SOME CHANGES REQUIRED BY THE PRESENT STATUS 
OF MEDICINE. 
ANNUAL ADDRESS 
DELIVERED BEFORE THE 
SOCIETY OF THE ALUMNI 
OF THE 
MEDICAL DEPARTMENT 
OF THE 
UNIVERSITY OF PENNSYLVANIA, 
COMPLIMENTS OF 
LEWIS H. STEINER, 
MARCH 13, 1879 
By LEWIS II. STEINER, A.M., M.D., 
PRESIDENT AMER. ACADEMY OF MEDICINE, ETC. 
PHILADELPHIA: 
COLLINS, PRINTER, 705 JAYNE STREET. 
1879. SOME CHANGES REQUIRED BY THE PRESENT STATUS 
OF MEDICINE. 
ANNUAL ADDRESS • 
DELIVERED BEFORE THE 
SOCIETY OF THE ALUMNI 
OF THE • 
MEDICAL DEPARTMENT 
OF THE 
UNIVERSITY OF PENNSYLVANIA, 
MARCH 13, 1879. 
By LEWIS H. STEINER, A.M., M.D., 
PRESIDENT AMER. ACADEMY OF MEDICINE, ETC. 
PHILADELPHIA: 
COLLINS, PRINTER, 705 JAYNE STREET. 
1879. ADDRESS. 
Mr. President and Brother Alumni : 
Thirty years have come and gone since the 
J cD 
speaker with one hundred and eighty-one others 
received, from the hands of the Provost of this 
venerable University, the diploma granting the 
degree of Doctor of Medicine. Your .invitation 
to deliver the annual oration before the Society 
of the Alumni of the Medical Department, as- 
sumed the shape of a semi-authoritative com- 
mand, which I have not dared to clisobey, 
although it brings me face to face with sad 
memories of those whose friendship I had learned 
to prize during my student-days, and whose de- 
parture from life I have mourned in riper years. 
In performing the task thus assumed, I may be 
excused in pausing for a moment to drop a tear 
to the memory of those young, enthusiastic, gen- 
erous hearts, which then beat so vigorously in 
manly bodies, and whose high aspirations for 
faithful work in the profession of their choice 
created an earnest rivalry in the attainment of a 
knowledge of its principles, and also of those 4 
grand masters of the profession whose oracular 
words were then received with the reverence due 
to genius and intellectual worth - Chapman, 
Jackson, Horner, Gibson, Hodge, James B. 
Rogers-all gone from the activity of life to the 
quiet repose of death, mourned and honored by 
thousands, who had learned to know and prize 
their professional and private worth I These 
have passed to their reward I 
Not only has death gathered a rich harvest, 
during these thirty years, from the men who 
taught in the Medical School and from those 
who sat as faithful students at their feet, but 
there have been buried also, in deeper graves 
than these, many of the theories which then 
claimed the attention of the profession, and their 
place is now occupied by others, based upon 
wiser and more scientific methods of investiga- 
tion, furnishing the modern practitioner with 
more intelligible and reliable modes of dealing 
with disease. The vis medicatrix naturae is once 
more elevated to a place of high consideration, 
and medicinal agents are employed mostly to 
aid nature in the effort to rid herself of disease, 
rather than for the direct purpose of curing the 
same. Huge doses are banished from the arma- 
ment of the physician-their essential constitu- 
ents have been extracted by the painstaking, 5 
laborious chemist, and are now used as adjuvants 
to, rather than cures themselves of, disease. This 
has been a progressive work, beginning, it is 
true, before the present century; its full extent 
can be seen only by him who will patiently com- 
pare the Materia Medica of the eighteenth cen- 
tury, or, still better, that of Nicholas Culpepper 
of the seventeenth century, with that of the 
present day. Its present status is due to a host 
of careful investigators. A mere enumeration 
of their discoveries would demand more time, on 
the part of the speaker and patience on that of 
the hearer, than could be reasonably furnished at 
an anniversary meeting like the present. 
Those of us who have witnessed many of these 
changes, look hopingly forward to other and 
greater discoveries in the future, and congratu- 
late those who shall see, with clearer vision and 
less obstruction, the truths for which the fathers 
and themselves have longed and struggled. The 
same love of science, the same earnest profes- 
sional zeal, the same devotion to duty, may ani- 
mate their labors; but with a greater flood of 
light illuminating their paths, how much grander 
and more glorious must be the results that they 
shall attain ! How much purer and more freed 
from the dross of empiricism will the profession 
become under their honest labors, and how much 6 
more sharply will the line be defined that sepa- 
rates the genuine physician from his horrible 
caricature-the calculating quack I And yet, 
even with prophetic glimpses of what may be 
expected, as investigation and science move 
hand in hand together, need we envy the honors 
that shall await our successors ? Non cuivis 
homini contingit adire Corinthum. Each has 
his own part to perform in life. The wise man 
strives to do this as well as he can, thankful that 
he can contribute something to the temple of 
science, which the whole race is eimag'ed in 
building up. "He hath done what he could" is 
the most honorable inscription that can be placed 
on our tombstones, and, although our names 
shall speedily die out of human memories, and 
the little we have contributed to human know- 
ledge may even be disconnected from those 
names, yet the record is preserved, and the re- 
ward will come. As the old gladiators saluted 
the emperor when they entered upon their peril- 
ous encounters, let us, catching the spirit with 
which their salutation has been employed by an 
American poet in a recent class poem, say to 
those who are now beginning their medical ca- 
reer: Nos morituri vos salutamur. We have 
striven to act our parts, we have endeavored to 
add to the treasury of medical science, we mean 7 
to continue the contest until the end, whether 
that be victory or defeat; yet, notwithstanding 
all this, wre salute you, young warriors, as you 
buckle on your armor for the fight, and bid you 
welcome to the field of honor and distinction! 
