DISSERTATION, ON THE i Si RESPECT DUE TO THE MEDICAL PROFESSION,|| AND THE REASONS THAT IT IS NOT AWARDED BY THE COMMUNITY. m I By WORTHINGTON HOOKER, M. D. P K READ AT THE ANNUAL MEETING OF THE CONNECTICUT MEDICAL SOCIETY, MAY 8, 1844. NORWICH: J. Q. COOLEY, PRINTER. MDCCCXL1V. m m m CfiS) DISSERTATION, RESPECT DUE TO THE MEDICAL PROFESSION, AND THE REASONS THAT IT IS NOT AWARDED BY THE COMMUNITY. By WORTHINGTON HOOKER, M. D. READ AT THE ANNUAL MEETING OF THE CONNECTICUT MEDICAL SOCIETY, 3IAY 8, 1844. '■• v . j.; c " • . ;>v V NORWICH : ' J. G. COOLF.Y, PRINTER. MDCCCXLIV. DISSERTATION. The relation which the physician sustains to the commu- nity is one of great respoftsibility and importance. In the magnitude of the interests depending upon it, it bears no comparison with any of the numerous relations of man to his fellow-man, except it be that of the embassador of the cross; but it stands out in bold contrast with them. They have regard, for the most part, only to comfort, con- venience and wealth; but this to health and life. It is true, the relation of the lawyer does sometimes rise above the common level of minor and temporary interests, when some great principle of right is called in question, and especially when the life of a fellow-man depends on his exertions. But this is only occasionally; while the physician has the issues of life and death hanging every day upon the efforts which he is making, in the ordinary rounds of his business. Besides the dread responsibilities thus resting on the phy- sician, there are other circumstances which add to the inter- esting character of his relation to society. He is admitted freely into the very bosom of families in every walk of life. He is to them the familiar friend, as well as the physician; 6 and when, in the course of years, he has been with them in seasons both of death and recovery, of sorrow and of joy, of urgent danger and then of relief and escape, the mutual attachment is often deep and tender. When we witness this in a single case, it stamps a high interest on the rela- tion of the physician. But when we see it multiplied by the great number of such cases, accumulating in an exten- sive and long-continued practice, this interest becomes a vast aggregate, making his station one of preeminent im- portance. Add to all this one other circumstance — the extent and variety of opportunity which the physician has for the ex- ercise of an active benevolence. No one gives more real and arduous service to the public gratuitously than he does. The poor, who are always with us, and who, from their ve- ry poverty, are more apt to be sick, and to suffer more in their sickness from the want of ctunforts, and the necessary struggle with their circumstances, draw largely on his time and his exertions. And without boasting, we can truly say of our profession, that when these are not cheerfully given, it is an exception to a general rule. Physicians are, commonly, actively benevolent; and the world, however un- just it may be in other respects, generally accord this to us. Such high and ennobling interests being thus clustered around the relation of the physician, if he be properly qual- ified for his work, so as to do his whole duty, and if, when thus qualified, he be regarded and treated by the community as one faithfully meeting such responsibilities should be, what dignity rests upon his station ! Feeling that the confi- dence which he merits is reposed in him, he goes on with vigor and gladness in his career of mercy and usefulness, quickened to exertion, and not disturbed and borne down, by his anxieties and perplexities and cares. I refer not to that false confidence which the physician cftc:i ob- tains in common with the empiric—and I regret to say by 7 the same base means — but to that well-grounded and intel- ligent confidence which we see sometimes awarded to the high-minded and honorable physician. When this is both deserved and awarded, we have in realization the beau ideal of the relation which the physician should sustain to socie- ty. But we have to lament that it is very seldom thus re- alized. And if this arose only from deficiency of qualifica- tions on his part, and in just proportion to that deficiency, it would be well. But this is not true, either of individuals, or of the profession as a mass. Confidence is not reposed in proportion to the amount of merit; but it is to a great de- gree governed by whim and caprice; and the whole com- munity do not regard an educated medical profession with that steady and intelligent esteem that they do the other pro- fessions. Let us for a few moments examine the proofs of this as- sertion. The first proof which I shall cite is the acknowledged fact, that there is more of quackery in medicine than in the pro- fessions of law and theology. The evidences of this fact are palpable and numerous. The amount of quack adver- tisements in the papers of the day, indicate the enormous appetite of the people for empiricism. In one paper of twenty columns, I counted recently eleven filled with such advertisements. And the evil has of late years largely in- creased. Formerly you would see but a few secret nos- trums advertised year after year, such as Anderson's Cough Drops and Moore's Essence of Life. But now there are new medicines constantly appearing in rapid succession, and going quickly through their several stages of rise, acme, and decline. Adventurers in this broad field of imposition spring up in abundance, and some are from our own ranks, which they have deserted, with the hope of making a for- tune in a day, instead of plodding along through life in the poorly-compensated but noble duties of the true votary of medical science. 