THE RELATION OE MEDICAL SOCIETIES 
TO 
PROGRESS IN SCIENCE. 
INAUGURAL ADDRESS 
OF THE 
PR ESID EN T 
OF THE 
J|ediral of ihe (|ountg of 
NEW YORK, 
ALEX. J. C. SKENE, M.D., 
JUNE 16, 1874. 
BROOKLYN: 
Home B hotiiers, Printers, 37 7 Fulton Street 
1 8 7 4. THE RELATION OF MEDICAL SOCIETIES 
TO 
PROGRESS IN SCIENCE. 
INAUGURAL ADDRESS 
OF THE 
PRESIDENT 
OF THE 
Jjjcdifai |>oii<|tg of the |,ountg of |jiit0S, 
NEW YORK, 
ALEX. J. 0. SKENE, M.D., 
JUNE 16, 1874. 
BROOKLYN: 
Rome Brothers, Printers, 377 Fulton Street. 
1 8 7 4. ADDRESS. 
Gentlemen,— 
With the intention of fulfilling- part of the duties at- 
tached to the office which I hold in this Society through 
your kindness, I propose to discuss briefly the relation of 
medical societies to progress in science. The subject 
chosen is certainly one of considerable importance, and I 
trust its consideration may meet your approval. 
lu dealing with this question, I hope we shall form a 
correct estimate of the true status of the profession, which 
we in part represent,—its weak points as well as its stiffing 
ones, and how far it has claims upon the respect and con- 
fidence of the public. If this object is accomplished, we 
shall more clearly comprehend the position of medical 
organizations to professional advancement, and may 
therefore entertain a surer hope of making true progress. 
The medical profession is anything but a homogeneous 
body, consisting as it does of men of every degree of na- 
tural ability, education, and social culture. A few devote 
their time to medicine through love of the science ; some 
practice the art to benefit mankind ; and a great many, 
it must be conceded, heal the sick in order to make a 
living. All of them, doubtless, desire to see the medical 
profession stand first in the estimation of the world, most 
powerful in its influence, and accomplishing the greatest 
amount of possible good to humanity. Take the profes- 
sion as a body, its record is worthy of all admiration. 
When we consider what has already been done by the 
profession to improve the physical condition of the liuman 
family, we might be tempted to rest satisfied with past 
achievements, and to trust to the future for the further 
development and growth of the science and art of medi- 4 
cine. There is enough in the monuments raised by past 
genius to interest the most profound mind, and to please 
the vainest of men. But in spite of our rich inheritances, 
there is plenty of work to be accomplished by those who 
desire to leave the science of medicine better than they 
found it. While we glory in our present strength, and 
point with pride to the knowledge which has been accu- 
mulated from previous ages, we cannot close our eyes to 
the heap of rubbish, in the shape of ignorance, which re- 
mains to be swept away, in order to bring to light the 
hidden truths within our reach. 
The more we know, the more readily we perceive that 
discoveries the most important remain to be made ; and 
we need men with talents, time, and opportunity to make 
them. And what is likewise essential, we need a more 
general and better knowledge of what is already estab- 
lished as truth in the science of medicine. We need more 
men prepared by education and practical training to 
master the science of medicine before they practice the 
art. If the ranks of the profession were filled by the 
right material, the public would soon learn to estimate us 
at a higher value than they do now. As it is at present, 
men succeed financially in practice, while exhibiting an 
ignorance of their profession which, if displayed in any 
art or trade, would lead to bankruptcy and the degrada- 
tion which it deserved. Sinners in the profession prosper, 
while the righteous can hardly earn their bread. 
Believing that a general and thorough education of all 
who seek to enter the profession is the surest way to effect 
true progress, I propose, in a brief way, to discuss the 
ways and means by which this reformation can most 
surely be effected. 
There are three avenues through which progress must 
come: 
1. Through the medical schools. 
2. Through legislation by the people. 
3. Through the profession, as individuals and in 
societies. 
The public and the profession naturally look to medical 
schools for all that pertains to medical education. They 5 
trust, or have trusted, to these institutions for ail re- 
quired progress and reformation in teaching. An ex- 
amination of this matter will show at once what the 
schools have accomplished in the past, and enable us to 
judge what we may expect of them in the future. 
As regards our present educational system, it is true 
that a good education may be obtained by any one who 
has sufficient courage and perseverance; but it has to be 
acquired under most trying difficulties. 
When we consider how the science of medicine is 
taught, we cease to wonder that the education of medical 
men is so bad, and are surprised that it is so good as we 
find it. In spite of existing circumstances, a few superior 
minds manage, by great perseverance, to acquire a good 
education; but thousands are allowed to enter the pro- 
fession who are most inexcusably ignorant. The result 
is, that we find the most thoroughly educated and' scien- 
tific physician practising alongside the greatest medical 
boor, who is not only ignorant of medicine, but sadly de- 
ficient in general culture. If the number of well educated 
men in the profession predominated, the unqualified few 
might be carried along without much harm to the profes- 
sion or the public. It must be confessed, however, that 
the superior men are in the minority. Were these 
errors being corrected by a better education of medical 
recruits, we might hope that present troubles would ra- 
pidly disappear in the march of progress; but we fail to 
perceive any reliable signs of improvement. 
The system of medical education all over the world is 
little better now than it was a century ago. While the 
stores of medical knowledge have vastly increased, the 
methods of imparting it to students have been well-nigh 
stationary. In this country, where we boast of all modern 
improvements, and are indignant at the slightest hint of 
being behind any of the older countries, our medical 
schools, it must be confessed, are as bad as in any other 
part of the world. 
