Medicine - Unity, Peace, And Concord
( Originally Published 1905 )
ON this occasion I have had no difficulty in selecting a subject on which to address you. Surely the hour is not for the head but for the heart, out of the abundance of which I may be able to express, however feebly, my gratitude for the many kindnesses I have received from the profession of this country during the past twenty-one years, and from you, my dear colleagues of this state and city, during the sixteen years I have dwelt among you. Truly I can say that I have lived my life in our beloved profession —perhaps too much ! but whatever success I have had has come directly through it, and my devotion is only natural. Few men have had more from their colleagues than has fallen to my lot. As an untried young man my appointment at McGill College came directly through friends in the faculty who had confidence in me as a student. In the ten happy years I lived in Montreal I saw little of any save physicians and students, among whom I was satisfied to work—and to play. In Philadelphia the hospitals and the societies absorbed the greater part of my time, and I lived the peaceful life of a student with students. An ever-widening circle of friends in the profession brought me into closer contact with the public, but I have never departed from my ambition to be first of all a servant of my brethern, willing and anxious to do anything in my power to help them. Of my life here you all know. I have studied to be quiet and to do my own business and to walk honestly toward them that are without; and one of my chief pleasures has been to work among you as a friend, sharing actively in your manifold labours. But when to the sessions of sweet, silent thought I summon up the past, not what I have done but the many things I have left undone, the opportunities I have neglected, the battles I have shirked, the precious hours I have wasted—these rise up in judgment.
A notable period it has been in our history through which we have lived, a period of reconstruction and renovation, a true renaissance, not only an extraordinary revival of learning, but a complete transformation in our educational methods; and I take pride in the thought that, in Philadelphia and in Baltimore, I have had the good fortune to be closely associated with men who have been zealous in the promotion of great reforms, the full value of which we are too close to the events to appreciate. On the far-reaching influence of these changes time will not permit us to dwell. I propose to consider another aspect of our work of equal importance, neither scientific nor educational, but what may be called humanistic, as it deals with our mutual relations and with the public.
Nothing in life is more glaring than the contrast between possibilities and actualities, between the ideal and the real. By the ordinary mortal, idealists are regarded as vague dreamers, striving after the impossible; but in the history of the world how often have they gradually moulded to their will conditions the most adverse and hopeless! They alone furnish the Geist that finally animates the entire body and makes possible reforms and even revolutions. Imponderable, impalpable, more often part of the moral than of the intellectual equipment, are the subtle qualities so hard to define, yet so potent in everyday life, by which these fervent souls keep alive in us the reality of the ideal. Even in a lost cause, with aspirations utterly futile, they refuse to acknowledge defeat, and, still nursing an unconquerable hope, send up the prayer of faith in face of a scoffing world. Most characteristic of aspirations of this class is the petition of the Litany in which we pray that to the nations may be given 'unity, peace, and con-cord. Century after century from the altars of Christendom this most beautiful of all prayers has risen from lips of men and women, from the loyal souls who have refused to recognize its hopelessness, with the wardrums ever sounding in their ears. The desire for unity, the wish for peace, the longing for concord, deeply implanted in the human heart, have stirred the most powerful emotions of the race, and have been responsible for some of its noblest actions. It is but a sentiment, you may say: but is not the world ruled by feeling and by passion? What but a strong sentiment baptized this nation in blood; and what but sentiment, the deep-rooted affection for country which is so firmly implanted in the hearts of all Americans, gives to these states today unity, peace, and concord? As with the nations at large, so with the nation in particular; as with people, so with individuals; and as with our profession, so with its members, this fine old prayer for unity, peace, and concord, if in our hearts as well as on our lips, may help us to realize its aspirations. What some of its lessons may be to us will be the subject of my address.
