With the Compliments of tiie Author. 15 Chestnut St., Beacon Hill, Boston, Mass , U. S. A. Lxr=15s.tat)Usf)mnu of tiie metrical profession. ANNUAL ADDRESS TO THE MASSACHUSETTS MEDICAL SOCIETY, JUNE 13, 1888. BY B. JOY JEFFRIES, A.M., M.D., OF BOSTON. of ti)e fHetitral profession ANNUAL ADDRESS TO THE MASSACHUSETTS MEDICAL SOCIETY, JUNE 13, 1888. BY . . B. JOY JEFFRIES, A.M., M.D., OF BOSTON. BOSTON: DAVID CLAPP & SON, PRINTERS. 35 Bedford Street. 1888. ADDRESS. Mr. President and Fellows of the Massachusetts Medical Society : It is very generally agreed that the lawyer, the minister, the squire, and the physician, do not hold the same relation to the community as they formerly did. As that position was one of trust and confidence, it well behooves us to carefully study the causes that have broken it down, and correct if possible any fault lying at our door. On the other hand it is equally our duty to right ourselves before the community, if our efforts have again placed us in a position to be trusted and conlided in. Moreover, if the community misjudge the whole from a part of the profession, it is the duty of those truthfully striving, not to have their labors misjudged and injured by any false sentiment towards others not so acting. There are of course many natural causes for the three professions not holding their ancient Note.—At an Adjourned Meeting of the Mass. Medical Society, held Oct. 3, I860, it Avas Resolved, “ That the Massachusetts Medical Society hereby declares that it does not consider itself as having endorsed or censured the opinions in former published Annual Discourses, nor will it hold itself responsible for any opinions or sentiments advanced in any future similar discourses.” Resolved, “ That the Committee on Publication be directed to print a statement to that effect at the commencement of each Annual Discourse which may hereafter be published.” 4 IiE-ESTABLISHMENT OF position. They are now but three of many exist- ing in the world. Science and art and technology have introduced distinctly professional fields of study and occupation. In the older compact and more isolated com- munities the diffusion of knowledge was less. The three professions represented nearly the whole of it. Moreover the diffusion of falsehood was less, though credulity remained. All forms of medical chicanery have increased and widened with the means of reaching by the public press and the post oflice a larger circle of the ignorant and credulous, poor and rich. Wealth does not now as formerly include knowledge and common sense. Money is more easily gathered than knowledge, and its accumulation does not preclude the con- tinuance of its owner’s previous credulity or gulliblity. Moreover money renders its sudden possessor more dogmatic in his superstition and infallibility. The poor man is open to teaching and advice, the rich man thinks that his wealth places him above both of these. In the village life of former days any question of medicine, natural science or natural philosophy was referred to the physician, and his decision taken. The common sense imbibed in medical education and practice enabled him to expose the falsehood started by cupidity and kept alive by credulity. The same confidence was reposed in the minister as to all matters of morality or theology, and in the lawyer as to property and legislation. But we are not concerned with them. THE MEDICAL PROFESSION. 5 Our own position alone should occupy our thoughts and efforts. Why have the profession as a whole lost then- hold on the community and the respect naturally theirs? In this country democracy has brushed away any glamour of office, all that which hedges in a class or an organization Even that which clings longest, namely any peculiarity of manner or dress which separated us from others, has melted away before the sun of common sense and general intelligence. When the physician pos- sessed more knowledge, more education than those about him in his community, he was respected for these as he should have been. But now-a-days those about him have in the general advance of education gained upon and only too often out- stripped him. In the struggle for existence the doctor goes to the level that he is entitled to by his education and the refinement this gives him. If the ranks are filled with men without education, except that which they are supposed to have medically, then the laity finding that such are des- titute of the former, very fairly doubt the existence of the latter. Good breeding and a good education are not now as formerly the natural attributes of those legalized by a diploma. Cheap and charity medical schools have multiplied over our country to a greater extent even than seminaries, colleges and so-called universities. The profession well know that these medical schools are but local advertisements, and that in their struggle for existence they underbid each other, not only as to 6 ItE ESTABLISHMENT OF medical education, but also receive as students and give medical degrees to men comparatively destitute of even a common education. The various state legislatures grant these medical schools the power to issue such degrees, which the laity ignorantly accept as a proof of education, and that is what they are sold and bought for. Now in course of time the laity have found out that the holding of a medical degree, being a doctor, does not preclude ill breeding and lack of education. And they have naturally arrived at the conclusion that a medical man may be pretty low in the social scale gauged by education, hence that the study and practice of medicine mean but little. To give every individual in the community without respect to color or sex an opportunity for the best education he can attain to and his ability deserves, is a noble charity on the part of the state or the private citizen. For the public or private institution to sanction by its seal ignorance and quackery in any form, is simply cheating the community for the moneyed benefit of the few and unworthy. The poor and unlearned are deluded by the title of doctor, and the delusion has the sanction of the state by the judge on the bench deciding that one medical degree is as good legally as another. The laity know nothing of and cannot judge medical matters, and hence are easily duped into giving state sanction to any and every form of rascality under the guise of medical teaching, from a Druid college to a Christian Scientist’s THE MEDICAL PROFESSION. 