Any capable observer, examining for the first time the 
ordinary medical curriculum, would certainly conclude that 
it could only be undertaken by students thoroughly pre- pared by a previous liberal education. A student is unable 
to satisfactorily study medicine without possessing at least 
the rudiments of a good academical education. In all 
civilized nations, except America, the student, before he is 
permitted to enter a medical school, must give satisfactory 
evidence that he has the required preliminary knowledge. 
It is certainly not to the credit of the schools of this coun- 
try that no such qualification is asked. The most illiterate 
and uncultured can take his place in the medical school 
alongside the most highly educated scholar. And, what is 
still worse, men are admitted to receive the degree of 
Doctor of Medicine on exactly the same terms. It is a 
notorious tact, that hundreds of men graduate in the 
medical schools of this country who, from want of element- 
ary education, would not be permitted to begin the study 
of medicine in Great Britain or Germany. This statement 
applies to all the schools in the country: at least I know 
of no exception. I am inclined to think that, as a rule, the 
more prosperous the school the less particular they are 
about the quality of the student. To the well educated 
and cultivated medical student, it is discouraging and 
humiliating to be classed amongst a number of men who 
could hardly rank with the scholars in a primary school. 
Professor Huxley, in an address quite recently delivered 
at the University of Aberdeen, Scotland, said, speaking of 
medical education:—“ I hold as strongly as any one can 
do, that the medical practitioner ought to be a person of 
education and good general culture; but I also hold by 
the old theory of a faculty, that a man should have his 
general culture before he devotes himself to the special 
studies of that faculty; and I venture to maintain, that if 
the general culture obtained in the faculty of arts were 
what it ought to be, the student would have quite as much 
knowledge of the fundamental principles of physics, of 
chemistry, and of biology, as he needs, before he com- 
mences his special medical studies.” 
Because this country is considered a land of political 
freedom, men claim the liberty to study medicine with or 
without reference to preliminary education. But the laws 
or liberties of a country cannot change the fact, that a man 7 
can make little or no progress in science with a mind un- 
trained to study. The knowledge acquired under such 
loose ideas of u freedom ” is sure to be of a superficial 
kind, and allows a man to be easily led away from stand- 
ard truths, while he is ready to accept every new theory 
as shallow and shadowy as the minds that conceived 
them. 
The question naturally arises here, as to the amount of 
preliminary education which should be required of the ap- 
plicant for medical honors. This is a subject I do not in- 
tend to discuss here, and it is one that would require to be 
decided by the voice of the whole profession. Some insist 
that a degree of Bachelor of Arts should be the standard; 
but this is impracticable, there being no standard for this 
degree itself, so that it may mean much in one place and 
very little in another. Whatever the maximum may 
amount to, we should at least demand that the medical 
student come prepared with a sound knowledge of Eng- 
lish, sufficient acquaintance with the classics to enable 
him to understand scientific nomenclature, and grounded 
to some extent in the elementary principles of natural 
philosophy. 
On a subject like this, where all are agreed as to the 
propriety and necessity of having educated men to fill the 
ranks of the profession, it surely will not be difficult to 
devise the means, when we once set ourselves to it. But 
till something definite is done in this direction, we cannot 
expect due progress or reformation in the science or art of 
medicine. 
We have sins both of omission and commission in medi- 
cal education. We use no efforts to secure trained men, 
and then we compel those who come forward to study 
under the most disadvantageous circumstances. The law 
in the majority, perhaps in all medical schools, ordains 
that the candidate for medical honors must study medi- 
cine for three years under a legalised doctor of medicine ; 
and that he shall attend two full courses of lectures in a 
didy authorised school. These rules are faithfully insisted 
upon, and are very seldom violated. Whatever benefit 
the schools and preceptors may derive from this law, so far 8 
as the student is concerned it is in general a failure and an 
imposition. 
The system of studying under a practising physician, 
as usually carried out, places the student in the most try- 
ing position to acquire knowledge. Men in active busi- 
ness have no time to teach, even should they possess the 
requisite knowledge, which they often do not. A man 
may be a successful physician, and yet make a very poor 
teacher. There are men possessing the necessary quali- 
ties for teaching and practising, but in my opinion they 
are the exception, not the rule. 
The usual way in which the student occupies his three 
years with his preceptor is somewhat as follows:—If the 
young man has means, he is permitted to occupy the 
office; and while the doctor is attending to business, the 
student, with a few books and bones, is left to educate 
himself, if lie is so inclined. Occasionally in the afternoon 
and evening, the doctor may take the trouble to ask a 
few questions. 
Another class, and the more fortunate of the two, en- 
gage a preceptor, and then teach school or work on a farm 
perhaps, going once a week for recitation. 
When students are thus practically left to themselves to 
get their education as best they can, why should the law 
compel them to employ and pay for preceptors ? The 
student is obliged to study so long and pay so much, but 
the preceptor is not bound to give any specified time to 
his work, nor impart any given amount of instruction. 
Instead of demanding a certificate of mere attendance on 
a preceptor, would it not be much wiser and more bene- 
ficial for all concerned to find out by some test what the 
student knows, irrespective of where he acquired his know- 
ledge ? In Great Britain the law demands that the applicant 
comes up to a certain standard before he is registered as a 
medical student; but it allows him to get the knowledge 
in the way most congenial to his taste or most suitable to 
his means. 
If we turn our attention to the mode of teaching prac- 
tised in the medical schools, very little sign of progress 
will be observed. The student is required to attend two full courses of lectures, each course being less than six 
months in duration. Thus in one year he is expected—his 
preparatory education having been obtained as we have 
seen—to learn anatomy, physiology, chemistry, and all 
the sciences which together make up the education of the 
physician, surgeon, and accoucheur. The time specified 
for the work to be done is ridiculously inadequate, even if 
the plan and methods of instruction were perfect, which is 
far from being the case. 
