverb—" Who shall decide when doctors disagree" ? I answer, the public decide, and they alicays decide adversely to the interests of our noble science. I would not be understood to say that physicians must always agree on all points of medical doctrine and practice, or even perhaps of medical economy and ethics, except indeed, in so far as the latter are founded on that universally binding precept of our Saviour— "All things whatsoever ye would that men should do unto you, do ye even so to them." Were this absolute union of sentiment and feeling jn all things possible, it would scarcely be desirable, since we would then have to bid adieu to all hope of progress in the developments of our science. But I would have the members of our profession call their philosophy—and more, their Christianity, to their aid, in advancing the 6 common interests of medical science, while they " agree to disagree" on minor points. " Exterior harmony is in entire accordance with the un- shackled maintenance of individuality." I believe it to be a fact worthy of especial notice, that the disagreements which so often disgrace our profession, are not usually founded on real differences in medical doc- trine or practice, but rather have their origin in those petty outbursts of animal feeling and passion, which hold the lowest grade in our fallen and sinful natures. Witness the bickerings, and quarrels which are so fre- quent, between members of our profession. Witness too, our courts of law, where, in suits brought against surgeons, for mal-practice—which, in nine cases out of ten, have their origin in cupidity and spite,—profes- sional men are found, who, with a view to advancing their own interests at the expense of a successful and rival practitioner, are base enough to give questionable evidence against him, which, in the minds of most ju- ries, will outweigh any array of knowledge and talent which may be brought forward by the defendant. These petty rivalries and jealousies, are as injurious to our own private interests, as they are to the general interests of medicine, as might easily be proved; and they are as unbecoming the dignity, the philosophy, and the liberality of our profession, as they are often puerile in the extreme. Why, sirs, it is, as if two well-fed hounds, should quarrel, not over a bone, insufficient to afford each a mouthful of nourishment, but over a fat ox, capable of satisfying the craving of a dozen famishing curs ! If I am considered severe, and undignified in the language I employ on this subject, the subject, and not the pencil of the painter is responsible. "I confess that to a refined taste, it is course and revolting. But the pitch was on the canvass, 1 but touched it and am defiled /" Yet while I thus speak of what does exist within the pale of our profession, I am happy to say that I know no member of this Society, to whom these animadver- sions are applicable. I feel that nothing is now more wanting to inspire the minds of the community with confidence in us as -medical men, and through us, in the science of medicine itself, than an evident union of feeling—a communi- ty of interest, that would not brook an evil report raised against a brother practitioner, and that would lead us to defend the interests of the science of medicine as represented in him, as earnestly, and as warmly as we would have him to do, were the foul tongue of slander seeking to ingratiate itself with him, at our expense. In other words, we need to cultivate more diligently those christian graces, which, like a string of pearls run through the whole of the thirteenth chapter of 1st Corinthians—which 7 " thinketh no evil" (the wish is often father to the thought,)—which "re- joices not in iniquity," (or the misfortunes of our brethren),—which "vaunteth not itself"—" is not easily provoked," and which " suffereth long, and is kind." We have already quoted the divine precept on which all sound ethics must be founded. Gentlemen, you may think it bold and presumptuous, that one of my age and standing in the profession, should use the language I do here. But, I announced it as my intention at the start, to seek some guiding star, some way-marks, by which to thread my path through the mazes that lead to the goal of professional ambition, and, if in my field of vision, there are unsightly crags and projections that will aid me, I presume I may use, while I endeavor to avoid them. It is because I regard these flaws as unmitigated evils, because I ear- nestly deplore them, and because I think that every influence should be brought to bear, that may tend to draw more closely the cords that bind us together as men, and as practitioners of medicine, the "noblest of all professions, but meanest of all trades," that I venture to bring forward, for your consideration, the following plans^ Should they at first view, seem Utopian, and impracticable, I pray my professional brethren not to judge and condemn them too hastily. Albeit they are the outburst of the youthful and ardent temperament of one who hopes and believes, that he is sincerely desirous of advancing the best interests of his chosen pro- fession, they are, nevertheless, the result of a good deal of study and ob- servation, as well as of much intercourse with his professional brethren. I believe the plans to be perfectly feasible, and that they will bear in" vestigation. 