BONDS OF PROFESSIONAL UNION, DELIVERED BEFORE THE MEDICAL ASSOCIATION ADAMS, BROWN, AND CLERMONT COUNTIES, 0.? AT BATAVIA, October 30, 184T. ~-_~*£L By JOHN P. HARRISON, M. D. Professor of Theory and Practice of Medicine in the Medical College of Ohio, QINCINNATI: ATLAS JOB ROOM PRINT. 1847. CORRESPONDENCE. Georgetown, O., Nov. 26th, 1847. Dear Sir:—At a meeting of the Medical Association of Adams, Brown and Cler- mont [counties, the undersigned were appointed a committee to express to you the high pleasure afforded the members of the Association by the able address recently delivered by yourself before them; and, also, to solicit a copy of the same for pub- lication. We take great pleasure in performing the duty assigned us, and beg leave to assure you of the high estimation in which your character and talents are held by the society which we represent, as well as by ourselves. T. M. TWEED, ) ALEX'R B. HETERICK, > Committee. P. J. BUCKNER, ) Prof. J. P. Harrison, ) Cincinnati, 0. ) Cincinnati, Race and 4th streets,) Nov. 29th, 1847. \ Gentlemen :—Agreeably to your request, so kindly communicating the resolutions of the Medical Association, 1 send you my address for publication. Accept my assurances of great regard, individually, and receive my thanks for your polite reference to the estimation in which you hold, Your very obliged friend, JOHN P. HARRISON. ADDRESS. Gentlemen :—Honored with your respectful invitation to address you on this occasion, I shall endeavor to meet your expectations by the discussion of a subject of general interest to the medical profession. The topic chosen for the following remarks is—what are the bonds of union in the regular medical profession. Physicians sustain three relations to society. As members of a particular circle, in the great body of citizens which compose the commonwealth, they sustain the special relations of neigh- bors, sons, husbands, and fathers. As members of the state, and of the general government, they sustain the relation of loyal subjects of a free, representative administration. Within the lesser orbit of domestic and social life, physicians are seen to revolve in a quiet tenor of existence, and as citizens of a repub- lican government they are undistinguished among the mass of their fellow men ; possessed of no separate franchises above their neighbors, nor endowed by any hereditary privileges beyond the birth-right of freedom obtained through a common charter of equality, which spreads its protecting canopy over all our heads. But within a circumscribed walk of intellectual effort, within the allotted limits of his peculiar vocation, the medical prac- titioner does hold certain inalienable possessions. He possesses knowledge of a technical kind, which makes his relations to his fellow citizens distinctive. He possesses certain rights ceded to him by the general consent of society, which endow him with a high capacity of control over the lives of his fellow citizens. And he possesses attributes of character which fit him for the exercises of the exalted functions of his professional duties. The mental acquirements of the physician should be of no ordinary compass and depth. For he has to deal with the myste- 4 lies of lite, of ilis.-.use, and of death. To him it belongs to penetrate the causes of the numerous maladies which afflict our race • to unravel the modes in which these causes act in dis- turbing the manifestations of life ; to trace the connection, and reciprocal dependence of one morbid action upon another, and io explore with ceaseless search all nature, through her animal, vegetable and mineral kingdoms, for substances which shall exercise curative powers over the multiplied diseases which he is called to treat. Standing in these special and most responsible relations to society, it behooves him most assiduously to make suitable prepa- ration for the discharge of the high and sacred duties appertain- ing to his office. To effect the great ends, and to fulfil the exalted duties which await his course of action, there are certain relations which he sustains to his profession which must be main- tained with an honorable consistency in his daily deportment. No incertitude, no ambiguity, no fluctuation of intention and conduct, should be exhibited by the medical practitioner in the maintenance of the great and important relations which he sus- tains towards his profession. These relations arise from the science and art of medicine, from the position the physician occupies in reference to his professional brethren, and from the final purpose of the institution of medicine as a humane pursuit. The bonds which unite the medical profession are those:— 1st, which pertain to the science and art of healing ; 2d, those which spring from the obligations we owe each other ; and 3d, those which are derived from the essential objects of professional action. The science of medicine, as made up of its elementary and practical departments of inquiry, possesses unity in four aspects of consideration :—First, unity of subject matter ; second, unity of modes of investigation ; third, unity of spirit prompting to investigation ; and fourth, unity of facts and doctrines. The art of healing is but the practical direction, and individual application of the truths of the science, and sustains such con- nection with the science as to be dependent upon every discovery 5 and improvement in the profession for coincident changes in the plans of curing disease. The profession of medicine in its integral, undivided character, is not only bound together by the science and art of cure, but its members stand related to each other in three special points: First, as cultivators of a common science, as gentlemen, and as practitioners of a common art. The essential objects of a professional action constitute another bond of union among physicians. These objects are the advancement of medicine in certainty, the promotion of a sentiment of respect in the community for the profession, and the wider extension of its usefulness among all classes of men. The great ends of the mission, which each physician should feel himself designated to accomplish, are to maintain an honor- able standing in his profession, and to illustrate the beneficent influence of medicine ; his final aim should be to cure disease, and mitigate suffering ; and the exalted destiny which awaits him in the fulfilment of his duties, is, to make preparation in this earthly theatre of his immortal being for an interminable scene of happiness beyond the,dark confines of the grave. The medical profession is bound together by the science and art of curing disease. And first by the unity of the subject- matter of all medical investigations. The human body is the subject-matter of all our inquiries. Its anatomy, its physiology, its pathology, and the modes of removing its pathological states, called therapeutics, these are the paramount objects of all the toil, protracted and varied, of medical practitioners, in all parts of the world. These have been the great ends of scientific labor in the profession during more than two thousand years. The regular