A comparison of the size of the Medical 
Faculty of the University thirty years ago, with 
that stated in the one hundred and thirteenth 
Annual Announcement, published last year, will 
show how much greater is the field now occu- 
pied by medical investigation, how many sub- 
jects have been recently introduced requiring 
specialists for their elucidation, and how Alma 
Mater seems to have selected the most available 
experts to fill her chairs of instruction. In 1849 
there were seven professors, with one Demon- 
strator of Anatomy, who were expected to lead 
the ambitious student safely over the difficulties 
that attended his preparation to enter upon the 
duties of the medical profession. Under their 
skilful hands he was to be taught the nature of 
the contest with disease and the weapons needed 
by the successful warrior. After being tried and 
approved as to his knowledge of all these, he was 
saluted, in the presence of the world, as brother 
by his old teachers, and welcomed to a career of 
usefulness. But the last Announcement, after giv- 8 
ing the names of the learned and cultivated Pro- 
vost and three emeritus professors, specifically 
mentions eleven full professors, seven demon- 
strators, twenty assistant demonstrators-all en- 
gaged in some way or other in the winter course, 
while sixteen lecturers on specialties are men- 
tioned as employed in the spring course. To these 
are added the names of a large hospital staff corps, 
and of another devoted to the needs and require- 
ments of the University dispensary service. 
This list of officers and attaches comprises some 
whose names are widely known in the profession, 
and many whose specialties have only grown to 
full development within the last score of years. 
Well may the student pause as he sees the rich 
fields of medical knowledge thus widely dis- 
played before him, and tremblingly ask himself 
the question: "Who is sufficient for this work?" 
Who can undertake, with a reasonable hope of 
success, the acquirement of a tithe of the know- 
ledge that this University demands of its stu- 
dents before they shall be admitted to its 
honors ? 
But without dwelling upon the past, and yet 
wishing to make the present address serviceable, 
I may be allowed to invite your attention to the 
consideration of a few subjects, that the present 9 
status of Medicine seems to present as requiring 
more attention henceforward than they have re- 
ceived of late years, and concerning which the 
profession may be obliged to recast its opinions, 
and possibly to determine new rules of action. I 
approach their consideration with some hesita- 
tion, but with a profound belief that I am not 
alone in my own opinions, and that these are 
gradually gaining respectful attention, if not 
warm advocacy, from some of the best and most 
learned men within our ranks. 
I. Suitable preliminary preparation for the study 
of Medicine.-The long list of subjects demand- 
ing attention of him who desires the doctorate, 
suggests at once the thought that not every 
D D D J 
youth of good habits and commendable ambition 
is fitted to compass their mastery-that there 
must be special preparation for the work, or prin- 
ciples will fail of appreciation, and their applica- 
tions will be a work of chance under circumstances 
where failure means injury to human health or 
life. Non omnes omnia possumus, and some are 
wholly unfitted by habit of mind for doing cer- 
tain things, that may be done skilfully and well 
by others. Again; many never succeed in suc- 
cessfully mastering the teachings of the Medical 
School, because they have not gone through that 10 
preliminary training, which seems to give ease, 
fitness, and facility for coping with the difficul- 
ties there to be encountered. They move along 
with the current of student life like pieces of 
driftwood, borne by a power not inherent that 
whirls them over difficulties, guards them from 
the dangers of failure which beset them on all 
sides, and finally carries them into port along 
with the vessels that are under the control of 
well-instructed pilots. But then--when the 
voyage is afterwards to be undertaken alone, de- 
prived of the aid of the current, ignorant of the 
use of the compass or of the position of the pole- 
star, without guide or assistance from others - 
their success depends upon accident, rather than 
upon an intelligent appreciation and knowledge 
of the dangers that beset their course. That 
such there be in the profession is painfully mani- 
fest to every educated man, who has mingled 
much with practitioners of the healing art. 
They may have gathered largely from the over- 
flowing treasury that has been placed at their 
disposal in the professional school, but without 
the slightest ability to classify, arrange, or apply 
the same. Medicines are prescribed, lines of 
treatment recommended in the most empirical 
manner, and chiefly because the latest text-book 
or the last journal article has so directed. Indeed 11 
it is exceedingly difficult to see what advantage 
such an one has over the self-assertive, blatant 
quack, so far as the treatment of disease is con- 
cerned. Each follows a kind of routine, whether 
adopted by accident or intention; and, once 
adopted, adheres to it with great tenacity. If 
routine is changed at all, it is for the purpose of 
substituting some new claimant for therapeutic 
celebrity in lieu of an older one, with the pros- 
pect, if it should prove efficacious, of employing 
it in all possible diseases, until its high position- 
shall be lost in consequence of the appearance in 
the list of new drugs of a new candidate for 
favor. 
