tfiTdHCoCft tA) -JK mmtm fovtit $»t SMfoai *****- ^S ____________- V') UNWRITTEN STUDIES AND DUTIES \ — or THE-- PHYSICIAN. FITCHBUB G:i?fiARJ PRINTED BY E. & J. F. D. GARFIELD, 1859. WmMm $Mxt$ awtf inti^ vi tto iftpfcfom. ANNIVERSARY ADDRESS BEFORE THE WORCESTER NORTH DISTRICT MEDICAL SOCIETY, APRIL 9, 1859. By ALFRED HITCHCOCK, M. D " Should the body sue the mind before a court of judicature for damages, it would be found that the mind would prove to have been a ruinous tenant to its landlord."' Plutarch. PUBLISHED BY VOTE OF THE SOCIETY FITCH&tJKG: PRINTED BY E. & J. F. D. GARFIELD, 1859. Dear Sir :— The undersigned, a Committee chosen for that purpose, by the Worcester North District Medical Society, have the pleasure to request of you a copy for publication of the Address written by you, and delivered at the annual meeting of said Society, on Saturday, 9th inst. Very respectfully, Your friends, T. R. BOUTELLE, ) JONAS A. MARSHALL, >■ Committee. DAVID PARKER, ) Alfred Hitchcock, M. D. Fitchburg, April 15, 1859. Fitchburg, April 25, 1859. Gentlemen :— Your favor of the 15th inst., communicating the vote of the Worcester North District Medical Society is received. My Address of the 9th inst. to which it refers, was hurriedly prepared, and solely with reference to our new local Society, and without a thought of its receiving a wider publicity than a reading on that anniversary occasion. Without interposing my own judgment against your personally expressed wishes and the formal vote of the Society, I herewith place the manuscript at your disposal. My thanks are due the Society for their action, and to yourselves for your kind personal interest in the subject. Very respectfully, Your obedient servant, ALFRED HITCHCOCK. To Drs. Boutelle, Marshall and Parker, Committee, &c. ADDRESS. Mr. President and Gentlemen :— A year ago your kindness and partiality imposed upon me the duty of addressing you on this occasion. With some personal misgivings, mingled with gratitude^ I accepted the responsible yet agreeable task. With pleasure I now bid you all a cordial welcome— a welcome to the first anniversary meeting of the Worcester North District Medical Society—a welcome to membership and to all the social and professional benefits which it proffers. From our individual, and somewhat solitary fields of labor, worn, jaded and sore it may be, by the rough, hard harness of professional toil, we come up hither for a day of rest and recreation— for a short season of professional communion, and to meet for the first time as a Society at the festal board. I trust the occasion may be one of pleasure and of mutual advantage. In order therefore temporaHy to ,%** relieve our minds, somewhat of the tedium and treadmill sameness of common medical topics, I shall avoid a 4 ADDRES S discussion of Apoplexy and Amputation, Consumption and Cancer, Fever and Fracture, Hemorrhage and Hernia, and shall for a few moments attempt to direct our thoughts in a channel somewhat aesthetic and ethical—shall briefly present a few topics not well defined in medical text books, but which in my judg- ment essentially belong to a correct Theory, and to the most perfect Practice of the healing art. I have there- fore chosen as the theme of the present discourse THE UNWRITTEN STUDIES AND DUTIES OF THE PHYSICIAN. This subject naturally divides into two parts, Studies and Duties. Under the first division the Physician should study 1st. HIMSELF. 2d. MAN AS A GENUS. 3d. HIS PATIENT SPECIFICALLY. 4th. NATURAL LAWS AS THEY AFFECT MAN. Under the second division the Physician will have need to practice unwritten duties. 1ST. TO HIMSELF. 2d. TO THE WOULD. 3d. TO THE PROFESSION. 4th. TO HIS PATIENT. 1st. In considering the Physician's study of himself, it is assumed, of course, that he is well educated in his profession;—that he has a thorough knowledge of ADDRESS. u those physical sciences which are the basis of our profession. It is assumed that he is well versed in those departments demonstrated by the dissecting knife, microscope and crucible, and that he appreciates and understands atomic laws and cell development in their relation to man as a living being. But having learned all this the Physician must study himself, physi- cally, mentally and morally. He must know his own intellectual calibre, and the extent, quality and availa- bility of his acquired knowledge. He must study his own prejudices and whims, if he has any,—likes and dislikes; must guage his own temper, self-control, courage and endurance. He must know the personal impression he makes on his patients and their friends. He should strive to possess the paramount trait of time- liness—the faculty of saying " the right word, with the right tone and manner, or doing the right thing at the right time;" of supplying from his medical and surgical acquirements, as from a full and well arranged armory, the weapon which the exigency demands. In a word, he must study the difficult and rare achievement of seeing himself as others see him. He must study himself in relation to that higher law by which candor, kindness, and a sincerely benevolent wish to make others happy becomes alone the basis of character that will win per- manent favor and enduring friendships. Above all he must know the priceless value of a conscience a void of offence." 