PRESIDENT'S ADDRESS 
By GEO. W. MILTENBERGER, M.D., 
Professor of Obstetrics, University of Maryland, 
Baltimore. 
Reprint 
FROM TRANSACTIONS OF 
medical and ff-hiruigical ?acultjj, 
Of the State of Maryland. 
1887. [Reprint from " Transactions of the Medical and Chirurgical Faculty of 
Maryland" for 1887.] 
President's Address. 
By Geo. W. Miltenberger, M. D., 
Professor of Obstetrics, University of Maryland. 
Gentlemen :-To no one could the honor which you have con- 
ferred upon me have been more unexpected than to myself. The 
honor of being called upon to preside over this representative body 
of the profession of the State, and of such a profession, in our good 
old State of Maryland, is surely just cause of pleasure and of pride 
to any man, and that not only in a professional point of view, but 
still more grateful to me as an expression of your personal feelings. 
When I look around and see and bring to mind so many who have 
deserved the honor, and who would so much more worthily have 
borne it, I feel perforce how much is due to age on the one hand, 
and to my personal relations to the profession on the other. There 
are few names on your roster of older date than mine, going back to 
1840, since which time not only have the art and science of medicine 
been entirely revolutionized, but the personnel of the profession has 
been almost entirely changed. A host of those to whom we have 
looked with respect, esteem, and reverence have gone over to the 
majority, and the forms and the voices of the loved and the lost 
greet me continually from the misty vistas of the past. 
It would be to me a most grateful task to recall to you the lives 
and the efforts, the courage and the daring, the devotion and the 
successes of those who have from cycle to cycle filled the places we 
now occupy and so worthily performed the duties we now attempt 
to continue; and I confess I have been tempted to undertake such 
a labor of love, and at the same time to gratify my own feelings by 
placing the chaplets of filial and fraternal affection upon the tombs 
of our worthy dead. But, upon consideration, there are so many 
topics of interest connected with our profession at the present day, 
in all its phases; so many changes in its study, in its character, in 
its extent, and in its interests-with its growth and development, it 2 
GEO. W. MILTENBEKGEK, M. D. 
has not only undergone these changes in itself, but has established 
such wider and more general relations with all other sciences and with 
the world at large, partly from its own inherent growth, and partly 
from the influence of the busy, active age in which we move, throb- 
bing with life and activity, that the present, rather than the past, 
demands our time and attention. 
No period of the world's history has more richly merited the title 
of an age of progress; in none have art and science more steadily 
and rapidly advanced; in none have the wider interests of humanity 
more forcibly addressed themselves to the best minds and feelings 
of their generation; in none have the efforts and struggles of the 
intelligent leaders of thought and action been more powerfully and 
consistently and successfully directed to the practical and the true 
than in our time and generation. The spirit of the age has been 
reflected and had its influence upon us. While we may revere the 
past, and willingly cull from its garners whatever may be sustained 
by the light of present knowledge, we no longer are blindly governed 
by precedent. We have lived long enough to learn how little we 
know; we have learned enough to know that self-presumption and 
dogmatism are neither knowledge nor wisdom; we subject every fact 
to direct observation, and every advance is forced to stand the test 
of persistent and enlightened criticism. 
It has been well said by Sir Henry Ackland: " This century is 
the century of criticism and of experiment. It is, therefore, the age of 
transition. In the course of its criticism and its experiments, and 
in its transition, it has had to devise new methods. By its new 
methods it has acquired new powers. Two of the chiefest of these 
powers are, first, a multitudinous host of individual skilled ob- 
servers, flooding the world with precise individual observations; and, 
secondly, the organization of associations for the direction of inquiry, 
the sifting the wheat from the tares in the vast harvest gathered by 
individual reapers, and the reducing of isolated data into principles 
and laws." 