A thousand times rather would I trust the life 
of a human being in the hands of a keen observer 
possessed of a moderate amount of medical knowl- 
edge, than of one with limited powers of obser- 
vation and no judgment in the use of the knowl- 
edge that he has not collected, but accumulated. 
In the latter case, the very abundance of the 
knowledge possessed will make him hesitate how 
to employ it successfully, and whatever course 
he adopts will be perilous to the patient, because 
it is followed blindly. The old adage, that 
"knowledge is power," carries so much convic- 
tion with it, that we assent to the dictum without 
thinking that the power spoken of may be for 12 
good or-ill. Dynamite, in the hands of a care- 
ful, skilful engineer, will do a giant's work in 
the way of aiding human labor to accomplish 
vast results; but if it be entrusted to one who 
has no appreciation of the manner it should be 
employed, or of the precautions necessary to pre- 
vent premature explosions, it becomes simply a 
monstrous, diabolical agent of destruction. I am 
willing to admit its powers, but if I can get no 
one-to take charge of it, in whose knowledge and 
judgment I can confide, I naturally rest satisfied 
with the slower, but much safer, unaided labor of 
the human hand. Similarly, would it not be bet- 
ter to trust Dame Nature than one who has ob- 
tained a knowledge of the truths of medicine, 
but fails to appreciate their applications or proper 
uses? In the one case harm may, in the other 
it must, result. 
The distrust so often shown towards medical 
men is not always occasioned by the ignoramuses 
who have crept into the fold, or who fraudulently 
claim to have the right to be there, but often by 
men laden with facts and theories from the 
schools, without a particle of ability to use them 
intelligently. The common sense of the people 
detects the helplessness of such learned dolts, 
and rushes blindly to the bold braggart who un- 
blushingly demands their confidence, while he 
boldly administers his nostrums. 13 
Do not misunderstand me. I plead not against 
an increase of medical knowledge, an increase of 
sound instruction on all the subjects that tend 
in any way to shed light upon the physiology or 
pathology of the human body, the fullest oppor- 
tunity for information by lectures, practical ex- 
ercises in laboratories-chemical, physical, bio- 
logical-and careful instruction in disease and 
its treatment by the bedside. I plead not against 
those grand advantages which our Alma Mater 
is yearly increasing for the benefit of her stu- 
dents. On the contrary, I feel a glow of per- 
sonal pride as I read how eloquently one of her 
Faculty has written of "Higher Medical Educa- 
tion-as the true interest of the Public and of 
the Profession"-how cogently he has presented 
the necessity of giving the student every possi- 
ble opportunity to familiarize himself with the 
great armament which Medicine now places at 
the disposal of him who would learn how to con- 
tend with disease. I read with intense satisfac- 
tion, in the Annual Announcement, that she is 
not satisfied with mere theoretical teaching, but 
lays great stress upon "systematic laboratory 
work in the fundamental medical sciences, as 
well as the personal teaching of each student in 
practical subjects of the greatest importance- 
such as physical diagnosis, clinical medicine, 14 
clinical surgery, and clinical gynaecology." I 
take a filial pride in learning that she lays no 
claim to public respect simply on the score of 
age and past respectability, however much they 
might entitle her to public consideration; but 
that, alive to every new truth and every new 
discovery, she is striving, with the energy of pe- 
rennial youth, to make her sons acquainted with 
these, and, by keeping in the front rank of the 
progressive medical institutions of the world, is 
deserving the support and reverence of those 
who prize present energy, united with genuine 
ability, far above mere dull respectability based 
upon past efficiency. 
Further; I believe that the work of medical 
instruction was never carried on as thoroughly 
in the past as at present, and nowhere else better 
than in the halls of this University. The diffi- 
culty lies not in the inefficiency of teachers or 
the imperfection of the instruction given, but 
in the lack of preparation of those who enter 
upon the study of Medicine. There is a want of 
sufficient foundation to bear in suitable equilib- 
rium the superstructure, which the schools are 
striving to erect thereon, and hence the want of 
that fulness and soundness of culture which 
makes the physician pre-eminently well fitted to 
meet every emergency, and to treat it with such 15 
means as his profession may possess for that 
special purpose. I desire to plead for the neces- 
sity of thorough preliminary preparation of those 
who are to have access to the great advantages 
now furnished by the medical schools, so that 
these may send forth graduates who shall honor 
their diplomas and add to the glory of Medicine 
as a learned profession. 
Examine the catalogues of the medical schools, 
and see how small the percentage of those names 
that have met the requirements of the old Col- 
lege-curriculum, have honestly toiled through the 
two years of preparatory study and the four 
years of careful drill in the Classics, in the 
Mathematics, in logical and philosophical stud- 
ies, and in the other branches recognized as es- 
sential to that curriculum-how few have made 
any effort even to substitute certain portions of 
this with other branches that might be consid- 
ered by some as more practical-how few have 
acquired sufficient knowledge of Latin and Greek 
to translate the phraseology that occurs on every 
page of our medical writers, formed out of these 
languages to express ideas for which English 
contains no equivalent-how few possess mathe- 
matical knowledge sufficient to understand the 
mathematico-physical investigations of modern 
physiologists, much less the intricate algebraical 16 
formulae employed by Donders in his great work 
on "The anomalies of Accommodation and Re- 
fraction of the Eye"-how few have enjoyed the 
advantages that a close, critical study of our 
own language brings to the student-how few, 
in fine, have undergone the training that should 
furnish the pass-word to admit them into the 
ranks of those who are thereafter to become 
members of one of the so-called learned profes- 
sions. 
