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MEDICAL  PRACTICE  MODIFIED
A SEMI-CETENNIAL ADDRESS,
BEFORE THE
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(CARLES H. GIBERSON, M. D.,
BROOKLYN, May ad, 1872.


     BROOKLYN;
Wm. 0. Wiltok, Printer, 397 Fultos Strkkt
       1S78. 
J
* 
ADDEESS.
Mil. President, Ladies and Gentlemen :

  Though honored by the good will which prompted my
selection for the present dut}T, the feeling is not unac-
companied by a sense of its responsibility.  You, my
brethren, imposed the task, and your generosity is relied
upon for kindly criticism.
  This Annual Meeting is another proof of our interest
in medical science, but more especially does it imply our
devotion to the Medical Society of the County of Kings;
to the principles embodied in its constitution, and  we
trust exemplified in the lives of its membership.   Such
occasions are among the few opportunities afforded us
of communicating directly with the outside world.  Pri-
vate acts  constitute the chief  bond between phj^sicians
and  the people; yet it  is not unbecoming that reunions
like  these should have place.  They lead to a better un-
derstanding  of the  relations which should ever  exist
between the laity and the professions.   We thus hope
to know each  other better, to stimulate each  other to
increased  confidence, to  cultivate  the  respect born of
actual knowledge of aims and hopes,  as well as to pro-
mote the general good.   Our Society has seen a number
of gatherings  like the  present.   It has  endured the
feebleness  of infancy, the tottering steps of childhood,
and now stands forth in full stature.  It only lacks the
completer  development which follows  proper  aliment,
exercise, and experience.  Its organic law has been care-
fully revised,  new  life  has inspired  its  counsels,  its
stated meetings are larger, and, we believe, more effect- 
2
ive than ever before, whilst to its fellowship have been
attracted new names and talents which promise to add
much to its usefulness.  AVe have now nearly two bund-            "]
red members—a larger number than ever before attained.
These  facts  are  matters of congratulation.   Though
peculiarly gratified by accessions, we  find them largely
counterbalanced by the loss of brethren whose memories
are sadly sacred.   Some have fallen in the outset of the
race, and talents of promise have been rudely crushed by
our common foe.   Others, whose names were a strength
to our organization soon after its birth, have been cut off
full of ripeness and good works.   These  bereavements
tinge our reflections with sorrow, but are relieved by the
thought that our loss is their eternal gain.   They also
admonish us  " To work while the day  lasteth, for behold
the night conieth."
  But we are reminded that this is no  ordinary occasion
in the history of our Society.  It is its fiftieth birth-day—
its first semi-centennial—its golden  anniversary.  These
facts suggest new thoughts and hopes.  Two dates stand
out before us—1822  and  1872.   These  represent two
histories, and the intervening space  is  crowded  with
events both novel and startling.  One fact  cannot fail to
arrest attention—that of change—steady, progressive,
inevitable change.  This has pervaded the world of mat-
ter and of ideas.  It has sometimes marked an advance ;
not always so.  This constant, ever increasing element,
has nowhere been more manifest than here. Brooklyn's
growth has been no less a marvel to ourselves than to our
neighbors.  Its influence has kept pace with its increase.
Its vices  too—though not metropolitan—have failed to
keep their secrets within the corporate limits.
  Let us hastily glance at some of the particulars which            A
make our great city of to-d'a,y so unlike the  village of fifty
years ago.  It then contained a few thousand people, less
than half a dozen churches, one district school, no public
institutions, and not until twelve  years later did it attain
the rank of a city.   Its  few hundred  buildings  were
clustered about the present sites of Fulton  and Catharine
ferries, whilst the spot on which we  now stand was quite
beyond the suburbs.  Two years later—in 1824—a total 
3
of 1013 voles was cast in the county for assemblyman,
a number less than was last year polled in some of our
more enterprising wards.  In the department of morals,
the description of fifty years ago will apply to-day.   Says
Furman in 1824 :—" The people of Brooklyn, it is true,
cannot be considered as rigid in religious matters as the
saints of Oliver Cromwell's army,  whose very cannon
had  on the inscription—'O'Lord, open thou  our lips,
and our mouths shall show forth  thy praise.'  But they
are far from being irreligious.  The  churches are well
filled,  religious societies are liberally supported, and
vice is discountenanced."
  This year Brooklyn had its first Board of Health. The
president received $150  per annum.   The  first  health
physician was Dr.  J.  G. T. Hunt, who received $200
per year.  These sums, compared with present rates,
indicate  the steps which have  led up from the  past to
the present.  Brooklyn was indeed small, yet she pos-
sessed a goodly number of truly royal souls.  Tried in
the fires of the Revolution and of the later war of 1812,
they had learned courage, as have  our people self-reli-
ance, by the fiery  ordeal  but just  passed.   Among
these sterling  men  were the founders of this Society.
Two years before the  rise of any other in  the county,
they, in obedience  to  a recent  law,  and actuated by
professional enthusiasm,  laid, with  strong hands and
believing hearts, the foundations of a structure  which
has grown with the cit}^, and strengthened with the ad-
vance of medical knowledge.   We honor the names of
Drs. Ball, Wendell,  Carpenter, Creed, DuBois and Van-
derveer,  practising physicians in the  County of Kings,
who on Monday, February 22, 1822, the  anniversary of
Washington's  birth, met in the  village of Flatbush to
consider the formation of a County  Medical Society.
We are doubly grateful to these,  and  three others—Drs.
Low, Hunt and Henry—who at  an adjourned meeting
held in the village of Brooklyn, March 2d, 1822, decided
to organize, and elected the following officers;—Cornelius
Low, president; Matthew Wendell, vice-president; Ad-
rian Vanderveer, secretary, and John Carpenter, treasur-
er.  These men joined hand with hand for mutual strength 
4
and the general good.  Not one of the nine survives to
celebrate with us the Fiftieth Anniversary of their work.
Their reward is with them, and ourduty is plain ; namely,
to carry forward with equal zeal the labors  they heroic-
ally  began.  We are denied  their presence,  but their
example remains.  We  still have in our ranks those
Avhose  connection with  the Society reaches  back  to
within a few years of its  origin.  They yet bear part  in
its counsels   They are the connecting link  between the
past of our history and its present.  Their experienced
hands  take hold on either side, assisting us  of the pres-
ent with wisdom gained from those who went before.
  But leaving this, let us  enter the field specially marked
out as the subject  for this occasion.  It  is to indicate
some of the relations which medicine in 1822 bears to the
same in  1872,—to note certain changes which  have oc-
curred, and to observe the chief agencies in their  pro-
duction.
  We have noticed some of the relations—political, re-
ligious and material—which Brooklyn as a village bears
to Brooklyn the third city of the New World.
  Now, in  what respect do the founders of  our Society
differ from ourselves ?  How does the spirit of their times
differ from that of ours ?
