AN ADDRESS TO THE ANNUAL CONVENTION OF THE MEDICAL SOCIETY OF CONNECTICUT, CONVENED AT HARTFORD, MAY 10, 1837. BY THOMAS MINER, M. D. PRESIDENT OF THE SOCIETY. PUBLISHED BY ORDER OF THE CONVENTION. M7/7 NEW HAVEN: PRINTED BY B. L. HAMLEN. 1837. 4 4 ADDRESS. Gentlemen,— I was not a member of the Medical Convention of 1832; con- sequently, when I learned the result of your proceedings, I was taken by surprise. 1 had no expectation of the appointment of Vice Presi- dent, no one having previously suggested that I should be considered as a candidate, any more than I had of being promoted to the Presi- dency of Yale College, or of any other equally important institution. You have been pleased to favor me with your suffrages ever since, and when my very respectable predecessor resigned in 1834, you very courteously appointed me to take his place. You have also obligingly accepted my sincere, though very imperfect, endeavors to perform the duties of the office till this time. With the greatest sincerity, I am able to express my most hearty acknowledgments for all the favors and indulgence which I have received. I am happy to say, that during this intimate connection of the last five years, I am not sensible of a single circumstance, that has had a tendency to injure my feelings, with respect to my relation to the Society ; and I should feel much grieved, were 1 conscious of any thing on my part which was intentional, that had a tendency to make an unfavor- able impression, as to my conduct or motives. From the indulgence which you have so uniformly shown me, I have no reason to suspect any thing of the kind. It is with great satisfaction, therefore, that I am able to take my official leave of you, with such mutual cordiality. You will be so good as to consider me as being no longer a candidate for the office of President. The length of time in which I have served in this capacity, my feeble health, the superior age of other gentlemen who are much better fitted for the place, together with various considerations which it would be needless to mention, have contributed to bring me to this decision. During the brief space which is allotted me for keeping the chair, and before proceeding to the choice of a successor, I must ask your indulgence to make a few hasty and desultory remarks.—It is hardly to be expected that the junior members of the Medical Society, which has been organized and incorporated about forty five years, can be familiar with its history, or without considerable enquiry, can be able exactly to appreciate most of the reasons, which existed at the time, for its formation. It is with great satisfaction, however, that I find two venerable seniors are members of this convention, who were in prac- tice for some years before the organization of our body, and are liv- ing chronicles of the medical condition of this State, before the incor- poration of our Society, and of the more important events connected with it, from its origin to the present day. In 1792, when the first 4 legislative act was passed in our favor, there were a few physicians of high eminence, whose talents had been developed by the Revolu- tionary war and other events of the day, distributed in perhaps every county of the State. In most of the towns, however, the great ma- jority of the profession were at a very low ebb. All who chose to practice were legal physicians, however indifferent their qualifica- tions. There were instances of men's setting themselves up for physicians, who had not pretended to study more than three months, and some of them had scarcely any other books than Buchan and a dispensatory. If possible, Surgery was generally in a worse state. We had three or four eminent operators, it is true, but it is probable that there were scarcely half a dozen in the whole commonwealth, who were prepared to meet any uncommon case. The department of Obstetrics was lower still, and though much of that business had fallen into the hands of the physicians, yet there was not probably a good practitioner to a county. Chemistry, Botany, and most of the auxiliary branches were hardly known by name, and had received scarcely any attention from more than three or four physicians in the State. The knowledge of morbid Anatomy was equally imper- fect. Further, there being no acknowledged rules of medical police, and of intercourse as respected each other, many of the physicians of that day were perfect Ishmaelites, constantly at variance among themselves, acting without concert, and feeling very little sense of the dignity as well as the importance of the profession. Even sev- eral of considerable standing did not blush to avow, that they had their secret nostrums, and openly to resort to the low arts of modern quackery. This state of things called loudly for reform ; and it was obvious that a reform could not be effected without union and concert among the physicians themselves. Nothing great and extensively good can ever be done in the world, without association, combination, and united effort. To this end, if the good is to be permanent, the associations must have a two-fold bearing; they must be both bene- ficial to the public, and to themselves. If they are not beneficial to the public, in free governments the public will not long tolerate them ; and if they are not beneficial to the associations, the members will not long be at the trouble and expense of meeting. There is not, therefore, the slightest clashing between the public and all proper organized societies. Indeed, it is impossible to promote their mutual interest in any other way than by such organizations. These asso- ciations form one of the most prominent distinctions between civili- zation and barbarism, and no extensive improvement can be diffused without such institutions. It would be difficult to name any associ- ation of this State, or in any other civilized community, that has better answered its end of promoting the good of the public, and of its members, than the Medicar Society of Connecticut. 