ADDRESS OF J. H. VAN DEIAN, M. D, PKESIDENT, CHATTANOOGA, HAMILTON COUNTY. READ BEFORE THE fyledidcil $ck5iety of Ter\i\e^ee, APRIL, 1876. .^IDXD^IESS OF J. H. VAN DEMAN, M. D., President, CHATTANOOGA, HAMILTON COUNTY. Gentlemen of the State Medical Society of Tennessee: One year since you honored me with the selection of myself as President of your respected and honorable body: and, in welcoming you again to our annual reunion—to renew our mutual vows in the profession—to make many, many fair promises as to our daily intercourse with our brethren, and it may be as often in the coming year cast them aside as of but little value—it is but just and proper, Gentlemen, that I express to you, without pretense or affectation, my warmest thanks for the honor thus conferred, viz., that of presiding over a body of Physicians noted for their intelligence, their learning and devotion to scientific pursuits—under any circumstances this is an honor, and so esteemed—but when I con- sider that my destinies are now cast with your own in this State, whose name stands second to none in the integrity, honor and bravery of her people, and who to-day is as much identified with her material interests as those of you who are proud to call her your native home, whose love for her time-honored institu- tions, her people, her climate and her soil, is not a whit less than your own—whose whole life shall be devoted to enlarging her usefulness, developing her resources, manifold in their nature, and keeping her before the world, what she is in reality, the garden of the Union ; and when I consider, further, that although now your interests are mine, yet but a few years since we met as strangers, I from a distant State, not ‘ to the manner born,” and when, unsought and unexpectedly to me, you thus chose me to preside over your deliberations, what did it establish?—That the Medical Society of Tennessee is composed of men free from that narrow, dwarfed and clannish spirit, born of ignorance and bigotry. It said to me, that, to which I might point with pride, that my bearing had been such in my inter- course with you, as to command your respect and confidence. It said to the out- side world, that our honorable profession recognizes no State lines, no sectional boundaries, but claims the whole “ boundless Universe as our nativity,” and ours an acknowledged brotherhood in whatever state, country, nation or clime, we meet. When I see before me to-day my cotemporaries of every age—the young man just entered upon his career, the middle aged, the venerable patriarch in our profession, men of acknowledged eminence, aye even a Nestor, whose name and fame has not only gained him a national reputation, but before whose knowl- edge and experience a continent bows in homage—you will not be surprised that I entertain misgivings that I may not pass unscathed the crucible of your criti- cism. 2 Medical Society of Tennessee. Allow me to hope that I will prove myself worthy the esteem and high trust you have reposed in me; and whether well deserved and worthily bestowed, the business transacted and the progress made in advancing our usefulness as a body at this the forty-ninth anniversary of our organization, will show, as it will also test, our unanimity of feeling, co-operation, earnestness and fidelity. The rules, regulations and customs, of this Society, has rendered an annual address a necessity, if not “ a thing of beauty and a joy forever.” I have ventured to present, for the consideration of this Society, a few crude suggestions as a base to found action upon for several subjects, that I feel are important to us as in- dividuals and as an organization. What are the relative duties and positions of Physicians to themselves, to the State, and to each other? First: The duties we owe ourselves as individuals. Granted, that we have passed the stage of a medical student, that we are no longer under the fostering care, espionage and tutelage, of wise preceptors or grave faculties, whose duty it was to impress upon us the responsibilities, duties, needs and annoyances, of our profossion, does not time and experience prove to most, if not all, of us, that we have chosen the most responsible of callings, because we have to deal with human life—the most sacred and important of all treas- ures—and that often upon us and our skill will depend, “for weal or for woe,” the persons, families, property, character and reputation, of not only this, but of gen- erations yet unborn ? We have chosen not only a responsible, but, under the most favorable circumstances, a slavish profession—have learned to know no pleasure when duty calls, except the pleasure of work—to know no night or day—to climb mountains, cross rivers, at all times and in all kinds of weather—have learned what it is to have our best hopes blighted by negligence, and sometimes wilful- ness, of patients, or by the mischievous machinations of some busybody or mar- plot, wise in his own conceit, bold with ignorance and pretense ; aye, a life may be sacrificed with their interference. We have endured that bitter pang which every honest physician has felt when the last remedy has availed nothing, and we stand powerless by the bedside of the dying, with the anxious gaze of both patient and friends speaking louder than words, “ Doctor is all done that can be done ? ” and we have to acknowledge that it has. We have learned that we are the most amenable to the laws, and have the least