profession of medicine are bound together in all quarters of the civilized world, wherever the light of a just philo- sophv has penetrated, and awakened into activity the faculties of man, bv the anatomical, physiological, pathological, and therapeutical researches carried on by the diligent cultivators of the science and art of administering to the sick. And we do not recognize any man as belonging to the true body of enlight- ened physicians who pretends to reach the ultimate conclusions G of practical medicine, without having hi^ mind habituated to those toilsome processes of inquiry which anatomy, physiology, pathology, and therapeutics demand, for their just and due acquisition. The unity which obtains in the modes of investigation into the appropriate branches of the science and art of healing constitutes an additional bond of union among regular phy- sicians. The truths belonging to anatomy, physiology, pa- thology, and therapeutics, are reached by a well defined line of perquisition. To comprehend anatomy, the human body must be dissected; to have enlightened views of physi- ology, observations of the operations of the animal economy in health, and in disease, with experiments on the lower animals, must be made ; to become conversant with the nature and seats of morbid action, the causes, symptoms and pathological anato- my of diseases must be studied ; and to conduct the treatment of patients successfully, the indications of cure, with the virtues of the agents by which these curative indications are fulfilled, must be most assiduously investigated. A wide scope is opened up to the faculties in the ample and diversified field of medical studies. And that the mind may not waste its efforts in random excursions, nor confuse its powers in perplexed and multiform trials to master the immense variety of data embraced in the almost boundless scheme of inquiry presented by Medical Science, it is of great importance that the student be early directed into the proper path of investigation. Beginning with the elementary branches, he is steadfastly to go forward, step by step, overcoming difficulty after difficulty, till he plants his feet upon the summits of the science. Those men who assume to themselves the prerogative of finding out the truths of medical knowledge without a careful and protracted examination of the fundamental branches of the science of life, and of disease, prove that they have been taught in the school of egotism, and that the lessons there inculcated partake most richly af the wisdom of him who has a fool for his master. Quackery, where science fails, steps in to their defence, And fills up all the mighty void of sense. 7 The spirit which animates and directs the inquiries of medi- cine, with pervading force, every where breathes its harmonizing inspiration upon the minds of the regular profession. This all. diffusive, directing, controlling spirit is made up of three elements: The love of truth, the desire of excellence, and the hope of be- coming useful. Inspirited by a love of truth, the medical student foregoes his stated seasons of rest—abandons the gaieties of social life—dedicates his hours to the perusal of the best authors—re sorts to some well conducted medical school, there to listen to the prelections of professors who have won a fair reputation for med- ical scholarship, and who have an ability for communicating the results of their scientific attainments to those who resort to them for instruction—and sedulously avails himself of the opportunities for dissection, and for clinical teaching, which every well con- ducted Medical College will afford. And this love of scientific truth will follow the well taught, thoroughly grounded, medical practitioner through all his subsequent life. Amidst the anxieties and privations of a laborious practice he will delight to hear of the progress of his favorite science, and with earnest curiosity will catch at every improvement in the profession, that he may render it subservient to the practical applications of clinical medicine. An aggrandizement of thought and of feeling pass- es over the soul of the true disciple of Esculapius as he contem- plates the onward and triumphant march of Medical Science, jand he hails with pleasure the presence of any of his brethren who sympathise with him in this love of truth, and with warmest regard he awards the tribute of his praise and admiration to each distinguished cultivator of Medicine. The desire of ex- cellence is ever found to accompany the love of truth. Positive excellence, of which the mind frames to itself an ideal concep- tion, but few attain. Some rarely endowed, heavenly guided souls, burst away from the narrow enclosure of the circumstan- ces which hems them in, and with a "brave disorder" seek new regions of discovery beyond the vulgar bounds of their little sphere, and thus assert and maintain their supremacy over the multitude around them. But most of men are actuated far more by a desire for comparative excellence than by abstract, or ideal conceptions of the true, and just, and fair, 8 A just and honorable emulation is the mainspring of action among men, in all the leading affairs of this earth. If an apos- tle wished to stir up the minds of his brethren by way of emula- tion to imitate and even surpass the deeds of liberality that others had exhibited, surely we may appeal to this same inherent power of human nature in matters pertaining to professional excellence. Great examples stir up in the mind of ingenuous youth a spirit of emulous strife to dare and to do—that the deeds of glory—the acts of high renown—which are embla- zoned on the page of history may be re-enacted with new dem- onstrations of personal valor, and accessions of human greatness. And living exhibitions of individual excellence tell with emphat- ic vividness upon our sensibilities—dead to all aspirations of goodness and of glory must an individual be who can gaze un- moved at the spectacle of a distinguished citizen, rising from the depths of poverty and obscurity, who, shining illustrious before his fellow men, owes all his proud elevation of station not to the accidents of birth, or of social position, but to the glowing impulses of his own generous nature, upon which God has stamped the bright signatures of his hand. The names of Boerhave, of Rush and of Good, awaken in the mind of every cultivated physician visions of goodness and greatness, which depart not from the bosom, warmed by their presence, during all the trials, and difficulties of his professional career. And the bright exemplifications of living excellence, intellectual and moral, which any of our professional brethren exhibit, are stir- ring appeals to our best emotions to put forth our most strenuous endeavors to imitate what we admire ; and even to go beyond in virtuous emulation the noble standard set before us, and thus to prove that we are linked in holy amity, in divine sympathy, with the good and the great The hope of hereafter becoming useful to society is another element in the spirit which animates the breast of every ingenuous young man to addict himself to the