NATIONAL LIBRARY OF MEDICINE Washington Founded 1836 U. S. Department of Health, Education, and Welfare Public Health Service THE ETHICS $ $tbiit*t |$**5itftt. HK&d Z>.% READ BEFORE THE SACRAMENTO SOCIETY FOR MEDICAL IMPROVEMENT. •ati\Vv v ■'fi.'-aioin^' BY JOSKI'H F. .MONTGOMERY, M.I>. SAN FRANCISCO : JOHN H. CARMANY & CO., PRINTERS, 409 WASHINGTON STREET, 1871. THE ETHICS OF THE MEDICAL PROFESSION. Medicine, or the healing art, or the medical profession, however we may term it, regarded in its most liberal and comprehensive significance, whether contemplated as it pre- sented itself in its feeblest infancy when human pain first demanded and human sympathy first administered relief, or as we see it in its present ample proportions, embracing the science and the art, or the principles and practice, of its various departments, has ever been recognized by all peo- ple, whether civilized or savage, in all ages of the world, as an agency of the highest importance to the human race, as evinced by their actions, whether their belief were founded in reason or superstition; and, as its votaries at the present day, it behooves us to consider well how best to enlarge and perfect its usefulness, to exalt its dignity and aniplify its power, that of a truth we may enforce a more decided and generous recognition of its worth, and thereby multiply our opportunities aud increase our ability to do good, each in his day and generation, according to his capacity. ^ Commencing, as intimated, with the origin of man, As far as we can learn from the traditional history or the dim 4 records of the past, obscured by fable and mythology, or as related in the pages of the sacred Scriptures, we find it was earliest practiced by heads of families, of tribes, and of nations; and then chiefly by priests, who were deified in the popular mind, and who resorted to divinations and in- cantations, as best calculated to inspire confidence, by oper- ating upon the superstitious imagination of those upon whom they exercised their influence. In succeeding cent- uries the art was pursued also by those whose origin was regarded as doubtful or enshrouded in mystery, and who claimed to be possessed of preternatural powers, or of sacred and exclusive knowledge derived from the gods; among such being aEsculapius and his pretended descendants, and their followers and ministers, the Asclepiacles. These col- lected in their temples, from observation and experience, materials and facts that were subsequently made useful. Until a recent period, facts regarding the ancient history of medicine have been sought for only in the classical authors of Greece and Rome; but late investigations show satisfactorily that to the Hindoos probably belongs the honor of producing the first systematic works on medicine, dating back to from the fifth to the ninth or tenth century before Christ. Those works give evidence of considerable medi- cal information at that early day, exceeding that then pos- sessed by any other people. This knowledge of remote Asiatic antiquity is derived mainly from the sacred books of India, as we are informed by late writings of several distinguished Europeai^authors. Egypt first profited by this Eastern learning, and subse- quently, Greece and Rome. Moderns have supposed that with some hints from the Egyptians, the Grecians were the originators of the medical science and art in Europe. A more extended knowledge of history, as mentioned, shows this not to be correct, their own most ancient records prov- ing that they obtained much of their knowledge from a mysterious nation in the East, which was very probably the Hindoo, among whom the arts and sciences were success- 5 fully cultivated, and whose great progress in medicine attracted attention, and was communicated through the Egyptian priesthood to the philosophers of Greece. With the assistance iu general literature thus obtained, the Greeks arrived at the most elevated period of their history. It was at this enlightened age that medicine assumed most certainly the form of a science, under the genius of Hippocrates, born 4'0 b. c, who has been styled the '■•Fa- ther of Medicine.'' He, like the mythical heroes of an- tiquity, was regarded—by the ignorant, at least—as descend- ed from gods and princes ; owing to which hypothesis, they explained the extent of his improvements and the accuracy of his supposed productions. But the value of his labors may be explained more rationally. Medicine was then, and for some time immediately antecedent thereto, more than ever before, appreciated as a science of the greatest importance to man, and facts concerning it were then ac- cumulated by the thoughtful priest, the observant physi- cian, and the skillful surgeon, who left to their successors their legacy of thought and skill. These were the sources of the knowledge that immortalized Hippocrates. Medi- cine was first cultivated in Greece by a succession of able men, placed in favorable circumstances for accumulating knowledge, assisted materially by physicians of other na- tions. Such an accumulation of facts enabled them to arrive at principles, which were systematized by Hippoc- rates and formed into text-books for the Western world. Thus, to the recorded experience of his predecessors in all accessible countries, he added the knowledge acquired dur- ing a long life of study and observation, at home and abroad; and, by condensing experience and generalizing facts, to suit the people and country, he attained great credit as an original author. Yet medicine made but little progress for many centu- ries following, owing much to the speculative, theorizing character given to it by its successive teachers and practi- tioners. Indeed, forgetting or disregarding the doctrines of 6 the reputed founder of the science, as laid down in his various