0 The policy which I advocate, is founded on the principle of associa- tion, and whatever, if any claim, it may have to originality, can be so^ in only part of its details. For,'in our State Society founded eighty-eight years ago, in our county Societies, in our National medical organization, as well as in all such associations, at home, and abroad, the principle is recognized, and by its very existence, triumphantly vindicated, for, had it not been found to work well, it would long ago have come to nought. It has come to be a general rule as well in the eyes of the discriminating public, as in our own, that he, and he only, is the respectable physician, who not only acknowledges fealty to some form of professional associa- tion, but who takes an active interest in the proceedings of such organ- izations. The man who holds the license of a Medical Society, merely for the purpose of placing himself under the segis of legal protection, is a " marked man," even in the eye of the public, 8 1 have reason to know that plain farmers' wives, read with interesty the meager reports, of our too often meager proceedings, which are pub- lished in the newspapers, and they know who of the physicians in their neighborhood are present at those meetings, and what part they take in them.* The city or village newspaper, which in an " item" chronicles the fact that any number of physicians, either in a simply social, or in a more public capacity, met as physicians, and had " a good time," in so doing, spreads abroad the intelligence who constitutes the profession of the place Or neighborhood. The day has long gone by, when a man could attain eminence in any profession, or command the respect of any community, without hard stu- dy, and close application, and he who by his attainments is entitled to respect, is as irresistably drawn into association with men of kindred tastes, as are particles of matter by the law of attraction. The apparent exceptions to this rule, are like malignant growths in the human organism, whither the disorganized cells convey and deposit, their morbid material, gathered alike from the fountain head of human intelligence, and from " those members of the body which we think to be less honorable." And, if one of these exceptions should claim pre- cedence on the score of a more liberal pecuniary support, it is, as if a cancerous breast should exult over its healthy fellow, or a morbidly en- larged organ over one free from disease—for money thus acquired, is unhealthy material, and will as surely eat into the vitals, " as doth a canker." Notwithstanding these facts, it is well known that there are some phy- sicians who are backward about connecting themselves with our societies, and many others, who, too often honor our appointments in the breach rather than in the observance. I would, by increasing the inducements to association, bring these men into the societies, and thus enlarge the sphere of our influence, and, at the same time, make more apparent the difference between us, and the horde of pretenders, who like jackalls be- set our paths. I would have some bond of union, other than the mere abstract principle of association—some nucleus, around which we may cluster in a sort of " social crystalization." It is extremely difficult to form an attachment to an abstract principle. " Where the treasure is, there will the heart be also." * I would here respectfully suggest the propriety of having the proceedings of our society published by the Secretary in eztenso, or, so far as may be proper for the pub- lic eye, in the newspapers of the day. I believe good would result from it. 9 In making an application of the foregoing suggestions, we will briefly consider them in reference to— 1. Our State Medical Society. 2. Our County Medical Societies, and 3. Our City or Village Associations. First, then— I advocate the formation by our State Medical Society, of a Library, Pathological Museum, and Cabinet of Natural History. The Medical Society of Virginia, at its annual meeting in April last, laid the foundation for such a collection, and appointed a curator. " Many hands make light work," and the principle once established, and the labor heartily engaged in by the members of our society, I be- lieve that such a collection could be made at a very trifling expense, and that it would steadily grow, and be of permanent value to the profession, and to the State. Books and specimens in Pathology and Natural His- tory would flow in, and the hills and valleys of Sussex would vie with the plains of old Cumberland and Cape May, and our large towns and cities would compete with both in adding to the common stock. Every con- tributor to such a collection, would have a personal and an abiding in- terest in it, and our Annual meetings would be vested with a new inte- rest. Indeed, once a year, would be found too seldom for these re-uni- ons of the profession of the state. These collections too, particularly those in the pathological and natural history departments, would inevita- bly call forth communications and essays which would give to the trans- actions of the Medical Society of New Jersey, an interest which would attract the attention of neighboring states, and indeed of the profession everywhere. These essays might always be written in a form suitable for binding, and thus be preserved in the archives of the society. The establishment of such a collection was a favorite project of the late Dr. James Paul, of Trenton, and had the proposition to that effect, which was brought before the Society at its Annual Meeting in 1852, been favorably received, I have reason to know that his valuable library would now have been the property of the State Society.* For the accommodation of such Library and Museum, I would ask, and expect, that the legislature of the state would appropriate to the use of the Society such room or rooms in the State Capitol as might be need- ed, and where all the business meetings of the Society could be held. The Society is a State institution, having a general, and not a local in- terest, and one which it is to the interest of the government to foster * I am happy to say that most of this Library is now in possession of physicians in this county. 