protection by the laws of this State of any law-abiding citizen within it. We have no legal means of gaining the very information the law demands of us as Anatomists, Chemists and Surgeons, when brought into our courts. We are not resurrectionists, but somebody is, and some one has to wink at the law, that we may gain the instruction we are obliged to have to successfully treat the surging mass of humanity, with all the ills and ailments that are entailed upon it as a common heritage. If there is one of you that does not know and has not learned from experience, that we are thepoorest paid of any class of men for the work we do, he will “rise and explain.” Name me a rich M.D., and I will show you an anomaly. We are not beggars, but we are not noted for our wealth. Why, then, do we enter the profession ? What have we to offset against the hard times and hard work, since we have no money? Men have the gratification of knowing that they are entering the most noble profes- sion known to ancients or moderns. Its origin dates back to antiquity, and there is no hitch in the succession—not apostolic. If there is any aristocracy in age, then we are all born aristocrats. The age, standing, and respectability of our profession accounts for the many miserable counterfeits upon it this day, for what rogue even counterfeits a worthless “ wild-cat ” bank? We have the honest Address of President. 3 gratitude of many a noble heart for rescuing from an untimely grave, or a crip- ple's fate, themselves or some dear friend—of knowing how to relieve suffering humanity the world over—to know that no hand is so delicate, no touch is so ten- der, to smooth the pillow of the dying man, no voice so consoling to whisper sweet counsel into his ear, as that of the kind physician. For this reason we have no “ hocus pocus ”—no royalty upon anything, neither medicines or instru- ments, invented by members of our fraternity, (and no instrument of any utility lias ever been invented by the Profession), and they all scorn to take out a patent, preferring to give their time and vast store of knowledge to further the ad- vancement of medical science. The passwords of the disciples of are» and ever have been, “ No secrecy, no humbuggery, no royalty,” in regard to wha* may be necessary to alleviate suffering humanity. In consequence thereof, we have “no royal road to eminence” in our profession, little money, but a sub- treasury of glory, upon which we may present sight drafts “ad libitum,” and will always find them honored. We owe it to ourselves to be ourselves, true, upright, honest and moral men; “who scorn to cringe the pliant hinges of the knee, that thrift might follow fawning;” to be not lukowarm and half hearted in our profession; to follow after no false gods for either policy or pelf; to be close students; to keep posted in every thing that will advance us in knowledge or efficiency in our calling; to investigate any and all discoveries, innovations, infractions or de- partures from established practice, availing ourselves of all improvements; not to condemn unheard, but “hew to the line” all humbuggery, quackery and dis- honesty in the profession. Whilst availing ourselves of every channel within our ability to obtain infor- mation, we should closely apply ourselves to our offices and business. A store- box doctor seldom amounts to much. Every man that enters the profession and fails to succeed, is a stigma and a detriment to it, We should assist and insist upon an elevation of the standard of our profession in this State, by insisting that those seeking to enter, should have thorough preparation, and suggest that at this meeting of the Society, some stringent measure be adopted that will control, in a certain degree, the standard of those who may be admitted to our offices as stu- dents. To make this matter practical, let us adopt a standard of education and preparation of study, to require of everyone, before he can be admitted to the office of any member of this Society—aye, I would that he must be a graduate of some accredited college, and though I am aware that a man may have a diploma— yea, a dozen of them and not succeed, but if forced to go through a certain cur- riculum of study for a number of years, the greatest numbskull must learn some- thing. It is ignorance and incompetence that we are warring against, not competition —the higher the standard of requirements in any business, the easier to guard the interests of all. Skilled labor always pays, and is always satisfactory, and skilled workmen are soon forthcoming for any corporation that demands them, and will pay them, and will have no other. Was there a judicious care exercised by us, as feeders for our colleges, it would prevent the base, the ignorant and inefficient from knocking at our doors, for ad- mission. With this precaution, the standard of applicants would he raised, a more competent class of young men would seek to enter the profession, and the standard, efficiency and respectability of the colleges would be guaranteed. Can we afford a continuance of this sloppy, slipshod manner, whereby any- body can enter, and have to be recognized by us, as members of so noble a pro- 4 Medical Society of Tennessee. fession? Shall we not adopt some feasible, practical plan for checking, if not preventing entirely this evil, and I fear a growing one? Do we not owe it to our- selves to adopt some measures that will, in fhe future protect us from miscreants