8 And quackery is far from being confined to the unlearned and ill-informed. Men of respectability and acknowledged good sense in other matters — men who would be sure to get the best legal advice, and to sit under the ministrations of a regularly-educated clergyman — are not only willing to take quack medicines, but they imbibe some of the wildest notions of the day, and employ the most ignorant empirics, and degrade the educated physician down to a level with them in their estimate of his professional character. The lawyer himself, though he sees his own profession hemmed in by the strict limits of a prescribed education, and by a formidable array of antiquated technicalities, thus opposing to the intrusion of quackery a firm though time-worn and moss-covered wall, that it cannot scale—even he is often seen encouraging in our profession empiricism of the grossest kind, and perhaps cheers on and assists an ignorant populace in pulling down our modern wall, which has been so recently built that its uniting cement is yet hardly dry. The legis- lator, too, appointed by the people as the protector of all those barriers which have been erected to guard them at every point against the evils of irresponsible ignorance and secret imposture, though faithful to his trust in relation to all other interests, and instinctively shrinking from jeopardizing them by the withdrawal of the defenses of law, batters down, with ruthless hand, the barriers which protect the health and life of his fellow-citizens, and sends in through the breach the whole motley herd of illiterate and reckless quacks. And the clergyman, who deplores gross theologi- cal errors that come from irregularity and forsaking of the old paths, and is of the straitest orthodoxy in excluding quackery from his own profession, is often seen foremost in the ranks of the patrons of medical empiricism. Though he may strain at a gnat in guarding against theological quackery, when he comes to medicine verily he is ready to swallow a camel. 9 And here we cannot forbear saying, that clergymen, above all men. should not be found among those who favor empiricism. For the most part they receive the gratuitous attendance of the physician, which is most cheerfully given to a class who labor so arduously, and for so small a com- pensation, as they ordinarily do, for the good of their fellow- men. And yet many of them often bestow the weight of their powerful and extensive influence on the encourage- ment of systems of quackery and patent nostrums. Some of the chief supporters of Homoeopathy, and other kindred delusions, are distinguished clergymen. Though quackery is more rife in medicine than in theology, it has of late years made some very serious inroads upon the clerical profession. Irregular and irresponsible evangelists, and their measures, bear the same relation to the established ministry, laboring in their appointed way steadily from year to year, that wandering empirics and their nostrums do to educated physicians and their modes of practice. The si me pleas are made for the one as for the other. It is said that the evangelist and his measures do good; and the same is as truly said of the quack and his medicines. And the same can be said, too, of the evil results in the two cases; viz, that they vastly overbalance the good that is done. It would be interesting to follow out the parallel, and show the similarity, in many points, in the results of quackery in religion and in medicine. But my limits will allow me to al- lude to only one of these points. As the votary of medical empiricism loses all rational confidence in educated skill, and is continually running from medicine to medicine, and from system to system, so he that imbibes the principles of quackery in religion acquires a distaste for the regular min- istrations of the gospel, and is ready to adopt every new notion or measure that can feed his desire for excitement and novelty. An unsettled and ever-varying state of things is the legitimate result in the one case as Avell o^ in the 10 other. And now that the clerical is suffering similar tribu- lation with that which has always burdened the medical profession, we shall hope to have some sympathy from that quarter—sympathy which will prompt the clergy to apply the same principles to medical that they do to theological quackery, and to eschew the former as decidedly as they do the latter. The second proof which I shall adduce of the truth of the assertion, that public sentiment does not award the same respect to the medical profession as it does to that of law or divinity, is the fact, that success is not in such just propor- tion to merit among medical men, as it is among the mem- bers of the other professions. Men of little talent and small acquirements, often obtain a large medical practice; while, on the other hand, many physicians can be found, of real merit, whose practice is very limited. This is not so either in the profession of law or of theology. Perhaps it will be said that some who are far from being good lawyers, acquire a large legal practice. But to do this, though they may not be accurate and learned in the law, they must have real talent of some kind, either as advocates or as business men. They cannot do it, as physicians often do, by mere tact and cunning, exercised not in the appropri- ate duties of the profession, but in producing false impres- sions of their skill on the public mind — not in managing disease, but in managing the whims and caprices of their employers. It is an utter impossibility that any lawyer should acquire a large business, with so small an amount of talent, as is possessed by some physicians who have an extensive practice — and that, too, among the wealthy and learned and titled in our land. And on the other hand, there are many members of our profession, delving their way through life with a practice that barely gives them a suste- nance, who would, with the same talent employed in the legal profession, obtain an abundance both of honor and 11 emolument. The same comparison can be made for the most part with the clerical profession. In natural connection with the proof just adduced, there is another. It is the fact, that a physician's reputation among the members of the profession, for talent and skill, is very often no measure of his reputation in the community — a fact which