7 bucket shop, thus helping to fill our grave yards aud insane asylums. The community demands protection in everything except precisely where it needs it, namely from ignorance, prejudice and superstition. It is from such causes it seems to me that the medical profession as a whole has dropped in the social and educational scale, lost power and lost influence. The public recognize that it is largely entered into as a trade or business, and that many of its members hold degrees and diplomas pur- chased of the mills, legalized it is true. But so are the dram shop and saloon legalized. The pro- fessors in our lawT schools well impress on their students that law has nothing to do with justice. One doctor is the same as another to the public, to such an extent that even men of attainment and culture fail to distinguish the honorable and well-educated physician from the quack and the charlatan. I have found many truly scientific men treating us most unfairly in this respect. They tolerate licensed or unlicensed pretenders in medicine without separating them from those of the pro- fession whose knowledge and proved ability really place.them on an equality with themselves. They give credence to and put faith in, associate with, men whose ignorance, charlatanism and want of breeding are such as they never would admit them in their own field of study. Men of science in other branches receive from no class greater recognition and respect than from the best men in 8 RE-ESTABLISHMENT OF our profession, who know enough to appreciate knowledge and its attainment. It is but fair that we ask of them such discrimination as they employ towards each other, and not attribute any protest on our part to narrowness, professional jealousy, etc. It can only be that they as members of the laity imbibe prejudice from inability to discern and judge of medical matters. The teachers and the examiners in the best Medical Schools all over the world are demanding greater educational requirements of men desiring to study medicine. And this most rightly, because it is impossible to teach medicine to those without thorough foundation. They cannot learn, and to give them diplomas half earned, but adds to the load the educated portion of the profession have to carry. The refinement which education gives is needed in the practice of medicine. Education of a high standard is needed for the doctor to hold his proper relations to the community, besides a thorough knowledge in his calling. Medicine can only recover its former just position when the world is forced by its existence to recog- nize that to be a graduate of a good medical school means to have the education of our best univer- sities in addition. The world will not now believe and trust in a man’s medical knowledge unless they have proof of other education besides, which adds force and power and refinement. The doctor must be, can be, and will be, a man of science. As such we can ally ourselves with the great body of men striving for knowledge and seeking truth. THE MEDICAL PROFESSION. 9 From the lack of this, a large part of our profession is not distinguishable from the man of business or the tradesman, perhaps perfectly respectable, but perfectly commonplace, and worthy only of the position trade and business take in the community. The avenues to wealth or official power are quite outside our calling. As physicians we cannot compete with trade or business. But this is our common lot with other scientific men. Wealth is a mighty power, but it falls palsied before know- ledge. Slowly but surely, I believe, is the former yielding place and respect to the latter. Certainly Croesus is never more flattered than when treated as possessing knowledge, education and the re- finement it brings. Are we not in honor bound to do all in our power to bring up the standard of education and the standard of professional requirements in our calling? Educators tell us that it would be a good thing for the world if nine-tenths of our so-called academies and little colleges were swept away and merged in large and strong institutions. Certainly it would be a good thing for the world and for our profession if nine tenths of the medical colleges were swept away, and what was good in them gathered into a few great medical universities, placed where teaching and study could best be carried out. Why should not this Society quickly raise its standard of requirement for admittance, such as would render membership a proof of educational refinement and professional knowledge? I grant 10 liE-ESTABLISIIMENT OF you that moral courage and backbone are needed to do this. Hut I insist that the possessors of these exist among us, and await only support from the majority. Let them have it, and this at once, or else the best men in the profession must separate and form themselves into a body known and re- spected for possessing what the others do not. May this necessity never come in my day. But we must sympathize with the man of scientific attainment and educational refinement forced to recognize another who is ill-bred and half-educated, simply because the latter holds also a medical degree which insures nothing of these. That is trades union. I hear expediency, desire to conciliate for ulti- mate purposes, compromise, saying, perhaps with bated breath, we cannot be so high toned, we can- not expect doctors to have the refinement of education, or more professional knowledge than enough to get along in practice. I answer at once, with no hesitation or reservation, that there is an increasing number of men in our ranks who have educational refinement and high professional attainments. Again I hear it said that the requirements of a physician’s vocation tend to break down his literary life and hinder any advance in his medical study. This is but an attempted defence of the ignorant who never should have been allowed to enter our ranks, and who have done so for trade through chicanery. No one of the laity has to descend to the low offices the sacred duty of a physician calls THE MEDICAL PROFESSION. 11 upon him to perform for his patient. Sueh never detract from his refinement or his dignity. Circum- stances may call upon us at times to do any manual or menial work. We elevate it, not degrade our- selves, by performing it as a part of the burden we assume with our title. There is nothing demeaning in taking care of your horse, your furnace or your boots* there is, in saying "I be,” and in calling yourself an "allopath.” A knowledge of the formation and working of the human frame, so called anatomy and physiology, the recognition of the diseases incident to humanity, the control of these latter by hygienic methods, drugs or surgical interference, are what separate our profession from the rest of the community. We are a very distinct class, wholly apart from the rest of our fellowmen who have gained or who are pursuing knowledge. Any intelligent person in proportion to his intelligence or capacity, may have some ideas of justice or injustice which we call law, of right or wrong which we call morality or theology, or of the great principles of the other professions now recognized. But no man or woman, no matter how intelligent, can make any truthful decision as to our bodies in health or disease, or how the latter may be prevented or mitigated by any human means. It is only the very shrewd among the laity who recognize and act on this. I do not mean the blind trust of the ignorant and credulous or superstitious. The great mass of the laity feel perfectly com- petent to judge of medical matters as they do of 12 RE-ESTABl.ISIIMENT OF other things, where there is seeming cause and effect. They feel as if it was