THE PROMOTION OF fjjftljrijl Mm oial |fl!4r*?!iw * W* W ' >k ' ’ w1’ BY A NEW ORDER OF FELLOWSHIP. By J. R. Black, M, D., Newark, Oi / Reprint from the Cincinnati Lancet and Observer, December, 1877. CINCINNATI : Cincinnati Lancet Press. 1877. THE PROMOTION OF ]||rili!,il mi BY A NEW ORDER OF FELLOWSHIP. J. E. Black, M, D., Newark, O. It will not be disputed that the present era is one of extraordi- nary progress and growing light. Improvements in art and dis- coveries in science succeed each other in a truly rapid order. The science of medicine has partaken largely of this onward tendency. Anatomy and physiology during the last two-hundred years have undergone very notable advances. Remedies for disease have been greatly increased, made far more efficient and unobjection- able'; not a few diseases once very fatal or prolonged are now under excellent control; injuries, deformities and pain are brought into a subjection no preceding age has equalled. In richness of material, in fertility of resources, the healing art is getting better and stronger every day. The populace has been the chief gainers by this advancement, and this is as it should be in all the ultimate aims of our avocation. It is quite opportune to look at the status of the promotors of this advancement. Has their standing improved, has it advanced with their advancements, have they been benefitted and honored in anything like a commensurate degree to their deservings ? I trow not. In proof of this, I have only to present the familiar fact that in every community, there are hundreds, nay thousands of persons entirely oblivious to the superlative claims and achieve- ments of regular medicine, who are wholly incapable of a correct judgment and discrimination between the best scientific worth, and 2 the most abject charlatanism. They are seen to honor and coun- tenance one quite as highly as the other; nay, the boasting empiric often receives the higher meeds of honor and of praise. Those in high places, as much, if not more than in low, turn their backs upon the genuine promoters of scientific medicine ; they ask in preference, counsel of empirical dogmatists, apparently regarding the new schools of medicine as the better advisers as well as the leaders of medical progress. Readily is it granted, that those un- versed in medical subjects have no criterion by which to know the quack from the man of learning. The former may use false and cunning arts at the bedside; calling every ordinary case of simple angina, diphtheria; every case of mismanaged and therefore tedious bilious fever, typhoid; every sympathetic disturbance about the head, brain fever ; and not one in a thousand of the laity are capable of detecting his ignorance much less do they sus- pect his cunning. As a consequence, he usually receives more credit for skill than the honest intelligent practitioner, he draws around himself the eclat of extraordinary skill in slaying the lions of disease, when in fact they were only mismanaged lamb-like disorders. The law refuses any efficient aid or protection against the intol- erable assumptions of empiricism, it will do nothing to uphold, en- courage or protect the genuine cultivators of science ; it grants charters to almost any half dozen of doctors seeking after noto- riety as college teachers, making them the unrestricted grantors of diplomas until every ignorant pretender and travelling mounte- bank of the day, can flaunt two or three of them in our faces. On precisely the same level in public estimation are the hydropathic, eclectic, homeopathic and regular M. D. What, if many of the irregular schools are so ignorant of the human body that if asked to describe the os uteri they will take it to mean a bone ; if asked to describe the relations of the prostate gland in the female they will make the attempt. Then the so-called new schools of medicine boldly proclaim that they are the progressive and most advanced cultivators of medical science, a brazen claim tens of thousands of lay persons—vTho think themselves exceptionally well informed, actually believe. If such persons be told, what is strictly accurate, that of all the dis- coveries that have served to lengthen the average duration of life, that have given the physician a power over many diseases and in- 3 juries only a short time ago undreamed of and unknown; not one has been made by the followers of the schismatic schools of medi- cine, they will be incredulous, and regard it simply as the plea of a sordid self interest. Few things are more difficult to overcome than popular prejudices, and to create these against regular medi- cine is the strong point of the followers of the irregular schools. Nearly all their leisure time is employed in this kind of medical demagogism, in making converts to their creed, and in depicting the imaginary evils of regular medication ; they have neither the inclination, time nor ability to add to the sum of medical knowl- edge. Indeed, all of these systems being founded and held to- gether by certain dogmas, to uphold them is the highest intellec- tual ambition of their followers; dogmas which must not be dis- puted or questioned. A more effectual check than this to progress the long experience of the dark ages has abundantly verified. The revival of such a dark age method is disgraceful to those pro- fessedly engaged in