The most unreasonable methods of education are prac- 
tised in medical schools. The instruction is almost wholly 
given by lectures, which are attended by students at all 
stages of progress—the youth just beginning his studies 
and the senior about to graduate occupying the same 
benches. It is difficult to imagine anything more absurd 
and more unmerciful, than the practice of compelling 
young men in their first year of medical study to sit six 
or seven hours a day listening to lectures which they do 
not understand. It is really a prostitution of mental and 
physical health and strength, which ought not to be toler- 
ated. No such mixing of all grades of students in one 
class would be permitted in any other department of edu- 
cation. And yet this erroneous system is not confined to 
this country, as it exists, with slight modifications, every- 
where. 
I would not be understood as condemning lecture-room 
and amphitheatre .teaching: they have their proper place 
in the course of medical study. But every member of the 
profession must see the objectionable nature of teaching- 
all the branches of medicine by lectures alone. Demon- 
strative teaching may be best accomplished by lectures in 
the amphitheatre; and so may the principles of medicine 
and surgery ; but beyond this lectures are a tedious waste 
of time. 
Within the past few years, a kind of sham reform has 
been attempted in this country, by making great preten- 
sions to clinical teaching. This pretended—not real— 
improvement has had the effect of reviving the declining 
interests of many schools; but the actual improvement in 
teaching amounts to nothing. A considerable increase of 10 
surgical exploits in the amphitheatre, arid so-called clinical 
lecturing, but really lecture-room orations about patients, 
constitute the improvement in clinical teaching. Now, of 
all the frauds in medical education, this clinical teaching 
in the lecture-room is the greatest. Some good comes of 
it, because the poor thus get the benefit of extraordinary 
medical skill; but so far as the students are concerned, the 
system is really injurious. 
A surgical clinique, as it is called, generally amounts to 
this: a patient is brought in, the professor says something 
about the case, and states the operation which is to be per- 
formed ; and the more heroic and unusual the operation, 
the greater the glory of the professor. The operator and 
his assistants gather around the patient, and the operation 
proceeds. Here and there a student in the larger class 
may get a glance at what is going on, but the great 
majority have to accept the proceedings in blind faith. A 
student might as well try to learn the art of painting by 
looking from a distance at an artist at work, as to learn 
surgery in this way. 
The lecture-room method of teaching practical medicine 
is about the same. It may be an agreeable way of passing 
time to hear the professor declaiming about cardiac mur- 
murs and abnormal pulmonary sounds as observed in the 
patient present, but it is not the way by which the student 
can learn the physical signs of disease. 
There are in many schools private tutorial classes, where 
the student, if he has the inclination and the means to pay 
extra fees, can get that kind of practical drilling which is 
necessary. But as this lies outside the bounds of an 
already crowded curriculum, and not at all compulsory, 
the harrassed student is very apt to neglect the oppor- 
tunity. 
The reason why these imperfect methods of teaching 
have existed so long, may be partly due to the natural 
conservatism of the human mind; but it is chiefly due, I 
think, to the fact, that the professors are poorly paid for 
the labor they already perform, and therefore they have 
little inducement to undertake reforms which would in- 
volve more work with no proportionate increase in re- 11 
numeration. There is nothing in the laws which govern 
medical schools to render the teachers independent of the 
students; and the teachers can scarcely be expected to 
injure their own interests for the benefit of the profession 
and the public. And then professors are under strong 
temptation to continue the present lecture system of teach- 
ing, as it relieves them of the drudgery of drilling students, 
which they have not time to do; and they enjoy the eclat 
which is awarded to well-delivered lectures. 
It seems to me that a serious mistake is often made in 
the selection of teachers. The schools generally try to 
secure men of known reputation, and having a popular 
style of lecturing attractive to students. Now it is a fact, 
that an eloquent speaker and brilliant operator may be a 
poor teacher. They may draw students to that school, but 
if judged of by the progress which pupils make under 
them, their merit as teachers would be poor indeed. To 
lecture pleasingly and teach science effectively, are two 
different qualities not necessarily conjoined. 
I am happy to say that there are medical schools in this 
country, though few in number, in which praiseworthy ef- 
forts have been made to raise the standard of education; but 
it is painful to add, that they have been rewarded by the 
students going to less particular institutions. Reformation 
in individual schools, while the general laws remain as at 
present, is a suicidal policy for those who make the at- 
tempt, and can have little effect for good. 
We have thus seen, that though urgent reformation in 
medical education is required, the medical schools, for 
various reasons, have shown no inclination in the past, 
and give no evidence as to the future, that the needed re- 
form will be attempted. 
We shall now look at the second avenue through which 
progress might be expected, namely, through legislation 
by the people. Little need be said under this head, as it 
is self-evident that our statesmen, as a rule, can have but 
very imperfect ideas of what the public require in this mat- 
ter. The influence of the profession with statesmen is not 
sufficient to guide them correctly in professional matters, 
unless we are unanimous, and combined in a manner 12 
which will be difficult, to procure. The honorable.busy 
practitioner has not time to manipulate legislators; while 
the tricksters who have an interest in things remaining in 
their present state of chaos, have both the time and the 
special qualifications for lobbying to any extent. 
