ADDRESS DELIVERED AT THE Third Annual Meeting OF THE Issociatiovf and OF THE MEDICAL DEPARTMENT OF THE UNIVERSITY OF BUFFALO, BY FRANK II. HAMILTON, A. M., M. D., LL. D. REPRINTED FROM THE TRANSACTIONS OF THE ASSOCIATION. B U KJ A L O : HANS MAN & W, PRINTERS, Cor. S. Division Sts. 1 A. I ADDRESS TO THE ALUMNI. BY PROF. FRANK H. HAMILTON, M. D., OF NEW YORK. Gentlemen, Alumni of the Buffalo Medical College :-It is pleasant after so many years to meet you again ; and I thank you for the opportunity which, through the courtesy of the executive committee, has been afforded me. Everything conspires to make this occasion pleasant to me. This beautiful city of the lakes was my residence during fifteen years of my active life ; and I remember with pleasure its broad, sloping and airy streets, its elegant residences, its beautiful parks, its invigorating atmosphere, cold and stormy enough in the winter, but soft and balmy, yet never sultry, in the summer ; always pure, fresh and wholesome ; sufficiently remote from the Atlantic coast not to be chilled and sodden by its "ill winds which blow nobody any good," its dry, northwest winds licking up just sufficient moisture from the lakes to soften their asperity, and the hot south winds tempered by the Apallachian range of southern New York and northern Pennsylvania. Under these favorable conditions it might easily be determined what the climate ought to be, and a considerable experience has convinced me that it is equal to any other in the world ; that it is eminently favorable to health, longevity, to both physical and mental vigor, and that as a cosmetic it is unrivalled. The energy of its citizens in the carrying forward and achievement of great commercial enterprises, the number who have attained distinction as statesmen, and in the several liberal professions ; the rank which its artists, men of letters and editors, have taken in their respective fields, and the beauty of its women, fully sustain this opinion. I am unwilling to make an exception even in favor of that charming region on the northern shore of Lake Leman in Switzerland, adjoining Clarens, of which Jean Jacques Rosseau wrote that here alone could he make himself happy, if blessed with the possession of a " true friend, an amiable woman, a cow and a little boat," and where the local guide-book in 1844 informed me that "no place in the world has so small a proportion of deaths, or of imprudent marriages." It is delightful to breathe again this atmosphere so full of nerve, and muscle and crimson blood corpuscles ; so full of inspiration, genius and thought; one draws a full breath in these open out-of-door streets, without an apprehension that the next breath will exhaust the small number of cubic feet allotted to him. The light comes down in great masses such as the painter from nature delights to copy, and in which one may plunge and bathe himself and be restored ; 2 coming out of that cerulean blue, wherein General Pleasanton has discovered the new creation-the source of animal and vegetable life, and the long sought fountain of health. Associated with Buffalo, there are, to me, many other delightful recol- lections. I recall with pleasure those citizens with whom I held relations of friendship, and my co-laborers in the practice of medicine and surgery. To the former I may say, a physician seldom forgets those with whose pains he has sympathized, and for whose restoration to health he has labored ; and to the latter I would presume, also, to say that the confidence, love and respect which they have so long enjoyed among their fellow- citizens, justifies my early experience of their worth and intelligence. But of all my recollections of Buffalo, none come back to me with so much freshness and fragrance as the memory of iny association with the faculty and students of the Buffalo Medical College. The present college building was, when it was first erected, quite outside of the city ; but now it is in the heart of the city, as I believe it is, also, in the hearts of the citizens. Some of the gentlemen who sit beside me, and myself, saw the corner-stone, laid and heard the stroke of the hammer from day to day until it was completed. A solid and comely building, admirably adapted to the purposes for which it was built, it was at the same time, a consummation of our long cherished hopes, a monu- ment of the taste and munificence of our fellow citizens. I recall the doubts with which we entered upon the scheme-the diffidence with which we at first pressed our claims, and the surprising alacrity with which the people responded. No one refused encouragement, and nearly all were as ready to give as we were to receive. So that when the work was happily accomplished we felt compelled to admit that what we looked upon as a formidable undertaking, had proved to be so easy as to have deprived us of a large share of the honor of success. The citizens of Buffalo, appreciating the value of such an institution to the interests of science, gave us the building and made no reckoning. I recall the humane and liberal sentiments of the late pious and learned Bishop Timon, who, unsolicited, made haste to invite several of the gen- tlemen connected with the Medical College to assume the charge of the Charity Hospital, which had just been opened under the auspices of the Catholic church, and to offer in return for their services the unrestricted use of its wards for the purpose of clinical instruction ; an act of