  That medical practice  has  changed is certain.  That
we act  quite differently from them under similar circum-
stances is  doubtless puzzling to honest minds.  These
pioneers, looking at history as  it is and as  it promises
to be, enjoyed the  dawn only of the  day in which the
sun has now risen seyeral  degrees.   Yet they were co-
laborers with  some  of the great men whose  genius  had
already begun to illumine paths previously past finding-
out.  They were the pupils of men who planted the seed
which is producing  the harvest we  reap—who, with  un-
tiring energy,  evolved secrets in nature which has revo-
lutionized medicine and  made the nineteenth century
distinct from  all  others.   Its beginning  foreshadowed
events which are now more fully realized.  It was a  sort
of transition period, pregnant with  promise.   Yet  our
science was in an unsatisfactory state.   There were  sev-
eral  leading schools all  professing  the same principles, 
n
but seeking by various interpretations  to establish ex-
clusive theories and formulae for guiding  practice.  There
was a want of harmony which paralyzed honest effort and
weakened faith.  TheBrimonian theory which held sway
in England was combatted and ridiculed  by Broussais in
France.  Rasori in Itaty, commencing with a belief in the
doctrines of Edinburgh, improved upon them, as he sup-
posed.   To these several, Anglican, French and Italiau,
was  added a fourth—the American.  Its  exponent was
Benj. Rush,  who  moulded opinion both  at  home and
abroad.  He fascinated by his eloquence, whilst he con-
victed by his earnestness and  perspicuity.   Each system
lived its brief space, and its disciples finally merged into
the one great, harmonious, working body of to-day. Not
that there are now no differences of opinion in the pro-
fession.  They still exist, but instead of governing are
subordinate ; instead of hindering knowledge by coun-
teraction, thej' stimulate by healthful rivalry.
  But amid these  divergent doctrines, a common spirit
pervaded practice.  All agreed on the necessity of treat-
ing promptly and  energetically.  Disease  seems to have
been regarded as  an enemy seeking the speediest de-
struction  of the  individual.   The treatment of  the day
was heroic.  Not  to actively interfere  met with  no re-
sponse  in mind of  patient or practitioner.  To  delay
using  the lancet  was equivalent  to  a  misdemeanor.
Emetics, revulsives, and counter-irritants were supreme.
In truth, the adoption of some telling plan was thought
the prime necessity.
  I need scarcely refer to the different methods now pur-
sued.   Personal  experience may  acutely suggest the
change.   Some of  the remedies then used are not heard
of now ; others  are  beyond hope of recovery ;  whilst a
large class is yet found good.   Our patients are allowed
fresh air and cold water where both were once denied.
Not to impose drugs on refractory stomachs is orthodox.
Finally,  the period has nearly arrived when  the  physi-
cian can reason thus :—Does  this case demand my active
interference, or may it safely be trusted to nature, assisted
by a proper regimen ?   Now,' we are more  radical in 
6
investigation, but more conservative in practice.  Where
the}' acted we often delay and watch.
  We thus perceive some of the relations which medi-
cine of the earlier date bears to that of the present.
  Before seeking the causes  which have  produced the
change observed, it may be desirable to understand that
no apology is offered for the supposed short-comings of
our antecedents.  It is not demanded.   They sought as
earnestly after correct principles  as do we,  and had their
labors been prolonged to  our time, they would doubtless
be in the front rank of the army  of improvement. They
lived in a period of scientific chaos, yet  set in motion
some of the forces which  have culminated  in the altered
practice of to-day.  For it is the practical  part of medi-
cine which should most interest  us.  Vain will be our
endeavors after knowledge, and  mistaken  our apprecia-
tion of the ends of science,  unless they tend towards the
relief of suffering.   Science and art are not  incompatible.
Eager pursuit after the former may blunt our relish for
the latter, but b}^ so much does medicine fail of its true
aims.  Whilst  a few men are philosophers only, to tiie
exclusion of being sound practitioners, the great majority
of minds  are so constituted that the highest scientific
attainments possible, coupled with a due  sense of their
proper ends, make  the possessor as far superior to him
who lacl^s them, as is the disciplined army to the body
of raw recruits.
  But  to return.  The  agencies which have produced
these noticeable changes are  both  direct  and  indirect.
The generally  accepted explanations are  various, often
erroneous.   Physicians themselves,  in attempting to un-
coil the chain of events which fill the gap  of fifty years,
have sometimes mistaken causes  for effects  and vice versa.
  All are familiar with the more noted acquisitions of
modern medicine.   I shall but briefly refer to them, and
more fully consider agencies not less important because
less direct.   As Prof.  Huxley   says:  "Shall try  to
distinguish  rightty between  prominent and important
events."
  From among causes direct, let us first question anato-
my to discover the value of its contributions to this end. 
7
Early in  the century it was as well understood in some
of its departments as at present.  The gross appearances
of tissues and organs had been accurately demonstrated.
Yet the  subject was  a narrow one  compared  with  its
modern extent.  Professors, and teachers, and authors,
had not  as a rule  gone beyond general characteristics.
It was coupled with physiology in the regular college
course.  But the field soon widened.  Bichat, at a single
stride, overleaped  the confines of former research.  Not
content with general knowledge, he sought after the con-
stituents which go  to make up organs—he resolved the
body  into its elementary tissues.   It was  his crowning
effort; accomplished in 1801.  His labor was the begin-
ning of a new epoch.  Others, inspired by his teachings,
went  further : they sought the minute structure of the
elements he demonstrated.  Improvements in the micro-
scope in 1832, aided  vastly in this work.   A new field
was thus rapidly opened up, constituting histology.
  To  this department then we naturally turn  for that
minute knowledge of tissues which, in a  most marked
degree, has changed the currents of  medical investigation,
and modified the art.   Prior to this, medicine was a com-
paratively "light and slender thing."  Without a dis-
crimination of these microscopic elements, we could have
no sure foundation for other branches not less important.
Without the  demonstration of ultimate cells, we could
not accurately determine any process either of life or
disease.  Histology now constitutes a leading branch of
the science.  Not  a tissue but has been analyzed,  not
an element but has been examined.
  Having here seen the minutiae of cellular life  and de-
velopment, a single step introduces us to the department
of physiological function—to the results of actions and
reactions constantly taking place in this human  labora-
tory, where each cell is a factor in sustaining life, and
in reproducing new forces to perform the work of those
constantly falling by the way.
  There  has been  a physiology ever since the birth of
medicine, but for  two thousand years was little more
than the rude observation of ordinary  animal function.
Not until Harvey was  it worthy  the  name of science. 
8
His efforts were ably seconded by Hoffman, Boerhaave
and Haller.  Yet they were unable by reason of radical
defects, since supplied,  to establish it  on a basis com-
mensurate with its importance.   Not until Magendie, in
the third decade of our century, had the actions of organs
been  studied, whilst  yet imbued with that mysterious
principle—life.   Dead tissue had been dissected, but its
inanimate particles could give no just  idea of function.