This brings us to consider the third direction from which 
reform may be expected, namely, through the profession, 
by means of its local organizations. As the members of 
the profession are the only parties who thoroughly under- 
stand the nature of the different points at issue, and as 
they suffer greatly by the present state of affairs, they 
ought to have an interest in procuring reform as speedily 
as possible; and that they have the power to do so, if pro- 
perly combined, may be taken for granted. Here, as 
elsewhere, union is strength. As we can expect little or 
nothing from the schools or the legislature, we must help 
ourselves. As every town, county, and state lias an 
organization of some kind, their object in all cases being 
the advancement of the science and art of medicine, it 
surely would be a quite x>ossible task to get something like 
united action as regards several points of reform, in refer- 
ence to which there is little room for difference of opinion. 
Assuming, then, that reform must come through the 
united action of societies such as this, the question arises 
what special points ought to be aimed at first, and how 
are they to be attained. Wholesale changes, even if pos- 
sible, are not always desirable; hence we should only 
attempt to reform the more glaring weaknesses of the pre- 
sent system, leaving many little improvements to be 
effected by time. 
I think there is no room for difference of opinion in re- 
gard to the desirability of all the members of our profes- 
sion being men of good education. Every sect could stand 
on that common platform. The manner in which this 
could be best accomplished, might give rise to some dis- 
pute ; but I think the simplest and surest, and for which 
we have good examples in Europe, would be to compel 
every one desirous of becoming a medical student to pass 
a preliminary examination before duly authorised boards 
elected for that purpose, or present certificates from 13 
acknowledged universities, guaranteeing the possessor to 
have passed examinations equal to those demanded by 
the medical board. Were this examination put in the 
place of the present very questionable system of studying 
with a practitioner of medicine, I have no doubt it would 
raise the standard of medical students, and x>rove of bene- 
fit to themselves, the profession, and the public. As this 
preliminary education could be obtained in any way most 
suitable to the student, he might easily do so while attend- 
ing to business; and thus the time all but wasted under 
the present apprenticeship system might be devoted to a 
more thorough course of training at the medical school. 
For this law of preliminary education to be of any 
value, it must be compulsory, and extend all over the 
country. It would be of little value it it were in force in 
the State of New York, while students could escape its 
enactments by crossing the North Itiver. As it would 
benefit all the schools alike, and could not be opposed by 
the smaller sects as oppressive or special legislation, there 
seems no reason to doubt that it only requires to be 
brought before the legislature by the unanimous voice of 
the profession, to be adopted at once as the law of the 
land. 
The next point for reform which I would urge, and 
which I consider of very great importance, is the relieving 
of the medical schools of the responsibility of examining 
and graduating their own students. This is certain to 
meet with serious opposition from many of the teachers ; 
but I think it conld not injure any respectable school, and 
if it were the means of closing or revolutionizing some of 
the more questionable establishments, every one would 
be a gainer in the long run. At present we have a most 
unwholesome competition in licensing men to practise 
medicine. If the competition tended to stimulate the 
schools to produce better scholars and more trustworthy 
physicians, then it would be valuable; but the tendency 
is rather to make bids for patronage by making the portals 
to graduation as wide and easy as possible. Thus there 
is no uniformity in the value of the medical degree. It 
matters not where the degree comes from, or what is its value, the possessor is protected by the law; but the suf- 
fering ignorant public have absolutely no guarantee or 
protection in the fact that the person they employ is le- 
gally qualified to affix M.U. to his name. 
What is wanted is a well-qualified Examining Board for 
each State, perhaps, where students from any school, on 
presenting the proper certificates, would be thoroughly 
and impartially examined, and granted a degree if found 
worthy. This Examination Board might be composed of 
representatives chosen by the different schools, by the 
local societies, or by the general profession, in any man- 
ner which could be agreed upon. The expenses of such a 
board could be met by the fees of the students seeking 
examination. They could meet at stated times during 
the year, in the places most suitable to the majority of 
the students. By this means, coupled with the compul- 
sory preliminary education, the public would have some 
guarantee that the possessor of a medical diploma was a 
person who might be trusted as a physician, without their 
having any special personal knowledge of the individual. 
As at present, the only safe way for the public is to look 
upon every man as a medical rogue until he has proved 
himself an honest man. In this way the younger 
members of the profession are seriously debarred from 
the share of the practice to which they are justly en- 
titled. 
It will be objected to a scheme like this, that the 
teachers of a student are the best judges of his abilities, 
and best fitted to examine him. There is certainly some 
truth in this objection; but if the student has been taught 
the principles of his profession, and not merely the opin- 
ions of his teacher, lie will be able, in the vast majority of 
cases, to indicate his knowledge to a proficient examiner 
whom he has never seen before. Where the examination 
is partly written, oral, and practical, as it ought to be, lie 
will be an exceedingly nervous student who fails to ex- 
hibit liis knowledge in each of the departments, if lie pos- 
sesses it at all. The examiners, in many cases, would be 
chosen from the professors in the different schools, and as 
a rule be men eminent in some department of the profes- 15 
si on ; and being quite independent of the students, a fair, 
impartial examination could be depended upon. 
Some mig’ht object that this method would materially 
decrease the already insufficient revenues of the medical 
schools, by depriving them of the graduation fees. This, 
however, need not result to any serious extent, if at all. 
The fees paid to the examining board need not be much 
more than pay the expenses of the members, and that 
would not be great; while the present class fees might be 
raised a little to compensate for any reduction otherwise. 
But supposing it did interfere with the revenues of a few 
professors, that is a trifling matter compared with the 
general good of the profession and the public. 