an insult to their common sense and discernment, not to be able to instantly judge, where we with all our knowledge and experience feel still incompetent to decide the present or the future. They regard the cautious safety in which we feel our way, as only a proof of ignorance or incapacity, referring to the glib answer they get from the charlatan in support of their opinion. Nothing irritates men or women of the laity more than to have their medical judg- ment shown up to them as silly credulities. They stand by these, and the quack who has induced them, the firmer the more they have been deceived. The greater the knowledge and education or even the scientific attainments, the more firmly will the laity feel assured of their capacity of judging things medical, and resent exposure of their special fad. In their own department of learning or research they would derisively laugh at any one arguing from such evidence as they have accepted without challenge in matters medical. I have often shown a business man to what silly credulity he has yielded in what concerned his own life and health, or that of those he loved best. And I have asked him what would be his position if he yielded to such charlatanism in his business and every-day life, acted on such evidence, and adhered to such falsehood. Many such a man has afterwards thanked me for the new thoughts I had given him, and the warnings to balance evidence with common sense and applied intelli- gence. THE MEDICAL PROFESSION. 13 Human nature is such that you often cannot argue with or convince it. But human nature is very sensitive to being proved silly, or even credulous. Nothing is more powerful than the exciting a smile at an opponent’s expense. Now when physicians meet in social intercourse with each other, what for them is more entertaining or affords greater amusement than the relation of their individual personal daily experience of the laity’s medical ignorance and hence medical credulity? No matter how great the rascality of the special quack or charlatan in question, he will not be inveighed against, the laugh is always at the expense of the dupe, the greater whose intelligence the greater his silliness of action. There is no more complete satire on humanity than just this never ceasing fund of entertainment the laity of all classes afford us. Could the public hear and understand our col- lected knowledge of this folly, their ears would tingle, and if shrewd enough they might profit by it. But the tailless fox, even with an unhealed stump, will recommend the trap to his friends. None know this better than the quacks and char- latans. The laughter we enjoy at the laity’s expense is a bitter medicine for them, but when judiciously administered may often be of great benefit. Its exhibition requires tact and moral courage. The "paths” who fatten on the laity’s medical credulity never offend the laity’s belief in the infallibility of its judgment, for this would soon affect their pockets. The "paths” pretend to be doctors; the pretence satisfies the laity. 14 RE-ESTABLISHMENT OF Our profession know only too well that there is no limit to human gullibility in all matters medical. High and low, rich and poor, ignorant and learned alike are human in all that relates to their bodies, and hence gullible, credulous and superstitious. Now it requires very little brain-power to fool those who know nothing of the subject concerning which they are being fooled, and who are willing dupes. The ignorant laity will swallow anything mentally and physically, and so will the intelligent and the learned if you only favor their conceit of knowing more of our profession than we do our- selves. This is the secret of the various pathic- quaeks’ success. The community never challenges the charlatan’s knowledge or ability whilst accepting his state- ments. To be a quack doctor is the easiest thing in the world; requires but little sharpness. The most successful medical pretenders could not earn their salt in any business pursued by their clients. All this proves that the whole laity are but a parcel of children in their relation to us, destitute of discernment, ability to discriminate, power of observation and deduction. A man or woman in bodily pain or fear, or seeing those they love so, is wholly without mental balance and seems to lack at times even common sense. Very little sharpness is then needed to prey upon human weakness. The subsequent shame of having been preyed upon when the quack is exposed, but renders the latter’s dupe his strongest defender. The laity always have resented and always will furiously THE MEDICAL PROFESSION. 15 resent being considered what the intelligent and educated physician knows they are, from that knowledge which he has and they have not. Shall we simply avail ourselves for gain of the laity’s ignorance of the subjects we are familiar with, their passions, prejudices, superstitions and unfathomable credulity? Is it not dishonest to do so, what in business is called sharpness? We may have to bow before our patient’s knowledge or scientific standing, but real or unreal pain or fear will readily make him bend the knee to our true or supposed superior position. Shall we take advantage of his condition? Why not, says the doctor whose profession is a trade; why not, says the sharp business man, it is perfectly legal. But law is not honor or justice. It is our duty, a part of the work of our life, to protect the community, to resist quackery, by always and at all times un- masking it, firmly, fearlessly, earnestly. Men and women are attracted to this or that quack by the special " pathy ” he pretends, and in belief that the quack applies the special pathy to his or her case. A man goes to a gambling hell in the belief that he is to play at a game of chance, and will excuse himself on this. The societies who are fighting these dens show up their methods, and prove to their patrons that it is not a game of chance, but a game of cheat,—not the accidental turning of a card or rolling of a ball, but that these are turned or rolled by the gambler to fleece his victim. ISTow why not be perfectly straightfor- ward and honest, and have moral courage enough 16 RE-ESTABLISHMENT OF to plainly tell the community the truth, namely, that there is no such thing as a "pathy,” that there is no true homoeopath, that men merely call themselves that or other things simply for gain? If you, as can so readily be done, show your client that the quack to whom he is attracted by any special pretence does not even practise that, you will help save him and the community from fraud. W e know that this is perfectly true, and we are in a position to know whilst the laity are not. Do we not fail in our duty in letting them be deceived? Does not our silence and hence seeming acqui- escence arise from motives which will not always bear the light? I am afraid that our so-called desire not to make martyrs of them does not always arise from simple prudence. Is it not rather a shrinking from offending our patrons and wounding their self-conceit and their misjudgment of things medical? Jlre know all about the quack and pretender, licensed or unlicensed, and we simply assist his cheating the community, be- come particeps criminis, by in any way seeming even to recognize him professionally or socially. One has heard in the past a great deal about physicians by their exposing and opposing quacks only inducing the laity to protect and patronize them as injured beings. Time has wholly con- vinced me that the laity only regard our tolerance and forbearance as proofs of our ignorance and wrong position, and whenever, as is not in- frequently the case, they learn of the true condition of affairs, simply despise us for want of courage THE MEDICAL PROFESSION. 