enlight- ened policy, which has, I am informed, been repeated by the managers of the Buffalo City Hospital, more lately established. Of the college faculty who were associated with me at that time, whether living or dead, there is nothing left but pleasant remembrances. We all tried, I believe, to do our duty-working together in these new fields as best we knew, cutting down, grubbing at the roots, building fences, turning up the fallow soil and planting the seeds. How well we ploughed and how well we planted this assemblage of educated and skilled medical men may attest. You, the Alumni of Buffalo Medical College, are the ripened autumnal harvest, gathered to-day in sheaves, bound together by the loving cords of your Alma Mater. There is a most delicate and tender affection which, as I think your own experience will confirm, springs up naturally between the teacher and his pupil, and which strengthens with each day of intercourse, but which is 3 by no means broken or interrupted when the degree of Doctor of Medicine is conferred and the young doctor is dismissed from the paternal roof with the paternal blessing. The student is, in most cases, young, earnest and confiding, and believes without question the statements which are made to him by his college preceptor, and he lays them away in a corner of his memory as so much capital for future use ; and to this respect for the opinions of his teachers there is added, in most cases, unflinching loyalty. The Professor is infal- lible, and whoever denies his authority is guilty of treason. The boarding- house table is daily agitated, to the great discomfort of the lady of the house, by the sharp contests on questions of doctrine and practice, which spring up between the young medical student attending his first course of lectures and the family doctor with a full-grown beard, who sits oppo- site, but was educated at Heidelberg and quotes Simon and Chelius; and in the after-life some of our most animated disputes are upon the question whether we are of Paul or Apollos, Virchow or Rokitansky. It is well, for the young especially, that they have a proper respect for authority. When children and young men begin to think for themselves too soon, they are apt to get from their own very limited experience and partially developed powers of reasoning, a great many crooked ideas ; and it is better that they should be too credulous rather than too skeptical. It is better to receive with blind and simple faith the teachings of chosen men of age and experience, eventhough the mind become inoculated with some errors which it may be difficult to eradicate, rather than to build up a faith of our own based wholly upon an early experience of the delight- ful effects of a few doses of paregoric and soothing syrup. My purpose, gentlemen, in calling your attention to the plasticity and impressibility of the mind of the student, and to the permanence of those early impressions, is only to explain to you how it happens that the youth who sits daily at the foot of his master, becomes, at first, only the recip- ient of ideas, then, as the revelation unfolds, the attentive and loving disciple, and finally the active preacher and propagandist of the faith. He is now not so much a counterpart as a part of his master-not only figuratively, but virtually, in all that pertains to the science of medicine, he is the child of his Alma Mater, reflecting her character, conduct and opin- ions as plainly as a child reflects, by inheritance, the features and character of one or both of his parents. By these signs we may judge of his legitimacy. The recklessness or caution-the craftiness, insincerity, frankness and truthfulness of the master, are reproduced, yet sometimes in a more or less exaggerated form, in his pupils. His mysterious powders, his famous pills, his precious and healing salves continue their miraculous functions in the hands of his humblest disciples. As Holmes said of the apothecary's son, you would know him easily, for he bears upon his face the liniments of his father. No one knows better than those who have been accustomed to teach medical students, the truth and force of the statements I have made, and how necessary it is that his instructions should be sound and incapable of misapprehension. He is writing upon wax, but which is soon to suffer a transmutation into stone ; and what is written will never be effaced until the tablets of the memory are broken. Pupils have quoted to me words which I had uttered in a lecture given twenty years before ; 4 and have declared to me that they had never ceased to be governed by the doctrines or practice which were then sought to be enforced. Happy the man who can, after twenty years of additional experience, look upon these old fragments of thought, which have been treasured and kept polished by his faithful pupil, and feel assured that they have been of some use to mankind. The close and watchful attention of the student, the modest question following the lecture, the respectful acceptance of opinions, and the ready answer in the daily examinations, seldom fail to secure the affection of the teacher. Nor are we insensible to the loud clamor, and rude, boy-like ap- plause with which a class of medical students are wont to greet our entrance into the lecture room, or to express their kind recognition of some, either successful or unsuccessful attempt at humor ; for there is a generosity in these youthful minds which induces them