5 Previous to 1792, the physicians of the county of New Haven had for many years been associated, and demonstrated the happy effects of mutual instruction, union, and friendly intercourse. The result was, that in that county there were probably many more able physicians than in any other, perhaps in all others, of the State. They early published a very respectable number of their transac- tions, which was not only read with avidity at home, but was received with high approbation in France and England. Here for a long time had been our best instructors, and among them probably Dr. Jared Potter, of Wallingford, was the most popular medical teacher of that day, having students resort to him from various parts of the State. Dr. Potter was the last student of the Rev. Jared Elliot, a cler- gyman, philosopher and physician, who is justly considered to have been the father of regular practice in Connecticut. He resided in Killingworth, which was then in the county of New Haven; and his influence was long felt by his successors in that county, and its happy effects have reached down to our times. With the bright example of the county of New Haven, the prac- titioners of the State in general soon saw the benefit of professional union, and in time organized themselves into the Medical Society. The effects of this society were quickly evident. The members either renounced or revealed their nostrums, cultivated a spirit of candor and frankness among each other, encouraged an attention to all modern improvements of medicine, and in a great measure ban- ished quackery and mystery from the profession. It was difficult for a candidate for practice to find regular employ, unless he had been licensed by their body, as a guaranty of his qualifications. Their requirements were found to be so reasonable, and a refusal to submit to them was so sure a mark of irregularity, and a consciousness of disqualification, that after eight or ten years the legislature disowned all pretenders, by withholding from them the legal power of collect- ing their professional debts, unless they had been legally examined and approved. Notwithstanding this last measure ha3 operated in the most fa- vorable manner, and by furnishing every town in the State with sev- eral well educated and honorable physicians, so that every empiric must come out boldly, and thus virtually be made to proclaim his own incompetency and imposition, as well as his dishonesty in pre- tending to an art for which he is unqualified, both the right and the policy of the law have often been questioned. With respect to the right, it seems to me strange that any man of information could doubt a moment. Legislators have certainly the right to interfere, whenever the public good is at stake; and it is their main business to protect individuals, where individuals have not the power to pro- tect themselves. They protect from fraud and imposition, as well as from other injuries, by placing barriers against dishonesty. Thus, they either do, or may, direct the inspection of every kind of pro- vision, lumber, or other article of merchandize, before it can be law- 2 6 fully exposed in market. They direct the 'examination of all offi- cers of the army and navy, previous to their receiving commissions. In most countries, they examine the qualifications of gentlemen of the bar, to prevent clients from being imposed on by pettifoggers. They commonly insist upon the examination of teachers, before they can become lawful instructors. In most parts of the civilized world, even a common trade cannot be exercised, unless the master has complied with certain forms, which amount to a strict examination. All these regulations are designed for the benefit of the people in general, and not directly for the benefit of the trades or professions. It is supposed that individuals could not have time, if they possessed sufficient knowledge, to examine the quality of every barrel of flour, beef, pork, and fish, that they buy, before purchasing them. Nor is it wished to have the client lose his suit, to discover that he has employed an incompetent advocate; or for schooling to be found to be worse than useless, from having employed an imcompetent teacher. I can see no reason, why the health of the community, and con- sequently public protection against ignorant and unprincipled pre- tenders—for pure quacks, whatever good qualities they may some- times possess, from the very nature of the case must always be knaves, since they only flourish by the falsest pretensions and most barefaced impositions—are not a subject of legal regulation, as much as the army, navy, schools, trades, manufactures, and in a word every other matter, in which individuals are either unable or indis- posed to protect themselves. Besides, no power on earth can give a quack or other impostor a moral right to his fraudulent gains ; should the State, therefore, from mistaken policy, legalize his claims, it would amount to granting a bounty to dishonesty, and as far as it goes would serve to sap the principles of morality. It is impossible to change the moral aspect of empiricism, or of any other fraud, whatever may be the supposed policy, as to legislative interference. A quack cannot be converted into an honest man, by any law whatever, much less can he be made learned against his will. The matter of right, in my view, therefore, is set at rest. It is sometimes found, however, in this imperfect world, to be a matter of policy and expediency to waive many of our important rights, as the enforcing of them, as valuable as they may be, might be a greater inconvenience, than to justify the expense of their defense. It is even supposed advisable occasionally not to prosecute crimes of considerable magnitude. The principle rather applies to the cau- tious removal of old abuses, than to opening the door to new offenses. We may be in such haste in ripping off the superfluous lace, as to be in danger of tearing the coat. Upon this point of expediency, I frankly acknowledge, there has been, at times, a considerable varia- tion in my own opinion. I shall not, therefore, pretend to speak very positively, upon this part of the subject, but content myself with making a few suggestions. 