17 and ability to hold our own. Professional inter- course with quacks of any kind is foolish, and is sure to react upon the one who attempts it, what- ever liis motives. Indeed such professional or social intercourse is worse than folly. It is of no use to beat about the bush. We know perfectly well that these men, no matter what their so-called standing in the community or number of dupes as patients, are cheating those confiding in them, not even following their pathy, as their clients believe, but simply doing what will draw from the pockets of the latter. Plow can you socially or profes- sionally recognize such men and women without helping them defraud the laity, whilst you finally but receive the latter’s contempt as your reward. Next to honesty, moral courage pays best in this world in the long run. I am sore afraid that the community lose and the quack gains by the lack of it in our profession, where if anywhere it ought to be found, and where most certain final failure follows its absence. I mean true moral courage, and not an assumed bluntness or brass too often found in imitation of it. Shrinking from one’s duty in exposing pretence to defend our patients and their surroundings from chicanery, is timidly called necessary expediency. The char- latan laughs at us for it, and the laity, when they sooner or later find it out, join in the laugh. We do no good in demeaning our profession. Even if our motives were good in semi-recognition professionally or socially of quack pathies, the community would not give us the credit of such 18 RE-ESTAB LISIIMENT OF motives. When a quack’s dupe has unearthed the rascality, his reaction is pretty violent; and if the physician, by action or inaction, has seemingly helped the rascality, he will come in for his share of the blame and be heartily despised. I have heard it argued in the past, that the various pathies in medicine, which follow one another in time, have from the ignorance of the laity gained such a hold that it is better policy to compromise with them, and seemingly recognize them, although they are pursued simply and solely .because they are an easy means of getting money from dupes. Moreover, that these dupes are often the highest and most talented in the land, hence those who cheat them must be respected by us. Why not respect the gambler and bunco-steerer, because his dupes are often the highest and sup- posed best in the land? No, our study of medicine teaches us the truth, which the laity cannot un- derstand without the same study. To deny or act contrary to this truth is a falsehood, whether you call it expediency, compromise, or a pharisaical desire to live at peace with all. One of the worst features and most dangerous tendencies of this very community is the desire to compromise, which is generally the combining the wrong of both sides, each party giving up what it knows is right and true. I have often received friendly hints and chides for uncom- promising opposition to medical quackery in the licensed and unlicensed. I can now look back with pleasure to not having yielded to these, but THE MEDICAL PROFESSION. 19 followed my own instincts and belief in my posi- tion of hatred for and determined fighting against every pretender, and in never hesitating to express to his dopes the exact truth, whether pleasant or unpleasant for me or them. I have lived to see, my enthusiasm if you will, honesty and fidelity to the profession surely, recognized and respect wrung from these very pretenders themselves, as proved by their sending their clients to me. Certainly honesty is the best policy, however low that is as a reason for right action. If we make quacks respect us, the community certainly will also, and we shall thus raise our profession to where it belongs before the world. I am sorry to see a desire and willingness to meet quacks and argue about quackery, as if this was absence of supposed professional jealousy, and showed a broader and more catholic spirit. Do the physicians who would do this know how the quacks laugh at them and despise them for it? A quack doctor knows he is such, and counts you a fool if you don’t know and can’t detect it, but he will be sharp enough to take advantage in any recognition of him as helping him dupe his victims. lie laughs at and uses you whilst you help him cheat the community. Touching pitch defiletli the fingers, and if the pitch is hot burns them also. Stop all social as well as professional intercourse with every pretender, and you will get his and the world’s respect. Our social position is a delicate one to touch on, as are all social questions in public, but our rela- 20 RE-ESTABLISH MENT OF tions to the family and the individual arc peculiar and often very close. Whilst in the community at large a person gravitates to his social level, it should not and cannot he so with ns physicians. Our professional calling should render us the social equal of any. Where rank and cast prevailed, the physician started with but little tolerated social position. As the profession has risen in scientific attainment, it has gradually claimed and received social recognition for itself, through itself. It has to contend with all powerful rank and title and office. It speaks well for our calling that it has wrung even toleration from them. But this it has done only by showing superiority in scientific attainment, hard work in seeking and accumulating knowledge, which is power. In our country the social lines are as strongly drawn as whore rank and cast prevail, but we do not have these latter to contend with in taking or maintaining our social status. What position we occupy depends upon ourselves. In this a physician establishes his own status. The force of position and family inherited from former times, has been since our civil war pretty thoroughly broken down. Our communities are in a transition stage. What formerly existed can never prevail again among us. Social force and power always have been and will be influenced by wealth, which now seems to govern above its legitimate authority. Of course social refinement and cul- tivation must greatly depend on accumulated wealth in the community, and if the latter is used THE MEDICAL PliOEESSKXN'. 