AN ADDRESS DELIVERED BEFORE THE MEDICAL SOCIETY OK THE STATE OF PENNSYLVANIA, AT ITS ANNUAL SESSION, HELD IN WEST CHESTER, IN MAY, 1857. BY R. LA ROCHE, M. D., PRESIDENT OF THE SOCIETY. PHILADELPHIA: T. K. AND P. G. COLLINS, PRINTERS. 1857. ANNUAL ADDRESS. AN ADDRESS DELIVERED BEFORE THE MEDICAL SOCIETY STATE OF PENNSYLVANIA, ANNUAL SESSION HELD IN WEST CHESTER, IN MAY, 1857. BY R. LA ROCHE, M. D., PRESIDENT OF THE SOCIETY. S ~ fo PHILADELPHIA: T. K. AND P. G. COLLINS, PRINTERS. 1857. AN ADDRESS. Gentlemen of the State Medical Society :— The progress of time has again brought us together. Another year has rolled by, since the members of this Society met to attend to the duties assigned to them by the organic laws which bind them together, and we have in our turn, from various portions of our extensive Com- monwealth assembled with a view of continuing the work commenced by our predecessors. On the last occasion the high and much prized honor was conferred on me to preside over your deliberations; and though distrustful of my ability to accomplish the task in a way calculated to meet your approbation, and desirous that it should be intrusted to abler hands, I yielded to the wishes of surrounding friends and accepted the appointment. In conformity with a usage set by the distinguished gentlemen who preceded me in the chair I now occupy, and in obedience, moreover, to the positive command of the society, as conveyed by a distinct resolution passed at the time, I am, as your presiding officer, to address you on some topic of general interest to us all, both as members of the medical profession at large, and as part and parcel of the special organization in obedience to whose decrees we have assembled. As you may all readily presume, the selection of a topic suited to the occasion is no longer an easy task. The very largest number of those that might prove acceptable, and be fitting to offer to the consideration of an assemblage like the present, have been often discussed, in the form of addresses and reports by abler minds and more graceful pens, as well before this Society itself, as before kindred bodies and our noble parent the American Medical Association. Coming, as it were, so late in the field, the sources from which I could have gleaned have been in great 1* 6 DR. LA ROCHE'S ADDRESS. measure exhausted, and I run much risk of finding nothing to pluck along my path worthy of being brought to your notice, and likely to fix your attention and compensate you for the moments you are so kind as to bestow upon me. In this dearth of suitable and unhackneyed sub- jects, it may be more prudent to abstain from selecting any one as the special theme of this address, and to trust to chance. Perhaps as we proceed, something may turn up not unworthy of being appropriated for the occasion. Doubtless, in an aesthetic point of view, such a pro- ceeding is not commendable ; but I console myself with the thought that those who made the selection of the artist, did so with the full knowledge that much could not be expected at his hands, and that hence if he fails to produce a work bearing comparison with those of a similar kind that have preceded, they will not experience much disappointment, and generously assuming the responsibility of their proceeding, exclaim mea culpa. Before I proceed, I cannot forego the pleasure of welcoming you to our present gathering, and of expressing the gratification I experi- ence at meeting you. Nor could I be moved by feelings of a different character. I see in this assemblage the well remembered features of highly prized and cherished friends, of some, indeed, in whose company I sat on the benches of our alma mater more than a third of a century ago, as well as of others who though not personally known to me, have, as all present are fully aware, earned very deservedly a distinguished name in our commonwealth, and beyond, for their intellectual endow- ments, their professional attainments, their practical skill and their moral worth, as well as for the efforts they have made and continue to make, to uphold the dignity of our profession and promote the progress of medical knowledge. The satisfaction I experience, is not based on such personal con- siderations alone. The history of the last ten years has tanght us that the annual meetings of this Society have been conducive o°f no small benefit, within the limits of its influence, to our profession, and indirectly to the public at large. And we may without stretch of imagination, conclude, from what has occurred, that still greater benefits are°in store' provided, however, as I trust will be the case, we continue to assemble together as heretofore, to commune with each other on subjects for the consideration of which .we have organized, and to discharge the duties assigned to us, in our individual and collective capacities with the zeal which has, from the onset, characterized our proceeding Through means of our meetings many discordant materials have been' and continue to be, harmonized. Many efforts at improvement on' various points of interest which, so long as they were left to individual DR. LA ROCHE'S ADDRESS. 7 energy, had failed of success, have, by combined action, been productive of useful issue. Through the same means, information of an important character respecting the medical topography, the climate, and the dis- eases—endemic and epidemic—of a large number of sections of the State, which, in all probability, would otherwise have remained con- cealed from view—for a long while at least—has been collected and spread before the medical world. The members of the County Societies, which through their delegates constitute the present association, are sti- mulated to contribute their quota towards the enlargement of our know- ledge. Their minds are set to work. They are incited to collect facts, and to give them shape, and the volumes of our Transactions attest how satisfactorily they have for the most part discharged the duties assigned to them. Most of what has been accomplished would have been left undone had not this Society been established. Some local medical societies, scattered through different parts of the State, supposing such to have been formed without the existence of this association, might, perchance, have directed their attention to those topics. But these societies being independent of each other, would have lacked the genial influ- ence of emulation resulting from a co-operation of exertion, or, at any rate, would have worked for the special benefit of their members, and so far as the medical profession throughout the State, and particularly throughout the country at large, is concerned, the information so collected would have proved of little avail. It would not have been heard of beyond the precincts of the locality which gave it birth. If otherwise, its usefulness, in a scientific point of view, would have been marred or entirely lost by the circumstance of its isolation, for the knowledge of what occurs in one locality of small extent, however interesting in reality it may be, must lead to results of limited utility, unless we are able to compare it with information respecting kindred occurrences in other localities more or less distant from the former. It is only by the accumulation of facts collected from diversified and remote positions, and by bringing together and concentrating, as it were, within a single focus the results obtained in the several sections of the State—comparing attentively the whole together, noting how far each section agrees in points of interest with the others, and in what respects it differs from them, that we can ever hope to succeed in drawing correct and useful deductions from the data placed before us for examination. Be this, however, as it may, we cannot be far from the truth when we conclude, that had it not been for the influential agency of this parent Society, the knowledge which has been collected in relation to the medical history of Pennsylvania would have been neglected or left unrecorded. 8 DR. LA ROCHE'S ADDRESS. But our Society has done more. Itself the creation of a more ex- tensive organization, it has fostered the establishment of a larger number of County Societies than would otherwise have existed, and infused life into their members by calling upon them for information respecting their several localities, and thereby assigning to these members the performance of certain duties which before had been in great measure unheeded or sadly neglected. Of the advantages that have resulted from the establishment of such local bodies, much might be said. By assembling together for scientific and other purposes, the members have been better able to ascertain the true force of the profession in their respective counties, to fix more accurately the character of the medical men around them, to draw the line of demarcation between the worthy and the unworthy, to purge themselves of, and stamp with the seal of reprobation the false pretenders and irregular practitioners by whom their path is crossed, and to enforce among themselves those ethical regulations which the experience of all communities has shown to be requisite for the purpose of preserving the peace and enhancing the dignity of the medical profession. In addition to this, by gathering together at stated periods at their places of meeting, and by delegating annually some of their number to the State. Society, and others to the National Medical Association, they have reaped and continue to reap the advantages flowing from the creation of an esprit de corps, or spirit of fraternity, which seldom fails to result from the frequent communing of many members of the profession, and is a stranger to individuals living apart from, and independent of, each other. They also derive those benefits which arise from the feelings of kindly regard inspired among men by the interchange of the courtesies of society. I hesitate not to say, as the result of no small amount of observation, that on these several points the medical profession in this State—and I doubt not the same may be averred of other States where organizations similar to our own have reached, and where the influence of the Medical Association has been felt—is in a far better position at the present day than it was before this Society came into operation. The spirit of legitimate emulation has been aroused. A due appreciation of the refining influences of the amenities of society is more generally felt; a consciousness of the obligation of cultivating feelings of kindly regard towards their com- panions in the thorny path along which they are travelling, animates much more than before the members of the profession who form part of the medical organizations, now happily scattered over the wide ex- panse of the commonwealth. They feel more than they did in bygone days like associates of a great, important, useful and honorable fra- ternity, having interests in common, possessing affiliations not only in their immediate neighborhood, but also in distant parts, Avhose ultimate DR. LA ROCHE'S ADDRESS. 9 object is usefulness to their fellow-men, and whose honor and dignity they are bound to uphold by every legitimate means in their power. Besides, they feel more amenable to those laws of ethics which are everywhere admitted to be necessary, in order that we may live in peace and harmony with our colleagues and with the world at large. Doubtless, much yet remains to be accomplished before our highest aspirations, in regard to the dignity and full amount of usefulness of the profession to which we have the honor to belong, can be realized. But granting that we have not yet been as successful in relation to that important matter as might be desired, few who have made the inquiry will hesitate to admit, that no inconsiderable advance has been effected towards the attainment of the object in view. The foundation is laid; the superstructure will soon follow, and I cherish the hope that, old as I am, I shall live to see the day when one of my successors in the presidential chair will be enabled, without fear of contradiction, to proclaim to the world, that the members of the medical profession in the State of Pennsylvania may be held up—in the fullest acceptation of the term—as worthy champions of the honor and dignity of their calling, and as occupying in point of intelligence, learning, practical skill, and a due appreciation of the courtesies of society, a rank in no degree in- ferior to that enjoyed by similar bodies of men in this or other lands. That much of what has already been attained is due to the influence of associated action, and that the additional benefit which I have pre- dicted will flow from the operation of the same influential agency, is to me clear and conclusive. For, like many of you, I have seen and learned enough to know that far greater advantages are obtained from com- binations of the kind, than from individual efforts far more energetic and multiplied, whatever be the professional and social standing of those by whom they are made, and whether the object in view be the prevention or correction of abuses, or the promotion and diffusion of scientific knowledge. Of the truth of this no one can doubt who has paid attention to the subject. Tbe power of associated action is felt in all departments of human pursuit, and cannot fail, and, indeed has never failed, to manifest itself in that which falls more particularly under the cognizance of the present assemblage. In medical as in other concerns to which the attention of man is called, we discover the correctness of an opinion long since expressed, that union is strength. No indi- vidual efforts, not even if made by a large number of intelligent and well informed physicians, spread over the broad surface of the State, could have accomplished the results to which I have alluded. These physicians lacked the vivifying influence of emulation, the stimulus to exertion springing from the co-operation or collective action of many minds equally interested in the attainment of one and the same 10 DR. LA ROCHE'S ADDRESS. object, as well as the opportunities of improvement flowing naturally from the interchange of thought, and personal intercourse with such of their brethren as enjoyed ampler means of acquiring a full knowledge on all, or some special branches of medical science, not less than on the condition and wants of the profession, or who, from their fields of observation being more or less remote from each other, were enabled to see facts under the diversified aspects they are so apt to present. Among many examples of the advantages that may be obtained from associated action, in regard to the upholding the peace and dignity and to the promotion of the usefulness of the medical profession, I may be permitted to select one which has fallen under my own observation in Philadelphia, and has always appeared to me to illustrate the fact in a satisfactory manner. In the early period of my professional career— some thirty-five or forty years ago—the medical men of that city, who, in point of intelligence, attainments, and practical skill, were inferior to none elsewhere, lived together in what has been denominated a negative state of harmony. Quarrelling and even worse was not un- common among them, and now and then, street fights, in one of which, that fell under my own notice, figured one of the brightest luminaries of American medicine, occurred. At the weekly meetings of the Medi- cal Society the science of Billingsgate seemed to have taken precedence of all others. Epithets of no complimentary kind were there and elsewhere bandied about without stint or measure. The pages of the medical journals then published among us were made the vehicle of bitter and insulting attacks, and scarcely a week elapsed without the appearance of some newspaper lampoon or scurrilous pamphlet. This state of things—the result of personal rivalries and jealousies and of diversities of clashing interests, not rendered the less influential, by the establishment about this time of a new school—an innovation the necessity, propriety, and justice of which, the leading men of the day could not comprehend—this state of things, I say, became unendurable. Those of the physicians among us who had at heart the peace, harmony, and dignity of the profession, felt that some change must be effected ; as otherwise we should lose caste with the community, and furnish food to satisfy the morbid appetite of those who lose no opportunity of making themselves and others merry at the expense of physicians and medicine. Such men have always existed from the days of Aristophanes and Pliny, to those of Lesage, Moliere, Montaigne, Voltaire, Rousseau, and are not unknown in our own times. But what Avas to be done to effect the desired change no one well knew, Avhen the late Dr. Samuel Brown, who then occupied the chair of practical medicine in the University of Transylvania, and than whom a more enlightened, honest, upright, and warm hearted man never existed, arrived among us with the DR. LA ROCHE'S ADDRESS. 