often to give equal emphasis to their expression of satisfaction, whether the attempt on the part of the Professor to be humorous is successful or not. The practice of applauding a Professor, who is seeking to enforce some grave and subtle matter of science, by a sally of wit, I must be permitted to say, in passing, especially as I am speaking to medical students as well as to Alumni, is not to be commended. It scarcely comports with the dignity of such occasions, or with your own assumed dignity as students of medicine. Nevertheless we like it ; and while we lift the hand in disapproval, the heart answers in approval. We are enchanted, sometimes, even by your coquetry. Alas that we are obliged to confess it; we arc human ; and when we ought to be vexed that you compel us to drop the thread of our discourse, we often turn aside to drop the tear of affection. Gentlemen, my visit here is especially to meet and talk with you ; but so many thoughts obtrude themselves after my long absence from the city that it seems impossible for me to give to you that undivided attention which, as your guest, you have a right to claim. Moreover, I feel myself at a loss what, in the brief time allotted to me, it is best to say. Most that I have learned in the interval of time which has separated us you have learned also. Our science has made progress, but you have kept pace with it. I have had personal experiences, and so have you. I can no longer take you into the old amphitheatre and swing around the circle, having all the talk and opinions on my own side-enforcing those state- ments which are difficult to understand with " demonstrations" equally difficult to see. You are here as my peers, and I feel diffident of my ability to either instruct or entertain you. Please indulge me then in my caprices, and permit me to say whatever comes uppermost. SPECIALTIES IN MEDICINE AND SURGERY. The question of specialties in Medicine and Surgery has of late attracted a good deal of attention and given rise to considerable discussion. The question is, are they useful ; do they tend to advance our science ? I answer yes and no. There are two sides to this question as there arg to most other questions. Within certain limitations and upon certain condi- tions they are useful, and the converse is equally true. To understand this matter, let us see what has happened within a few years. When I commenced the practice of my profession, and within your recollection, 5 we, who simply called ourselves Physicians and Surgeons-general practi- tioners,-occupied the entire field. There might have been here and there a strolling specialist, but they failed generally to secure the confidence of the people or to make any dangerous inroads upon our practice. Our leg- itimate right to the entire territory was practically undisputed. Since then, however, following upon a few established successes, there has sprung up suddenly a great excitement, such as inevitably follows the rumors of the discovery of a new bonanza ; and emigrants, with no other capital than a pick and gun, have crowded into the territory, and never so much assaying "by your leave," have selected their ground and driven their stakes until little or nothing is left to the original proprietors but the barren title of Doctors, and which title is found to have no weight in law as against the intruders. To-day there is scarcely an organ of the body or an anatomical and classified structure into which their stakes have not been driven, and from which trespassers are not warned. Let us mention a few of these specialties. For the head there is the oculist; the aurist; the catarrh doctor for the nose ; the throat doctor ; the dentist, of whom there are several sub- ordinate and separate departments. There are heart doctors, and lung doctors ; and some who include both of these important organs in their practice, and might properly be called chest doctors. The liver is an old claim, which was worked a good many years and then abandoned as being worked out. There are kidney doctors, also ; but no one has ever driven a stake into the spleen, although I do not see any good reason why it might not be worked profitably. There are a great many people who are spleeny, and if any one could summon the courage to put up a sign, I am sure he would be well patronized. There are doctors for the nerves and for the blood, doctors who can expel by their medicines all the bad humors, and leave their patients in good humor. There are skin doctors and bone doctors, spine doctors and crooked-leg doctors, hair doctors and corn doctors, and bone-setters, some of whom are natural born There are doctors for women, also, as distinguished from doctors for men ; but there are no doctors for men as distinguished from women. We do not feel offended at this act of partiality toward women. Bless their souls, no. So far as we are concerned, we would be quite willing they should have all of the doctors, and that we should be left to suffer and to die without their help. But one cannot help asking whether, if it be true that the cordce tending of women's hearts are more delicate than ours, and their nerves are attuned to a higher key-whether admitting this and much more, there is really any more difference between a woman and a man than between a man and a women ; or whether the establishment of the specialty of a woman doctor, means that a woman is a man plus a woman, and that a general practitioner cannot be expected to