' --abtdr'ess DELIVKRED BEFORE THE MEDICAL SOCIETY OF VIRGINIA. THIRTIETH ANNUAL MEETING Held in Richmond in April 1853. l/ / BY JAMES BEALE, M.'.D. PUBLISHED BY ORDER.OF THE SOCIETY. Jo ^3 !Uf.l)mcrriuV m. PRINTED BY RITCHIES &. DUNNAVANT. 1853. ADDRESS. Gentlemen, In the year 1823, the medical men of Virginia seem first to have been awakened to the necessity of an or- ganization which would give to their labors a more extended usefulness, and, by a concert of action, confer upon them an influence, which, singly, they were unable to exert. Accordingly, in that year a charter was granted by the ge- i neral assembly of Virginia to certain individuals and their successors, with powers and privileges set forth in their act of incorporation. The names of the pioneers in this noble cause, as recorded, are: Wm. Foushee, senior, George Cabell, George Watson, James Henderson, John Hays, Micajah Clark, Thomas Nel- son, William A. Patteson, James Blair, William H. Herring, James Warrall, John Adams, Lewis W. Chamberlayne, Ro- bert H. Cabell, R. A. Carrington, John Dove, Branch T. Archer, Wm. Tazewell, Nath'l Nelson, Ed. H. Carmichael, R. L. Bohannan, Philip Augustus Klipstine and William R. McCaw. This act constituted them, by the terms of their charter, " The Medical Society of Virginia." By far the larger number of these have gone to that bourne whence no traveler returns. But their memories are impe- rishably connected with the rise, the progress and the future history of the institution of which they were the founders. Nor is there one among them, who was or is not among the foremost in the ranks of the profession. Each one of those who are gone from among us, illustrated a life. Among the survivors there is not one who does not con- tinue to exercise all those virtues characteristic of the true de- votee to the noble art which we profess. 4 The powers and privileges granted to them by the act of in- corporation it is unnessary to recapitulate here. That instrument is within the reach of every one, and may be easily understood. Suffice it to say, that they are very large, conferring the widest liberty that could be claimed by men desirous as were these, in the language of their preamble, for the advancement of medical knowledge throughout the state of Virginia. The society was duly organized under the charter, pro- ceeded in its work, and among the first evidences of its prac- tical value, published a volume still extant, containing contri- butions from several, perhaps most of its members, upr n in- teresting medical topics. From various causes, however, it soon began to languish, and for many years was dormant. About ten years ago, an effort was made to revive it, and to render it what it was intended by its founders to be, practi- cally useful. Those who sought to revive it were animated by the same motives which prompted its founders: their objects and aims were the same. Correspondence was opened with every section of the state ; and after repeated effi>rts, an annual meeting brought here, as the central point, delegates from auxiliary societies in almost every portion of our commonwealth. These efforts have been attended with signal success; for there is scarcely a county or town in the state in which there does not exist a branch, based on the plan of the parent so- ciety, and with the same objects and aims. Much however remains to be done. All agree as to the ne- cessity of concerted and enlightened action. Each one is ready to enter the list and to contribute his aid to the con- summation of the desirable objects which we seek to attain, were the means pointed out to him. I said that the same motive*, which actuated the prime movers in this cause, had influenced those who sought to revive it. What are those motives? « 5 We declare them to be: the advancement of medical sci- ence throughout the state; the elevation of the standard of medical education, and, by our efforts, as a corollary from our position as teachers, to protect the public, by all proper means, against quackery and imposition. The first of these has been, or will be, effected by carrying out the terms of the charter; by a more perfect medical organi- zation ; and by the interchange of sentiment and opinion, as well as the extension of social intercourse among; the mem- bers of the profession. Much good has been effected too by the establishment of a journal in our midst; and should the plan recommended here to day (of making that or some other journal the property of l the society) be adopted, it will, in my humble judgment, still farther increase, not only the usefulness of the publication, but, as well, the influence of the society. The second of these grand objects has been sought to be accomplished by the institution of primary boards of examina- tion, designed to subject the candidate for study to an exami- nation before entering into the office of a private practitioner, and by that mode to test his capabilities for entering upon the study of our difficult and laborious profession. This plan originated, I believe, in the state of New York, with what