works, the theories and the practice promulgated through an extended lapse of time were of the most ab- surd and irrational character, even among those esteemed the most enlightened nations of the earth, as the Egyptians, Greeks, and Romans, already alluded to. Even Galen, in the second century before the Christian era, a pupil of the Alexandrian school, who paid more heed than others to the doctrines of Hippocrates, which were founded upon facts derived from observation and experience, and who, by his learning, industry, and talents, contributed much to the records of medicine, was j-et too much imbued with the speculative spirit of the age to accomplish the good he might otherwise have achieved. As it was, his doctrines, though founded simply in reasoning, and that radically erroneous, were comparatively absolute for fourteen centu- ries ; those who followed him servilely adopting his teach- ings as true, without daring to investigate or think for themselves, or to question the authority of their master. During a part of this time, extending from about the year 620 a.d. to the end of the fourteenth century, the Arabs, under the influence of Islamism, became powerful and made extensive conquests, including therein India, S3*ria, Egypt, Spain, and Persia. In the last-named country the JSTestorians dwelling there, possessing a knowledge of Gre- cian and Roman literature, had founded schools; and there, and elsewhere, under the power of the Arabs, learning, including medicine, was fostered and preserved during the Middle Ages. Thus, through them, a link was established and maintained, but for which much of the ancient knowl- edge we now possess would have been lost. Their instruc- tion, example, and labors hastened much the revival of let- ters in the West. Early in the fifteenth century the art of printing was dis- covered, and that, added to other causes, contributed to a general awakening of the human mind, after long ages of torpor, and a taste for books, libraries, and sound erucli- 7 tion was rapidly diffused throughout Europe. At the begin- ning of this period the Arabic literature was still predom- inant in the schools of medicine, and the only authorities then invoked and explained were Rhazes and Avicenna. But the monuments of Greek and Latin antiquity were soon hunted up and published, and letters became fully revived. During the two succeeding centuries the separa- tion of medicine from the priesthood was effected, celibacy ceased to be obligatory on physicians, and they no longer obtained ecclesiastic benefices; surgery was reunited to medicine ; schools, hospitals, and dispensaries followed the upward march, and governments turned more of their so- licitude to the regulation of medical police and hygiene, and then commenced a notable amelioration in the sanitary condition of the people. This sketch is presented to show the indispensable need of the Profession to the human race, and to prove its vital- ity and indestructibility under the most adverse circum- stances, where society has any existence—to show that where man is there must be also in some form, or to some degree, the healing art; for, in the darkest period of the world's history, when barbarism and vandalism swept over the best portions of the earth, demolishing governments and dynasties, and destroying libraries and temples, and every thing sacred and beautiful and pure, as though they would blot out the last vestige of literature and learning, even then medicine survived, and quickly enforced the regard and patronage of the rulers of the rude races who had themselves wrought the deplorable destruction. And when, at last, man recovered his reason, and civilization and learning revived and advanced apace, medicine was ready for the bound, and thence made steady and enduring progress in the road to greater perfection. During the two succeeding centuries — the seventeenth and eighteenth—still further advances were made in the science, and its various departments were established and given specific form. Some of the most noticeable discov- 8 eries in the.century are, the circulation of the blood, iu 1628; the virtues of cinchona, in 1638; the lymphatic sys- tem, in 1647, and the true nature of respiration, in 1668. Steady and striking progress was made in the several depart- ments in the eighteenth century, but we have no time to allude to them, except to the discovery of vaccination, as published to the world in 1798. Xor is the nineteenth century behind, if it be not in advance of, any of its predecessors, in its solid additions to the science and the art of our noble vocation. It is dis- tinguished for many discoveries, foremost among which is the anesthetic, that so effectually shields against pain as to divest operative surgery of its terrors, and next, chloral, the new remedy that promises, with due caution and discrimi- nation in its use, great benefits to the race, as an agent whose special action on the nervous system tends to induce sleep when much needed, and to allay and arrest that fear- ful class of diseases attended with spasms or convulsions, especially eclampsia gravidarum and tetanus, and which, hitherto, have often, if not generally, defied all means at our command. But the most striking feature in the contributions to the science in this century is the extent and variety of the means devised and employed to insure a clearer diagnosis of the multitudinous disorders of the human system. First among these we will place the methods or means designed to develop or convey the physical signs of disease, as men- suration, palpation, percussion, succussion, and auscultation; and then the implements that serve as aids in the same direction, as the thermometer, the specula for the several outlets, the sounds, the ophthalmoscope, the laryngoscope, and the