6 ADDRESS It is said the Persian curriculum of study in a boys education is " to learn to ride, to shoot and to speak the truth!1 A Physician is excusable for not riding or shooting in the most expert manner, but he can never be pardoned for habitual disregard of the third and divine part of a Persian's education. Perfect integrity should mark all his conduct. His name should be the synonym of truth. He should wear it as a coronet of gold—as a gem on his forehead—that the sincerity of his heart and the purity of his motives may be known and read of all men. 2d. The Physician must study the world—he must study man as a genus—especially in his intellectual and moral nature. His emotions and passions must be studied. In the books and the dissecting room he has learned the location,the weight, capacity and anatomical relations of the material heart; and this is essential knowledge ; but not less imperious is the necessity that he penetrates and scrutinizes the deeper and more subtle realm of human passions and affections. He must study man as a psychological being. He must follow with a searching glance his emotions and passions in all their labyrinths. He must judge of their power and tendency, and be able to appreciate and measure each; and, as a good Physician, bring all under his moral therapeutics in ministering to the sick. ADDRESS. 7 3d. The Physician must study and know his patients —and he must study each patient specifically. The books have written the anatomy, the pathology and the physical remedy. This knowledge is applied at the bed side and the diagnosis is made out, and in an instant as a logical sequence the drug is suggested to the mind of the Practitioner. But here let me urge the Physician to delay his therapeutics, and from another stand point, again investigate the case. Beyond this routine of duties—this mere inanimate skeleton of ideas there is a vitality, an (Esthetic nature that defies all the laws of dead matter; a spiritual and emotional force that sometimes bends the body at its will, modifying and intensifying its diseases. These passions and emotions, fears and hopes of the patient must be studied. For the moment the Physician must personify the patient. In other words, he must exercise a kind of mental ubiquity—he must tempo- rarily put in practice the doctrine of transmigration of souls. For the moment he must occupy his spiritual status—must feel as he feels—must go with him into the inner temple of his spirit and walk along the corridors and labyrinths of his spiritual dwelling place— he must view the disorder and dilapidation of its columns and arches,—he must even drink in the illusion by which the actual ruin and desolation of the edifice is magnified, or concealed from its possessor—and then, when from that point of view he returns to a position 8 ADDRE SS. more real and tangible, he can attack the disease with a more certain aim and a surer success. Again, he must look as the patient looks at every nook and corner of his spiritual dwelling. In one apartment there may be a Demon, imaginary in fact, but real to the patient, (and such it should be to the Physician) which, having seen, without miraculous power, he may thus be able to " cast out." Look out with him upon the external world of mind and matter, and see what kind of a photograph is produced in his brain—whether natural or distorted, and then use those pictures in guiding the patient to physical and mental health. Does the patient view himself or the world through a roseate or jaundiced medium, or with magnified or refracted light? Such must be the Physician's mental vision. He must take on the patient's mental condition precisely as a play actor puts on the costume, and hates and loves, and weeps on the boards of a theatre. All this he must do in sincerity and kindness, for the good of his patient; and without this subtle knowledge, this mental sympathy, this measuring of the heart's deep passions and emotions he cannot, in many cases, impart the highest and greatest amount of good to the sick. In the chronic diseases of adults this kind of intimate mental acquaintance with the patient is most important. It is true that many who are sick get well without an intimate knowledge of their whole mental and physical ADDRESS. 