and charlatans that overflow her boundaries to-day—a scourge worse than a pes- tilence, because no note of warning has been sounded, and yet their victims swell the annual mortuary statistics of this State, beyond all calculation to those who have given this matter no attention? I will note Chattanooga with which I am better acquainted, and she is but an example of every other place of any size, and my experience that of almost every physician present. We have in that place about fifty lawyers of all grades; eight or ten of these do most of the busi- ness; many of them are high-toned, honorable gentlemen, some are scallawags, bummers around police courts—no account generally, but each and every one of them is entitled to practice in our courts, and has certain rights and privileges, in which he is protected, that no one dares trespass upon with impunity. He is protected against you, against me, or anyone who has made no special prepara- tion for this calling. We cannot come into court and even plead our own cause ; we may draw up our own deeds, contracts, etc., may furnish witnesses, take depo- sitions, may play nurse generally in our case, but if it gets desperate and we are obliged to go into court with it, we are compelled by the laws of Tennessee, to employ one or more of these fifty .lawyers to bring it before the proper tribunal, but each and every one of these men before they can do this for you, or accept a fee from you as a lawyer, has had to prepare himself for admission to the bar. There is a certain curriculum of study appertaining to his profession he has had to master. It may be that the standard in law is low—I think it is—be that as it may, he is obliged to have some preparation, and his license proclaims to every one he has complied with the required demand, and therefore, is not entirely ig- norant of his duties; he may be a rascal, a scoundrel, have little sense and less judgment, but even in dishonest practice, ungentlemanly or unprofessional con- duct, there is a limit; and he transgresses the prescribed ethics of his profession at the peril of being debarred, thus prevented from plying his calling at all, “ Othello’s occupations ” being gone as soon as he offends the proprieties of his profession. Do not the interests of the commonwealth demand this protection, and even more from the lawmakers of this State, for her property? What would be the justice, who would invest their money when anybody, black or white, male or female, could set themselves up and be a recognized expounder of the law, with- out preparation ; ignorant miscreants, that would dupe the many, Pandemonium would be a paradise in comparison with the state, county or neighborhood, where such license was permitted, sanctioned and protected by the statute. God forbid the anathema should go forth that our property is protected, but our lives are in jeopardy every hour from the vicious, base and uneducated swarm of self-styled doc- tors, that invest Tennessee, and against whose pretensions we have no redress. Two years since my attention was called to this matter as it had never been before. A Georgian came to Chattanooga with his family ; the next day his wife was taken in labor, and he asked a neighbor, “ Where he could get a doctor ? ” was pointed to a “fellow” styling himself such; he came, was soon beyond his depths, sent for his partner, a fac simile of himself The two tortured the poor woman all day. Some ladies coming in towards night told him, “ Those fellows were no doctors, that he might just as well call anyone passing, and if he did not want his wife to die, he must go at once for a doctor.” He came for me, I refused to go, after he had called in such fellows; was in much distress, “ was Address of President. 5 afraid his wife would die,” said “he was a stranger,” and began to anathematize the place where any common loafer could call himself a “doctor”; and says he, “why do you not have such fellows sent to the penitentiary, how can a stranger know who are doctors ana who are not? but I reckon my wife must die.” I told him “if I went and she did die, he could see how I was placed.” Finally I thought the man was not to blame and went with him. His wife was soon relieved as she would have been at any time during her sickness, by anyone who understood his business, but those ignoramuses would have let her die rather than expose their duplicity, by sending for a physician. That settled them for being doctors. It impressed me forcibly, that physicians were not the only sufferers from the want of legislation. But how is it with medicine in this State? White or black, male or female, can set up as a doctor, and be just as much protected by law as any of us; indeed, I have sometimes thought, that it seemed a pleasure to taunt the regular profession with these scapegraces, and as there is no limit to their privileges, so there is none to their pretensions. For every regular physician in our city, we have a quack to pit against him. We have a negro doctor, a faith doctor, a spiritual doctor, a Mrs. doctor, all itinerants; then we have the Homcepathists and other “pathists,” ad nauseum. Now, aside from the impostors recognized by the cognomen of doctors, we have “midwives,” so called, black and white, who ply their vocation with no preparation for its responsibilities— adding a large per cent, to our mortuary reports, attributable to incompetent ac- coucheurs. If these women would confine themselves to