Magendie,  by vivisections, not only showed results, but
demonstrated the modes of their production.   The ac-
tions of the heart and its appendages ;  peristaltic move-
ment ; respiration, in  all the beauty of its adaptation to
a specific end;  the absorbent system, permeating every
part—all these and  many more were first observed by
him.
  The only method of arriving at correct conclusions in
physiology, viz., by experimentation, is  a feature of its
modern studj7.   The  time for philosophic  dreaming is
past.   He who will win  must observe facts brought out
by skilful experiment.  The last twenty-five years  have
seen more of  it  than all  previous time.  A precision has
also been given to observation by the employment of new
instruments.  Nervous activity is thus made to write its
own record.  The pulse now portrays  its  features in
mathematical characters. But I stop not to specify these
aids.   They were fully described by him who last year
occupied this place.
  By a familiar illustration we may get a glimpse of how
modern physiology has  affected medicine.  Take diges-
tion, which lies at the base of life and health, and compare
the knowledge  now  had with that of fifty years ago.
Some facts had  then  been acquired by observation, and
by experiments on inferior animals and man, but actual
demonstration was wanting.   In June 1822, three months
after our Societ}^ was organized, an accident happened
to Alexis St.  Martin, which was  taken  advantage of by
Dr. Beaumont of the U. S. Army.  In  1825, his experi-
ments, known to all,  were begun. They were continued
at intervals to 1856.  In 1833  his work " On the Gastric
Juice and the Physiology of Digestion" was published.
With it a  new era dawned.  Correct calculations took 
y
the place of ingenious speculations.  Indirectly,  this
event also taught much—it proved that an artificial open-
ing through the walls of the stomach is not incompatible
with life and health.  Physiologists were led to create
such  in  the  lower  animals.  This  success assured, no
course of medical instruction would be thought complete
without recourse to the new method of demonstration.
  The information  repeated experiments  have given of
other fluids  instrumental in  converting our daily food
into appropriate pabulum for nourishment and growth,
has had an  effect  scarcely less striking than  the  re-
searches of  Beaumont.   More correct notions  of the
functions of  the liver have led almost to the abandon-
ment of certain preparations formerly emplo4yed, it would
seem, both to stimulate and repress its secretion.   Since
physiology lias taught that it is, in the language of polit-
ical economy,  a producer as well  as a  consumer, our
views of its  relations to  the  whole body and to each
organ have been modified. It now receives more kindly
treatment, though  still found hard to abandon former
errors.   Physicians have perhaps re-acted too strongly
from some previous methods of cure in these derange-
ments.   Scepticism threatens to make us  too unmindful
of them, and  too  cautious  in the  use of remedies an
earlier generation found good.
   If we had  time to speak of the functions of respiration,
circulation, absorption, excretion and reproduction, facts
not less important  in their bearings on medical practice
would be found.
   With brief reference to the nervous S3'stem,  and we
pass on.  Our knowledge of it is yet limited, but in com-
parison with fifty  years ago seems very considerable.
Sir Charles Bell and Magendie had just  taught the re-
spective qualities of the anterior and posterior roots of
the spinal nerves; but the legitimate fruits of their re-
search could not be realized until Marshall Hall in 1832
discovered  reflex  action—" the greatest physiological
discovery  since that of  Harvey."  By  this new light
various normal activities, as well  as symptoms of dis-
ease,  were first interpreted.  The actions of remedies
thus came to be better understood.  Light dawned on 
10
the principles governing vegetative, organic-life processes.
Facts imperfectly observed by these men have been fully
verified by recent experimenters.  The labors of Ber-
nard, Robin, Dal ton, Brown-Sequard and others, have
brought out new points of great practical service.   Para-
lysis  has  become intelligible by  reason  of new  truths
regarding nervous  conduction.   The  removal  of the
cerebellum from living birds has taught us much we
know of  co-ordination of muscular, movement.   Ber-
nard's teachings of the vasomotor system  have given
true direction to many of our remedial agents.  The re-
lations which pain and spasm  bear to the  state  of the
circulation have been  elucidated by direct  observation
and therapeutic measures.  But  hardly  has the field
been entered.   The  facts ascertained are  but occasional
links  in the endless chain  which reaches  back into the
darkness of the past, and forward into the mysteries of
the future. We accept them with gratitude.  They are the
product of our  own time, and mark the advance of mod-
ern ph37siology.  There is  scarcely an organ  in the bod}7
whose functions are  not now better understood  than  a
score  of years  since;—scarce a process in the complex
system of nutrition but has been enlightened by modern
study ; scarce  a sensation of pleasure or pain  but is
more  perfectly appreciated and explained than even ten
years ago.  The whole  science is but of j7esterday, com-
paratively speaking.
  Again, at the time this Society was formed, there was
at best a very imperfect appreciation of the necessity7 of
linking morbid changes with the symptoms or treatment
of disease.  Our fathers could not look into  the minuter
details of structure,  nor watch tthe  more  intricate pro-
cesses of nature as can we.  Their eyes were not armed
with the perfect instruments which aid our vision.  Then,
general pathology held sway as does special now—hence
a reason  for the change  which has been noted.  We
would be dull indeed if adhering to  former methods, the
logical results  of former  reasonings.   No,  we  have
brought these systems within range, and transfixed them
by the electric  beam which  reveals their  defects. Old 
II
dogmas have been overturned with many of their reme-
dial attributes.
  This power of a true pathology is strikingly illustrated
in the department of renal affections, elucidated by the
researches of Richard Bright, who in  1837 first taught
the relations certain  signs bear to  structural changes in
the kidne}7.   He  furnished the clue to a train of symp-
toms, some  of which had before  been  thought actual
diseases.  Others had been attributed to morbid changes
in the brain,  heart or lungs.   Bright gathered up these
various evidences of imperfect action, and traced back
their origin to a common seat.  Before his time the treat-
ment of renal  dropsies,  uremic coma  and convulsions,
was uncertain and ill-directed.
  Turning to cutaneous affections,  we may again observe
the fruits of a more correct pathology.   Now  we can
classify  them  more accurately,  and determine  their
natures more precisely.   The present system of Wilson,
founded on peculiar tissue changes, has greatly simpli-
fied their management.   He has unified what was diffuse,
and  given true bent to research.  Our knowledge  of
parasite agency is of recent date.  But for this, patients
with  scabies and  the varieties of tinea, would perhaps
still  be depleted  by bleeding, low diet and general ex-
haustive measures.   The  subject of  contagious germs
has been newly awakened by Pasteur and kindred spirits.
Of certain  diseases,  he  (Pasteur)  says:  "It is in  the
power of man to make disappear from the surface of the
globe parasitic maladies,  if,  as is  my  conviction,  the
doctrine of spontaneous  generation is a chimera."  That
it is a myth most scientists now believe.  Its epitaph has
been  written  in  characteristic language  by Huxley :
"But the tragedy of science ;  the  slaying of a beautiful
hypothesis by an ugly fact, which is so constantly being
enacted  under the eyes  of philosophers, was played."
