Modern medicine, its need and its tendency · 2017. 1. 12. · Modern Medicine—its Need anditsTendency. THE ANNUAL DISCOURSE BEFORE THE MASSACHUSETTS MEDICAL SOCIETY, MAY 25, 1870

Modern Medicine—its Need and its Tendency.

T II E

ANNUAL DISCOURSE

BEFORE Tilf?

MASSACHUSETTS MEDICAL SOCIETY,

MAY 23, 1870.

BY

WILLIAM W. WELLINGTON, M.D.

BOSTON:DAVID CLAPP & SON 334 WASHINGTON STREET.

1870.

Modern Medicine—its Need and its Tendency.

THE

ANNUAL DISCOURSEBEFORE THE

MASSACHUSETTS MEDICAL SOCIETY,

MAY 25, 1870.

BY

WILLIAM W. WELLINGTON, M.D.

“Every thoughtful physician must feel the present to be a time of transition, and so to acertain extent of hesitation and pause, before large impending changes in our systems oftherapeutics.”—.Vnstib.

BOSfON:DAVID CLAPP & SON 334 WASHINGTON STREET.

1870

At an Adjourned Meeting of the Mass. Med. Society, held Oct. 3, 1850, ft wasResolved, “ That the Massachusetts Medical Society hereby declares that it does

not consider itself as having endorsed or censured the opinions in former publishedAnnual Discourses, nor will it hold itself responsible for any opinions or sentimentsadvanced in any future similardiscourses.”

Resolved, “ That the Committee on Publication be directed to print a statement tothateffect at the commencement of each Annual Discourse which may hereafter bepublished.”

DISCOURSE.

Mr. President and Fellowsof the Massachusetts Medical Society :—

The spirit of inquiry, which is a marked charac-teristic of the present century, is pervading everybranch of human knowledge; No creed, opinion,or formula of belief, however sacred and time-honor-ed, escapes its questionings. It interrogates exist-ing dogmas, theories, and institutions, and boldlydemands their credentials. It lets in the light ofday upon shams, sophistries and baseless speculations,and exposes their hollowness or absurdity. At timesit is irreverent. Unawed by eminent gravity or pre-tentious respectability, it rudely penetrates the sol-emn mystery which enshrouds venerable idols, andwithout ceremony unmasks or dethrones them.Modern investigators have no undue respect for thetraditions of the past. They have ceased to regard

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potent, grave and reverend seniors as of necessity“ very noble and approved good masters.” In placeof reverence and veneration, they have substitutedobservation and analysis. So little are they affectedby what once profoundly impressed the minds ofmen, that a French savant has expressed his convic-tion, that even the Roman Senate, that most augustof human assemblies, would not have unnerved him.

The results of this spirit of the times, which someregard as beneficent, others as pernicious, may beseen in all directions. Theology has received roughusage. Its salient points have been sharply attacked,its prominent doctrines have been boldly assailed bylogic, sarcasm and ridicule. So earnestly and suc-cessfully has the warfare been waged, that manyexcellent but timid persons have feared that thefoundations of religion itself were becoming under-mined. In politics, the last decade in this countryseems like a century. The abolition of slavery, andits fitting supplement, the adoption of the fifteenthamendment to the Constitution, are events whichprove that the world moves, and that humanityadvances.*

The rights of man having been assured, the rightsof woman are engaging public atttention; andquestions concerning the sphere of woman, female

* It is with grief and humiliation, as members of a liberal profession, that wefind the American Medical Association, assembled at the National Capital, inthis year of our Lord 1870, interposing a puny effort to arrest the progress ofevents, and to set back the clock of time. Such a procedure calls forcibly tomind the memorable contest, so graphically depicted by Sidney Smith, betweenMrs. Partington and the Atlantic Ocean.

ITS NEED AND ITS TENDENCY.

suffrage, and the true relation of the sexes, are nowin the full tide of successful discussion. In Biology,Darwin’s theory of the origin of species by naturalselection has survived the stage of ridicule, and seemsto be gaining ground. In Physics, the old doctrineof the materiality of light, heat and electricity haspassed away, and the great law of the conservationof force and the correlation of forces, one of themost grand and far-reaching generalizations everachieved by science, appears to be established. InHistory, the work of demolition has been bravelygoing on. The “ noble Brutus ” has lost much ofhis nobility, and has become quite an ordinary con-spirator ; the early history of Borne, so long believedwithout question, has been proved to be fabulous ;Xanthippe has ceased to be the typical scold, andturns out to be simply an average wife ; even JudasIscariot has found apologists; the story of WilliamTell is, in great part, a myth ; and the pleasant littleromance of Pocahontas and Capt. John Smith hasvanished into thin air.

This radical tendency of the times, this dispositionto look into things instead of looking at them, must,of course, affect the science of Medicine. In fact, ofall sciences in the world, Medicine is perhaps the mostopen to attack. So much of it is uncertain and con-jectural, that it offers a fair field in which men mayexercise both their wit and their reason. It is pro-bably, at the present day, passing through an ordealmore severe and searching than it has ever beforeexperienced. The present period in its history, as

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Dr. Aitken has truly said, “ is one of probation aswell as of progress.” While, on the one hand, it isenriched, as at no former time, by the contributionsof scientific inquiry and observation, on the other,its theory and practice are subjected to a remorselesscriticism, which must needs expose their deficiencies,and reveal their short-comings. Especially the actionof drugs, and their influence on disease, are under-going a scrutiny, which must eventuate in essentialmodifications of existing modes of treatment.