11 plan of a general medical society, or fraternity, which he proposed to establish in the various sections of the country, and which was in- tended to embrace all the leading, reputable and influential practitioners of medicine that could be enrolled under its banners. The object of this association was to unite its scattered members—whether residing north or south, east or west, into a single homogeneous body, and by fostering, among them, reciprocity of kindly, fraternal, and honorable feelings, insure the establishment and cultivation of harmony in their ranks, while, at the same time, it would, through various means, be instrumental in exciting emulation and promoting the advancement of medical knowledge. The Society, which had already been planted in the West, by Dr. Brown, and the existence of "which was then, for various reasons, concealed from the public, was established among us by the initiation of four physicians, in whom the founder thought he had discovered the elements of character he was in search of—Professor Jackson, Professor Meigs, Dr. Thomas Harris, of the navy, and myself. Others whom we selected with care were soon added to our number. The laws and regulations framed by Dr. Brown were adopted. By- laws, suited to meet our special exigencies were prepared. A promise, modelled in great measure on tbe oath of Hippocrates, was exacted of each member at the moment of his admission—to obtain which a unanimous vote of those present was necessary. By this promise the member bound himself to live in peace and harmony with, and to do everything honorable in his power to promote the welfare of his brethren in and out of the Society, and to abide implicitly by a stringent code of ethics that had been prepared for our guidance. The ranks of the Society gradually filled through means of a sort of process of suction on the part of the existing members ; and leaving out some who were intractable, from whom it would have been next to an impossibility to eradicate the belligerent propensities they had hereto- fore manifested, and who for these and other reasons could not have obtained a unanimous vote; and also a number whose careers and professional standing were not of a nature to make us desirous of their company, we succeeded in forming a corps of some sixty or seventy practitioners, among whom figured the greater part of tbe leading phy- sicians of the city. Harmony was almost immediately restored among them, and, before long, through their influence, among other medical men around them. Writers of controversial and abusive pamphlets and of newspaper articles were frowned down. Losing the interest they had once created, or the encouragement they had enjoyed, they ceased to trouble the public with their unwelcome productions, and if a few— sometimes gross—irregularities were committed about us, they were sure to be traceable to individuals placed beyond the pale of the Society, 12 DR. LA ROCHE'S ADDRESS. and whose misbehavior could cast no shade on the dignity and honor of the profession ; while all the difficulties that occurred among the mem- bers, and these were few, and of trifling character, were soon silently and amicably adjusted. The Society did more. At its meetings much was done to excite emulation among the members, and to promote the advancement of me- dical science. A journal, placed under the editorial guidance of a com- mittee of the Society, was established, and continued to appear quar- terly during six consecutive years. It does not become me to speak of the merits of this journal; but, if what has been said of it by more dis- interested judges can be relied upon, the medical profession of this city, or indeed of the country at large, need not be ashamed of it. After an existence of several years, the Society closed its career, or rather ceased to hold its meetings. But the work of reform was in great measure' accomplished. Peace among doctors was comparatively restored, and is now but seldom broken; and when the unwelcome event occurs, the infractor—whatever be the social or professional position he may oc- cupy, and the real or supposed Avrongs which impelled him to act in the matter—so far from eliciting the approbation of his medical brethren, is openly and decidedly censured by all—whether friends or otherwise ; while, at the same time, and in some measure in consequence of the more healthy tone of professional sentiment accruing from the course pursued, the honor and dignity of our calling have been elevated to their legitimate standard. The journal ceased at last to appear, the editorial duties interfering with the other engagements of the gentlemen who con- ducted it, but the latter constituted themselves into a club which con- tinues to this day to hold frequent meetings, and has contributed in no small degree to cement friendships, to which the parties revert with feel- ings of the warmest gratification. Other associations of a similar kind have, as it were, grown out of the one mentioned, or have been formed on the same model, and embrace a large number of the younger mem- bers of the profession. These several associations harmonize together • their respective members reciprocate courtesies at their weekly meetings where are always to be found other physicians not attached to either. In a word, the physicians of Philadelphia are now a peaceful set-__thev perform their arduous professional duties with as little jarring as could well be expected from so large a body of men, influenced by common interests, and animated by the spirit of competition; and if perchance some differences between them happen to occur—and how could it be otherwise—the parties have most generally the good sense to keep them concealed as much as possible from public view, or at any rate to make little noise about them. I have, however, dwelled sufficiently long on this piece of local profes- DR. LA ROCHE'S ADDRESS. 13 sional history. What the Society to which allusion has herein been made has effected in Philadelphia, and what other branches of it have accom- plished elsewhere, in the way of salutary reform, the promotion of har- mony, peace, and dignified bearing, and the enforcement of stringent ethical regulations among their members, have since been undertaken by the National Association, and in this and other commonwealths by State and County Medical Societies. Relatively to the degree of success obtained on these points by the first of the institutions named, I need not enlarge on the present occasion. It is a matter of history, and well known to you all, and so far as the doings in other States are concerned, we can feel but a general and indirect interest. Suffice it again to remind you, in reference to our Society and the county institu- tions of which it constitutes, as it were, the complement or uniting link, that they have not been inactive and unsuccessful, and that if, as has been correctly said of the National Association itself, the benefits de- rived from their agency have not been commensurate with our wishes, there can be no reason to doubt that, in the progress of time, results of a nature calculated to gratify all sincere lovers of their profession will be obtained. But from societies of this kind other benefits than those having reference to the general bearing and conduct of medical men living within the sphere of their jurisdiction are looked for. As already pointed out, such associations tend in various ways to elevate the cha- racter, honor, and dignity of the medical profession. It is not enough, in order to attain this desired object, that laws and regulations for the proper guidance of their respective members should be enacted and en- forced through means of the connected action of properly constituted bodies. It is not enough that, by such bodies, all irregularities occurring in the professional and social bearing and conduct of such members should be corrected, and the repetition of them prevented, and that the requisite means to remedy the evil accruing therefrom should be indicated. A certain degree of influence, both direct and indirect, must be brought to bear on those members individually, with a view to stimulate their zeal and energies to the vigorous pursuit of inqui- ries of an intellectual character. They must be roused from the state of mental inertia in which, generally speaking, men are apt to fall, when deprived of external stimulus. They must be saved from that condition of stagnation which, " in the moral, as in the physical world, generates corruption." Again, they must be made sensible of the import- ance of collecting and arranging systematically, useful facts of a patho- logical, etiological, and therapeutical kind, and of communicating these, and the deductions drawn from them, through some channel or other, to the medical community at large. Little or nothing is effected in respect NEW SERIES.—PART II. 2 14 DR. LA ROCHE'S ADDRESS. to the progress of medicine, considered both as a science and an art— and towards the promotion of professional utility and professional dig- nity, unless the task here briefly sketched be successfully performed, and to reach this end the votaries of this science and this art must enter the field armed with no small share of the zeal and energy to which I have referred. The statement has been made, and its correct- ness is almost too generally admitted to be here referred to, that man is under the obligation of acquiring as large a share of knowledge as the circumstances of his position will permit. For the physician this obli- gation is transformed into a positive law. Medicine has been defined one of the thousand forms assumed by Charity: but what is charity without science to guide it to a satisfactory issue ? We are members of a profession which calls upon us to pronounce daily on questions of life or death. Is it not obvious then that a degree of ignorance which it is in our power to avoid, but from which no pains have been taken to escape, may well be viewed in the light of dishonesty ? Nay, we may say that, in medicine, ignorance is a crime. What are called plain and simple practitioners—men who contemptuously look down on the indus- trious student and place him in the same category with sheer biblioma- niacs; who ignore book learning, and stigmatize as useless theorists, all physicians disposed to attach importance to an inquiry into the causation, nature, and relationship of pathological facts ; Avho affect to rely exclu- sively on bedside experience, or what they characterize as simple ob- servation ; who care little for the results of the experience of their pre- decessors or contemporaries;—smiling at the idea of the necessity of comparing the phenomena they observe, and the therapeutic results they obtain with those that fall under the cognizance of their fellow practitioners, and greatly doubting the utility of pathological anatomy and other kindred branches of medical knowledge;—such physicians, I say, are not, as a rule, the instruments employed by Providence to promote the progress of medical science, elevate the character and secure the dignity of the profession. They may succeed, and have, doubtless, often succeeded, here and elsewhere, in becoming safe practitioners. They may learn to man- age in a satisfactory manner certain classes of stereotype cases of morbid derangements which they daily encounter. They may in that way succeed, ultimately, in becoming useful to those who honor them with their confidence, and also, not a little to their private inte- rest—eliciting the applause and commanding even the admiration of a large portion of the community, who, in total ignorance of the true requirements of a physician, sing the praise of simple and unsophisti- cated experience, and deny the necessity of theory, Avhich they stupidly confound with hypothesis, while they regard in the light of useless and DR. LA ROCHE'S ADDRESS. 15 dangerous dreamers, all who aim at something beyond the standard they have fixed upon the essential qualifications of a medical practitioner. They may do all that; but I hesitate not to say, that he who looks to them for aid in furthering the progress of medical science in any of its multifarious departments, will be very much deceived. Even practical medicine, on their skill in which they pride themselves, receives but slen- der benefit at their hands. Physicians of that class are at a loss whenever they encounter cases such as they had not seen before. Even the less usual modifications of ordinary complaints, are but too often to them a source of embarrassment—not unfrequently a rock on which they founder. Or if, through means of an unusual degree of native saga- city and medical tact, or a constant habit of the sick room, they suc- ceed, at last, in surmounting some of these difficulties, certain it is, the number of such fortunate physicians is exceedingly limited, and what- soever be their success, they teach nothing to their own, and particu- larly to future generations. They never prove benefactors to science. The latter, in their hands, never advances beyond the point at which they found it. Indeed I am not sure that, if left to their fostering care alone, it would not retrograde. Medicine, with the greater number of such routine and empirical physicians, is not a science. It is not even an art. It is a trade. Content with finding a remedy for the disease for which they are called upon to prescribe, or for some particular phe- nomenon ; employing this remedy because they think it has been useful in some instances of like kind, they ignore principles ; or if they raise the pretension of being guided by pathological views, it is ten to one that such views are not founded on sound principles, and are calculated to excite a smile from all well informed physicians. But let this pass. It is not to such individuals, as already stated, that the guardianship of the honor and dignity of the profession can safely be intrusted; no, the due performance of that duty implies the possession, on the part of those intrusted Avith it, of scientific attainments, intellectual culture, and accu- rate and enlarged knowledge and learning in the several departments of medicine. However high, besides, the standard of moral rectitude of the class of individuals under consideration maybe; whatever be the amount of the sense of honor by which they are swayed—whatever their gentlemanly bearing and courteous manners, they can scarcely be expected to feel alive to, and deeply interested in the exalted character of a profession to which they are attached merely in so far as the prac- tice of it affords them the means of promoting their worldly interest; while they contribute nothing towards the advancement of the science on which that profession is based, pay no regard to and almost com- pletely ignore what others have done, or are doing in that respect, and in fact, do not appear to care whether such progress is attained, or 16 DR. LA ROCHE'S ADDRESS. whether matters remain at the same point at Avhich they stood centu- ries before. The class of physicians to which allusion is here made, and the type of which, common everywhere, is generally encountered among those who, from choice or necessity, are secluded from habitual or frequent intercourse with their better trained fellow practitioners, who are not placed under circumstances to enable them to experience the vivifying influence exercised by nurseries of medical knowledge, and who either do not enjoy or neglect the opportunities of exchanging thoughts and comparing observations with other medical inquirers differently situated from themselves. That men thus circumstanced occasionally emerge from their obscurity, and shake off the state of apathy or inertia under which they, as it were, labor, or ward off its inroads, and by a diligent course of study—though not encouraged or stimulated by the example of any around them—have enlarged the sphere of their medical know- ledge, and kept up with the progress of science, thereby assuming a respectable, or even high position in the ranks of the profession, our biographical records and our medical literature afford undeniable proofs. But instances of tbe kind are not often met with. They form exceptions to, and serve to confirm, the rule. Much more frequently, whatever may have been the case at the outset of the career of physicians so situated, their zeal, failing to experience the beneficial effects of excitement result- ing from the sources mentioned, fades away. They study less and less, and finally come to the conclusion that mental culture is not an import- ant or necessary item in the life of a medical practitioner. In many cases the disposition to act differently never existed, and, impelled by the example of those about them, they content themselves with going their rounds in a sort of mechanical way, distributing their medicines after a fashion of their own, and spending the residue of their time in a manner little deserving the name of scientific. As distinguished from simple medical practice, Science ceases to be to the former an object of interest. To the latter section of the same class it never con- stituted an object of the kind. Far be it from me to deny here the advantage—nay, the absolute necessity—of experience, as obtained at the bedside of the sick. No one more than myself knows that to maintain that it could be