21 to promote the former then civilization is advancing among ns. Already, however, the accumulation of money has reached its limit of effect and power. One Croesus is very much like another. Midas, whilst at first he is most lavish to obtain social recognition, soon becomes more eager to help his descendants to a cultivation wholly dependent on knowledge and its pursuit. If now the cultivation and refinement which family gives, is to be brushed away by democracy, and if democracy is not to bow down to accumu- lated wealth, then where shall social power and recognition come from? What shall constitute it? To me it is very plain that it can only come from and really exist in those who become refined by learning, the pursuit of knowledge, and the search of truth for truth’s sake. Cultivation makes re- finement. An uncultivated community cannot be a refined one in our country. I think I see the signs of culture becoming a social force, of a society based on the power of knowledge and the amenities of life this brings with it. In such society our profession should be, and duly recognized there. Can we as a body claim such social recognition? Where are w?e to-day in the science and literature of our country as a body? When social distinction depends on the successful pursuit and accumulation of knowledge, and the character and refinement this gives, where shall the physician be placed? Is it not plain that he must gravitate socially to the level his ignorance 22 BE-ESTABLISHMENT OF drags him? Is it not plain that the lack of educa- tional refinement holds the profession from the social position it would naturally have? Has not the profession lost its force in the community from lack of the power of knowledge? Is not even now the individual physician’s social position de- pendent on his individual educational refinement? The community is forced to grant us a know- ledge of things affecting the public health. Hy- gienic medicine is perhaps more respected than any other branch. Those pursuing it have gained their position by proving their knowledge. In time of panic we are always looked up to for advice, freely given by us, but rarely followed if it affects the individual pocket or the pockets of a class. Against human greed we are compara- tively powerless. When to this greed is added lack of every moral restraint up to absolute crimi- nality, then we can hope for but little good effect from our efforts. Should we not for that very reason more strongly put them forth? Our profession cannot contend with what is called business in the accumulation of wealth. No man ever made a fortune as a physician. I mean no one ever paid his expenses and laid by at interest enough to live on, through the practice of medicine. I do not of course refer to those who have entered into business with their gains, by speculation or speculative investments. Such may have gained or lost as other so-called business men do. This we have in common with the other pro- fessions, though we are not so well positioned as THE MEDTCAL PROFESSION. 23 they, as we advance in life. Even with continued health and strength, and the largest possible amount of practice, a physician in this country can never acquire by his toil the incomes readily made in other occupations now recognized as professions. Moreover, many of these place a man in direct opportunity to become profitably interested in business enterprises, more or less associated with his special work. It is therefore useless for us to contend with trade or business either in earning a living or the accumulation of money. Our profession is most essentially not a trade. Those in it who attempt to make it so but lower themselves to the level of trade, or simply money-making. Our calling be- longs to that department of man’s work recognized as scientific or knowledge seeking. We are simply men of science, that is, men of knowledge and its pursuit, the attainment of which is to benefit other people primarily. Now the world over, men who give themselves up to the pursuit of knowledge have been considered as worthy of only so much of this world’s goods as will simply keep them bodily in a condition to work with their brains and hands in science seeking. When these other professional men apply science, knowledge, to the useful arts, that is, render money- making possible, then their recompense may be very large. But the physician’s science or know- ledge is applicable only to relief of pain, the saving of life, or the increased healthfulness and bodily comfort of mankind. This the world does not 24 ItE-ESTABLISHMENT OF similarly recompense. The world at large values knowledge only as a means of making money. I say the world at large; fortunately for mankind there is a body of truth seekers for truth’s sake. To this class our profession should belong. And we deserve recognition in it, because we do not keep what we learn, but disseminate our know- ledge as quickly as possible for the benefit of hu- manity. True this humanity or the world at large simply regard us as fools for so doing. But the diligent study and the honest practice of medicine gives a man a power, and a self respect, and a consuming interest, a love of his profession, which lifts him above the assaults of the world. The physician has a contentment which aggravates as well as surprises those he comes in contact with. In this contentment we understand and hold by each other as kindred spirits. No class in the community know better than physicians the baneful effect of what in general terms is called w filthy literature.” Here our knowledge is of value, and our opinions will be received by the community. Have we not dreaded giving them from disgust at cant, pseudo-morality and false sentiment? But there are associated together for*the sup- pression of vice, good, honest, mentally strong, shrewd and prudent men and women, who have in their work to contend with the best paying crimi- nal rascality and foulness existing among us. Money will flow like water to prevent legislative control. Are we as physicians, knowing and see- THE MEDICAL PROFESSION. 25 ing all, doing our share in helping those properly at work for the suppression of vice? There can be no false stigma attached to any professional efforts of the kind. Certainly one thing we should do, namely, by united action and condemnation, prevent medical book notices from being distributed, containing wood cuts, often perhaps totally unnecessary in the books themselves, and which in the pamphlet advertisements never induced the rightful sale of a single copy. The respect of the old due to the young—I do not think anywhere in life this applies more strong- ly than in our profession. The young have first what time and the wear and tear of life slowly but surely eat away, namely, enthusiasm. "Without this but little can be accomplished, and that little only as a burden. The young have that power of adapting themselves to new or changing circum- stances which old men have not, and progress in our profession means just this. Capacity for work, both physical and mental, exists in the young that the old no longer possess, or but very exceptionally, and only to prove the rule. A man has had thorough preliminary instruction in youth, and