ANNUAL ADDRESS DELIVERED BEFORE THE American Academy of JAedicine, AT PITTSBURGH, PENNSYLVANIA, OCTOBER 12th, 1886, BY R. S. SUTTON, A.M., M.D., President of the Academy. ANNUAL ADDRESS DELIVERED BEFORE THE +> + + v + j\meriatn jj\.catle!iit! off Jffeilidtte, AT PITTSBURGH, PENNSYLVANIA, OCTOBER 12th, 1886, BY R. S. SUTTON, A.M., M.D., Of Pittsburgh, pa„ President of the Academy PHILADELPHIA: PRESS OF WM. F. FELL & CO., 1220-24 Sansom Street. 1 887. The Council of the American Academy of Medicine invariably disclaims all official responsibility for, or endorsement of, the individual opinions contained in the Annual Address of the Presi- dent of the Academy. Fellows of the American Academy of Medicine: — Gentlemen : Upon this, the occasion of our eleventh annual meeting, permit me to thank you for the honorable position in which you have placed me with reference to your Association. The position has been rendered all the more honorable by means of the conditions which you demand for fellowship, and which make your Association peculiarly distinctive in the United States. Because of the responsibility connected with the position, it was accepted reluctantly, for I was conscious of my own inability, and pos- sessed a decided opinion that there were other Fellows better quali- fied than I to discharge the duties of the presidency. I was privi- leged to be at the birth of this Association, and the seven others who were present on that September evening at Philadelphia, in the year of our National Centennial, are all living, and probably now present. During the ten years of our associate existence, death has claimed twenty-three of our fellow workers:— Necrological Roll. William Henry Allen, George Miller Beard, William C. Bennet, Charles Frederick Clark, Charles Henry Crane, Louis Elsberg, Horace P. Farnham, Austin Flint, Samuel D. Gross, Elisha Harris, Frank Hastings Hamilton, Theophilus Stewart Hartley, Hugh Lenox Hodge, Henry G. Landis, Frederick D. Lente, Thomas A. McBride, Isaac B. Mulford, Henry W. Newcomet, James Culbertson Rea, Joseph A. Reed, James M. Shearer, J. Marion Sims, Albert H. Smith. 4 Two of these served as Presidents of this Association, and left it their blessing and aided in advancing its interests. We are not alone in mourning the loss of these truly great men. By their death American medicine and American surgery have lost bril- liant lights. They were men of high intellectual culture, and departed in possession of the desire and hope that a higher standard of education should, in the future, be attained by all members of the profession they honored and that has honored them. In accordance with a rule of your Association, each of the nine presiding officers who have preceded me have made addresses. These were illustrative of the principles and purposes of this Asso- ciation, and were remarkably able and exhaustive. They were delivered in the oldest, best educated and most cultured sections of our country, and in both professional and non-professional circles. And it may be further stated that these addresses were always received with the most cordial approbation. I have a desire also to thank you for selecting Pittsburgh, my home, as the place of the present meeting. It is not now the “ Smoky City” nor the “ Dirty City ” of which you have so fre- quently heard in the past, and our citizens have always prided them- selves on their energy and ability to furnish their enterprise with energy and mind and money. Our factories are somewhat older than our institutions of learning, but during the latter years the last named have greatly increased. Doubtless, we resemble other people in that we prefer food and raiment to education, but we affirm that our appreciation of the latter is fully up to the average of the same sentiment in our sister cities. This is the first time your Association has held a meeting west of the Allegheny mountains, and on this auspicious occasion we tender you a most cordial welcome. Our city is a proper place for your first encampment, in your march toward the “Golden Gate.” Pittsburgh stands at the gateway of the great valley of the Ohio and its tributaries. Here stood old Fort Duquesne, for a time the outpost of civilization. May our present session prove a presage of an advancement in our loved profession. As from this point the principles of free civil government were borne westward on the bosom of “ the beautiful river,” so may the principles of a better education of physicians go forth from this society, to take root all over this broad land, and when you and I shall have been 5 forgotten, and the faithful pioneers of American medicine shall have passed into history, they will bear golden fruit in the might of the men who will succeed us, and in the preservation of the lives and health and the promotion of the happiness of the people privi- leged with their services. The desire just expressed animated the bosoms of those who organized this society, and now dominates each member of it. We disclaim all other motives; we seek neither emolument nor fame, but being lovers of our kind, genuine philanthropists, we are moved to seek the amelioration of the phys- ical condition of our fellow men. Our single aim is the public benefit to be derived from an elevation and an increase in the use- fulness of our chosen profession. That there is