There might be a little difficulty in getting some of the 
smaller medical schools to acquiesce in a movement like 
this. But there could be no powerful honest opposition 
on the part of any sect who desired to ensure the protec- 
tion of the public against ignorant physicians—and every 
sect pretends this is their aim. The anatomy, physiology, 
pathology, and chemistry of all schools are alike in es- 
sentials ; it is chiefly in therapeutics that any difference 
is to be discerned; and some elasticity might be allowed 
on this point by the board of examiners. But it ought to 
be imperative that all presenting themselves for gradu- 
ation, whatever theory they might afterwards practise, 
should be possessed of a safe amount of knowledge in all 
the essential points in the science and art of medicine and 
surgery in its widest sense. 
Strenuous efforts are being made in Great Britain to 
accomplish a scheme of reform similar to the above. 
There they have nineteen different graduating bodies 
throughout the country, the requirements of the lowest 
being probably greater than our highest. But to do away 
with all unhealthy competition, it is contemplated to have 
an examination board in each of the three kingdoms, 
composed of representatives from each of the present 
licensing corporations and the chief medical societies. 
Tt is termed the “ one portal system,” but does not ex- 
clude members of universities from the special honors to 
be derived from examinations in their different schools. 16 
That we stand in need of some reform of the kind indi- 
cated, few will deny. Once the principles of the scheme 
were adopted, the details would not be a serious matter 
to settle. By means of such machinery, it would be an 
easy matter to raise the standard of education year by 
year, which under the present competitive system is prac- 
tically impossible. So long as human nature remains as 
it is, students will most readily flock to the examiners who 
Avill give them least trouble ; but were the standard raised, 
and the student forced to graduate at a Board such as is 
here indicated, there need be no fear that the requisite 
number of recruits would not come forward to All the 
ranks. It would thin out the idle and the inefficient, and 
establish a*clearline of demarcation between the ignorant 
impostor and the properly educated physician. This 
scheme would give the public the only means of making 
a distinction between the medical sects which it can pro- 
perly understand, that is, the guarantee of a sound scien- 
tiflc education. It would thus raise the confidence of the 
public in the profession, and benefit themselves and us. 
The schools would be restricted to their legitimate 
function of teaching, and be removed from the temptation 
to commit the crime of thrusting half-educated men on an 
ignorant public which trusted them for protection. 
If ever the profession obtains this desired power, it 
must be exercised in a liberal and intelligent manner. 
They must endeavor to protect principles, not persons ; 
science, not sects. The spirit of all true law is to legislate 
for the greatest good of the greatest number; and I think 
it cannot be denied but the measures indicated would 
tend for good to the whole community. 
There was, I believe, a move made in the State Medical 
Society to bring about some reform in medical teaching; 
and I trust that Society will be foremost in this good 
work, as it has been in kindred schemes. 
In any attempt at medical reform, the co-operation of 
the medical press would be of great value; but unfortu- 
nately the proprietors and conductors of such journals 
are frequently teachers and others who fancy their inte- 
rests lie in matters remaining as at present. They pro- 17 
bably reason to themselves, that if they preach this re- 
form, and talk as if it were a change the necessity of 
which was patent to all, they thereby would be accusing 
themselves of gross carelessness as regards the public in- 
terests in times gone by. A man maybe willing to accept 
a new thing readily, but not if such acceptance implies 
culpability in his previous conduct. However, if the pro- 
fession generally are determined on reform, the journals 
will be bound to follow suit if they do not take the van. 
The contributors and subscribers can soon make their 
power felt, even in the sanctum sanctorum of the most 
conservative editor. 
There are some of opinion, that great advantage would 
accrue to medical education if the schools were endowed 
either by the government or by wealthy laymen. But 
this is an impracticable scheme. It is not at all probable 
that sufficient funds could be had from private sources; 
and as our Government treats all alike, the legislature 
would be as likely to endow bad schools as good ones. It 
would be a splendid field for political jobbery and pilfer- 
ing, of which we have already enough, and would not be 
any real benefit to the profession or the public. There is 
a wide field for private benevolence in wealthy laymen 
giving as much as they wish to the present schools and 
hospitals, to be expended in scientific research or more 
active charity, as the donors or regents might see best. 
The only legitimate way' of supporting medical schools, 
is by making the students pay the expenses incurred in 
educating them, whatever that may amount to. 
Some very sentimental folks are afraid that high tuition 
fees would debar poor but promising young men from 
joining the profession. Probably it might, in rare in- 
stances ; but though an occasional genius might be lost 
in this way, it would be amply compensated by the ex- 
clusion of a great number of both poor and unpromising 
youths, who enter the profession simply because it can 
be done cheaply, without any regard to their aptitude for 
performing its duties aright. There need be no fear of 
the stream which supplies the profession drying up; and 
our great effort must be, not to cheapen medical educa- tion, blit to enlarge and improve it. The fact that it will 
take time, money, and hard application to enter the 
ranks, will sift the recruits and improve the whole 
army. 
Having thus briefly and imperfectly considered the 
relations of the profession to the education of its mem- 
bers, we shall now glance rapidly at a kindred topic, 
scarcely less important, namely, the relation of the pro- 
fession to the education of the public in questions of 
medical science. 
That the great body of the public are lamentably 
ignorant regarding even the simplest branches of medi- 
cine, is an assertion which can not be called in question. 
Proofs of it abound everywhere. Every one who pays 
any attention to social science, but more especially 
medical men, must be aware of the vast amount of 
misery caused by the ignorant use of drugs, and through 
belief in false doctrines in medicine. This great evil 
cannot be correctly estimated or reduced to figures; but, 
as a public scourge, it may be fairly classed with the un- 
reasonable use of alcohol and tobacco. 