success I am unable to say. It is, however, I think, the most equitable yet devised ; for although a licentiate board of examiners would constitute a most valuable feature in the economy of our administration* yet, while aimed at the correction of abuses in the schools, in their terms of study, &c, its manifest operation is indirectly upon them, but directly upon the unfortunate wight who may be deemed unworthy of a license. Each private practitioner should compose his own board, and have independence enough to declare to any applicant for study in his office, his belief of his unfitness for such a pursuit. For it is certain, that if candidates for the doctorate are found to be unqualified when their examination for diplomatic ho- nors arrive, or at any future period, a great share of the blame 6 incident to it, should lie at the door of the practitioner in whose office his course of study was commenced. The establishment of a state board of examiners, as one means of elevating the standard of medical education, has claimed a large share of the attention of the society ; and while the necessity for reform is felt from one end of the Union to the other, and different plans are suggested in the different states of the confederacy, we deem this to suit our case the best. With us it is a necessity arising from the con- dition of things in the profession, from the defective mode of licensing authorized by the law of the state—and the feeling entertained by the profession that they are better judges of the competency of their confreres than a sheriff, however intelli- gent, can possibly be. In truth, it is but changing the persons who are to constitute the board ; since at present the sheriff is, ex officio, in fact the examining board, and finds pathological, surgical and obstet- rical knowledge embodied in a five or ten dollar bill, lawful money of Virginia. I trust I may be excused for reverting to this portion of the subject at all: the able manner in which it was discussed by our late president, has left me nothing to say in regard to it. The last object which we profess—the protection of the public against quackery and imposture—is perhaps the most difficult to be attained; for while the right sense of the pro- fession, alive as it is to the matter, may accomplish the former, indeed it is an evil which to some extent will correct itself, as all crying evils generally do. This one is so insidious, and so protean in its character, that you can scarcely seize it. And first, as to quacks. A quack is defined to be " a vain, boastful pretender to any science or art, which he does not understand, particularly medicine; an irregular, tricking prac- titioner in medicine." The code of ethics, adopted by the American Medical Association, lays down the rule of action for the physician, not only in his intercourse with his professional brethren, but also with the public. Those who do not choose to follow it are re- 7 sponsible to their own sense of right for the violation of a plain rule of duty, and are amenable to no other tribunal. Those who abide by it, find their reward in the approbation of their own conscience and that of their brethren. "I owe," says the late Mr. Ryan of Dublin, " my success in life, not so much to any talent I may have possessed, as to the fact, that throughout my professional career, I have not only scrupulously avoided any infringement of the rights of others, but have faithfully respected those of the humblest members of the profession." This, let it be recollected, in a land where there is no writ- ten law, indeed no law, save that inherent in the mind of every liberal and enlightened man. Our own constitution prescribes, for the qualifications which entitle to membership, as follow: " The candidate shall have received from some public school, society, college or univer- sity, legally authorized, a degree of bachelor, or doctor of medicine, or surgery, or diploma, or other certificate, evidenc- ing his capacity to practice medicine or surgery." Now while we do not pretend to wage war upon any species of pathy whatever, we have the undoubted right to prescribe our own rule of right, and to exclude from among us those who do not come up to its requirements. They, therefore, cannot com- plain. According to our code, a quack is one who professes to practice on any other principles than those which the accumu- lated experience of the profession has recognized as their land- marks. Any one who procures himself to be distinguished as re- markable for curing any particular class of diseases, or by means different from the known and recognized principles of medicine and surgery, is, ergo, a quack, and deserves to be treated accordingly. It is a stale trick of him, who is deemed unworthy to enter into fellowship with his professional brethren, to enlist the sym- pathies of the laity in his behalf. The cry of persecution is at once set up. The unfortunate 8 individual is discovered to possess talents which he himself never dreamed of before, and the sympathizing public, who always regard the summum jus as summa