dispensed with, would be no less than to maintain an absurdity. Nothing can compensate the practitioner for the absence of that requirement. But the possession of experience, in the usual acceptation of the term, is not alone sufficient to constitute an accomplished, philosophical, souud, and truly useful physician. Other qualifications must be combined with it to entitle its possessor to that appellation. No, gentlemen, to attain eminence in our professional career, to contribute to the advancement DR. LA ROCHE'S ADDRESS. n of medical science, to stimulate the mind to the acquirement of the diversified knowledge necessary to all who aim to that appellation—to do this, I repeat, and thereby enhance the utility of the art, raise the standard of professional character, and add dignity and lustre to our calling, its members must be imbued with a large fund of zeal and energy. They must engage in the pursuit with enthusiasm. At the same time they must, by a constant and careful reference to the sources of information furnished by their predecessors or contemporaries, fami- liarize themselves with the results obtained elsewhere by competent judges, on subjects similar or kindred to those constituting the objects of their own investigations, and compare the whole together. They must study carefully the relationship of phenomena occurring before their eyes, in order to arrive at a knowledge of cause and effect. They must weigh accurately not only what they have themselves seen in those and other respects, but what others who are as competent as themselves, who have enjoyed a wide field of observation, under different conditions of locality and climate, and who are well prepared for the task of com- municating the results, have pointed out. They must bring to bear on the cases that fall under their observation an enlarged acquaintance with the various branches of knowledge which, in their aggregate, con- stitute the science of medicine. Except by those who entertain a belief in tbe sufficiency of a pure empiricism, all these requirements are universally deemed indispensable. Nor is this all. The science of physiology; that of pathology as based, in great measure, on the latter; semeiology and morbid anatomy cannot be omitted in the catalogue of subjects deserving the special attention of the physician. They are progressive sciences, and the more thorough investigation of them must necessarily be intrusted to those who have the leisure and opportunities to carry it on to a success- ful issue. Neither must the accessory branches of medicine be over- looked or neglected. They, too, are progressive, and the investigation of their principles and details must be confided to special scientific agents. The knowledge attained on all those diversified topics are con- tained in publications, which it becomes the bounden duty of the con- scientious physician, who has at heart the desire to store his mind with all the knowledge necessary to enable him to become an ornament to his profession, and to perform his duties to the best advantage to those confided to his care, to study attentively. In a word, much of the in- formation we need, cannot be obtained otherwise than by a constant reference to, and careful study of the writings of such of our predeces- sors and contemporaries as have furnished us with reliable records of the results of their investigations in the various departments of medical knowledge, and other topics connected directly or indirectly with the 18 DR. LA ROCHE'S ADDRESS. main object of our pursuits. On the necessity of this continuous course of medical instruction, it is impossible to dwell too impressively, and its importance and the little heed too usually taken of it, must serve as my excuse for enlarging upon it in this place. Though, as already re- marked, the idea of denying the paramount importance of clinical ex- perience, and of substituting for it the information obtained by a reference to tbe printed records of medicine, would be absurd, yet I have no hesitation in again expressing the opinion that the experience in questiou, unless materially aided by a large share of information de- rived from an extended and continuous course of reading, will seldom, if ever, suffice to make an accomplished physician. By following out the views here suggested, the medical inquirer learns much of what he had not seen or heard of, even in reference to subjects he himself had occasion to investigate. No man can observe everything himself, or see what he observes in all the phases it may, and does assume, whether it be during different seasons in the same place, or during the same season in different places, marked by diversified climates, geological formations, and topographical conditions; or again in localities iden- tical or similar in those respects, but differing, at the time, by peculiar and unusual hygrometrical and thermometrical states; or by being in- habited by different races or classes of men. Many questions connected with, or having reference to the etiology, pathology, and therapeutics of disease, cannot be decided otherwise than by the survey and comparison of facts which have been too numerous to fall, or to be likely to fall under the cognizance of a single individual. I have already stated that many branches of medical inquiry are and must inevitably be under charge of individuals who can devote themselves in an especial manner to their investigation; who, from taste or the circumstances under which they may be placed, apply themselves more or less exclusively to a specialty, and acquire therein a greater experi- ence, and a more enlarged knowledge than the rest of the profession. Ad- mitting, therefore, that a physician has at his command the opportuni- ties and appliances required to pursue the inquiry with success, and to acquire a complete knowledge of one or more of those branches, he cannot succeed in many or all—for the same individual cannot attain eminence by original experiments and deep research, in every depart- ment of mental pursuit. In medicine, as in all things else, there must be division of labor. Such being the case, it is evident, that in regard to branches, to the investigation of which his attention has not been particularly called, the physician must still have recourse to the re- searches of fellow laborers in the path of science. Now, how this is to be done otherwise than by a diligent course of reading, or by oral instruction—the latter of which is not accessible to the generality of DR. LA ROCHE'S ADDRESS. 19 physicians, while the former is so to all, and can interfere in no way with their ordinary avocations—I leave to those who can discover to say. I acknowledge my inability to do so. By an extended and well regulated course of reading, as well as by a frequent communing with professional men of refined and well stored minds, and, I may add, by the cultivation of polite literature, the phy- sician not only acquires an amount of useful information, which he would not otherwise possess; he not only learns to avoid the practice of jumping at hasty conclusions from what he may have seen, but he dis- covers the impropriety of regarding himself as a discoverer of important truths or as the originator of lucid theories respecting the cause of some peculiar disorder, or of all disorders, or again as the founder of medical doctrines, for he is thereby enabled to perceive that his facts do not correspond with those recorded by others whose veracity, opportunities of investigation, and talent for observation, it would be unsafe to deny ; that his theories had long before been suggested and as often refuted, or if new, could not bear the test of examination ; that he has a great deal yet to learn before he can pretend to turn critic, to teach those who know more than himself, and to hold up as absurdities opinions on scien- tific or practical questions which are admitted or viewed with respectful consideration by the enlightened portion of the profession; and that he is not of the stuff reformers are made of. The physician, by pur- suing the course pointed out, will not only derive the advantages men- tioned, but while doing so, will find that his ideas acquire clearness and distinctness, and a tendency to a proper classification, that his taste is improved, and his language purified. These requirements are essential to all classes of physicians. But they prove still more so to those who, from choice or in the discharge of their duties, undertake to communicate their thoughts and disclose the results of their observations and reflections to the public through the medium of the press, or otherwise. To them an extended course of reading is absolutely necessary if they wish to suc- ceed in their undertaking. I have elsewhere referred to the expressed views of Sprengel on this subject. " When the observer," says the great historian of medicine, " whatever be the extent of his genius, has never- theless not enough of erudition to be acquainted with the observations of his predecessors, he runs the risk of repeating what has already been said a hundred times before, and of publishing it as his own discovery." Certain it is that the larger share of what is most valuable, and likely to be lastiug in the literature of France, England, and indeed, of all other countries, has been furnished by men whose minds had enjoyed the training referred to. In the same way the most distinguished medical teachers have, with few exceptions, been found among the same class- uniting experience to well stored minds, refined taste, and correct Ian- 20 DR. LA ROCHE'S ADDRESS. guage, and a power of lucid arrangement. On the other hand, we as certainly discover that the usefulness of original and important observa- tions is often considerably marred—not unfrequently completely neutral- ized, or even destroyed—by being conveyed in the unskilful, confused, incorrect, and tasteless mode of composition appertaining to an un- trained and unread mind. Nothing, it has always appeared to me, is more devoid of force—I had almost said more senseless—than the opposition that is so often made to what is sneeringly denominated book-learning, and the reason assigned to justify that opposition—i. e., that a physician who spends much time in reading, who is learned in books, and especially who cul- tivates general literature, cannot, on that account, become an experi- enced and successful practitioner. Doubtless, as said before, an exclu- sive devotion to information derived through such means, and a neglect of that furnished by an assiduous attendance at the bedside of the sick, would lead a physician to results of a doubtful character. But because such a mode of proceeding would never enable him to acquire the clini- cal experience requisite to render him useful in a practical point of view, it does not follow, as is but too often asserted by some physicians, and is still more generally echoed by the public, that a reading physician cannot become skilful and successful in the practice of his art. So far from this, when restricted within reasonable bounds, and combined, as it should and may easily be, with clinical knowledge, that much abused book- learning generally proves of the most decided advantage to the practical physician, and places him in a much higher position in respect to his usefulness as an attendant at the bedside. The history of our profes- sion furnishes us with numerous cases in illustration of the truth of this statement; for we therein find, that among the greatest practitioners and clinical teachers whose names adorn its pages, a large number were well and even deeply versed in the literature of the science—many in general literature ; while not a few of those who, from want of time or inclina- tion, had neglected to store their minds with information derived in the way mentioned, would evidently have avoided many errors, and risen higher than they have done in the estimation of their contemporaries and successors, had they followed a different course. A well read physician, has more resources at his command when placed at the bedside of the sick. Knowing what has been observed and done by others, as regards the treatment of diseases Avhich fall under his observation, as well in their pure as in their complicated states; aware also of the results of the researches made in various places, and under diversified circumstances, by individuals competent to the task, relative to the nature and seat of those diseases—the symptoms by which they can be detected, the signs by which they may be diagnosed, the textural and organic changes they DR. LA ROCHE'S ADDRESS. 21 occasion, or which reveal their true nature—he is better prepared to combat them with success, whatever be the modifications under which they present themselves, and, instead of groping as it were in the dark, resort to the means found useful in the management of cases similar to those before him, but which he may not have already seen in their pre- sent aspect. He is more certain to arrive at a correct diagnosis and prognosis even in cases, or modifications of cases, of unusual occurrence. He is less apt to find himself at a loss in moments of emergency, and more adequate to take an enlarged and correct view of the causation and na- ture of the diseases under his charge, and to deduce from his observa- tions principles calculated to guide him successfully in the selection of his remedial means. To this let me add, that a physician of the class under consideration, is less in danger of merging into the mere empiric, or of lapsing into quackery than the indiscriminate condemner of book-learning. The latter contribute little or nothing to the progress of even practical medicine. They live, they die, and are forgotten. At the time of their disappearance from the stage of life, the amount of practical resources at their command is scarcely greater than it was when they commenced, except as is afforded by a certain degree of familiarity with the salient phenomena and the progression of diseases commonly encountered by them during their rounds, and with the effect, in the treatment of these, of common remedies. They leave nothing likely to benefit others. They are besides seldom fastidious in regard to professional ethics, and are not in general looked up to as beacons for the guidance of their brethren in their endeavors to elevate the medical profession in the estimation of the public at large. From what precedes you perceive—indeed you know already, and scarcely need be reminded of it in this place—that the medical inquirer who does not apply himself to the task I have briefly sketched, with zeal and energy, has but little chance of success. He cannot expect to raise his head above the lower levels of professional gradations. Yerily, the life of a physician possessing, in a suitable degree, the requirements above alluded to, or aiming at their possession, is no sinecure. Much of his time must be devoted to attendance on the sick, in the wards of hospitals, or in private houses—often in the hovels of the poor. There his feelings are daily, nay hourly, harrowed by necessarily witnessing every shade of bodily and mental suffering to which flesh is heir. His time is not his own ; for he is subject to constant interruptions by day and by night. His patience is put to the severest trials in every ima- ginable way. His annoyances, nay his mortifications, are Avithout end. His duties are incessant. His life, in short, is a life of toil, of self- abnegation, of self-sacrifice. When he succeeds in obtaining the con- fidence of the public—and this seldom occurs before he has reached that 22 DR. LA ROCHE'S ADDRESS. period of existence when physical fatigue can least be borne—he must bid adieu to repose, and to those sources of recreation so conducive to health and happiness. Does he retire to his home after an exhausting round of professional visits, he finds there, or is soon aroused by, a fresh summons to the other end of the town, or to some more distant locality, and however worn down by fatigue of body or mind, or whatever be the state of the weather, he cannot and must not say—to-morrow. When at last the day's labor is over, and during the few moments of relaxa- tion to his toil, he has another not less imperative duty to perform. He must apply himself to rectifying and enlarging his knowledge by a care- ful study of the productions of authoritative writers on all subjects con- nected with the object of his pursuits, and by communing and exchang- ing thoughts with his professional brethren. How he can sustain himself under the influence of those depressing cir- cumstances ; how he can emerge, as it were, from obscurity, and contribute to the improvement of the science he cultivates, unless he be buoyed up by a more than usual degree of energy of character and of professional zeal—to say nothing of the sense of duty—it would be difficult to say. De- prived of these incentives to exertion, he will, as has already been remark- ed, run great risk of relapsing into a state of inertia; for physicians are not made of different materials from other men, and few of them are able to resist the proclivity to idleness, even if stimulated to action by the external means that have occupied our attention, unless these are aided by the internal impulses alluded to. Energy and zeal, I repeat, are essential ingredients in the character of every true, conscientious, philo- sophical, and ambitious physician. Indeed, unless impelled by a certain degree of enthusiasm, a physician will likely fail to succeed in fulfilling satisfactorily the professional duties he has undertaken to perform. He will, in all probability, stagnate in the inferior ranks of the profes- sion. At any rate, he will fail to attain eminence, or to effect something calculated to add to the stock of our knowledge, and by his discoveries, his learning, and the number, excellence, and usefulness of his produc- tions, to perpetuate his name beyond his lifetime, and by his example to aid in elevating the character and dignity of his calling. We may, perhaps, never reach, in sciences and arts, the ideal perfec- tion of which their cultivators naturally think they are susceptible of attaining. Indeed it is doubtful whether the thought of attaining that point should ever be entertained by reasonable and philosophical minds. Nevertheless, there is a point at which we can hope to arrive. But« even to succeed thus far, the investigator must not only possess a considerable fund of intelligence, and be properly prepared for the task by a suitable training; .but, as Yoltaire has long ago said, he must be, in no small degree, under the influence of that inward fire which the DR. LA ROCHE'S ADDRESS. 