-?Ji IX it ADDRESS RECIPROCAL RELATIONS EXISTING BETWEEN PHYSICIANS AND THE PUBLIC, DELIVERED BEFORE The Medical Society of the State of California, ANNUAL SESSION, APRIL, 1873, F. W. HATCH, A. M., M. D. PUBLISHED BY THE SOCIETY. SACRAMENTO: T. A. SPRINGER, STATE PRINTER. 1873. ADDRESS RECIPROCAL RELATIONS EXISTING BETWEEN PHYSICIANS AND THE PDBLIC, DELIVERED BEFORE The Medical Society of the State of California, ANNUAL SESSION, APRIL, 1873, BY F. W. HATCH, A. M., M. D. PUBLISHED" BY THE SOCIETY. SACRAMENTO: T. A. SPRINGER. STATE PRINTER. 1873. ADDRESS ON THE RECIPROCAL RELATIONS EXISTING BETWEEN PHYSICIANS AND THE PUBLIC. By F. W. HATCH, A. M., M. D., or Sacramento. Mr. President, Ladies and Gentlemen: With great reluctance, and with unfeigned distrust of my fitness for the duty, yet in obedience to an invitation from a source which should not be disregarded, I have consented to present, very briefly, some thoughts upon the general subject of the relative duties of the profession and the public—the reciprocal relations existing between them. This whole subject has been, and is, but little understood or reflected upon in every community; nor is the position of the physician rightly appreciated, or the claims of the great and philanthropic science he professes properly appreciated. In my comments to-night I shall studiously avoid any im- proper allusion to such as differ from me and those with whom I associate in the profession. For all of these, if they are honest, I entertain the respect to which, as men and gentlemen, they are entitled. I simply design, with the Code of Ethics as my guide, to review the claims and position of legitimate Medi- cine, and, as incident to these, the respect and deference which are its due. The world is full of novelties. There is a charm, a fascina- tion, about them which captivates the mind and enchains the fancy. Indeed, the present has somewhere been called the age of novelty; but it has been the same, if we read aright the 4 PHYSICIANS AND THE PUBLIC. record of the past, in all ages. It is a characteristic of human nature—this passion for something new—this weariness of what is old and familiar. We see it illustrated, nowadays, in every department of business, in dress, in association, in the common affairs and intercourse of life. It has become the basis of fashion, the arbiter of taste; it invades the balls of science; it has taken possession of the pulpit. It has been the same for centuries past in medicine. The sorceries and incantations of olden times, the doctrine of sig- natures, the metallic tractors, the chrono-tbermal treatment, the great sulphur cure, the grape cure, the psora theory, the spir- itualism and clairvoyant medicine of the present day, and all the pathies of which we bear so much, are but a few of the medical novelties which, appealing to this love of what is new— this slavery of fashion—have been, at different times and in different degrees, successful in winning converts and gaining zealous advocates. The striking peculiarity, the prominent feature of all these methods—for systems they are not—is, that they rest upon an exclusive dogma; that they are narrowed down to a single idea, from which, if there be a momentary departure, the vitality of the thing is lost. But such is not now, and has never been, the case with legiti- mate Medicine. Tracing its origin back to the earliest ages of the world's history, we may call to mind the long catalogue of heroes upon whose labors this great system has been built. Look at them, as age follows age and generation succeeds to gen- eration, plodding with unwearied steps and ever-elastic energies along the thorny paths of discovery. A great science was to be erected—a system was to be founded out of the scattered and disjointed fragments which, here and there and in slow succession, patient investigation and unprejudiced experimenta- tion had been able to establish. Behold them, as they pass along through the ages, even from Chiron and vEsculapius, thirteen hundred years before Christ, to Hippocrates, seven centuries later; to Galen, in the second century, earnestly collecting together the results which had been achieved before him, explaining to attentive audiences in Rome the discoveries— wonderful for the time, and far in advance of all who bad pre- STATE MEDICAL SOCIETY. 5 ceded him—which he had made in anatomy; to Harvey, in the seventeenth century, laboring incessantly for the truth, and startling the world by new anatomical demonstrations, and proclaiming to admiring listeners the great doctrine of the cir- culation of the blood; to Cullen and Brown, and Broussais, whose theories, however much we may disregard them now, have left their impress upon the medicine of to-da}T; to Laen- nec, and Louis, and John Hunter, and Bicbat, and Virchow, advancing our knowledge of the nature of disease, and connect- ing effects with their causes, and expounding the beautiful structure of histology. We need not follow them to our own age and time; to Watson and Niemeyer, and M. Hall, Gross, and Da Costa, and many others whose names are as household words, and whose memories will live while medicine itself is read and practiced. Such were some of the men to whom we are indebted for the proud position which medicine occupies to-day—a system of active benevolence and beneficence, which, as "the attribute of mercy, is twice blessed." It reposes upon no dogma. There is nothing exclusive about it. While venerable in its age, it is active in its progressiveness. It recognizes no beaten path to which it is compelled to adhere. Its spirit of investigation is insatiable, and in its search after whatever is useful and condu- cive to the