study of medicine. To do good and get good, is a strong motive to action. Selfish and sordid must that man be that looks on his fellow men as mere tools with which deception may play its winning 9 trade. And the vile tendency of empiricism is in nothing more signally displayed than in the miserable, degrading selfishness which characterizes all its dark doings. Quackery is ever characterized by the four prominent attributes of ignorance, impudence, cupidity, and inhumanity. Ignorant the quack will be, because he has no love of truth, no breathings after the disclosures of science. Impudent the quack will be, because he has no desire of excellence—no bright visions of mental and moral greatness ever floated before his prospects in life—his sterile nature was never warmed by any glowing aspirations after the good, the fair, the just. He has no bright examples before him to shame his sordid aims— no exalted standard to keep him humble—no urgent promptings after higher attainments to make him feel that "he that is wise in his own conceit is worse than a fool," (a person born imbe- cile,) " and there is no hope " of such an inflated mortal. For how can a man, given up to a devout adoration of his own greatness, ever be led to " admire superior wisdom and doubt his own," when all his time is occupied, and all his feeble intel- lect is engrossed by this one absorbing topic? Greedy of gain the quack is, and to his cupidity he is ready to sacrifice all fair pretensions to science, to honor, and to humanity. The spirit of quackery leads to bold and ignorant assumption of superior skill ; prompts to abuse of the regular profession ; urges to con- cealment of remedies, and to extraordinary modes of gaining a practice. Inhumane the quack is, because he assumes responsi- bilities which is totally inadequate to meet, and without prepa- ration deals out his nostrums to the credulous, whom he has snared into his meshes by his vaporings of skill. But the con- scientious and aspiring medical student surveys the whole ground which he is about to traverse, and feeling assured that without a strenuous consecration of his best powers to the subject he will never master the abstruse truths of medical science, he de- votes his entire man to the work. Never will a cloud of regret pass over the horizon of his contemplations in after life because he has too diligently given himself up to this worthy enterprise. Oh no! blessed and peaceful will the retrospection be, when the •2 10 now practitioner of medicine meditates on the deep responsibil- ities of his position, that by industry and perseverance he has thoroughly imbued his mind and disciplined his habits of thought and action, by a pains-taking dedication of his medical pupilage to the great interests of his profession. And now he feels in- dissolubly bound to that profession, and to all its genuine mem- bers, by the solemn associations of duty fulfilled, and of a warm espousal of his soul to all those glorious revelations of truth which medical science unfolds for the benefit of mankind. Ac- quitting himself of his obligations as a student when he takes upon himself the active duties of the profession, his self respect sustains him in the many trials he has to encounter, and the approbation of friends which circulates around his daily path, receives an echo in the gratulations of his own enlightened conscience. The unity pervading medicine in the great leading facts and doctrines which constitute the science, is another bond of union among cultivated physicians. There is an orthodoxy in medi- cine which stamps essential oneness on the. entire body of its truths. The fundamental points upon which all orthodox phy- sicians agree are—1st. That disease is a real evil—2d. That medical interference is an honest attempt to remove disease— 3d. That no honorable physician will tamper with the lives of his fellow men by reckless experiments, nor compromise the safety of the sick by studying disease as a matter of natural history—4th. That decision of character and promptitude of action are required in the practice of the profession—5th. That in order to meet the just demands of the public upon our skill, we must not only be prepared by previous study for the exercise of the responsible duties of the profession, but we must, by strict devotion to our business, be ever ready to fulfil its claims —6th. That the science and art of curing disease are advancing every day towards higher degrees of certainty and usefulness— 7th. That medicine is a liberal profession, and that in the regu- lar profession there are no secret remedies, no concealed pro- cesses of cure—8th. That anatomy is the basis of all scientific medicine, and that on anatomy physiology is established ; that 11 pathology which includes etiology, or the doctrine of the causa- tion of diseases—symptomatology, and morbid anatomy, must be simultaneously cultivated to enable the practitioner to pro- nounce a correct diagnosis of any case ; that thoMpeutics, which comprises indications of cure, and materia medica, or the reme- dial substances employed to carry out the curative intentions, must be made to emerge from a true conception of the nature and seat of disease, or from a just diagnosis; that chemistry, as a handmaid of practical medicine, has greatly aided its advance- ment ; that to the valuable contributions made to materia medica, by chemistry, the enlightened physician adds those deriv- ed from botany, and a few articles from the animal kingdom— for the candid and conscientious and well instructed practition- er rejects no remedy from prejudice, nor will he give up his soul to the base delusions of a pragmatic, dogmatic, and erratic set of doctors, who boast of their exclusive vegetable or botanic medication. Fit inhabitants of the weeds they love! "So morning insects that in muck begun, Shine, buz, and fly-blow in the setting sun." Physicians are related to each other by their common science, by the courtesy of refined society, and by their participation of attendance at the bed-side of the sick. Mutual advantages redound from the collision in friendly discussion of mind with mind in all the departments of human knowledge. And upon the recognition of this truth, have medi- cal associations, such as is here assembled to-day, been formed, for the furtherance of the great cause of medical improvement. The genial attractiveness, ever exerted by science upon its vo- taries, has been felt and responded to by the very respectable attendance of medical practitioners from this and the adjoining counties. As gentlemen medical practitioners are bound together in all the respectful regards which unite the refined and cultivated in the best states of social intercourse. Self-respect, deference towards the feelings of others, and a ready sympathy with them, are the sources whence flow all the amenity of manners, and kind communications, which constitute genuine politeness.