any scientific pursuit, and ought to be resent- ed to the utmost. It was this method which held the minds of men in chains for centuries, and which has, and whichever will put a bar upon progress in the irregular systems of medicine. Ever since the time of Bacon regular medicine has acknowledged no dogmas—it has no creed orescientific doctrine. To it the most heretical course is for any class of medical men to place arbitrary limits on dogmatic assumptions, for instance as to dosage, or the department of nature from which remedial agents may be drawn. Entire freedom to question one’mode of treatment and advocate another—or whatever experience has demonstrated is the most effective in the removal of the disease, is the chief corner stone of medical orthodoxy. Heterodoxy is to attempt to fetter the judgment by the mere ipse dixit of a creed or authority. A regular physician may advocate the doctrine, and present the evidence that the best mode of coping with disease is the more frequent use of cathartics, or their entire abandonment; he may advocate that small doses are better than large, or that vegetable remedies only should be used in the treatment of disease and be perfectly orthodox. But the moment be seeks to erect his judg- ment into dogmas, or into a system of practice from which others are not to depart, he forfeits all title as a free thinker and genuine promotor of medical knowledge. Should a follower of Hahne- man investigate for himself and act upon the light he may there- 4 by gain, whether, for instance, the best way to remove the filth which often disorders the stomach and bowels is not by cleansing emetics or cathartics, he would forfeit his standing as a genuine homeopathist. If he gave large doses instead of very small, when he thought it best for the good of the patient, he would be, to all intents and purposes—a regular physician. The eclectics say they select only what is best in other systems of practice; in other words, they repudiate being cultivators and are only unscrupulous appropriators of other men’s labors. But it is not my object to enlarge on the dark age methods of the irregular systems of medicine, or to portray the utter falseness of their pretensions as benefactors of mankind through their dis- coveries in medicine, as they have made none ; my purpose is to enquire if the disadvantages under which we as a profession labor cannot be lessened—if we cannot protect ourselves—no others be- ing likely to do it, if there be not a mode of rendering better en- couragement and sustenance to scientific progress, to a higher standard of qualification, and at the same time secure for ourselves the honors and rewards to which we are rightfully entitled; in short, if we can not infuse some of the progress of the age into our status as a profession. As before remarked, though regular practitioners have intro- duced all the great improvements that have been made in the healing art, unscrupulous rivals appropriate them, reviling the dis- coverers as old fogies, creating a wide spread disaffection and dis- trust in influential circles toward scientific medicine. In this way, the sphere of usefulness of legitimate medicine has been lessened, damping the ardor and spirit of scientific culture to a far greater degree than any unreflecting person can credit. By a very large class of estimable people the only promoters of medical advancement are regarded as the dead weights of progress, and the influence of all such is thrown upon the side of popularizing a shallow empiricism. An endeavor to get at the primary cause of the low estimate in which we are held by the public, no higher with the majority than quacks,—and below them in the estimation of many, will I think carry to the opinion that it lies in the unlimited publicity which is given to every fresh discovery, and to every new remedial meas- ure. An immediate effect of this, is to disassociate the honor from any class and to put them into the hands of cunning empirics 5 who speak of them with glib familiarity, as if such discoveries were the result of their own labors. In this way a false impression is made on the popular mind, most unjust to regular physicians, besides rendering new remedies subject to serious abuse and fur- nishing opportunity for the creation of ignorant prejudices. Even the laity take up with each new remedy, soon deeming themselves quite as competent to use it as the discoverers. Here a little knowledge is a dangerous thing. New remedies are no sooner introduced, than, as in the examples of chloroform and chloral hydrate their employment by the popu- lace is subject to serious abuse. Laws have been enacted to check the evil, prohibiting the sale of dangerous drugs except on a physi- cians prescription. But they are nearly always dead-letters. Not only this but many druggists getting a slight clue to remedies for disease actually prescribe for quite as many persons as some physi- cians ; and on what degree of knowledge ? Simply on a guess that a person’s symptoms are similar to some other ones in which a remedy had been used successfully. Clues like this, constitute also, the fons et origo of patent nostrums. The druggist finding by a physicians prescriptions that some one acts extremely well in some disorder, straitway puts it up as his discovery, disguising it by and a sounding title, and