does not exist, to any extent at least, in the other professions. It is often the case that a physician of small practice is highly respected by his medical brethren, and his advice is valued by them in difficult cases; while, on the contrary, there are men enjoying a lucrative business, whose opinions have very little weight with their brother physicians. Considerable deference is paid to them, it is true; but it is only from necessity, from .the elevated station into which the community have put them from a false esti- mate of their merit. This distinction between reputation in the profession and a mere popular reputation is often so palpable, that it is a subject of common remark; and it is a most decisive evidence that medical skill is not estimated by the public upon right grounds, and often fails to gain that respect which is its due, and which is more surely awarded to talent in the other professions. 1 have no reference in the above observations to physi- cians who have talents of a high order, and yet who have not good judgment and common sense to guide them. There are many such, who, though very acute and ingenious in their speculations and theories, are far from being good prac- tical physicians. These may and sometimes do succeed in gaining a reputation among the people, in spite of their real incapacity for a judicious performance of the duties of the rhys;cian; though they ordinarily do not. These are not the cases which I had in my mind. I referred to cases in which t';e failure to succeed dees not arise from any deficien- cy of judgment in managing disease; but from want of skill cr rather tact in producingconfidence on the part of the com- 12' munify. This is a talent, it is true ; but it is one which i» possessed by many who have very little skill in the treat- ment of disease. One more proof of the truth of my assertion remains to be noticed. * The standing of a physician, with the public is nofnecessarily influenced by the opinions which he avows on medical subjects. A reputation for wisdom and talent in the other professions is very much affected by the doctrines which are advanced and defended. If they militate against sound reason and common sense, the wisdom of their au- thor is called in question. If he be fanciful in his notions and theories, his opinions have little practical weight with the community, though it may accord to him the merit of talent and ingenuity. The people, for the most part, render a just verdict in such cases. But it is far otherwise with medical men. Sound judg- ment and real wisdom need not to be stamped upon their opinions and teachings, to give them favor and currency with the people. False, fanciful, and even ridiculous doc- trines may be advanced by a physician without injuring his standing with his employers—as well those who are learned and well informed, as the illiterate and unthinking. Nay, they may even add to his popularity. Men seem, when they come to the subject of medicine, to leave behind them all those tests, which they commonly apply to sentiments and opinions, to discover their wisdom or to detect their folly. Even those who exhibit great stability and acuteness of mind in sifting truth and rejecting plausible error on other subjects, are often seen to be blown about by every wind of doctrine in medicine. Homoeopathy furnishes a good illustration of these re- marks. This new science, (as it is impudently styled by its advocates), has among its votaries many of the wise and learned. It is the refined and polite system of quackery of thejn-esent day. though it is now threatened with an eclipse 13 by the rising Hydropathy of Priessnitz. It is really aston- ishing to see persons of acute discernment, who are accus- tomed to examine every thing minutely, and receive almost nothing upon trust, devour with the open mouth and closed eyes of credulity, the wildest notions of Hahnemann. There is one of his doctrines which I believe they do reject, and it is one which he says it cost him twelve years of study to establish. It is this. The great majority of chronic com- plaints arise from the disease vulgarly called the itch! The difficulty in receiving this is not its folly, for his other opin- ions are as palpably foolish as this is. The true reason is, frfht it is too gross and vulgar for the refined followers of Hahnemann, and therefore they say nothing about it, even though this great reformer in medicine proclaimed it as one of the three grand discoveries> which were to make him immortal in fame. But it is often said that many physicians have adopted the Homoeopathic views, and that some of them are of high standing. This is far from being true. Very few physi- cians of any respectability have adopted them, and none of those few have ever had a commanding influence in the profession. So far as my observation has extended, those physicians who have become Homoeopathisls belong to two classes — those who are visionary, and who are apt to en- gage in new projects with enthusiasm ; and those who have taken up this mode of practice to secure patronage, which they would fail to obtain by pursuing a rational course, without regard to the prevailing whims and tastes of the community. The doctrines of Homoeopathy have sometimes been most unjustly classed with other theories that have been advanced by medical men, such as that of Broussais, for example. And it has been said that physicians dislike, and treat with con- tempt, any one who introduces any new doctrine or system. This is not so. Though the doctrine of Broussais was di- 14 rectly opposed to the commonly-received notions of the pro- fession, he was always treated with respect, and even hon- or, by his opponents, because in the midst of his errors truth was developed, and real talent was displayed. But it is not so with Hahnemann. His doctrine is an outrage on all truth, and even common sense. It is as much out of the way of all reason in medicine, as Millerism or Mormonism is in religion. It is worthy only of mingled pity and con- tempt. The