— Honor should ?it enthroned upon the mind of the enlightened \2 physician. True honor is the legitimate offspring of a cultiva- ted and sensitive self-respect, joined to a high appreciation of the dignity which attaches to a truthful character, and a strict estimate of thc^hherent turpitude of every act which infringes upon the rights, the peace and the interests of our fellow men. Professional honor will impel us to maintain a courageous con- sistency in keeping along a direct path in quest of the advanta- ges of the profession. Directed and controlled by the honor and feelings by which gentlemen should be governed, we will strive to encourage and to aid each other in our professional career, and never permit the effusions of the baser passions to mar the harmony of our union and communion with each other. As participants in the administration of a common art, the ars curandi, at the bed-side of the sick, physicians are often brought in close approximation. Gentlemanly deportment should ever characterize such meetings, and each should realize the sacredness of the tie which binds them to union of thought and purpose in devising means of relief, and of restoration, to those committed to their charge. There arises from the ulti- mate, or terminating objects, of the medical profession another strong link of the chain which binds us together. These termi- nating objects of all our scientific acquisitions, and of the errors of appliances and resources which a prolific materia medica has accumulated, are, the more perfect control of diseases by medi- cine, the elevation of the profession in popular estimation, and the more diffused utility of our science among all classes of society. Medical men should earnestly contend for the progress of their favorite science. They should, with incessant and multiplied labors, push forward the conquests of medicine. And it is a matter of congratulation that we belong to a profession that has ever been, and still is, distinguished, not only for its general erudition, and varied researches in other fields of science, besides medicine, but for the ceaseless work going on with such earnest- ness in all parts of the civilized world in every department of medical knowledge. The causes, phenomena, relations and lo terminations of morbid action, as it occurs in every organ, tissue, and moldfcule of the body, have never been submitted to a more searching exploration than at the present day. And the ingeni- ous devices, and multiplied suggestions, for the relief of suffering humanity, were never more rife than now. We live in an age of progress, of change, of melioration. Our science largely shares in this onward movement of the times. Quickened in its speed, already richer fields of research and more inviting prospects open upon us. Gathering up the materials of the past, and decorating herself with the trophies worn during the existing era, medicine summons all her lojral subjects to come up to the aid of humanity, and no longer loiter behind her triumphant march to higher achievmcnts of her saving power. Day after day the warfare is going on—disease and quackery arrayed against humanity and science. Nor are the public idle spectators of this strife. They are the gainers or losers in the issues of the contest. Many there are, with proud notions of their sagacity, that are the willing dupes of a pernicious empiricism. Among such, with deep mortification, do we see now and then, men of education, whose mental culture, unassisted by sound common sense, can- not save them from the lures of a vile charlatanry. Let us not cease from our solemn protests, and earnest objur- gations, in view of the patronage bestowed by the literary men of our country upon every species of empirical pretension in medicine. From the bluster and the glare—the noisy demon- strations and the silly exclusiveness of the thunder and storm system, with its lobelia and red pepper, its steam and its number three, on, through every phasis of imposture, to the attenuations and infinitesmals, the rubbings and shakings, of the moon-shine and mosquito system, there are educated men among us who yield their minds up to the dark, and mischievous abominations of quackery. Especially should the ministry of our holy reli- gion not abet such practices as quackery is ever fertile in, nor countenance the low cupidity which instigates to such modes of obtaining money. Every scientific, honorable physician delights in witnessing the enlarged beneficence of his profession. He is intent on dis- 14 covering the sources of unhealthiness, and of suggesting their removal. His sphere of observation extends to every thing cal- culated to prevent, as well as to mitigate and cure, the numerous maladies which assail the body of man. With exultation he points to a Jenner as a just representative of the nobleness and philo- sophy, the philanthropy and practical utility, of medicine. In every quarter of the globe, where a regular cultivation of the science is carried on, the same logical induction which conducted to the discovery of vaccination, and the same divine charity which persuaded to its promulgation, are still cherished and made available to the discovery, and the promulgation of facts emi- nently conducive to the good of mankind. Thus united by the strong ties of science, by the feelings of gentlemen, and by the essential objects of the practice of medicine, we are met together on this interesting occasion to consult, to deliberate, and to inter- change views. We love our profession, and therefore we attend to its call for a convocation. We are attached to the investiga- tions of medical science, and therefore have we come together to discuss the best methods of promoting its advancement. We desire our own individual improvement, and wish to reciprocate opinions, and receive additional light from the narration of the experience of other practitioners. And, above all, as humane, christian men, we most sedulously exercise our best ability to render our profession, in a far more augmented degree, useful to our fellow citizens. Enlivened by hope, and by an animating consciousness of the approval of Supreme Goodness on every effort made for the well-being of the dependent creatures, whom He has framed after his own image, we are determined to pro- ceed in the way of our deliberate choice—the way of science, of honor, of philanthropy, of usefulness. Gentleman, among the measures best adapted to promote the ends on which we have been expatiating, is such an association as is here congregated. It is one eminently conducive to the attainment of these great purposes. Three great beneficial ends are attained by a well conducted medical association, if the purposes for its formation are such as stand approved by the enlightened judgment of the professon. 