The Responsibilities of the Medical Profession. 
AN ADDRESS 
TO THE 
Graduating Class at the Commencement 
OF THE 
ALBANY MEDICAL COLLEGE, 
MARCH 16, 1887 
By ANDREW S. DRAPER, 
State Superintendent of Public Instruction. 
ALBANY, N. Y. 
WEED PARSONS AND COMPANY, PRINTERS. 
1892. The Responsibilities of the Medical Profession. 
AN ADDRESS 
TO THB 
Graduating Class at the Commencement 
OF THB 
ALBANY MEDICAL COLLEGE, 
MARCH 16, 1887. 
By ANDREW S. DRAPER, 
State Superintendent of Public Instruction. 
ALBANY, N. Y. 
WEED PARSONS AND COMPANY, PRINTERS. 
1892. AN ADDRESS. 
Mr. President and Gentlemen of the Graduating Class : 
The sympathy of so much of the world as has any feel- 
ing, goes out towards young men at that time of life when 
character is taking shape and form, and when they are 
drifting into, or trying intelligently to decide what their 
life work shall be. 
What can I do best ? What is best for me ? Shall I 
be content to try to earn a living by my untrained physi- 
cal strength ? Shall I undertake to become a skilled 
artisan? Shall I seek to enter a profession? If so, which 
one ? Is it worth while to try to get a liberal education ? 
Do I want to go to college? If so, will it be possible? 
These are questions which force themselves upon the 
mind of every young man who has character enough to 
decide them, and then to prepare for and seek an hon- 
orable employment. They are troublesome questions, 
burdened with the largest consequences, and exceed- 
ingly difficult of intelligent determination. 
He is something of a man who, when approaching man’s 
estate, coolly sits down and deliberately decides these 
questions for himself. Comparatively few men do it. By 
far the greater number drift down the river and then float 
carelessly or helplessly upon the billows of life’s great 
ocean, tossed hither and thither by the waves of what we, 
improperly I think, call destiny. Men very commonly 
become mere drudges, or mechanics, or professional men, 4 
because their fathers were the one or the other, or because 
a chance employment at an early age started them in the 
way of one vocation or another, and they lacked the mind 
and nerve to make a change. 
PHYSICIANS DELIBERATELY CHOOSE THEIR PROFESSION. 
But this is not so always. Some men never drift. They 
are not made in that way. They have a mind of their 
own and they do a little independent thinking on their 
own account. Men who have this quality show it early 
in life, for it was born in them. They decide what they 
will undertake for themselves. They follow an inclination 
which has seized upon them, they scarcely know how or 
why, or they deliberately determine that this occupation, 
or the other, holds out the largest inducements, gives the 
best promise of rewards or of usefulness and is therefore 
the best for them to undertake. I have an idea, that from 
the latter class, physicians are largely drawn. Fortunately, 
it is daily becoming more and more difficult to float into 
any of the professions. But I should name the medical 
profession, in particular, as the one which places so much 
responsibility and such exactions upon its members as 
to forbid its becoming a gathering place, or a resting 
place, for men of shiftless habit or aimless purpose. But 
whether or not I am correct in supposing that physicians 
themselves come from the one class of persons I have 
spoken of, I have entire confidence in my belief that the 
necessity for them arises out of the other class to whom 
I have referred. If all men were of an active, positive and 
progressive temperament, there would not be enough 
dyspepsia and biliousness in the world to keep gigs and 
saddlebags in a suitable and becoming state of repair. 
If I am sound in my reasoning, then you enter the pro- 
fession of medicine to-day in the fulfillment of a deliberate 5 
purpose and in the carrying out of a carefully prearranged 
plan. How fortunate it is that inclinations differ and that 
we do not all think alike! I confess it is difficult for me 
to understand the influences or the reasoning which have 
led you to determine to engage in a calling which will re- 
quire you to respond at everyone’s beck and call, generally 
at a dollar a call, not in the day only, but in the night as 
well, not six days in the week, like ordinary mortals, but 
the seventh also, and to pass your life among colics and 
colds and fevers and dyspepsia and accidents and death. 