We have been weaned from the evils and uncertainties of poly- 
pharmacy ; we have been released from the tyranny of the schoolmen ; 
we are no longer shackled by the force of precedent alone; we are 
undeterred by dogmatism, and we are not seriously or for any length 
of time misled by the delusive and uncertain in theory, however 
brilliant and seductive it may be rendered by the light of genius. 
"The mass of human knowledge," as has been truly said, "has president's address. 
3 
become greater, purer, truer. With all our errors, with all our 
blindness, and with all our backslidings, there is steadfast yearning 
after truth and an ever-reaching forwards toward good. Our concep- 
tion of the relation we hold to ■ the whole order of things is more 
clear, and is perhaps more true. The light of keen criticism is 
turned with full blaze on every quarter and from every side. Though 
the variously colored rays impart not seldom confusion more 
bewildering than darkness, in the end the ' lumen siccum,' the pure 
white light for the most part prevails. It then at once illuminates, 
defines, and warms." If this be true in art and in science as a 
whole, it well behooves us to see if like advance has characterized 
our own pursuit. Is there any one whose professional life extends 
over the past half-century who has not, from time to time, in the 
retrospect, felt a glow of shame at the recollection, in the light of 
present knowledge, of the ignorance, I may call it dense, of his 
earlier years? And yet he may feel somewhat consoled by the 
reflection that what he then knew was not only the best of the then 
time, but that that belief and those views were the necessary steps 
and phases of the evolution which was more or less rapidly, but 
always certainly, leading up to our present higher sphere. The 
acquisitions of the past fifty years have unquestionably more than 
doubled those of the previous fifty, and, as far as we can see, will 
in the future augment in constantly increasing ratio. 
It has been just fifty years since Schwan and Schleiden first 
promulgated the doctrine of cell growth, cell nutrition, and cell 
development, the basis of our present physiological knowledge; and 
within that period, and through the labors of its ardent, zealous and 
accurate workers and observers, there has matured to its present 
status the science of Biology, with its accuracy and minuteness of 
observation, and the priceless results which it has already conferred 
upon the other branches of our profession. Morphology, physiology, 
embryology, thus embraced, are pure sciences, not arts, and drawing 
their contributions not only from all living things, but from all with 
which such life is related and by which such life is influenced, ofier 
the widest range of research, and by the contributions of their able and 
enthusiastic cultivators have placed medicine upon a firmer, a more 
enduring and more philosophic basis, and while improving our 
methods and establishing new powers, have made our advance more 
permanent and more assured. 
Naturally and of direct consequence, as these sciences are inti- 4 
GEO. W. MILTENBERGER, M. D. 
mately connected with the doctrine of disease or pathology, this latter, 
constituting the intermediate link between the science and the art, 
between the pure science just referred to and the art of therapeutics, 
our final end and object, and resting upon both the others, has of 
necessity advanced with equal strides and almost equally positively. 
And while the science of medicine has thus progressed, the art of 
medicine, therapeutics, the practice of medicine, has in this time 
entirely changed, and for the better-has advanced with the progress 
of the science, partly, it is true, empirically, but undoubtedly in a 
considerable degree as based upon positive science. 
We have a truer, a more thorough, a more accurate knowledge of 
anatomy and physiology, of structure and of function, of the 
relations of structure to function, of the influence of one function 
on others, or their correlation-of the changes impressed upon 
structure or function by the varying influences impressed upon them 
from within and from without. We have traced and followed, and 
to a large extent established, the morbid changes and alterations 
resulting from the action of causes hereditary, acquired, and 
accidental; the influences resulting from race, from climate, from 
occupation, from habits, either individual or general; the connecting 
link or the morbid impresses which may exist between or be con- 
veyed in one or other direction to or from the pathological states 
respectively of man and the lower animals; and while nothing 
seemed less likely to be of practical utility than the researches of the 
few naturalists who, from Leuwenhoeck to Ehrenberg, studied those 
most minute of living things, the vibrionidae, we have now the 
researches, most practical in character and results, of Lister, of Koch, 
and of Pasteur. 