15 The purposes of such an association should be—1st, the promo- tion of a closer intercourse among medical men ; the recip- rocation of friendly greetings ; the interchange of views on medical subjects; the elicitation of a generous spirit of em- ulation, by which we shall be urged to higher acquisitions in medical science ; and the adjustment of a basis of professional conduct, upon which all matters touching the pecuniary demands, and all dissentions among the members, may be ratified. Mutual advantage, obtained in the modes suggested above is the first great end secured by such an association. The second final purpose in the formation of the association is comprehended under this head—manifested unity of the pro- fession. To exhibit to the community the oneness of the regu- lar profession; its separateness from all irregular and empiri- cal pretenders ; its open, undisguised grounds of action, in the free discussion of all the topics legitimately within the range of consideration ; and to prove, by a devout consecration of our efforts to the furtherance of truth in medicine, and by a kind of respectful bearing towards each other, that physicians can agree as gentlemen, and more especially agree in the high concerns of scientific investigation. The third general ultimatum to be reached, is the advancement of the profession in science, in skill, in endowments of character and in positive, as well as relative excellence, in all that relates to an abiding, beneficent influence in society. It is obvious to any discerning observer of mankind, that the happiness of life is greatly promoted by civility of manners, and a cheerful reciprocity of the usual forms of social intercourse. And in our happy country, amid the outbreaks and fierce denun- ciations which are often witnessed in party politics, and amid the keen controversies of religious sects, how soon the halcyon morn arises, dispersing all the lurid clouds, and opening up again to our delighted gaze the mild azure sky of heavenly peace. This happy state of quick reviving kindness and good will among the American people, after the most intense excitement of the passions, is the result of our unrestrained intercourse with each other. 10 And in order to diffuse kindness and good will among the medical profession, there should be a free, frequent, and general communion among them. No ingenuous minded physician ever attended a convocation of his professional brethren, where the leading objects, as announced in your late circular, were kept in view, without high personal gratification, and an enlargement of his thoughts and feelings towards the profession. You have de- clared, Mr. President, in your circular letter, by which we are called together, that this meeting is to "exhibit to the world, that we have not combined together, as our enemies assert, for base and mercenary purpose, but to repel the encroachments of empiricism—to redeem our profession from the degradation of underhand competition—to promote social feeling and friend- ship__and to elevate the standard of medical education." Noble objects, against the accomplishment of which no one, in or out of the profession, who has a soul to appreciate the dignity and usefulness of medical science can, for a moment, demur. No rational doubt can be entertained by any one here present, but what our coming together will be for our mutual advantage in all social respects ; that we will leave here impressed with the conviction, more durably and vividly operative upon our future lives, that as iron shapens iron, so does the countenance of man his friend ; that the fountains of our better nature emit their purifying streams when made to gush forth in sympathy with others, and that thus mingling together they descend to fertilize and to gladden, wherever they direct their course. The mind is always quickened and invigorated by contact with other minds. Each one is indebted to the opulence of other intellects for the greater portion of all his mental wealth. The recorded, and the vocal utterances of thought which he receives through his eyes and ears, stir up the capacities of thinking within, and direct the faculties in their way of advancement. Cut off from the communion of kindred souls, the mind becomes dwarfed; the spirit of emulation languishes ; and the whole man suffers a pause, a suspension, almost an asphyxia, of his mental activity, of his aspirations, and of his many-sided development. New truths, or old truths in new relations, are exchanged in such an 17 assemblage, and the familiar facts of the science and practice of medicine, are more conspicuously shown in their useful applica- tion by having the attention more pointedly directed to them by their agitation. All honorable members of the profession will consent to adopt in their respective localities, a common standard of remunera- tion for their services. In such an association, a matter so im- portant as this, for the preservation of a good understanding among practitioners, is a proper object of deliberation and action. And in order to the preservation of harmony among its mem- bers, there should be in the general body a sort of guardianship over the friendly relations of all who claim the right of member- ship. It is, of course, to be the free will oblation of every one to the common cause, to offer up on the altar of science, hu- manity, and mutual esteem, the unsolicited surrender of his pri- vate judgment in all points involving personal difficulties. Fully confiding in the honor, friendly regard, and sound judgment of his professional brethren, where painful passages occur between members, each will feel disposed to refer the adjudication of all such differences to the dispassionate scrutiny, and equitable deci- sion of the association. The manifested unity of the profession is not a trivial concern in this day of hydra-headed empiricism,—this laudable mani- festation of oneness among us can be, in no mode, more lumin- ously evinced than in our spontaneous aggregation, under the law of an elective affinity, which receives its primary force of action, from the impellent movement of a magnetism, which is neither animal nor terrestrial, but sciential. Our pole star is truth ; the compass we steer by is benevolence to man ; and the chart which lies before us is the knowledge of man's physi- cal frame, in its varying modes of health and sickness ; in its gradual growth from the intra-uterine punctum saliens to its more advanced condition of joyous activity in youth, its matured energy in manhood, and its declining powers as years accumu- late, to the decadence, and final extinction of all its phenomena in complete senescence. Our noble ship is well timbered, for already she has rode the rude surges for more than two thousand 3 18 years ;—she is tightly rigged ; her sails are open to the favoring breeze, and all things are ready for a prosperous voyage. Shall not all hands be aboard ;—shall there be any mutiny in her crew ; or want of intelligence in her officers,—that will frustrate her destination, or subject her to piratical marauders ? The advancement of the profession in science, in skill, in endow- ments of character, and in positive, as well as relative, excel- lence in all that relates to an abiding, beneficent influence in society, constitutes the third general aim of a medical associa- tion. The Science of Medicine is amenable to four distinct, yet mutually related, and closely united, means for its progress. The first is preliminary education; the second is professional pupilage ; the third, medical literature, and the fourth medical colleges. As respects the proper preparatory or