And to how many a charming theory will these words
apply !   How often have the pioneers in  natural knowl-
edge stripped  off the mask which concealed plausible
error, and with a single incisive factdestroyed its false life !
  Increased pathological knowledge  has also taught that
a number of diseases  before thought primary, rarely occur 
12
as such.  Says Dr. Gull : "The investigations of morbid
anatomy have thrown a flood of light upon the so-called
idiopathic diseases.   Formerly such affections were sup-
posed to be of common occurrence, and the treatment of
the day was adapted to their  supposed violence.   But
how rarely now do we meet with a case of  acute inflam-
mation of the membranes of the brain,  or  of the perito-
neum,  or indeed of any-other texture,  which we cannot
refer to some chronic lesion, or to some distinct cachexia ;
the only idiopathic part of the case being that which was
formerly overlooked or unrecognized—some chronic tis-
sue  change unnoticed in the storm of acute disease to
which it had  given rise."
  Turning to  chemistry, we can barely  glance at what it
has  recently  wrought.  It deals with matter, and takes
no cognizance of vital force except to attempt  its inter-
pretation by  chemical law.  Hence  it can calculate re-
sults with mathematical exactness.  It tells us how much
food and drink a man requires;  how much oxygen he
absorbs, and  how much carbonic  acid  he exhales ; how
fast  the tissues waste and form.   It measures muscular
and nerve power by weighing the products of excretion.
It shows how waste of tissue affects  the constituents of
food, and how the loss may be prevented in the greatest
possible degree.  It has taught us how  to recognize some
of the  commonest affections we are called upon to treat.
It has analyzed the blood, thus enabling us to supply
deficiencies and cure disease.  It has taught the diffusion
of medicines  after entry into the circulation—has traced
them to remote tissues—and now studies to know the
effects there produced through the channels of oxidation
and nutrition.  The test-tube, associated with the micro-
scope,  discovers morbid action, tells the result of regi-
men and treatment, and guarantees success where fifty
years ago all was  uncertainty.   Chemistry points  out
defects of nutrition  or assimilation,  pries into  nature's
secrets  and  extorts  answers  by delicate experiment.
It even  seeks to account for  life itself by the mutual
actions  and   reactions of molecular  particles.   Call-
ing  galvanism to  its aid,  it has decomposed matter
previously thought  elementary : and by spectrum ana- 
13
lysis brought within range of human sight components
of sun and  stars.   By synthesis it creates new bodies ;
by analysis  breaks up and tests those already existent.
It has aided pharmacy by introducing new remedies, and
by divesting old ones of nauseous and inert constituents.
By the discovery of anaesthesia it has abolished pain,
robbed surgery of its chief terror, and given new impulse
to vivisections.  These  are a  few  only of the facts of
modern medical chemistry.   It  is now more  active and
far-reaching than ever  before.  Its  possibilities  cannot
yet be known.   The chemistiy of nutrition  in  all its
steps, of secretion, of sensation  and of motion is being
investigated by thousands  of prying eyes and  honest
seekers after truth.  With each  new development let us
hope  to know  better  how to cure  disease  and grant
relief.
   Another reason for the difference between old and new
school practice,  arises from  the  present  more  perfect
knowledge  of the natural history of disease  uncompli-
cated by art.   At  the commencement of this century
neither the temper of profession nor public was favorable
to its study.  Not until a later period did  the expectant
plan  come  into vogue.  By it we were taught to wait
and watch,  in cases where the indications were not clear.
More attention began to be given the patient's surround-
ings, including fresh air and sunlight.  Fifty years ago,
no extended means of  observing how much  nature  un-
aided could accomplish was in actual possession of phy-
sicians.  The  expectant plan has done good service here,
but we owe more to the results of so-called  medication
according  to  the ideas of  Hahnemann.   His mode of
cure  has unwittingly afforded an opportunity to observe
what results  from a  strict  reliance  on  the healing
power of nature.  It has helped to separate  the class of
ailments  which certainly tends to  recovery,  from  the
smaller class which surely tends to death.
   The plan of non-interference also, leaving nature un-
trammeled  in the contest, the medical attendant acting
only  when  danger threatens,  holds  an important place
in the conservative medicine of our day.
   From  these passive methods we have learned that dis- 
14
ease is subject to natural laws ;  that  certain of them are
self-limited as Dr.  Jacob Bigelow wrote  years  since :
"incurable now by art, yet  susceptible of recovery un-
der natural processes."  We thus recognize in sickness
the beneficent hand of nature trying to repair any injury
following the infraction of  her  laws.  We have  thus
been led to greater conservatism in practice, and made
to feel content with being the ally of nature, rather  than
the antagonist of disease.   This knowledge teaches us
to avoid active treatment in the acute  eruptive fevers,
as scarlatina,  smallpox, and typhus—particularly in the
early stages.   We  forbear giving medicines at all  un-
less special  indications demand them.    Then those
causing least perturbation of the system  are selected.
Our science  is not the mere administration  of drugs.
Quackery is  founded on that idea.  It is probably true
that rational medicine doses less than any of the spurious
systems of the time.  It proves our growth and strength.
  We have thus indicated some of the modes by which
recent attention to  the natural history of disease has
wrought changes in practice.  Lest there be a misunder-
standing, it may be remarked that nature is not always
beneficent. Up to a certain point she is invariably  con-
servative ; beyond it no less destructive.  There may be
considerable jarring of the structure,  and yet its inherent
power to correct will suffice.  A sudden shock or long-
continued  pressure may overturn  or  undermine  the
fabric.  Then, the very activities which before served to
regulate, will tend to swifter and more complete disrup-
tion.   These  are  the cases which demand prompt and
intelligent  interference, and  fortunate will be he  who
both instinctively and by the light of science can foresee
the danger in time to avert it,  or being suddenly con-
fronted by it,  can stay its'progress by the resources of his
art,  "The strength of modern therapeutics," again says
Dr. Gull, "lies in the  clearer perception than formerly
of the great  truth  that diseases are but perverted life
processes, and have for their natural history not only a be-
ginning, but equally a period of culmination and decline."
  The agencies so far considered belong to the domain of
pure science.   Their laws are as invariable as gravitation 
15
or planetary motion.   They aid, however, in clinical in-
vestigation and  diagnosis.  These last draw largely on
simple observation.  Much of the knowledge here gained
is intuitive.   When called to the bedside we may not be
able to unriddle the problem by any known laws ; and
yet we cannot wait for science to explain.   Were less at
stake we might afford to stop and dream.   But knowing
that certain  measures  promise relief, action  must be
taken.  Clinical medicine too includes all  we can learn
of the natural history,  besides peculiarities of race or
family, temperaments, pre-dispositions, age, hereditary
transmissions and general  surroundings.   The present
knows  greater opportunities for its  study  than an}7 for-
mer time.  The tendency of population towards  cities,
coupled with a  spirit of increased benevolence,  have
brought larger numbers of sick people together into hos-
pitals,  infirmaries and asylums.   These  are  not the
growth of half a century by any means,  for  hospitals
sprang up soon after the birth of  the Christian religion.
