Social Ethics as connected with the Business of the Physician. THE MUTUAL DUTIES OF PHYSICIANS AND SOCIETY: BEING THE ANNUAL ADDRESS DELIVERED BEFOEE THE MIDDLESEX DISTRICT MEDICAL SOCIETY, MAY 23, 1849. BY AUGUSTUS MASON, M. D., Member of the Massachusetts Medical Society and of the Middlesex District Medical Society, LOWELL: JAMES ATKINSON, PRINTER. 1849. < Social Ethics as connected with the Business of the Physician. THE M-UTUAL DUTIES OF PHYSICIANS AND SOCIETY: BEING THE ANNUAL ADDRESS ' DELIVERED BEFORE THE MIDDLESEX DISTRICT MEDICAL SOCIETY, MAY 23, 1849. BY AUGUSTUS MASON, M. D., Member of the Massachusetts Medical Society and of the Middlesex District Medical Society, <~.- — ----------- *r - WW LOWELL: JAMES ATKINSON, PRINTER. 1849. • ADDRESS. Mr. President, and Gentlemen: Honored by an invitation to address you on this occasion, the anniversary of your Society, I must in advance beg your indulgence for the inadequate manner in which I shall perform the office. Duties of this kind rarely fall to the lot of medical men, and when they do so, much allowance is to be made for their inexperience in the arts of public address. During the past year, you have frequently met together for the purpose of mutual improvement and consultation. Upon those occasions, subjects directly connected with the practice of medi- cine, have been freely and profitably examined. From those frequent meetings, which bring you into more intimate association with each other, and from your free interchange of opinions, much '^manent advantage will result to the Profession. But upon this . _v;asion, you have invited the public to meet with you; at least such of them as take enough interest in our Profession to induce them to spare an hour of their leisure, in listening to subjects con- nected with its existence and prosperity. I shall therefore appro- priate your anniversary hour to the consideration of a topic which has an equal bearing upon yourselves and the community at large. I mean the Reciprocal Relations of Physicians and Society. I shall speak of the duties and obligations which these two parties owe to each other ; of the proper position of the Physician in society; of the causes which have lowered the Profession in public estima- tion, and of the means of elevating it to the standing which is its due. I shall treat this subject in a plain and common-place manner; 4 speaking of those things only which you already know, and feel, but which I fear you too often forget in the daily practice of life. I enquire, primarily, what society may require of the Physician ? What preparation, and qualities of mind, the Physician must pos- sess, in order to perform the duties dependent upon his office and position ? I answer, that the foundation, most of all others neces- sary for the Physician, is a high standard of medical education. Society has a right to demand this of the Physician, for it is a demand which she makes in other Professions and pursuits, not by any means so essential to its well-being and happiness. For a geologist to be unacquainted with the structure of the earth's sur- face, with its various strata and deposits, would be an absurdity. So an astronomer, who was a mere star-gazer, or was ignorant of any other system of planetary revolution, than the hypotheses of Ptolemy or Tycho Brahe, would be the laughing-stock of a school- girl of the present day. It would seem, then, that where the subject of study is so impor- tant as that of human life, its protection and preservation, no man would be so reckless, or so daring, as to embark upon the practice of medicine, without first having made himself master of all the elementary branches of medical science. Nor could we believe (were we not living witnesses of the fact,) that in the nineteenth century, ignorant pretenders would be permitted to tamper with the health and lives of the community; that parents would confi- dently trust them with the safety of their little ones, any more than a man would trust the helm of his ship to a captain ignorant of navigation, to voyage over an unknown sea, without chart or compass, without expecting his vessel to be shipwrecked upon the sunken reefs of the first dangerous coast, or to go down amid the yeast of waves and the pitiless howlings of the first angry storm. It is fashionable to boast of the wisdom and general information of this nineteenth century. We teach anatomy and physiology in our schools, and there is hardly any person in the community who has not obtained some smattering knowledge of himself, from the glib tongue of the popular lecturer. Still we find in the mass of society, a large class of people who recognise the necessity of knowledge in the common pursuits of life, but who devoutly believe the Art of Healing to be a heaven- inspired gift. 5 The bitten snake crawls to his healing plant and revives; the sick dog searches for his couch-grass, and the cat for her fragrant mint. Did man possess the instinctive " wisdom of the serpent," " sagacity of the dog," or " cunning of the cat," he might per- haps be satisfied with cultivating his brute instincts alone, and physic himself to his own satisfaction, from the green and succu- lent herbs of the field. But man is a creature of reason. The child, it is true, has a few instinctive impulses — but beyond those, his mind is a virgin page, to be impressed as his years advance, by his contact with the outward world ; and by lessons drawn from the experience of others. The greater the quantity of those experiences, the more pre-eminent is his condition above that of the brute. The pro- gress of art and science has been gradual, but advancing with more and more rapidity. In the eighteenth century, Watt first advantageously applied steam to mechanical purposes. It wit- nessed the first steamboat from the hands of Fulton. Franklin, late in that century, drew the lightning from the skies, and proved its identity with electricity. At the end of that century, galvanism first became known. The nineteenth century has given us rail- roads, and the electric telegraph. Had it not been for the discoveries of the eighteenth century, we should have had no steamboats, or railroads; no steam press, no lightning-rods to shield us from the impending thunder-cloud, no electric telegraph. I do not mean to say that these were simply accidental discoveries. They were efforts of reason acting upon previously acquired data, or resulted from phenomena fortunately observed by minds capacitated by sufficient previous knowledge, to investigate and find out the motive power. I speak of these things in this connection, because there is another large portion of the community about us, who think dis- eases can be treated better after the rude and imperfect experiences of savage life, than according to the wider and confirmed expe- riences and accumulated knowledge which constitutes the medical science of the present day. It was in the sixteenth century that Ambrose Pare applied the ligature to divided arteries. It was in the seventeenth century that Harvey discovered the circulation of the blood. Only fifty years ago, the immortal Jenner introduced vaccination ; within this cen- 6 tury, Laennec gave to