9 condition being known to the Physician—but with this knowledge he would in all cases have greatly increased power for good, diminishing the severity and duration of symptoms, and hastening and perfecting convalescence. Many cases of sickness, with diseases not necessarily fatal, often linger surprisingly, the Physician as well as the patient being in a state of unsatisfied suspense and darkness. With many of these lingering cases it may undoubtedly be found that some mental or moral cause is the barrier to recovery. These cases should be studied in their more subtle nature, and the fears, the hopes, the sympathies and aspirations of the emotional nature should be brought to act a curative part in harmony with more ponderable therapeutic means. Human faces are not alike, so neither are diseases of the same name. The intellectual and emotional nature of every sick person is also unlike every other. Every physical disease is thus yoked together with a diverse spiritual nature, and hence every patient becAmes a study per se, physically and mentally, and is to be truly and radically investigated as though no other had ever existed. In treating the diseases of children this kind of discrimination is no less necessary. Though their intellects are less developed, yet their feelings, their desires, and their temperaments play a very important part in modifying their physical diseases. Their mental and moral peculiarities should be deeply studied and nicely measured before selecting for their use what is commonly called " medicine." 2 10 ADDRESS. 4th. The Physician should study the laws of nature as they affect man. His study must be mingled with Faith —a faith in the reality and magnitude of phenomena and laws not yet demonstrable by science. In this department of study he must labor while life lasts, excluding on the one hand a blind or weak credulity, and on the other avoiding the skepticism which some times, wrongfully appertains to demonstrative science. More than twenty years ago I heard a distinguished Professor repeat with approval the Atheistical dogma borrowed from France, " That a Physician should doubt every thing not capable of anatomical, chemical or micro- scopical demonstration; and that science would fail of its highest possible achievement until by synthetic combination organic life, in vegetable and animal form leaped forth pulsating with vitality from the retort of the Chemist." Such a dogma annihilates faith—and at once hopelesly plunges the inquirer into the cheerless and bottomless abyss of skepticism. I need not in this presence combat such a pernicious sentiment. I feel assured of your hearty sympathy with me in repelling a doctrine so repulsive to every sincere and trusting believer in man's immortality, and the existence of God as the Supreme Author of all moral and physical law. Medical science should approach this subject with rever- ence and meekness—and should, like Sir Isaac Newton, patiently pick up pebbles on the shore, while cherishing ADDRESS. 11 a sublime Faith in the unknown richness, grandeur and immensity of the great ocean of Truth. The Poet Rogers, in graceful allegory, represents " Reason and Faith as twin-born—the one, in form and features the image of manly beauty—the other, of feminine grace and gentleness; but to each of whom alas! is allotted a sad privation. While the bright eyes of Reason are full of piercing and restless intelligence, his ear is closed to sound; and while Faith has an ear of exquisite delicacy, on her sightless orbs, as she lifts them towards heaven, the sunbeam plays in vain. Hand in hand the brother and sister, in all mutual love, pursue their way through a world on which, like ours, day breaks and night falls alternate; by day the eyes of Reason are the guide of Faith, and by night the ear of Faith is the guide of Reason." Socrates said " he only knew that he knew nothing," and yet he drank the hemlock with an intensified Faith in man's immortality, and God as a moral Ruler of the universe. It has been a besetting and easy fallacy with Physicians and Theologians that they too hastily take it for granted that they already knoiv the whole of their respective sciences. Such an assumption naturally results in practice and preaching better adapted to man as a fossil than man with a sentient body and a living soul. Medicine and Divinity were linked together when science was darkened by superstition, and they will more nearly approach and affiliate with each other when 12 ADDRESS. Science and Faith shall be recognized as different, but harmonious aspects of the same Divine wisdom and goodness." The labors and writings of the lamented Hugh Miller have done much to dissipate the doubts of inquirers, and harmonize the relations between natural science and Christian Faith. To promote and perfect that harmony should be the ambition of every medical man. We should let our science and faith gracefully bend to each other, for there is nothing repellant in their nature; and then in relation to man's spiritual future, we shall find, as Pascal beautifully expresses it, " there is light enough for those whose sincere wish is to see,—and darkness enough to confound those of an opposite character." In studying Nature's laws, as they relate to man, and especially to the individual condition of our patients, we should remember that great and important results follow very silent and quiet causes. Nature works by easy and simple means. A kernel of wheat, enclosed for three thousand years in the cerements of an Egyptian mummy, when brought under the noiseless and timely influences of soil, sunshine and rain, expands and glows with reproductive life. A rude dissection of that kernel, or a torturing of its substance in the crucible of the Chemist could not have revealed the secret law of its vitality; but a slight and insignificant change of circum- stance, developed its law and power of growth to the patient and admiring observer of nature. Nature some- ADDRESS . 