Our care for the sick poor only faintly reflects the spirit
of Him who regarded suffering with divine compassion,
and taught the universal brotherhood of man.  Yet at
no previous time has there  been so general a disposition
to include within the scope  of charity the entire range of
suffering.  And since a few years only has there been uni-
formity of system in the classification of hospital cases.
The establishment of  separate institutions for  diverse
classes—grouping diseases of special types—arranging
them  most favorably  for  study and comparison—all
these  give the superior opportunities now afforded the
clinical observer.   Of late the  necessity for bedside
instruction has taken hold of teachers and pupils.   The
better  the means for  supplying this  demand the more
successful colleges become.  So keenly has the fact been
 felt that now each school seeks rather to show its hos-
 pital advantages than boast its celebrated names.   It is a
 long step in advance.   And  yet we must regret that
 medical education, especially in the United States, is so
 defective.   None realize it  as  sensibly as  the profession
 itself.  Our National Association is doing much for its
 improvement.   Our State Society heartily seconds the 
16
wish so generally felt.   On  us, the Medical  Society of
the County of Kings, is laid a responsibility in this mat-
ter which I am sure will not be disregarded.
  Again, medicaltreatment basal ways been influenced by
the prevailing idea of what underlies manifest symptoms.
To know the quality of a disease has ever been believed the
first necessity.  No dissensions among professional men
of all generations here.  As science advanced, the means
of arriving at this end have multiplied.  Each decade has
added to knowledge previously acquired.  New methods
of exploration have been instituted.  Changes of struc-
ture and function of internal  organs are now recognized,
and symptoms formerly  without  meaning  been  made
plain.   We appreciate the large class of chest affections
with a certainty unknown prior to auscultation and per-
cussion.   We look into the interior of the eye, and not
only learn  the  nature of diseases peculiar to  itself, but
gain reliable information regarding the circulation in the
brain,  and  morbid changes  occurring in the kidney.
Near!}7  all  the instruments  for illuminating  the dark
cavities are of recent birth.  The various means for esti-
mating  the forces of propulsion  within  the  body,  of
measuring  its temperature, and of appreciating its irri-
tabilities, date not beyond our recollections.   These are
not a tithe of the  new aids now employed.  Pathology
also helps  by explaining  symptoms  before without
import, or  falsely attributed  to  wrong  factors.  The
recent knowledge  that vegetations  sometimes  break
away from the valves of the  heart, and plug important
vessels, has fully accounted for many instances of  idio-
pathic gangrene  of an extremity.   Here then  a  new
diagnostic   fact illustrates  a train of symptoms and
necessarily  varies treatment.  The recognition of what
will probably  follow certain morbid conditions  of the
brain gives us the clue to a variety of nervous  complica-
tions.  Symptoms once described as diseases have found
their subordinate sphere.  Affections once believed iden-
tical,  are known  to be  distinct.   The various cachexias
are more perfectly estimated.  But this  will suffice to in-
dicate the influence which modern aids to diagnosis have
exerted on the therapeutics of the day. 
17
  Further,  the  division of labor among  medical men
whereby specialties arose,  became imperative with the
increasing desire for knowledge.  The fields of new in-
quiry became too extensive for any one mind to com-
pass in all their  departments.   Says Tyndall:  "The
system of things which we call nature is, however, too
vast and various to be studied first hand by any single
mind.   As knowledge extends there is always a tendency
to subdivide the  field of investigation, its various parts
being taken up by different individuals, and thus receiv-
ing a greater amount of attention than could possibly
be bestowed on them, if each  investigator  aimed at the
mastery of the whole,  lilast, West, North and South, the
human  mind pushes its conquests; but  the centripetal
form  in which  knowledge  as a whole advances, spread-
ing ever wider on  all sides, is due in reality to the exer-
tions  of individuals,  each of  whom directs  his  efforts
more  or less along a  single line."   Such  method is a
feature of  later times.  Branches, now well developed,
had only spasmodic life until made the subjects of special
stud}' by men peculiarly fitted both by tastes and op-
portunities for their work.  These several lines converge
to a common centre, and their mutual reactions are stim-
ulating and healthful.   New facts are  thus brought
within  the circle of medical knowledge, and  old errors
exposed.
  Nor would we  ignore the effects of irregular systems
on  the profession.  Indirectly  they have been of service.
Rational medicine is not willing to reject aught of good,
through whatever channels it may come.  It only refuses
what is not proven.   We believe in few specifics.   Both
reason  and experience teach that a broader basis must
underlie sound practice.   In truth, the history of these
systems go to prove  the strength of ours,  as  they con-
tinue existence only by approximating more  and more
nearly  the methods we   pursue.  But without seek-
ing to  conceal their influence, or ignore the "soul of
truth"  however small, which  doubtless every belief of
even  moderate  growth envelops, we  still must measure
each  by  its accord  with reason and common  sense.
From this  stand-point it will be perceived that medicine, 
18
based as it is  on the several sciences  considered, and
governed by laws variously derived, must be incompati-
ble with  systems founded on  exclusive theories.  It is
this incompatibility which prevents union—which fore-
stalls any  attempt at honest  commingling.  We  owe
homage to  that venerated idea, born of  the  stern neces-
sity which  demanded relief for the infirmities of fellow
man.   Our faith  is in principles early  derived  from
observation,  nurtured during the  pre scientific period
by  priest and philosopher, which in  latter  times have
brought to  their advocacy the highest  culture, the keen-
est experimentation,  sound logic,  vast clinical  teach-
ing, and have been verified by an advanced and modern
scientific thought.
  Next let us notice the past and present effect of theory
in its relation to  this question.  The time  is not long
since medicine was dominated  by such influence.  Each
doubtless contained a germ of truth.  No rumor gains
currency but had  its  beginning in some fact; no tradi-
tion coming down from remote ages but infolds a want,
an experience or action of the past, which has its coun-
terpart in our own times  or persons.  The fact of enter-
taining such is not reprehensible ;  the error is in allowing
it  to usurp the  place of positive, abiding proof.   Hy-
potheses may aid  in  our branch as well as  in algebra.
When confined  to subordinate spheres of action much
benefit may thus be derived.   The labor of rational med-
icine has been to sift these, and by repeated  winnowings
secure the grains of wheat.
