IN MEMORIAM ANDREW FLEMING, M. D. IN MEMORIAM ANDREW FLEMING, M. D. Born, July 3, 1830, Pittsburgh, Pa. Died, August 18, 1896, Magnolia, Mass. " I have finished the work which Thou gavest me to do." PITTSBURGH: THE EICHBAUM PRESS. 1898. IN MEM0R1AM. MARGARET LYON YALDEN. Pittsburgh Chronicle Telegraph, September 19, 1896. We scarcely realized that the twilight shadows were falling about him; we only saw the sunset glow ; and through its radiance watched the busy, active, noble life of him we loved ; nor did we dream that night time was at hand. How could we ? There was naught to warn us-naught to tell us that the day was waning in the life of one whose age was " clearer than the noon-day." He. who was always ready with comfort and cheer for others, never thought or spoke of self. In the death of Dr. Andrew Fleming, at Magnolia, Mass., August 18, 1896, the City of Pittsburgh lost a distinguished citizen, many lost an eminent physician, and how many, only our own hearts can estimate, lost a beloved friend. With him his profession was an art, and into it he threw the profoundest passions of his soul-but it was an art without limitation-a single restriction. It emanated from a mind trained and broadened by intercourse with all that was best in the realms of intellectuality, and extended into the most intimate relations of home and social life. Whatever was new in scientific fields, he quickly grasped and assimilated, and in the world of literature he was first and fore- most in laying hold of all that was of weight and value. He possessed the rare faculty of sifting out the great from the little, the true from the false, and to this his extensive library bears ample and striking testimony. 2 In the small coterie of brilliant men, which perhaps repre- sented the most real intellectual life of our city, Dr. Fleming was one of the choice spirits, and it was in his home that, for many years, these friends spent an evening together each week, in grave and gay discourse. It was a privilege, indeed, to be present on such an occasion, and is recalled as one of the pleasant memories of the past. Dr. Fleming's gift for languages was, well known. In addi- tion to being a fine classical scholar, he was a deep student of French and German literature, besides having a conversational knowledge of the Italian and Spanish tongues. I remember very well entering his office one day and finding a copy of the New Testament in Italian lying open on the desk. To my question, he replied : " The best way to commence the study of a language is to read through the New Testament." And it was not long before the Italian was added to his previous store of languages. A visit to that office was always a treat to me, for I was sure to bring away something besides the mere physical cure. He had such large, warm sympathy, such ardent desire to relieve, such tenderness for the small pain, with all the time an almost miraculous insight into the real trouble. How often have I left his presence with a lighter heart and a smiling wonder over my recent depression. But that door is closed now and the dear, kind voice is silenced. He possessed the confidence and love of his patients to an unusual degree, and many, many sorrowing hearts have testified to their deep sense of loss for friend and physician. One friend, thoroughly appreciative of the Doctor's character, thus beautifully writes : " How can we do without him ; so kind, so affectionate, so true, so honest, so pure in character, with the simplicity of a child and the intellect of a giant? " Only those who penetrated beneath the Doctor's naturally reserved and quiet manner fairly understood the finely strung, sensitive nature that shrank from any outward demonstration of 3 thought and feeling. His sometimes apparent abruptness was often made to hide the tenderest emotion, and his full, rich voice, trained to professional firmness, never lost its sweeter note of sympathy. Ah, words are cold indeed, when they try to speak of one who never spoke of himself; whose unnumbered kindnesses and generous gifts were flung with lavish hand-but so quietly, so silently, that God only knew. To give utterance now to the many acts of beautiful generosity that colored the Doctor's life, would be to tear aside the veil sacred to him who drew it about him in his lifetime. "Not by the page, word-painted, Let life be bound or sainted; Deeper than written scroll, The colors of the soul." But it was in the home circle that the bright joyousness of the Doctor's nature drew its full breath. Those cherished home ties which came late into his life, but how, in an intensity of happiness, they made up for the emptier years of single life. He was friend, counsellor and guardian to those with whom these ties connected him, and there are aching hearts to-day that scarcely dare whisper the loss that has come to them. Oh, his was a life lived for a purpose, a divinely wrought purpose, and the beauty of Truth and Love that crowned its splendid achievement " has deposited on the silent shore of memory, images and precious things that do not die and cannot be destroyed." I leave it to others to tell of all that Dr. Fleming accom- plished for the advancement of medical science, and of his superior abilities in other directions-mine be it to speak of the loving kindness of the friend who fell asleep ere we had time to bid good night. The music of such lives is never stilled. Ever and again we hear the echo of the song-nearer, still nearer, 'til we catch the oft repeated refrain : " Earnestness alone makes life an Eternity." 