It can be nothing short of the promptings of honorable 
impulses, of sympathy with the afflicted and unfortunate 
and of participation in that common respect and esteem 
in which the world holds the medical profession. 
CHARACTER AND RESPONSIBILITY OF MEDICAL PROFESSION. 
You have chosen an old, an honorable, a responsible 
and an exacting profession. 
Ancient and honorable it is, indeed. From the time 
when priest and physician were one upon the plains of 
the Orient, when man, in his ignorance and superstition, 
reasoned that all diseases were the manifest indication of 
the immediate displeasure of the Deity and that those, 
who were upon terms of amity and good will with the 
Almighty, were the only ones to turn aside the Divine 
wrath and so work the cure, when magic and medicine 
were in some way part and parcel of each other ; when 
no remedy was administered without mystifying cere- 
mony and incantation, down through all the phases 
of a constantly changing and developing civilization, 
the medicine man has been held among all peoples, not 
only in esteem and respect but almost in reverence and 
awe. In the early days there was, of course, something 
of superstitious ignorance and fear about the feelings of 6 
the people towards him, but in later times, and in all 
countries, even the children by the wayside have testified 
to his importance as they have stopped to stare as he 
rode by; and peasant, priest and king alike have felt their 
hearts in their throats as they have watched the expres- 
sion of his face or waited for the cautious word which he 
should utter. 
The feeling which has always impressed me most in 
connection with the medical profession, is the sense of 
responsibility which it bears to the people in their per- 
sonal and home affairs and to society in its organized 
state. It is a responsibility, which if not greater, is cer- 
tainly more constant and more immediate, and I have no 
doubt presses more heavily upon its members than that 
borne by any other profession. If I should say that this 
responsibility upon the medical practitioner was greater 
than that upon the minister of the Gospel, I should be at 
once charged by some good man with heterodoxy and told 
that the responsibility of the divine was as much greater 
than that of the doctor, as the welfare of the soul is 
greater than that of the body and as eternity is longer than 
time. But when I answer that your responsibility is akin 
to and participates in that which he bears, while it, at the 
same time, extends beyond it, I am confident that I shall 
be more than half way right. 
As life and health are more precious than property, so 
is the responsibility upon him who practices medicine 
above that upon him who practices law. 
Our genial and always refreshing New England physi- 
cian and poet, Dr. Oliver Wendell Holmes, who has come 
to belong to everybody else as well as to New England, 
in his breakfast table talks, declares that of the profes- 
sional men, the lawyers are the most clever, the ministers 
the most learned and the doctors the most sensible. I  7 
hope that the last part of the proposition at least is true, 
for I know of no vocation or calling, the prosecution of 
which so involves the necessity of good sense as does that 
upon which you are entering. Fair learning, a sound 
heart, a disposition to be progressive, a capacity which 
will enable one to assimilate with all circumstances and to 
adapt one’s self to all phases of life, tact at managing men, 
and women too, a kindly and sympathetic nature, a rea- 
sonable dignity of bearing, a quickness and keenness of 
perception, a good and reliable judgment, prompt and 
resolute action, and an ability to keep professional confi- 
dences are, it seems to me, essential to any marked or 
lasting success in medical practice. Men in other call- 
ings may and do succeed without many of these qualities, 
but it is difficult for me to see how one can come to be 
much of a physician without, in some degree, possessing 
each of them. 
INCREASING RESPONSIBILITY. 
In a purely scientific sense more is expected and re- 
quired of physicians than formerly. The time was when 
your profession was expected to treat only such hurts or 
ailments as might appear upon the exterior of the body 
and were therefore visible to the eye ; but that time has 
long since passed away. More frequently than other- 
wise, you are now called upon to treat diseases, the seat 
or cause of which is hidden from sight, and which you can 
discern or diagnose only by some outward manifestation 
which would elude any but the keen eye of professional 
experience and skill. 