7 In the first place, our system has hitherto worked well, and to the great benefit of the public has given the profession of medicine an elevated position, which it otherwise could have hardly reached. Notwithstanding every regulation, some unworthy officers are to be found in the,army and navy; in the law, there are several who are little more than pretenders; and our schools are not always furnish- ed with suitable teachers ; but on the whole, all these departments have been improved, just in proportion as the laws have been strictly executed. The state of our profession is exactly parallel. Quackery and false pretensions, in a great measure, are excluded from our body. In order to be a quack, a man must now openly avow himself to be one, before all the world. People, who are so ignorant or so gullible as to employ him, are not deceived by a hid- den pitfall, but plunge into the gulf with their eyes open. It is a common idea, I well know, that quackery has much increased, of late years. This is very questionable, and on a little consideration, most probably, will be found to be a mistake. While human infirmity is the same as at present, there is always likely to be about the same proportion of attempts at imposition and delusion. It only operates in different ways, and exhibits itself un- der various garbs. Formerly, empiricism, in a greater or less de- gree, tinged most of our physicians, and therefore, the counterfeit was often found in the same purse with the sterling coin. Now, though the wheat may not be entirely winnowed from the chaff, it is not noxious from being intermingled with tares. Each portion is by itself, and easily distinguished. Empiricism, therefore, makes a greater show, assumes a more formidable appearance, and seems to have much increased, though it may not be, by any means, more general or extensive, as respects numbers and limits. It is very possible, in reality, that it should increase in noise and impertinence, just in proportion to its ill success and want of employ. Clamor of this kind is not rare in the world. Further, quackery has become organized ; it has its associations, conventions, and secret unions, so as to be one of the most hideous and impudent monopolies, which has ever appeared in civilized society. Who would have believed, that in the boasted light of the nineteenth century, a body of empi- rics, a monopoly that excludes and condemns all who are not initia- ted into its mysteries, and of course who are not as ignorant and dis- honest as themselves, could have been organized upon the principles of ignorance, fraud, and impudence ? That all the qualifications, which should be required to make a man fit to take charge of the health and life of his fellow creatures, consists in purchasing a book for twenty dollars, with an oath or promise of secrecy as to its con- tents ? It is said, though I do not know upon what authority, that the price is now reduced, so diat any one may become a physician, for the trifling sum of five dollars. Upon such a disgusting subject, as that of being obliged to defend learning and science, with the ex- perience of ages, against the most palpable ignorance and imposture, 8 I can only remark, that it deserves the most serious consideration of the Society, as well as the wisdom of the legislature, to pause and think deliberately, before they adopt any measure, that may, direct- ly or indirectly, be construed as favoring, or countenancing, or sub- mitting to such absurd and dishonest claims. It would seem to be a very strange state of society, denoting a degree of ignorance equal to that of the dark ages, which should make it a matter of policy, to listen a moment to such groundless pretensions. A madman or a robber will naturally seize the first weapon, that lies in his way ; but now, the question is, whether we shall legally put a sword into his hand? Enough of firebrands, arrows, and death will always be scattered about, to prove the imperfection of this state of trial and temptation; but, shall we give their diffusion the sanction of law? It has been supposed, that our present laws aid quackery, by pro- ducing a reaction in its favor. If this were the fact, quacks could never be so anxious to have this legislative assistance, though of the negative kind, removed, that they might appear to be regular prac- titioners. The very idea of having a body of professional men, as an essential link in the chain of civilized society, supposes that they have acquired some qualifications for their station, which citizens in general do not possess. It goes upon the principle of the subdivi- sion of labor, and that no one man can know or do every thing. Modern quackery, as now organized, does away this all important principle, this only sure basis of all stable improvement, and pre- tends that without learning, discipline, or experience, any man may be fit to manage the most important concerns for the health and happiness of mankind; and that, because he has the audacity to make these pretensions, he is to be recommended to the world, and elevated to the high dignity of a professional station, by legislative enactment. Medicine when regularly practiced is a liberal profession, in every sense of the term. No body of men among us, not even excepting the ministers of the gospel, do so much by way of charity, and relieve so much distress gratuitously, as the physicians, without any fee or reward, except the satisfaction which always attends the con- sciousness of doing our duty. This has respect to us in our individ- ual capacities, as men and citizens.