23 French have designated by the name of Diable au corps—the sacred fire—the demon of genius—the digito monstrari of others—the enthusi- asm of all. So necessary did an able philosopher and deep thinker— Diderot—regard the possession of this inciting power, that he declared that without it a man cannot succeed in achieving any object—even to the making of pins and needles. And some of you may have trea- sured the recollection of the story, related by Charles Matthews, of a French boot-maker, who refused peremptorily to sell a tiny and elegant pair of boots, because, as he said, he had made them in a moment of enthusiasm. What is enthusiasm ? Signifying literally to be inspired or agitated by God, it may for present purposes be defined an exalta- tion of our intellectual and moral faculties by which we are elevated, as it were, beyond ourselves, and rendered thereby adequate to the great- est achievements. It has its application to every variety of subjects connected with our mental and moral natures, and necessarily to the science and art, which it is our province to cultivate, and the duties im- posed by which we are called upon to perform. That enthusiasm when misapplied—when not restrained within just bounds, by common sense, sound judgment, or sound moral precepts, has been the source of great errors—often of mischief and of crime—may be, and is, indeed, very true. Nor is it less certain, so far as medicine is concerned, that it has been, in some one or other of its various modifications, the parent of many of those innumerable doctrines and theories—I should more pro- perly say, hypotheses—by which our annals from the days of Hippocrates to the present, have been disfigured. But on the other hand, enthu- siasm has not unfrequently—nay, it has over and over again—been the source of the noblest, the most useful, the most glorious actions. Need I point out, that in the Christian order, enthusiasm has given origin to the Prophets, to the inspired writers, martyrs, anchorets, and saints, both ancient and modern. In the social order we may trace to the same cause, according as it has exercised its influence on the will, the intellectual powers, or the imagination ; or again, on the love of good, the love of truth, or the love of the beautiful, the existence of those benefactors of humanity, whose names will live to the end of time on the pages of history : those votaries and improvers of science, to whom we revert with sentiments of pride and gratefulness: finally, those numberless artists who have so successfully ministered to our pleasures, and contributed to our intellectual and moral refinement.* . Medicine, of course, comes in for a share of the beneficial influence which enthusiasm thus spreads all around; and if time and space per- mitted, it might be shown that, in order the more effectually to contri- bute to its advancement, its cultivator must be incited by no small * See Estor, Discours sur l'Enthousiasme Medical. 24 DR. LA ROCHE'S ADDRESS. share of that passionate ardor, of that warm aspiration after truth, which by exalting the intellectual faculties multiplies the powers of these ; in a word, that the true and philosophical physician, who is fully alive to the usefulness, nobleness, and dignity of his calling; who is ready to devote himself to a conscientious performance of the arduous services it imposes upon him; who is desirous of storing his mind with all the knowledge necessary for that purpose, and ambitious at the same time of the honor of aiding towards the advancement of medical science, should, in order to succeed, be embued with both the enthusiasm of duty and the passionate love or enthusiasm of science. All this, I say, might be shown, but I cannot indulge in many details on the subject, and will merely remark that it is to the influential agency of the first of these modifications of enthusiasm we, in great measure, owe those acts of heroism—or, as it has sometimes been called, medical courage—of which our professional history furnishes so many striking examples, as manifested in the midst of epidemics, on the field of battle, and under a variety of other trying circumstances. I shall not allude in a par- ticular manner to the reputed devotion of Hippocrates, during the cele- brated plague of Athens, " when death grew frantic with its own work of slaughter;" for though often referred to," and resting on an autho- rity of ancient date, there is reason, from the silence of Thucydides, in relation to him, to doubt of Hippocrates having been in that city at the time of the calamity. But who has not heard of the devotion and self-abnegation of Deydier and Chicoyneau, during the disastrous plague of Marseilles, in 1720—a devotion only eqnalled by that of the saintly and immortal Bishop of that city, and contrasting with the con- duct of Galen, Sydenham, and a few of more modern date, who, to their shame, fled, on similar occasions, from the scene of danger ? Who can forget the almost equal devotion of Berthe, Lafabrie, Brous- sonet, at Cadiz, in 1800—of Pariset, Mazet, and others, at Barcelona, in 1822 ? What physician can read without a glow of professional pride, of the courageous act of Desgenettes, who, to revive and sustain the drooping spirits of the French army, in Egypt, and though fully im- pressed with the idea of the danger of the experiment, publicly inocu- lated himself with pus ? Who would refuse to place a crown of im- mortals on the tombs of the surgeons left at Jaffa, by Bonaparte, to attend the pestiferous soldiers, whom he was forced to abandon. In full conviction of their impending doom, they did not flinch, and unhesitatingly stood at the post of honor, which, to them, was the post of death ? Who can revert, without like feelings, to the instances of our northern physicians, during the yellow fever epidemics they have so nobly confronted, in New York, Philadelphia, and other cities; of our northern physicians, again, during the awful visitation of the same dis- DR. LA ROCHE'S ADDRESS. 25 ease at Norfolk, in 1855 ? Again, I ask, Avhat high-minded physician and lover of his profession can read, without pride, of the thirty assist- ant physicians doing duty at the Bellevue Hospital, in New York, dur- ing the prevalence of ship fever in that city a few years back—twenty- one of whom took the disease, and five died ; while of the nine who escaped it, three had already suffered from it in other medical institu- tions? But, yet, as the chronicler of the event adds, "their ranks were always full." In 1848, the cholera smote the town of Sandusky. The six physicians of the place were soon exhausted. The cry of help, was raised, and scarcely forty-eight hours had elapsed before those six phy- sicians were replaced by four times that number of regular graduates and five medical students. A few years later, an analogous scene was enacted in Columbia, Pa. Assistance was sought in Philadelphia. The messenger arrived there on Sunday, and on the evening of the same day, in the midst of a pelting rain, a special train returned to Columbia with several physicians, and I speak from personal knowledge, when I say, that these physicians did their duty. When the place was visited on the succeeding Tuesday, by the members of the Com- mittee appointed, for the purpose, by the Philadelphia College of Phy- sicians, they there found physicians from Baltimore, Harrisburg, and other places, who, unmindful of danger, had already hastened to tender their services to the afflicted inhabitants. But why multiply instances of the kind ? They are of daily occur- rence, and no longer excite attention. They are, in fact, taken as a matter of course, and, as has been remarked by one not of the profes- sion, it is only the refusal to submit to the ordeal, by declining to pro- ceed when wanted, to the scene of danger, or by flying from it, which elicits the remarks of the public. The physician, let me say—though for so doing, I may, as one, be charged with egotism—is, as it were, by profession a philanthropist. He should select as his motto words which, when pronounced in the theatres of Ancient Rome, extorted the plaudits of the multitude— " Homo sum ; humani nihil a me alienum puto." lam a man, and nothing that interests man is indifferent to me. To him the whole human race constitutes an immense family, the members of which are linked together by the bond of a universal fra- ternity, and have equal claims to his devotion. He is essentially a cos- mopolite. The unfortunate and sufferer of all nations are entitled to his professional assistance and kind attentions. We read of Hippo- crates refusing the presents of Artaxerxes, and declining to proceed to Persia, then ravaged by the plague, on the plea that he would not lend the succor of his art to the enemies of Greece. Fortunately for the honor of the father of medicine, and to the gratification of every true 26 DR. LA ROCHE'S ADDRESS. lover of his profession, this story—fit only to excite the plaudits of ultra and misguided patriots and village politicians, such as abound everywhere, and are not unknown in this free country—so far from being well authenticated, rests on testimony of an apocryphal charac- ter ;—the letters and discourses forming part of what is denominated the Hippocratic collection—and has been rejected with disdain, as Dr. Adams admits, by all the modern scholars who have touched upon the subject. How different the conduct, among other instances I might cite, of Larrey—of him whom Napoleon pronounced to be the most virtuous man he had known. Larrey made no difference on the field of battle, in the wards of his hospital, or anywhere else, between his wounded countrymen and his wounded enemies. They shared equally his professional assistance and his humane care. What was the result? Had Hippocrates, admitting the above story to have been founded in fact, possessed no stronger claims to the regard and veneration of his successors than such a melodramatic display of misplaced patriotism, and such an absence of true philanthropic feelings, it is doubtful whether his name would ever, as it continues to this day to do, have revived a sentiment of grateful admiration and a feeling of professional pride. It would not have been treasured up by the medical profession of all times and all places from his own to the present day; while, by the public at large, it would long since have been completely forgotten. In regard to Larrey, I am not aware that he has left in his professional writings anything likely long to survive. But the remembrance of the characteristic trait I have referred to will never be lost. The record of it has been placed on the pages of history, and from these it will never be obliterated. See the consequence of the reputation he thereby gained. After the battle of Waterloo, Larrey, while still occupied in the discharge of his duties, was wounded, made prisoner, stripped, pinioned, and dragged from post to post by the enemy. He was, indeed, about being shot, when, recognized by a Prussian surgeon, he was released, conducted with suitable marks of respect before General Bulow and thence introduced to Marshal Bliicher, by whose orders he Avas set at liberty and trans- ferred, under charge of a guard of honor, to Louvain. Soon after, he proceeded to Brussels, where his health, which had been greatly im- paired, gradually improved. There, true to his instinct, Larrey devoted himself to an attendance on the sick, in and out of the hospitals—dress- ing the wounded, and extending his professional aid to all—regardless of differences of nationality. Not long after, he was ordered to Paris, not by his countrymen, but by the chiefs of the allied armies. Certainly, it is far from my thoughts to assert that the enthusiasm of DR. LA ROCHE'S ADDRESS. 27 duty is a special attribute of our calling, and does not show itself among, and exercise an influence over the conduct of, other individuals pursuing different paths in the walks of life.* The laws, the customs, the usages of all civilized communities impose more or less stringent duties on individuals composing these. The consciousness of the obligation to perform those duties is often so strong that this obligation is held in the light of a point of honor. To it is connected, in great measure, the existence and permanence of the social state, which languishes when the former becomes relaxed, and perishes when the other is completely neglected. How often do we not find the inclination yielding to the sense of duty ? The man, animated with a proper degree of courage, prefers a life of indigence to the possession of wealth and honors, if that wealth and those honors are to be obtained at the expense of that sense. The soldier, impelled by the feeling in question, remains at his post when ordered to do so, and there dies sooner than disobey. History tells us of Regulus, who returned to Carthage, though fully aware of the cruel fate that there awaited him. All this, as well as the sacrifice of ease, comfort, repose, and even of life, exhibited in times of public distress and of epidemics, and of like circumstances by many classes of individuals, by the ministers of religion, and by those different orders of Sisters of Charity who, from the days of St. Vincent of Paul to our own, have proved themselves true to their calling, and have ever been held in the light of angels of mercy amid the sick and the dying; all this I say, and much more that might be added for the purpose, attest the cor- rectness of the admission that the enthusiasm of duty is not an exclu- sive attribute of our profession, but pervades, to a greater or less extent, all classes of the human family. Nevertheless, we may, without fear of being taxed with exaggeration, maintain that, in no profession is the obligation in question more strongly appreciated, and the duties which it imposes—however irksome, harassing, and dangerous—more sacredly and cheerfully performed, than in that of medicine. So much for the enthusiasm of duty. I have said enough to indicate my belief that a physician cannot hope, and is not destined to attain, the object in view, still less to ac- quire an eminent position among his brethren, and contribute to tbe advancement of any one of the several branches of the science he culti- vates, unless he be endowed with the love or enthusiasm of science, and enters into the pursuit of the knowledge necessary to the proper per- formance of his professional duties with more than a common alacrity. Open the records of the profession, and task your memories respecting the physicians you have heard or read of, or Avhom you are now personally * See Estor, op. cit. 28 dr. la roche's address. acquainted with, and you will agree with me in the opinion that all who have contributed to the results mentioned; all who are, or de- serve to be numbered among the ornaments of our profession__who have attained a high position among their compeers on the score of their attainments as physiologists, pathologists, anatomists, chemists, botanists, &c, were, or are endowed with a greater or less share of the enthusiasm in question. Even those who have pursued with success the department of clinical medicine, and who usually are regarded by the public at large and a certain class of practitioners, as the beau-ideal of physicians, and as belonging to the only useful class of medical men on the score of being, as it is thought, more practical than theoretical in their tendencies—even they have reached their eminence in the ranks of the profession through the influential agency of enthusiasm. For medi- cal observation is not simply the result of a passive operation of the organs of sense. It requires, in order to lead to useful issues, a force of mind, a quickness of perception, a degree of penetration, and hence efforts of the intellectual functions—a constant and rapid appeal to the faculties of causation and comparison, which cannot be exercised to the required point unless under the stimulus of enthusiastic excitement. Had he not been under the control of the agitating and impulsive feel- ing in question, Hippocrates would not have been remembered in after times. Nor would Galen, Celsus, Avicenna; nor Boerhaave, Harvey, Stoll, Selle, Cullen, J. Hunter, Broussais, Louis (I mean he of Surgery), nor Bichat, Rush, Tommasini, and a thousand others I could mention. None of these, I repeat, could have attained the eminence they occupy, and stamped their names in imperishable letters on the pages of our professional history, had they not felt the vivifying effects of the sacred fire in question. In the course of the above remarks, which I fear have been extended beyond proper limits, I have several times adverted to the subject of the usefulness, honor, and dignity of the medical profession. I have thus, gentlemen, almost unconsciously, found a theme well worthy of being brought to your notice, and upon which an individual more skilled than myself could find much to say ; for all the influences that tend, directly or indirectly, to lessen the first and tarnish the others, cannot be too often pointed out and earnestly deprecated; while, on the other hand, those which have a contrary tendency—increasing the one and elevating the others—become objects of interest to every high-minded phvsician. I cannot do more in the short moments that are left me on the present occasion, than to add a few words to those I have already hazarded on the subject. In doing so, I take for granted that all who favor me with a hearing, are fully impressed with the importance of the points to which I have alluded. Hence I shall not dwell on the question of the dr. la roche's address. 