Medicine is the only world-wide profession, following everywhere the same methods, actuated by the same ambitions, and pursuing the same ends. This homogeneity, its most characteristic feature, is not shared by the law, and not by the Church, certainly not in the same degree. While in antiquity the law rivals medicine, there is not in it that extraordinary solidarity which makes the physician at home in any country, in any place where two or three sons of men are gathered together. Similar in its high aims and in the devotion of its officers, the Christian Church, widespread as it is, and saturated with the humanitarian instincts of its Founder, yet lacks that catholicity—urbi et orbi—which enables the physician to practise the same art amid the same surroundings in every country of the earth. There is a unity, too, in its aims—the prevention of diseases by discovering their causes, and the cure and relief of sickness and suffering. In a little more than a century a united profession, working in many lands, has done more for the race than has ever before been accomplished by any other body of men. So great have been these gifts that we have almost lost our appreciation of them. Vaccination, sanitation, anaesthesia, antiseptic surgery, the new science of bacteriology, and the new art in therapeutics have effected a revolution in our civilization to which can be compared only the extraordinary progress in the mechanical arts. Over the latter there is this supreme advantage, it is domestic—a bedroom revolution which sooner or later touches each one of us, if not in per-son, in those near and dear—a revolution which for the first time in the history of poor, suffering humanity brings us appreciably closer to that promised day when the former things should pass away, when there should be no more unnecessary death, when sorrow and crying should be no more, and there should not be any more pain.
One often hears as a reproach that more has been done in the prevention than in the cure of disease. It is true; but this second part of our labours has also made enormous progress. We recognize to-day the limitations of the art; we know better the diseases curable by medicine, and those which yield to exercise and fresh air; we have learned to realize the intricacy of the processes of disease, and have refused to deceive ourselves with half-knowledge, preferring to wait for the day instead of groping blindly in the dark or losing our way in the twilight. The list of diseases which we can positively cure is an ever-increasing one, the number of diseases the course of which we can modify favourably is a growing one, the number of incurable diseases (which is large and which will probably always be large) is diminishing—so that in this second point we may feel that not only is the work already done of the greatest importance, but that we are on the right path, and year by year as we know disease better we shall be able to treat it more successfully. The united efforts of countless workers in many lands have won these greatest victories of science. Only by ceaseless co-operation and the intelligent appreciation by all of the results obtained in each department has the present remarkable position been reached. Within a week or ten days a great discovery in any part of the world is known everywhere, and, while in a certain sense we speak of German, French, English, and American medicine, the differences are trifling in comparison with the general similarity. The special workers know each other and are familiar with each other's studies in a way that is truly remark-able. And the knowledge gained by the one, or the special technic he may devise, or the instrument he may invent is at the immediate disposal of all. A new lifesaving operation of the first class devised by a surgeon in Breslau would be performed here the following week. A discovery in practical medicine is common property with the next issue of the weekly journals.
A powerful stimulus in promoting this wide organic unity is our great international gatherings—not so much the International Congress of the profession, which has proved rather an unwieldy body, but of the special societies which are rapidly denationalizing science. In nearly every civilized country medical men have united in great associations which look after their interests and promote scientific work. It should be a source of special pride to American physicians to feel that the national association of this country—the American Medical Association—has become one of the largest and most influential bodies of the kind in the world. We cannot be too grateful to men who have controlled its course during the past ten years. The reorganization so efficiently carried out has necessitated a readjustment of the machinery of the state societies, and it is satisfactory to know that this meeting of our state society, the first held under the new conditions, has proved so satisfactory. But in the whole scheme of readjustment nothing commands our sympathy and co-operation more than the making of the county societies the materials out of which the state and national associations are built. It is not easy at first to work out such a scheme in full detail, and I would ask of the members of this body not only their co-operation, but an expectant consideration, if the plan at first does not work as smoothly as could be desired. On the county members I would urge the sup-port of a plan conceived on broad national lines—on you its success depends, and to you its benefits will chiefly come.
Linked together by the strong bonds of community of interests, the profession of medicine forms a remarkable world-unit in the progressive evolution of which there is a fuller hope for humanity than in any other direction.