at once proclaims it as a remedy for nearly all the ills to which flesh is heir. After years of application and patient investigation to find our- selves on the same level or actually below it in popular estimation with such thieving quackery is not only extremely humiliating, but it tends to foster the belief that some humbuggery in the prac- tice of medicine is necessary and even more successful than merit. The frequent repetition from daily observation of such impressions upon the mind, undoubtedly tends to lower the animus of the physicians aims, to lead him to scout the necessity of diligence and thoroughness in knowledge as the main avenue to success, and of openly avowing that some humbuggery is absolutely required if we would hold our own in popularity, and make a financial success of our avocation. Even students of medicine do not escape the baleful influence of the observation, how well quackery succeeds. The free way with which our remedies are made familiar to the popular mind has another disadvantage worthy of mention. It deprives us of what has been termed the psychological influence of remedial agents. Let the sick take a medicine with which 6 they are familiar, and the therapeutical influence of the imagina- tion, or of a high mental expectancy as to its mystic virtues, does not aid in the removal of the disease. Some awe, emotion and mystery concerning a medicine are unquestionably helps to the restoration of health. It is thus, that ignorant and obscure charlatans have frequently succeeded in overcoming disorders after physicians of high attainments had failed. It is easy enough to enumerate the obstacles and discourage- ments which environ us as a profession—but what to say or do for their mitigation or removal; something that will be practicable and efficient, is most difficult. The subject has been anxiously discussed in our medical journals, societies and associations but with unsatisfactory and dissonant results. One medical college after another animated by the laudable purpose of improving our status as a profession have determined that the best way of its accomplishment is to elevate the standard and requirements of admission into its ranks. But it is difficult to see how the con. sciousness of superior knowledge will improve our relations with the public. The latter as a rule, are wholly incapable of distin- guishing between the most profound, and the most superficial attainments. As the curative art at present appears to the popu- lar eye, there is no test, no mark of superiority that readily and unmistakably distinguishes the regular school from any other, un- less it be in the query, are you a calomel doctor? The cunning and misrepresentation of empirics are competent to prejudice and vitiate the judgment on the subject to an incurable degree. We all know that we are often blamed when really entitled to great praise, and praised for skill when really entitled to censure for our mistakes. Besides it is a specialty of the followers of the empir- ical art, always to bestow high sounding titles to the little disor- ders they manage, so that in the outcome they have the name and credit for curing far more of the very worst diseases than the most accomplished and conscientious scientist. The people cannot detect the deceit, and when a competent physician attempts its exposure, ten to one he will not be credited with speaking truthfully but only in his own interests. Oh, say they, you doctors are always running each other down! If we wait in the hope of overcoming the evil tactics of empirics and the incoinpetency of the public to judge aright of medical qualifications simply until we know more ourselves, we will wait and watch until doomsday. 7 The mitigation or removal of our gievances cannot be accom- plished by meeting in conventions to draft and adopt resolutions. The faintest ripple of their influence does not permeate into any department of extrinsic social life; they possess for the great pub- lic about as much interest and influence as the acts of a Chinese mandarin. If our relations to empiricism and to the public are in many respects unsatisfactory, they are to be bettered, if at all, by a new adjustment of the relations of individual members of the profession at the points of contact with empiricism and with the public. If our status is not what it should be, and mainly on ac- count of the impracticability in the existing inodes of enlighten- ment, of opening the popular mind to the truth, we should adapt ourselves to the exigency. Perhaps this adaptation may not attain to an ideal moral standard. But the fault in this does not necessarily attach to the adaptor. It is often claimed that what is highest and best ought to be pwooewred absolutely, not rela- tively; but absoluteness of end, involves absoluteness of means, which I think none will aver pertains to the enforcement of any- thing like a just conception and maintenance of our claims as the genuine promoters and representatives of the healing art. To promote this, and to infuse the spirit of greater ardor and pro- gress into our ranks, I would propose in lieu of a loosely formed society like this, the organization of a physicians guild ! in outline as follows : Six or more regularly educated and reputable physi- cians to unite and meet for private consultation at least once a