• Some with little more intellectual armor than 
that which is furnished in the grammar-schools 
of the land, some with even less-have rashly 
determined to enter upon the study of medicine 
with the most meagre knowledge of the elements 
of reading, writing, and arithmetic. Some have 
left trades for which they found themselves in- 
competent, deserted their places behind the 
counter and the plough, and some have under- 
taken the labors of medical study because they 
have failed in everything else. And all these 
occupy seats by the side of those who have care- 
fully, toilsomely, and zealously undergone that 
curriculum which the experience of mankind, ex- 
tending through many years, has selected as the 
necessary preparation for professional study. 
How can the best plans of the schools, the ablest 
and most learned teachers, or the most thorough 17 
advantages, out of such a miscellaneous collec- 
tion produce results that shall be at all uni- 
form, and graduates who will equally redound to 
the honor of their Almae Matres, or be of equal 
value to the public? Indeed, it would seem im- 
practicable to make the same course of instruc- 
tion equally applicable or advantageous to per- 
sons who possess such dissimilar preparation for 
study. There is one mode of presenting scientific 
truths to the scientific mind, and another-much 
more elementary and rudimentary-to the mind 
that has never experienced the advantages of 
continuous mental drill and intellectual training. 
Desiring to adapt himself to both classes, the 
teacher fails to do full justice to himself, his sub- 
ject, or his scholars. Hence I contend that the 
best results of first-class medical instruction can- 
not be attained with classes thus constituted of 
young men or-women, whose preliminary train- 
ing has been so different, and whose preparation 
for the highest medical education is so dissimilar. 
They may be all alike in zeal and ardent desire 
for knowledge, but these will not wholly compen- 
sate for lack of due preparation. 
But some one may say, why insist upon this 
long and wearisome preparation ? It is not ab- 
solutely necessary for success. Within our own 
experience have occurred brilliant examples of 18 
distinguished personal success in men, whose 
preliminary training was as slight and insignifi- 
cant as the lowest you have mentioned, but who 
nevertheless displayed the highest talent and the 
greatest fitness in the daily practice of the va- 
rious branches of the profession, whose merits 
have been recognized not only by the crowds of 
patients anxious to secure their services that 
daily throng their offices, but also by the medi- 
cal schools themselves, where they have been 
invited to don the professorial robes and to aid 
in teaching the principles of medical science. 
To which I can only reply, that rules are not 
constructed for exceptional cases-for transcen- 
dent natural talent or irrepressible genius. 
These overleap difficulties, and, with supernatu- 
ral strength, fight against a host of obstacles 
until they gain the prominence for which they 
seem predestined. We lay down laws and rules 
for the great majority. In every department of 
life we consider the training needed for the ave- 
rage man, and, while this is always arranged so 
as to produce certain definite results, we are not 
surprised at the exceptional cases of those who 
seem to grasp such results by intuition, without 
labor or toilsome preparation. We do no harm 
to such men-whose number is small and excep- 
tional-by requiring that the ordinary student 19 
shall tarry at an intellectual Jericho until he has 
acquired by thorough discipline the mental 
strength, the maturity of judgment, the general 
culture that will best fit him to pursue the diffi- 
cult curriculum of study which the present con- 
dition of medical knowledge requires should be 
mastered by every one who intends to go forth 
to minister unto suffering humanity, and to up- 
hold and maintain the honor of one of the noblest 
and most intellectual of human callings. 
But another objection still may be brought to 
this plan, that it will drive away many who wish 
to enter the profession, because they have neither 
the preparation contemplated, nor are they wil- 
ling or able to spend the time and incur the ex- 
pense to secure it. Would this result be called 
a calamity? Is it not within the experience of 
every one that the present overcrowding of the 
profession, composed of men well-prepared and 
men ill-prepared, stimulates the latter to adopt 
plans of doubtful propriety to attract public 
favor, and to be conversant with practices that 
cannot be distinguished from those employed by 
the quack? In time, it is true, there is a spe- 
cies of " survival of the fittest," provided these 
are not starved out while waiting, and in the 
long run competency must receive proper recog- 
nition. But how much of this tedious waiting 20 
would be obviated if the poorly prepared were 
not in the contest, and their places were unoccu- 
pied in the profession. Diminution of numbers 
would not be a calamity, if increased fitness and 
efficiency could be secured thereby. Nay, it 
would be a blessing both to the public and the 
reputation of the profession. 
The preliminary preparation here contem- 
plated is that which the experience of many 
years has pronounced best adapted to prepare a 
youth for any study or occupation he may select, 
because it gives him thorough command of his 
own mental apparatus, cultivates the judgment, 
gives self-reliance, matures the reasoning facul- 
ties; in a word, develops into full maturity, and 
places under his control, all those mental powers 
which enable him to contend successfully with 
difficulties, and to master them with certainty. 
Through such training he is fitted to appreciate 
every new fact, and to appropriate every truth 
that he may meet in his professional studies. 
He has been taught to arrange and classify, to 
store away what he learns systematically, and to 
keep his knowledge subject to his command 
whenever and wherever the exigencies of his 
after life may require its use. He will practise 
medicine neither by routine nor at hap-hazard. 