medical science the precious gift of aus- cultation. This century has enriched the Pharmacopeia with iodine, bromine, quinine, morphine, and many of our most valuable thera- peutic agents. It has given us animal chemistry, at the hands of Liebig, and microscopy, rudely springing from Malpighi and Lewenhoeck, has rapidly increased our knowledge of the intimate structure of the animal tissues; last, but superior in practical use- fulness to the other discoveries of this century, God has granted us the ether, at the hands of Jackson and Morton ; that boon which has robbed surgery of its terrors and agonies — made the soul insensible to the sufferings of its frail tenement, and soothed it in elysian dreams, amid the dreadful horrors of the most savage operations. Was it no advance when Ambrose Pare rescued the quivering limb from the searing iron, or the boiling pitch ? Was it no ad- vance when Jenner gave immunity to nations from their greatest and most loathsome scourge ? Was it no advance to banish plague and pestilential fever, by enforcing the laws of Hygiene ? When Baglivi cried out in his despondency and despair, " O, how difficult it is to cure pulmonary diseases! O, how much more difficult to diagnose them ! " was it for nothing that Laennec leaped forth, with a shout of exultation and triumph, holding up in his hands his immortal book, almost perfect in itself, giving to us the precious secret of thoracic exploration ? Was it for nothing when the groans of the wretched sufferer under the severing knife and crushing saw, struck terror to the feelings of his friends, and made the surgeon's heart bleed with sympathy, that ether and the chloroform came in " with sweet, oblivious antidote," " To free the foul bosom of the perilous stuff that weighs upon the heart" ? Who now among us is willing to confide in the amulets and verses of the Koran, which satisfy the blind superstition of the Ashantee ? Who would trust his life to the incantations of the medicine man of the North American Indian ? Who so lightly esteems his life that he would be content to die, like the superstitious Hindoo, by the banks of the Ganges, perish- ing under the blaze of its burning sun, and strangled by the holy mud of the sacred stream ? 7 But such is the instinctive and inexperienced treatment of bar- barian life. In such life, the dwelling is but a wigwam, a hut, or a shed — food is poor, and scanty, and woman a digger in the fields, and degraded. It has been the increase and dissemination of knowledge, which has raised the civilized races from so ignoble and brutal a position ; which has made the comforts of life of the laborer of to-day, surpass those of the princes and nobles of the past; which has doubled the term of human life within two centu- ries ; which has exalted woman to respect and beauty, made her the idol of man — his gentlest of nurses, and a ministering angel. Has medical science been behind hand, or inoperative, in this great work ? No. It has kept pace with the march of civilization, and while human life has become more valuable and precious to com- munity, the progress of medical knowledge has thrown around it an additional shield of protection, and increased its security and enjoyments. Nor has the Physician been idle or inefficient in other ways, in performing his duty, in contributing to the social elevation of man. Upon you, gentlemen, in this vicinity, has fallen the mantle of Hippocrates. You claim of your fellow-citizens to confide to your treatment, the lives of themselves and their families, as due to your industry, your abilities, and your medical attainments. The diplomas which you have received from medical institutions of good standing and reputation, guarantee your possession of suffi- cient acquirements to render you safe and trustworthy practitioners. You have enjoyed facilities and opportunities for obtaining medical knowledge, which no other persons in the community in which you reside can have obtained. You are familiar with anatomy and physiology; with pathology and morbid anatomy; with therapeu- tics and hygiene. You understand the importance and the means of a correct diagnosis; and are able, from your clinical and ac- quired knowledge of disease, to satisfy the anxiety of patients and friends, in a great degree, in regard to the duration and result of different maladies. You are expected by the public to keep pace with the progress of medical knowledge, and to make use of all the valuable con- tributions which the accessory sciences make to your art. You are even expected to add somettang to the common store — some new fact, wrested by toil and p}tiem study, from the grasp of Na- 8 ture,— some truth, to keep your memory green in the annals of posterity. You claim lineage with the great Father of Medicine. Remem- ber with what assiduity and devotion he travelled from place to place, visiting the temples, and gathering from the tablets there, on which the sick had inscribed their diseases and treatment, that accumulation of experiences which he was to apply to the cure of others. That little stream, which sprung from the hills of Cos, has been swollen by a thousand nutrient rivulets, till it has become a mighty river, the waters of which are for the healing of the nations. The fruits of the labors of Physicians for more than twenty centuries, are at your disposal. Much is required of him to whom much is given. It is ours to see that the knowledge won by their sweat and agony, still profits the world. Nor should we be satisfied with merely working the mines they have explored ; we must penetrate deeper into the mountain, where richer veins remain buried and undiscovered. I have assumed that society has a right to require of the Physi- cian a knowledge of his Profession. I will briefly examine the position which the educated Physician occupies in the estimation of society. In the United States, any man has a right to practice medicine, if he will, and every man has an unlimited license to kill or cure himself and his family, by employing any Physician or any igno- ramus, that his individual sovereignty may fancy. In some of the governments of the Old World, the rulers have a guardian care over the lives of those who are incapable of judging for them- selves ; and thus they protect from harm that part of the commu- nity which in this country becomes the prey of the impostor and the quack. It was remarked by a Physician from Baltimore, at the recent meeting of the American Medical Association in Boston, that he would rather have a certificate of professional ability, signed by a fashionable clergyman, than a diploma backed up by the faculty of the most eminent college in the land. " A miserable quack introduced by a clergyman, would be shown into the best parlor, while the Physician is permitted to tread his rugged path alone." Dr. Warren, on the other hand, expressed an opinion that the 9 medical Profession stands higher, and is more popular than any profession that ever existed, that does now exist, or ever will exist. This diversity of opinion may be easily accounted for from the different formation of society in various sections of our country, or from the peculiar circle in which a Physician