month for the following objects ; the advancement of the various departments of the healing art, obligatory and unreserved commu- nication to each other of every discovery and improvement in therapeutical resources, and the protection of our claims as the only representatives of science and progress in medicine. You may think this in no respect different from what we already have, but it is, and radically so unless you have caught the full import intended to be conveyed by the phase “ private consulta- tion.” By this is meant that all the discoveries, all the improve- ments which we as diligent students of medicine may make must be kept alone for the eye and ear of the guild; in other words, the class who make the discoveries and improvements in medicine, are the only ones competent and rightfully entitled to use them and so reap reputation, honor and profit of their labors. To carry this out in detail, would I am aware be a decided revolution, and 8 by some may be considered impracticable. Let us see how the plan would work in detail. Monthly meet- ings would be held to communicate with each other as to the best modes of managing disease drawn from the school of observation. There is scarcely a physician of large experience who has not found some special mode of treatment for some disease unusually successful—a mode not to be found in any The ripe experience of one in obstetrics, of another in diagnosis, of another in pathology, of another in therapeutical procedures etc. etc., is, let us suppose, laid before a local guild for verification. If found of advantage and an improvement upon the methods already known, to be put in print and sent as the voice of one guild to the others. All such communications, of course, to be reciprocal. There is a good reason to believe that many very valuable modes of treating diseases often die with their originators, sometimes from modesty in the discoverer, or the lack of practice in presenting clearly to the minds of others a new plan of treatment; and oftentimes from reluctance to make public certain points of practice, which would deprive the publisher of a practical vantage ground over the quacks by which he is surrounded. For one, I may say that there is scarcely a disease in which I prescribe according to the text- books, or a single affection in which my plan of treatment has not undergone important Those as long in practice no doubt can say the same thing. And now, should this special knowledge or expertness in the management of some diseases die with it not be well to make it the property of a guild—all being mutual contributors, and so build up a structure of progress in knowledge out of the most select materials ? In this way, the guild would soon become, exceedingly rich in new and more successful methods, imparting to its members eclat for exclusive and therefore distinctive wisdom and success in the man- agement of disease. The empirical harpies who thrive on the dis- coveries of others, no longer having access to the writings and practices of medical leaders, would be thrown upon their own barren resources, precisely where they ought to be,—to enable the public to form a just estimate of their merits. An organization like this would form an excellent school for the young as well as the more mature practitioner. From time to time the most advanced methods of dealing with disease would be brought .before tbe mind, and under a form which would give 9 them a consideration not hitherto accorded. With such an exten- sive and private source for accumulating new and verified reme- dies and methods of treatment, the fellows could go on from one stage of progress to another, until in skill and fertility of resources they would so distance those not of the order that the most illiter- ate could not fail to perceive and acknowledge their exceptional learning and success in the management of disease. All their dis- coveries, all their improvements being known and used by them alone, would soon tend to form an easily discerned and distinctive mark of superiority which would, without words or effort, and in the mere application establish^I itself in the minds of every observing person. In a test of the kind there could be no mistake, and all questions of rivalship in the minds of the people as to who are in the foreground of progress would cease, as all would see the empty pretentions of irregular medicine precisely as we see them. A broad and practical line of distinction would thus be drawn be- tween scientific men and impirics, one amounting to infinitely more than a mere name which is about all that very many suppose con- stitutes the chief difference between the followers of the so-called old and new schools of medicine. Those members of the guild not especially gifted as contributors to the common fund might be of some use as critics, Incapable of adding to the general stock they might now and then detect a weak point in the statements of others. But much of this kind of talent is far from desirable. The minds of such persons are always in the shadow of doubt, they have no eye for beauty, only for defects, deformity and death, no admiration, or love of truth and progress Their barren minds refer to the productivity of others, much as an old maid refers to the fecund wife with the spirit of detraction, racking the wits to raise prognostication