scholastic training of a student of medicine, there are three points well established by the concurrent judgment of the most judicious men in the pro- fession. First—That a young man, before he commences the study, should be well versed in the common elements of Eng- lish literature, so that he may understand his vernacular tongue correctly ; that, with grammatical precision, and orthographical accuracy, he may speak and write it; and that his orthoepy or pronunciation, be likewise according to the best authorities. Second—That before entering upon the prosecution of his stud- ies he should have his faculties trained to application, and to analysis or logical reasoning. Third—That in order to acquire the most precise and effec- tive discipline of the mind, the dead languages with mathemat- ics are of great importance. Classical learning in a physician is always a desirable accomplishment, and although not indis- pensably necessary to constitute a ground-work for the study of medicine, it confers on its possessor advantages, which, he that enjoys them, and he that realises his deficiency in not possessing them, both feel assured, tend much to the success and gratifica- tion pf scientific pursuits. The rapid march of educational facilities in our land should 19 be met, on the part of every admirer of literary excellence, by a correspondent liberality of patronage, that these academies and colleges, which beautify the scenery of their location by the magic charm of intellectual culture afforded by them, may not languish from defect of encouragement. If parents are able, let them confer on their children the best education that can be obtained among us. And if their sons can have no other inheritance but that of a well trained and richly stored mind, they have all that is needful to the successful prosecution of the business of life ; for with a good education, connected with industry, perseverance and strict moral integrity, any young man can conquer his way. To preserve the weight and influence of our profession in the midst of a cultivated community we must have well educated physicians. Aside and independent of any direct and collateral benefits which flow to the student in the more ready compre- hension of the technical language of medicine, and in the train- ing of his faculties for patient inquiry, the social and profess- ional standing of the physician will always be enhanced by the reputation he has justly acquired for being a man of learning. The pupilage to which a young man submits is a matter of moment in reference to its duration and the manner in which it is conducted. A sad dereliction obtains in this very important matter, among too many respectable practitioners. Four points should be attended to with scrupulous exactness by every physi- cian, who consents to receive a student under his charge. First—That the young gentleman possesses, at least, a good English elementary education. Second—That the most ap- proved medical authors be put into the hands of the student, who should be examined by his preceptor twice a week, for at least one hour at each recitation, on the work he is perusing. The practical works should be deferred, till the student has been pretty thoroughly instructed in anatomy, physiology, hy- giene, chemistry, general pathology, general therapeutics and materia medica. Third—The student should be made familiar with the sensible qualities, chemical relations, modes of acting, pharmacy, and curative uses of the medicinal articles which the 20 practitioner has in his shop. He should be instructed not only in the therapeutical applications of each remedial substance he handles, but in the pathogenesis, or morbid results, of their mis- applied and exceptive modes of action. Fourth—He should have opportunities of witnessing diseases—of seeing the sick, and of being an eye witness of the effects of remedies. As to the period of study, that is less under control than the other points already insisted on ; but the more protracted the pupil makes his period of study, the better will it be for him in after life. If possible the period should be at least three years be- fore graduation. Medical Colleges are the dymometers—the real measurers— of the medical education of a country. They mainly regulate the kind and amount of qualifications necessary to the practice of medicine. Medical education may, in the majority of phy- sicians, fall below the standard of our medical schools, but, except in a few brilliant instances, it will not surpass it. There are three kinds of attraction that may draw students to a medi- cal college, but which are of unambiguous detriment in their operation on the profession. These three kinds of attraction may not, we state it as a bare probability, be conjoined, though ordinarily they co-exist. The first is, low tuition fees—the se- cond, superficial instruction, and the third, facility in getting a diploma. The rule is of universal application—unless an adequate remuneration is made for the products of human skill they will be either withdrawn from the market, or no one will fit himself for their finished manufactory. Imitation articles may be cheap- ly forced into the market, and in the absence, or because of the higher valuation by the owners of the genuine products, a false economy may prompt to the purchase of these imitation articles. The reputation, ability for teaching, and solid attainments of a professor in a reputable, well established school of medicine, can only be acquired by years of arduous toil, and of unremit- ting devotement, to the investigations of medical science. If profound himself in the knowledge of medicine, he will not in- culcate superficial opinions; if well aware of the depth and 21 compass of the science and art of healing, he will not too rea dily give his signature and approval to a document which con- fers the doctorate on one inadequately informed on the great themes of life and death ; of health, and of disease. The literature of the medical profession is every day becom- ing more abundant and excellent. Greater accuracy and precision in the statement of facts ; stricter logical deduction from premises ; a more varied scope of inquiry ; an augmented spirit of original research, with a far less reliance upon theoretic suggestions and plausibilities, characterize the medical literature of the present day. Periodicals, of a weekly, monthly, semi-monthly, quarterly, and semi-annual appearance, teem around the path of the pro- fession, and from their burdened pages the physician can draw fresh instruction, and have his mind daily quickened and invig- orated. A medical association should extend its benign supervision toward the encouragement of the medical literature of the day. Essays, addresses, and reports, should find their way from such a body into the press, to be either issued in the form of transac- tions, or be published in some of the medical journals. The endemic, epidemic, and prevalent sporadic diseases, should receive attention, and special reports, as well as individu- al papers, ought to be offered on these topics. Particular con- sideration should