moves. Dr. War- ren is the Nestor of our Profession, in New England. Descended from a distinguished line of Physicians, a Physician, so to speak, by hereditary right — with the blood in his veins of him, untimely but gloriously lost to our Profession and his country, on the field of Bunker Hill; elevated by wealth, superior to the little tricks and meannesses of the Profession, experiencing an almost un- limited degree of popular regard, how could he feel otherwise than that his Profession was superior in popular favor, to all others ? But many of you, gentlemen, think otherwise. You move in a different sphere. The community in which you reside is made up of ruder and less cultivated materials ; more easily resigning itself to the opinions of the designing, and more readily seduced from the paths of judgment by ambitious and boastful pretensions. You have seen the streets of our city swarming with quacks of every hue and caste, feasting and fattening for a season upon the credulity and folly of the public; and at the same time you have seen your professional brethren, members of this Society, slan- dered, villified, and abused by the press and by the people. It is said of our city that she numbers two quacks to one regular Physician ; and of quack medicine it is no exaggeration to say that it is swallowed by the barrel. Nor is Baltimore the only place where the clergyman gives to the miserable pretender an entrance into the best parlors. Many a quack rides and thrives among us, more on the religious sympathies of the " sisters," than he does on any acquisitions or exhibitions of medical knowledge. There is a peculiarity about much of American society; it has a state of half education, which is neither the ignorance of the lower classes abroad, nor the refinement of the upper classes. It is better fitted than the masses of other nations for conducting business and obtaining a respectable share of the luxuries and necessaries of life. It despises the poor and hates the rich; it looks with contempt upon the positively ignorant, and holds in small respect the intellectual or educated ; if it excels in any thing, it is in an exaggerated good opinion of itself. It passes criticisms, 10 without reserve, upon every person and every thing, however supe- rior to the capacity of its own understanding. Now the positively ignorant do show some regard to their acknowledged superiors in capacity and education; but these, like the robber Procrustes, lop off every person to one length — and that one is exactly their own. Their dogmatic opinions are crowded into every business of life. In medicine, he who thinks just as they do, is a wise man. A Physician of learning and skill, is unhesitatingly set down as a fool. They know nothing of, and do not appreciate the accumulated knowledge which the real Physician has acquired. They are boast- ers themselves, and give a ready ear to the pompous swaggerings of others; while they cannot enter into nor understand that quiet and unpretending disposition, which so well befits the character of the scholar and the gentleman. So they pass by with a sneer and contemptuous indifference, the door of the enlightened Physician, to sound the brazen knocker of some tinker, who has taken it into his head to dub himself " Doctor," or to purchase some patent catholicon from a peripatetic essence peddler. Now, in no Profession is a little knowledge so dangerous as in ours. Here one should drink deep, or taste not. Common errors may be palliated or amended, but mistakes in matters of life and death, are fatal. There is no recall after death. Are not those words true in medicine, which Shakspeare puts in the mouth of Othello, when in his jealous madness he meditates the murder of Desdemona ? — " Put out the light, and then---- Put out the light! If I quench thee, thou naming minister, I can again thy former light restore, Should I repent me; — but once put out thine, Thou cunning'st pattern of excelling nature, I know not where is that Promethean heat That can thy light relume. When I hare plucked thy rose, I cannot give it vital growth again,— It needs must wither." With such a community, the only hope of the Physician is time, and its accompanying advances in popular education. The second generation of many of those who migrate hither, will be immeas- urably improved by the great privileges of education which our city freely offers to them. We have no reason to expect that the law and the government will throw its protecting shield over their healths and lives. Our people will not suffer restraints. They 11 Jove not, nor will they obey sumptuary and restrictive laws. On the contrary, instead of co-operating with us in elevating the medi- cal character and the present required standard of medical knowl- edge, we have seen the Legislature of Massachusetts, from which we should have expected better things, chartering an irregular med- ical institution, with an inferior and secondary grade of medical requirements. I should, however, myself be committing a wrong and an injus- tice, if I did not remark that the Profession itself might be respon- sible in some degree, for its present position in public estimation. Is it true to itself? Has it a high sense of professional honor and propriety ? Or do Physicians, moved by jealousy and envy, or by some untoward collision of interests, like other men, slander and abuse each other, not only in the company of their brethren, but out-of-doors, in the public market, and at the street corners ? Gentlemen, it becomes you to maintain the dignity and unblem- ished reputation of your Profession. Its honor is centred in your- selves. If you do not sustain it, it has no inherent power to sustain itself in the estimation of the public. If you play the quack, how can you justly complain if the easily deluded crowd, deceived by you, run pell-mell after other quacks, less scrupulous and louder boasting ? If you decry each other, then with reason, the public may consider you as the best judges of each other's capacities and skill, and hold the whole Profession in mean estimation. Character thus lost, cannot be regained in a day. It takes weeks to heal a wound that may be made in a moment. So, I doubt not, our Pro- fession has received many a secret stab, the recovery from which will be slow and painful. Were you true and united, gentlemen, true to each other, emu- lous only of deserving patronage by adding to your stock of medical knowledge, vieing with each other in the fairness and honor of your dealings, allies, not opponents, preferring to suffer wrong than to do wrong, strict in the observance of professional courtesy and etiquette, you would possess in this association an irresistible power before which the empire of quackery would be subdued, were it ten times more formidable than now. You might challenge the respect and confidence of the public, and pour such a flood of truth and light upon its jaundiced mind, that its prejudices and ignorance and credulity would give place to reason and just dis- 12 crimination. I can conceive of nothing more irresistible than the moral power of such an association as ours, acting in concert and unanimity,— every man having Truth