10 O times loves to reveal her laws to us indirectly and by unexpected avenues. She would not have us ask rudely for a revelation of her secrets. She would have us like children wait trustingly and mingle faith with our vision. Her disclosures are often collateral or inci- dental to our inquiry, and in this way many of the most important discoveries in science have been made. Astronomers say that when observing with the naked eye, they see a star less clearly by looking directly at it than by looking at the next one ; and an elegant and refined writer (Margaret Fuller) has well said, " Nature will not be stared at" She is modest, simple and noise- less in her laws and in their operation—nay, she is often coy and must be kindly and tenderly approached if we would understand the subtle, yet beautiful and simple means by which she accomplishes her work. Like children we are permitted, with patient eye and ear and with gentle touch, to linger in the vestibule of her secret temple, and little by little, through the partly open door to learn something of her hidden mysteries. In studying the nature of disease, the Physician can sometimes indirectly get a glimpse of important truths which will be shy of direct pursuit. He should listen attentively to every such incidental hint; he should wait for it and cautiously follow it; though erratic at first and meteor like, yet a great truth or an important law may follow in its track. The scientific man, in the rigid application of the 14 ADDRESS. laws of dead matter may err and make ruinous blunders when those laws are applied to life. In discoveries and inventions, even when they are the result of scientific inductions, the philosophy of mechanics steps in with too bold and confident claims to guide and control the new application of an old truth. When the first attempt at ocean steam navigation was made, the scientific mechanics of Europe proved, (on paper) that it was an impossibility. They did not know all the laws and powers of water and steam. The Atlantic Telegraph was many times proved by Philosophers and Electricians to be an impossible achievement; and when the attempt was at length made with complicated brakes and ingenious machinery to control and graduate the running out of the wire from the stern of the ship, five times they made a failure; and afterwards, more closely studying nature's simple laws, they threw aside their cumbrous machinery; for the sixth time spliced the cable in mid-ocaan, and letting it run out at full speed from the stern of the diverging ships, it naturally and safely found its resting- place on the bottom of the ocean. This was really a triumph of science; and yet how palpable is the truth that the success of this great achievement was well nigh frustrated by the cumbrous machinery used pro- fessedly to let the wire down safely in aid of the simple law of gravitation. True science always works with the laws of nature ADDRESS. 15 and it is the failure to interpret those laws which often leads to forced and disastrous blunders. When human life is in peril, such blunders are unpardonable. The Physician is morally responsible for such forced blunders. The thread of life will break easier than the Atlantic cable, when tortured by needless machinery, or overwhelmed by unnatural drugs. Study then, the silent and simple laws of nature. She will reveal many of her secrets to the patient and zealous inquirer; and her laws are the only safe guide in therapeutics. In Hannibal's army at Zama, the trained elephants, it is said, turned back upon his own troops and des- troyed more than did the foe; to his regret he found that it had been much better for him if he had had no elephants. So too in a medical assault upon a disease the Physician should beware of elephants in the shape of ponderous drugs or cumbrous machinery, lest they rend or crush the patient he honestly intended they should cure. He should be cautious, too, how he draws a bow at a venture, for it is a fallacy of quacks that a " medicine does no harm if it does no good." He should never adopt extreme medical or surgical measures unless he has acquired the precision of the Parthian archers, whose arrows were equally sure whether aimed forward on a flying, or backward on a pursuing foe. In surgical practice we often see too much and too com- plicated apparatus used, professedly, in aid of the power of nature. The best Surgeon works with the 16 ADDRESS. simplest means, and modestly acts as a coadjutor with nature. He is conservative in his views and conscien- tiously careful in his practice. He would not mutilate a fellow-being