one great end it has in view, it explores the whole domain of nature, disdaining to gather new materials neither from the earth beneath us, nor from the flower which blooms upon and beautifies its surface. It is, therefore, confined to no one plan or method, but avails itself of what is good in all; and, in this respect, it is distinguished from all others. In a word, it claims and embraces everything capable of aiding and advancing its great mission. Hence, regular medicine recognizes no distinc- tive title, but rejects every appellation savoring of exclusiveness, or which in any manner allies it to a sect. We do not believe that water, however useful in its proper place, will cure all diseases; we do not credit the assertion that all remedies of value are confined to the vegetable kingdom; wo are not satis- fied that the utility and curative power of all drugs is in direct proportion to their attenuation or dilution; but we are, to use the words of another, " simply physicians, as yet unaware of 6 PHYSICIANS AND THE PUBLIC. the fixed but mysterious laws that others claim—who now, as always, will use .any application or any remedy that, judging by experience in their use, or from well-settled mechanical, chemical, or physiological principles, will cure disease." The title of allopath, therefore, so often assigned to us, even by intel- ligent persons, is as misapplied as would be that of homoeopath, or hydropath. We use such means as science has revealed to us to be applicable to the cure of disease, and, the utility of which experience has demonstrated. How these remedies act, may be the subject of beautiful and exhaustive theories, but is, after all, of the very least importance in a strictly practical point of view; and, in many familiar cases, will possibly be forever unknown. We know that opium exerts its benign influence upon a certain part of the organization, and produces certain results; we are assured, by familiar use, that quinia possesses a power incom- parably beyond any other remedy in arresting the progress of periodical fever; but, old as it is, familiar as it has become, the wisest and best men in the profession are to-day engaged in elaborate, yet not entirely satisfactory, efforts to discover its modus operandi, and fathom the deep mystery of its wonderful power. I have dwelt thus long upon this portion of the subject, with the view of explaining what medicine—regular medicine—is, and to contrast it with the methods of the dogmatists; to indi- cate the labor, the mental preparation required of those who profess its name and minister at its altars; to exhibit some of its claims to veneration and respect, and to justify the demand which it makes upon the public for the recognition of th'ese claims, and the observance of the obligations which are its due. These obligations are briefly hinted at in our Code of Ethics— a law equally binding upon every honorable physician, as are the laws of the land' upon the citizen. Hear it in Article second, section first: "The members of the medical profession, upon whom is enjoined the performance of so many important and arduous duties towards the community, and who are required to make so many sacrifices of comfort, ease, and health, for the welfare of those who avail themselves of their services, certainly have a right to expect and require that their patients should entertain a just sense of the duties STATE MEDICAL SOCIETY. 7 which they owe to their medical attendants." It goes on to enumerate them, placing the claims of the profession in their true light, and basing them upon the reciprocal duties of the profession to the public. " A physician," it says, " should not only be ever ready to obey the calls, of the sick, but his mind ought to be imbued with the greatness of his mission and the responsibility he habitually incurs in its discbarge." And again: " As good citizens, it is the duty of physicians to be ever vigilant for the welfare of the community, and to bear their part in sustaining its institutions and burdens; they should be ever ready to give counsel to the public in relation to matters specially appertaining to their profession. * * * It is their province to enlighten the public in regard to quarantine regu- lations, * * * in relation to the medical police of towns, as drainage, ventilation, etc., and in regard to measures for the prevention of epidemic and contagious diseases; and when pestilence prevails, it is their duty to face the danger, and to continue their labors for the alleviation of the suffering, even at the jeopardy of their own lives." Having thus broadly exposed the reciprocity of obligation between physician and patient, it seeks; by timely and appro- priate counsel, to guard the latter against some of the errors which experience has shown to be common in every community, especially the habit of vacillation and inconstancy—of roaming about after different medical advisers in every new case of sick- ness, or even in the same case. "A patient," it says, " should confide the care of himself and family, as much as possible, to one physician," and it goes on to explain the reason for the advice; "for a medical man who has become acquainted with the peculiarities of constitution, habits, and predispositions of those he attends, is more likely to be successful in his treatment than one who does not possess that knowledge." So necessary is this injunction, in the estimation of the framers of the Code, that they go further, and make it the duty of the physician himself to oppose his influence against it, and to counteract, as far as possible, the prevalence of the habit. " A physician," it affirms, " ought not to take charge of or pre- scribe