4 J. A. LIPPINCOTT, M. D. The Pennsylvania Medical Journal, August, 1897. By the death of Dr. Andrew Fleming, at Magnolia, Mass., on August 18, 1896, from intestinal obstruction, the Allegheny County Medical Society has lost one of the most distinguished of its members. He was one of the founders of the organiza- tion, and took an important part in the efforts made to establish its efficiency and influence in the community. In 1878, in view of the then approaching meeting of the State Medical Society in Pittsburgh, his commanding position in the profession sug- gested the propriety of his election to the presidency of the County Society, and many persons present will recall the dignified courtesy with which he performed the duties which devolved upon him on that occasion. Dr. Fleming was born in Pittsburgh, of Scottish parents, July 3, 1830. He read medicine with Dr. Joseph P. Gazzam, at that time one of the leading physicians of the city. In 1853 he went to attend lectures at the Jefferson Medical College, from which he graduated in 1855. He was soon afterward elected resident physician at the Pennsylvania Hospital, where he served the regular term of eighteen months. During that ser- vice, under the guidance of such men as the famous Gerhard, with whom he was a special favorite, he already gave evidence of the powers which led in later years to such marked success, and stories of the acumen of the young Pittsburgher are still among the traditions of the hospital. After completing his residential term he returned to his native city and entered into partnership with his old friend and preceptor, Dr. Gazzam. This partnership, to both agreeable and beneficial, terminated only with the death of the elder physician. From that time up to the moment when he left the city for his last holiday. Dr. 5 Fleming was engaged in active practice in the extremest sense of the word. His activity was enormous. His reputation became so thoroughly established and so widely extended that he was enabled to lend a helping hand to many a struggling practitioner. Nevertheless, although his clientele as a whole was what is usually called a select one, many of the tears dropped upon the bier of this "beloved physician" were shed by the children of poverty; for Dr. Fleming, like every true physician, realized that " the poor are our best patients, since God is their paymaster." His vast capacity for work was due partly to an intense sense of order. He could at a moment's notice lay his hand on any book in his extensive library, or on any one of the hundreds of interesting specimens, anatomical, botanical, mineralogical, etc., which he possessed ; and this orderliness was manifested in all the details of his professional life. To this quality was joined a lively appreciation of the value of time. He was never hurried, but he was never idle Wie das Gestirn, ohne Hast aber ohne Rast. At consultations-and his consulting practice was large-he invariably arrived at the exact hour appointed, and he was somewhat impatient of tardiness on such occasions, although his rebukes of the " weaker brethren " took the form of good humored banter. Dr. Fleming was exceptionally gifted with the faculties that go to make the ideal physician. His perceptive powers were extraordinary. No detail escaped his penetrating glance ; odors and sounds imperceptible or meaningless to most others were never lost upon him ; and the tactile sense residing in his delicately moulded hands seemed preternaturally acute. His mental processes were so rapid that he often seemed to arrive at a diagnosis by intuition. As a result of his wide experience and unceasing study, aided by a memory that never failed, his mind was a storehouse in which was collected a rich and orderly array of the treasures of medical science in all its departments. 