—The public efforts of the Medical Society of this state, considering the circumscribed limits lor our exertion, have probably been as beneficial to the community, as those of any other association of the same means for operation. In conjunction with as prosperous a literary institution as any other in the Union, we have founded and sustained one of the most re- spectable and important medical schools in our country. The Re- treat for the Insane, which was in a sense founded by the genius and talents of our lamented associate, and former president, Dr. Todd, is perhaps inferior to no other hospital of the kind, and owes its origin entirely to the efforts of the Medical Society. 9 At this very day, by far the most important regular business of this convention, arises from our connexion with these institutions, in our appointment of committees of nomination for supplying vacan- cies, as well as the committee for the examination of the medical candidates. In fact, much the greater portion of the utility and re- spectability of this convention depends upon the judicious selection of their committees. We are apt to overlook the importance and nature of the blessings which we enjoy, and to consider them as matters of course, without adverting to the causes, and to the untiring efforts of our predeces- sors, which were indispensable to putting things into such a favora- ble train. The difficulties which existed, and the obstacles which were surmounted, have long since disappeared, and consequently are hardly to be realized, by those who have but recently entered upon the stage of life. Our society is undoubtedly still susceptible of many improvements, and we have never claimed an exemption from the common infirmi- ties of humanity ; but we have met the wants of the times, and have kept up with the spirit of the age, probably, in a much greater degree, than most similar associations. Ever since our first incor- poration, the legislature has duly appreciated our importance, and has generally treated us with great courtesy and liberality. As long as we do our duties as well as we have done, and con- tinue to respect ourselves as well as the public, I can have no ap- prehension of any undue legislative interference.' In order to merit respect, we must continue to make ourselves respectable, and thus show that we are worthy of the confidence and patronage of the public. One part of the duty of professional men, and that by no means the least, is to instruct and inform the public mind. Professional men are a kind of missionaries in the civilized world. In the divis- ion of labor, not for their own benefit, but for the public good, they are the great teachers of mankind. It is the practice of all legisla- tive bodies occasionally to consult them, and it is just as necessary to obtain the opinions of physicians, before making laws for preserv- ing health, as it is to advise with merchants, manufacturers, and me- chanics, concerning their several departments. It devolves upon our profession to teach the public the nature of quackery, and to expose the absurdities and dishonesty of empiricism. This duty is now peculiarly incumbent upon us. At the present day, and in accordance with the spirit and improve- ments of the age, additional skill, learning, and industry are de- manded, in every lawful and useful pursuit. The superior cultiva- tion of our age requires increased dexterity in every mechanical and liberal art. Is it possible, that medicine alone can be an excep- tion, and that physicians may be formed, without the labor of a severe course of study, strict mental discipline, and persevering industry ? Can a man acquire a single art, science, profession, 10 employment, or trade of any kind of importance, in the short time, and with the slender means, that are required to make a proficient in modern quackery, so as justly to entitle him to the honors and emoluments of a master in his department ? Where is the policy of attempting to place ignorance and fraud upon the same legal level, with knowledge and skill ? The danger, however, is not so much from elevating quackery, for that can never be raised to dignity, as it is from depressing and discouraging regular practice, so that men of talents may no longer have an inducement or encouragement for studying a degraded profession. At this very time, in those parts of the country, where medicine is depressed, men of talents are leaving the practice for more reputable employ- ments. Our society has always been distinguished by the harmony, order, and unity of its proceedings. We have hitherto kept aloof from most of the exciting and agitating topics of the day, and no religious, political, or local party, has as yet ever been allowed to show its head, or to exert its unhallowed influence, in our favored association. We have strictly adhered to the purposes for which we were organized and incorporated—the improvement of Medicine within our State. We do not meet, merely to favor our own private views, and to consult our individual, personal interest, but for the benefit of the communi- ty, in aid of the cause of humanity, to contrive means to mitigate the pains and diseases of mankind. We are in a very high and important sense, officers, appointed and commissioned under the authority of the State, to take charge of the health of its citizens. The trust which has thus, by public authority, been reposed in us, is one of the highest importance and greatest responsibility. In all our deliberations and debates, it becomes us to act with coolness and calmness, free from any fashionable, temporary, or lo- cal excitement, without indulging that appeal to passion and preju- dice, often resorted to in popular harangues. Here, the understand- ing alone need be addressed, and rhetorical flourishes are worse than useless. We ought to consider ourselves, rather as addressing a dig- nified and learned court, who perhaps understand the subject better than we do as individuals, instead of having recourse to artifices which might captivate a popular jury. Our acts have not respect to the present time merely, but may produce an effect upon our remotest successors. It is nearly impossible to resume a right, which has been once waived or relinquished. I have one