This preparatory education has trained his 21 
faculty of observation, and this will not be per- 
mitted to be unused in his professional career. 
The knowledge that he has accumulated at the 
medical school is in possession of one who knows 
how to employ it, and this knowledge thus be- 
comes first-class power to be used for good 
under the direction of a well-trained judgment. 
Having been trained in logical methods, he is 
not likely to be imposed upon by any of the 
protean forms of quackery, and his character 
will present that happy admixture of the pro- 
gressive and the conservative, which renders one 
ready to hold fast to that which has been tried, 
while he is constantly on the alert for new truths 
and fresh discoveries. 
I would prefer that this preliminary preparation 
should be that embraced in the old college cur- 
riculum, and not a collegiate course composed, 
as is too much the fashion now, simply of such 
studies as the student himself may elect-a plan 
as little entitled to approval as one that would 
permit a child to elect which of the letters of the 
alphabet he desired to form a knowledge of, 
and of which to remain in absolute ignorance, or 
as one of a medical college that would permit its 
students to elect some of its elementary branches 
and to neglect others. Where the elective sys- 
tem prevails, the student is most apt, on account 22 
of his very ignorance of the employment of cer- 
tain studies as means to an end, to thrust these 
aside, and to devote himself to others which he 
conceives to be of a peculiarly practical nature. 
The experience of the learned for ages has 
agreed upon a certain curriculum as that best 
adapted for fitting the intellectual athlete for the 
labors he will be called upon thereafter to en- 
counter, and I would have that adhered to, as 
approved by such authority, beyond the possi- 
bility of any alteration proceeding from the 
whims or fancies of the youth to whom it is 
offered. 
But how shall the Faculty of the Medical 
Schools be satisfied that the applicant for ad- 
mission to their halls has honestly and faithfully 
undergone the necessary preliminary prepa- 
ration which I have advocated as essential? 
The land is burdened with institutions calling 
themselves Colleges,-each equally authorized 
by legislative enactment to confer diplomas 
with such titles as may seem good to their fac- 
ulties. If a diploma be required setting forth 
any particular degree, any ignoramus coming 
with a purchased diploma from a worthless in- 
stitution would be entitled to as hearty a wel- 
come as an earnest, laborious student, who had 
won his collegiate honors at a reputable institu- 23 
tion by means of patient toil. The diploma as 
such should not be received as prima facie evi- 
dence of preparation. A certain preliminary 
curriculum should be imperatively required, and 
that this has been passed through creditably 
might be determined either by direct examina- 
tion on matriculation, or by the recognition of 
the diplomas of such reputable colleges as should 
be approved after a thorough examination of 
their requirements and methods. The former 
would be the best plan, although it might not be 
practicable for some time. In another place I 
have said, that it was " the duty of the educated 
members of the profession to contend for the in- 
crease of requirements from those who enter the 
halls of our medical colleges, and to demand 
that none shall be ushered into full professional 
privileges, save in extraordinary cases, but those 
who have been fully and thoroughly trained, and 
whose training has been tested and approved by 
honest, earnest, faithful masters."1 In this pres- 
ence I repeat this, feeling that it will not be 
coldly received by the sons of that Institution 
which has so solemnly devoted herself to the 
task of furnishing the best possible medical edu- 
cation to those she sends forth with her endorse- 
ment as Doctors of Medicine. Here there can 
1 Reformed Quarterly Review, January, 1879, 85. 24 
be nothing but sympathy for all that will aid her 
in accomplishing her noble object, whatever may 
be the reception such views shall receive else- 
where. 
IT. The duty of the Profession in regard to the 
employment of its members as Experts in legal 
examinations.-The enlargement of the field of 
medical study, arising from the successful re- 
searches of modern students, has been so great 
recently-one discovery following fast after an- 
other, and separate and distinctive sciences 
spring up to-day of which only a few facts were 
known yesterday-that it has become a task of 
Herculean magnitude for any one person to com- 
pass the whole. The most one can do is to ac- 
quaint himself with principles, and the class of 
diseases that most commonly prevail in the re- 
gion he proposes to locate in, together with the 
probable range of surgical requirements he may 
be called upon to meet. In addition to this, 
however, if his tastes or the necessities of his 
situation create a demand that he wishes to 
meet, he may be drawn to some one or more of 
the departments of his profession, which he will 
specially cultivate and more or less completely 
master. He thus paves the way for becoming a 
specialist, and, should his skill and ability in his 25 
specialty become recognized by the public, he 
may find it advisable to drop general practice 
and devote himself wholly to the cultivation of 
the speciality. Although specialism as such 
was formerly not received with much favor in 
this country, yet the profession is beginning now 
to recognize its imperative necessity. There are 
many very able and even brilliant physicians 
who have chosen to devote themselves solely to 
one branch, in which they must necessarily at- 
tain special success and special reputation. Of 
course, these are all exposed to the danger of 
having their judgments so warped as to see 
something connected with their speciality as an 
important feature in every ailment brought under 
their observation, or to slide down the declivity 
that leads from professional honor to the depths 
of that Quackery which makes use of the infirmi- 
ties of humanity as sources of selfish gain, and 
employs its special knowledge as a means of ex- 
torting; enormous fees from the suffering;. These 
are, however, not necessary consequences, nor do 
I believe them at all common, although they are 
possible in every one who confines himself to 
any one line of thought, unmindful of all else 
about him, or whose moral sense has not been so 
cultivated as to make him recoil instinctively 
from everything that smacks of dishonesty. 26 
The profession finds it a great convenience to 
have the assistance of the specialist, and does 
not hesitate to call upon him when the case is 
one requiring special knowledge and skill. And 
when the general practitioner and the specialist 
are both governed by a keen sense of professional 
honor, with full recognition of the requirements 
of the Code of Medical Ethics, touching "the 
duties of physicians to each other and the pro- 
fession at large," the two can act harmoniously 
together, to their own benefit and that of the 
patient. 