microscope. Then, again, the beautiful instru- ments, of wonderful contrivance and mechanism, that have been added to the case of the surgeon, to enhance much his ability to employ his skill with gratifying success. And yet again, the augmented facilities for acquiring a thorough knowledge of the Profession, as afforded in the munificent 9 increase and diversification of the means for imparting in- struction in the schools. The advancement and the achieve- ments of the Profession have been striking and grand in- deed, and we should all much the more, in consequence, love and honor it, and be proud of our affiliation with it. But in view of all this, in the midst of these congratula- tions, we fear an important constituent or adjunct of our honored calling has been too much overlooked or slighted. We mean, as you may anticipate, the Ethics of the Profes- sion, without which, all else is comparatively "as sounding brass or a tinkling cymbal." It is to the Profession as the vital spark to the previously inanimate body; for, as the perfect physical or material man, formed after God's own image, was as any.inert, worthless matter, until the breath of life had been breathed into him, so the medical profes- sion— it matters not what may be its genius, its learning, its science, its splendid achievements — will lack true dig- nity and power, the charm to animate and delight its fol- lowers, the grateful, soothing assurances of mutual good- will to cheer and sustain its members in their trying work, unless there exist and be diffused among them, the genuine esprit de corps of a confiding, undoubting, harmonious broth- erhood, composed of high-toned gentlemen, scrupulously governed in all their conduct by the purest principles of morality and honor. We have a comprehensive and admirable Code of Ethics, the offspring of the American Medical Association, that does it credit, apparently providing for every relation, con- tingency, and occasion, as relates to the Profession and the public, and which, if fully obeyed, it would seem, should accomplish all aimed at in its preparation, and should for- bid and provide against all cause for serious discord or strife or enmities among our members; but how far it has fallen short in fulfilling its laudable design is made sadly manifest all over the land. In every city, town, and village in the country there are lamentable instances of unpleasant rivalries between physicians, leading to disturbances vary- 10 ing in degree from formal coolness, instead of cordiality, to bickerings, mutual detraction, and open rupture, highly dis- creditable to the parties immediately involved in them, while they soil the reputation and impair the usefulness of the Profession generally. Why is this ? and how shall it be remedied? are important questions that should awaken inquiry, and employ the talents of the best men in the Pro- fession to devise means to remove the disgrace and repair the damage shared, more or less, by all its members. It may be safely assumed that the fundamental cause of this trouble is, in the main, the innate selfishness of man, which leads him, too often, to resort to many questionable, if not disreputable, expedients to subserve his own interest, without duly regarding the feelings or the rights of his professional brother. Such a selfish and mercenary dispo- sition may tempt him to make a display of diplomas; to advertise himself in the secular press, either in pretentious cards, or in notices of his connection with cases arising out of accidents, or with others of unusual local interest, par- ticularly those involving operations; to court the rich or the distinguished to secure their recognition and favor, while adroitly turning the poor over to his more conscien- tious fellows; by exacting notoriety by fast driving with a showy turn-out; to allude, on occasions deemed auspicious, to his successes, while, possibly, adverting to the misfortunes or maladroitness of his rivals; to employ, or encourage, or allow, agents or too partial friends to sound his praises among the patients and patrons of others and encourage them to summon him in their place, instead of defending his brother and sternly refusing to supplant him ; to indi- cate by a shrug, a frown, or a word that his predecessor or competitor had erred; to agree to a fee-bill and then un- warrantably disregard its conditions, or to arrange with apothecaries for percentages on prescriptions, or with oth- ers, particularly with associations or corporations, to share the benefits of their business by mutual encouragement and aid. Then, the same spirit or disposition leads to the 11 rormation of cliques, rings, or factions, who league or co- operate together for mutual benefit, to the exclusion, mainly, of all others. And, further still, the same craving spirit has led some to so far forget their true dignity and a just regard for the honor of their profession, as to consult with irregulars or homeopathists, simply to put money in their purse, thus, to their shame, yielding to the promptings of a sordid and debasing desire. These, and many other like deviations from the true line of professional propriety aud duty, necessarily—inevitably, indeed—tend to the unpleasant condition of things we de- plore ; for, to insure general good feeling and harmony, a catholic and unselfish spirit must prevail, and reciprocal courtesies and impartial fairness must be extended alike to all. The aim should be assimilation and homogeneity in the ranks, as far as practicable ; that while the most gifted shall not be depressed, the less favored may be assisted and urged upward to a higher grade of excellence. The only legitimate hope for success or aspiration for distinction, rests upon a thorough knowledge of the Pro- fession and an active, vigilant, considerate, and faithful