for a patient who has been recently under the care of another member of the faculty, in the same illness, except in 8 PHYSICIANS AND THE PUBLIC. cases of sudden emergency, or in consultation with the physi- cian previously in attendance, or when the latter has relin- quished the case," etc. Indeed, the principle involved in this rule cannot be too strongly enforced. The custom to which it alludes—the habit of changing one's physician for trivial causes, or even from mere fancy, caprice, or fashion—has been the fruitful source of evil; it interferes seriously with the success of treatment, and the consummation of the remedial measures which have been deemed necessary; it engenders suspiciouf misunderstanding, and ill will among those who ought to work together hand in hand, and with united purpose, in the responsible and difficult duties of their profession; it tends to create distrust among those between whom, bearing to each other the relation of phy- sician and patient, there should be the utmost confidence and a harmony of interests; and in many ways it leads to the most serious consequences to the sick. It seeks not to dictate to the public whom they shall employ as their medical attendant, for this we have neither the right nor desire to do; but it under- takes to warn them against what every candid and intelligent person must admit to be an evil fraught with danger and dis- aster. In cases of extraordinary difficulty or danger, or wherp dissatisfaction exists, it suggests the remedy in a consultation, which no honorable physician would decline, and which, to use the language of the law, "gives rise to confidence, energy, and more enlarged views in practice." Finally, the closing injunction of th'e Code should be every- where read and observed: " The benefits accruing to the pub- lic, directly and indirectly, from the active and unwearied beneficence of the profession, are so numerous and important, that physicians are justly entitled to the utmost consideration and respect from the community. The public ought likewise to entertain a just appreciation of medical qualifications, to make a proper distinction between true science and the assumption of ignorance and empiricism." In these plain words it points out to all the course of interest and duty. It distinctly asserts the claims of the profession to consideration and regard, and risks the imputation of selfish- ness in its philanthropic effort to guard the interests of the STATE MEDICAL SOCIETY. 9 community from the wiles and specious arguments of the pre- tender. The reason is obvious. As the knowledge of medicine can never be intuitive, as its science is only to be acquired by close study and adequate preparation, and skill in its art and application to disease only by experience and observation, he alone should be considered worthy of confidence who possesses these qualifications. But, says one—we hear it so said every day—" these irregu- lar methods, of which so much is said, cure disease." It is a fact, to which all intelligent physicians will testify, that of the diseases met with in daily practice two thirds or three fourths would, sooner or later, and with more or less inconvenience and difficulty, recover without medicine. Oliver W. Holmes says, I believe, ninety out of every one hundred. A carefully regulated diet, rest, and proper hygienic measures, secure the happiest results. Take the case of rubeola, or measles, which has been exten- sively prevalent during the past few months in Sacramento, attended by all the distressing symptoms peculiar to that dis- ease, and naturally calculated to excite alarm. Of the cases coming under treatment, with tho possible exception of a few of uncommon severity and abnormality, does any one believe that to the remedial measures employed the recovery of their patients was positively due ? Certainly no intelligent physi- cian will make the assertion, when the fact is patent that for every one hundred cases treated by a medical attendant there might be enumerated another one hundred equally successful instances in which no medicine was given. This is but an example of what occurs in many other diseases, and hence, perhaps, the apparent efficacy of some of the popular methods of the day, and to this may be added the influence of faith. It is related of Lord Chief Justice Holt that, when a young man, he possessed, as the story reads, " a flow of animal spirits which could not be restrained, and he happened on one occa- sion, with some companions, to stop at an inn in the country, where they contracted a debt of such an amount that they were unable to defray it. In this dilemma they appealed to 2 10 PHYSICIANS AND THE PUBLIC. Holt to get them out of the scrape. Holt observed that the innkeeper's daughter looked remarkably ill, and was told by her father that she had an ague. Hereupon he gathered sev- eral plants and mixed them together with a great deal of cere- mony, afterwards wrapping them in a piece of parchment upon which he scrawled certain letters and marks. The ball, thus prepared, he hung about the woman's neck, and the ague did not return. After this, the never-failing doctor offered to dis- charge the bill, but the gratitude of the landlord refused any such thing, and Holt and his companions departed. When he became Lord Chief Justice, a woman was brought before him accused of being a witch. She was the last person ever tried in England for witchcraft. She made no other defence than that, she was in possession of a certain ball which invariably cured ague. The ball was handed up to the Judge, who untied it, and found it to be the identical ball which he had made in his youthful days, for the purpose