  But, it may be urged, what gain to  have even  correct
theories of  life and disease, of catalytic action, psychical
peculiarities, etc., whilst we possess no power to control
their  processes?  The answer  lies here.  All thinkers
will seek in some mode to account for the activities going
on about and within them.  To discover and accept the
true,  will at least exclude the false.   Besides,  it  pos-
sesses force.   "Right or wrong,'' says Tyndall,   "a
well-uttered theory has a  dynamic power which operates
against intellectual stagnation ; and even  by provoking
opposition is eventually of service to the cause of truth."
Formerly dogmatic, they are now subservient.   To per- 
19
ceive clearly how our present estimates of them have in-
fluenced practice, let us quote  from a late  president of
our State Medical  Society  (Dr. White,  1870):  "The
greatest improvement we have to chronicle as occurring
during the last forty years in the practice of medicine,
consists  in the broader and more rational  views  now
taken of disease.  Physiology and pathology guide in
diagnosis and treatment instead of a preconceived theory.
It would now be impossible for any one to lead a large
number of  the better portion of the  profession into the
adoption of a system so partial and unsatisfactory in its
foundation as Broussaism, which prevailed  to a great
extent at the commencement of the period under consid-
eration.  No practitioner of the present  day deems it
necessary to bleed simply because the patient has pneu-
monia.   No intelligent physician would be sustained in
giving tartar emetic or turpeth mineral where croup was
diagnosed, at least  until its peculiar character was first
ascertained."   Theories then,  as such,  have lost their
former power to direct our actions. They are entertained
on!}- long enough to be tested ; are still employed as in-
struments for unearthing facts.
   Again, we sometimes hear of the decay of general health
as a reason for the change.  Whether  true or false, similar
ideas have had  place since the earliest historical records.
Nevertheless, we know the average of life has been length-
ened within a century past, and more than doubled since
1500.  Medical  art  doubtless keeps  alive a feeble class
who would otherwise  succumb.   These  blend with the
more robust and form intermediate grades.  Whether or
not the  general average of health is thus lowered, is still
an open question.   The belief does not enter largely into
the estimate of physicians, or  account in any marked
degree for  their modern milder practice.
   But the development of new symptoms within a recent
period,  associated with their depressing effects upon the
sick,  accounts  in a  measure for the present supporting
plan, as opposed to the lowering methods of fifty years
ago.  A living author (C. Handheld  Jones) says : " It is
difficult to form a decided  opinion in the matter, but
there seems reason to entertain the belief that failure of 
20
nervous power  is much more characteristic of disease of
the present day than of that which prevailed forty years
ago.   For this  there may be various causes ; the greater
confinement of  large numbers of the population within
doors, and  often in unhealthy  rooms and  workshops ;
the harder  struggle to be  maintained in the battle of
life ; the greater amount of  the commoda vitoz  (luxuries of
life) may  all tend to increase the  susceptibility of the
nervous system, and to impair its resisting power."
  With increased attention to hygiene we also find an
important cause of change.  This branch, formerly neg-
lected, has now acquired strength to stand alone.  It has
sought out causes, taught the  natural history of mala-
dies, and proved the uselessness of combative treatment.
It takes cognizance of all the circumstances which modify
the effects of medicine.  Age, temperature, season of the
year,  light,  air, soil, drainage, modes of life, passions,
diathesis,  individual peculiarities,  food, raiment;—in
fact,  all the surroundings of man are included in its
study.  Its  investigations go  further, and in directions
different from  those pursued by our fathers.  Its influ-
ence is ever widening.  It assumes an importance superi-
or to the routine of medical practice.  It teaches and re-
strains it by arguments derived from nature  herself.
  Another class of agencies which operate in the direc-
tion we are considering, may be grouped under that com-
prehensive and suggestive idea,  "The spirit of the nine-
teenth century,"—investigating,  analyzing,  gathering
from  all  sources, securing greater  precision  by surer
processes  of reasoning, by experiment, by invention, by
aids derived from physical science, and more than all by
the indomitable energy of a host of laborers enlightened,
prompted and  often rewarded by it.  One of the fruits
of this spirit is seen in the ever increasing number of in-
dependent minds devoted to the interests of  medical sci-
ence.   A legitimate outgrowth is the prevailing scepti-
cism which challenges the legal claims of accepted doc-
trines.  We  recognize two qualities of this.   One, the
offspring of ignorance, is destructive ;  questioning not for
the sake of truth, but to crush belief.  The  other is the
healthy criticism of existing faith, not to destroy but to 
21
prove it; a qualit}7 which every strong and honest mind
possesses. The more diffuse becomes a sound education,
the more this disposition shows itsel f.  It examines every
fact, and seeks its true value.  It doubts theories not thor-
oughly canvassed, and practice not fortified by well direct-
ed  experience.  It is eminently healthful ;  burning up
the dross, but makes the gold more lustrous by the fiery
ordeal.  It  is accused of lack of reverence for high
authority; but this  is only  apparent,  It reviews each
system from varied  stand-points, and thus enlightened
becomes more capable of judging  rightly and teaching
authoritatively.   It pervades every department of "na-
tural knowledge," and questions revelation itself.  With-
out stopping to  inquire  its effects on religion ; which
we believe to lie outside the sphere of scientific fact—to
be  founded on truths  miraculously revealed—we cordi-
ally admit its aid to a better understanding of nature.
But the outgrowths of this wholesome quality—independ-
ent thought—involve  danger to  the  cause  it  hopes to
serve.  To pass from old errors even to new truths, and
avoid the  inevitable shock  of change, must  be  slowly
done.  Advantage will be taken of the transition to in-
culcate ideas which may captivate  by their  novelty  and
retard true science by their falsity.
   Nor has  medicine escaped  the effects  of  reactions
consequent upon loss of faith in doctrines once ardently
professed.  It has had  periods of increase and  decline
—now believing much, then  doubting all.  The  time
was when  to doubt was  heresy.  The  spirit of  intoler-
ance was  as potent in  medicine as in religion.  "To
question,"  says  Dr. Peaslee, "the infallibility of Hip-
 pocrates or Galen was as rare as to doubt  the teach-
ing of St. Paul or St. Augustine."   The doctrines of the
medical fathers was law.   Their errors escaped criticism.
 This blind faith forbade inquiry and  hindered progress.
 Not until  our century was it supplanted  by intelligent
 doubt.  To this  latter we owe much.   But for it many
 facts now open would be a sealed book.
   Another  quality  born  of independent  thought, so
 characteristic of  the past twenty-five years, is analysis.
 Its bounds are co-extensive with the limits of knowledge. 
22
Its  modes  of operation are as  multiform as the laws
which govern matter.   Its tests are as minute and critical
as they are decisive.  Not content  with physical ele-
ments, it seeks to grasp the essence of soul itself.
  Again, the spirit of  modern times is apparent  in the
ever widening range of diseases coming within the scope
of medical influence.   Who would  have thought, five
decades since,  that intemperance would  have a place
here, to be subjected to laws of physical hygiene, and
to be restrained  by material remedies?  We believe in-
ebriety to be a disease affected by hereditary influence.