subsequent professional education of the best. He has talent and ability, and knows how to use these. He is urged for some place of trust and influence for which he is well qualified. " Don’t you think he is rather young?” is heard from some over prudent objector. No, I want to reply, but your saying so proves that you are 26 RE-ESTABLISIIMENT OF already too old to retain your place. Respect for the young1 is prudence as well as justice. IIow many years ago would it have been rank heresy to have urged any one under sixty years of age for the presidency of the then Harvard College, but the University has been built up by such an one, and not least the department we are interested in. Our society should reverse the maxim, young men for action, old men for councillors. What! would you throw away the value and weight of experience? Certainly not, if the latter had any knowledge to start with, and the power and ability to constantly accumulate further, and to impart it. Merely having lived or practised so long, does not necessitate the increase of know- ledge or a greater power of its application. Quite the reverse,—it may have simply frittered away originality by dull routine. Inexperience is often of real value, because it dares to do and try what experience has shown some one else lie cannot do. Years of accumulated sameness is only worthy of the respect which age alone gives. Mere time does not make valuable experience; the latter comes from constant and progressive thought and study, and their intelligent application to profes- sional life and work. Experience may or may not come with age; the latter does not of itself make it. This is one of the greatest fallacies of the present age in all departments of life. Old age is to be respected for itself, but when it would guide our actions by its experience we demand to know what that has been, and of how THE MEDICAL PROFESSION. 27 great value. Age as well as youth must prove its ability to have observed and drawn truthful conclusions, that is, to have advanced by intelli- gent study. Time does not make solid ignorance knowledge. But how eagerly the world seeks the experience of those who have proved themselves capable of having profited by it. The fancied accumulation of knowledge from the mere lapse of time is a dangerous mistake. I often recall the following instance. In the Directors’ room of a railroad corporation I had shown the officials the practical results of defective color sense by instances from among their em- ployes. They could not and would not understand or admit it. One otherwise pleasant old gentleman sank back in his arm chair, and with almost a snarl of doubt and derision exclaimed, "Why Dr. Jeffries I have been railroading more than forty years; now if any such thing as color blindness existed, I must know all about it.” And how far is the community from this now? Education is the teaching the hands to work at advantage and the brain to think rightly. Cer- tainly this applies to medical education. Proper medical education cannot he given the ignorant young man, and only young men should be made doctors. If the hands and brain have not been trained how to work, they cannot be properly em- ployed in the higher field of human activity occu- pied by the physician. The advance in modern education comes not from additional amount of facts poured into the school boy or student, but 28 RE ESTABLISHMENT OF from applying improved systems by which brain work tells better. It is possible to teach the power of observation, deduction, the application of principles, and sharpen the brain, the wits, to seize the time for action. The medical schools admitting young men without such preparation, even if they attempt to teach well and thoroughly, never can turn out the best physicians. The young man in this country who wants to go into medical trade thinks he has only to learn a little and get his diploma as he would fit up a grocery shop. The community thinks so too. The so-called medical colleges scattered over the coun- try are ready to help him for the fees he can scrape together to pay them. This tradesman opens his shop for custom, and the world looks upon and patronizes it like any other shop. But in medi- cine as in all the true professions, work but com- mences with the responsibility of occupation, and never ceases while that lasts. Better for a man if it lasts through his life. Now these medical colleges, backed by the com- munity, want the profession to foster such trade doctors, and have us accept them as colleagues. These men themselves claim our support and recognition, and would pull ug down to their level to help their trade. The time has amply come for this to stop. The physician must rest on his in- dividuality, on his learning and his power of using his know ledge. If you carefully observe the men teaching and THE MEDfCAL PROFESSION. 29 learning in this and the two adjacent buildings,1 and then compare them with the men teaching and learning in the building further on, in which we are, or should be, all interested, there will be found a difference of a peculiar and subtle character, the difference between the medical and the technical man. Perhaps only our profession can understand this. I have found very shrewd men. in other professions, even the allied ones, much puzzled by it. Here in technology, arts, sciences aside from us, the student learns facts, physical laws, principles, and their adaptation to physical conditions, and relies on set and fixed laws and rules for action. His work in life is a continuation of this. Here two and two make four, and can always be de- pended on as making four, mathematically dedu- cible and proved as we say. Now in the other building the medical student learns also facts, physical laws and natural prin- ciples. But in practice he has to apply them to unnatural conditions, disease. And he learns that the conditions of disease render mathematical application of seemingly fixed principles impossible. Two and two may not make four, and he must be able to grasp this fact. The study of medicine is for this, and four years is little time enough to learn the needed facts, their application, and so to speak misapplication. This it is which besides all else separates us from other professions, and but puzzles them. They see us arriving at results 1 Buildings of the Institute of Technology and Natural History Society. 