We now stand upon a firmer basis than in any previous era of our 
history; we have a fuller, a truer, a more reliable knowledge of all 
that constitutes the science of medicine; we have a pathology more 
thorough, more accurate, more minute and more intimate in its 
details, wider and more extended in its range, and sufficiently ex- 
panded in its truthful observations to enable us to deduce and estab- 
lish general principles and laws. We have devised new methods, 
and have had placed in our hands the instruments of precision which 
have played so large a part in our progress. By these new methods 
we have acquired new powers. We have thus gained immeasurably 
in clearness and accuracy in that " porch and eye of medicine-diag- 
nosis." We have learned to an unprecedented degree the natural president's address. 
5 
history of disease, that absolute necessity to the pathologist and the 
practitioner. We have unquestionably attained to a more simple, a 
more useful, a more rational therapeutics. 
The advance in these respects justifies one of the latest utterances 
of the lamented Flint: "The medical profession will have reached 
a high ideal position when the physician, guided by his knowledge 
of diagnosis, the natural history of disease, and existing therapeutic 
resources, may, with neither self-distrust nor the distrust of others, 
treat acute diseases by hygienic measures without potent medication. 
When this time comes, a system of practice which assumes to sub- 
stitute medicinal dynamics for the vis medicatrix natures will have 
been added to the list of bygone medical delusions." 
An approximate idea of the advances and accumulations thus 
made in this time may be gained from the fact that in 1881 it was 
estimated that one-thirtieth part of the whole mass of the world's 
literature belonged to medicine and its allied sciences. It appears 
from this that our medical literature thus formed a little over 
120,000 volumes properly so called, and about twice that number of 
pamphlets, and that this accumulation was increasing at the rate 
of about 1500 volumes and 2500 pamphlets yearly (Billings). It has 
been asked: " What will the libraries and catalogues and bibliographies 
of a thousand, or even of a hundred, years hence be like, if we are 
thus to go on in the ratio of geometric progression which has gov- 
erned the press for the last few decades? The mathematical formula 
which would express this, based on the ratio of the past decade, 
gives an absurd and impossible conclusion, for it shows that if we 
go on as we have been going, there is coming a time when our libra- 
ries will become large cities, and when it will require the services of 
every one in the world not engaged in writing to care for and cata- 
logue the annual product" (Billings). 
With this vast amount of materia], scientific and practical, thus 
accumulated, it is utterly impossible that any one human mind could 
grapple with, much less master, this whole field. The day of 
Admirable Crichtons has passed and for ever. The time may have 
been when one brain could lay claim to universal knowledge, but not 
only can no human intellect make now such claim, but none can now 
cover or embrace the whole sum of medical knowledge. But little 
over a hundred years ago Haller, in Gottingen, was professor of 
anatomy, botany, physiology, surgery and obstetrics, and lecturer on 
medical jurisprudence. At the same time he was writing one review 6 
GEO. W. MILTENBERGER, M. D. 
a week and summing up existing medical science in his Bibliotheca. 
To-day any one of these branches requires all the time of the most 
energetic and learned of our contemporaries (Billings). You can 
all recollect the bitter fight against specialism in medicine-one of 
those embittered and acrimonious and personal contests which have 
marked every successive epoch of development. But the division 
was absolutely necessitated by the extent and richness of the fields 
to be cultivated, reaped and gleaned. Specialism in general, and 
specialties-ophthalmology, otology, dermatology, the diseases of the 
nervous system, gynecology-all met the same objections, the same 
opposition; but the necessities of the case overruled all obstacles. 
There must be specialties and specialists in medicine; and while, as 
in other things, there is no unmixed good, while the results are both 
good and evil, the former immensely preponderating, the latter fall- 
ing principally upon those who take too narrow a view of their pur- 
suit and expect to be good specialists without being good physicians, 
the most determined of their opponents have been forced to recog- 
nize and acknowledge not only their advantages, but the advances 
which have thus been conferred upon the science and art as a whole. 