engraven upon his shield, and bearing into " the world's broad field of battle," into " the bivouac of life " a spirit of intelligence, of courteousness, of hu- manity, of perfect uprightness, such as should ever characterise the Physician and animate the gentleman. To accomplish such an object, every Physician must act upon principle. He must act for himself, and not follow the lead of another; doing no wrong because another has wronged him, nor expecting mutual recrimina- tion and retort to end in peace and good feeling. To err is human. You will all find much to forget and forgive in your mutual con- duct ; but if you will, each and all, conscientiously and faithfully discharge your various duties, the blessing will follow not only to yourselves, but also to your Profession. There is one more consideration which I will present while upon this point. It is the necessity of the medical art. This running after quackery even, is a virtual acknowledgment of its necessity and wants. It is no homage to us, as its representatives, but it is a tribute to the indispensable need of the medical Profession. But you, gentlemen, are in advance of the intellectual calibre of the times. With you, medicine has become an actual science, while with these it yet remains a myth and a miracle. So they believe in seventh sons, mesmerisers, Indian doctors; or others prefer (as I before remarked) a grade of knowledge equal to their own — botanic doctors and Thompsonians — any thing but a scientific? Physician. Science is the bugbear. They are afraid of science ; as if the word meant the opposite of knowledge, instead of mean- ing knowledge itself. Fortunately for mankind, the mass of knowl- edge is diffusible. Medical knowledge is no exception. A great quantity of facts bearing upon the public health, has been incor- porated into the general information of the people. They have become such common property, that no credit is given to the first proprietors. The secret of their toilsome discovery is lost. They have been "Things which like fleeting insect mothers, Supply recording life to others, And forthwith lose their own." Such common stock, with some crude gatherings into the garner, 13 serves for the capital of the quack of to-day. Natural Physicians are much more scarce than natural humbugs. Hippocrates was one of the greatest of natural Physicians ; and, besides, he omitted no means of profiting by all that was known in his time. He im- mortalized himself as a Physician, and with Apelles, the painter, immortalized the little island of Cos, which gave them birth; and yet if one of the natural Physicians of 1849, introduced into his practice the absurdities and crude conceptions of the " Father of Medicine," he would be set down by the most ignorant of the age, as an ignoramus in medical practice. I have said thus much, because it seemed naturally to fall in with my opinion of the necessity of the medical art; and that you, as regular Physicians, were in advance of community. I have heard many regret the past, and think the times were retrograding for Physicians. It is not so. Medical associations are of compar- atively recent date. The standard of medical knowledge has been largely elevated. The lines between regular practice and quackery have become defined. But in the past, all medical men were more or less empirics. Much less respect than now was paid to profes- sional etiquette; but little preparation was required of the practi- tioner. There was almost an ad libitum license to play the quack. No, gentlemen, it is not to the past, but to the future you must turn. " 'Tis distance lends enchantment to the view." The " dolcefar niente " is before you. It lies in the increasing regard for professional honor, and in the increasing intelligence of the people. I have great hopes from the American Medical Association. That it may prove the great central power, whose influence shall extend over every quarter of our beloved Union, giving character, elevation, and dignity to the whole Profession. Already by its influence it has saved the country from being deluged and poisoned with the refuse and adulterated drugs of Europe. And yearly it will assemble delegates from the widely-separated parts of our country, uniting them into one confederacy, where the bright ores of many precious mines shall be fused together, impressed with the seal of the Association, and circulated for the universal good, like gold dollars fresh from the mint, with the head of Liberty stamped upon one side, and their legal value impressed upon the other. 2 14 At the same time, for our encouragement, the world is not with- out its leaven. There are many, a great many, who know what is due from the Physician ; his real value ; the importance of edu- cation; the danger of encouraging or tampering with quackery. These will sustain and reward you in all your endeavors for their benefit, with liberal remuneration, with gratitude and applause. And do we not often, within ourselves, feel the necessity of a more extensive knowledge ? Does there not often come an hour, even to the best prepared, when they are not satisfied with doing all they know, but anxiously inquire if they know all they should ? — when on its fluttering wing, some spirit poising between earth and heaven, still casts a lingering, loving look below, then breaks the chain and soars its upward flight; and though we would not call it back from heaven, to wave again that silken hair, to light those loving eyes, or whisper in a mother's ear, " I love you," still had we known some secret charm, some potent drug, that might have bound its fleeting breath to earth, no power had taken it hence. While education is an indispensable requirement of the medical art, there is another element, another requirement, without which no person is qualified to assume the regalia of our Profession. There is an adaptation, a fitness or quality of mind, a mental pe- culiarity which brings men, as it were, " en rapport" with some particular pursuit or calling. This is as true in medicine, as in any other art, trade, or profession. All men will not make good painters or sculptors. You cannot make an engineer, musician, dentist, or mechanic, out of every man you meet with in a crowd. The pursuits of life are extremely varied, and so are the habitudes of mind which fit mankind to fill them. You can make a common laborer out of every man who has bone and muscle, but the higher grades of art require somethir.g else ; they demand skill. Now, it is too true that Physicians have been made out of every thing. They have been manufactured — stuffed with a certain quantity of medical knowledge, which their memory retains suffi- ciently well for a passing examination; and thus they quit their alma mater for the broader stage of active life, armed with all the insignia, jura, honores, dignitates et privilegia, of the medical Pro- fession. Men who could not shine in other Professions, have found hope and refuge in ours. Our Profession has sometimes been said to be the making of dull men. I would not that men should resort 15 to medicine as a refuge for their dullness, when not possessed of sufficient talent to adorn any other sphere of