need for such a movement, the statement of a few acknowledged facts will prove. For many years, three learned professions have been recognized and patronized by the people. That of law deals with man’s rela- tion to his neighbor. Theology concerns itself with man’s rela- tion to his God. Medicine finds its sphere of operation in man’s physical condition. Our race is mortal; far reaching causes of dissolution obtain ; these are diseases and accidents; they have occasioned the origin of our profession, and furnish the reason for its continued existence. President Mark Hopkins has made the remark, that human nature is a pyramid, of which the physical is the base ; the truth of this sage saying is too apparent to require either argument or illustration. Deprived of life, man flies the earth; wanting health, he is not only useless in it, but is miserable himself and a burden to his associates. In the United States, the life and health of near sixty millions of people are under the care of the medical profession. This is a weight of responsibility, and none but the broad shoulders of education are capable of bearing the burden. Would an intelligent and impartial examination of the medical profession lead to the conclusion that it is fully able to meet this responsibility? Your speaker is prepared to claim as much as any well-informed man for his professional brethren, but is com- pelled to declare that while there are many men of might in this noble vocation, there is a large number who are absolutely desti- tute of both general and professional knowledge. The intelligent observer of public affairs is aware that there is a great and growing dissatisfaction with the profession. The fact that venders of patent 6 medicines become millionaires, while many diplomated doctors fail to obtain subsistence, proves this proposition. The multiplication of medical mountebanks, peripatetic physicians, is another argu- ment strongly sustaining this statement. And alongside of these considerations may be placed this fact, that in too many instances improper and unmanly methods are resorted to for the purpose of obtaining practice, by regularly licensed physicians, and the strug- gle suggests that hunger is the motive for such extraordinary exer- tion. These and similar evils demand attention. I ask your indulgence while I proceed to point out some of the detrimental things in our profession, and indicate suitable methods for their repression :— i. The injurious cause that I mention first is the number and nature of our medical schools. Our civil government was born of necessity, and in this respect is analogous to our institutions for instruction in the healing art. The people required medical treat- ment and a set of educated men to furnish it, and the education required the schools. In common with all institutions of a new country, the origination and development of our medical colleges were cramped with poverty. As the nation greatened and wealth accumulated, money was attracted to these enterprises, and in the New England States, New York, Pennsylvania, Maryland and Illinois, institutions of this sort were founded and fostered, which are now fast becoming the peers of those that are the proud boast of England and the glory of the continent of Europe. Private persons and State Legislatures bestowed large sums of money on these schools, and they are the pillars of our American temple of medical science. Who among us is so ignorant of public affairs as not to have heard of the munificent gifts of Johns Hopkins, the Vanderbilts, and our own distinguished townsman, Andrew Car- negie? In the West and South the early schools of medicine did commendable work. Enterprising men in these and other sections of the country, during the first century of our national existence, sowed bountifully and reaped a rich recompense. The rapid increase of population demanded doctors, and these schools supplied them. But at the end of our first century the demand for an increase in the number of physicians had ceased, and the medical schools had multiplied to such an extent that the men they supplied far exceeded the requirements of the people. The principal part of the excess 7 came from a large number of small schools, whose insufficient capital prevented them from competing honestly with their more favored rivals. Necessity made them cheap institutions, selling cheap wares, and flooding the country with an imperfect product. Financially they have been failures, and their faculties have lost money by operating them. But the instructors found a solace for their depleted purses in being dubbed Professor, and there was some financial return in that their incompetent graduates were compelled to become drummers for their Alma Mater, sending to the faculty cases they were unable to treat successfully. The medical men in other centres of population taking knowledge of this phase of competition, secured charters, erected buildings, and organized themselves into faculties for medical instruction. In this manner medical mills have been multiplied, until at the present time there are one hundred and one incorporated institutions, good and bad, in the United States, attended annually by nearly fifteen thousand students, graduating each year almost one-third of this enormous number. It is an assertion that must be accepted by all