This very creation of specialism causes its cul- 
tivators to be recognized by the public as Ex- 
perts, and their services to be called into requisi- 
tion, not only in ailments or injuries that simply 
involve the person concerned, but also where 
legal investigations are carried on in regard 
thereto. The Expert has become an important 
personage in courts of law, and, unfortunately, 
has not there acquired for himself or his profes- 
sion the respect which both should receive from 
the members of the legal profession. Indeed, 
such disrespect has been created for expert testi- 
mony that a recent legal writer says, "In fact, 
the calling of experts has now come to be re- 
garded as the signal for a display of forensic py- 
rotechnics, beneath whose smoke and lurid glare, 27 
law, common sense, and unalloyed justice are 
swept away in a whirlwind of metaphysics." 
Why is this? Simply because it is not un- 
natural, nay, it is exceedingly common for Ex- 
perts to be engaged by one or other side in a 
case, and to conceive themselves from that fact in 
honor obliged to do the best for the side on 
which they are employed, instead of bending 
their entire energies to the discovery of the 
truth, no matter whom it might injure. Prof. 
Emory Washburn, of Massachusetts, in an able 
paper read before the American Public Health 
Association, on "Expert Testimony and the 
Public Service of Experts," says: "Whoever 
is at all familiar with court proceedings, has 
been fortunate if he has not seen and encountered 
exhibitions of expert testimony from witnesses 
hired, like the counsel in the case, to carry a 
verdict by the skill and ingenuity with which 
conjecture is put forward as fact-partial truth 
made falsehood by suppressing that with which 
it is connected, and science prostituted to dis- 
honest purposes. On this point I shall content 
myself with the language of others whose oppor- 
tunities for judging cannot be questioned, after 
reminding you, from the fact that such witnesses 
testify to opinions alone, if they are willing to 
sell their reputations for science for such a price 28 
as an employer is willing to pay, they can do it 
with substantial impunity." And he quotes 
from the charge of the Chief Justice to the jury 
in the famous Palmer case: "There were also 
gentlemen whose object was to procure the ac- 
quittal of the prisoner. It is in my opinion in- 
dispensable to the administration of justice that 
a witness should not be turned into an advocate, 
nor an advocate into a witness." 
To this evil I wish to ask your attention for a 
few minutes, this arrayal of medical expert 
against medical expert in bitter and deadly an- 
tagonism, frequently resulting in such angry and 
harsh denunciation of each other as to excite the 
ridicule if not the absolute contempt of the pub- 
lic. This has not only been so in cases like that 
of Palmer in England, bnt also in cases already 
classic in this country. True, the experts them- 
selves have not generally been to blame for the 
improper use which has been made of their testi- 
mony. Their opinions rather than their facts 
have come into strong antagonism, but this real 
character of their testimony has been concealed 
by the counsel, pouring denunciation upon the 
head of one and fulsome eulogy upon that of the 
other, simply because their opinions were respec- 
tively either detrimental or advantageous to the 
side upon which the counsel was engaged. 29 
Now, what should be the position of a medi- 
cal expert in a court of law ? Certainly not that 
of an advocate-a prosecutor or a defender of 
one charged with crime ! Rather that of a judge 
to whom certain facts are reported for examina- 
tion, who is expected to view them by the clear, 
passionless light of science, and thus to pro- 
nounce his opinion upon them. Their value or 
meaning, in connection with the case in court, is 
to be determined by the bench or jury, as the 
custom of the State may provide. 
Granting that this view of the function of an 
expert be correct, the question then comes up, 
how shall the tendency of the expert to advocate 
the side on which he has been summoned be pre- 
vented ? And the answer is, that it may be mea- 
surably prevented by an earnest determination 
on his part to preserve a judicial relation to the 
case, and to avoid the feeling of necessary hos- 
tility towards all others similarly summoned as 
experts, whether these are men of science or moun- 
tebanks ; that it may be absolutely prevented if 
experts should be appointed by the court, or a 
permanent commission could be created to which 
all subjects, requiring the opinion of medical 
men, might be referred for examination and de- 
cision. I have no plan of my own to present, 
and propose simply to set forth the evil in its 30 
present form as one requiring remedy. Any 
position that tends to prevent a full, comprehen- 
sive consideration of a subject, is fatal to that 
exercise of judgment which science demands of 
her votaries, and leads to the arrayal of one 
member of the profession against his brother un- 
der circumstances which too often result in dis- 
courteous expressions and even personal attacks. 