Dr. Maudsley says: "Multitudes of human beings come
into the world weighted with  a  destiny  against  which
they have neither the  will nor the power to contend ;
they are the step-children of nature and groan under the
worst of tyrannies—the tyranny of a  bad organization."
  The present treatment of the insane was derived from •
a like cause.  The knowledge of the interdependence of
physical and psychical symptoms, both demanding con-
servative guidance, and clearly  shown  to depend on
physiological and pathological laws, flows from the re-
cent interpretations of the phenomena of life and  dis-
ease.
  There is abundant indication of this spirit in each de-
partment of our science.
  " Now,  as never before," writes  Herbert  Spencer,
"men  of science  throughout the world subject each
others  results to the most searching examination,  and
error is mercilessly exposed and  rejected as soon as dis-
covered."
  The rapid interchange  of thoughts and ideas  made
possible by our more perfect methods of communication,
has contributed largely to  this end.   Knowledge is now
more generally diffused, and bears rich fruit,
  In earlier years the  ultimate  actions  only of drugs
were studied.   Now we seek, in addition,  their local
effects and their  special modes  of production, whether
chemical, mechanical,  or vital.  Wre are not a whit in
advance of our ancestors, nor they of the ancient Hindoo
or Arab in observing  the  ultimate result of  remedies.
They watched as closely and observed as candidly as do 
we.  Yet  their  practice was empirical—not in its  re-
proachful sense.  We are proud of their deeds,  but with
new resources seek to lift our calling to a higher level.
  The  tendency of our  times is well summed  up by a
late President  of the British Medical Association (Dr.
A eland):  "We are  living in a  critical period of our
country's history ; in a new era in the history of man.
Every  part of our social fabric is undergoing scrutiny,
revision,  and reform.  Government,  trade, institutions,
laws, the artificial usages of society, the character to be
given to our children by the method of their early train-
ing, are not only being criticised, but are most of them
being  changed—changed with  unexampled rapidity ;
and the  change is, some think, a tendency to  absolute
perfection, or, according  to  one  philosopher,  a last
plunge down the  Falls of Niagara.  The  facility with
which ideas are communicated through the whole human
family, distinguishes our  age from  all that precede it.
Our own profession is not exempt from their influences."
But as here implied, this characteristic spirit is not free
from  peril.  A balance wheel  is ever  necessary.  We
find in our ranks  the party of progress and the party
of order.   They must be made  to harmonize.  Each has
its functions, and within certain limits their relations are
wholesome.  One perhaps seeks to advance too rapidly ;
the other  may be unduly conservative.  Our endeavors
must  be to make each react properly on the other—now
restraining, now urging forward, with mutual respect
and earnest desire for genuine advancement.
   In view of  the facts noticed, can it be wondered at that
some of  the old landmarks have been  forgotten, or that
new methods  have  been adopted  to  correspond with
modern  revelations ?  On the contrary,  should we  not
be astonished to find medicine  pursuing  the same  old
paths?  Instead of diminishing  confidence, or being  a
reproach, it should be our pride and hope ; stimulating
effort, strengthening faith, and widening our influence
for good.
   We all concede the change.  I have tried to point out
the chief agencies  producing it.  We  may do well to
note where it began; whether within our own  ranks or 
with the prior demands of the non-medical world.   Not
with the latter,  we  believe.   Professional opinion has
ever been in advance of society's knowledge of its medi-
cal wants.  The laity, too long mystified by the intrica-
cies  of our art, is slow to be convinced.   Reactions in
public sentiment have frequently occurred, but usually
from one extreme to its opposite.  Fashion has its vota-
ries here as well as elsewhere, and physicians have some-
times been its slaves, obeying its dictates.  Certain reme-
dies have their day, and pass into oblivion.   Systems
flourish for a  time, and then become only facts in history.
Dogmas dominate the multitude for brief seasons, and
thus expend their force.   These influences act their part
in modifying opinion and practice ; yet we must seek in
the profession itself for the little leaven which has leav-
ened the lump.   In 1846, Sir John Forbes surprised his
brethren by the  publication of views  far in advance of
his time.  He propounded a series of startling questions.
They were radical—touching the foundations of practice.
He set a power in motion which has aided immensely in
establishing the present methods.   Time has proved the
keenness of his perceptions, and our  art has been pro-
portionately  advanced.   Other influences seconded his
desires.   Physiological arguments  enlightened ; pathol-
ogy  demonstrated ; chemistry analyzed ; physics sup-
plied the  means.  A few years later, Dr. Bigelow, of
Boston, satirically called attention to the importance of a
" new departure."  His essay gave a powerful impulse
to the little  stream which has now become a  mighty
river.  Others pleaded, yea, demonstrated  the same ne-
cessity.   Now, physicians generally recognize  the new
order of ideas and seek  their acceptance.   A few only
cling to pre-scientific dogmas.   Careful thought  con-
vinces us therefore, that all  material changes have, as a
rule, originated within our ranks.   Those who  minister
in healing have  ever been more alive to the necessities
of medical art than those minstered to.
  But amid so much of change, the question arises as to
what, in medicine, is fixed ?  Its fundamental principles
are invariable, but the  precepts guiding  treatment de-
pend upon the standpoint from which those principles 
25
are viewed.  These various angles account for the numer-
ous sects which have existed.   Rational medicine, know-
ing no exclusive theories, seeks to infold these principles
and establish  laws of action from observation  of facts,
reinforced by ample verification.  But without perfect
knowledge principles will be variously interpreted.  And
shall we exclaim, how have faith  in  medicine, because
of disagreements among its expounders, as if principles
were to be set up or cast down by the varying  opinions
regarding the best modes of carrying them into  effect?
   It is not so with other branches,  either of politics, sci-
ence or religion.  We do not find clergy and churches
of one jnind as  to  the best mode of  christianizing the
world.   The interpreters  of civil law are  not always
found to accord ; and  it would be surprising indeed  to
have journalists, statesmen and  honest politicians  a
unit on the subjects of tariff, reconstruction and other
important questions of the day.
   In view of these, we  cannot wonder at divergent
opinions about the details of a science  so  complex  as
ours;  made up  from  materials  derived  from  many
sources; dependent on several classes of inquirers;  in
wiiich discoveries and  improvements, owing to the ne-
cessity for fidelity  and capacity  in  individual observ-
ers, are often clogged with discrepancy and confusion.
   Then there are erroneous impressions regarding the sta-
bility  and powers of medicine.  The  idea of fixity has
no analogy in  other systems.   Basic pillars  remain,
but the structure above assumes new shapes to  meet the
imperative demands of new ideas.  This necessity evokes
new forms of law, and is the  normal outgrowth  of an
enlightened sentiment.
   There should be no misunderstandings between the pro-
fession and the intelligent public  on these points.  We
have, perhaps, claimed too much  for our science ; have
been too anxious to explain away and mystify its failures,
instead of confessing them.  It has done well, but that it
is destined to overcome all the diseases now pronounced
incurable, or that through its agency the average of life
will be greatly increased, we have no good reason to hope.