reasonable people, that this supply is largely in excess of the needs of our present population. Of the faculties of these schools something ought to be said, and it is the desire of your speaker to temper honest severity with kind charity. Many of the men in them are possessed of such ability that they are crowned with praise by an appreciative public, but justice requires that it be affirmed that there are others in this highly responsible position who are totally incompetent to discharge the onerous duties imposed. The some other way than ability and aptness to teach whereby these men have climbed into these promi- nent positions is unknown to the general public, and regard for the reputation of the profession prevents its description here. Let it suffice to utter the warning, that if speedy reformation does not soon take place, a Daniel will come to judgment, and this iniquitous system of medical education will crumble, as surely as did the throne of Darius. The profits of these positions are derived from class fees and clinic privileges, increased by the addition of graduation charges and the money obtained from the practice that is attracted by the title of Professor. It is to be expected that this sort of schools will present all kinds of inducements to lure within their walls, young men, ambitious 8 to write M.D. after their names, and the state of the finances requires that they be graduated at the earliest period possible, regardless of attainments and ability. This society proposes to endeavor, by creating public sentiment, to prevent the multiplication of these superfluous schools that, with incompetent faculties and imperfect equipments, are ruining what ought to be an honored profession. 2. A cause of injury that I speak of secondly, is the number and nature of the doctors legally licensed to practice medicine. At the present time there are ninety thousand two hundred people so privi- leged in this country. During the decade between 1870 and 1880 there was an increase of twenty-five thousand medical men. This number is comparatively much larger than that of other countries equally advanced in civilization. In Canada there is one physician for every 1200 people ; Great Britain, one for every 1673 ; France, one for every 1814; Germany, one for every 3000; Belgium, one for every 2408; Austria, one for every 2500; Italy, one for every 3500; and in Russia, one for every 2500. We have, proportion- ately, double as many doctors as Canada, three times as many as England, four times as many as France, and five times as many as Germany. Comparatively, this country is more healthy than those named, and these considerations make it evident that we have too many men for the work to be done. The ratio of physicians to population in some of our cities is higher than the general average of the country. St. Louis has one prescriber of drugs for every 475 inhabitants; Chicago, one for every 548; Denver, one for every 260; and in the cities of Pittsburgh and Allegheny, it has been estimated that there is one for every 650 citizens. These figures furnish the inference that it is no longer compassion for a community destitute of medical attendance that prompts the establishment of more medical colleges in the United States. It is a lamentable fact that young men ambitious of success, and willing to make every possible exertion to rise to usefulness and eminence legitimately, are positively prevented, because their limited income does not permit them to purchase the necessary professional equip- ment, and to battle with the necessities and competition in life, while they wait long for recognition and remunerative employment. And it is not an unusual thing to find now, in this field, a hoary head humbly held low because of the depressing presence of Burns’ “ill-matched pair,” age and want. The excess of numbers is so 9 great that the money diverted to this channel is not sufficient to furnish a comfortable subsistence to all, and too often the scholar is beaten by the tactician. In plain words, there are too many doctors for the wages paid, and not seldom does it fail of distribution according to the worth of the workers. The charge made is double; it affirms that there are too many medical men, and that many of them are incompetent to the tasks required. And our statement is that there is a lamentable deficiency, not only of technical knowledge, but also of general information, in a vast majority of those graduated in medicine. It is one of the objects of this society to rid the profession of illiteracy. It requires as an essential condition of membership, not only a knowledge of the theory and practice of medicine, but also graduation, either classical, literary or scientific, in some reputable institution of learning, and we aim to make it an indispensable requisite to admission as a student of medicine, that the candi- date have a diploma from a chartered college. The other learned professions are making advancement in this direction, and it is time that we should take this step forward. The churches that once accepted uneducated men as students of theology, now refuse them. The wall that separates the legal fraternity from the common herd of mankind is being constantly increased in height, and such is its present altitude that only trained mental athletics are able to scale