doctrines of Broussais and Hahnemann are both false doctrines; but while that of Broussais has some mix- ture of truth in it, and has led to investigations which are really beneficial that of Hahnemann is,wholly false and rid- iculous, and leads to no good results. Perhaps it will be said that false theories are often main- tained in law and theology, and their authors get much cre- dit for their talent and ingenuity. But they are theories of the same stamp as that of Broussais is in medicine. No le- gal or theological doctrine, so fanciful and so encumbered with folly as Hahnemann's is, could ever give its inventor applause among the learned and refined, as Hahnemann's doctrine has done for hrm. He would be ridiculed, not only by the members of his own profession, but by all the wise and judicious in the community, many of whom give to the Homoeopathy of Hahnemann and other kindred follies their approbation and their patronage. Having thus considered the principal proofs of my asser- tion, that the medical profession is not respected as the other professions are, I now invite your attention to the causes of this want of respect. As my object is a practical one, bear- ing directly upon our responsibilities and duties as physi- cians, it is not my intention to go into an examination of ail these causes, but only those which exist in the profession it- self. Let us look at these faithfully, and do what we can to remove them. I have already spoken of a false and fanciful confidence, 15 which is often reposed in the physician, as well as in the empiric, in contrast with a rational and steady confidence, based on true grounds, and having nothing in common with empiricism. It is this latter kind of confidence which the medical profession should claim of the public as its right. But this claim is too often waived by the physician; and he enters the lists, to obtain the prize of popular confidence and applause, on the same terms with the most arrant quack. Like him he yields to the caprice and whims of the multitude to gain their favor. When he does this he inflicts a wound upon the honor of the profession; and, by bringing it down from its noble and elevated calling to a competition with empiri- cism, essentially degrades it in the eyes of the community. I would be far from recommending that the physician should-court a war with every popular notion of a false char- acter. But he should never shrink from the encounter, when by doing so he would compromise the dignity of the profession. Yet there are many physicians, who not only prove treacherous deserters at such times, but. actually go over to the enemy, that they may get a share of the spoils. You can find an illustration of these remarks in any of the popular errors of the day. Take, for example, the pre- judice which has existed against the use of calomel. Many physicians have made use of this prejudice, to a greater or less extent, as a hobby to ride into popular favor; while, perhaps at the same time they have administered this reme- dy nearly, if not quite, as much as they ever did, but con- cealed in combination with other medicines. Instead of striving, as they should do, to convince their employers of the truth on this subject, they yield an assent to their notions, and aim to produce the false impression that they use this drug much less than other physicians do, perhaps even that they do not use it at all; thus, by base insinuations, in- flicting an injury upon their brethren, and on the profession 16 at lame.* Let me not be understood to claim that the fact of its use should always be made known, as a matter of course. The good of the patient may require that this knowledge be withheld, and then it should be done, if it can be cmsistsntly with real honesty. Bui, I do protest against such sheer deception as giving this remedy in combination with something else, and calling it, for ex- ample, a quieting powder, a deception which I have known to be practised more than once. And I protest, also, against makins use of this, or any other popular whim, to build up one's own interest to the detriment of the interests of others. Similar remarks might be made in regard to other prevalent notions, but this will suffice. I have said that the physician has two kinds of reputation ; a reputation with the people, and another with the profes- sion- that they are for the most part based on different grounds ; and are often no measure of each other. There is too much disposition, on the part of many physicians, to prefer decidedly a popular reputation to a strictly professional one, for two reasons. It requires less skill and talent nnd study to obtain it, and when it is obtained it is more profita- ble. Many therefore determine to acquire this at all haz- ards, even if it be at the expense of honor and good stand- ing among their brethren. They thus waste their energies in efforts, which not only tend to impair, rather than increase, their skill in the treatment of disease, but contribute also to lower the general standard of attainment in the profession, and consequently the respect which it receives from the community. The science of patient-getting is often more assiduously studied than that of patient-curing. Real suc- cess is not s:: much desired as the mere appearance of it. *Armetiian bole, as it is an inert substance and yet has a decided color, is quite a favorite article with those who practice this concealment, a.id many a physician has gained much credit from the wonderful effects of his pink powders, hit. patient not once dreaming that they are calomel in disguise. 