the limit of their abil- ities as nurses, they would fill an important niche in communities. All the protection the people of our State or ourselves have is what is guaran- teed them by the rules and regulations governing members of this Society, and the code of ethics of the American Medical Association, to all of which each in- dividual subscribes when becoming a member of this Society. These protect the people only so far as it governs ourselves. The law does not say you cannot take human life into your hands without due preparation, as in law. It inflicts no penalties, prescribes no limits, exacts no license, from either the native or foreign dabbler in human life. Let us determine that our cities, towns and country, shall not be afflicted with this pestilence, that might be stayed in competent hands ; nor need we console ourselves with the flattering unction that the “peo- ple love quackery, love to be humbugged,” and we say “it is good enough for them, let them die.” I contend that this is a slander upon the intelligence of the people, for that is the very string that a first-class quack pulls, and by flam- ing handbills proclaims to the world that he has had unusual advantages—has been Physician and Surgeon to the Great Mogul—is an Alumnus of the College of Physicians and Surgeons of London—makes a specialty (O! the specialty humbug, was there ever a greater?) of chronic cases, the diseases of the eye, the ear, the lungs, the stomach, but especially of “ diseases of women.” He is pro- found, looks wise, announces a lecture (private for ladies only). Drowning men catch at straws, so does a poor afflicted creature on terra firma. They have at first but little faith in him, but think they will hear what he says, he has had such good advantages, better than any of our doctors. See what he does say: “ Why, of course, I can cure you, at least I could if you had only called me in time.” Thereupon, “King Cure All,” with an eye to the main chance, strikes a bargain with his patient; he is to have so much money, and they will then have so much treatment. They have no means of testing his imposition. This fellow’s stock in trade is that he has convinced the people that he has had superior advantages for their particular cases. Medical Society of Tennessee. 6 This illustration is drawn from the course pursued by one of the boldest and most successful of these scamps that ever fell under my observation, except that he also announced himself as agent for the Union Hospital of New York city. He treated patients in our city for so much: but an additional charge must be made if they were removed to the hospital. Several were anxious to go, but there “were no vacancies then; as soon as one did occur, they should have the advantage of it.” For weeks people flocked in crowds to his rooms, like “ Pil- grims to Mecca.” The Methodist minister dismissed Wednesday evening service that the ladies of his charge might attend a lecture irom this vagabond upon the most delicate of all subjects pertaining to their sex or our profession. Some friend of one of his dupes wrote to New York to a mutual friend, asking for in- formation concerning this “ Union Hospital ” at such a number and such a street, and the answer soon came, “ that there never had been, and was not now, any such hospital in the city, but that the number mentioned was the lot upon which the Trinity Church graveyard was located.” This settled the matter, and our young man left and stood not upon the order of his going, but left at once. This was a great blow to this vagrant, and his victims felt it so keenly, were so much cha- grined, that for some time we had an immunity from them ; but where was the return? A coat of tar-and-feathers (what he deserved) if he had remained, was the worst they could do, and as soon as he could wash that off, “ Richard would be himself again ” : nothing gained, nothing lost to him. He proved to be an auc- tioneer from Ohio; sold our people completely, and for a good round price. Now the people would welcome with a joyalaw that would place them beyond the pale of such imposters. What plan is feasible to rid ourselves of such trash. I would suggest that a committee of our most eminent medical men and scientists draft a law, and use their best endeavors to have it passed by our Legislature, making it in reality a law, that a certain standard of medicine shall be laid down, of which each member of the profession shall avail himself. Let certain credentials, or their equivalent, in a certain number of year’s practice, be re- quired of not only those now practicing medicine, but also of those that may enter the profession in the future in this State. Let us also ask that our people may be protected from these itinerants and medical tramps coming into our State to practice medicine. Let them all pass before an examining board at Nashville, Tenn., and receive a license just as it is in law. The most eminent lawyer in the United States cannot bring a case before any court in Tennessee without first having procured a license so to do, and it is right, it is just to the people, because it protects them from traveling pettifoggers and jobbers in law. It is just to the fraternity, because it protects them from the vagabonds of the profession that may hail from a distance, they having no time to hunt up their lineage or attainments; besides we, her citizens in law or medicine, are entitled to this protection. Our lawmakers