performance of its responsible and delicate duties. The arts of the shopkeeper or the charlatan to acquire pelf, should be despised and spurned, and any who could be so base as to resort to means so degrading, should find neither favor nor recognition with honorable members. Xo one should seek or desire an advantage of another, but, on the contrary, he should scorn to profit by any injustice done his fellow by the public. Physicians should stand by and de- fend each other in every thing that is reasonable and just, and, above all, they should determinedly oppose the brutal custom of dismissing one medical man, while in charge of a case, and employing another in his stead. This often perpetrates a wrong that nothing can atone for, in the wounds inflicted upon the feelings of sensitive and honora- ble gentlemen that the vulgar can have no conception of. Each should defend and sustain his brother under such cir- 12 cumstances, and insist upon consultation in lieu of dis- missal. The public must be made to respect the Profession, and to do justice to every individual member of it, or else no one knows how soon he may be the victim, of detraction and ostracism. We would hope that the harsh indictment herein presented, or the unsightly picture drawn of the vicious conduct and unseemly short-comings of some, is suited to but few comparatively ; yet, still, those few may be sufficient, unhappily, to disturb the harmony of the en- tire body. The remedy for the evils complained of must lie chiefly with the ruling spirits, the master-minds of the Profession, the professors and teachers, and those whose purity of char- acter and distinguished talents and attainments, as well as their great labors and successes in practice, command for them universal respect, and give them vast influence among their fellows. All these, we humbly submit, should, for the honor of our calling, earnestly direct their best efforts to correct the vicious state of things unfortunately exist- ing, and which we have endeavored, though feebly and im- perfectly, to present and detail in this paper. The reform must beaan in the schools, and be rigidly enforced in every community by those of our number who have a just appre- ciation of the sacredness and dignity of our mission, and of its high importance to the welfare of our fellow-men, until our name shall have been completely divested of the cruel reproach now resting upon it. The more surely and thoroughly to effect this, a ('hair of Ethics should be added to all medical schools, where the true principles that should ever actuate a gentleman in every position of life, particularly in his confidential and sacred character of physician, should be so continually and forcibly impressed upon the mind, presented in every form applicable to the many conditions and circumstances liable to arise in the multifarious and delicate relations he must sustain in the discharge of his duties, that he could not well be at fault, or do aught unworthy his high office. 13 It may be contended that the reformation proposed is impracticable, and, therefore, should not be undertaken — that it presupposes a capacity for perfection in man at vari- ance with nature, and, consequently, that the improvement and elevation suggested are not attainable; but we can perceive nothing in this view that should discourage the aim at greater perfection than that now existing. Great advances have been and are continually and steadily being- made in medicine as a science, and its morale also has lready much improved, although, in both respects, we will concede, it falls far short of what it may become under the persevering labors of its zealous disciples. We should be encouraged, therefore, to give the Ethics of the Profession greater consideration and more prominence, realizing that it has hitherto been too much neglected in the earnest search after strictly scientific truth, or the eager pursuit of sordid gain. While we may not be able to make gentle- men and blameless and honorable men of all who may enter the ranks of the Profession, we maintain that the plan or course indicated must needs result in much good, and virtually accomplish the grand consummation we so ardently crave and hope for. But few young men, however unfavorable or unpropitious may have been their early asso- ciations and training, taken through the ordeal proposed — taught by men of great learning, exalted character, and refined tastes; brought in daily contact and intimate asso- ciation with a body collected mainly from amongst the best youths in the country, and breathing, as it were, an atmos- phere pervaded by every manly and ennobling sentiment— could well fail to be rendered worthy disciples of a Profes- sion, even as noble and honorable as we could hope ours to become in the improved character contemplated. All would be taught to regard it as a Profession, and not a trade; and so refining and elevating would be their instruction that few, if any, could do aught to cast a sliadow or affix a stain upon it. And, then, in all places, where even a few members could congregate, societies would be formed, the 14 code would be strictly enforced, and if any member could be so base, after enjoying such advantages, as to violate its obligations, he would be expelled from their association, and branded before the world as one unworthy the recogni- tion of his fellows, or the respect and confidence of the public. If we attempt so much, we will surely accomplish strik- ing and enduring good, even if we do fall short of our high- est aims. m* ?•(£« C\i THE ETHICS I ijjui READ BEFORE THE SACRAMENTO SOCIETY FOR MEDICAL IMPROVEMENT. BY JOSKPIl 1-'. MONTaOMEKY. M.D. SAN FRANCISCO: IOIIN H. CARMANV & Co.. PRINTERS, 409 WASHINGTON STREET 1 87 1. V2> y Med. Hlit. VJ2L X70 1271 vl,:.-. 4*a F^l m *s> '-vvWhIIJI