6 This was, perhaps, especially noticeable in the domain of thera- peutics. His accurate and comprehensive knowledge of the materia medica gave him an exceptional fertility of resource in prescribing, for, unlike most men past middle age, he did not believe in " settling down to a few drugs." But while Dr. Fleming was primus inter pares in his chosen profession, he was at the same time a man of the broadest cul- ture. His general library was one of the largest and best selected in the State, and its contents had been thoroughly assimilated. His knowledge of biography, history, poetry, and even of lighter literature, was encyclopedic, and his immense fund of information was frequently drawn upon to decide dis- puted questions. The extent and variety of his reading were favored by the possession of a rather uncommon gift for acquiring languages. He was fairly familiar with the ancient classics, he had a work- ing knowledge of Italian and Spanish, and he spoke French and German about as fluently as his mother tongue. He found time amidst the cares and toils of an exacting prac- tice to cultivate an acquaintance, by no means superficial, with most of the natural sciences, geology, physics, astronomy, chemistry, natural history, botany, etc., and his keen faculty for minute and original observation gave such a piquancy to his conversation that his acquaintance was eagerly sought by experts in these sciences. In truth, he was a passionate lover of Nature, and ardently wooed her in all her myriad unfoldings. The flowers of the field and the trees of the forest yielded up their secrets to him as to a familiar friend. There was not a bird in our woods, not a fish in our streams, with whose characteristics and habits he was not intimately acquainted. In his summer outings he seemed to pick out by instinct the salient features of the locality in which he happened to be, and he has enlarged the list of attractions of more than one such locality by his discovery of interesting natural objects which had escaped previous observation. So shrewd a student of nature could scarcely fail to be a 7 sound critic of art, and Dr. Fleming's judgment, naturally dis- criminating, was trained to a high pitch of excellence by a study of the masterpieces in painting and sculpture, ancient and modern, in most of the cities of Europe. Considering Dr. Fleming's great experience and his varied accomplishments, his contributions to medical literature, as in the case of many busy men, especially of the passing generation, have not been so Numerous as could have been desired, but they make up in quality for what they lack in quantity. Perhaps his most extensive literary effort was the work on " Blood Stains," published in 1861. It was undertaken at the special request of his friend, the Hon. E. M. Stanton, Lincoln's famous War Secretary, at that time a light of the Pittsburgh Bar. Stanton was about to try an important murder case, and he felt seriously the lack of an authoritative analytical exposition of the value of this sort of evidence. Dr. Fleming's brochure, which contains a scholarly analysis of the literature of the subject then in existence, and in addition gives evidence of many laborious hours spent in original and fruitful investigation, is even now, after the lapse of thirty-six years, an instructive and readable work. Among other publications may be mentioned his sug- gestive paper on "Emotional Fever," which appeared in the volume of the Transactions of this Society for 1879, and remarkably able and beautifully illustrated address on "Antero- Lateral Sclerosis," delivered at the expiration of his presidency of the County Society, and published in the American Journal of the Medical Sciences, Series LXXXL, p. 17. At the meetings of the Nathaniel Bedford Medical Club he read about two score papers, all of which might have been published with profit to the profession. They were characterized by industrious research, penetrating observation and profound reflection. This club, which was the first medical organization west of the mountains to enjoy anything but an ephemeral exist- ence, was founded in 1864 by Dr. Fleming, together with eight other medical gentlemen, and had a continuous and active life of nearly twenty-one years. It was not only serviceable in 8 promoting scientific inquiry, and a laudable esprit de corps in its own membership, but its successful example stimulated the formation of other similar organizations, and, as the mother of the Allegheny County Medical Society, it will always be accorded an honorable place in our medical annals. In the dis- cussions which followed the reading of papers in the Bedford Club, Dr. Fleming's remarks, embodying as they did the reflections of a sagacious and earnest observer upon a rich and well-digested experience, were invariably heard with respectful attention. His intercourse with his medical brethren, whether in or out of the consultation room, was marked by a refined courtesy which respected the spirit as well as the letter of our code of ethics, and his pecuniary contributions to medical objects were given with no grudging hand. He possessed the affectionate confidence of his patients to a very unusual degree, especially