It does, however, lie within the power of improved science 
26
to " stamp out"'  some of the loathsome affections of the
time ; to add to the comfort of humanity by a more uni-
versal education of the laws of life;  to distinguish more
clearly between  the classes curable and those not so,
affording  perfect relief to  the former whilst lightening
the heavy burdens which oppress the latter.  To do these
things is glory enough.   Let us pursue them studiously
—with enthusiasm—and not waste time or powers in fol-
lowing after ignesfatvi beyond the reach of human grasp ;
making efforts as vain  as  were those of the  cabalistic
school who ransacked heaven  and earth for the "phi-
losopher's stone" and the "elixir of life."
  There is also a too general idea that  physicians them-
selves are becoming more and more incredulous regard-
ing the power of  drugs.  True, fewer are now given than
formerly, and why % We have  learned to rely more on
the curative powers of nature,  to discriminate more per-
fectly between cases requiring  aid  and those which can
be  safely trusted to her care, subject to proper condi-
tions of rest,  temperature, diet and air.   Old practition-
ers employ few remedies, but cling to these with child-
like faith. The profession has  learned the uselessness
of some,  and the  wider range of  efficacy of others.
Their modes of preparation are  more perfect, their phy-
siological effects better  understood.   Those in use  are
more  concentrated, more agreeable,  divested  of inert
matter.   Then,  medicine now  dares plead ignorance of
many vital questions.  It has less fear of subverting old
theories by new facts.
  Another drawback has been the desire to reduce thera-
peutics to an exact science.   At best it is an art, but may
be practiced in accordance with scientific rules.  Yet the
science  and art  must be distinct.   One seeks to know.
the other to  do.   Art may precede science, or science
may give the first clear intimation of the necessity of art.
In former times they had less interdependence.  Of late,
science  has  dignified art,  and made it more skilful.
There are excellent physicians whose scientific  attain-
ments are nil—whose practice  is  therefore  empirical—
whose knowledge of disease does not extend further than
from the general aspect of  the case in hand to others of 
27
a similar nature  previously observed.  Between such
practice and that directed by the light of thorough scien-
tific training, lies  the vast domain represented by  the
various branches of medical knowledge.
  For a parallel, I quote from one of Mr. Froude's ad-
dresses to agricultural students.   Says he: "The peas-
ant's  business  is  to make the  earth grow food.   The
elementary rules of his art are the simplest, and the rude
practice of it the easiest; yet between the worst agricul-
ture and the best lie agricultural chemistry,  the appli-
cations of machinery, the laws of the economy of force,
and  the most curious problems  of  physiology.   Each
step of knowledge gained in these things can be imme-
diately applied and realized.  Each point of the science
which the  laborer masters  will  make him not only a
wiser  man, but a better workman ; and will  either lift
him, if he  is ambitious, to a higher  position, or make
him more  intelligent and more reliable if he remains
where he is."
  Similar intermediate  steps, understood  and applied,
constitute  the  difference between the scientific  practi-
tioner and the mere routinist.
  Another influence which has perverted practice, though
now less potent, arises from the  fact that  medicine  has
been so hampered by superstition.  Unlike other branch-
es,  it  must lie outside the circle of general education.
Having been long  held as one of the " occult  sciences,"
monopolized during  its earlier  history by those  who
claimed it as a special gift from Heaven, it is not strange
that a sort of mystic halo has ever enveloped it.  Though
the spirit of our century has laid most of these ghostly
forms, it is still the department about which false teach-
ers and a credulous community love to weave the web
of romance.  The victims  of its doctrines falsely inter-
preted, like to believe and do not like to be undeceived.
The marvellous has a charm which the "logical  feeble-
ness of science" cannot break.   The remedy lies in  the
surer process of education, rendering the mental soil  un-
fit for the growth of weeds.  Its just appreciation by the
sceptical must be the legitimate fruits of healthful ideas
cast into the soil  by its honest  expounders.   Then, as 
28
seed requires warmth, and light, and moisture to spring-
up  and bear grain,  so must the  advocates of rational
medicine bring their facts into the light of literature,
water them with the dews of 'experience, and  furnish
warmth through a wholesome enthusiasm which goes far
towards conviction.   Without these we shall surely fail
of much result.   Apathy in the best of causes is without
effect other than to induce a reaction against it.
  Some may think I have  belittled the value of the pro-
fession.  Not so.  I  have sought to place it in its true
light.  No special pleading  is  needed  to establish its
claims.  We can afford to speak the truth, relying upon
its  merits for  timely vindication.   Facts  cannot shake
the faith  of those best informed,  nor can light reveal
aught we  are  not most anxious to avoid.  We do not
claim perfection. What system of government, educa-
tion or philosophy can do it?  Yet medicine has kept
pace with other  departments.   It is in advance of, and
perhaps restrained  by  the tendencies of society.  We
believe in no startling revolutions,  overturning good and
bad alike.   We rather seek  to separate the chaff from
the wheat.   We  desire to hold fast the  good of every
century, to imbibe  from  every  source,  to lay  under
tribute every power which can aid  in the prevention and
cure of disease.
  There are yet  problems of vast import to be  solved.
The mysteries of medicine are not easy of explanation.
If so it would not deserve  its present  rank.  The multi-
tudinous  phenomena which  fall under  the  observation
of an inquiring physician are the results of laws far-
reaching and obscure.
  Divesting it of all  scientific claims, and thus reducing
it to  the level of a  simple healing art, tends to empiri-
cism, and dwarfs the intellect.  It is mystery which pro-
vokes activity and  develops those royal  qualities  of
mind which have distinguished so many in our ranks.
  The possibilities of our  times are immense.   A score
of years more will give results not yet conceived.  Intel-
ligent faith admonishes  us  that  we are right  on  the
threshold of greater achievements.  Some claim to have
already half entered the "promised land;" others still 
29
grope and feel their way.   But there is no royal road to
truths  yet  undeveloped.  Hard,  earnest, faithful work
alone  furnishes the means.   Much progress has been
made since our Society was organized, but more remains
un wrought,
  " Medical science will be complete only when the struc-
ture and the functions of all the tissues and organs in the
body  shall be  understood,  and  all the counteracting
agents to all abnormal structures and diseased functions
are ascertained."
   The true end of all this research lies in an increased
 power to relieve suffering and cure the ills of life.
   ,1 ust in proportion as this Society aims thus to do good,
 will its  members enjoy the peaceful fruits of conscious
 right,  and retain the generous confidence reposed in them
 by the citizens of Brooklyn.   So doing, should any of us
 survive  its centennial, we shall be able  to scan the  cen-
 tury closed, as now we contemplate the  fifty years past,
 and with  just pride feel  that the  Medical Society of the
 County  of Kings has not existed  in vain. 
 
 
\*&