of curing the woman's ague and paying his own bill." There is present here, to-night, a member of this society, who is able to bear witness to the success of a not dissimilar charm in his own person, applied for the cure of a most distressing and agonizing toothache. The inscription of certain secret words upon a piece of paper, and this carefully folded and sewed inside of his cravat by an old and secluded hermit, with the exacted promise never to open the package, and the payment of a fee, was suddenly, perfectly, and permanently successful. Weeks afterward, when the pain had gone, and even the fear of its return, curiosity overcame his youthful prudence, and upon opening the cravat and the mysterious paper it contained, he read these memorable words: "If ye have faith as a grain of mustard seed, ye shall say unto this mountain, Remove hence to yonder place, and it shall remove." In both these instances, the charm acted through the medium of the imagination—its saving virtue rested securely upon the strong arm of£n implicit faith. The same may be said of the horse-chestnuts, so often carried in the pockets as a certain cure and preventive of rheumatism; and upon a similar principle may be explained the efficacy of the live eel, formerly prescribed Sir Kenelm Ligby, for fever STATE MEDICAL SOCIETY. 11 and ague. The recipe is thus given by Oliver Wendell Holmes: Pare the patient's nails, put the parings in a little bag, and hang the bag round the neck of a live eel, and place him (the eel) in a tub of water. The eel will die, and the patient will recover." It is the same with many other things in medicine, in which the fallacy lies in the assumed connection of cause and effect. The patient gets well, therefore the last prescription cures him, and, as a consequence of the habit of which we spoke just now, of changing one's physician during the progress of a case, the injustice is too often done of ascribing the recovery to the supe- rior skill of the last comer, or the last method tried. In reality, he may have had nothing more to do with it than the eel with the cord around its neck, or the horse-chestnut which one car- ries in his breeches pocket. The observations just made are applicable to a large number of diseases, such as are " self-limited," whose history is definite and well known, which naturally run through a certain series of symptoms or variations, which medicine is powerless to in- terrupt or abbreviate, and in which time and nature are capable of doing more for their cure than the most practiced art. It is in such that the irregular methods have their apparent success. They are commonly the acute forms of disease—many of them familiar to every one as belonging to the class of mild erup- tive fevers, of which measles, to which allusion was just now made, may, as it ordinarily appears, be considered one. They are precisely the cases in which the physician is most fre- quently called, occasioning alarm from the seeming severity of the attack, and the prominence in which certain active symptoms are presented, but in which, in reality, the true office of the physician is to guard against accidents and complications, to palliate their violence, to alleviate suffering—in a word, to con- duct the patient safely and comfortably through, with little medicine, but with special attention to the more essential sub- ject of a well regulated hygiene. Important offices!—far more important and difficult, at times, than administering active drugs or pleasing the fancy with small pills! But these remarks, however true in themselves, and however applicable to the complaints so commonly met with in practice, 12 PHYSICIANS AND THE PUBLIC. cannot be used as an argument against the utility of medicine, or the necessity of securing the services of a physician, even in the incipiency of disease. All diseases are not self-limited and curable by the unaided efforts of nature; and of those to which this appellation may properly be applied, it often happens that the most active and judicious interference is suddenly demanded. In all cases, he only can judge—and he who is the most skillful can judge best—of the necessity of medication. The physician is needed, moreover, to give encouragement to the sick, to allay undue apprehension, and to place them under conditions favoi'able to recovery. But there are some diseases which medicine can cure, and medicine only. The most dangerous forms of disease may be lurking under what, to the untrained eye, may appear a trivial beginning; and hence the advice of the Code, where it says: "A patient who has thus selected his physician should always apply for advice in what may appear to him trivial cases, for the most fatal results often supervene on the slightest accidents. It is of still more importance that he should apply for assist- ance in the forming stage of violent diseases; it is to a neglect of this precept that medicine owes much of the uncertainty and imperfection with which it has been reproached." It is in cases like these that medicine achieves its real tri- umphs; it is in the hour of danger, when the issue of life may rest upon the decision of a correct judgment, a quick discern- ment, and the application of a read}' skill, that regular medicine rises above the vagaries of the hour, and extends its benefi- cent aid to relieve the pangs of suffering, or rescue trembling humanity from death. It is in just such cases as these that the physician becomes, the real benefactor—in such as these, that the painful, arduous duties of his ministry are softened and sweetened by the consciousness of duty nobly done, and his confidence reassured in the amazing resources of his art. It has been, then, in no spirit of exaggeration that I have designated the office of the physician as one of active benevo- lence. It embraces, in the exercise of its highest functions, something more than his routine care and daily attendance at the bed of sickness. By his intercourse with the families of his charge, he is brought into close personal relations with STATE MEDICAL SOCIETY. 