29 usefulness of the medical profession, but limit myself to a few remarks relative to some of the circumstances which seem to me to affect its honor and dignity. Need I remind you that few subjects are better calculated to command the interest of all true lovers of the medical profession—of all who have at heart its honor and dignity, and its position in the social order, and who feel the importance of adopting every proper means of elevating the character of its members, and insuring to them the respect and con- fidence of the public—than that of medical education ? Every intelligent individual connected with our calling who has reflected on the subject of its condition in this and other countries, and witnessed the consequences resulting from a neglect of its requirements will agree in the opinion, that the desirable objects alluded to can never be attained except through means, or at any rate through the aid-of a high standard of pro- fessional knowledge aided by a liberal and refined course of preliminary instruction. The physicians of modern times do not resort, in their en- deavors to secure the respect and confidence of the world at large, and to add dignity to their calling, to those adventitious means on which our ancestors laid considerable stress. In our own country, the neglect of such means is still more striking than it is in Europe, and without expressing the wish that matters were restored to precisely the same footing as they were in by-gone days, I hazard nothing in saying that we have gone somewhat too far on the score of what is called reform, and that we pay the penalty of that course. In the good old times, the ceremonial observed at the examinations of the candidates, and especially at their admission to the doctorate, was imposing and well calculated not only to give them an exalted opinion of the character of the profession, on the duties of which they were about entering, but also to inspire the spectator with a feeling of respect towards them personally, and lead to the conclusion that they were well prepared to the task of taking charge of the sick. The dress and bearing of the physician contributed, in no trifling degree, to the same results. He wore the cocked hat and his head was ornamented with a flowing wig; his coat, cloak, breeches, stockings, shoes, buckles, were of a corresponding kind, and he held in his hand a long and ornamented gold-headed cane. His manners were stately; his speech was sententious; he rode majestically along the streets, and whatever he may have done in the bosom of his family, or among his intimate friends, he shunned all manifestations of familiarity in public, and was guarded in his inter- course Avith his patients, and even with his colleagues. These, together with a finished collegiate education and a thorough course of medical instruction, made of the physician a man above the standard of the mul- titude ; and though they have been the source of amusement to the wits 3 30 DR. LA ROCHE'S ADDRESS. of the period and have been ridiculed in prose and verse—on the stage and off the stage—there can be little doubt that, notwithstanding some drawbacks arising from the quarrels which occasionally arose among them, the medical men of former days succeeded in upholding the honor and dignity of the profession, more effectually than many of their successors. In some regions of the civilized world, many of the adventitious means above alluded to, have been laid aside; but while there phy- sicians dress, talk, walk, ride, laugh, and chat like the rest of the community, it is expected of them that they will have such manners as will entitle them to be admitted in refined society, and, above all, they are by law compelled to receive a complete collegiate education, to go through an extended course of instruction in all the departments of medical knowledge, and to acquit themselves perfectly in numerous and strict public examinations before they can aspire to the honor of the doctorate. By these means and by being, at the same time, protected in the exercise of their functions by the prohibition of quackery, or rather of secret nostrums, and the interdiction of the practice of medicine to all but those who have given proofs of their fituess, and obtained a license, they, like their predecessors, succeed in upholding the honor and dignity of their calling. In this country, as every one knows, we have shown a still greater tendency towards radicalism, so far as regards the organization of the medical profession, as we unfortunately show in most other points con- nected with the social state. In almost all the colleges of the country, the necessity of a preliminary education is done away with. Indeed, I am not aware, that in any, pains are taken to ascertain whether the aspirant to the honors of the profession can correctly spell the com- monest words in the English language and construct the simplest English sentence ; while no attention is paid to the nature of his deport- ment, manners, and language. At the same time, in all those institu- tions throughout the broad extent of the land—and, in this respect, those of the State of Pennsylvania form no exception to the rule—the course of instruction is too limited, the scholastic periods are far too short, and the lectures, in consequence, too crowded together. Suffi- cient attention is not paid to clinical teaching—I mean hospital clinical teaching ; for that adopted in the lecture-rooms of medical schools has little to recommend it, and is open to serious objections. Besides this, the examinations for graduation are too few and of too trivial a charac- ter to insure those by whom they are conducted against the commissions of the greatest blunders in regard to the state of preparation of the aspirant, and to enable them to turn out annually a set of young men properly qualified to take charge at once of the sick. It is true, that DR. LA ROCHE'S ADDRESS. 31 some professors assert, as I have myself heard them do, that young men, who have passed the ordeal of their examinations, have little more to learn in the branch they teach, and that the same may be said of the results obtained by all the other teachers in the school to which they belong; so that the graduates who issue in shoals from the portals of those institutions may, one and all, be safely regarded as accomplished physicians and skilful practitioners. On this point, hbwever, we may be permitted, without fear of being accused of undue skepticism, to demur, especially as some, who make the assertion, have been twenty or thirty years in learning what they know, and do not yet know much more than is absolutely necessary; and surely if such has been the case with teachers, we cannot easily admit the possibility of young men who have gone through a course of instruction such as has been referred to, can so rapidly have acquired the degree of knowledge necessary to entitle them to the favorable opinion thus expressed. Especially is it impossible for any examiner to ascertain, during one sitting with tbe candidate, whether the latter has really qualified himself to the extent that is here pretended. One short examination of some ten to twenty minutes on each branch taught, and conducted most generally in private, is not and cannot be sufficient for that purpose. Many must and do pass through the ordeal, who, so far from being accomplished physicians and skilful practitioners, are perfectly unquali- fied on some of the branches and not much better off in respect to the rest. Of the truth of this there can scarcely be one among us who has not had evidences-before his eyes; and surely, when we find some facul- ties examining between two and three hundred candidates in the short space of a month—sometimes amid the bustle of lectures and of private and public practice,'and admitting them all, or nearly all, we cannot but presume, d priori, that such must often be the case. Homer him- self was at times found napping. The same has been said of many conscientious and venerable confessors, and we must be pardoned for thinking that medical professors are not unfrequently subject to the same fate. That some of the young doctors so hastily made, do not immediately venture on offering themselves to the public as candidates for profes- sional occupation; but continue for some time longer, either at home or abroad, in prosecuting their studies, may be, and is doubtless true. But the number of those who constitute this better class is compara- tively small. More usually the young graduate, fresh from the benches of the school, opens his office and announces his readiness to enter on the practical duties of his calling. It is true, that some of these ulti- mately become by dint of study and long experience good and safe prac- titioners. This result, however, is of slow growth, and I hazard nothing 32 DR. LA ROCHE'S ADDRESS. in stating that it cannot be obtained otherwise than at the expense of human life. The consequence of these defects in the system of medical education adopted in this country has always been felt among us—not in this State alone, but everywhere. It continues to be so felt to this very day. Perhaps I may go farther and say that it is more keenly felt now than ever before; for the establishment of cheap schools and of free schools in many localities—often in places where the duties of teachers are assumed by men imperfectly qualified for the task, and who would themselves not be the worse off for a proper course of instruction and plenty of reading; and where the appliances for effective teaching, and for clinical instruction particularly, cannot be obtained, has opened the door to many abuses and served to increase and perpetuate the evils to which allusion was made above. In former times, the expenses of travel, added to the high price of medical tuition and medical gradua- tion, deterred many from resorting to distant schools, who otherwise would have selected medicine as their business, though better qualified, from Avant of early education and mental training, to do justice to some less intellectual or some mechanical pursuit. At the present day, they labor under no such difficulty; for they find near home schools where they can, in a short time and at little or no expense, obtain a regular medical degree. Nay, not a few may take or have taken advantage of the facilities afforded by some schools located even in places where they could least be expected to be found, and which have two sessions and two periods of graduation in the year. Need I say that all these schools are instrumental in enticing into the ranks of the profession a number of individuals AATho do it no honor and ought to be otherwise employed; and contribute largely in increasing an evil re- sulting from an effect which our older and better organized medical establishments proved themselves perfectly adequate to accomplish— namely, spreading over the whole country swarms of half educated physicians ? Let it not be supposed from what precedes, that I am an uncompro- mising opponent of the establishment of cheap schools. Still less am I adverse to the existence of free schools. But, in order that either set of institutions should deserve the full approbation of the profession, it is necessary that some method should be adopted to insure the selec- tion of proper teachers; that the requirements for admission to the lectures, and more especially to the doctorate, should be of a high order; that the course of medical instruction should be long and com- plete, and that the examinations should be public, frequent and strin- gent. When these measures are adopted, such institutions may be entitled to approbation. Until then, they must be viewed as more mischievous than schools conducted agreeably to the ordinary plan. In DR. LA ROCHE'S ADDRESS. 33 respect to double session schools, I have no hesitation in remarking that in a country Avhere the doings of medical institutions are con- cealed from public view, they cannot be otherwise than perfectly objec- tionable. For though the faculties of such institutions may be occasion- ally composed of honorable men (as is now the case in the one located in this State) who will not abuse the privileges of their position, and sell their diplomas too cheaply to young men whose term of instruction has been shorter than is allowed by usage if not by law, yet those facul- ties have not always been, and may not always be so safely composed, and we all know that from these schools have issued graduates who, so far from having studied the usual time, had done so less than a year. Certainly, such things are intolerable. What has been done at one time may be repeated at some future day, and it becomes imperative on us all to express our disapprobation of the existence of schools where they may be done. From a consideration of what precedes, the conclusion is inevitable that a reform in the medical education of this country cannot be too soon effected, and has become a desideratum with every lover of his profession. But of the nature of this reform, and of the means by which it can be brought about, I need say nothing here. They have been made the subject of investigation and comment on very many occasions and through many channels. What the efforts of the American Medi- cal Association have been is well known to you all. They have so far failed; and matters stand now very nearly where they stood when the subject was first presented to the consideration of that body. By only two institutions—so far, at least, as I am informed—were the appeals of the latter respecting the extension of the course of medical instruction responded to. It is with no small pride that I revert to the fact that of the two institutions here referred to, one is located in, and bears the name of our State, and is the oldest and most renowned in the whole country— the University of Pennsylvania. It cannot but be a matter of regret that the example thus set was not followed by other large and influen- tial schools; inasmuch as to their refusal to follow out the recommenda- tions of the association, except perhaps to an extent so trifling as to amount to almost nothing, we may, in great measure, attribute the failure of the experiment. Nor is this the only point in reference to which regret may justly be expressed. As if the course of medical instruction were not, in all conscience, short enough, a plan has been adopted in some large and influential schools which makes it, in some respects, shorter still, and, according to my view of the case, prevents students from reaping to the full extent the advantages they are promised. The plan heretofore pursued in all the schools of the country was to 34 DR. LA ROCHE'S ADDRESS. postpone the examinations of the candidates for graduation, till after the close of the lectures. By this means the student enjoyed, or might if he chose enjoy, the benefit of two courses on each of the branches, of full four months, or four months and a half, according to the institution he selected, without having his mind diverted, during that time, by ne- cessarily dwelling on other considerations than those connected with the subject of the lectures and demonstrations he was attending. When these were over he had more or less leisure to pass in review the various subjects which had been brought to his attention, and especially to per- fect himself on those topics in relation to which he felt himself de- ficient—besides taking advantage of means of further instruction offered in the way of private lectures and examinations. At present, the exa- minations in the schools alluded to commence in the early part, and continue during the whole course of the last month of the term. They proceed simultaneously with the lectures, and are there, as in some other establishments, conducted in private and by each professor separately. Young men are keen enough to discover from the manner in which they have answered questions put to them, and the tone and language of the examiners, whether or not they have been successful. Very few can have, nor, usually, have they, any doubts on the subject. Now, it stands to rea- son, that as soon as they have passed through the hands of a professor, they will, generally at least, neglect the remaining lectures of that profes- sor, or at any rate, will fail to pay particular attention to the concluding portion of his course. Their time must be otherwise occupied, for they will necessarily endeavor to post up and to prepare for the examinations which are to succeed. This is done not only at the expense of the lec- tures of the passed professors, but of some of those who have not yet put the qualifications of the candidates to the test. Let me add, that it is doubtful whether the minds of young men are in a fit state, for some weeks prior to the advent of the impending examinations, to attend diligently, or derive full advantage from, the lectures of the various pro- fessors. Be this as it may, when they have passed all the examinations they lose interest in the school exercises. The principal object they had in view Avas to secure the possession of a diploma. They now feel satisfied on that score, and have no disposition to continue their studies. They hence avoid, or lounge about, the lecture-rooms and amuse them- selves in the best Avay they can till commencemeut-day, after which, having received, with proper formality and to the sound of music, their long wished for testimonial, and having, besides, been very gravely told that they are proclaimed, before the large assemblage gathered together to witness the ceremony, " Physicians, not only in name, but in knowledge, Doctors in medicine, to whom the husband may intrust the safety of his beloved wife; the wife, the health of her cherished husband ; the parent, DR. LA ROCHE'S ADDRESS. 