Were an intelligent inhabitant of some other planet to 
take a holiday tour over our continent, he would be apt 
to think we lived to a large extent on drugs. He would 
be forced to conclude that the body social, from the crown 
of the head to the sole of the foot, was “ full of wounds 
and bruises and petrifying sores.” He would find every 
prominent corner occupied by a glaring, gaudy drug 
store, with not a few between the corners. Every news- 
paper and periodical he came across would seem to 
depend for existence on advertising cures. Going along 
the streets, he would find posters urged upon him by 
people possessing invaluable medical secrets. Wherever 
he went, in fact, by horse or steam cars, boat, or foot, he 
would be continually faced by posters, mammoth or 
microscopic, detailing the virtues of certain cures. Every 
rock, tree, fence, gable, roof, pillar, and post seems to be 
pressed into the service of the drug vendor. 
The price which the public has to pay for all this rub- 19 
bisli is something simply appalling. The extent to which 
people permit themselves to be imposed upon by ignor- 
ant, audacious business men who deal in drugs, is 
sufficient to make one almost doubt the sanity of the 
human race. Even those who manifest ordinary intelli- 
gence in all other things, are often victimised by the most 
superficial deception in medicine. And this general ignor- 
ance is displayed in reference to other medical matters 
besides drugs. How helplessly ignorant most people 
are in regard to the qualifications of their medical adviser ! 
He is chosen out of many for no particular reason, and 
lauded as being at the top of the profession, for reasons 
the most absurd. The most shallow egotist is often con- 
sidered by his admiring clients as the very embodiment 
of the medical science of the century. A certain kind of 
business tact will often succeed where honesty and sound 
learning will fail. 
The ignorance being acknowledged, we may with ad- 
vantage inquire why it prevails. Doubtless the causes 
are many. While the ignorance of the masses concerning 
medical subjects is lamentable, it is perhaps not more so 
than regards other departments of science; but from its 
nature, and every-day character, it is more apparent, es- 
pecially to the medical profession. When we consider the 
nature of the science of medicine in its widest sense, we 
cannot blame the public so very severely. Medicine em- 
braces so many subjects, different but cognate, that no 
one but a specialist, who devotes his whole time to the 
subject, can expect to be well posted in its details, or even 
have a correct knowledge of its principles. And then the 
different medical sects tend to darken and puzzle the non- 
professional mind. They seem to think that where doc- 
tors differ so much, it would not be safe for them to de- 
cide, and they lay themselves open to the loudest-talking, 
widest-advertising medical panderer to popular prejudice, 
whether he be in or out of the profession. 
I am inclined to think that the medical profession is 
somewhat to blame for the prevalent erroneous notions of 
the masses regarding health matters. There are few in- 
dividuals, and fewer families, but come under the charge 20 
of some member of the profession, more or less, during 
their lives. As a rule, the public reverence their medical 
adviser, and generally accept without questioning what- 
ever he says. Now, if the medical men who preceded us 
had faithfully discharged their duty, and instilled into 
their patients some of the simpler and settled principles 
of the science, surely we would not have had to meet such 
gross ignorance as at present prevails. Formerly, and 
even still to a lesser extent, physicians treated their pa- 
tients as individuals for whom they were called upon to 
write a Latin prescription, and give a few directions as 
to their conduct while ill. The principles which had been 
violated in producing the sickness, and those involved in 
the recovery, were looked upon almost as trade secrets, 
not to be told to the uninitiated. The patient being ill, 
he must swallow a certain quantity of drugs, and in due 
course of time he would get well. As a natural conse- 
quence, the people got the idea that disease was a battle 
to be fought with drugs, led on by the doctor; instead of, 
in the majority of cases, a derangement due to the viola- 
tion of physiological principles which must be rectified 
by a different mode of living. Seeing drugs always pre- 
scribed, and evidently the chief part of the treatment, 
they have been led to think that they may sin unhesitat- 
ingly, believing that Nature has kindly provided an 
antidote to save them from the legitimate result of their 
folly. Who can blame them ? Had we not better blame 
ourselves for inculcating so extensively the idea that 
drugs and disease were natural born enemies, the antag- 
onism of which might always be relied upon, if the fight 
were conducted by a man affixing M.D. to his name f 
If the public had been instructed by precept and example 
that drugs formed but a subsidiary part of the treatment 
of disease, they would not thus readily resort to the 
counter of the drug store for advice, or accept the pre- 
scription of the medicine vendor through the medium of 
the public prints. The profession and the public are 
thus reaping the pernicious fruit of the seed planted by 
our physician ancestors; and we must see to it that we 
do not perpetuate the evil if we cannot eradicate its pre- 
sent fruits. 21 
The question which follows is, how can we atone for the 
transgression of the past, and avoid all such evils in the 
future! That the public have a right to look to the medical 
profession for education in health matters, is as just and 
proper as that they should look to the Church for instruc- 
tion in matters theological. We dare not be so inhuman 
as to try to keep them in darkness, that our fees may be 
more numerous. Fewr will credit ns with motives so 
mean; but we should see that “evil is not wrought 
through want of thought,” as well as by wilful negli- 
gence. 
From the extensive ramifications of the medical pro- 
fession amongst the people, and the personal character of 
the connection, there is little doubt that a most potent 
influence might be brought to bear on society were more 
pains taken by physicians to instruct their patients and 
friends regarding the simpler principles in physiology 
and hygiene. The conscientious and educated practi- 
tioner would ultimately be repaid for his trouble, by keep- 
ing his patients and their friends from falling so readily 
into the traps laid by designing men. On the low plane 
of expediency it would be advisable to act thus; but the 
higher law, to do as we desire to be done to, makes it im- 
perative on ever}' man who would lay claim to the cha- 
racter of a true scientist. 
The universal habit of prescribing medicines has doubt- 
less been the most important means of establishing the 
popular faith in all kinds of drug specifics and panaceas. 