Concentration, fusion, and consolidation are welding together various subunits in each nation. Much has been done, much remains to do; and to three desiderata I may refer briefly.
In this country reciprocity between the state licensing boards remains one of the most urgent local needs. Given similar requirements, and examinations practically of the same character, with evidence of good character, the state board should be given power to register a man on payment of the usual fee. It is preposterous to restrict in his own country, as is now done, a physician's liberty. Take a case in point: A few months ago a man who is registered in three states, an able, capable practitioner of twenty years' standing, a hard student in his profession, a physician who has had charge of some of the most important lives of this country, had to undergo another examination for licence. What an anomaly! What a reflection on a united profession! I would urge you all most strongly to support the movement now in progress to place reciprocity on a proper basis. International reciprocity is another question of equal importance, but surrounded with greater difficulties; and, though a long way off, it will come within this century.
The second urgent need is a consolidation of many of our medical schools. Within the past twenty-five years conditions have so changed that the tax on the men in charge of the unendowed schools, has become ever more burdensome. In the old days of a faculty with seven professors, a school with 300 students was a good property, paying large salaries, but the introduction of laboratory and practical teaching has so increased the expenses that very little is now left for distribution at the end of the year. The students' fees have not increased proportionately, and only the self-sacrifice and devotion of men who ungrudgingly give their time, and often their means, save a hopeless situation. A fusion of the schools is the natural solution of the problem. Take a concrete example: A union of three of the medical schools of this city would enable the scientific departments to be consolidated at an enormous saving of expense and with a corresponding increase in efficiency. Anatomy, physiology, pathology, physiological chemistry, bacteriology, and pharmacology could be taught in separately organized departments which the funds of the united school could support liberally. Such a school could appeal to the public for aid to build and endow suitable laboratories. The clinical work could be carried on at the separate hospitals, which would afford unequalled facilities for the scientific study of disease. Not only in this city, but in Richmond, in Nashville, in Columbus, in Indianapolis, and in many cities a "merger" is needed. Even the larger schools of the larger cities could "pool" their scientific interests to the great advantage of the profession.
And the third desideratum is the recognition by our homoeopathic brethren that the door is open. It is too late in this day of scientific medicine to prattle of such antique nonsense as is indicated in the "pathies." We have long got past the stage when any "system" can satisfy a rational practitioner, long past the time when a difference of belief in the action of drugs—the most uncertain element in our art!—should be allowed to separate men with the same noble traditions, the same hopes, the same aims and ambitions. It is not as if our homoeopathic brothers are asleep; far from it, they are awake—many of them at any rate—to the importance of the scientific study of disease, and all of them must realize the anomaly of their position.
It is distressing to think that so many good men live isolated, in a measure, from the great body of the profession. The original grievous mistake was ours—to quarrel with our brothers over infinitesimals was a most unwise and stupid thing to do. That we quarrel with them now is solely on account of the old Shibboleth under which they practise. Homoeopathy is as inconsistent with the new medicine as is the old-fashioned polypharmacy, to the destruction of which it contributed so much. The rent in the robe of Aesculapius, wider in this country than else-where, could be repaired by mutual concessions—on the one hand by the abandonment of special designations, and on the other by an intelligent toleration of therapeutic vagaries which in all ages have beset the profession, but which have been mere flies on the wheels of progress.