of possible evils. No society is the richer and rarely any the better for what they accomplish. They do not assist any one to a greater mastery over disease, but on the contrary often do great harm by their attempts to display subtility, —confusing knowledge and throwing the shadow of doubt by never ending quibbles over what is almost axiomatic in medical science. Obviously, an organiza- tion like the one proposed should not seek shelter and countenance such dead weights, men who are secretly absorbing, or in other words have a strong endosmosis but not the slightest exosmosis of information after even the tightest squeeze. By having a new remedy or plan of treating disease verified and endorsed by each guild before communicating to others, an immense boon would be conferred on those endeavoring to thread the labyrinths of medical progress. As medical journalism is at present conducted, it is confusion worse confounded. The most diverse views of the nature and treatment of disease are pre- sented, each apparently about equally well authenticated, and all claiming exceptional success, until one is almost led to exclaim that the whole matter is a humbug or a delusion. If each modi- fication or new plan of treatment were first subjected to a crucial test by the guild to which it is first communicated, and if con- firmed then ordered as a communication to the others, far, far more dependence would be placed upon its value than upon those pub- lished after the system now in vogue. Progress under such a plan could not fail to be rapid, sure and steadfast—the type of a prevailing malady would be far more accurately determined and always considered in the results, errors in diagnosis corrected, and more than all, mistakes from lack of attention to post hoc, ergo proctor hoc, will be largely obviated. In addition to the great gain to medical culture by such an or- ganization would be the creation of a distinctive order of physi- cians whose standing and reputation would be absolutely in their own hands. Colleges might turn out every year regiments of in- competent doctors, who if found unworthy, would be refused ad- mittance or recognition by the guild. Under such circumstances their college titles would avail them little. The thousand or two turned loose each year upon the public by the dogmatic schools, and who flaunt a Medicine Doctoris in our faces, in effect declaring I am all that thou art and a little more, would find a gateway to honor and to knowledge in their pathway, which if not opened would place upon them for life the stamp of unworthiness, of ille- gitimacy and of a low standing as scientists. It does not seem possible for the medical profession to carry out effectual self-protection except by the organization of a medical order like this, around which should gather high reputation, ad- vanced culture, profound learning and exceptional skill. This order must be placed at an altitude unapproachable to all others. The public would then cease to think one kind of doctor about as good as another, or in fact, those the best of any who boast the longest and loudest. How can such an altitude be made clearly obvious to the popular eye ? SSimply and plainly by making dis- coveries and their discoverers 1 one; in other words by confining the applications of discoveries] to the class who made them. The representations* of sectarian methods practiced by their superiors and so be compelled to own their ignorance, besides being cut off from the means which a smattering knowledge confers of misrep- resenting and creating popular prejudices against whatever hap- pens to conflict with the welfare of the sect. We all know that the dogmatic schools have not made a single great discovery, a single great improvement in any of the departments of medi- cine, but depend upon the investigations of regular physicians, and then hold them up to the derision of the public as a set of fogies, away in the background of scientific progress. the opinion of a large, if not the largest number of those considered the most intelligent in every community, one can readily as- certain by a little careful inquiry. And, is it not most humilia- ting, most unjust when all the credit for progress is upon our side? Would there have been any doubt upon this head, if all the dis- coveries and improvements that have been made in the last half century, and that are the glory of regular medicine, had been jealously held and used as the exclusive property of the class who made them. The public would then have known beyond all doubt or question who are the real promoters of scientific advancement, as all those not of them, would be in -such deep ignorance of late improvements that all would be enabled to see the sects in medi- cine as we see them. We pride ourselves in being a liberal profession, but we have overdone liberality, so much so as to have seriously impaired our usefulness, and placed ourselves in an unjust and humiliating atti- tude before the public—one in which, except to a very few, are we at all distinguishable from the horde of empirics by which we are surrounded. Consider for instance, the tone of the newspa- pers—that great modern moulder of public opinion toward the various pathies of medicine,—and it is too plainly evident that the number who exhibit any discernment, or special regard for the