Hence, while we bewail the tendency of the public to 
prefer at times some nostrum to our prescriptions, we 
have the consolation of knowing that the profession is 
responsible, to a great extent, for their education. 
Next in importance to the personal influence of the 
profession, is the power they might wield through the 
press. This is a field which has been as carefully avoided 
by the regular members of the profession, as it has been 
sedulously cultivated by the hosts of fraudulent business 
men who form the vulture-like camp-followers of the 
regular medical army. Because popular medical litera- 
ture has generally been written by speculators of the vilest description, who interlarded their advertisements 
with sham science, to act as a decoy duck, on this account 
few respectable men have had the courage to appear in 
the field, lest they should be confounded with the usual 
class of “ popular physiologists.” But this stand-aloof 
principle is not right. It looks too like the “ close-com- 
munion” practice of some of our theological friends, and 
is apt to make the public think we do not wish them to 
acquire the knowledge they so much need. 
There are many health journals for the people in the 
market, but almost without exception they are issued by 
one-idea’d fanatics, by those who have some axe to grind 
or pills to peddle. We have one class, and a very numer- 
ous one, who seek to inculcate the idea that man is 
largely an amphibio-herbivorous animal, that he should 
use no fluid, outside or inside, but water, and live entirely 
on fruit and farinacea. Others think that phrenology 
solves all the mysteries of life, and teach us to carefully 
avoid carbonaceous food, salt, milk, spices, and live some- 
what like Nebuchadnezzar of old. They generally agree 
that all physic should be thrown to the dogs. Journals 
such as these, with others specially got up to advertise 
private business concerns, and almanacs filled with path- 
ology to suit their pills, are what the public have to 
depend upon to a great extent. In fact, every petty 
one-thought sect pushes its claims on the public through 
the press. The regular profession alone, either through 
Pharisaic self-complacency, carelessness, or callousness, 
lets the public discover the truth as best they may. 
We are clearly acting a foolish part in thus quietly 
looking on while so many false doctrines are being dis- 
seminated. A species of jealousy seems to lie at the bot- 
tom of this “ masterly inactivity.” Each is afraid to 
move, lest he be. accused of self-seeking. To write an 
article for a journal or a pamphlet on a popular medical 
subject, is so apt to be looked upon as an attempt to sur- 
reptitiously advertise the author, that it is generally 
avoided. Meantime, the public are being devoured by 
medical sharks. 
It has been suggested that a popular medical journal 23 
should be started, under the auspices of a society such as 
this, to be conducted on the basis of sound medical 
science. While this might undoubtedly be useful, I be- 
lieve that tile time and talent necessary for this undertak- 
ing would be better employed in endeavoring to reach 
the masses through the widely-read popular journals 
which already abound in the country. Special journals, 
on health or any other subject, are usually very limited 
in their circulation, and are generally purchased by those 
who need them least. Were some of our prominent 
members to write a few articles for a popular periodical, 
there is not a doubt but they would find ready admission, 
and would thus reach and be read by the very class most 
requiring such instruction. Were all the members thus 
to use their influence on the local journals, and keep the 
public well posted on the essentials of physiology and 
hygiene, and expose the false doctrines so assiduously 
obtruded on tlie people, incalculable good might be done, 
both to the public and the profession. 1 am delighted to 
see that much of this good work is already being done by 
The Sanitarian, which is fast gaining in favor with the 
people as well as the profession. I am happy to say, 
also, that some attention is now being given towards in- 
structing the rising generation in the principles of sound 
physiology, through the medium of the school-books, by 
means of carefully-prepared simple lessons. This, aided 
by simple illustrations from the teacher, cannot fail to be 
productive of much good in time to come. 
And why should we not learn even from our enemies, 
and have carefully-written pamphlets on various subjects, 
controversial matters being avoided, that we might leave 
with or recommend to our patients ? It is by means such 
as these, more than by intrinsic merit, that many of the 
petty systems manage to push themselves along in the 
world, at the expense of the public good, and to the 
serious detriment of the legitimate profession of medi- 
cine. 
The platform, too, has been as carefully avoided by the 
profession as in the case of the press. Although every 
American is supposed to be born au orator, the faculty is rarely used to teach medical science to the people. The 
platform is a popular institution in this country, and 
might be utilised for great good in teaching the masses 
the laws of health. There is no lack of talent in the pro- 
fession ; but the objection that prevents the press being 
used is as powerful as regards the platform. Fear of 
being looked upon as advertising himself keeps many an 
eloquent tongue quiet, and thus again the public are 
cheated out of their rights. It is high time we were 
getting over these petty feelings and jealousies, and ap- 
pearing before the public in some other light than mere 
diagnosticians, therapeutists, and surgical operators. 
We certainly have public duties as well as private ones, 
and should see that both are properly fulfilled. 
I trust ere long to see in this arid kindred societies, in 
addition to the Pathological and other sections, a depart- 
ment of Public Instruction. A committee of this nature, 
which would see that the local journals were supplied 
with useful and authoritative articles on health matters, 
would be productive of much good. Were articles for 
popular journals and pamphlets endorsed by such a 
committee, they could be given anonymously to the 
world with enhanced authority, and without giving rise 
to any objection on the score of personal advertising. It 
might also arrange for the delivery of public lectures on 
Popular Physiology, by the members of the Society, or 
others. How much more certainly would we benefit the 
public and the profession by this means, than by warring 
with narrow sectarians, who only thrive the more on the 
publicity thus given them. 