35 the lives of his dear children; and the community, the security of those illustrious servants who minister to the glory and safety of the country;" having, I say, received these encouraging assurances, they depart seve- rally for their homes and apply themselves at once to the task of dimi- nishing the mortality around them—ministering to the sufferings of the sick and imparting comfort to all who are wise enough to seek their professional advice. Surely, such students cannot, strictly speaking, be said to have at- tended two full terms of lectures on each of the branches taught in the school where this objectionable plan has been adopted. They have lost a month or so of attendance on lectures of several of the professors before whom they presented themselves for examination—lectures, too, the subjects of which may have been of the most interesting character, and which were necessary to complete the circle of their medical studies. If the candidates fail to be examined on subjects on which the professors, before whom they appear, have not yet lectured, the faculty which passes them runs the risk of granting its diplomas to persons having little or no information on those topics; for on these they have had the benefit of but one lecture, and that, too, a year before, and there are no means of ascertaining whether they have attended that lecture, or remember what was therein taught, or have derived some information concerning the subject of it by study during the intervals of the scholastic terms. If they are examined on those subjects then they are not treated fairly ; for their qualifications for the doctorate are tested on points of doctrine, or on practical matters, upon which they have heard but one lecture—and that, in like manner, a year before, when, in all probability, their minds were not sufficiently matured in reference to medical topics to embrace the full scope of the subject presented to them. They must trust, there- fore, in order to answer correctly, to the faint recollection of what they had heard on that occasion, or to their small stock of reading. Viewed in every aspect, the plan is objectionable; nay, injurious, and calculated to add to the defects—already numerous enough—of the course of medi- cal instruction in this country. The only advantage that can accrue from its adoption is that it permits the graduates to return to their homes a few weeks sooner than they would otherwise be able to do. Another, has been occasionally, though doubtless unjustly suggested, that inas- much as, in order to enjoy the benefit of a shorter residence at the place where the school is located, students are more disposed to fill the benches of institutions where they can obtain the doctorate with the least pos- sible delay, the emoluments of the professors are thereby increased. Be this, however, as it may, the plan was tried in the University of Pennsylvania, and abandoned. By its adoption, we do not, it is very certain, advance one step in the march of improvement as regards the 36 DR. LA ROCHE'S ADDRESS. medical education of the rising generation. It is a bad example set to institutions of inferior note and popularity, or less recommendable for the efficiency and reputation of their faculties. Let us hope that it wall be everywhere abandoned. Nay more, let us trust that the day is not far distant when the system of private examinations will also be aban- doned, and the qualifications of the candidates will be tested, on tbe several branches taught, in presence of medical commissioners appointed by the governors of the schools or by tbe Society of the States where these schools are located. By expedients such as that mentioned, schools may curry favor with students and enlarge the number of their matriculants, but they do not contribute to the creation of a class of physicians calculated to elevate the character and enhance the honor and respectability of the profession. Doubtless we labour under more difficulties in this country than is experienced elsewhere in relation to the attainment of the desirable object to which your attention is now called. They arise from the popu- lar—often radical—nature of'our institutions; from the objectionable character and the incompetency of the individuals in whose hands the government of those institutions is very generally placed, or by whom it is monopolized, and from the go-ahead, reckless, unreflective, and pre- sumptive disposition of a large portion of our population, and their ig- norance in many matters they undertake to control. From these circum- stances there results this fact, that many things are done which affect injuriously the character and interests of the medical profession, and as many are left undone, which that profession would require in order to assume the position to which it has just claims. Raise the cry of the "People;" talk loudly about our "noble republican institutions;" insist upon the vast superiority of these over all other institutions; abuse everything European; especially abuse England and her aristo- cracy ; and enlarge on the liberty which every free-born American citizen possessed of doing as he pleases, and you will be almost sure to obtain from our wise, disinterested and patriotic governing bodies the enactment, within the limits of their influence, of any law however truly objectionable to the well informed and clear-sighted, respecting the organization of our medical institutions, and the rejection, on the score of monopoly, tyranny, and what not, of any clause imposing restrictions on the rapid manufacture of doctors, and on the practice of medicine— in fact, on everything likely to protect and raise the character of the profession. We have, in our endeavors at improvement—in our efforts to promote the interests and secure the rights and liberties—civil, reli- gious, and political—of the "people," succeeded, step by step, rather in placing, the higher, or educated classes of the community on a level with the lower, than in elevating the latter to an equality with the for- DR. LA ROCHE'S ADDRESS. 37 mer, until at last the natural order of things has been reversed; power has been assumed by those least qualified to exercise it. In a word, we now find ourselves in the hands of a set from whom little of what is just, wise, useful, or ennobling—nothing indicative of that intelligence, know- ledge, and experience which should ever constitute the essential attri- butes of those who aim at governing their fellow men, can be antici- pated. Judging from the results, one would almost imagine that in the selection of their rulers and public servants our liberty-loving and equa- lity-seeking people frequently follow the system referred to by Figaro : " I was almost in a state of despair. My friends thought of me for an office; but unfortunately I was qualified to fulfil its duties. It was an accountant that was wanted; a dancing master obtained the situation." But whatever may be the case as regards other matters, certain it is that in all that relates to medicine, such august bodies are not to be trusted. Nothing of a truly useful character can be expected at their hands ; while those who control the medical institutions them- selves are fettered by influential circumstances which render improve- ment next to an impossibility. And yet this profession can scarcely hope to attain the high position to which it is entitled, not only so long as the standard of education of its members is not raised; the period of probation of the candidates for the doctorate lengthened, and the plan of examinations improved; but also so long as proper and efficient measures are not adopted to insure the selection of competent and experienced teachers and the location of schools only where they are needed and can be useful. As matters now stand, any set of medical men, even in out of the way places, where the requisite appliances for imparting instruction are not accessible, may, with some little manage- ment and political influence, obtain a charter for a school and start at once on their professorial career—no inquiry being made as to their competency, or to their possessing really the right to assume a title which they regard themselves as fit to confer upon others. They may even receive a donation of funds from the State for the purpose of erecting a college building, or for other objects. Depending for the support of their establishment on the number of pupils they can gather, and these, being but too often attracted to an institution by the facilities they there enjoy in hastening the period of their studies, and smoothing their path to the doctorate, those self-constituted professors and their successors, are not always as particular as they ought to be as to the nature of the requirements that should be exacted of pupils, and in regard to the results of the examinations to which these are submitted, and, as a consequence, send forth their quota of imperfectly educated physicians. In many of these institutions, as indeed, in others of older date and higher repute, the selection of the professors is intrusted to boards of 38 DR. LA ROCHE'S ADDRESS. governors or trustees, who are irresponsible in their acts. The plan, if those boards were always judiciously composed, could answer a use- ful purpose. It may be added, also, that on many occasions they have made very good choices, and I could name faculties selected by such governing bodies which would do honor to any school. But, unfortu- nately, those bodies are not always composed as properly as might be desirable, considering the duties assigned to them. Hence the choices they make are only occasionally, and accidentally of the satisfactory kind mentioned. In general, they are made up of members of the bar, of clergymen, of merchants, and now and then they contain a sprinkling of physicians—often none at all. The consequences of this arrangement, whenever the members of a body so composed are called upon to make choice of a medical professor, may be easily foreseen. Conscious of their inability to judge, themselves, of the merits of the several candidates, and to select the most competent person to fill a vacancy that may have oc- curred in the faculty, they are compelled to rely on the opinion of third parties in—often out—of the profession, who, feeling no particular in- terest in the success of the school, are guided in their advice by their personal regard for a certain applicant, and are, of course, seldom im- partial. Not rarely, the electing body is governed in its choice by family influences and personal considerations, and unheeding the admonitions of better judges, but too often give its preference to inferior men who cannot add to thevreputation of the school, but acquiring reputation by being connected with it, tend not unfrequently to lower its character and lessen its influence. In some institutions, the selection of professors is intrusted to governors or regents appointed by State authorities or legis- latures. These boards being generally composed of the same materials as the former, are open to similar objections; but were such not the case, the experience of this country teaches us but too well, that in all selec- tions made by a body so composed, politics is a lever more powerfully effective than the appreciation of the merits and fitness of the individual appointed to fill an office; and so far Ave have had no good reason to presume that a medical appointment left to such hands will be made agreeably to other principles. In some of the institutions of the coun- try, it may be added, the faculties have the power of nomination; in others they have the right of recommending the individuals they think, or know to be, most fit to fill vacancies in their bodies. In a different set, however, the faculties are not allowed, in their corporate capaci- ties, to say a word on the subject; Avhile the opinion of their members, as individuals, has little weight with the electing board. Here, again, I must express a hope, namely, that the day will come, and that soon, when a change in the latter respect will take place in the schools just DR. LA ROCHE'S ADDRESS. 