Many seek peace, few ensue it actively, and among these few we, alas! are not often to be found. In one sense every one of us may be asked the question which Jehu returned to Joram : "What hast thou to do with peace ? " since our life must be a perpetual warfare, dominated by the fighting spirit. The physician, like the Christian, has three great foes—ignorance, which is sin; apathy, which is the world; and vice, which is the devil. There is a delightful Arabian proverb two lines of which run: "He that knows not, and knows not that he knows not, is a fool. Shun him. He that knows not, and knows that he knows not, is simple. Teach him." To a large extent these two classes represent the people with whom we have to deal. Teaching the simple and suffering the fools gladly, we must fight the wilful ignorance of the one and the helpless ignorance of the other, not with the sword of righteous indignation, but with the skilful weapon of the tongue. On this ignorance the charlatan and the quack live, and it is by no means an easy matter to decide how best to conduct a warfare against these wily foes, the oldest and most formidable with whom we have to deal, As the incomparable Fuller remarks: "Well did the poets feign Aesculapius and Circe brother and sister, . . for in all times (in the opinion of the multitude) witches, old women, and impostors have had a competition with doctors." Education of the public of a much more systematic and active kind is needed. The congress on quackery which is announced to take place in Paris, with some twenty-five subjects for discussion, indicates one important method of dealing with the problem. The remarkable exhibit held last year in Germany of everything relating to quacks and charlatans did an immense good in calling attention to the colossal nature of the evil. A permanent museum of this sort might well be organized in Washington in connexion with the Department of Hygiene. It might be worth while to imitate our German brethren in a special national exhibit, though I dare say many of the most notorious sinners would apply for large space, not willing to miss the opportunity for a free advertisement! One effective measure is enforced in Germany : any proprietary medicine sold to the public must be submitted to a government analyst, who prepares a statement (as to its composition, the price of its ingredients, etc.), which is published at the cost of the owner of the supposed remedy in a certain number of the daily and weekly papers.
By far the most dangerous foe we have to fight is apathy -indifference from whatever cause, not from a lack of knowledge, but from carelessness, from absorption in other pursuits, from a contempt bred of self-satisfaction. Fully 25 per cent. of the deaths in the community are due to this accursed apathy, fostering a human inefficiency, and going far to counterbalance the extraordinary achievements of the past century. Why should we take pride in the wonderful railway system with which enterprise and energy have traversed the land, when the supreme law, the public health, is neglected? What comfort in the thought of a people enjoying great material prosperity when we know that the 'primary elements of life (on which even the old Romans were our masters) are denied to them? What consolation does the 'little red school-house' afford when we know that a Lethean apathy allows toll to be taken of every class, from the little tots to the youths and maidens? Western civilization has been born of knowledge, of know-ledge won by hard, honest sweat of body and brain, but in many of the most important relations of life we have failed to make that knowledge effective. And, strange irony of life, the lesson of human efficiency is being taught us by one of the little nations of the earth, which has so far bettered our instruction that we must again turn eastward for wisdom. Perhaps in a few years our civilization may be put on trial, and it will not be without benefit if it arouses the individual from apathy and makes him conscious of the great truth that only by earnest individual human effort can knowledge be made effective, and if it arouses communities from an apathy which permits mediaeval conditions to prevail without a protest.
Against our third great foe—vice in all its forms—we have to wage an incessant warfare, which is not less vigorous because of the quiet, silent kind. Better than any one else the physician can say the word in season to the immoral, to the intemperate, to the uncharitable in word and deed. Personal impurity is the evil against which we can do most good, particularly to the young, by showing the possibility of the pure life and the dangers of immorality. Had I time, and were this the proper occasion, I would like to rouse the profession to a sense of its responsibility toward the social evil—the black plague which devastates the land. I can but call your attention to an important society, of which Dr. Prince Morrow, of New York, is the organizer, which has for one of its objects the education of the public on this important question. I would urge you to join in a crusade quite as important as that in which we are engaged against tuberculosis.