It would be a matter of some importance, and useful to 
. the public, if we could define exactly the difference be- 
tween legitimate medicine and what is known as 
quackery. Not one in a thousand outside the pro- 
fession has any definite ideas on this, subject. Indeed, 
1 have searched our own literature for a well-defined 
statement of the distinction, but failed to find it, until 
I heard it in the Oration recently delivered by Dr. 
Hutchins. Theoretically, the difference is, that the one 
is educated and honest, the other ignorant and unprin- 25 
cipled. There is a well-marked distinction between the 
typical representatives on the two sides. One deals in 
truth and honesty, the other in fraud and trickery. 
Practically, as we find men mixed in the world, the line 
of demarcation is not so clearly drawn between the mem- 
bers of the regular profession and the empiric. The 
honest scientist, who ranks at the head of his profession, 
bears, of course, no resemblance to the designing, igno- 
rant pretender; but as in zoology it is sometimes hard to 
say whether a specimen belongs to the animal or the 
vegetable kingdom, so here there is a borderland where 
it becomes difficult to accurately determine to which side 
the individual belongs. There are many in each army 
near enough to shake hands; and there are not a few in 
the regular army who would be more at home under the 
rebel flag. 
The only real Doctor in Medicine is the man who duly 
qualifies himself by a liberal and scientific education, and 
faithfully exercises all his knowledge to relieve suffering 
and benefit mankind. He is bound by no theory, sect, or 
school, but takes the good of everything in science to 
serve him in his efforts for the amelioration of distress. 
He is the only true eclectic, seeking aid from every avail- 
able source. And wheir he fails, he is ready honestly to 
acknowledge it. 
The man who serves his own interest, on the other 
hand, has one theory by which he squares all his cases, 
and one remedy or system of medication, which he applies 
to “all the ills which flesh is heir to.” He generally 
vaunts his system as infallible, and, however disastrous 
the result, owns no defeat. 
The scientist accepts all truth in nature, and respects 
it for its own sake. He is ever ready to give up cherished 
ideas when they are disproved by well-attested facts. 
Personal reputation and success he sacrifices, whenever 
that is necessary, to serve the cause of truth and justice. 
The illegitiniist, on the contrary, is ready and willing to 
sacrifice facts and principles to secure his own commercial 
prosperity. 
The Judas among the disciples of Esculapius is a com- 26 
pound of ignorant credulity, selfish ambition, and brazen 
deceit. He is the restless spirit of the age, who believes 
in liberty without law, and strives to obtain knowledge 
and riches without working for either. Such men are 
scattered all over the world—thick enough, perhaps, in 
Brooklyn. Here and there we find solitary specimens, 
each one claiming peculiar virtue in his special skill. 
Again we find them combined in leagues or sects, and 
claiming to constitute a new school in medicine. They 
discard the facts in science which have been accumulat- 
ing for ages, and laying hold of some specious theory as 
a basis for their creed and stock of knowledge, proclaim 
that they have inaugurated a new era in medical science. 
Such institutions are exactly like the new schools of art, 
where they teach painting in ten lessons, and sculpture 
in the same length of time. 
The candid scientist gives a ready ear to all such 
claims, and weighs well their value. He listens atten- 
tively to the Hydropath, who claims all the virtues of the 
Pool of Siloam for his aqueous applications; and acknow- 
ledges that water is very powerful and useful, but is far 
from being omnipotent in the cure of disease. 
He hears of a new school which lias for its foundation 
and superstructure the Shakespearian maxim— 
“ One fire burns out another’s burning.” 
This sect claims that their theory is absolutely true, and 
that you must reduce your drugs to a minuteness of 
division far beyond anything dreamed of in the natural 
constitution of matter. The scientific physician tests 
this doctrine by actual experiment, and finds it fallacious. 
It evaporates in his crucible, and leaves scarcely a trace 
behind. He certainly is justified in believing that either 
the theory is false, or the observations of its promulgators 
are wilfully or accidentally incorrect, when he carefully 
repeats a given number of experiments, and finds the 
results all opposed to the claims of its exponents. The 
philanthropic physician regrets that these vaunted dis- 
coveries are not true. 27 
The pathologist would be delighted if he could look 
through the human structure with the eye of a clairvoy- 
ant, and see the exact molecule which was out of place, 
or the changes going on by reason of perverted vital 
action. The physician would be glad if he could sum- 
mon the “spirits from the vasty deep” to aid him in the 
detection and cure of disease; but he cannot accept the 
statement of the best “medium” without a demonstration 
of the truth of the doctrine. 
The man who has but one theory, one principle in 
therapeutics, which he advocates under all circumstances, 
does not belong to the liberal profession of medicine. 
We have an insignificant few in the world who claim that 
they constitute several new schools of medicine. They 
have existed for many years, but they have not added a 
single discovery, not a single idea to anatomy, physi- 
ology, pathology, surgery, obstetrics, or hygiene. All 
the special science which they possess might be reduced 
to manuscript, and put into a nut-shell. Their literature 
consists of a small budget of theories and imaginary 
facts, put together less ingenuously than an average 
dime novel. 
All these multiform parasites, who live and thrive on 
the wounds and sores of society, are a great public bane, 
and the profession regret that they are permitted to exist. 
They have been attacked with all the caustic at the com- 
mand of scientists, but still they live and multiply. We 
might as well leave them alone, and turn our attention 
to bettering our own position, and enlightening the pub- 
lic, so that imposition may die a natural death, through 
want of fools to be fleeced. To sweep all the rubbish in 
medicine from the face of the earth, is a work which can 
only be accomplished by medical societies. The public 
cannot do it, and the schools will not. By raising the 
profession, the non-professional will fall. The weeds will 
gradually disappear from the garden of life as more at- 
tention is paid to the cultivation of good fruit.