30 RE-ESTABLISHMENT OF from data that their knowledge and experience prove mathematically can not come. This elusive something is the spirit of medicine; lie who has it most will most successfully be able to detect and cope with disease, be the most successful physician. I do not mean as to the number of his clients. That is no proof of medical talent. It is in fact in this country more generally a proof of its absence. The pretender and the quack have the largest number of applicants for a time, till the next quack comes. Since the slavery rebellion our nation has settled down to its civilization, lias our profession ad- vanced with increasing education? .Not the whole of it, for the reasons 1 have given. Hut there are many more men than ever before giving their strength and lives to the accumulation of know- ledge in our calling, and its diffusion. Never before have there been so many men so highly educated in medicine as now. I cite as proof, the papers and discussions at our Society meetings, the articles published in our journals, the respect our best men are gaining from the thorough medi- cal scholars and teachers of England and the continent. I cite further the greatly increasing number of physicians in the various branches of medicine who are becoming good and valuable teachers among us. Never before have we had such competent and thoroughly taught piactitioners under thirty years of age. Never before have we had so much true scientific work going on in our profession. The graduates of even our best THE MEDICAL PROFESSION. 31 schools are not content to stop their work, but seek in Europe the best teachers, to compare their acquirements, and bring' back to us the highest medical culture of the old centres of learning. Should these men be classed with the ill-bred and half-educated graduates of the remaining nine-tenths of the medical schools of this country? Because they have the same title, must they be put on the same plane as the business and trade doctors our communities are overrun with? Yet this is precisely the way they are at present treated and regarded by the laity, who make no distinction between one physician and another. And this by all classes of the laity, high and low, rich and poor, learned and unlearned. The scientific man is often now startled by finding " a doctor ” familiar with his own depart- ment. It is quite a revelation to him. Why, nearly all the work in the various sciences outside ours, now followed as professions, was formerly done by men graduates in medicine ! Among us and in our Society, this advance in medical education has been brought about by the thorough and complete change in the plan of teaching and instruction of our University School, the raising the standard of requirement, and the absolute refusal to grant a diploma of Harvard to any graduate who falls below such standard. Moreover, this elevation of the profession has been helped by the Massachusetts Medical Society also raising its standard of requirement. This is by no means so easy a thing to accomplish. The 32 KE-ESTABLISIIMENT OF School is strong enough to be independent and insist on a, proved preparatory education before entering on its curriculum. Our Society can at present only insist, by increased severity of exami- nation, on greater medical attainments. But it can do much to support our School and its teachers in their position by letting it be un- derstood, and acting on the declaration, that to enter our ranks the applicant must equal the Harvard graduate. The laity have no conception of the character of the teaching of our School. Have all the profession, all the members of this Society, a knowledge of its work and standing? The most learned and sc’entific men in other departments have, I believe, but little if any knowledge of what this branch of the University and the very few other schools of similar stand- ing in the United States are doing for the world. I regret that there are those, to whom to give this my judgment and words force and truth, I must say, as did the first president of the Suffolk District Medical Society1 when in his annual ad- dress eight and thirty years ago he praised the ''Boston Medical School,” ffI do not utter this under the pressure of the official toga which I have never worn; but I record it as the tribute of a grateful pupil.” Having said this, I am free to ask, is our School and others like it doing all needed to fit men to practise medicine, to use their hands and brains professionally? The success and the growing 1 The author’s father, Dr. John Jeffries. THE MEDICAL PROFESSION-. 33 number of poly-clinics and post graduate courses, right among our best schools, seem to me to posi- tively prove that the student and the graduate find there is something more to be learned, and something worth giving time and money for. What better argument for the need of an additional year’s study, however this may have to be arranged in reference to the under-graduate department of our universities and colleges? If there are men who can as teachers attract earnest students outside of the regular courses, I do not see why they cannot be employed as teachers in the schools of four years’ curriculum. This extra outside teaching I think has hindered the adoption of a four years’ course as compulsory. It has fostered unfortunately the worst form of trade doctors among us, namely, the "two to six weeks’” fully fledged specialist with any "scope.” I disregard the objection to four years on the score of cost. The men who built our present medical school did not stop for this sort of objec- tion, and time has proved them right. I record here my conviction, and I wish I could record the conviction of this Society, in the support of the teachers and workers trying to elevate the standard of the profession, and thus, for only thus can it be done, replacing our calling in the respect of the laity, at the same time completely separating us in their judgment from the bands of quacks, trade doctors et id genus omne. There is not in medicine the same danger of the teacher becoming the pedagogue as in general 34 KE-ESTABLISIIMENT OF education. But I have suffered and seen others suffer so much from the latter that I cannot help give a warning word. Medical teachers hold the same sort of relation as do other educators. They must not be too sensitive to the push and prod of students and assistants in the struggle for exist- ence. This should hut keep them up to their work, as do the whole corps of young assistants the professors in Europe, whose places some of the former must finally fill. A man must wear his spurs after he has won them. Remember the respect of the old due to the young. It is perhaps naturally expected of me here to say something in favor of those much used and much abused physicians called specialists. Whatever may be said against them, it must he admitted in candor that to stop the work they are doing would check the scientific advancement of the profession as a whole. Specialism means work, seeking science, knowledge, truth. It cannot he said that they keep from the profession or the world the results or benefits of their labors. The same is now unfortunately true of the specialties as of the general profession. All I have said as to the laity’s inability to distinguish between the true and the false applies with ten fold force as to specialists. Physicians recognize this even in their own inability to decide between pretence and talent, knowledge and ignorance, experienced training and assumed. I greatly respect other specialties, and cannot see how we can get along without them. I have THE MEDICAL PROFESSION. 