13 them, he assumes the character at once of physician and friend, and oftentimes, under the most trying and delicate circum- stances to which poor, weak humanity is subject, it is his special office to become the confidant and counselor, to bind up the bleeding heart and administer consolation, as he only can do, to the broken spirit. There are those who fully appreciate this solemn and interesting relation; there are those to whom the visit of the physician is as the return of a friend, and who lighten the responsibilities of his position by tokens of confi- dence, and encourage his labors by evidences of their apprecia- tion. From such as these, and in such acknowledgments as these, he receives his highest reward; for no pecuniary com- pensation, no sordid or mercenary consideration, can equal the gratification which springs from the recognition of acts of gratitude, and spontaneous, open-hearted attestations of esteem. Unhappily, the observance and appreciation of this true rela- tion of physician and patient are seldom witnessed; and the fact may be due, in part at least, to the unfitness of many who assume the name, properly and intelligently to fulfill the responsible duties of the profession. Often, too, the public has no means of distinguishing the worthy from the unworthy, the educated, but unassuming man of science, from the ignorant and, sometimes, unprincipled pretender, and has come at last, through bitter experience, to entertain distrust and suspicion. Perhaps, until the public shall have learned to distinguish the one from the other, until by sad disappointments and unrealized hopes it shall have been taught the lesson of discrimination, legitimate medicine must continue to suffer for the sins of empiri- cism. This is especially true of new communities and societies. It is only when population becomes stable and permanent that the medical attendant, once chosen, descends as it were by right of inheritance, the trusted reliance of a family, the friend, the confidant, and counselor. Such a condition of things may be seen hereafter even in California, when the habit of changing the physician for trivial cause, or running after each new method *as it arises, from motives of caprice, may be the exception rather than the rule, but it will be only when men have learned, as sooner or later they will learn by sad and afflicting tokens, that the path of safety lies in placing full confidence in the physi- 14 PHYSICIANS AND THE PUBLIC. cia» of their choice, and by entwining and associating his interests with theirs, to strengthen the ties of mutual attach- ment, and confirm his zeal in the important duties of his mis- sion. With these running and imperfect commentaries upon our Code of Ethics, in so far as it refers to the relations of the phy- sician and the public, I shall relieve your patience. They have not been made for the purpose of attack or defence. With other methods, it is not the office of the regular physician to contend, nor does the great system to which he holds allegiance need defence. Resting upon the experience of ages, enriched by the labors of the best and wisest of men, fertile in its resources, vigorous in its maturity, it pursues its steady, onward career, drawing its pabulum from every source, extending its sphere over all the world, and distributing its priceless bless- ings wherever disease has entered or humanity suffers. In the ranks of this profession the great benefactors of the world have lived and labored, and here their triumphs have achieved. " This profession," to use the language of another, (*) "is to-day the custodian of all the great hospitals of the world, from Constan- tinople to London, from New York to Pekin. The student of medicine who visits the Old World for instruction will find that not one of their great schools has swerved from the ancient but progressive faith. He will return a disappointed but a wiser man, if he expects to find a school where the dogmatists are teachers. " The literature of the practice of medicine, from Hippocrates down to our own Watson and Niemeyer, is ours, and does not contain a line of comfort for absurd theorizers about the princi- ples upon which remedies act. "The anatomical and physiological researches of Galen, Val- salva, Eustachius, Corti, with hundreds more down to Helm- holtz, Richardson, Flint, Dalton, and Draper, of the nineteenth century, form one of the quarterings on an untarnished shield. " The surgical achievements of Pott and Larrey, of Syme and Simpson, of Cooper and Dieffenbach, of the Potts, Parker and Mott, of Stromeyer and Billroth, of Langen bach, Erich sen, (1) D. B. St. John Koosa—Address. STATE MEDICAL SOCIETY. 15 Ferguson, Bigelow, Sims, Van Buren, Pancoast, Sayre, and Gross, are the glory of the profession, in which the adherents of dogmas have no part. " Pathology, the offspring of modern times, is one of her chil- dren, and she points with pride to such names as Rokitanski, and Virchow, Strieker, Robin, Claude Bernard, and Beale. " In special researches, where, outside of her ranks, can be found the peers of Mackenzie, Ardt, and Bowman, Wilde, Troltsch, Gruber, and Politzer, Donders, Hebra and Wilson, Emmett and Learning, and what body but the regular profes- sion is the guardian of the memory and fame of Albrecht Von Graeffe?" v..