professional occupa- tion. True, brilliancy that would adorn the pulpit and the bar, is not demanded at our hands. The eloquence that would move senates, would become voiceless in the melancholy stillness of the sick-chamber, where the prayer of the priest is almost a mute pleading with Heaven. A ready judgment, a power of minute analysis, an active love of humanity, an inquisitive, investigating spirit; these instruments, more for use than show, are to be in the possession of the Physi- cian. These, with the education with which to act, will fit him for his calling. These will give him progress, action, enthusiasm. With these, he will have that skill which will render his daily path a blessing to himself and others; and without them, his Profession becomes a mercenary and slavish pursuit. With these, he will be armed as a man should be armed who offers himself as the de- fender of the public against attacks of disease, and interposes his aid to assist nature in her efforts toward health, and to throw the protecting shield of his art over the loved and lovely of the earth. But if you equip a man with a bow and arrow, whom Nature never designed for an archer, God save the mark, if it be a human being. Many Physicians pass through life without any particular tal- ents. They jog along from day to day, with a round and a routine, and exhibit a very comfortable balance-sheet of income; and all without thought, without study, without enthusiasm, without love for their art. And what do such accomplish for the elevation of our Profession and for the general good of society ? They obtain that for which they entered the Profession — a title and a livelihood. "They bend the supple knee, And find the thrift which follows fawning." But alas! how is the honor of the Profession degraded by such mercenary motives ! How is it made to bear the reproach of lives sacrificed secundem artem ! Do I err then, in saying that society has a right to demand skill of the Physician ? This skill is not the heirloom of any class or station in community. The poorest, the humblest, have possessed it. It has burned within them, like the inextinguishable flame of Vesta. Through toil, through want, through neglect, they have nourished the sacred fire, till they have 16 ennobled themselves, and given dignity and fame to their Profes- sion. It has given them power to surmount all difficulties,— the lowest origin, the extremest poverty. This has been more particu- larly the case in France and in this country, where the means of rising are open to every man. In France more than this country, as the Concours gives equal chance to all, and satisfies the ambition of the poor student, if he will but suffer and persevere, with the highest rewards. To that we owe a Dupytren, a Larrey, Civiale, Lisfranc, Velpeau, and a host of others, whose names will survive in honorable remembrance, when the lethean wave has buried in oblivion all traces of our ever having existed. The Physician must also be a man of self-denial. What hour can he call his own ? He stands ready to obey the summons, come whence or when it may. In his hours of study, in his hours of rest, he must always be ready. Does he give up some mo- ments to amusement ? Does he stand in need of some relaxation ? Is he at the festive board ? Is he enjoying the society of his friends ? Is it cold and stormy ? Is the night-wind piercing and damp ? Are the roads perilous, and the night dark as Erebus ? Still he is at his post. Is there a moment when the cry of pain may not escape the lips of a human being ? Who knows at what minute some new sufferer may be writhing in agony, and waiting, O, how impatiently! for the Physician to arrive, bringing him hope and speedy relief? Nay, more; when friends, when parents, wife, and children flee in terror from the malignant breath of some devasta- ting epidemic, then must the Physician remain, passing from bed- side to bed-side, inhaling the poisonous effluvia all day long, dying, if need be, in the performance of his duty. Thus have we seen our friends falling away one by one, in a recent epidemic, in the prime and glow of their youth; falling into unknown but honorable graves, ere their hopes of distinction were realized. No; the soldier may not desert in the heat of the battle. It is when the arrows of death arc cleaving the air, that society calls loudest upon the Physician for his faithful care, for his educated skill. Recreant were he to his Profession, to human ity, who flies in the hour of peril, when upon him alone rests the forlorn hope of defence. So also society demands of the Physician kindness as well as skill. It is not enough to give what you are paid for, a prescrip 17 tion and an opinion. A patient demands your interest and your sympathy. He is a brute who can look upon human suffering without feeling and without sympathy. A kind word will soothe that painful tension of the mind, which sometimes equals the agony of the disease. It transforms strangers into friends; it elicits their confidence —that confidence so essen- tial to the successful practice of medicine. This kindness does not consist in complying with all the whims and caprices of the patient. It is not embraced alone in those pleasing words, yes and yes — pleasing, but often dangerous. True kindness often consists in saying no, decidedly but tenderly, and in such a manner that the patient may perceive that you have his best interests at heart. Admitted within the family circle, within that veil which shuts out from the world the home secrets, acquainted with the joys and griefs that are never to be known beyond the Lares and the* Penates; the confidant of ills that are never to be whispered, even to the moon; how necessary that kindness should attend his steps, that his presence may ever be greeted with the warm glow of confi- dence and affection! The most rugged natures have been kind in the privacy of prac- tice. Scarcely had I entered Paris, when Auguste Berard, so amia- ble and accomplished, was suddenly summoned to an early grave. Though not old, yet by his rare talents, heightened by a kind dis- position which ever prompted him, without a selfish thought, to assist the young members of the Profession in their struggle up- ward, and which scattered flowers into all the rough paths of life, he had been elevated upon the smiles and applause of all, to the highest honors of the Profession. It was not long before Lisfranc, who, then suffering under mortal disease, was eager only to com- plete his last great work, was also taken away. His was a rugged, lion-like nature, that strove to be foremost in the Olympiad of medicine, by indomitable perseverance, and by the display of his own fierce originality. In that ambitious race, where so many brave competitors had entered for the prize, he, above all others, had his master mind tinged with the deep and black bitterness of rivalry and enmity. But that hour came when ambitious longings cease, and when a man's true fame, if he deserves, gleams forth like Sirius in an empyrean of lesser lights. In the vast cathedral of St. Sulpice, shrouded in nave and chapel, with the heavy dra- 2* 18 pery of mourning, assembled a multitude in whose bosoms all