I have heard it said, and from the changed conditions 
surrounding human life I should not be surprised if it were 
true, that disease has continually grown more and more 
prevalent. But the knowledge with which to contend 8 
against disease has been accumulating also. This has 
been especially true in recent years. The passing away 
of the popular prejudices against post-mortem examina- 
tions, the increasing facilities for dissection, the discovery 
of anaesthetic agents, and the invention of various me- 
chanical appliances for peering into the doors and win- 
dows of this tenement house of clay in which we live, 
even when all is life within, have very greatly added to 
the knowledge of that most complicated and difficult of 
all the accomplishments, the scientific knowledge of the 
human body. Then too, chemistry has proved a most 
valuable assistant to medical science, particularly so in its 
analyses of the excretions of the human system. The 
improved microscope has brought new revelations. The 
discovery of unknown curative agents, greater familiarity 
with the nature and effects of drugs and the increased 
care with which they are being compounded and adminis- 
tered, consequent upon the advances of pharmaceutical 
knowledge and the legislative action of our own and other 
States, have greatly aided and promoted the science of 
medicine. 
PROGRESS OF MEDICAL SCIENCE. 
In short, medicine has not been a sluggard or a lag- 
gard in this busy day of ours. In an era that will proba- 
bly stand out in the world’s history above all others, be- 
cause of the mighty advances which it has witnessed in 
discovery and invention, and because of the wonderful 
strides which have been made in all classes of learning, 
medicine and surgery have kept pace with all the rest. 
More than this, it is carrying its blessings to all the peo- 
ple. The magnanimity and humanity of the profession 
and the widespread philanthropy of the day, bring to the 
poorest the benefit of better medical service than the 
richest could get in the days of Cromwell or Elizabeth. 9 
All this places a greater responsibility upon you than 
those who have gone before you were obliged to bear. 
The larger the knowledge and achievements of the pro- 
fession and the more generally they are brought to the 
doors of the people, the greater will be the expectations 
and exactions of the public and the more liberal must be 
the endowments, and the more assiduous must be the 
labor of any physician who would attain success. 
I have no doubt that the study of medicine is, like other 
sciences, divided into two parts, the theoretical and the 
practical. It is one thing to understand principles and it 
is another thing to know how to apply them. It has 
always seemed to me that the exactions upon a physician 
in relation to the application of his science, are more than 
those upon any other professional man. Frequently, he 
is called into an awful presence, and upon his knowledge, 
his judgment and his immediate and resolute action, must 
turn the issue of life or death. This involves the necessity 
of a man not only intellectually equipped, but of one who 
is clear headed and well balanced and determined as well. 
AN IMPURE PHYSICIAN INTOLERABLE. 
And there is something beside scientific attainments 
and an ability to apply them, requisite to the success of a 
medical practice. Integrity of character, a condition pre- 
cedent to any substantial success in all of the callings of 
life, is preeminently so in yours. You are entering upon 
a business in the management of which the people will de- 
mand not only capability but reliability. You will come to 
our homes when the clouds are thick and when the heart 
aches. The presence of an impure man at such a time is 
an intolerable offense. You will be trusted implicitly. 
You will administer the most deadly remedies, but your 
directions will be followed with undoubting confidence. 10 
Some of you will acquire expertness in surgery, and your 
trained hand will guide the keen blade close to the lines 
where the life currents flow. It is a tremendous responsi- 
bility, and no people will knowingly intrust it to one who 
is not professionally skilled and expert, who is not clear 
headed and who is not sound at the heart as well. 
CONFIDENTIAL RELATIONSHIP. 
You are going to learn more of human nature than is 
given to most men to know. You will be in the highest 
circle of society this hour, and in the lowest the next. But 
wherever you go, the relationship into which you enter 
will be a sacred and confidential one. In the intent of the 
law, our homes are our castles, into which none can enter 
without leave, but they will not be barred against you. 