to show an advertising specimen of good carving. A late writer says, "By conservative surgery we signify those means which recognize the power of nature to repair disease or injury that appears beyond repair, and it implies on the part of the Surgeon a deep know- ledge and experience of the subtle, yet marvellous powers of nature, and an instinctive recognition of that point where nature fails, or is overborne by morbid agencies, and where operative surgery must come to the rescue of human life at any cost of mutilation." But to be a good conservative Surgeon, he must not only calmly and deeply study nature, but he must forget' self-interest. An enlightened conscience, and a deep sense of personal responsibility, like a pillar of cloud by day and fire by night, should guide his researches and govern his practice. With the intellectual analysis of surgical facts the moral feelings should be enlisted, so that he may sympathize with the patient, and in a measure make each case his own. Before proceeding to mutilate with the knife, he should pause and measure the disease or the wound by the golden rule, on his own person. It is a lamentable fact that a love of surgical eclat sometimes trespasses on thorough conscientiousness, missing pages 17-18 ADDRESS. 19 to tell them the knack was a very bad one." In other words, they were very close in their creed, but very loose in their morals. Such a knack the Physician should never possess, and h*e should never be too polite to condemn it in others. 2d. The world has a claim on the Physican which he cannot resist. The vow is upon him when he enters the profession, and his services are henceforth offered for the relief of human ills. He should shrink from no lawful duty in the line of his profession. While he justly feels that he is worthy of pecuniary reward, he should not shrink from serving mankind without ex- pectation of gold or gratitude; his only reward often being a consciousness of humanity served and duty done. It is his duty, literally and absolutely, to make the world better for his having lived in it in the capacity of a Physician. He should strive to make man physically, mentally and morally better. He should be to the world a clear light on a hill, beckoning men upward, by lofty precept and pure example, to a higher and nobler life. 3d. To the profession as a body, each Physician owes a duty. It is common and very proper to speak of Esprit du corps among medical men, a sentiment I fear existing oftener in words merely, than exercised prac- tically in their relations with each other. It is a great misfortune that Physicians have so little mutual 20 ADDRESS. acquaintance. As a class they suffer from segregation. The tendency of this kind of solitary life is to make them opinionated and exclusive in medical practice, if not to say illiberal and 'jealous in their feelings. Frequent intercourse at the bed side and in the social circle, will tend to modify and perfect practice, as well as to harmonize, refine and elevate the personal relations and feelings of medical men. And I will venture to suggest the opinion that a very large portion of the petty differences and heart burnings among neighboring Physicians would be avoided or easily cured by a frank and thorough acquaintance with each other. The hasty or earless word, the misinterpreted motive would often thus be found powerless for evil. Every Physician in active practice is able to contri- bute something valuable to every other; and all will need to learn so long as they practice the healing art. He should move among his fellows, absorbing as well as radiating knowledge, thus enlarging and perfecting the capabilities of the profession. An important truth in Astronomy or Navigation is only established by the concurrent observation of many persons, made at various times, from different points and opposing circumstances. So, too, in medicine we should associate our varied knowledge in order more certainly to establish standard truths. A more frequent communing together in our search for medical truth will do us good—will do the world and our patients good. It is an old idea, and I wish I could say it belonged ADDRESS. 21 only to the dead past, that Physicians are from the nature of their calling occasionally competitors, in an odious sense; and that their competition is sometimes of a very ungracious character. If this is true of indi- viduals it certainly is not of the profession at large; nor is it in any sense a necessary element in profes- sional life. None but small and jealous minds will merit such a reputation. I think it is possible, even before the millennium, for Physicians to compete mag- nanimously for business; and by a more frank and free intercourse with each other, to disabuse themselves of the now commonly imputed charge of ungracious rivalry. It is only selfish, weak and vulgar minds that attempt their own exaltation by depreciating their fellows. They forget that real professional strength consists in union and combination, and not in envious or invidious contrast. Every Physician ultimately finds his proper place among his fellows. If he is an honorable and honest man he will appeal with satisfaction to his pro- fessional peers for the true estimate of his worth. The hearty and intelligent respect of the medical profession is a valuable prize, slowly gained, and an irreparable loss when forfeited. Mere public fame or professional notoriety won by dashing pretence or stratagem or partizan zeal is fickle and transient, and will sooner or later recoil upon its possessor in the shape of forgetful- ness or disgust. It is a very great calamity for a Phy- sician to lose the confidence and respect of his fellows. 