2 10 and protect, and which it will do if we are true to ourselves,—and if we evince a disposition to engage heartily in such a work, I have no fear but the appropriation would be promptly and heartily made. Legislation has reference to the future, as well as to the present well-being of man,. and I ask in all candor, if such action as that proposed on the part of our State Medical Society and Legislature, is not fraught with benefit to the profession, and through them to the whole people of New Jersey. But, it is objected that such a collection at the State Capitol would be of little or no value to the profession in remote sections of the State. I answer, that legislation has reference to the greatest good to the greatest number, and, with the present and prospective facilities of travel, togeth- er with the necessarily frequent communication with the State Capitol, the large majority of the physicians of the state would have compara- tively ready access to the collection. Besides, the advantage to the pro- fession at large, which would result from the attractive force, so to speak, of such a Library and Museum, would far counterbalance all such ob- jections. These objections are not of sufficient force to prevent our Na- tional and State Legislatures from collecting at their respective seats of government, extensive libraries for the use of legislators, and no one questions^ that notwithstanding the outlay from the public funds neces- sary to establish, and keep up these libraries, the money is well expend- ed, and that they will be of lasting advantage to the public. These Li- braries are often consulted by public men during the recess between the sittings of the legislatures. What valid reason is there why physicians should not have equal facilities for consulting an extensive library of medical authors ? In reply to the objection that the extensive medical libraries of the cities of New York and Philadelphia, would render the proposed collec- tion unnecessary, I would simply say, that it would be as reasonable for our legislature to rely on the extensive public libraries of those cities as for us to do so,—and besides, we would not, and could not feel that free- dom in resorting to, and using those libraries, that we would in resorting to one of our own. To my mind, the argument, in any view, is clearly in favor of such a collection as the one proposed. Second.—I advocate the formation, by our County Medical Societies, of similar Libraries and Museums, on a scale, of course, proportionate to the extent of the sources from whence they are to be drawn. Inter- changes of duplicate copies of books, or specimens in pathology or natu- ral history, might often be made with the State or other County Socie- ties. For tlie county Libraries and Museums, I would ask, and expect II accommodations in one of the public buildings of the county, for the same reasons that I would ask such accommodations in the State Capitol. Here, the county meetings, which ought to occur afe often as once in three months, should be held. The several advantages to be derived from such collections, enumerated under the first head, are as applicable to this, and need not be repeated. Third, and lastly,—I would carry the same principle as far as prac- ticable, into our cities, towns, and villages. Wherever there are two or three physicians, I would have them hold a room in common, in a pub- lic part of the town, easy of access, and known as " the doctors' room." Here let each physician deposit, for the time being, such books from his own library, and such specimens from his cabinet, as he can spare, each marked with his own name, and the whole properly secured in glass cases; each physician being provided with keys to open them. Then, at suitable hours each day, let this room be thrown open to the public. Let there be here, skeletons of the human frame, wired and natural, for the inspection of the curious non-professional inquirer. Let the room be attractive in size and furniture, and be a common resort at all hours for the profession of the place, where they may meet, as they have opportu- nity, for social converse, and where they may hold frequent stated meet- ings of a professional character, and where, in the larger towns and cities, there may be, on proper days, certain hours in which the physicians in rotation, could meet, and prescribe for the poor. I need do no more than mention the advantage of such an arrangement to the medical student. The physicians might agree to subscribe for different medical periodicals, and thus have the advantage of receiving medical intelligence from vari- ous sections of the country, and from abroad. The profession and the public too, would thus often enjoy the advantage of reference to valuable collections in mineralogy, botany, conchology, etc. etc., and the body of physicians in the place, would, necessarily command more entirely, the respect and confidence of the public. The trifling expense of furnishing such a room, is not to be thought of, in view of the great advantages that would result. Such frequent interoourse among physicians, as the proper carrying out of these plans would require, would make them too well acquainted with each other to render it possible, except in very rare cases, that any serious misunderstanding should arise between them, and the medical profession would present the grand spectacle of the devotees of a benevo- lent and useful science laboring unitedly, and earnestly, to promote the welfare of mankind. Then would this temple of science present to the 12 popular view, one massive structure, whose integral parts are fused into a whole, against whose broad and deep foundations, the surges of popu- lar superstition and error dash in vain, and whose fair and faultless pro- portions, as they loom up against the gathering clouds, bid defiance to storms and tempests. }j> u r t e ;? SNAKE-BITE CURABLE AND HYDROPHOBIA PREVENTIBLE. 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