35 to thank the men of talent and standing practising them, and have always found them as willing to help me as I them. They can defend themselves better than I can. Of my own I will say but a word. A foreign body in the cornea cannot be 'prayed out or ]>ried out. The first our patient’s wife has probably urged, the second been tried by a fellow workman or the nearest doctor. But a drop of cocaine, a lens, a rightly shaped and sharp needle in a steady hand, directed by an ex- perienced eye, quickly relieves our patient of his foe and fee. This is specialism, and as such is likely to remain among us. It was said in praise of a physician who died some years ago, that he was never seen in any place his profession did not call him. It was a proof of devotedness to his calling. In the then relations of the doctor to the community perhaps it was wise and necessary. All that has certainly passed away, never to return. We are now forced to been rapport with the world, its people and affairs, and, I believe, with a gain thereby to our useful- ness in the practice of our profession. The more a man knows outside of and in addition to his medical work, the better physician will he be. Such knowledge will never hurt his professional judgment, and will very often give him thereby a better opportunity to enforce what he knows to be necessary. When a patient finds that we are by no means ignorant of his special work or business, can ex- press an intelligent opinion thereon and have some 36 HE-ESTABLISI1MENT OF interest in it, then that patient is now-a-days much more likely to respect our professional advice and follow it. We have to guide and govern men and women, and we cannot without respect from the governed. The community somehow still have an idea that physicians as a class are not capable of anything else than their own work, without business capacity, not practical. This certainly is not now the case. Well educated men in the profession are most practical, most prudent financially from necessity and experience, always recognizing and deploring waste and extravagance. In the expenditure of money for public and private charities they are now recognized as conservative and shrewd. Physicians, and most busy ones, had greatly to do with the collecting money for and its expenditure in the building of the great educational institutions on this street including the one in which we are now assembled. Not only is a physician now-a-days allowed, if I may so say, to have some knowledge of the world of affairs, but he is beginning to be granted some familiarity with literature or with scientific pursuits, even when the latter are not directly con- nected with medicine. The profession at large and a part of the laity now begin to recognize the value of scientific thought and scientific study in our calling. It does not now hurt a man to be known as scientific, that is, seeking knowledge by mental labor. There was a time when this was a positive detriment, and militated against a man’s opportunity to gain a livelihood. THE MEDICAL TliOFESSION. 37 When you ask an ignorant man to sign his name or read a sentence, he, rarely with shame, more often with a certain brutal indignation, announces that he is no "scollard.” This is hut a relic of the time when a feudal lord would have spurned the ability to write as his scrivener did. I see the same in the uneducated doctor when he declares, with a touch of resisting pride, that he " does’nt pretend to be scientific,” as if all he did know was but the first step of science, in the path of which he has never trod or has lost his way. It is a dan- gerous thing for the profession to attempt to decry or belittle any scientific work its members are engaged in. In the great world of scientific work our pro- fession is needed and has its place. Its labor is special and separate, but calls strongly for think- ers, observers, truth seekers. This is the study of medicine, whilst the practice calls for the great- est endurance, patience, forbearance, toleration, and courage physical perhaps as well as moral. A thoroughly educated physician is a man of no mean parts, and will be able to hold his own with others in the world’s affairs. His training makes him a good " all round man ” and a We should not resent but welcome the coming into the profession of young men with wealth and means that render them independent of work. Even if they practise they have the right. It was once said with some truth that the possession of thirty thousand dollars would kill any man’s advance and work in our calling. That is not 38 RE-ESTABLISIIMENT OF true now. But the young men I speak of are most valuable in softening the spirit of gain and strife. There is work in abundance for them, and to advantage of us who must delve for our living. Their position enables them to do for us what we most need but cannot accomplish. They have hours for work without anxiety. To study medicine and take a degree in a first class medical school after a collegiate course is a training most valuable. The knowledge gained is aside and besides all other, placing the grad- uated physician at very great advantage over his literary, artistic, and other professional friends. Moreover the study of medicine is earnest, serious, mentally stimulating, and gives a man breadth of character. It teaches him the value of work. One of the class of young men I am speaking of whom I had advised to follow our profession, said to me with great satisfaction and self respect: "To graduate here at our school sickens one for loafing and idleness.” The student learns that life and happiness mean work, work for others or self, but work, without which life at last is found not having been worth the living. The graduate learns also that there is no place in medicine for the Bohemian or the dude, that all attempts to act or imitate the one or the other are wholly out of place, as any of* the peculiarities which were the marks of a physician in gone-by days. Even the white cravat worn at other times than when socially demanded, is now pretty well recognized as a medical hypocrisy, THE MEDICAL PROFESSION. 39 Chinese mourning for departed patients. The time physician does and should dress as any other quiet gentleman. Fortunately for us in this present day, and for the communities in which we live, the absence of means does not preclude the possibility of pre- paratory and medical education, and that of the highest grade. The State and the individual citizen has now given every man a chance who has brains to use and is willing to use them. It is the State's and individual's charity. Harvard University is an endowed educational charity of which every graduate is a recipient. Hut absence of means must be an incentive to action, to labor, to study. For myself I know that any good which I have done for the com- munity or for myself, has been done from the pressure of complete dependency on my own action. I believe every man finds this the case in life, hard as it may seem to him. Necessity is the mother of invention and the father of success. In the Kampf um Dasein let us join hearts and hands and brains for the re-establishment of our beloved profession.