further suggestion, which I wish it were in my power to enforce upon all deliberative bodies, that would maintain harmony and good feeling. It is this, never to attempt to carry an important question, by forcing it through with a lean majority. When an im- portant resolution, after much debate, only passes by a majority of one or two, as a very general rule, some cool and moderate man, who voted in its favor, would do well to show magnanimity enough to rise and propose a reconsideration, exhibiting by this means, that 11 he is not so sanguine in his private opinion, as to wish to wound the feelings of a respectable minority. Some condescension of this kind, when agitating questions hap- pen to occur, is the only way to preserve peace, and to prevent the body from being split into hostile parties, and becoming a prey to faction. A measure often may be very properly negatived by the majority of a single vote, or even by the casting vote of the presi- ding officer in case of a tie, and there may be no grounds for dissat- isfaction ; but the affirmative decision of an important question, where the best minds are apt to vary in opinion, is rarely satisfac- tory, popular, or expedient, unless it has the sanction of about two thirds of the members. A love for our profession, or rather for the humane objects which it has in view, should be the highest motive with every physician. It is in fact the highest motive with the great majority. With some very few exceptions, owing to peculiar circumstances, physicians, in our country, are never to expect to become rich, from their practice. If they can only gain a respectable support, it is all for which they may indulge a reasonable hope. They do more gra- tuitous services, as has already been observed, than any other class of men ; and where they are able to collect their pay, their remu- neration is less, in proportion to their labors of body and mind, and the moral responsibility attached to them, than probably in any other employment in our country. The far greater portion of their reward must consist in the consciousness of doing good, and in the satisfaction which always attends the exercise of humane and benev- olent feelings. The preceding remarks have reached to a much greater length, than I had at first intended. 1 did not feel satisfied to take my leave of such respectable associates, with whom I had spent so many pleasant days, and from whom I had so frequently received many unexpected and unmerited favors and attentions, by a mere brief and formal expression of my sense of obligation. I have therefore taken the liberty to trespass on your time, and perhaps your pa- tience, by stating some of the views which I have of the past and the present state of the Medical Society, and of its vast importance, both to the public, and to the harmony and improvement of the profession. The subject has grown upon me as I advanced, and brought it - nearer to view. Indeed, till after some reflection and attentive in- vestigation, I did not myself realize but a small portion of the pub- lic benefit of our association, or of the evils of the loose and imper- fect state of medicine among us before it existed. I have to regret, that the narrow limits allotted me, together with my feeble abilities, only admit of pointing out a few of the more prominent landmarks, without attempting even to trace the outlines of this extensive field. I have mentioned but a small part of the advantages, which the community has derived from our Society ; and still less have I ex- 12 posed the numerous and irremediable evils, that would be likely to result from the present attempts to reduce our profession back to the state in which it was fifty years ago, to degrade it to the level of the most ignorant empiricism, and thus place it half a century behind the age, should they prove successful in putting the regular practi- tioner and the empiric on the same legal footing. Whatever may be, in the eye of the law, our future condition, we can never remain respectable, and consequently highly useful as a profession, with- out retaining our fraternal union, demonstrating to the world that we fully merit all we claim, and adhering, as respects ourselves, to the fundamental principles of our organization. I have now only to add, that your prosperity as individuals, and as one of the most important institutions in our State, will be always near my heart. So long as your deliberations are conducted upon the same principles of harmony, condescension, and concession, as have uniformly marked the proceedings of your predecessors, the Medical Society will justly retain its influence, and continue to be a blessing to the community. By the favor of a kind Providence, although I have been visited with much sickness and many infirmities, so that I broke down, in a sense, in middle life, my days have yet been spared, till 1 have be- come an elderly man. I have great respect for the labors and ex- ertions of our predecessors, without wishing, however, to indulge that excessive veneration for the past, or extreme apprehension for the future, which is common with many old men. Nor am I insen- sible of the great value of the present, and of the superior means which we possess for preventing, removing, or mitigating the moral and physical evils, which are incident to humanity. I am not dis- posed, by any means, to consider that every thing, to be good, must have the sanction of antiquity. Every improvement is necessarily an innovation. Some changes must take place in accordance with the times, and new variations occasionally be introduced. Those upon the stage and in active life, must be the judges of the wants of their age. I have but little apprehension, therefore, that our suc- cessors will not be able to manage their affairs upon as correct prin- ciples, as those upon which our predecessors and we have founded and conducted our own institutions. With these views, I cheerfully and confidently resign my small share in the direction of the Medical Society.