feelings of rivalry were forever hushed, and who, proud that such greatness had lived upon the earth, had gathered to honor its ashes. Whence comes that numerous band of poor and aged ones, from whose eyes flow forth the waters of deep and inconsolable grief? How seldom, in this hard world, is a man truly wept,— wept with such tears as fall from the eyes of these aged men and women, as standing there in the glare of their funeral torches, they take a last farewell of the dead ! But to them the Thunderer of La Pitie had been as a kind and gentle parent; and they were the children of his benevolence and skill. For years had age silently stolen upon them all, yet through those many years, not the onerous duties of his Profession, not the toilsome hours of study, nor the tedious labors of composition had shortened the daily- space he devoted to the relief of the suffering poor; and like Ju- piter descending from Olympus, he passed out from his stormy ampitheatre, smoothing away the angry passions of ambitious rivalry, to be again the kind and skilful Physician. So it is with us ; however cold and unfeeling the Physician may appear in the eyes of the world, how few, how very few in number are those who are unkind and ungenerous in the bed-side practice of our humane and benevolent Profession! For the performance of these duties and many others which I have not had time to mention, the Physician has a right to expect a proper return and remuneration. The obligations are reciprocal and mutual. He devotes to the public his time and service; and like other servants of the public, deserves a proper compensation. Now, many individuals have a very inconsiderate idea of the remuneration due the Physician. They see him enter the sick- room, spend a few minutes with the patient, write a prescription, and depart. Such service they would measure by the hour, like that of the day laborer. The time and expense of going from house to house, is forgotten; the hours necessarily spent in study and improvement, are not thought of. Nor does it once enter their minds, that while the work of the day laborer is constant and the same, that of the Physician is limited, and varies at different sea- sons, as the health of community varies. Nor is this but a small fraction of the Physician's claim. Education is money put at interest. It is capital, not invested in bank stock, nor railroad 19 stock, but invested in knowledge, and expected to return a good per cent. Let us examine, then, the position of the Physician in this light. The first years of life are devoted, as with others, to acquiring the elementary branches of education. Two years of academic life are given to preparation for a collegiate course. Four years are passed within the walls of some university, in preparing the mind for the more direct study of the Profession. The Profes- sional course begins. Three years more are required for its com- pletion. Here, then, are at least nine years of constant labor — of mental labor — the most confining and arduous of all labor; all the years of youth and the spring of manhood ; nine years of continuous outlay for support, for books, for instruction, in prepar- ing the fallow soil to bring forth fruit. The Physician enters the world. He brushes away the dust that has gathered on his student's robe, and commences his life- long career. Does he receive at once, from an appreciating pub- lic, the summum bonum of his wishes — a deserved confidence and a remunerating patronage ? I cannot do better than quote those lines in which Holmes, the physician and poet, equally distinguished in literature and his profession, has bitterly, but too truly pictured the early career of the young practitioner: — "But thou, poor dreamer, who hast vainly thought To live by knowledge, which thy bloom has bought,— Thou who hast waited, with thy martyr smile, Hope ever whispering, yet a little while,— Too proud to stoop beneath thy nobler aim, While prostrate meanness crawls to wealth and fame; Thou all unfriended, as thy blossoms fade In the chill circle of thy senior's shade, Go, spurn the art, which every boon denies, Till age sits glassy in thy sunken eyes; • Go, scorn the treasury that withholds its store ! Till hope grows cold, and blessings bless no more." In no other Profession is it such a crime to be a young man. Fitted by cultivation and tastes to enjoy life, in the heyday of its spring and the^blossoming of its summer, yet condemned to vege- tate in the seclusion of an office, undisturbed by those in need of his science, or fretted by the clamorous and beastly attacks of creditors, who are as earnest for their due as his few and thought- less patrons are to forget his. In a world where poverty is a crime, where one's fellows think it no wrong to give a stone to 20 him that asks for bread, and a serpent to him that begs for fish ; in a world full of dishonesty, of malice and slander; in a Profession where youth is condemnation; thus too often vanishes life's young dream. With advancing years, comes increasing business. The paling light burns brighter as the lamp is fed with oil. Such is the natural course of our Profession. Success beckons from the distant summit; and through painful years the inward prompting will not permit the young physician to surrender. It comes at last, as it always does to the deserving. That is the hour when his capital begins to pay,— that capital of time, of money, of untiring toil into the arcana of science, of suffering, and neg- lect. Society is to pay him db initio, for the present and the past— it is his right. The majority of young Physicians have struggled through many difficulties, to obtain their Profession. Society should give them a helping hand, by placing at their disposal all legitimate means of advancement and support. Were there no young trees reared, the forests would soon pass away. Were there no young Physi- cians, who would fill up the vacancies when the old Physicians fall ? The young Physician should be paid, not grudgingly, but lib- erally and promptly. He has consecrated his life to the public good, and should receive a generous and substantial support. He has spent the freshness of the morning of life in fitting for the public service. Every hour of each succeeding day he stands at his post, like a sentinel, with his armor on. He should, then, be remunerated not only for the passing moment of service, but should receive an equivalent for the value of that advice which has been* obtained at the cost of so much time, toil, and expense. The Physician not only claims remuneration; he also has* a right to the confidence of society. He presents credentials which! should be esteemed satisfactory. The public can have none bet- ter — because no better are to be found between the shores of the Atlantic and the Pacific. But the Physician often finds in the community self-constituted judges of his skill and acquirements, who at the same time are destitute of the knowledge and ability requisite to fit them for the office. Superannuated grannies and meddlesome old women, who take for their model some very com- plaisant and accommodating Physician, who treats their self- 21 confident opinions with the utmost