of those who had known him long enough to penetrate the reserve of manner which concealed a deeply sensitive nature. They appreciated him not only as a conscientious and thoroughly equipped physician, but as a kind and sympathizing friend. He always shrank from taking a prominent part in municipal affairs, but he took a lively interest in the welfare of the com- munity, and his public spirit was attested by the untiring assi- duity with which he devoted himself in season and out of season to the splendid work of the Sanitary Commission during the eventful years of the war. A few intimate friends for many years used to meet around Dr. Fleming's hospitable hearthstone on one evening in the week, when the winged hours sped in conversation on any topic, literary, scientific, philosophical or what not that might be sug- gested. On these occasions the host showed a rare skill in eliciting the opinions of others, drawing, only when the need became apparent, on his own ample stores for an illuminating fact or idea. On these occasions, too, his keen sense of humor was evidenced at times, and many a mirth-provoking anecdote, and many an amusing word picture of odd characters at home and 3 9 elsewhere, illustrated with an exceptional knack of mimicry, will linger long in the memories of those who heard them. Visiting friends of the guests were warmly welcomed, and a special interest was not infrequently imparted to these gatherings by the presence of men who had achieved distinction in the fields of art, science, invention, travel and literature. Such men recognized the host as a kindred spirit, and many of them have testified to the depth of the loss sustained by them in his death. In 1874 the Doctor married Mrs. Eliza Thaw Lyon, who survives him. His domestic life, an ideally happy one, is thus alluded to by a writer competent to describe it: " It was in the home circle that the bright joyousness of the Doctor's nature drew its full breath. Those cherished ties came late in life, but how, in an intensity of happiness, they made up for the emptier years of single life ! He was friend, counsellor and guardian to those with whom these ties connected him, and there are aching hearts to-day that scarcely dare whisper the loss that has come to them." To these mourning ones, and to all who knew him, he has left a fructifying heritage of good deeds, and the stimulating example of an earnest and stainless life. Like Ian Maclaren's inimitable Dr. Maclure, Dr. Fleming was too busy giving aid to the sick and suffering to be conspicuous for his attention to religious forms, but, like the hero of the Bonnie Briar Bush, he had an ear " attuned to celestial har- monies." And this sketch, perhaps, cannot be more fitly closed than with the words quoted by him in the hearing of a friend, who sat one night some years ago by his bedside during a severe attack of illness. After hours of pain and sleeplessness, as the tired lids at last began to droop, and the weary head sank back upon the pillow, he softly murmured the exquisite utterance of the inspired poet: "He giveth His beloved sleep." 10 JOSEPH ALBREE. The Standard History of Pittsburgh, Pa., 1898. The ordinary life of a physician of extended practice in a large city, while not usually marked by startling events attracting the attention of the public, is nevertheless one taking a most important place in the lives of most men, for there are often times when the happiness, the means of livelihood, indeed, the entire future of the families, depend upon the ability and devotion of the physician. It is not surprising that the faithful physician justly claims, and ordinarily receives from those patients who have any true appreciation of the great responsi- bility devolving upon him, their respect, confidence and affection. While the main events of the life of Dr. Andrew Fleming can be stated in a few lines, it would be very difficult to record and give any correct idea of the great number of homes he brightened and cheered, or of the many valuable lives lengthened by his assiduous care during a laborious practice of over forty years. There are but few families in this vicinity that he attended, the members of which do not gratefully recall instances where the lives of dear ones were saved by his ministrations. Andrew Fleming was born in Pittsburgh, July 3d, 1830. After reading medicine with Dr. Joseph P. Gazzam, he continued his medical studies at the Jefferson Medical School in Phila- delphia in 1853, and was graduated there with honor in 1855. Immediately upon receiving his degree, he was elected Resident Physician of the Pennsylvania Hospital, Philadelphia, where he served a term of eighteen months. Very soon after his entrance on the duties, he was appointed to the responsible position of druggist in place of one who had served in that capacity for twenty-five years. In the