The profession should take some decided posi- 
tion in regard to the subject of expert testimony, 
that may protect it from the unkind criticisms 
and sneers to which it is now exposed from the 
legal profession and the public. It should also 
come to a definite conclusion in regard to the 
nature of the compensation when summoned to 
perform expert duty. Ko mechanic or crafts- 
man can be compelled to exercise his trade, un- 
less some arrangement satisfactory to him is 
made as regards his compensation. Why should 
the physician be required, when summoned as a 
witness in a case where he has no knowledge of 
any facts except those presented to him for a 
scientific opinion, to spend his time and employ 
his professional skill without a compensation 
other than that given as per diem for attendance 
as a witness? The question answers itself in 
the negative, and the answer is in full harmony 
with that section of the Code of Medical Ethics 31 
which says: "Medical men should also be 
always ready when called on by the legally con- 
stituted authorities to enlighten coroners' in- 
quests and courts of justice on subjects strictly 
medical, such as involve questions relating to 
sanity, legitimacy, murders by poison or other 
violent means, and in regard to the various other 
subjects embraced in the science of medical 
jurisprudence. But in these cases, and especially 
where they are required to make a post-mortem 
examination, it is just, in consequence of the 
time, labor, and skill required, and the responsi- 
bility they incur, that the public should award 
them a proper honorarium." 
Called to aid justice, the physician who can 
claim to be an expert in consequence of special 
study and practical experience, is entitled to 
such remuneration as may be agreed upon as 
proper for this order of professional service, but 
he should always feel that his position is one of 
special dignity and importance; that he should 
not swerve a hair's breadth on account of fear, 
favor, or affection towards any of the parties in- 
volved in the case; that pecuniary compensation 
must not be suffered to stain the judicial ermine 
with which he is pro tempore adorned; that 
truth alone should be the guide to his steps, 
which should be strictly confined within the 32 
limits of the subject presented for his opinion. 
Let this position be taken by the profession, and 
it will soon be recognized by the public, which 
at present is disposed to look upon the expert as 
a scientific advocate, retained to secure the suc- 
cess of a particular side of a case. To use the 
words of Prof. Washburne again: "Every man 
of science, whatever may be the department in 
which he has made its laws a study, owes it to 
himself to do what he can to educate and en- 
lighten the public mind to understand and ap- 
preciate the proper character and office of an 
expert, upon whose testimony the property and 
even the life itself of the citizen may depend." 
III. Compensation for Medical Services.- 
Here, as in the other subjects to which I have 
invited your attention, it seems to me there is 
probably needed a new rule. The Code of Medi- 
cal Ethics states: " That some general rules 
should be adopted by the faculty, in every town 
or district, relative to pecuniary acknowledg- 
ments from their patients; and it should be 
deemed a point of honor to adhere to these rules 
with as much uniformity as varying circum- 
stances will admit." It lays down, however, 
certain exceptions to such rules: ''Poverty, pro- 
fessional brotherhood, and certain public duties 33 
(specifically mentioned) should always be recog- 
nized as presenting valid claims for gratuitous 
services." These words of the Code-the past 
practice of the profession is in full recognition 
of their propriety-look to the fixing of a pecu- 
niary value to medical advice during an attack 
of disease, and the reception of a compensation 
for attentions through convalescence. Whether 
the payment of this sum is to be made at each 
visit, at the termination of the special sickness, 
or at stated quarterly, semi-annual, or annual 
periods, the idea involved is, that the physician 
is to be paid for his services in contending with 
disease. But, has not medicine taken a new 
position of late years on this particular ques- 
tion? In the reinstatement of the vis medicatrix 
naturae upon her throne as the great curative 
agency, and the recognition of medical agents 
simply as her adjuvants in the contest with dis- 
ease, attention has been turned to a new subject 
of study, viz., that of preventive medicine, which 
places the physician in a still higher position 
than he has heretofore held, because prevention 
is a grander and nobler work than cure. . 
Do not the indications of the times foreshadow 
a new relation of the physician to the patient, 
one connected not merely with the restoration to 
health of those who are suffering under the ex- 34 
han sting effects of disease, bnt also with their 
preservation in high health and protection from 
all possible morbific influences? We have been 
making profound investigations into the hygienic 
rights to which every human being is entitled; 
seeking to find out how defilement of air, water, 
and food are prejudicial to health-how improper 
clothing renders the body liable to disease-how 
noxious gases, proceeding from decomposing 
vegetable or animal substances, are antagonistic 
to the healthy play of the vital economy-how 
mistaken notions as to the treatment of the in- 
fant result in such injuries that leave their effects 
indelibly imprinted upon the whole of its after 
adult life-how violations of well-known hy- 
gienic laws as regards food and exercise are 
prolific causes of morbid tendencies that require 
years to remove. All these subjects, and a 
thousand others of a kindred nature, have been 
and are now being investigated. The results 
attained cannot be made of their full practical 
value to mankind, merely through the agencies 
of treatises or lectures. They must be con- 
stantly impressed upon the laity by a living in- 
terpreter. The evils man should avoid, the ad- 
vantages he should secure from modern hygienic 
truths, require that the latter be brought to bear 35 
directly on his individual case,'so that he may 
avoid those errors of diet and modes of living 
which will engender and establish disease. 