respect and deference ; and not only these, but the majority of mankind who are not satisfied with- out a reason, in cases where experience is the only guide, and who will lend a listening and credulous ear to any theory, however fool- ish and presumptuous, rather than to confide in the safer course of well attested fact. These are obstacles in the path of every skil- ful and high-minded Physician. In medicine, every thing is not yet known. No science has advanced so far that there is no beyond. The ultima thule of the Art of Medicine has not yet been reached. " Why do you give this ? " says the old woman to the doctor ? " I give it," replies the Physician, " because in such cases, it has been proved by a thousand experiences, to give the relief we wish." " Tell me why it gives that relief? " inquires the investigating old lady. Similia similibus—" Like cures like," answers the Homoeo- path. " It keeps up heat, which is life," shouts the Thompsonian. " It is the Philanthropic remedy," insinuates the foreign pretender. " It is a revelation," says the Mesmeriser. " I neutralise the dis- ease," says the chemist physician. " I purge the humors," says the pill-vender. " I purify the blood," says the dealer in quart bottle panaceas. And thus the quack has an ever ready answer on his tongue. But the Physician has no such meagre and exclu- sive theory. When the Indian, drinking of the pool impregnated with the properties of bark, found himself freed from his ague and fever, and investigating the cause, found the healing virtue in the bark, did he inquire, " Why does the bark cure the ague ? " or was it enough for him to know that he had drank and was healed ? Would it have been wise for him to have said, " I don't understand this; I should like to know how this operates. I want the secret of the cure ; till I have discovered the manner and the method, I ill burn and shiver and shake " ? No. He would rather say, " I will drink and be healed; in time, perhaps I may learn the secret; let me now bless the happy accident which has put so pre- cious a gift in the power of humanity." How often do we hear it said with a sneer, that the scientific Phy- sician doesn't know the action of the tools he uses! It may not be long ere the progress of animal chemistry will give, in many cases, an explanation little dreamed of in the phi- losophy of ignorance. • 22 Then the quacks of every grade, strive to weaken the confidence of the public in the regular Physician, from the Thompsonian, whom you meet rushing into the purlieus of credulity, with his bottle of hot-drops in his hand, to the Homoeopathist, who will impale your disease at a moment's warning, on the minutest point of an impalpable chrystal, or the unprincipled medical knave who seeks to hide his own foul dishonor of a noble profession, by un- sparing malediction and calumniation of its regular practitioners. These decry, without ceasing, the integrity, the Professional knowl- edge and usefulness of the regular Physician. The envy, jealousy, and avarice of the members of the Profes- sion, also leads them to attempt to rise, one at the expense of another, and thus weaken the hold of the Profession generally upon the esteem and confidence of the public. While I have endeavored to show that you, gentlemen, as the possessors of all that is known in medicine; as acquainted with all the theories and hypotheses, new, or in the process of verifica- tion, or already proved erroneous; that you, on account of this knowledge, deserve the confidence of the public; I need not re- mind you that your feelings are often wounded by its sudden and inconsiderate withdrawal. The impatience of the patient, ill-judging friends, interested advisers, have wrested cases from your hands which you had diagnosed with skill, and were managing with the most judicious treatment. Or in those incurable cases, admitting only of pallia- tive treatment, when you have performed your duty as Physicians, and as honest men, in making a candid revelation of the inevitable issue, you have been disdainfully cast out, your opinion rejected ; and you have seen the patient pass the whole round of quackery, in a vain and useless attempt at recovery, and neglecting that relief and palliation which still remained in his power. I Nor has this wound been a mere personal or mercenary one. It was not a question of dollars and cents, but the want of faith and confidence in that Profession in which you have a just and honorable pride. It was the contemplation of that weakness of human character, which slighted the evidence of knowledge and integrity, and put its confidence in the thousand-and-one-systems of imposture and folly. Need I say that the Physician expects to receive in his profes- 23 sional intercourse with society, kind, gentlemanly, and considerate treatment ? I have said that the feelings of the Physician when called to a patient, were not wholly mercenary. He is actuated in the performance of his duties, by sympathy, and should conduct himself with kindness and gentlemanly courtesy. In the confi- dential relations of the family Physician, he becomes a friend,— an intimate, trustworthy friend — a relationship which should not lightly be broken. It should be a permanent relation. In the course of a life, it will be cemented by many a joy and many a grief. It will be a bright and joyous path, when amid smiles and rejoicings, all danger passed, some new and tender plant is added to the family parterre ; bright and joyful, when the withering breath of sickness passed, the young flower wakes again to bloom and beauty; sad and sorrowful, when all efforts vain—as vain they often must be — the Reaper enters the garden and cuts down the young plant with his fatal sickle. For "There is a Reaper, whose name is Death, And with his sickle keen, He reaps the bearded grain at a breath, And the flowers that grow between. • Shall I have naught that is fair ?' saith he; ' Have naught but the bearded grain ? Though the breath of these flowers is sweet to me, I will give them all back again.' He gazed at the flowers with tearful eyes, He kissed their drooping leaves; It was for the Lord of Paradise — He bound them in his sheaves. ' My Lord has need of these flowerets gay,' The Reaper said, and smiled; ' Dear tokens of the earth are they, When he was once a child.' And the mother gave in tears and pain, The flowers she most did love ; She knew she should meet them all again In the fields of light above." Sad it is for the Physician, when having watched with anxious solicitude and unremitting attention by the couch of a little suf- ferer, when every endeavor of love and skill has been baffled and proved hopeless, to see God's holy providence overlooked, and a new Physician summoned on the next need, when before all was good-will, love, and confidence,— as if the loss was chargeable at his door; as if his art, when properly exercised, was unfailing, 24 The ties of the family Physician may sometimes be sundered by reason of more intimate friendship, or by the accidents of nearer relationship ; but in such cases, there is no lack of confidence, no aspersion, no reproach. There should be no ill-feeling, no com- plaint. There is a very common