regular or scientific school is very small; a surprisingly large per- centage of them openly declaring that we are slavishly bound to old time methods, or in other words, that we are respectable but conservative fogies. There is not one of the rural yet numerous and influential newspapers that does not puff some charlatan almo st every week as if he were among the great if not the greatest of physicians, on whom the sick may confidently rely for restoration to health. To read these day after day, occasionally interlarded with the favorite theme of the presiding officers of medical socie- ties, to wit : a toploftical dissertation on the fame and dignity of the medical profession, is enough to bring a sickly smile to any one’s face. For the thoughtful and studious physician to be placed by any one, not to mention the great moulders of public opinion, on the same level with charlatans is sufficiently humiliating, but to be rated far below them is to create an intense disgust toward the whole vocation. In truth all this is simply intolerable consid- ering the facts. Who discovered the circulation of the blood; brought forward vaccination as a safeguard against small-pox ‘ who was the means of preventing scurvy by which the lives of tens of thousands of se&men are annually saved ; who discovered chloroform, invented the laryngoscope, the ophthalmoscope, the aspirator, hypodermic syringe, the Esmarch bandage, the plaster jacket, and many other improvements of intense import to suffer- ing humanity ? Why of course there is but one answer, the mem- bers of the regular school. To show what progress has been made by them alone, take a single illustration. Only a little more than two centuries ago, when any one met with an accident which rend- ered amputation necessary, the trembling victim was tied to an operating table while the knife and saw did their work. The bleeding vessels were not ligated as now, but the raw stump was seared with red-hot iron, or dipped in hot-pitch to stop the bleed- ing. The mortality as near as can be ascertained was about 75 per cent. Now, when such a misfortune befalls any one he is thrown into a sweet sleep only to awake after the offending mem- ber has been painlessly removed and the stump nicely dressed. The mortality is exactly l’eversed, or about 25 per cent. To whom is the credit due for this wonderful change? There is but the one, same old answer—the regular school. Yet forsooth we are supposed by large numbers of lay persons of high standing to be the retarders instead of being, as we are the only promotors of medical advancement. Had all the discoveries and improvements been kept as the property of those who made them, such a sup- position would not have been possible, as the difference between regular physicians and empirics would have been so wide and dis- tinctive as to leave the latter in absolute obscurity. But, says one: wliy not enlighten the people on these topics, so that they may be enabled to form a juster estimate of regular physicians? It is not practicable or creditable for the latter to imitate the arts of quacks by publicly boasting of what they have done and can do, or to put any question of superiority or precedence into all the uncer- tainties, humiliations and aggravations of dispute, or to waste their time in proselytizing when their spare hours can be turned to far better account. The matter can be much more easily and decisively settled by the arrangement proposed, of a new organi- zation. Those the richest in progress will soon move to a higher and nobler plane of excellence, while those poor or barren in scientific discoveries will be left far, far below. There would then be no question who were the true friends of progress and of hu- manity ; no question who far outranked all others in learning and skill. To secure these ends it is only necessary that regular physicians all over this land should organize themselves for mutual culture and private intercommunication. In lieu of multitudinous journals filled with crude and contradictory statements—sometimes designed far more to gratify personal ambition than scientific growth, there would be an official journal in each state to record the announce- ments of the discoveries and improvements that have been made and verified by one guild to another, and this being their exclusive property the knowledge would be a sealed book to all not of the order. To carry out these objects fully, a return to the old-time cus- tom of physicians dispensing their own medicines either by trained assistants, or by students as a school for their practical training would have to be adopted. Retail drug houses by the way are the great nurseries of quackery, besides affecting the ioterests of physi- cians in other ways most unjust and unfair. For example a fifty - cent prescription is given,—the druggist files it away often giving a duplicate to the patient who not only uses it himself for a dozen of years or so, but hands it around to his friends, The only one who derives anything like an adequate profit for the benefit con- ferred is the druggist. He clears on the prescription some 15 or 20 dollars to the physician’s 50 cents. Nor is this all, the druggist finding from the talk of his Customers, what good service the com- pound has done, issues it as a prescription of his own to others. Again and