be directed to the meteorology, geology, and topography where endemic, or epidemic complaints are pre- sented. The medical botany of the entire district of country, within thevbounds of the habitation of the members of the asso- ciation, might profitably engage the attention of those who have the acquirements, leisure and taste, for such a pursuit. Every conscientious and intelligent practitioner is aware that all his acquisitions must be made contributory to his skill in treating disease. That however splendid and diversified may be the gifts and erudition of a physician, yet if he fails here, he proves derelict to the grand design of the science of medicine. Here the wide spread rays of knowledge must converge; here the previous investigations of anatomy, physiology, general pa- 22 thology, and general therapeutics, must be blended together in common fusion, by the solvent power of a strong judgment; and the special pathology and special therapeutics of each disease we are called to treat, be made to conspicuously emerge out of the mingled elements of knowledge existing in the mind. The art of healing, without the guiding light of medical science is but a crude and circumscribed—an humble and stationary—de- partment of human power. To confer on the ars medendi the dignity and force, the progressiveness and multifarious adapted- ness which belong to modern medicine, the ratio medendi must precede, and preside over, and subordinate all the processes of the art. Still, as long as the administration of drugs is kept under the dominion of principles in medicine, we pretermit no opportunities of observation, and no available sources of testi- monial information through printed and spoken communications, to enlarge our acquaintance, and render more accurate our views of the sanative virtues of the various articles of the materia medica. Three points, which relaie to the skill of treating disease, de- serve attention. First, the extended use, or modified application of our familiar remedies ; second, the introduction of new arti- cles ; and, third, the expectant method of treatment. Our most common articles, such as mercury, antimony, quinine and opium, admit of additional enlargement in their therapeutical uses ; and every day practitioners are adding their testimony to the diversified virtues of these staple articles of our materia medica. The extended use of mercury as an alterant by Abernethy, the augmented doses of antimony by the Italian physicians—the decided opiate practice of Armstrong in enteri- tis,—and the large quantities of quinine given by our Southern practitioners, prove the beneficial results which arise from a farther extension of the uses of these well tried and most effective weapons of our medical warfare. Nor should we be indifferent to the cautious employment of new resources in practical medicine. There is, perhaps, in many minds an urgent tendency to give preference to any novel measure, and to slight, or undervalue, the older and well estab: 23 lished agents. This is an unhappy proclivity of mind, and augurs unfavorably to the stability of judgment in a practitioner, who entertains, and especially gratifies it by perpetual excur- sions into newly discovered regions of medication. The expectant plan of curing diseases has always received the consideration it deserves from the regular medical faculty. Hippocrates is the father of medicine, and he is also the warmest advocate for expectantism. Non-interference is sometimes our best method of conducting a case to a successful issue. Optima interdum medicina est medicinam non facere; sometimes the best medicine, is to give no medicine. Now, whilst we recognize this truth, we should not indulge in any visionary dependence on the vis medicatrix naturce, as a sort of sovereign, provident, dis- posing power, which penetrates every part, and is adequate, by an inscrutable, invisible, interposition, of arresting morbid pro- cesses. All the philosophic meaning that should be attached to the vis medicatrix naturce is the operation of the laws of the organism, in health and in disease. In the rectification of any abnormal state of the body, we should understand well not only the physiological relations, as grounded on the structure of the various parts,—and the laws of pathology—the action of morbid causes—the rise, procession, phenomena, and terminations of pathological states, but the modes of action, the direct, immediate, remote, and cumulative effects, of remedies. Enlightened on anatomy, physiology, pa- thology, and therapeutics, the sagacious physician will often find it best not to drive on his perturbating medication, nor to attempt too much in a brief space of time ; but to wait expec- tant on the changes incident to the actions of the system, which, either through physiological or pathological laws, may bring about a restoration to health. For instance, sleep may restore the nervous, and through that, the other functions of the body, in cases of slight departure from health, to its normal state. Cuticular secretion may carry off a slight fever—augmented movement of the bowels may relieve slight determination to the brain—and a copious expectoration may relieve an attack of asthma. In such methods of physio- 24 logical action, weak morbid states may find a curative termina- tion. Or, contemplating the immense influence often exerted by the mind on conditions of health and disease, we may discover a solution of a rapid cure in severe attacks, by the transmutations wrought on the nervous, vascular, and secretory functions, by powerful appeals to the faith and hope of the sufferer. Expectantism is to be regarded in another light. Diseases are curable and incurable ; self-limited and indefinite in their career ; persistent and intermittent. Measles, small pox, and scarlet fever, have a certain course to run, and all that is proper to be done in their treatment, is to moderate abnormal action, without attempting suddenly to extinguish it. The physician should carefully reflect upon the different laws of pathological action—the relations of diseases—their constitu- tional character ; their extension from organ to organ, through vascular and nervous connections, and identity of structure and coincidence of function ; and their metastasis, or transfer from the original site to a proximate, or a distant part. Again, the modifying agency of age, sex, temperament, constitution, and other circumstances on disease, and on the results of remedial interference, must be gravely determined, that we may under- standingly prescribe our more active measures. Excessive medication in self-limited and incurable maladies, should be avoided. Neither should we exhibit our herculean remedies in slight seizures, but always endeavor to quadrate the means of relief to the nature of the attack. After all that can be uttered in favor of expectantism, in experience it will prove very frequently that the ancient designation by which it was characterized, is true—thanatou meleten—the study of death. For what is disease, but a messenger of death, a vis necatrix; and what is the apprehended issue of every