22 ADDRESS. 4th. The Physician is in duty bound to cure his patient if he can. This he would do if self-interest alone prompted him. But there is a moral responsibility in the case which he cannot evade. When the diagnosis is made out and the therapeutics arranged, the duty to the suffering is not wholly ended. The emotional nature is to be guided and made to subserve the medical treatment. Make him feel that you are thoroughly imbued with his case, that you earnestly desire to do him good, and that by your presence and labor he is to become physically, mentally and morally better, in short, inspire him with hope, and point him to the silver lining on the other side of the cloud that now obstructs and darkens his path. Dissipate the depressing emo- tions of sorrow and fear; impart a complacent contem- plation of the issue of his disease; and teach him, if possible, the blessedness of a calm and perfect trust in the hands of Him who cares for the falling sparrow. "The sick and their friends are often tossed on the tumultuous sea of human passions; a sea often rocked into fury by maddening excitement of selfish hearts; let the Physician remember when medicine fails, that the remedy which alone can make its waves peaceful as the sea of Tiberias, is a trusting faith in the Great Physician—the wonderful Son of God!" The repose which such a faith sometimes imparts to the sick is certainly a most important and valuable aid in the cure of physical disease. ADDRESS. Mb, President and Gentlemen :— I have thus briefly, and in a very desultory manner presented my thoughts on a few medical topics which are not definitely written in our books of science. The importance and magnitude of these topics has so much increased and expanded before me that I shall be quite satisfied if my effort proves suggestive to others for a more thorough investigation on the same subject. While bearing the burden of active professional service, I have gleaned and brought together these thoughts as my " mite," for this day's contribution to our common treasury of knowledge; and if it proves not to be worth the half-farthing, I trust it will be accepted as evidence of respect and good-will to the fellows of this Society. The organization of our new Society is an important and auspicious event. There are circumstances apper- taining to our profession in this district which are very fortunate, and may properly be referred to with mutual congratulations. To say nothing of the professional ability of the members, it is pretty certain that a good degree of mutual confidence and friendship exists among the fellows. The middle aged and juniors, are especially fortunate in the society and counsel of the seniors at our board. We have a large proportion of aged and honorable men, some of whom for more than a third of a century have served in the ranks of our profession, and who now are active in our midst. The 24 ADDRESS. public and their fellows have long known and honored them for their moral worth and fidelity to professional duty. Their well earned reputation was not the growth of a night, to perish like the Prophet's gourd, but is the result of long and laborious professional service, characterized by magnanimity and moral worth. Those who are still ascending in the journey of life may safely copy their examples, and they will always be doubly fortunate if they enjoy their professional counsel and personal confidence. May the light of their noble examples long continue to allure and retain others in the path of professional integrity and honor. On this first anniversary of our Society is it not proper, my friends, that we here and now erect a new professional altar, Let each of us bring a stone for its building and place it in order. Let each bring wood and lay it on the pile. On that altar thus mutually prepared let each, as he may, place, for sacrifice, his own selfishness, and short comings in duty, and all of ungenerous professional rivalry that has ever overborne his better nature. Around that altar with joined hands and united hearts let us renew our vows of fidelity to our profession, our pledges of mutual confidence and friendship. Let us do this in sincerity; and as the burden we have laid upon the altar shall consume from sight and from memory, we will return and resume with renewed strength and a more fervent zeal the responsibilities of our profession. s \