again have I known numbered bottles representing a R for a disease doing duty in more than one family. Little wonder under such a system that drug houses multiply and do a thriving busi- ness. Each one usurps a business of hundreds of dollars annually that ought in justice and right to go into the hands of physicians. After years of patient trial and observation I have arrived at the knowledge of a compound very efficacious in that ubiquitous'disease nasal catarrh. I do not give prescriptions to my patients for it— for the simple reason that if I did, the druggist would soon take all the business out of my hands; a consummation not wholly nor devoutly desirable. Some conveniences, it is true, would be sacri- ficed by the change proposed, but the counterbalancing advantages would be ample, and the plan far safer and more acceptable so far as the public are concerned. But some may think, there are our text books of practice open for any one to read and learn. Well, let those who choose avail themselves of what they contain. For one I have such faith in the progress of medicine, that in a few years all books of the kiqd would be, therapeutically, well nigh obselete. Especially, would this be the case if all the best physicians of our country were united together for the facilitation of intercommunication as to every discovery and improvement. By making the requirement obligatory on each fellow of the order to communicate anything of value that comes under his observation, an immense collection of the most select medical knowledge, of methods verified by several observers as yielding exceptionally good results, would soon be in the hands of all the fellows of the order. This would quickly put in the hands of all, the best methods of each, and so render advancement in knowledge and skill unprecedentedly rapid. The advantages of an organization such as I propose, over those now in existence, may be summed as follows: a stronger consciousness of unity in aims and interests. Like a close coopera- tive body, its wealth of knowledge and improved methods would depend upon individual contributions, and the richer it became in these, the higher would it rise in exclusive skill, and the more distinctive would it become in public estimation. The pride and interest of each would be so identified with the organic union as to lead all to strive earnestly to collect a large fund of select know- ledge for the common, but exclusive use of its members. It would carry into immediate effect efficient self-protection, not only as against integral professional deterioration, but as against the assumptions of empirics. A barrier would be erected, absolutely under the control of the profession, truly republican in form—in every city, county and township of the land, which would in effect say to the unworthy, this far and no farther. The attitude toward empiricism would be a strong and the only true one for the over- throw of this gigantic evil, not of an offensive, but a defensive character. By the simple identification of all the discoveries and improvements in medicine in the popular mind with regular physi- cians a silent, but most effectual warfare would be kept up against empiricism, which would provoke no controversy or sympathy in in its behalf. The shallow emptiness of its pretensions thus silently revealed, it could not fail to languish and be consigned to the obscurity it so richly deserves. Fellowship in such an order could not fail to be highly prized, as it would be the “ open sesame” to the most recent discoveries and improvements in medicine, besides conferring identification with the class that the public would soon learn are the only ones entitled to high regard and who make and possess superior instrumentalities for the alleviation and cure of disease. Membership and good standing could not fail, under such inducements, to be eagerly sought, and those who from an inordinate self-sufficiency, imagined that they could dispense with its advantages would soon find them- selves lagging far to the rear of the grand march forward. Very quickly would all such realize that they were, not of, but to the outside of the great medical world. Kemedies and plans of treat- ment would soon be in the hands of those of the order, to the out- sider, strange and unknown. Not to be a member, would be equivalent to professional ostracism. Under such inducements honorable conduct and observance of medical ethics among the order could be enforced as never before. It would go far to unite the fellows as a band of brothers, and tend to transfer the disposi- tion to war against each other, to a Avar against empiricism in every form. Investigations and contributions to improvement would be stimu- lated as never before, each member feeling that now regular medicine has an available Avay of proving its superiority to every mind, not by windy words, but by discoveries and deeds of exclu- sive skill. All the improvements and advances of the future would be made as in the past by the regular school, and if they were known and used by it alone the better methods and their 16 originators would become so thoroughly identified in the public mind, that no longer would there be any question who are the real promoters of medical science and the benefactors of their race. 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