spring of 1857 he began to practice in Pittsburgh, associating himself with Dr. Joseph P. Gazzam, 11 his old preceptor, on Sixth avenue, a partnership which was very soon terminated by the retirement and death of Dr. Gazzam. Dr. Fleming remained in the same location until 1888, when he built a beautiful, convenient residence on Western avenue, in Allegheny. He was married November 24th, 1874, to Eliza Thaw Lyon, who survives him. He died at Magnolia, Mass., on August 18th, 1896, of a sudden severe attack of intestinal obstruction. His body was brought home and interred in the Allegheny Cemetery, August 22d, 1896. It was sad that his death should have occurred just at the beginning of the summer vacation, when he hoped for the rest and recreation that would the better prepare him for his arduous duties. Few men have passed into the other life with a fuller record of daily good deeds done than Dr. Andrew Fleming. Starting in his profession well prepared for the duties involved, he was unusually successful in gaining rapidly an extensive and lucrative practice, and in taking a place among the first physi- cians of the State. His practice soon reached a point where he was obliged to restrict it territorially, and to refuse to go beyond certain limits. Always exceedingly regular in his habits of life, and paying the strictest attention to his own health, the con- tinued labor and constant strain resulted in a dangerous illness of some months' duration in 1881. Absolute rest and a sojourn in Europe restored perfect health, and he learned, before it was too late, that there is a limit to human exertion, even in a good cause. As a student he was remarkable for two traits that charac- terized him during his entire life-thoroughness and accuracy. His systematic habits of study and his patient persistence not only enabled him to grasp the main principles of medical science, but to so make himself master of all the details that he could apply them practically. Heartily and enthusiastically devoted to his profession, he was above all things a physician. Naturally endowed with a power of quick observation, accuracy of eye and dexterity of hand, he diagnosed correctly and operated 12 rapidly and neatly. Until the day of his death, he was an earnest and laborious student of medicine. Keeping himself fully informed of all that was being discovered anywhere in the gread medical world-carefully investigating for himself any newly suggested remedies and improved modes of surgery ; reading and speaking the modern continental languages almost as readily as his own, nothing that transpired in the medical centers of Europe escaped his attention. Holding steadfastly to the fundamental principles of medical science-intolerant only of ignorance and quackery-he heartily greeted, and after most searching examination, adopted, any discovery that would relieve pain or cure disease. He was always prepared for emergencies and fertile in-resources. If the most perfect appliance for any special purpose was not to be had at the moment, his mechanical dexterity and ready hands immediately provided a useful substi- tute from materials at hand. None but his patients can tell how suffering was relieved and comfort increased by his attention to the little things, so essential to the rest of the nervous, wearied invalid. He was anxious, not only to make his patient well, but to make him as comfortable as possible. His bright, cheery face was like sunlight in the sick room. His personal presence, his gentle touch and musical voice, were as efficacious as medi- cine. Regarding him intellectually, Dr. Fleming was strong and broad. He not only knew what he knew, but he knew for a definite purpose, for a practical end. Outside of the domain of social gossip, for which he had no taste, he seemed to follow the injunction of the son of Sirach : " Be not ignorant of anything in a great matter or a small." His love of his profession, and the enthusiasm with which he pursued it, were apparent to every one who enjoyed his acquaint- ance ; and whatever books or experience could teach him, he was always eager to learn and to store up for use. As his mind was of a notably scientific cast, he was highly interested in all scientific subjects, and no discovery in the range of science, no novel or ingenious speculation of a scientific character, escaped his notice. 