You can pass the gate almost without knocking or wait- 
ing. You will learn of more than our bodily infirmities. 
You will see all phases of life. You will walk in the sun- 
shine and in the shadow alike. You will see the strong 
points and the weak points of nature at once.- You will 
find that felicity and thrift which are the crowning glories 
of our American homes, and you will have abundant in- 
troduction to the faults and frailties and foibles of this 
weak human nature of ours also. You will see how 
different many of us are from what we appear to be. But 
it is in the bargain that you keep the knowledge to your- 
selves. You will come to know a thousand household 
secrets, many of small, but some of great importance, 
none of which are to be repeated, in confidence even, to 
a next friend in the office, nor told with a mock assump- 
tion of superior knowledge and wisdom, in the public 
lounging places. 
There is a public judgment of physicians, almost un- 
erring among men and almost intuitive among women, 11 
which soon measures one at his real worth. The people 
can not be fooled and they will not long employ an insin- 
cere and frivolous man, unworthy of confidential relations. 
If you think otherwise, you will pay the penalty in failure. 
LIABILITY OF PHYSICIANS. 
Aside from the moral responsibility which one assumes 
upon entering the profession of medicine or surgery, he 
takes upon himself certain legal obligations and subjects 
himself to certain liabilities which the laws of the country 
impose. It may not be uninteresting to you to have the 
general principles of the law concerning a physician’s 
liability compactly and briefly stated here : 
The physician holds himself out to the public as possess- 
ing that reasonable degree of learning and skill which the 
members of his profession ordinarily possess. 
Those who hold themselves out as specialists, who 
claim to have special skill in treating the diseases of single 
organs, such as dentists, oculists or aurists, are deemed 
to be what they claim for themselves, and are held to a 
larger liability in the practice of their specialties than are 
those who do not so announce themselves. 
Physicians of note, having large practice and charging 
large fees in popular centers, are held to a peculiar re- 
sponsibility over those of more moderate pretensions in 
smaller places. 
When a physician takes a case, he contracts not only 
that he has average professional skill, but also that he 
will attend to it with reasonable diligence and care. 
Physicians are not legally required to cure, unless they 
specially contract to do so, and then they are liable in 
damages if they fail. 
The practitioner is bound to exercise skill and diligence 
in watching and guarding against accident or indulgences 12 
which, overlooked, may delay or prevent the restoration 
of the patient. In what he does he must take into ac- 
count any latent predisposition to certain diseases, the 
lack of vital or recuperative power on the part of the 
patient, the want of pure air, proper nourishment, and 
good attendance. He is also bound to look to it that his 
directions are carried out. 
A physician is not responsible for want of success ; nor 
is he even responsible for his own mistakes in diagnosing 
or treating doubtful cases, provided he has brought 
ordinary skill and reasonable care to the treatment of 
the case. 
It seems to be pretty well established that a physician 
or a surgeon is not liable in damages for a mistake in 
judgment, where it appears that he possessed ordinary 
professional skill and intelligence, although one case is 
reported, where a doctor was mulcted in damages for not 
taking off enough of a patient’s leg. But this case is not 
well sustained, probably on the ground that it is unsafe 
to hold out an inducement to the doctors to carry away 
any more of the patient than is necessary. 
The physician’s liability is usually a civil one only, 
which can be compensated for in damages, and for which 
he is not criminally liable. But this is not always so. 
Some things are specifically prohibited by statute and 
punished as crimes. Even beyond this, there is such a 
thing as criminal malpractice, but it involves the most 
dense ignorance, or the most criminal inattention, or the 
most unreasoning rashness. 
It seems to be the policy of the law to place few re- 
strictions in the way of those who desire to practice the 
profession. There are statutory regulations in some of 
the States bearing upon the subject, but they seem to be 
loosely drawn and of small consequence, and quite as 13 
often as otherwise they become the surest protection of 
the unprofessional scoundrels for whose punishment they 
were nominally enacted. It seems to be the purpose of 
the law to give allopathic and homoeopathic, and hydro- 
pathic, and electropathic, and botanic, and magnetic, and 
pneumatic and the faith curers too, old schools and new 
schools, and no schools at all, full liberty to practice at 
their own sweet will, limited only by that care and caution 
which most people will exercise in a matter of so great 
consequence, and by the legal liabilities of which I have 
been speaking. 