attain to a knowledge of the plus. I have only this morning seen an advertisement in a Syracuse paper, in which a homoeopathic doctor announces that he makes a specialty of children. Very small ones, I suppose. I have not, by any means exhausted the list of specialties which are to-day recognized in medicine and surgery ; but I think you will see that there is a good deal of crowding, packing edgewise and some overlapping, 6 and that not much chance is left for the old-fashioned physician and surgeon. The condition of matters will be best illustrated by a supposed case ; and which I shall take care not to exaggerate very much beyond what has repeatedly come under my own observation. A lady called upon a physician for advice, stating that her health was "completely broken." and that she was "afflicted with a frightful collec- tion of maladies," but as she did not specify them particularly, the doctor began to interrogate her about the condition of her nervous system ; when she replied promptly that he need not trouble himself to inquire into that matter, as she had consulted Dr. Brown-Sequard, and under advice she was taking strychnine and iron, and phosphorus to build up her nerves. The doctor then suggested that he would like to examine her heart. " Oh," said she, "that is in a very bad condition, but Dr. Clark is giving me aconite, belladonna and digitalis to lower its action." "Your lungs ?" said the doctor inquiringly. "Dr. Metcalf has examined my lungs," was the ready reply, "and J do not care for any other advice in that matter. He is giving me several cough mixtures." " But I notice," said the doctor, hoping that he had now hit upon the weak point, and the one which she proposed to entrust to his special guardianship. " I observe that you have still some cough, and perhaps the trouble is in your throat rather than your lungs." "Dr. Metcalf thought this might be so," said she, " and he sent me to Dr. Elsburg, who says there is trouble there, also, and he is applying daily iodiforin spray, and other things. "You wear glasses ?" " Yes, my sight was a little affected, but Dr. Noyes thinks they will be cured if I wear glasses and take his medicines long enough." "Pray, madam," exclaimed the doctor completely baffled in his attempt to find an unprotected point in this splendid line of defences, "will you kindly inform me what organ, or fragment of an organ, or tissue you wish to place under my charge, or consult me about?" "Yes, Doctor, if you please. I have consulted a good many other specialists, and as I am abundantly able to do so, and as health is of more value than money, 1 propose to consult them all. I know you by reputation very well, and I I felt sure you could tell me better than any one else who makes a specialty of warts, and I would thank you to give me a letter of introduction to whoever you think is best. I have a wart on the back of my neck, and as 1 would not like to leave a scar, you will please recommend me to some one who will cure it without cutting." I am not ignorant, gentlemen, of what specialists have done for the science of medicine ; nor do I hesitate to accord to them all the credit and honor they deserve. There are among them, both in this country and abroad, many men who have contributed greatly to the true advancement of medicine and surgery. By a division of the subjects of investigation and by narrowing their fields of observation and of experiment, they have been able to make most valuable contributions. I am familiar with their labors, as you are also ; and if I omit to mention their names it is because I would not wish to make invidious distinctions ; but especially because I wish to feel at liberty to criticise their practice without seeming to be per- sonal. In the minute anatomy of the various organs and tissues of the body they have made many advances. They have supplied many new observations and plausible theories in histology and pathology ; but you cannot fail to have noticed that very often they do not recognize the fact, or they seem to have forgotten that the same pathological lesion has been a thousand times described as seen in other parts of the body, and that there is not in the observation anything new beyond the fact that it is in a new place, and they have described it under a new name. Specialists have also in many instances greatly improved mechanical surgery. There might be furnished an abundance of illustrations of the truth of this statement ; but it must not be supposed that the mere multi- plication of surgical appliances necessarily implies improvement. Precisely here is one of the most glaring evils of specialism. Partly because they have only a small field upon which to exercise their ingenuity, and partly because the invention of a new instrument is found to be one of the most successful means of advertisement-for these, and for other reasons not known to me, they invent and urge upon the attention of the profession, a multitude of useless and showy instruments, polished brass and nickel plated steel, such as the general practitioner might be supposed to con- template with envy, but can never hope to be able to buy or to use with intelligence , yet which, happily, he does not need. It is in operative surgery, however, that specialists have achieved their greatest triumphs. There is a certain class of operations which demand great manual dexterity, and this can only be acquired by a large and constant practice. Baron Wenzel said that