17 Common ground is taken with the boasting charlatan. The people are to be imbued with a great sense of the physician's skill without any reference to real merit. The object is to be attained, at any rate, and whether it can be done on true or false grounds, seems not to be very material. If this evil were confined to but a few members of the pro- fession, and those few were of low character and limited in- fluence, I would not dwell on this point. But it is a fact that cannot be disputed, that some physicians of real skill and talent are tempted.out of the right path, to cater for the em- pirical tastes of the multitude, in order to build up their rep- utation. And they are sometimes heard to justify such a course by the false and cowardly plea, that often the only way to compete successfully with the ignorant and dishon- orable is to meet them on their own ground, and fight them with their own weapons. Self-interest is often seen thus sacrificing the good of the ^ profession, when the two come into apparent opposition. The very language, which some physicians habitually use in regard to the practice of medicine, prompted by this spirit, is calculated to degrade it in the estimation of the multitude. Instead of defending the profession, and its members, against the attacks of empiricism, and the more common, and at the same time more injurious, attacks of sly and covert insinua- tion, they lend to them their approbation and encouragement, looking only to their own private advantage, and caring not for the welfare or character of their brethren or of the pro- fession. But if we wish the profession to prosper, and to prosper with it ourselves, this narrow and selfish spirit must be ban- ished from among us. We must cultivate an honorable es- prit du corps, and temporary emolument must be given up whenever required to advance the interests of the whole. It is a short-sighted policy to pursue a different course. Though success may be the result, it is at the expense of 3 18 great pains-taking, and coupled with the loss of self-respect and of an approving conscience. Besides, success thus obtain- ed is insecure. Built on tastes and notions which are evan- escent and changing, it may be easily lost. And if it be re- tained through a long life, it is done by such constant and anxious labor to ensure conformity with popular changes, that there is none of that quiet and dignified enjoyment, which attends the success of the honorable and independent man of science. The physician who chooses to employ mean and empirical arts in acquiring his reputation, does so for the most part with impunity, so far as public opinion is concerned. The community generally have very loose ideas of the rules of honorable intercourse among physicians, and are disposed to cast contempt upon anything like medical etiquette—a dis- position, which dishonorable members of our profession, for obvious reasons, are very willing to encourage. And then, too, the quackery, of which regular physicians are guilty, is apt to be of an intangible character, escaping the eye of the common observer. It is very much like the profanity of some people, which instead of being bold and open, is ex- pressed in language so modified as to keep within the limits of a conventional decency, and in prinfe appears only in ini- tial and terminal letters with a dash between them. This stealthy skulking quackery among medical men, that fears the face of day, does vastly more injury to the profession than glaring and shameless empiricism, with all its array of certificates and advertisements. These thrusts in the dark from professed friends inflict more severe wounds than are ever received from the open foe. The evil of which we speak commonly exists to a greater ex- tent in the country than in large towns and cities. Wherever there are physicians enough to form a real medical commu- nity, having a public sentiment as a living efficient principle of its organization, we have a good corrective for this evil, 19 though not an adequate one in all cases. Under such cir- cumstances a character with the profession, both for honor and for skill, is obviously of more value to its possessor than it is in a scattered population, where one's strictly profes- sional character is not so well known by the people, and where any infraction of our established rules of intercourse can meet for the most part, with only individual rebuke, which, however just and proper it may be, is exceedingly liable to be attributed to personal feeling and prejudice. If all physicians would adhere strictly to the rules that are laid down in our articles of medical police, and endea- vor to make the intelligent and influential in society ac- quainted with them, and point out their reasonableness on all proper occasions, the petty contentions which now so of- ten degrade the profession, would cease, and it would no longer be a by-word for its uncertainty and its disagree- ments, not to say its quarrels, but it would command, as it should do, the confidence and respect of the whole commu- nity. We may sometimes find a striking verification of these remarks, by looking at the comparative state of the profes- sion in different places. Wherever you see physicians har- monious, careful of each other's character, seeking for repu- tation on right grounds, and governed by the rules of honor in their intercourse and their competition, there you see the profession receiving the esteem which is its due, and quack- ery hides its head in shame. But where you find the mem- bers of the profession in any place engaged in contentions with each other, and relying upon mere tact and the artifices of empiricism in gaining a reputation, you will see that community placing a low estimate on educated skill, and quackery will be bold and impudent, basking in the sun- shine of popular favor. A single physician often does great harm by lending his influence to produce such a state of things in a community; and thus makes one of the best il- 20 lustrations in the world of the important truth, that • one sinner destroyeth much good.' He introduces jealousies and broils among brethren, who would otherwise be at peace — provokes them to retaliate his dishonorable treatment — and puts them in a false position by making false issues with them before the public. And if he be endowed with some tact, he may do all this and yet manage to keep the good opinion of a large portion of the community; especially