PUBLIC OBLIGATIONS OF PHYSICIANS. 
I have been considering the obligations of physicians 
to the individuals who employ them. But this estimate 
alone, in my judgment, comes far short of the full measure 
of your professional responsibility. You owe something 
to society. You bear an important and close relationship 
to the public well-being. 
In the first place, you are, of necessity, very largely, 
the conservators of the public health. Considerable at- 
tention has been paid to this subject of late, but the ne- 
cessity for such attention is constantly augmenting. The 
increase of population and the growth of towns are con- 
stantly adding importance to the problem of public health 
and, at the same time, surrounding it with greater danger 
and difficulty. The improper ventilation of our buildings, 
private and public, imperfect drainage and the difficulty 
in procuring an adequate supply of proper food and whole- 
some water in large communities, the sanitary condition 
of public charitable and criminal institutions and particu- 
larly of school buildings, the gathering and recording of 
vital statistics, are matters which are peculiarly within the 
province of physicians, and with the general supervision and 14 
care of which, they are specially charged. You know the 
causes and the modes of the propagation of disease, and 
you therefore know how to remove the cause and reduce 
the danger to a minimum. Experience proves the efficacy 
of preventive medicine. One of the most reliable of au- 
thorities shows that two centuries ago the mortality rate 
in London reached 80 in 1,000, while now it is less than 
23. Here are great opportunities for public usefulness, 
which will be continually broadening in this country. 
The public expects the medical profession to look after 
these matters which are so naturally and necessarily within 
the scope of its knowledge and duties. 
PHYSICIANS AS EXPERT WITNESSES. 
Then too, physicians stand in an advisory attitude to 
the public upon many subjects of grave and general con- 
cern. Whether heinous crimes have been committed, and 
whether or not the perpetrator was responsible for his act 
and should be excused as unfortunate or punished as a 
criminal, it is very frequently left to physicians to deter- 
mine. It is left to you to say whether persons are of such 
unsoundness of mind as to justify the public authorities 
in restraining their personal liberty or taking away their 
ordinary right to manage their own affairs; whether a tes- 
tator had sufficient mental capacity to make a will ; whether 
this citizen should be absolved from attendance as a wit- 
ness or a juror, or that one from service in the army or 
navy. 
Your profession has almost a monopoly of this thing. 
No other witness will be heard in a court of justice upon 
these subjects. Upon any other question than a scientific 
one a mistaken witness can usually be cornered or success- 
fully disputed. But not so with the doctor. He gener- 
ally finds a road out of a dilemma. The only way to dis- 15 
pute him is by the use of another doctor, and after the 
two have disagreed, the matter must be determined by 
men who know nothing about it and who usually go with 
the side which had the doctor who looked the wisest, 
seemed the most certain, or told the best story. But more 
than this. Other people, when they become witnesses are 
obliged to tell only what they know, what they have seen 
and what they have heard. They are compelled to leave 
their sophistries and their reasoning and their sympathies 
and their prejudices all at the door of the court-room. 
But physicians are asked to state, taking their technical 
knowledge as a basis, what they think about it. Their 
manners upon the witness stand and their way of apply- 
ing such scientific knowledge as they may possess to a dis- 
puted state of facts may control large estates, blast char- 
acter, lay homes in ruins, restrain personal liberty or send 
a man to the scaffold. 
That physicians commonly, almost universally, act con- 
scientiously in these matters, I do not doubt. That their 
technical knowledge has been of incalculable aid to the 
public in the furtherance of justice and in the general ad- 
ministration of public affairs, there is no question. I am 
not opposing the system. I do not undervalue its impor- 
tance. There is some reason for believing that a change 
in the system which would make the scientific witness the 
friend of the public, for the purpose of determining the 
truth, rather than the agent of one party employed for 
the purpose of proving his case, would be an improve- 
ment. You can not, however, make the system over. 