39 mentioned, and when the faculties, instead of being, as it were, gagged, whenever the choice of one of their colleagues is concerned, will be consulted, and their advice taken into the most serious consideration. Nor are the preceding the only difficulties experienced in the country in relation to the matter before us. It is said that the character of a nation may be ascertained from the nature of its literature. With equal propriety we may affirm that the position, honor, and dignity of a pro- fession may be estimated by the same standard. If submitted to this criterion, we are compelled to admit that the reputation of the medical profession in this country will not stand the ordeal; for we discern nothing in our literature, viewed in its totality, calculated to shed lustre on our calling—much, on the contrary, to affect injuriously its honor and position, and lessen its dignity. I have said, gentlemen, in its totality, for in several of its'departments that literature, though in its infancy when compared with that of Europe, has attained a degree of eminence of which every American physician may justly be proud. My remarks apply more especially to the periodic medical press, in which, if we except some journals and reviews, that would do honor to the literature of any country, and are fit representatives and supporters of the character and re- spectability of the profession, are exhibited an absence of solid knowledge, a jejuneness, a lack of useful materials, a prolixity about things perfectly unimportant—which everybody knows, and often for which nobody cares-^-and very generally a deficiency of refinement, good breeding, and literary culture, little calculated to aid in raising us in the estimation of the scientific world, and in promoting the attainment of the desirable object to which allusion has so often been made. Every place must have its journal—sometimes more than one; every physician thinks himself qualified to edit a journal. It not unfrequently happens that he has ne,ver seen or treasured up in his recollection anything worth communicating; and that he has no one around him competent to aid him in the under- taking. As frequently it occurs that he is located in a position where facts of a novel, important, or interesting character are never encoun- tered ; or when so are at best not sufficiently numerous to furnish food for more than a short annual communication. As often his pursuits have not been, and the appliances within his reach are not, such as to enable him to carry on pathological, therapeutical, or other investiga- tions in the way best calculated to render them truly useful and accept- able to medical inquirers. It may happen, also, that he, no more than his colleagues, if he has any, is an adept in the art of composition, and that he is deficient as regards the simplest elements of a correct and polished style. It is not unusual, besides, to find that he, for the most part, limits his reading to a few text-books and sundry journals of a merit equal to that of his own bantling, and that in point of tone, taste, 40 DR. LA ROCHE'S ADDRESS. and discretion, he can lay but slender claim to the approbation of culti- vated minds. But no matter—his place must have a journal, and he must be the editor. He is full of^an idea of his importance, and blind to his many disqualifications to perform with proper efficiency the duties he has under- taken. So, his production is launched forth into the literary Avorld to the no small injury of the entire profession, of whose intellectual and scientific position, no less than of its honor and dignity, it is but too apt to be viewed by the medical critics and readers of Europe, as well as by a large portion of the public here, as a fitting exponent. We could, of course, scarcely expect to find, in such journals, judicious, well written monographs on important medical topics; or a detail of in- teresting cases establishing their true pathological character or therapeu- tical indications ; or other communications, exhibiting a correct know- ledge of the subject-matter. Equally futile would it be to search therein for fair, elaborate, and learned reviews of recent publications, temperate and courteous in tone, however severe in criticism. But while such things cannot well be looked for in the kind of journals here referred to, we might expect that the better sort of periodical publications, and especially those of a high order, published in cities of some literary pre- tension, would escape the charge of being, occasionally at least, re- ceptacles of essays and especially of reviews of an indifferent and other- wise objectionable kind. This, however, I regret to say is not the case ; for instances might easily be pointed out in which the pages of those journals have been disfigured with trite, unmeaning, childish, so-called original articles, and with bibliographical notices and reviews, in which American and other works of merit and importance are mentioned in the* most flippant and trifling manner, or dismissed with a few words or lines suited rather for a publisher's advertising sheet than the pages of a scientific journal, or, what is worse, in which the authors no- ticed are treated most unfairly and uncourteously—represented some- times as saying the reverse of what they have really said, turned into ridicule on points of doctrine or practice on which the reviewer hap- pens, ten to one wrongfully, to differ with them; taxed roundly and unceremoniously with want of experience or knowledge of the subject under consideration; and not unfrequently charged with falsehood and insolence for uttering sentiments unpalatable to a certain clique, a fa- vorite writer, or a popular teacher. Not a few editors of, or contributors to, medical journals—indeed the larger number of self-constituted critics who furnish reviews to these— however fresh they may be from the benches of the schools, appear often to consider thdmselves as compelled, from the very nature of the duty they have undertaken to perform, to search for and point out the defects, DR. LA ROCHE'S ADDRESS. 41 or what they consider such, contained in the writings of authors for whom they happen to entertain no personal regard. Still more severely lashed are those who have incurred their displeasure. If their accounts of such writings are to be relied upon, the defects therein exhibited crowd under the pen like the phantom inhabitants of the gloomy kingdom of Pluto on the Styx. They take no heed of beauties or excellencies. In other instances, on the contrary, swayed by influential circumstances it is not my business to probe, they can discover in the writings they review little besides beauties and excellencies, and slur over, in the most praiseworthy manner, defects, which to other minds are grossly evident. In all this we can discern nothing having the faintest approach to wholesome criticism—we find indiscriminate, heedless, and bitter censure on the one hand, and fulsome and unmeasured praise on the other. To the careful attention of these reviewers I must recommend an ingenious fable of Boccalini: " A famous critic having collected all the faults of a celebrated poet, presented them to Apollo. This god received them Avith his accustomed grace, and resolved to offer the author a recom- pense proportioned to the pains he had taken. With this intention he placed before him a portion of unsifted wheat, and ordered him to sepa- rate the grain from the chaff, and to place them separately. The critic engaged in this new occupation with considerable industry and pleasure, and when he had completed the separation, Apollo presented him the chaff for his trouble." It is not by such productions that the medical literature of the coun- try will be improved and the character of the profession elevated and sustained. We often complain of the flippant tone, uncourteous terms and unfair manner in which American publications are noticed in Europe—certainly, in some cases, not without reason. But if we wish others to treat us in a proper way, we should not fail to do the like uuto them; and surely American writers may justly think themselves entitled to come in for a share of the fairness and kind and polite treat- ment of the medical reviewers of their own country. No profession can expect to command the respect of the public and attain a high position, whose members have not all learned the simple elements of politeness, and are forgetful of the obligation of avoiding to treat each " other with disrespect and vituperation for the most trifling cause—often without any cause whatsoever. Another difficulty in the way of the attainment of the object in ques- tion arises from the fact that in no country is the physician surrounded, elbowed, encompassed and interfered with, by one-tenth—nay, one hun- dredth__part of the quackery and quacks he encounters in our own; and no less in our State than in other parts of the Republic. We have quacks of all kinds, of all colors, of both sexes, of all nations, and 42 dr. la roche's address. quackery presents itself in every form imaginable. Pills, liquids, plas- ters, oils, embrocations, syrups, elixirs, tinctures of all kinds—even of gridirons—electric cils, electric sugars, balsams, panaceas, float, as it were, around us. We have infallible medicines to be used internally by the stomach ; others that are administered by inhalation ; others, again, that are applied externally. The number of the inventors, venders, dis- tributors and prescribers of these articles is legion. I shall not occupy your time with a complete enumeration of the different varieties, species, and genera of the quacks by whom our land is polluted—though the statistics of this particular class of natural history would be curious—some pretending that they practise in accordance to what they are pleased to call doctrines of their own; and others discarding or ignoring all doctrines or theories, and appealing to experience obtained by empirical means— homceopathists, hydropathists, eclectics, steamers, Thompsonians, mes- merisers, electricians, chronothermalists, &c. &c. They start up before us in every direction; reach us from almost every shore of the known world, and, as if the material of which they are formed Avas not easily enough found in the shape of unemployed and lazy shoemakers, book- binders, blacksmiths, butchers, ignorant, crack-brained and noisy preachers, and the offices of unprincipled or starving doctors, a foreign sovereign has been kind enough to send us, in the guise of a public functionary—brainless, so far as most matters are concerned, but, as it would seem, expert in the art of curing consumption. These quacks penetrate everywhere, openly or clandestinely. They even find their way into the families, and almost under the very noses of regular physicians. I should certainly be very unwilling to be understood as stating, even by inference, that quack doctors and secret nostrums are nowhere to be found but in this country. The tribe of the former has existed every- where and at all times, and are to be found at the present period in every section of the civilized world ; while the latter abound wherever the others are encountered. Indeed the love of being gulled would seem to constitute an original attribute of our nature. It has ever betrayed, and to this day betrays itself even in classes of individuals whose intellectual endowments, powers of reasoning, and literary and scientific acquirements, as well as experience of the Avorld, might well have been thought capable of shielding them from its baneful effects. Amulets and charms were, as we are told, in vogue from the earliest times, and have not altogether lost their influence over a large por- tion of certain communities. Priests and kings Avho have in turn disputed the government of mankiud, arrogated to themselves the pre- rogative of distributing these supposed instruments of cure among the people. Even before the Greeks had thought of constructing a code of dr. la roche's address. 43 medicine, the Hierophantes manufactured amulets out of the most sin- gular substances the imagination could suggest. Sammonicus subse- quently invented the queer word Abracadabra for the purpose of curing double tertian fever. The Jews attributed the same virtue to their word Abracalan. Long after, the Arabs invented their talismans—the Eu- ropeans the touch of their kings and their relics. Well has it been said that the history of human belief on points of this kind exhibits the most singularly varied feature of the weakness and vagaries of the mind. But early as the belief in quacks and quack medicines may have com- menced, and common as both may be everywhere, it is doubtful whether either sets of nuisances are as frequently encountered in Europe as on this side of the Atlantic. This, I think, is especially true in re- gard to the Continent; for there none are permitted to practise without a certificate or diploma from some chartered medical school; and while an individual may obtain a patent for a medicine, the composition of that medicine must first be declared to competent judges appointed for that purpose, and whose duty it is to certify as to the safety of its employment and its fitness in the cases for which it is proposed. In England, a greater amount of liberty is allowed in both respects; but even there, the safety of the public is cared for to a certain extent, and any overt act, on the part of an unlicensed quack, or in the administra- tion of a secret medicine—especially when the case ends fatally—is usually visited by the application of severe and stringent laws. But neither in England, nor on the continent of Europe, are the members of the medical profession elbowed and circumvented and openly beard- ed, as it were, by such low-bred, ignorant, and unprincipled quacks, as those by whom we are here infested. Nowhere is the market so overstocked with secret and other quack nostrums. The quack doctors in England are, for the most part, licensed graduates, who have taken to their nefarious practices after obtaining a diploma in some regular me- dical school. They are, of course, either fools or rogues; but still they are not uneducated men, and there is less disgrace in being placed on an equal footing with them by the public, than we are made to expe- rience in this land of liberty. Here a physician—even of the highest eminence—is regarded in the same light, in a professional and social point of view, not only as an erring graduate, but as the most arrant empiric and ignorant booby and rogue that may be pleased to assume the office and title of doctor. In Europe, the law for the most part, recognizes regular and legiti- mate medicine, and none other, and protects the exercise of it. If, in some places, the practice of certain speeies of quackery, as homoeopathy, hydropathy, and the like, is sanctioned, still, it in great measure is not allowed to pass out of the hands of regularly educated physicians. 44 DR. LA ROCHE'S ADDRESS. From these circumstances, the cultivators of our science—the practi- tioners of medicine in its legitimate form—have, notwithstanding some drawbacks, a chance of upholding- the honor and dignity of their pro- fession, which, by the high standard of education required of them before they can enter its folds, they are so well prepared to adorn. Here, on the contrary, we enjoy no advantages of the kind; for, inde- pendently of the fact, already adverted to, that owing to the shortness of the course of instruction in our colleges, and to other facilities offered for obtaining diplomas, our ranks are apt to be filled with men of an inferior stamp and little calculated to do honor to the profession ; the latter receives neither protection nor encouragement from the law or the public. Well has it been said that medicine furnishes a proof that by the law, which has, indeed, done all that statutes can do to abolish it effectively, much which, in the organization of society, has been held in a high degree expedient, if not necessary, may be sacrificed to a theory. "Equality," Dr. Clark remarks, "is the procrustean bed to which everything must be shaped," and our profession must submit to the ordeal. Our wise legislators cannot perceive why a man who has not gone through a definite course of study and passed one or more exami- nations, should not be as free to practise medicine as he would be to pursue any other avocation without being regularly educated to it. They themselves exercise the trade of politics—they assume the duties of statesmen and make laws without prior training, and, as may readily be presumed, without much acquaintance with those important matters. They might, if they chose—and it is a pity they do not oftener thus choose to do—make shoes, or turn carpenters, or saddlers, or bookbind- ers, instead of governing the State; and if allowed to adopt, though untaught, either of these modes of earning their bread or accumulating v a fortune, why, they ask, may not they or any one else have a like privi- lege to compound and sell secret medicines, to drug people Avho Avish to be drugged, and—assuming the title of doctor—perform the same duties as regularly bred physicians ? The profession, in consequence of this state of things, as well remarks a distinguished member of this society,1 is laid open alike to even- one who may think proper to enter it—without question as to his competence for the faithful performance of his duties as a member. Whoever assumes to himself the title of doctor belongs of right to the profession—there being no legal provision by which his claim to membership may be tested or denied. In fact, the individual, upon whom the title of doctor in medicine has been conferred by the most distinguished university, to indicate that he has completed a regular 1 Coudie, Am. Journ., ii. 265. \ DR. LA ROCHE'S ADDRESS. 