case we are required to treat, but lesion of structure, which if not immediately destruc- tive of life, will render the patient miserable all his days ? A bold, judicious plan of treatment in all acute cases of dis- ease, is true economy in four respects. It saves time—it saves money—it saves sufferings—it saves subsequent impairment of strength in the organ attacked, and thus saves the future well- 25 ( being of the patient. Even were expectantism safe, it is a very expensive mode of cure. Time, to the majority of mankind is, in an economic point of view, their estate. To keep a patient two, three, or four weeks in his bed, waiting for the wearing out of the morbid action through the strength of his constitution, or through the definite modes of action of the pathological condi- tion present, is subjecting him to an expensive reliance, as well as to the uncertainties and perils connected with such an expo- sure. The pecuniary outlay may be for the benefit of the prescriber of such a non-interfering plan, provided the unfortunate man has resources beyond his daily toil, ample enough to meet all other expenditures. Expectantism is often cruel—it sees suffer- ing—hears the groans of pain ; and yet, relentlessly stands by to study the natural history of the case. Moreover, by not directly and efficiently arresting disease, the patient may be encumbered during all his remaining days, with impaired health. The above enumerated points on the best methods of treating disease, will often come up before a medical association, and by their candid and free agitation, the skill of the members in the management of the cases committed to their respective charge, will be rendered more successful. The endowments of character, which our friendly intercourse with each other is calculated to promote, are industry, persever- ance, and professional contentment. Industry is the primal fountain of all advancement in scientific attainments. It is the great artificer of the mighty mass of human knowledge. It is the man awake, beneath a genial sky, with the voice of all nature souuding in his ears—with the incessant movement of the heavens above—and of the earth he treads on—and of the clouds that deck the azure canopy with their varying hues—and of the winds which blow as they list, but still blow on—and of the seasons that in silent, solemn, procession, are ever treading the varied circle of the year—all call on man to be alive to his present duties—alive to his high obligations—alive to the glorious destiny which awaits him. 4 26 And perseverance secures, perpetuates, and consolidates the triumphs of industry ; it treasures up the bright rewards of the past, and fixes upon a lasting basis, the acquisitions of by-gone years. And contentment, with all its peace, and inward strength, and confident reliance on the future, cannot exist without the con- stant presence, and unintermitted activity of industry, and the enduring vitality and immutable stability of perseverance. A single noble example of these endowments of character will rouse a multitude into new life- Many such, we trust, are to be found in this association, who stir each other up by an alert, and untiring effort to advance the great interests of the profession. The traits of a lovely moral life are often illustrated by physi- cians. The lineaments drawn by God's own hand, the orna- ment of a meek and quiet spirit; the gentle endearments of a kind, forgiving nature; the quick sympathy for human wo; and the ready hand extended to bind up the bruised heart—these exalted attributes of character claim kindred and affiance with the First Good ; and often seen clustering around the path of the physician, they show forth the work of God wrought within. The benevolence of our profession has never been impugned by any liberal minded, observant man. To the calls of distress, to the plaints of wo, few, very few,'physicians ever turn away their ear. And to the active philanthropy of our profession, the temperance cause of our land owes much of its success. In this there has been an exemplification of the preventive wisdom, and benevolence of the regular profession, as displayed in the sug- gestions offered, and plans devised for the arrest of epidemic visitations of disease. The vital statistics of all christian nations show that with the improvements in medical science there has been a corresponding diminution in the sickness and mortality of a people. Gentlemen, you are assembled on this occasion for beneficent ends. These arc the promotion of the science and art of healing; —the cultivation of friendly relations with each other ; and the advancement of the medical profession in dignity, in usefulness, and in honorable repute. Abstractly considered, the diffusion of 27 science among any people is a great public benefit. To with- draw the intellect from an exclusive occupation and engrossment of its powers with the affairs of earth, and to fix its contempla- tions on the beautiful adaptations, and glorious harmonies of the universe ;—to call away the immortal mind from the gratifica- tions of sense, and send it in quest of the joys of communion with the invisible Spirit, through the works of his hands so profusedly scattered around us ; and to penetrate the causes which originate, and the laws which govern, the phenomena of nature, that man may subordinate to his economic uses the material substances of the world he inhabits ; and even to make available to his bold career over the ocean's trackless waves the obscuration of the satellites of a planet near four hundred millions of miles from us. Such exalted ends, achieved by science, redound richly to the elevation of any people in all the endowments and attributes of character which distinguish a refined and civilized country, from one abandoned to ignorance and sensuality. If a science is directly ministrant to the well being of man ; if not remotely, nor contingently, but by immediate application, it subserves the good of the species, then should it be corres- pondency appreciated by the public, and be commensurately cul- tivated by those who profess to preside over its interests. The science of medicine has always been honored by the enlightened, and the medical profession has ever occupied an elevated position among the learned and liberal, the useful and dignified avoca- tions of society. That all due honor be awarded the science, and that all fitting, and just considerations of respect, and of deference, be paid to the profession, let physicians assert and maintain their claims upon the good will, and the sound judg- ment of the public by zealously urging on the advancement of medicine, as a science and art, and by cultivating those pro- fessional and social acts of friendship, which gild with hues of enchantment the scenes of daily life. May we all be constantly found engaged in the promotion of the certainty, dignity and more enlarged usefulness of medical science ; and may we never cease our honorable efforts to ad- vance the standing and influence of our profession in the re- specive positions in society which each of us may occupy. r 1 vl |M.*-^v £