Opinions would differ as to what were wise modifications. 
The system places upon the profession what I consider 
some of its heaviest responsibilities. You must necessa- 
rily, in time, assume them. I have spoken of the matter 
to the end that I might arouse or strengthen a purpose to 16 
meet these great duties manfully, only with adequate 
equipment and preparation, after full reflection and con- 
sideration, and then without fear or favor, without sym- 
pathy or prejudice, with a becoming appreciation of the 
fallibility of human reasoning and only with a sincere 
desire to arrive at and establish the truth. 
PHYSICIANS AND GENERAL EDUCATION. 
Then again, physicians, who are very commonly the 
principal representatives of scientific culture in every com- 
munity, should do more than they customarily do to ad- 
vance the interests of general education. The school 
system stands much in need of your advice and assist- 
ance. In the places where many of you will commence 
practice, you will find school buildings erected when the 
people knew little of, or cared little about such matters as 
sanitation, ventilation, lateral lights or adequate breathing 
space. If you will inspect these buildings and look in 
upon the school, you will find an inexcusable disregard of 
the laws of health. If you will stop a little, you will see 
a system of general education which is running upon the 
line of intellectuality alone. You will see no signs of 
physical culture, but you will find a decided tendency to do 
away with even the recesses, so that there shall not be 
any yelling, or running, or shooting marbles, or playing 
ball, or turning summersaults, or standing on the head 
around the schoolhouse. 
In this State, and in many around us, the Legislature 
has directed that the studies of physiology and hygiene 
shall be taught in the schools. It is an important step 
in the right direction. These branches may be made of 
great advantage to growing children. But the teachers 
very commonly require a little assistance and direction in 
the matter which you can very easily render. It is not 17 
impossible either that in thus helping others, you would 
help yourselves, for five-sixths of the teachers of the State 
are ladies who will prove decidedly interesting to men of 
your youthful age and tender sensibilities. 
In short, physicians can easily help the school system 
in a hundred ways, and being able to do so, it has claims 
upon them — claims which can only be referred to here, 
but which I beg you to take into full consideration. 
CONCLUSION. 
I must conclude. Briefly, I have endeavored to present 
some of the views which address themselves to a layman’s 
mind, touching the responsibilities of the medical pro- 
fession. If what I have said, has served to give you a 
clearer vision of the broad field upon which you are en- 
tering, or has conveyed to you a fuller appreciation of the 
delicate and responsible duties you are assuming, or has 
inspired your souls with a determination to meet those 
duties wisely and manfully, I am content. 
I commenced by saying that the world sympathizes with 
the man who is trying to determine what his life work 
shall be. I close by saying that the world congratulates 
the man who has decided the question and decided it 
right. As you go down the front steps of your Alma 
Mater and out into the world this afternoon, you carry 
with you the best wishes of all. This institution lets you 
go with a lively interest in your future ; this radiant au- 
dience waives its handkerchiefs in salutation ; this city, 
which has been your temporary home, parts with you 
with regret to-day but with hope of the morrow; every 
friend of the race says to you an earnest God-speed. 
Your professional success will be what you make it. But 
you can not make it in an hour. Do not be afraid, you 
are better equipped than the majority who have gone 18 
before you. Be diligent, be active, stick to your business, 
be public spirited, be progressive, keep your eyes open 
and inquire about things, be affable, be true to your con- 
victions, do what in your power lies to ameliorate the 
condition of the unfortunate and to advance the well-being 
of the race. Patiently wait for results and you will not 
wait in vain. When life’s lengthened shadows shall en- 
compass you, it will be yours to know that the name of 
him who loved his fellow man, will, in the feelings and 
sensibilities of the people as well as in the eye of heaven 
lead all the rest.