45 pupilage, and is qualified to practise the art he has fully and faith- fully studied, and he who has but yesterday deserted the workshop of the mechanic, or the counter of the tradesman, and without natural abilities or any preparatory study announces himself as a doctor of the healing art, are both equally recognized and protected by the law. In some of the States, continues the author referred to, the title of Doctor has become, in popular estimation, synonymous with that of practitioner of medicine—without the slightest reference to the mode or place in which the individual who bears it has qualified himself for the office it implies. Hence the title is assumed everywhere around us by pretenders of all sorts ; by some who are ignorant of the fact that the terms mean two different things, and would, perhaps, abandon it were they apprised of their error, but by many more who care not Avhe- ther they possess or not the right; knowing as they do full well that there is no law to prevent them, and that their interest will be served by having the title affixed to their name. Nor is the theft committed by ignorant mechanics and notorious impostors alone; for, as we are further reminded, more than one of the members and even teachers of the most rigid religious sects practise medicine under the assumed title of Doctor; nay, even affix the initials of the degree to their names. Be this as it may, these undoubted impostors and quacks of all denomi- nations are protected, and in some sections of the country encouraged by law and by the public. In one place the so-called Eclectics have received a legislative donation of many thousand dollars in support of their college; while an appropriation of the same amount for the benefit of the regular school was negatived. In several other States, not only eclectic, but homoeopathic, and other irregular colleges, have been char- tered and are now in full operation. In one State, the respectable faculty of a regular medical school, and through it the entire body of American physicians, were near being insulted by the addition of a professorship of homoeopathy to those usually composing such institutions. Every- Avhere the teachers in those bastard schools, as well, indeed, as practition- ers of all species of quackery and venders of quack medicines are treated with as much respect and courtesy as—sometimes, when they have been successful, with more respect and courtesy than—the regular members of the medical profession. They are accosted with the title of Doctor whether or not entitled to it, and although it may be known, not only that they are grossly illiterate and profoundly ignorant, but that only a short time before they were working at trades but little calculated to fit a man to take professional charge of his fellow-beings. Their opinions on professional subjects are cited in opposition to those of eminent practi- tioners and profound pathologists. Their testimony on points of medical jurisprudence, involving the reputation, liberty, and life of individuals, 4 46 DR. LA ROCHE'S ADDRESS. is received in courts of justice with as much deference as that of the most experienced and learned physicians and medical jurists. Their schools are sometimes placed under the management of boards of trustees composed, in part at least, of, and even headed by, men holding a respectable social position, some of whom do not scruple—with what consistency and propriety it is difficult to discover—to assume at the same time like duties in distinguished Universities, where of course they may be, and are occasionally called upon to make choice of medical teachers. It has even happened that unprincipled renegades from the ranks of the profession, and unblushing venders of secret, quack, and worthless nostrums, have been thought worthy of being placed at the head of large and important hospitals; and when the members of the medical profession express their indignation at the outrage—when the medical officers attached to the disgraced institution resign an office they can no longer retain with honor, they run much risk of being fur- ther insulted by the vulgar set by Avhom that outrage has been committed. Nay, they are laughed at and vilified by the public press, which, pre- sided over, as it but too generally is, by men far from proverbial for the possession of a high sense of honor, sound moral principles, and a strong appreciation of true gentlemanly feelings, is ever ready to uphold the cause of quackery in all its multifarious phases, especially when, by so doing, its advertising columns can be profitably filled. Thus, raising the pretension of being a fourth power in the State, it imparts, by its teachings in reference to the subject mentioned—to say nothing of many others—a low tone to, and exercises a blighting influence over, a large portion of the community. But the recapitulation of these various points must be painful to you all, as it is certainly to me, and I dismiss the subject with the remark that it is no easy task to account for the incongruities of legislation in respect to medical matters. " Government," says a distinguished writer of a neighboring city, "carefully defends the people against their own ignorance, by proving and stamping every pennyworth of gold and every pennyworth of copper that is put into circulation as money, and with honest severity punishes every counterfeiter who cheats us of a single dollar; it refuses its sanction to those who offer to judge for that same people of all that relates to the deep mysteries of life and disease; it has no punishment, no reproof even, for the counterfeit physician who cheats us of our life. It inspects drugs and medicines, destroying all that are not of standard purity, and yet it cares nothing Avho uses them ; thus the government officer is made to sharpen the sword, and throw it into the circle, indifferent Avhether it fall into the hands of the trained and tried soldier or into those of the highwayman." Boileau tells us of an individual who "de mauvais medecin devint DR. LA ROCHE'S ADDRESS. 47 pire architect." In our beloved country we often see bad shoemakers or the like, becoming worse doctors. In the former case the charge was nothing but an unfounded sarcasm; for the bad physician who, accord- ing to the French satirist, became a worse architect, was no less a per- sonage than Perrault, and he, whatever may have been his medical defi- ciencies, will certainly be admitted to have exhibited no slender claim to respect in his new avocation ; seeing that he embellished Paris with the magnificent facade of the Louvre. But had the charge of degeneration been well founded, there would have been this difference between his case and what happens among us, that the bad architect would have obtained no employment in his new line of business—certainly would not have w7orked on the Louvre—whereas our bad shoemakers, who be- come Avorse doctors, command the confidence of the public, and gene- rally reap a rich harvest. Little does the medical profession merit the treatment here referred to ; for it has everywhere greater claims upon the gratitude of the pub- lic than the latter seems to be aware of, or at any rate, than has ever been repaid. Medicine is, and cannot be otherwise than, a progressive science. For thousands of years the members of that profession have toiled in the cause of suffering humanity with an ardor and zeal which ignorant, thick-headed, and whisky-soaked legislators, and the illiterate, unwashed, rough-handed portion of the community may be pardoned for not knowing or appreciating, but which should not be overlooked or forgotten by men of a different calibre of intellect, of high social posi- tion, and enjoying the advantages of a refined education. Say what the vulgar may, physicians have, in the progress of time, succeeded in erecting a monument which, though not perfect in all its details, rests upon foundations of a lasting character, and the superstructure of which may compare advantageously with those due to the skill and exertions of the cultivators of other departments of human knowledge. Their path from the earliest dawn of science to the present day, has been at- tended by increasing benefits to mankind. Their services in lessening the evils resulting from the baneful action of morbific causes on the human frame, were freely admitted long before the advent of Hippo- crates. In full recognition of their services the Greeks, from the re- motest times, had placed among the inhabitants of their Olympus a god of medicine; and one of their philosophers only echoed the cur- rent sentiment of his countrymen when he denominated the physician the merciful hand of the Divinity. "The nobleness of the physician's art," as Lord Bacon remarks, " is well shadowed by the poets, in that they made ^Esculapius to be the son of the Sun, the one being the fountain of life, the other the second stream; but infinitely more honored," he continues, " by our Saviour, who made the body of man 48 DR. LA ROCHE'S ADDRESS. the object of his miracles, as the soul was the object of his doctrines." Hippocrates was held by those of his day as the benefactor of his race, and when he died statues were erected to his memory, and from that period to the present the science of medicine in all its diversified depart- ments, has gradually and step by step improved. Every century; nay, every year—I had almost said every day—has witnessed some new disco- very, leading with more or less certainty to the acquisition of additional treasures, and he must have read in vain the history of his species who has not perceived that the loss of life in all communities, as well as the sum of bodily sufferings, has gradually lessened, and that this happy result has generally been ascribed and is truly due to the medical pro- fession. To medicine more than to the improvements which have oc- curred in all the relations of society, the prolongation of human life is due. It has even been said that all that is valuable in the changes effected in the physical condition of this and other countries where those results have been obtained, as well as much of what has reference to the social condition of the people, are based on principles elaborated and ex- pounded by the medical profession. I may also point out the fact that the services which the members of our profession have rendered and continue to render to society, are not restricted to subjects connected directly or indirectly with the special objects of their pursuits. Open we the annals of every department of human knowledge, and the records of every variety of useful human action, and therein we shall find in honorable competition with those of the greatest the world has produced, the names of men who had stored their minds Avith medical lore, who had sued for and obtained the honors of the doctorate, and had during a time, or to the end of their lives, discharged the duties of their profession. It will be unnecessary to cite examples; they are familiar to every votary of mental, moral, or natural philosophy; to every reader of history, travels, and poetry; to every student of ethnology, antiquities, and natural history, in all their varied branches. Physicians have furnished their quota to the list of statesmen, diplomatists, and military commanders. Let me add, that our country can boast of but few arctic explorers, and of these the most prominent by far—whose name will reach posterity in fit companionship with the greatest of whom Europe can boast, was a physician—a distin- guished graduate of our University of Pennsylvania. In consideration of what precedes may we not ask, Avith one address- ing a society kindred to our own, " Is it not true, then, that medicine is the first of the progressive arts; and not first only, but incomparably above and beyond all others in the priceless benefits it has bestowed on man ? Yet, who has risen to give public thanks for its Herculean labors ? Who has proposed to commemorate the vast achievement of prolonging DR. LA ROCHE'S ADDRESS. 49 the years of the life of man more than one-fourth their former average, throughout civilized Europe and America, in the short period of half a century ? Well, is it not better thus ? for what celebration can ade- quately commemorate these triumphs of medicine! What monument can typify their greatness ? Yet we have a right to demand a fair esti- mate of the value of our profession to society, and an honest acknow- ledgment of what it has done for the well-being of man."1 Will any one say, and be believed by individuals, Avho, with an ordi- nary share of intellect and good sense, have turned their attention to the subject, that results such as I have alluded to can be ascribed to perpe- trators of quackery—be the form of the latter what it may—or to the effects of any of the million of quack and secret nostrums and specifics by which the market has ever been glutted ? Can they have been due to the operation of either or any of the multifarious irregular so-called systems of medicine that have succeeded at various times in exciting the admiration of a portion of the public ? Surely a statement of the kind, if ever made, would be without foundation. Such systems have been, and necessarily are, too short-lived—such practitioners have ever exer- cised too ephemeral a sway oyer the public mind, and those innumerable nostrums have too constantly been ultimately found to be inert, inef- fectual, or injurious, to be entitled to the credit of having contributed in the attainment of the beneficial effects mentioned. While legitimate medicine has progressed steadily—while its advantageous results have gradually, and step by step developed themselves till the world has reaped the fruits of its improvements in the Avay to which I have alluded, empirics of all kinds, with their specifics or other instruments of cure, and their new fangled doctrines or theories, have appeared and disappeared with almost telegraphic rapidity. In fashion one day, and the objects of the admiration of the ignorant multitude, they are forgotten the next, and make way for some other impudent and noisy impostor, and some other nostrum whose tenure of existence will in- evitably prove of equally limited duration. ' If ever useful—which I deny—none of them, at any rate, have been permitted by Providence, to play a part on the stage of life of sufficient length to enable them to effect any result of an important character. Quack practitioners, what- ever be the denomination in which they rejoice, are either fools or knaves—fools if they believe in their doctrines, modes of practice or medicines—knaves if, as is generally the case, they do not believe in either. From those of the first class it would be useless to look for anything good and important; while those of the latter, intellectually endowed though some of them may perhaps be, are usually too 1 Clark, 19. 50 DR. LA ROCHE'S ADDRESS. ignorant to be enabled, and always too intent on accumulating wealth (for which purpose alone they follow their nefarious practices) to be ever inspired with the desire of applying the energies which God may have bestowed upon them, to the acquisition of truly useful know- ledge, and the achievement of useful deeds in matters of science, of arts, or of any other, branches of human pursuits. There may have been exceptions to this rule, but they are few and far between. Judged in their totality, Ave may say that if the members of this fraternity go down to posterity, it will be in the way which befits them best; while the in- fatuation they may have produced among the public will ultimately find place among the many and diversified aberrations to Avhich the mind of man is subject. But why should I prolong this discussion ? You are as Avell aware as I am, myself, of the injurious tendencies of the doings of the whole tribe of irregular practitioners. You are not ignorant of the menda- cious character of the reports put forth by them and extensively circu- lated respecting the efficacy and success of their remedial means. You know, full well, the really murderous effects, when Avrongfully applied, especially—as they are so often apt to be—of many of the quack medi- cines sold in every nook and corner of our country, and of the ineffi- ciency and inertness of others, Avhether prescribed empirically or in supposed accordance with some so-called medical doctrine. Equally sensible are you of the absurdity and baseless nature of those doctrines; and you are not less so of the fact that by extending to these depreda- tors on the vitals of the community the same legal rights in respect to the exercise of their calling as are accorded to regularly educated phy- sicians—by permitting every one, whether graduates of an authorized medical college, or doctors of self-creation, to undertake the cure of disease—by encouraging and protecting them in their mischievous traffic—treating them with the respect and deference due to honorable men, and placing them on an equal footing with the alumni of our most distinguished Universities—nay, with the most eminent men who adorn our profession—patenting their secret nostrums—extolling their views— indorsing their statements and their boasts of success—placing confidence in their skill and remedial measures—recommending them to friends and going about singing their praise with a view to enlarge the circle of their business; you are sensible, I repeat, that by so acting the law-makers of our country as well as the community at large, not only afford no very striking evidence of possessing a superabundant stock of common sense, but commit an injustice towards a profession to which the world is deeply indebted for services of the most important character. Need I repeat what was said before, that the state of things referred to, exist- ing as it does to a greater extent in this country than elsewhere, our DR. LA ROCHE'S ADDRESS. 51 profession naturally encounters among us greater obstacles towards the maintenance of its honor and dignity. In the language of a writer, already several times quoted, I may say in conclusion, that " if the public offer us no rewards, no honors, no en- couragement, they give us no occasion to complain of their demands. The profession in this country presents the novel spectacle of a body of men conscientiously forcing themselves to acquisitions of knowledge and skill, not only not demanded, but actually discouraged by those for whose benefit they labor. Medicine is the only profession that is striving sys- tematically to resist the down-levelling tendencies of legislation; the only profession, which every year demands of its votaries higher and still higher attainments." Well may we say, we are justly proud of our calling, and prepared to respond cheerfully and liberally to its claims. " Medicine demands of us that we be men of integrity and honor; men of character, that she may be respected in us; men of charity, that she may be loved; men of learning, that she may exercise her rightful authority; men of research and labor, that she may claim from each something to be added to the general stock of knowledge."