injuria, straightway erect themselves into judges of a matter of which they are profoundly ignorant, and of which it is almost impossible for them to ascertain. A false issue is set up, and that which is a measure often of most painful necessity, is attributed to sordid motives : either to the desire of pecuniary gain, or the fear of being out-shone by this new light. Well, we have but to say to the public, that we are the best possible judges of our own affairs; that by no possibility can medical men, as a body, be driven to the perpetration of a gross wrong, or the neglect of a known duty; and this lesson can only be inculcated by presenting on this, and all kindred subjects, an undivided front. Let each one feel that on him individually rests the honor and interests of the whole; let him fearlessly exercise the right of conserving the sacred trust confided to him, and of carry- ing out to the fullest extent all that the common weal requires at his hands. If some lawless professional Ishmaelite rushes into the arena, making war upon his brethren, they have no other re- course but to cast him from the bosoKi of their society. This is but the formal expression of what the community of pro- fessional men deem wisest and most just for the general welfare. It has no prison-houses in which to incarcerate him ; no court in which to try him ; no power to place him in duress; no funds to pay for his lengthened detention there. If a vio- lation of ethical rule be committed, the community aggrieved have the right to protect themselves, and this they can only do by inflicting that punishment which the common suffrage has declared to be just. They are the only judges to which the offence can be referred, and they have the perfect right, when the fact of guilt is established, to proceed at once to the execution of their sentence. 9 For many popular errors, are not physicians themselves re- sponsible? There is no class of men whose sayings are so carefully treasured up for future reference as the physicians'. There is no class which should so carefully avoid the expres- sion of opinions which become axioms for the uneducated, and which are sometimes quoted not only against themselves, when they would fain correct an error, but continue long after they have ceased to exist. An example of this I will mention here, as it is somewhat remarkable. It was related to me by a gentleman of high standing, as coming within his own knowledge. A certain professor in one of our oldest universities, among other evidences of a proclivity to good cheer, was immode- rately fond of pheasants. During a winter of universal se- verity these birds were found to be scarce, and consequently dear. Our bon vivant, finding the market supply not equal to his demand for them, drops into the daily papers a paragraph warning the public against eating them, as their flesh was apt to be poisoned by the " unusual food which the rigor of the winter compelled them to seek." The pheasant lovers left him a clear field, and the wily doctor got them in abundance, and at his own price. But now mark the effect. This oc- curred in a remote state, yet the opinion obtained in Virginia not many years ago; and to this day, in the state of New York, where they abound, though the author of the fraud has been dead for thirty years, they are rarely eaten until, after being subjected to careful examination and various culinary tests, their flesh is pronounced to possess nothing deleterious. Can human credulity go farther ? Yes. For the instances are not uncommon in which the most extraordinary feats are attributed to medical science—such, for example, as taking a man's liver out, washing or scraping it, and restoring it to its place—in the hearing to» of the individual to whom the per- formance of these magical dexterities is ascribed, uncontra- dicted by him or his friends. Here, without direct assertion, a physician is accessory to a fraud. He purchases reputation by a suppressio veri, and is therefore as much a quack as is 2 10 any mountebank who professes to draw teeth without coming within arm's length of the patient. " Time was, that when the brains were out, a man would die." But now, could the sturdy thane, who made this exclamation, arise to witness the triumphs of modern quack surgery, he would become con- vinced of the fallacy of his judgment in that respect. There are cases, to be sure, in which the patient gets well in spite of the disease, (I did not say doctor,) where, perhaps, one is not bound to diminish the patient's gratitude by a frank exposition of the truth. But here the praise is well earned by the untiring devotion to the case, the anxious hours spent by the bed-side of the sufferer, when all other feelings seem to be merged in the deep regard which is experienced in his welfare. This is what gratitude alone can repay—money cannot. The cases are so rare, however, in which even this unsub- stantial return is freely made, that they are indeed green spots in the desert of professional life. But enough of this. So much for the quack homo. But it is yet more difficult to deal