Unity promotes concord—community of interests, the same aims, the same objects give, if anything can, a feeling of comradeship, and the active co-operation of many men, while it favours friction, lessens the chances of misunderstanding and ill will. One of the most gratifying features of our professional life is the good feeling which prevails between the various sections of the country. I do not see how it could be otherwise. One has only to visit different parts and mingle with the men to appreciate that every-where good work is being done, everywhere an earnest desire to elevate the standard of education, and everywhere the same self-sacrificing devotion on the part of the general practitioner. Men will tell you that commercialism is rife, that the charlatan and the humbug were never so much in evidence, and that in our ethical standards there has been a steady declension. These are the Elijahs who are always ready to pour out their complaints, mourning that they are not better than their fathers. Few men have had more favourable opportunities than I have had to gauge the actual conditions in professional private life, in the schools, and in the medical societies, and as I have seen them in the past twenty years I am filled with thankfulness for the present and with hope for the future. The little rift within the lute is the absence in many places of that cordial professional harmony which should exist among us. In the larger cities professional jealousies are dying out. Read Charles Caldwell's Autobiography if you wish for spicy details of the quarrels of the doctors in this country during the first half of the last century. I am sorry to say the professors have often been the worst offenders, and the rivalry between medical schools has not always been friendly and courteous. That it still prevails to some extent must be acknowledged, but it is dying out, though not so rapidly as we could wish. It makes a very bad impression on the public, and is often a serious stumbling-block in the way of progress. Only the other day I had a letter from an intelligent and appreciative layman who is interested in a large hospital scheme about which I had been consulted. I quote this sentence from it in sorrow, and I do so because it is written by a strong personal friend of the profession, a man who has had long and varied experience with us: "I may say to you that one of the distressing bewilderments of the layman who only desires the working out of a broad plan is the extraordinary bitterness of professional jealousy between not only schoolmen and non-schoolmen, but between schoolmen themselves, and the reflections which are cast on one another as belonging to that clique, which makes it exceedingly difficult for the layman to understand what way there is out of these squabbles."
The national and special societies, and particularly the American Medical Association, have brought men together and have taught them to know each other and to appreciate the good points which at home may have been overlooked. As Dr. Brush said yesterday in his address, it is in the smaller towns and country districts that the conditions are most favourable for mutual misunderstandings. Only those of us who have been brought up in such surroundings can appreciate how hard it is for physicians to keep on good terms with each other. The practice of medicine calls equally for the exercise of the heart and the head; and when a man has done his best, to have his motives misunderstood and his conduct of a case harshly criticized not only by the family, but by a colleague who has been called in, small wonder, when the opportunity arises, if the old Adam prevails and he pays in kind. So far as my observation goes there are three chief causes for the quarrels of doctors. The first is lack of proper friendly intercourse, by which alone we can know each other. It is the duty of the older man to look on the younger one who settles near him not as a rival, but as a son. He will do to you just what you did to the old practitioner, when, as a young man, you started-get a good many of your cases; but if you have the sense to realize that this is inevitable, unavoidable, and the way of the world, and if you have the sense to talk over, in a friendly way, the first delicate situation that arises, the difficulties will disappear and recurrences may be made impossible. The young men should be tender with the sensibilities of their seniors, deferring to their judgment and taking counsel with them. If young graduates could be taken more frequently as assistants or partners, the work of the profession would be much lightened, and it would promote amity and good fellowship. A man of whom you may have heard as the incarnation of unprofessional conduct, and who has been held up as an example of all that is pernicious, may be, in reality, a very good fellow, the victim of petty jealousies, the mark of the arrows of a rival faction; and you may, on acquaintance, find that he loves his wife and is devoted to his children, and that there are people who respect and esteem him. After all, the attitude of mind is the all-important factor in the promotion of concord. When a man is praised, or when a young man has done a good bit of work in your special branch, be thankful—it is for the common good. Envy, that pain of the soul, as Plato calls, it, should never for a moment afflict a man of generous instincts who has a sane outlook in life. The men of rival schools should deliberately cultivate the acquaintance of each other and encourage their students and the junior teachers to fraternize. If you hear that a young fellow just starting has made mistakes or is a little "off colour," go out of your way to say a good word to him, or for him. It is the only cure; any other treatment only aggravates the malady..