owe it to themselves and the profession, that claims for medical attention should have preference over every other claim, not from the fact that “ all that a man hath will he give for his life,” but from the reason that a physician has, but in few cases, any alternative but to answer the calls of distress at the moment. He cannot say, as in the case of the grocer and haberdasher, the undertaker and merchcnt, “that he will not go until his bill is secured.” The community would condemn, stamp as mercenary, and de- spise the physician that would not go when called at all hours of day and night in cases of emergency, trusting to luck and frail humanity for compensation. What class of men, what profession, yea, what trade is there that performs so much labor without any remuneration? Are ire not to blame in this matter? Do we demand our pay at the time when we should demand it? Do we not al- low our bills to run too long before we present them to our patients ? Is it not a fact that when the danger is passed and life is saved, that the patient forgets how near he hovered to the brink of the grave, comes back to the “ dollar and cents ” Address of President. 7 part of his existence, and his only thought is how long can he make his doctor wait for his bill ? But say you, how does this affect the people ? As the law now is, a large majority of that class who should die without priest or pai’don—namely, those who could pay, but will not, and by stay laws, exemption laws, etc., make it more trouble to collect a bill of small amount than it is worth ; therefore it is charged to profit and loss, and we are compelled to increase our fee bill, so that those who can and will, have the bills of these rascals to pay indirectly. To make the matter plain, if there was some means by which those who could pay, if they would, without so much trouble, we could reduce our fee bills one- half, and be then better remunerated than we now are. We then could furnish our own medicine, save to our own patients 100, 200 or 300 per cent; but we cannot afford to lose both time and money; consequently we have a rich druggist at every corner—a lot of sub-doctors from their study of our prescriptions. They are our students now ; it does not take them long to become our rivals in specific diseases, the mutual relation between the druggist and physician being so little understood. I would be glad the time would soon come when every physi- cian should keep his own drugs, dispense his own medicines, and have no clap- trap of a druggist’s clerk, or two-weeks porter in a drug store, tampering with the life of his patient. Let the responsibility rest upon the physician, and, my word for it, there would be fewer mistakes made, and less deaths from errors made by unqualified clerks. But here I am trespassing. Let us not be backward in the means whereby we may prevent disease, in enriching our people with that knowledge that teaches them, not how to cure, but to prevent disease. Let Senators and Representatives learn that the health of our people is paramount to every- thing else: let us keep hammering away at the doors of the Legislature for proper laws upon this point, and ere long they will be convinced that the old law maxim —‘'Solus populi, suprema lex est ’’—can only be obtained by the constant care and watchfulness of her people: that the health of this nation is the source of all her wealth ; and this great sanitary movement cannot be carried on without united action upon our part, and a corresponding one upon the part of those in author- ity. Understanding all this, our Legislature will only be too eager to place Tennessee as a leader in the van of protecting her people, as well as all who shall claim allegiance within her borders. Let us press this matter while we have an Eve, a Lipscomb, a Briggs, a Bowling, a Winston, Mayfield, Maddin, and a host of others almost without number in this Society, whose names will add might and influence with our legislators, who may be glad to bow in deference and honor to those who have so much honored our State by their devotion and un- swerving integrity to their profession. Let a memorial be presented to our Sen- ators and Representatives, signed by every member of this Society, setting forth these facts. It would be respectfully considered, and would be the entering wedge to a successful issue in remedying the defects of our present laws. For the protection by law to our interests, what should be our return, and what would the community gain? First, a faculty of physicians who are only limited in knowledge and influence by their ability to acquire more—who would be ready, in and out of season, to watch the sanitary interests of the State—to use every endeavor to prevent pestilence entering her borders—who would be the “ signal corps ” to warn the cities of approaching disease—who would understand how to read the character of the enemy, and warn all by their interpretation. We should be the watchmen upon the tower to protect and guard her health interests in every community where a physician may launch his bark. Our interests, then, being relative and mutual, we should and would vie with each other in strengthening the bonds which unite us. Again, our charitable institutions should be watched, guarded with tender care, nourished and petted by the profession, they being the great schools for the ame- lioration of the unfortunates confined therein afflicted with those forms of disease so