with its inanimate manifestations. Utterly Protean, you no sooner demolish it in one form than it assails you in another. Like the hydra—strike off one of its heads, another stares you in the face. Destroy it in the form of pill, it springs up in the form of liniment. The liniment is put down by common consent, when, phcenix like, up rises an all-healing salve. It says, "I will arise," and verily it does. Plato's system of phantoms must have been typical of this many-headed mon- ster. The eye, and the taste too, as well as some other senses, are gratified by the exhibition of the various forms of beauty under which the favorite nostrum of the hour is exhibited. A painter like Fuseli might borrow from the shop-windows of our apothecaries hints for many a devilish design. The ear only remains unregaled in this delicious olla. But nil desperandum. We may yet have our musical tastes gratified by some artistic combination of herbs and minerals. Possibly, ere long, 11 every accomplished lady may find, in an attachment to her piano, the ready remedy for the relief of pain, and for the cure of the gravest maladies, while those of less cultivated tastes may discover it transferred from their own imaginations, where it now exists, to some ordinary object of household luxury. Even a greater curse than the annual utterance of remedies in the various forms of pill, bolus, &c, with which the country is flooded, is the influence exercised by itinerant swindlers, each one of whom is a soi disant professor. These gentry travel over the country, disseminating their smatterings in every direction, and manage, under the specious plea of pure philanthropy, to poison the understandings and pick the pockets of those who are credulous enough to attend their so called lec- tures. They ask no compensation, they seek no gain, they lavish their precious teachings without money and without price. In the end, however, they manage to secure booty in the shape of tributes to merit, presented by a committee of ladies. In some cases, though they refuse pecuniary remuneration for their valuable services, they are the sole patentees and in- ventors of an abdominal supporter, or some other equally useful commodity, which they are willing to part with for a consideration, say ordinarily three times the price that one recommended by an intelligent physician would cost. Now, if people are duped they don't like to acknowledge it. Straightway every lady discovers that, somehow or other, the professor has got a desideratum, and buys one, to be pre- served as a relic of the last false prophet! Like the followers of Mokanna, they can see nothing in the unveiled hideousness of their prophet but traits of benignity and self-sacrificing kindness. Instead of feeling like Desde- mona's friend, that every woman's hand should be armed with a whip to lash such rascals naked through the world, even when he says to them, as has been done in one instance, " There, ye wise saints, behold your light and star, Ye would be dupes and victims, and ye are"— their faith remains unshaken. 12 Now, is there no help for this? Are there no arms by which we can combat this many-headed monster? There are annually graduated in the various schools in the United States from ten to twelve hundred young men. In many cases these young gentlemen, invested with the honors of the doctorate, are not overburdened with this world's gear. They crowd into cities where living is expensive, and they there seek professional employment. They come into a field already occupied by older, perhaps not abler men. Many of them expend much of their means in waiting for practice, as it is termed. What wonder, if sick at heart, with hope de- ferred, and pressed by the res angusta domi, they become dis- satisfied with their condition, and seek to better their fortunes. There are, to be sure, some other pursuits in which they might profitably engage, but that dearly bought diploma, and the title of doctor, they are unwilling to part with. Failing to succeed in regular practice, they embrace any " pathy" that happens to be in vogue. So your " regular" doctor is transformed into an " irregular," and has so much the better chance of success, that he is triumphantly held up by a discerning public as a rare example of a convert from error. Now, employ the talents of these young men, if they have any. While they are waiting for practice, encourage them to become missionaries in the holy cause of instructing the popu- lar mind on the subject of medicine. I do not expect to make doctors of people generally : we do not wish it; but in propor- tion as you teach the ignorant to admire, then will you teach them to distinguish the false from the real. If our men are to be taught to keep their hair from falling off, and their brains from being addled, let the information be imparted by a gentleman and a scholar. If our women are to be inducted into the mysteries of the toilet, and told, by arithmetical calculation, how many jupons they shall wear, and of what fabric, let it be done by one who enjoys the confidence of the community in which he lives, and who, being a part and portion of society, will not abuse its in- dulgence. 