it. And it is our purpose that no longer shall the lamely illiterate overleap our wall of contravallation as easily as Remus is said to have surmounted the incipient mural defenses of ancient Rome. A professional platform is an elevated plateau, supposed to have for its occupants educated people, and as there is a general uplifting of the masses by means of increasing education, it must have a cor- responding elevation if it retain popular respect. The anecdotes excoriating the medical profession with ridicule and read with relish by the people, indicate that it is no longer to them a cloud black with bounty over their heads, but a fog bank, so far below them that it is an object of contempt. One of the fathers of our civil gov- ernment said: “We must educate or perish by our own prosperity and it is apparent that we must either educate or perish by our comparative insignificance. A certain amount of authority is accorded to the members of the learned professions in their respective domains; it is a kind of 10 aristocracy, a rule of the educated, and if the members of the medical profession retain an exalted position and maintain their superior power, they must make themselves worthy of it by secur- ing a higher education. We do not rule by divine right (medicine has long ceased to be a priesthood), but by superior power exer- cised in the amelioration of the condition of suffering humanity. Of the three curricula offered by modern colleges, the classical, scientific and literary, the first named is most serviceable to the stu- dent of medicine. Several considerations support this proposition. 1. The nomenclature of the medical, as well as the other sciences, is derived from the Greek and Latin languages, chiefly from the former. The reasons for this need not be stated here ; it is the fact alone that claims attention. It is well known that even in the best of our medical schools, some of the students fail to absorb any great amount of the instruction imparted. That which is presented may be as penetrative as lanolin, but there is so much of the pachy- dermata in a majority of these young men that inunction does not succeed. The understanding is not reached because the terms em- ployed in the lectures heard and books studied are not comprehended. In addition to this, there are men whose ignorance of classical languages occasions their misuse of words in a manner that rivals Mrs. Partington’s Ike, and exposes both themselves and the profes- sion to ridicule. (The case recently reported by the papers of a doctor having been asked by an attorney, when giving testimony in a court, if he had ever performed the operation known as decapi- tation, and his reply, that he had accomplished it repeatedly with- out losing a single case, is an illustrative instance.) 2. The study of these languages increases the capacity of the memory, and makes it more ready to return its treasures when required. A retentive memory and a ready recollection are of inestimable importance to the practicing physician. 3. Attention to minute points is a requisite of proficiency in these languages, and it cultivates the habit of close scrutiny, that is of inestimable value in scientific research. 4. Much of lingual study consists of the analysis and synthesis of words and sentences, and is closely analogous to the examination of the abnormalities of disordered physical faculties and functions. 5. Classical terms have several meanings, some of them widely different, and deciding which is the one intended in a particular 11 passage develops the reasoning powers. Other things being equal, ability to reason correctly determines who will become eminent for success in practicing the healing art. The history of a doctor weak in this faculty is a record of blunders. 6. A linguist possesses a large vocabulary, and his exercises in translating from one language to another give him skill in the use of his large and various stores, make him able to explain his views with unmistakable clearness, and to impart through the press his knowledge to his brethren in an acceptable and profitable manner. In confirmation of the opinion here advanced, I call attention to the fact that Professors Billroth and Esmarch have both published to the world their conviction, that this line of study is indispensable to the medical student. Modern languages, chiefly German and French, are in the curriculum of every literary institution, and are now regarded as essential elements of a liberal education, and the physician who is in direct and constant contact with the world can- not afford to ignore them. Many of the best treatises on medicine are in them, and without a knowledge of them vast stores of most precious knowledge are a hidden treasure. It is eminently desirable that a solid foundation of Greek and Latin should have a superstructure of German and French erected thereon. The soldier who wars against disease is not panoplied who has not supplied himself with these weapons. The other elements of a liberal education are also of great value for the purpose of preliminary training. Mathematics furnishes ex- ercise to the reasoning faculty that increases its powers better than anything else. The protracted attention and involved processes of accurate reasoning develop the ability that is needed to solve the enigmas that hourly confront the busy