he had destroyed a hatful of eyes before he had learned how to extract the lens. One would not like to see his own eyes in this first hat-full of experiments. If the Baron, having learned how to make this operation successfully, thereafter con- fined himself to the operation of extracting lenses, he must have made himself very useful to a later generation ; but if, presuming upon his suc- cess in this line, he ventured upon a new series of experiments outside of his original and narrow field, it is probable that he did to the world more harm than good. In the matter of exact diagnosis, I need not say, also, the specialists have placed us and the public under many obligations. There remains one department of medicine, however, by no means the least important in my view, namely, therapeutics, in which specialism has subjected itself to severe and just criticism. If specialists have advanced our knowledge of the anatomy of organs; if they have made discoveries in histology, pathology and diagnosis ; if they have established new and per- fected old methods of operating, they have not in an equal degree im- proved the treatment of disease, which after all is the great end and pur- pose of our study. There is a natural tendency in specialism to limit its vision to the local malady, and to overlook the general dyscracy or the remote lesion upon which its existence depends. The human system is a wonderfully complicated machine. No one part is independent of the other ; the heart suffers with the brain and the brain with the heart : the nerves and arteries are distributed and woven into every part of the fabric ; and while it is necessary for the physician to study every organ in detail, it is equally necessary that he should study it as a whole, when all the parts are put together and are in motion. The specialist discovers a pimple in the ear, and limiting his observation to what the tube of his otoscope discloses, he fails to discover that there is a pimple on the nose also ; and he does not, therefore, recognize the fact 7 8 that the pimple in the ear implies a fault in the general system, nor that, while it may contribute to the comfort of the patient to extinguish the pimple by a local application, it is sure to be followed by another here or elsewhere, unless the remote or constitutional cause is removed. The outward sign may be blotted out, but the latent poison still courses through the veins undisturbed. Specialists will no doubt admit the truth of this general statement as to the constitutional origin of many local maladies ; and they may, perhaps consider it an unjust imputation upon their good sense, that I venture to question their judgment and their practice in this particular. Then they must hereafter speak in a way not to be misunderstood. I read their reports of cases ; I listen to their discussions, and I have frequent occasion to observe their practice, and I notice constantly that they give very little attention and credit to general treatment as compared with local treatment. I have listened an hour to the discussion of a proper treatment, of trachoma,-granular conjunctiv- itis,-conducted by eminent ophthalmologists, in which a variety of local applications were considered and their comparative value carefully estimated, but not one word was said about general treatment and hygiene. Yet every practitioner knows, and perhaps they knew also, that in nineteen cases out of twenty, if not in every case of this form of chronic disease, and probably in the vast majority of all chronic diseases, their existence depends w holly upon a general dyscracy, and that while local medication may be useful it is by no means an essential part of the treatment. It is spongingout a wound to stop hemorrhage and neglecting to tie the artery that supplies the blood ; it is Mrs. Partington again mopping the Atlantic from her door-step. There is, I observe, a natural and a most irresistable tendency in special- ism to attach undue importance to the local lesion, and to put it in the relation of cause, w'hen it actually stands in the relation of effect. To resist this tendency specialists need, first of all, a complete knowdedge of medicine and surgery as a science, and from this specialism must come as a natural outgrowth. No man can become an opthtalmologist or an aurist, by a study of the eye or ear alone. All of our really great specialists were at first general practitioners, who having attained distinction as such, became afterwards by gradual and almost insensible departure, specialists. Even then the habitual limitation of the vision is liable, eventually, to narrow the breadth of their horizon. In short, gentlemen, specialists need help from the general practitioner, quite as often as the general practitioner needs help from them, and in my opinion, much oftener. In addition to the opthalmoscope, otoscope, laryngoscope, stethoscope, micro- scope, and many other useful instruments of this class, for which we must acknowledge our indebtedness to them, they need a telescope, and a wider- scope-aids to vision most often found in the hands of the general practi- tioner. ABUSE OF DRUGS. I have a few words to say to doctors in general ; that is, to you and myself. That same Dr. Holmes, whose head is as full of wit and sense as an egg is of meat, has said that it would be well for the world if most medicines were thrown into the sea ; that it might be bad for the fishes, but it would 9 be better for mankind. For