dangerous to life, heart-rending to the friends, and so disastrous to the patient. Look often to their interests; give them your counsel and advice; the moral sup- port of your Society; use your best endeavors to protect them from all harm— leave no stone unturned that will benefit their inmates, and not only the unfor- tunates, but their thousands of friends will ‘‘rise up and call you blessed.” Now, what shall I say as to the duties we owe each other? Our relations to each other should be of the strict golden rule standard, standing firm by our rights, and 8 Medical Society of Tennessee. the ethics of the profession, eschew quacks, I care not of what school they are mem- bers, neither countenance or consult with them, have nothing to do with them, the world is wide and large enough for you all. Our ethics is of so high a stand- ard, is founded upon such broad and enlightened views, that it adds additional dignity to our calling, and should make every member of our profession display a delicacy of culture, and treatment of our brethren, that would amount almost to fastidiousness. The very hardship of our lives would seem to stimulate us to an elegance and refinement of feeling in this matter, that, even in the pressure of our busy and checkered lives, we should always find time to practice. This admi- ration for our calling constitutes its greatest safeguard against any tendency to vulgarize and make it savor of a trade. For this reason it is derogatory for any member of our profession to patent, own, peddle or recommend any patent medi- cine, instruments, inhalers, supporters, and the thousand and one tricks and in- ventions to humbug the unwary. We owe it to each other to see that this is not infringed upon. Whilst the bar of this Society should not be the forum for settling petty contentions, yet it should not shirk responsibility or lose sight of the local societies that are feeders, for not only this, but the American Medical Association. My opinion is, that the usefulness and effectiveness of any local society is not dependent upon its members, but upon the quality of those composing the same. Its harmony and usefulness must necessarily depend upon the material of which it is composed. Guard well the portals. This Society should spurn from its doors all such as have entered or may seek to enter, who are put beyond the pale of society at home for gross immoralities or nefarious practices. No nostrum ven- dor, patent medicine or instrument peddler, or even snake phenomenon exhibitor, but desires and will work for recognition from this State Medical Society. Local societies have their duties and prerogatives to perform, and this Society must look after them. The wily, oily charlatan at home, rolls it as a sweet morsel under his tongue, and a fine advertisement, that he, having covered his tracks at home, is a feature of the State Medical Society—a feature which the honest physician can not afford, and we owe it to each other to expose such—to work zealously for the good of the profession, discountenance all irregularities therein, uphold her rights, protect her interests, and to yield not one inch when she is assailed by unprincipled men of any profession. To the young men and strarigers of our profession who come amongst us, we owe a courteous and kind treatment, for we will not live always, are not a sample end of eternity, and it should be a pleasure for us to know who will fill our shoes. We should not forget that we were once young, and young men should not pre- sume, that because they discover a crow’s foot or a silver hair, that we are old fogies—have forgotten all we ever knew. A respect and deference to our relative positions will be healthy for both, and a mutual advantage. Experience is a dear school, young man, but it is thorough. We owe to each other professional courtesy, gentlemanly conduct and treatment. Our ethics being so plain a guide, I be- lieve the man who errs, does so intentionally, and should do it at his peril. And now, what do we owe to the slow and steady old coaches in the profession who plod along in the same old rut of days gone by ; who read nothing but the musty books of half a century ago; think anaesthetics an innovation; prefer the actual cautery to the ligature, eschewing all bloodless amputations as inventions of the Evil One; insist that jallap and cream of tartar, bleeding and cupping are the sheet anchors of the profession; and that everything else will soon be discarded and all fall back to their long since exploded theories; and in-fine, believes the men of their day were wiser and better than those of the present day; simply this, the world will still move on in its sphere, the science of medicine will still advance, improvements will be the order of the day, and the profession will be the better off when we have a few first-class funerals of just such men. And now, gentlemen, thanking you for your indulgence and attention, allow me again to express my gratification for your kindness and consideration, and may I add for your forbearance and magnanimity with my shortcomings. I am at the bar of my peers, have submitted my case, and am content to abide your judgment. I trust that to-day we have met upon the level, that we will always act by the plumb-line of justice and right, and when we part, may we part upon the square, and so square our lives and actions that our future lives may be cast in pleasant places, and all may be joy and peace.