This being so, these accumulations having been made, this vast 
increase of knowledge both scientific and practical having been 
secured, the necessarily resulting deftness of manipulation and the 
skill which have flowed from these mechanical appliances and instru- 
ments of precision being assured, the necessity for the division of 
effort and labor being recognized, there are certain lessons and duties 
which perforce follow and impress themselves upon us. 
We are compelled to appreciate that with these augmented means 
and opportunities come also increased responsibilities. Immediately 
growing out of this is the demand for further and constantly in- 
creasing labor, the life-long and full-hearted devotion of all our time 
and our intellect to the further development of a profession than 
which there is none purer or nobler. Again, from the more assured 
position of medicine as a whole, from the comparative positiveness 
of diagnosis and of therapeutics to which we have attained, we can 
now at least afford to abstain and free ourselves from the petty and 
acrimonious strifes and disputes which too often in the past have 
marred the beauty and the healthfulness of our progress and derog- 
ated from the dignity of our calling. 
In the words of Dr. V. V. Bowditch: " While individuals disagree, 
there is a common bond of unity which cannot be ignored by honest president's address. 
7 
men. We are all members of a profession which, when regarded in 
its true light, above the plane of party strife and mere selfish gain, 
I regard as the finest and noblest of all, and the feeling grows stronger 
within me with each year of practice. There is that in it far above 
the mere desire and ability to cure disease-that which can soothe 
all regrets for possible failure and disappointment in our daily work 
-I mean the power of human sympathy; the power which bids the 
young mother silently and gratefully press the hand that helped her 
in her hours of trial; the power that impels the dying man at the 
very last to turn to him who, though powerless to save, yet by a 
word, a look, a touch of the hand, gives strength and courage to one 
just passing to that 'undiscovered country from whose bourne no 
traveller returns.' In the midst of discord and disappointment let 
us keep this thought before us, gentlemen, and at the end perhaps we 
may be permitted to see our past life, as it were, stretched before us, 
and feel that we have done our small share toward making' our chosen 
profession what it should be-a blessing to all mankind." 
Our oriflamme floats freely, without spot or blemish, in the sight 
of God and men, over fields bravely won and nobly held. We can take 
our stand upon the truth, the honesty and the dignity of our pro- 
fession, and, appreciating the duty to ourselves, to our profession and 
to society, to uphold that truth, honesty and dignity personally and 
professionally, we can well afford to disregard isms and heresies, and 
wholly devote ourselves to working out its highest and its purest aims. 
In our profession, as in others, there is no royal road to true prog- 
ress and advancement. We have a jealous mistress who admits no 
half-hearted dalliance, nor confers her highest honors on him who 
palters with his duty for the sake of pleasure or of ease. Clever fellows, 
good fellows always abound; the world in1 all ages wants men. In- 
dustry, perseverance, devotion, and self-sacrifice will alone crown him 
with her richest rewards, and the sooner we fully appreciate this and 
act accordingly, the better for ourselves and for the profession. Wait 
not, then, for your difficulties to cease. There is no soldier's glory 
to be won on peaceful fields; no sailor's daring to be shown on 
summer seas; no trust or friendship to be proved when all goes well. 
Faith, patience, devout love, heroic courage, gentleness, are not to 
be found where there are no doubts, no irritation, no difficulties. 
And without love, patience, faith in yourself and your profession, 
you cannot attain your highest goal: with these, true success must 
follow. Be true to yourself and your calling, and recollect that in 8 
GEO. W. MILTENBERGER, M. D. 
the great scheme nothing is lost in life or in death, in growth and 
development, or in destruction, no atom totally disappears, but re- 
appears and revives in some other form, returns to the soil to vivify 
and nourish some new being, it may be of higher or of lower grade, 
but continuing to fulfill the purposes for which it was originally 
produced. 