if he can link in with himself some of his medical brethren by the strong bond of self-interest, so that they will be dis- posed to defend or at least palliate his conduct. Many of the members of our profession have been guilty not only of using the arts of empiricism, but of giving cur- rency to its nostrums. To say nothing of the occasional ad- ministration of patent medicines to gratify the desires and whims of the sick, a long array of distinguished men from our own ranks could be adduced, as having given the weight of their influence to quackery by certificates setting forth the virtues of secret medicines. And as the voice of the whole profession has not been loudly and perseveringly lifted against this evil, it is chargeable with the sin of consenting to its existence. Never can we offer a bold and unbroken front in opposition to quackery, till we individually and col- lectively maintain to the letter the true principle on this sub- ject, which is this : that secrecy in regard to the composition of medicines is opposed both to the usefulness and the dignify of the profession, and is calculated to deceir'c and injure the community. The multitude of boasted new medicines which are constantly put forth, are, with very few exceptions, old combinations of well-known remedies, perhaps a little mod- ified ; and they would have no favor with the public if they were stripped of the charm of secresy. The only way to guard effectually against this kind of imposture is obviously to discard utterly all secret nostrums. If any physician has made any real discovery, let him bring it out to the light, 21 and prove his title to the high honor of a discoverer in the fields of science; but let him not enter into competition with the herd of pretenders, who are palming off upon the public old remedies as new discoveries, merely because., he may in this way realize more pecuniary profit. The fact that he does so is presumptive evidence that he really belongs to that vulgar herd. There is one evasion of the principle that I have stated, against which I must here most strongly protest. Some phy- sicians have offered medicines for sale, informing their agents that the composition can be made known to any medical man who desires it. This is a very different course from that which the honor of the profession demands of one-of its members. For after all, while the composition of the medicine becomes in this way very slowly known to physi- cians in different parts of the county, its sale is rapidly forced upon the public by blazoning advertisements and nu- merous agents in every quarter; so that, if it be found to be really nothing new, the community are effectually cheated, for a time at least, and the more so perhaps from the appa- rent candor and honesty with which its author is disposed to treat his medical brethren. So popular and successful has this course been, that some of the 'venders of secret rem- edies out of the profession have also adopted it. Our duty is so clear, and so well established in regard to secret nostrums and patent medicines, that I have had some hesitation in dwelling at all on this subject. But there has been, and still continues to be, so much laxity among the members of the profession on this important point, that it seems to be necessary on all proper occasions to proclaim our principles, and insist upon a strict observance of them. I have thus, with all plainness, pointed out most of those causes of the want of respect on the part of the community towards the medical profession, which have their existence in the profession itself. I have done it for a practical pur- 22 pose, with the hope that we may be aroused to the removal of these causes, so far as they may be found within the bor- ders of our society. To effect this we must do our duty, both individually and collectively, in obedience to those principles by which, as men of science and fellow-members of a noble profession, we ought to be governed. Let us address ourselves then in good earnest to the work of building up the marred and decayed honor of our profes- sion, and endeavor to place it in that elevated position which a profession should have, bearing such high responsibilities, engaged in so noble a work of humanity, and justly claim- ing to be the repository of the medical knowledge which has been accumulating from the labor of ages in study and research and experience. Let us have no communion with empiricism in any form. Let us carefully discard every thing that is inconsistent with honor and a good conscience, for no body of men nor profession can command the respect of the community for any length of time without self- respect, any more than an individual can. Let competition always be honorable, and not descend to the low arts of the mere pretender to skill. Instead of being actuated by a nar- row and unjust selfishness, let us cultivate* that esprit du corps which will lead us to act in unison for the good of the pro- fession as a whole. There never has been a time when there was a more im- perative necessity for the application of these principles in our profession; and I may say, too, there never has been a time when they could be applied to more effect. Never has there been so much of empiricism as there is now. Never has it assumed such a variety of forms to suit all tastes, and never has it made such daring onsets upon the medical pro- fession. Never have the opinions of the people been so thoroughly unsettled in regard to different remedies and modes of practice; and the remark is heard every day, even from men of intelligence, ' in medicine I know not what to 23 believe.' But I see the dawn of a better day for our profes- sion in this wavering public sentiment, and in this abund- ance of quackery. There seems to be a crisis coming now. Quack remedies and systems used once to succeed each other so slowly in the public favor, that the empirical taste of the community was simply well nourished ; but now it is becom- ing so satiated that disgust must to some extent