The second great cause is one over which we have direct control. The most widespread, the most pernicious of all vices, equal in its disastrous effects to impurity, much more disastrous often than intemperance, because destructive of all mental and moral nobility as are the others of bodily health, is uncharitableness—the most prevalent of modern sins, peculiarly apt to beset all of us, and the chief enemy to concord in our ranks. Oftentimes it is a thoughtless evil, a sort of tic or trick, an" unconscious habit of mind and tongue which gradually takes possession of us. No sooner is a man's name mentioned than something slighting is said of him, or a story is repeated which is to his disadvantage, or the involuntary plight of a brother is ridiculed, or even his character is traduced. In chronic and malign offenders literally "with every word a reputation dies." The work of a school is disparaged, or the character of the work in a laboratory is belittled; or it may be only the faint praise that damns, not the generous meed from a full and thankful heart. We have lost our fine sense of the tragic element in this vice, and of its debasing influence on the character. It is interesting that Christ and the Apostles lashed it more unsparingly than any other. Who is there among us who does not require every day to lay to heart that counsel of perfection: "Judge not according to the appearance, but judge righteous judgment?'' One of the apostles of our profession, Sir Thomas Browne, has a great thought on the question:
While thou so hotly disclaimest the devil, be not guilty of diabolism. Fall not into one name with that unclean spirit, nor act his nature whom thou so much abhorrest—that is, to accuse, calumniate backbite, whisper, detract, or sinistrously interpret others. Degenerous depravities, and narrow-minded vices! not only below St. Maul's noble Christian, but Aristotle's true gentleman. Trust not with some that the Epistle of St. James is apocryphal, and so read with less fear that stabbing truth, that in company with this vice thy religion is in vain. Moses broke the tables without breaking the law; but where charity is broke the law itself is shattered, which cannot be whole without love, which is the fulfilling of it. Look humbly upon thy virtues; and though thou art rich in some, yet think thyself poor and naked without that crowning grace, which thinketh no evil, which envieth not, which beareth, hopeth, believeth, endureth all things. With these sure graces, while busy tongues are crying out for a drop of cold water, mutes may be in happiness, and sing the Trisagion in heaven.
And the third cause is the wagging tongue of others who are too often ready to tell tales and make trouble between physicians. There is only one safe rule—never listen to a patient who begins with a story about the carelessness and inefficiency of Dr. Blank. Shut him or her up with a snap, knowing full well that the same tale may be told of you a few months later. Fully half of the quarrels of physicians are fomented by the tittle-tattle of patients, and the only safeguard is not to listen. Sometimes it is impossible to check the flow of imprecation and slander; and then apply the other rule—perfectly safe, and one which may be commended as a good practice—never believe what a patient tells you to the detriment of a brother physician, even though you may think it to be true.
To part from the profession of this country and from this old Faculty, which I have learned to love so dearly, is a great wrench, one which I would feel more deeply were it not for the nearness of England, and for the confidence I feel that I am but going to work in another part of the same vineyard, and were it not for the hope that I shall continue to take interest in your affairs and in the welfare of the medical school to which I owe so much. It may be that in the hurry and bustle of a busy life I have given offence to some—who can avoid it? Unwittingly I may have shot an arrow o'er the house and hurt a brother—if so, I am sorry, and I ask his pardon. So far as I can read my heart I leave you in charity with all. I have striven with none, not, as Walter Savage Landor says, because none was worth the strife, but because I have had a deep conviction of the hatefulness of strife, of its uselessness, of its disastrous effects, and a still deeper conviction of the blessings that come with unity, peace, and concord. And I would give to each of you, my brothers—you who hear me now, and to you who may elsewhere read my words—to you who do our greatest work labouring incessantly for small rewards in towns and country places—to you the more favoured ones who have special fields of work—to you teachers and professors and scientific workers—to one and all, through the length and breadth of the land—I give a single word as my parting commandment:
"It is not hidden from thee, neither is it far off. It is not in heaven, that thou shouldest say, 'Who shall go up for us to heaven, and bring it unto us, that we may hear it, and do it? Neither is it beyond the sea, that thou shouldest say, 'Who shall go over the sea for us, and bring it unto us, that we may hear it, and do it?' But the word is very nigh unto thee, in thy mouth and in thy heart, that thou mayest do it "-CHARITY.