4 13 In referring to Dr. Fleming's literary work, the cause for regret is that his professional duties allowed him but little leisure for that he did so well. Among his published papers may be mentioned the monograph " Blood Stains," prepared at the request of, and dedicated to Lincoln's Secretary of War, Edwin M. Stanton-a clear exposition of a most difficult and intensely practical subject-a paper which is still regarded as authoritative. Another most exhaustive paper on " Antero-Lateral Sclerosis," read before the Pennsylvania Medical Society, and extensively published, was valuable to the profession not only as the result of his own observation- and practice, but as a complete summary of all that had been discovered by the most eminent physicians in France and Germany, whose original notes and papers Dr. Fleming, by great personal exertion and at considerable pecuniary cost, had secured. In his brochure on " Emotional Fever" (1879), the clinical description was so clear and precise that the disease could be readily recognized, although its manifestation was in the narrow borderland separating purely physical disease from mental alienation. To the Bedford Club-composed of the best physi- cians of Pittsburgh and Allegheny-he contributed about forty papers, highly esteemed by his associates. They were prepared with the utmost care, always conveyed original information with a precision of statement and an accuracy of detail that indicated a complete knowledge and mastery of his subject. His fellow members of that club say that his remarks and criticisms on the papers of others were characterized by a gentle, courteous spirit of generous commendation where deserved, but marked by a correctness of statement and a clearing away of the difficulties of the question under discussion, while at the same time avoid- ing any disputation or any remarks having the slightest tinge of acrimony or personal feeling. One of the oldest members thus writes : " I think every member was indebted to Dr. Fleming, not a little, for the light and wider field that his prelections secured for us, by their accurate survey and observation." A marked trait in his conduct, not only with his conferees, 14 but patients, and every one with whom he came in contact, was his unfailing and uniform courtesy. In his intercourse with the members of the medical profession he manifested a delicate sense of the relations existing between those whose sole aim was the good of humanity. His quick perception and cordial recogni- tion of ability and merit in those younger in years, and not so skillful or experienced as himself, was prompt and genuine. Such expressions of approval were the more valued because he was naturally reserved and reticent, never speaking a word of praise unless he felt that it was deserved. Early in the war, in 1861, a Soldiers' Home was opened near the Union station, in Pittsburgh, by the Subsistence Committee, to care especially for the multitudes of sick and wounded soldiers on their homeward journey. Dr. Fleming was at this Home, on the arrival of the trains, every noon and every mid- night, dressing the wounds of the sufferers and prescribing medi- cine for the sick. As the number of soldiers needing attention was from twenty-five to one hundred each noon and midnight, these merciful ministrations took from one to three hours of his valuable time, but during the four years of the war he rarely failed to make the two daily visits. Aside and apart from all that made Dr. Fleming an ideal physician, there was the other phase of life and character more difficult to portray, because it was so personal and distinctive in all its traits. Indeed, his own conception of what was required for the profession was so high, broad and all-embracing, that he was constantly striving to attain a complete knowledge of all related science. In every department of scientific research-be it archaeology, astronomy, biology, botany, zoology, any branch of physics, the main principles, the latest discoveries and the present status of each, were so accurately stored in his wonderful memory that they were immediately available. Eminently practical as he was, he cultivated a love of the beautiful in art, and had a thorough acquaintance with the best pictures and statues in the European collections. A perfect rendition of the masterpieces of music was to him a source of the keenest pleasure. 15 Few,, even of his intimate friends, had any true idea of the lavish generosity that marked his daily life. Not only did he give freely of his rich stores of medical skill, but his open purse provided for the wants of those in need. Often his benefactions were so secretly and delicately conveyed that the recipients knew not the source of the gifts. His reticence and reserve regarding anything relating to him- self were so great-his repugnance to the mere mention of his name in the public prints was so strong-his hatred of what he considered an intrusion upon the privacy of his personal life was so marked-that the rich, rare and varied qualities so constantly manifested in his daily life are matters too sacred for public record. So suddenly came his death, that the many who knew and loved him could not realize that the kind friend and " the beloved physician " had passed from his labors and entered upon that blessed rest which follows a life of beneficence and love. 16