be the con- sequence. The intelligent and well informed among the vo- taries of quackery cannot but see the utter folly of the pre- tensions which herald every one of the thousand remedies and the many systems that are now struggling for the favor and patronage of the public. They will soon get weary of following after so marry bubbles, only to see them burst and disappear, and will come back from their wanderings in the ever-Varying mazes of empiricism, to repose a steady confi- dence in educated wisdom and skill. In this state of things — truly a transition state — much can be done by physicians in moulding public sentiment aright. In order to do this, it is plain that the process of purification must be gone through by the profession itself. It is in vain to expect even the intelligent and judicious, to ;say nothing of the ignorant and unobserving, to give up em- piricism, unless we banish it from among ourselves. And there are some evident signs to encourage the hope that this will be done. The rapid increase of quackery has aroused the profession; and though some have proved deserters and some are prowling about to gather up the spoils, wherever they may be found, the great mass of its members are be- ginning to give up mutual dissensions, and sacrifice their selfish interests, to unite their energies against a common enemy. I cannot conclude this dissertation without remarking upon one event which touches material^ the interests of the pro- fession in this State. I refer to the repeal of the eighth sec- tion of our charter. If this repeal simply gave to the em- 24 piric the right to collect, in common with us, his dues, I would not waste a word on the subject. It is a great mis- take to suppose that this is the point of our objection to that act.of the legislature. The results of that act, of which we complain, are Of vastly greater importance than this. We object to it, first, because the legislature in their capacity, as the representative wisdom of the people, have thus openly said that education in medicine is valueless, and that the community need none of that protection against the hazards of unskilful ignorance which is thought so necessary to guard all other stations of responsibility and trust. And we object to it, secondly, that this act has, without any consent on our part, essentially affected our .organization — that is, as a society existing under the protection and supervision of law. For in that repealed section is contained the only pro- vision pointing out the kind of persons who shall compose the society. So that no physician who was not then belong- ing to the society can become a member under our present regulations: and when those who were members by law when the act of repeal was passed, shall ail be deceased, the society, in the eye of the law, will be deceased also, if things are allowed to remain as they now are. Though, as I shall soon show, another part of the charter fortunately furnishes as with the means of repairing the breach thus made, nev- ertheless the legislature has destroyed the present principle of our organization, iipon which the society has acted for years, and has driven us to the alternative of asking for a restoration of this, or of adopting a new principle for the admission of members. This result was probably not in- tended by those who passed the act. But it is not wonder- ful that, when the legislature undertook to give its sanction to quackery, it should betray its own quackery by the com- mission of so gross a blunder as this certainly was. And here I would remark that the Thomsonians have made a great mistake, as well as the legislature. The re- 25 peal of the eighth section places them in no enviable attitude. Besides taking out of their mouths the false but popular cry of persecution, it opens the door for quackery too wide even for them. The effect will inevitably be, that this mode of practice will be taken up by so many fresh from the work- shop and the field, that it will be profitable to no one. And the people, too, are beginning to see that as it is claimed that very little discrimination is needed, and that but a few hours' study is required, to enable one to practice Thomsonianism, they can do without a doctor as well as they can with one in administering Thomsonian remedies. Some of the Thomsonians themselves, when they found that the eighth section was at last really to be repealed, were shrewd enough to foresee thess results, and actually endeavored to prevent its repeal, and to get an act passed, granting to those who had gone through a certain length of Thomsonian pupilage the same privileges with the members of our society. They had thus the effrontery to ask that they might possess, in common with us, that which they have always branded as an unjust and odious monopoly. This is a morceau in the history of Thomsonianism, too precious to be lost. In the present legal condition of our society, it becomes an inquiry of some interest, what course it is most advisable for us to pursue. I have said that since the repeal of the eighth section no new members could join the society, under our existing regulations. And yet it appears clear that there is granted to us in another part of our charter the power of making such regulations as will effectually remedy the evil. You will find in the fourth section of the acts of incorpora- tion, as passed in 1834, that we have the power "to make rules for the admission of members" —■ a very brief expres- sion, but giving us as comprehensive a power as we need for our purpose. This power has hitherto been exercised only in relation to unlicensed physicians who began practice pre- vious to the year 1800; all other cases being considered as covered by the eighth section, which says that " all persons 26 licensed to practice physic or surgery, and practicing within the State, shall, of course, be members of the medical socie- ty." That it can be exercised in regard to all other cases, by the adoption of some regulations on our part, there is not a