To be faithful to the discoveries of Protective 
Medicine, and to make them of the greatest use 
to our fellow men, is it not necessary that the 
physician should be the constant adviser during 
the days when health prevails, before pain indi- 
cates the intrusion of morbific agencies, before 
life becomes wearisome from the anguish and 
suffering which interference with its normal phe- 
nomena too often brings, before the perfection of 
the human organism is impaired by agencies for- 
eign to itself? Place the physician in charge 
of the health of the family, not only as their 
ready resort when danger has arrived, but as the 
guard to keep it away from the household; not 
only as the commander of the Reserve Corps to 
assist nature in her fight with disease, but on 
duty at all times conducting preventive measures 
so as to reduce the probability of an engagement 
to the minimum; not as the savior of the sick, 
but the preserver of the well-this would be to 
put him in a higher and more useful position 
than he occupies at present. 
A distinguished English physician, availing 
himself of all the recent discoveries of Sanitary 36 
Science, has furnished us an account of an ideal 
city, where hygienic errors will have no tolera- 
tion, and where men will rejoice in full posses- 
sion of all their hygienic rights. Many years 
must pass away before an approximation to his 
dream shall be embodied in the construction of 
the city of Hygeia, but it would be practicable 
to do something in this direction for single fami- 
lies as regards their material stirroundings, if 
they were placed under the supervising care of a 
physician thoroughly acquainted with modern 
sanitary science. 
I claim that the position, which the physician 
ought to occupy hereafter in regard to the fam- 
ilies under his care, should change the nature of 
the compensation for his services, from fees for 
attendance during sickness to a specific salary 
or annual compensation for services as medical 
director to the family. I am aware that in cer- 
tain districts such a plan would be condemned 
by the majority of the profession, because they 
claim that it conduces to unfair, undignified, and 
unprofessional underbidding, but why it should 
do this more than the present plan of special 
compensation for special services, I cannot con- 
ceive. The man who lacks professional honor 
will avail himself of every opportunity to secure 37 
undue advantage over his professional brother, 
no matter what plan of compensation may be 
considered proper. This plan does not neces- 
sarily aid him in his nefarious designs upon his 
brother. The faculty of each town or district, 
as stated in the Code, could adopt some rate of 
annual charges, contingent upon size of family 
or situation of house occupied, and its members 
should deem it a point of honor to adhere to the 
same as far as possible. 
Another obstacle, still more formidable, may 
present itself to the change here suggested as 
desirable-the public may be unwilling to con- 
sent to any such arrangement, hoping that the 
Doctor's bill for attendance during sickness may 
be much less than it would be for services in the 
preservation of the health of the family. This 
obstacle, at first, would be very great, on ac- 
count of general ignorance of the value of hy- 
gienic laws, but as this ignorance would give 
way before clearer and more intelligent views, I 
take it, that the plan would be agreed to by the 
laity as one entitled to their warmest approval, 
and not necessarily involving increased drain 
upon their income. 
A momentary consideration of the attractive- 
ness of such a relation of the physician to his 38 
patients will, I think, create a kindly feeling for 
this plan, even with those who want to look 
upon it as an unjustifiable innovation upon an- 
cient usage. The doctor becomes the intimate 
friend and confidential adviser of the families un- 
der his care. It is his interest to protect them 
from all pernicious errors as regards diet, dress, 
and material surroundings. He becomes the 
welcome guest in the household; the children 
are attracted toward, instead of being repelled, 
as is too often the case now, from him; confi- 
dence is reposed in his judgment, faith is created 
in his skill, and when disease appears, as it will 
oftentimes despite our most intelligent care, his 
prescriptions and advice will be assisted by that 
most useful adjuvant to the practitioner-unfal- 
tering belief in his knowledge and medical judg- 
ment. Thus he will become a blessing to the 
family in disease, because he has been one in 
health. His life will be one continuous round of 
usefulness, smiles and kind words greeting him at 
every step he takes, and love delighting to ren- 
der him the tenderest offices. And, when his 
own final hour shall come, those whom he lov- 
ingly attended on earth will lovingly watch his 
pathway to the tomb, and shed warm tears of 
affection over the grave of "the beloved physi- 
cian." 39 
I hope that the changes which I have men- 
tioned, as, in my opinion, required by the present 
status of Medicine, may not be considered un- 
worthy of calm consideration by my brother 
Alumni. If they are dreams, they came to me 
in open day. They may be forecastings of what 
shall not come to pass for many a year, but they 
will be recognized as imperatively necessary in 
the near or the distant future. They will add to 
the fitness of the members of the profession for 
the calling they pursue; will protect their dig- 
nity from the charge of becoming hired advo- 
cates instead of mere mouthpieces for the utter- 
ance of scientific deductions before the courts, 
and will exalt them to the position of sanitary 
advisers with a fixed compensation instead of 
that occupied now of sporadic advisers when dis- 
ease is revelling in the human organism. Our 
profession is so progressive, that its members 
must expect to modify their plans to adapt them 
to an enlargement of its boundaries, and these 
are extending so rapidly that blind attachment 
to the past must not prevent such modifications. 
My task is done. Would it had been better 
done ! Knowing that the authorities of the Uni- 
versity are keenly alive to everything that will 
keep it in the fore front of science, I have not 40 
hesitated to present these crude thoughts as the 
contribution of a loyal son, who finds peculiar 
pleasure in recognizing the allegiance due his 
Alma Mater. May the success that honest effort 
in behalf of genuine professional progress always 
should receive, be hers, so that her future repu- 
tation may exceed even that of her youth I