13 Ought we to do this? Are we not pledged, by the third condition of our existence as a society, to protect the public against imposture'; and if it be true, in the words of a cele- brated moralist, that " he who can drive a nail straight is guilty of a moral dereliction, if he allow his neighbor to drive it crooked," does it not become a solemn obligation ? Teach the ignorant: whatever we mean for the public eye, we mean for the public good. It is the duty of the poet, the dramatist, the artist, the mu- sician, to portray human suffering, passion and vicissitude, and to show them in their true colors. It is theirs to show the beauty of truth, the sublimity of devotion, the dignity of fortitude, the grandeur of forgiveness—it is ours to exhibit to the world the blessedness of holy charity. Teach the igno- rant ; for it is a charity greater than that which giveth bread to the poor. Send forth your young men, with your pa- tronage and your influence—make them soldiers of an idea— let them devote themselves to make a theory a fact—let them, as scientific lecturers, instead of stooping to the common mind, lift it up to their level—let them teach the ignorant, until they enable them to perceive the great truths of harmony, of order, of adaptation, of development—all that the works of creation reveals, and that revelation explains and simplifies—show them God speaking in his own works, and deigning to be in- terpreted by their lips. If they cannot find diseases to cure, let them try to prevent them. Ventilation, diet, apparel, drainage—all are correla- tives of our art, and deserve especial care. Thousands die annually from want of due regard to these essentials of healthful existence—and we fulfill a duty in inculcating hygienic rule, which in no other manner can so profitably be done, as by public lectures on the subject, de- livered by persons recognized as competent by the highest authority. It is true that the cheap novel and the penny theatre have rivaled each other in ridiculing pretensions like these, as they do all other things, whose tendency is to elevate. The po- 14 lished wit has done the same—for D'Alembut defines a doctor to be a blind man, striking at random with a club. If he happen to hit the disease, he saves the patient, but if he hit the patient a good blow, he kills him. Voltaire deals in pretty nearly the same strain of sarcasm. Bitter enough. But the man who could afford to die without the consola- tions of religion, might very well dispense with the services of a physician. He who could face death, mocking the pro- mises of peace, might well deride what he understood full as little. In spite of all this, the name of the humble dairy- man who first discovered the vaccine pustule in the ud- der of his cow, or of the immortal Jenner who propagated it, will be remembered, when all the infidel essayists who made " France drunk with blood that she might vomit crime," are consigned to merited oblivion. Some six or seven years ago, I had the honor of presenting to the Medical Society of Virginia a resolution appointing a committee to draft a plan for the creation of a fund for the relief of decayed physicians, their widows and orphans. A committee was raised in consequence, consisting of Drs. Beale, Deane and Carmichael. The draft of a plan was made, which, from some causes not now recollected, was never presented to the society. In a word, the committee did not report. I considered it then, as I do now, a paramount subject for the consideration of the society, and I trust it will be their pleasure at this communication to adopt such mea- sures as may mature the matter. Since our last annual communication, death has dealt with us with a sparing hand. It is my melancholy duty to announce to you officially the death of our worthy brother Daniel Trigg of Abingdon, one widely known for his high professional at- tainments, and beloved for his social virtues. The death of William E. Horner, while it has left a blank among a wide circle of friends, has filled a niche in the temple of science. Ranking as he did among the first anatomists of the age, his loss must be extensively felt and deplored. A Virginian by birth, he early left his native state, but ne- 15 ver ceased, during a long and well illustrated life, to cherish a love and veneration for the state of his nativity. The past year has taken from us many over whose ashes the heart of the nation weeps. The eloquent, the patriotic have gone forever, but be—the worker in the silent field, un- ostentatious in his life, devoted as it was to the elucidation of truth—shall he not rank with these ? For his and theirs, alike " are deeds which should not pags away, And names that must not wither, though the earth Forgets her empires with a just decay ; The enslavers and the enslaved, their death and birth— The high, the mountain majesty of worth, Should be, and shall, survivor of its woe, In the sun's face, like the eternal snow, Imperishably pure, beyond all things below." \ X