doubt. In this state of things, there is some difference in the views of physicians as to the proper measures to be adopted. Some are in favor of surrendering our charter wholly, and becoming a purely voluntary association, having our own private rules and regulations, without any regard to law. In this case we should be obliged to begin dc novo, and the difficulties that stand in the way of this, in relation to our fiscal affairs, the labor of perfecting our organization, so as to be satisfactory to all, and the dissensions which might arise on various points, I need not stop to notice. Others prefer to adhere to our present organization, pro- vided that the legislature can be persuaded to repair the breach which they unwittingly made in it. Others still choose to go on with what is left to us by the legislature, (and which I think is all that is necessary for our purpose), making such regulations as we shall think proper, for the admission of members. I should much prefer the last of these three propositions. This will not, it is true, enable us to compel every licensed physician to join us, whether he desires it or not, as the eighth section did. So far as the admission of members is concerned, we shall thus become a voluntary association. And the more I think of membership by compulsion, the more repugnant it is to my feelings. If it be not a privilege to belong to our society, which the physician will seek for, it is not worth the trouble of keeping it in existence. And the fact that it has thus far been considered a privilege, has, in spite of the occasional complaints from discontented mem- bers, effectually saved us from the odium which would otherwise have been attached to this feature in our organi- zation. 27 Our present plan of organization under the protection and supervision of law, I think should be essentially adhered to, for this simple reason, if for no other; that it has been put to the test, and has been found to be very efficient in promoting the great object for which it was designed. At the time that our State society was formed, in 1792, the medical profession was in a bad condition. There was then no well-defined boundary between it and empiricism. The formation of our society at once created such a bounda- ry, and by enclosing the profession within the barriers of a prescribed education, protected it from ignorant intruders who might otherwise come in to degrade and injure it. And if the principles which lie at the foundation of our society could be carried out into full operation, with the cordial and uniform support of the community, there would be almost no empiricism, and the benefits of educated skill would be secured to the public as thoroughly as it can be done by any organization. Whatever of deficiency there is in the attain- ment of this object is not to be attributed to any defect in the organization itself, but to the obstacles which lie in the way of its perfect operation. There is one very common error in the public mind on this subject, which ought to be corrected. It is supposed that our State society was formed for the benefit of physicians, to protect them from the evils resulting from competition with ignorance and imposture. This is by no means the case. The great object of our organization is to defend, not phy- sicians, but the people, against the injury which they are lia- ble to suffer from quackery. And it proposes to effect this important purpose by the only way in which it can be done; that is, by securing to the community the services of a body of well-educated physicians. The mistake has been in sup- posing the means to be the end ; and too often has the pro- tection of law been considered as a gratuity, conferred on physicians as a very deserving order of men, for their sole benefit; whereas the great design is to bestow a benefit up- on society at large, and the advantage which accrues to the 28 profession is incidental, and in fact subsidiary, to that design. Public sentiment should be enlightened on this point. The people should be made to see that it is their own interest, which should prompt them, on the principle of self-preser- vation, to maintain, by the sanctions of law, those barriers which experience has shown to be the most effectual in guarding them against the monstrous, and often deadly, evils of ignorance and imposture in the practice of medicine. The medical profession, let the people understand, is not dependent on the protection of law, and it comes not to their hall of legislation to beg any favor. It can have its own or- ganization, and stand upon its own character alone. If the charter should be surrendered, and the plan of voluntary as- sociation should be adopted in full, renouncing all depend- ence upon law, those who entered into it would probably en- joy as much emolument from the practice of medicine as they now do. But, as law gives authority and steadiness to any organization, and makes it to have a wider hold upon the community, our society without a legal organization would not contain as many members as it now has, and ir- regular and irresponsible practitioners would multiply. Un- der such a state of things the society itself would be more pure and more free from empiricism than it is now ; and its members, a noble brotherhood, with an unsullied honor, and actuated by stern principle and devotion to the interests of medical science, would secure the confidence of the better part of the community. But while our society and the pro- fession would perhaps experience no real detriment from the change, the public would suffer from abounding quackery, beguiling on every hand the ignorant and the unwary. In conclusion, let me say, that I hope that it will not be in vain that I have brought these subjects before the conven- tion. It becomes us to look at them seriously, and to endea- vor to correct all those evils that may exist among us, so that we may as a profession both merit and obtain a well- founded and uniform confidence and esteem on the part of the community.