practitioner. Disease is a Sphynx with its riddle, and in many cases the life of the patient depends on the doctor’s ability to discover the answer. Some of the branches of study offered have a direct bearing on medi- cation. Mineralogy and Botany are the keepers of the storehouse of nature from which Chemistry obtains the materials with which to fill the pharmacopoeia. Natural Philosophy enables the student to understand the mechanism of the human body, and Zoology fur- nishes him illustrative parallels. Medical men are called as expert witnesses in questions of sanity, 12 and it is impossible for a man to understand disordered mental action who has no knowledge of normal intellection. There is no calling in life that offers the same opportunities to do wrong without detection, and to no person is there so much solicitation to sin, as to the man who holds in his hand the keys of life and death; and, above all others, the physician should be well versed in the science of Moral Philosophy, and his life should be ruled by its principles. In addition to these considerations, I state the well-known fact, that a physician’s success in his profession depends in no small degree on an acceptable personal appearance and gentlemanly address. Education imparts a polish to the genuine solidity of character that secures appreciation. An Abernethy may become eminent in spite of boorish manners; but the average medical man needs to lay aside every hindering weight, and avail himself of every helpful wing, in his professional race. There are two specifications in this indictment. One is an insufficient preliminary training, and the other is a want of proper professional equipment. England keeps open but nineteen doors by which the medical profession is entered, and each one is carefully guarded. Before entering upon the study of medicine, a young man must pass an extended preliminary examination, and after spending forty-five months in diligent study in a medical college, another severe scrutiny must be undergone. In Germany a four-year course at a university is required in order to secure a degree, but the student is not permitted to practice until he has spent another year in study and passes the searching examina- tion of the board appointed by the Government. The same extended course of preparation is required in other civilized countries. With us, registration in a physician’s office, with or without application to the primary studies of the profession, and twelve or thirteen months’ attendance at a medical college, is supposed to fit any man to assume the charge of the life of a human being. “The seventh son of the seventh son,” and the “good for nothing else but a doctor,” are sent to. these mills, to be metamorphosed into a physician by being taught Latin formulas by men who are unable to spell correctly in English, and in a brief time are labeled and sent out to be supported by the public, who, as a rule, know 13 but little difference between educated and uneducated medical graduates. Flocks of these fledglings fly about from place to place like migratory birds seeking subsistence, until, entrapped by some ism or quackery, or dying of inanition, their places are filled by other issues of the rookeries. How are these evils to be remedied ? I answer, only by legis- lation. There is now no law forbidding men to teach or study any science, be it law, medicine, or theology; such legislation would be a limitation of human rights. But the police power of the State has authority to regulate by law the practice of law or medicine, or anything else that affects the welfare of the citizens. As in Germany, this Commonwealth ought to separate the teaching and the licensing authority of the medical profession. It is the duty of the State to create a board of examiners, who shall try and pass upon the qualifications of every one who proposes to affect the physical condition of the citizens by means of medication. It should be composed of thoroughly educated men selected from each of the established schools of medicine. It should stand as a safeguard between the inadequate medical colleges and the suffering elements of the populace. It is for the purpose of securing such benefits for our profession and our population that we have banded ourselves together in this Association. At our first meeting eight Fellows originated this organization, and now, after ten years of existence, our roll numbers about four hundred. We ought to welcome to our society every educated and conscientious medical man. The objects sought by us are such as commend themselves to the approbation of the best men in the profession, and to all educated people. We may yet see the day when creed in medicine shall have a name only on the page of history, and when a legal doctor, thoroughly educated and protected by State laws, shall alone exist and stand on equal rights with his neighbor. Is it, there- fore, Utopian to anticipate the time when physicians shall meet on common ground in their efforts to save the sick from the sophistries of the charlatan, and join hands in preserving precious human lives and conserving the dignity of the medical profession ? In that time every man who makes medicine a trade will be ostra- cized, and all to whom it is a learned and noble profession will be worthy of the title of Doctor of Medicine.