So no utterance, no opinion falls to the ground utterly void and 
of no effect. The good word, spoken fitly and in season, may ger- 
minate, bloom and fructify in a quarter least expected, or at time of 
utterance least probable; or the idle word, once spoken, may blast 
and taint and corrode the moral tone of the utterer or listener, or 
both. 
And withal be patient, not forgetting that the seeds of truth remain 
in the mind, and only wait the friendly aid of a hard winter, break- 
ing up the cold, selfish clods of clay, to share in the loveliness of a 
new spring and be perfected in the beauty of a new summer. Haste 
is a sign of immaturity. He who is conscious of his knowledge, who 
knows thoroughly his tools, neither worries nor hurries, but watches 
and waits. 
And so, with patience, love for our art, confidence in our profes- 
sion, with industry and self-sacrifice, with hand and heart and mind 
clean and void of offense to our fellow-man, undaunted by difficulties, 
and fully determined, whatever the temptations or the obstacles, to 
do our duty, and our whole duty, to ourselves, to our profession and 
to humanity, not only may we be assured of a fair share of worldly 
success, but the higher reward of the innate consciousness of a life 
by our own efforts purposeful, useful, and rounded with the best 
results to ourselves and to others. 
No nobler sight is seen, no prouder object can present itself, than 
the physician who has conscientiously and intelligently fought the 
fight with the great conqueror, Death, and has come off victorious; 
not pandering to personal vanity, not filled with self-glory, but with 
bowed head and reverent heart returning thanks to the Almighty 
Father that he has been deemed worthy to be the instrument of His 
illimitable love and mercy. 
In conclusion, I feel I cannot do better that adopt in word and 
spirit the advice of one who, as scholar, as physician, as author, in 
his personal and professional character, is the peer of any of the 
noble spirits who have adorned our ranks-Sir James Paget-"And 
then let us always remind ourselves of the nobility of our calling. I president's address. 
9 
dare to claim for it that among all the sciences, ours, in the pursuit and 
use of truth, offers the most complete union of those three qualities 
which have the greatest charm for pure and active minds-novelty, 
utility, and charity. These three, which are sometimes in so lament- 
able a disunion, as in the attractions of novelty without either utility 
or charity, are in our researches so combined that, unless by force or 
willful wrong, they hardly can be put asunder. And each of them 
is admirable in its kind. For in every search for truth we can not 
only exercise curiosity and have the delight, the really elemental 
happiness, of watching the unveiling of a mystery, but on the way 
to truth, if we look well round us, we shall see that we are passing 
among wonders more than the eye or mind can fully apprehend. 
And as one of the perfections of Nature is that in all her works 
wonder is harmonized with utility, so is it with our science. In every 
truth attained there is utility, either at hand or among the certainties 
of the future. And this utility is not selfish; it is not in any degree 
correlative with money-making; it may generally be estimated in the 
welfare of others better than in our own. Some of us may indeed 
make money and grow rich, but many of those that minister 
even to the follies and vices of mankind can make much more than 
we. In all things costly and vainglorious they would far surpass us 
if we would compete with them. We had better not compete where 
wealth is the highest evidence of success. We can compete with 
the world in the nobler ambition of being counted among the 
learned and the good who strive to make the future better and 
happier than the past. And to this we shall attain if we will 
remind ourselves that, as in every pursuit of knowledge there is the 
charm of novelty, and in every attainment of truth utility, so in every 
use of it there may be charity. I do not mean only the charity which is 
in hospitals or in the service of the poor, great as is the privilege of 
our calling in that we may be its chief ministers, but that wider 
charity which is practised in a constant sympathy and gentleness, in 
patience and self-devotion. And it is surely fair to hold that, as in 
every search for knowledge we may strengthen our intellectual 
power, so in every practical employment of it we may, if we will, 
improve our moral nature; we may obey the whole law of Christian 
love, we may illustrate the highest induction of scientific philan- 
thropy. Let us then resolve to devote ourselves to the promotion of 
the whole science, art, and charity of medicine. Let this resolve be 
to us as a vow of brotherhood, and may God help us in our work."