this unasked and impertinent suggestion he lias received a good deal of orthodox censure, which I am here now to share with him, for I am of the same opinion as Dr. Holmes, and this opinion has long been a part of my Christian faith. That the major part of the world does not agree with us is plain. Indeed most people seem to think that the chief end of man is to take medicine. Babies take it in their mother's milk ; children cry for it ; men and women unceasingly ask for it and no one dies without it. Shrewd men have taken advantage of this instinct, and in most civilized nations it is to-day one of the chief articles of manufacture and of commerce. It is one of those things which is never permitted to be out of sight-'but it is thrust upon you in the nursery, in the streets, upon the lamp posts and upon the curbstones, along the highways, from the rocks which border the rivers ; the medicine- chest follows you at sea, as if the sea itself, a vast gallipot of nauseants, were not enough. In this model city, a drug store sends its blue and green lights from every business corner not occupied as a liquor store, giving a ghastly and ominous complexion to the faces of all who pass or enter. Jeanie Deans, stopping at " the great city " of York, on her sad journey to London, to implore the clemency of Queen Caroline in behalf of her poor sister, wrote back to Butler, as the first token of comfort she had derived from her long foot-toil, " They hae inair medicines in this town of York than wad cure a' Scotland, and surely some of them wad be gude for your complaints." With what an increase of comfort and acceleration of hopes, had this great city been in her way, might she have looked upon the prodigious stores of medicines displayed from the shelves of its drug stores. Enough, one would say, to cure not only all Scotland, but all the world besides. One might naturally suppose that the supply would at length exceed the demand ; but it does not. Everywhere the people are stretching out their arms, and begging for medicine, blessing him who gives and cursing him who withholds. They believe in their simplicity, that if medicines can do no good, they can at least do no harm. They imagine also, that there is a medicine which may be regarded as a specific for every human malady, and that these are known to science, and that therefore we have the means of curing all diseases; but the people imagine a vain thing. Whatever medicine is capable when properly administered, of doing good, the same medicine is equally capable, when improperly administered, of doing harm ; and drugs often substitute a malady more serious than that which they were intended to cure. The Irishman said his physician stuffed him so with medicine that he was sick a long time after he got well. Patent medicines are especially to be classed among those drugs which destroy many valuable lives. Advertised as "sure cures," they are well known to kill more than they cure. The proprietor of one of these medi- cines accidentally told the truth once when he advertised for agents to undertake the sale of his medicines, which, he said, he was sure would prove very profitable to the undertaker. Admitting that Hahneman was neither insane noran idiot, there remains only one rational explanation of his life. He was a philanthropist, and having seen the immeasurable injury done by excessive medication, he determined if possible to get rid of medicines altogether ; so he invented 10 that absurd and fanciful theory of medicine, in which it was proposed to doctor men with moonshine. If so, however, and he were permitted to re-visit this earth, he would be sadly disappointed, since even his own disciples have denied the faith, so far as the infinitesimal doses are concerned, and are now giving arsenic, strychnine, aconite and nearly all of our most deadly poisons, with a freedom and recklessness which would dismay a regular practitioner. In this respect Hahneman's scheme has proved a failure ; and this was the only rational or useful purpose it could have served in this world. There is no taint of treason in these remarks, gentlemen ; I have always been loyal to my profession and shall remain so until death. 1 know the value of certain drugs, when properly administered, and can testify to the great improvements in therapeutics within the last quarter of a century. It is the monstrous abuse of medicines that I am denouncing, and all really intelligent physicians join in this denunciation. We believe there are many other medicines than those found in the drug shops, which are cheaper and safer and less nauseous-air, light, exercise, a light heart and a clear conscience, are all good medicines. Do you also think with me ? If you do, I ask of you that, making all diligence, you add to your faith courage ; and that on all proper occasions you declare your opinions openly. It may be, if you look at the practice of medicine only in the light of a trade, that it will not seem wise or politic to be over-zealous in contending with the public appetite for medicine ; but I feel assured that you do not look upon your profession in that light; and that under no circumstance you will make commerce of your con- science, or permit policy to sit above honesty, but that in this as in all other matters in life, you will follow the advice which the Bishop of Lonsdale gave to those who came to him enquiring the way to Heaven : "Turn to the right and then go straight forward."