sentiment, rife everywhere, a mysteri- ous something, called understanding the family constitution, by which old Physicians are able frequently to prevent their younger brethren from obtaining such crumbs of practice as might other- wise fall into their hands. That there is some advantage gained by constant attendance upon the same family, no one can deny; but that is an advantage which is easily surmounted by observa- tion, skill, and care. But there is something painful to a sensitive nature, in the very idea of change. To leave the spot where one dwells; to bid adieu to scenes endeared by many pleasant, ever-rising memories; to depart forever from those consecrated aisles where so often our misanthropy and hatred have been dispelled, and love to God and love to man returned to sooth and beatify the heart; such pain is there in sundering friendships — for if the silver chain is once broken, it can never be soldered together so smooth and even as before — and the new friend may not replace the old. " My old friend, he was a good old friend, And I thought, like a fool, his face to mend; I got another ; but ah! to my cost, I found him unlike the one I had lost." But we hear many people say, " I have paid my old doctor, and sent for you. I have paid him all I owe him ; what business is it of his ?" Well, perhaps none. You have wounded his self- esteem, weakened his trust in human nature, diminished his confi- dence in his fellow-men, thrown suspicion into his association with society, drawn a cloud over his daily path; but he has received his pittance, what right has he to complain ? Let us hope that the time may come when the enlightened Physician may claim, with- out presumption, a generous support, a courteous treatment, and a just confidence at the hands of the public. Finally, Gentlemen, if you wish to sustain an honorable position in society, if you wish to win and preserve its regard, its respect and confidence, you must ever maintain, with unremitting vigi- lance, the esprit du corps of your Profession. You must exhibit 25 in every act of life, your own respect for its honor and usefulness. You must not stand by and see your brethren unjustly condemned by the public ; nor, on the contrary, are you to uphold their acts, when committed through culpable ignorance or neglect. You are to uphold no wrong, but are to be the fearless champions of the right. Do you stand one side, and for your own pecuniary profit, suffer one of your brethren to be trodden upon, undefended, you commit high treason against the whole of the Profession. Shall we now " Contaminate our fingers with base bribes, And sell the mighty space of our large honors, For so much trash, as may be grasped thus ? I'd rather be a dog, and bay the moon, Than such a Roman." You, all of you, know well the difficulties which attend the Physician's office ; and that encountering these difficulties, he must act decidedly, and according to his judgment, his knowledge, and experience. There are cases where the wisest foresight may not see the end, and where all that can be done is to summon eminent counsel, and to act according to their light and your own. An honest opinion thus formed, may prove erroneous or injudicious; if it had been followed, a sacrifice might have been made; and yet in ten similar cases, it might be insanity or folly to follow a different course. An honest and conscientious opinion of that kind, not recklessly nor carelessly given, is to be shielded by every one of us from prejudice and reproach. It may fall to the lot of any of you to be placed in such circum- stances, and to be sacrificed, one after the other, while in the con- scientious and faithful discharge of your duty. You must not pander your professional reputation according to public caprice, but remaining equal to the confidence of society, rise superior to its prejudice. Like all other men, your aim is to secure your greatest share of happiness. But happiness is not so much connected with outward things, as with the inward self. He is not the happiest who desires most or possesses most, but he who is content with the least. Can it be in the nineteenth century from the advent of our Lord, that cultivated men deem the service of Mammon more blessed than the service of the Truth ? The pomp and show of the world, its honors and baubles, its flatteries and riches, pall upon the longing 26 and unsatisfied soul, which has obtained its desire, and given up its peace. The long-sought for and promised enjoyments vanish with the getting "like Dead Sea fruits, which turn to ashes on the lips." You are thankfully to enjoy such rewards and honors as you win by your honest labors and skill. But be not envious or jealous of those more fortunate members of the Profession, upon whom Fortune showers her amplest favors. Worldly success is not necessary to your happiness. You may be smitten upon both cheeks, have your feelings stung every day by the proud and thoughtless, be misunderstood and unappreciated; and yet with the " mens conscia recti " sustaining you, no man in the vast and prosperous crowd of the worldly, shall be happier than you. Gentlemen : It yet remains to me to perform the saddest office belonging to this occasion. From year to year you have assembled here, not alone for mutual congratulations, but to be reminded by the ab- sence of one or more of your number, of the uncertainty of human life, and that there is a Power whose simplest will is superior to the sublimest efforts of your art. You, too, supplied with all the weapons that may successfully combat disease, are not exempt from the general law of mortality. It has entered into your midst, taking away one who for many years has been your constant associate, but who will meet with you no more on earth. The Reaper has also entered the gardens of our brethren, and at the stroke of his keen blade, their beautiful flowers have been gathered into the sheaves of Death. But that blessed faith, first taught us at our mother's lips, dimly gathered of old from the pages of Nature, and now definitely affirmed by the Holy Book of Revelation, assures us that we live again. We must all travel through the valley of the shadow of Death, ere we reach the better and the promised land ; and whether the summons comes to us when our brows are mantled with gray, or we are called away in the bright flush of youth and manhood, let us take a lesson of these little ones, that it may find us unsoiled by the base allurements of the world, with an innocence like theirs, and a hope as sure. " Oh, it is hard to take to heart the lesson that such deaths will teach; but let no man reject it, for it is one that all mu«t learn, and 27 is a mighty, universal truth. When death strikes down the inno- cent and young, for every fragile form from which he lets the panting spirit free, a hundred virtues rise, in shapes of mercy, charity, and love, to walk the world and bless it with their light. Of every tear that sorrowing mortals shed on such green leaves, some good is born, some gentler nature comes. In the Destroy- er's steps there spring up bright creations that defy his power, and his dark path becomes a way of light to Heaven."—Dickens. ' l\ ■erit.