It must be confessed that the manner in which themedical profession is regarded by the community atlarge is not such as in all respects to gratify our self-love, or to flatter our vanity. Physicians have fromtime immemorial been satirized and ridiculed. Poets,dramatists and novelists have considered them fairsubjects for wit and sarcasm. If a physician be in-troduced into a play or a novel, he is commonlyrepresented as a clown or a simpleton. Mr. Addisonin the Spectator had the heart to write thus :—“ Ifwe look into the profession of Physic, wr e shall finda most formidable body of men. The sight of themis enough to make a man serious, for we may lay itdown as a maxim that when a nation abounds inphysicians it grows thin of people. This body ofmen in our country may be described like the Britisharmy in Csesar’s time. Some of them slay in chariots,and some on foot. If the infantry do less executionthan the charioteers, it is because they cannot be car-ried so soon into all quarters of the town, and des-patch so much business in so short a time."


Coleridge represents the devil as starting forthone morning from his brimstone bed “ to visit hissnug little farm the earth.” In the course of histravels, sings the poet,

‘ * He saw an apothecary on a white horseRide by on his vocations :

And the devil thought of his old friendDeath, in the Revelations.”

The New-York Nation, a competent critic of coursein such a matter, announces that medical “ thera-peutic literature resembles nothing so much as afarmer’s almanac or a cook-book.”

The eminent historian, the late Mr. William H.Prescott, in a letter, thought by his biographer tobe worth publishing, thus expresses his sentimentstowards the profession :—“ I am delighted that youare turning a cold shoulder to iEsculapius, Galen,and tutti quanti. I detest the whole brotherhood.I have always observed that the longer a man remainsin their hands, and the more of their cursed stuff hetakes, the worse plight he is in. They are the billsI most grudge paying, except the bill of mortality,which is very often indeed sent in at the same time.”*

* It is stated by one who knew him well and was occasionally consulted byhim, that this letter was the morbid offspring of some dyspeptic moment andgrossly misrepresents Mr. Prescott’s real feeling. No one more anxiously con-sulted or more implicitly relied on his medical adviser, and no one more thanhe wouldhave regretted to have a passing jest recorded as a deliberate opinion.

In the hour of peril, among the earliest to seek medical aid are those who,when at case, were foremost in deriding it. As Byron says-—•

“physicians mend or end us,Secundum artem; but although we sneer

In health—when ill we call them to attend ns-,Without the least propensity to jeer.”

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In popular estimation, all who pretend to practisemedicine, the regular, irregular, and defective, aregrouped indiscriminately, and the motley crowd isregarded as composed of rival sects or parties, eachcontending for the mastery, and each entitled to ahearing. Much to our astonishment, and slightly toour annoyance, we find ourselves christened Allo-pathists, a name which we repudiate; and we areexpected to enter the lists upon equal terms with amushroom sect, which was born yesterday, and willdie to-morrow, and to defend our claims to publicrecognition and regard. Believing, as we do, thatwe are the lineal descendants of the men who firstraised medicine to the rank of a science, and that werightfully belong to the noble company, who, in suc-ceeding times, by their genius and labors have con-ferred on it whatever of worth and dignity it pos-sesses, it is not surprising that wT e are sometimesdisturbed at finding ourselves placed in the samecategory with sectarians and quacks, and that we areoccasionally inclined to indulge in complaints againstthe injustice and stupidity of mankind.

It is well, however, in matters of this kind, to begoverned by reason and not by feeling. It should beremembered that although the community, at times,seems disposed to undervalue our services, the medi-cal profession proper has ever held, and still holds, ahigh place in the public regard, and that, in the longrun, it is recognized as the true exponent of existingmedical science. If we are ridiculed and satirized,we but share the fate of many a good man and goodcause. If poets, essayists and occasionally historians


give utterance to sharp sayings, is it not thus writtenin the Book of Books 1 —

“ Honor a physician with the honor clue unto himfor the uses which ye may have of him : for the Lordhath created him. The skill of the physician shalllift up his head : and in the sight of great men heshall be in admiration. Then give place to the phy-sician : let him not go from thee, for thou hast needof him. There is a time, when in his hands there isgood success.”

But if, after a careful review of the facts in thecase, the conclusion is forced upon us, that there isin the public mind a lurking doubt as to the efficacyof medical art, will it not be wr ell to inquire whetherafter all there may not be some ground for such adoubt, and a real cause for the seeming want of con-fidence in our professional skill.

With regard to the progress that has been madein many of the branches of our profession in pasttimes, and especially during the last half century, itmay safely be said, that as much has been accom-plished as could reasonably be expected, when wetake into account the difficulties which necessarilyattend medical investigations. Anatomy seems tohave nearly reached its culminating point. So care-fully has every region of the human body been ex-amined, and so minutely and accurately has its com-plicated structure been described, that much fartherprogress in this department, without the aid of themicroscope, is hardly to be expected. As a proof,however, that the whole field of Anatomy has notyet been gleaned, may be cited the recent discovery,

MODERN MEDICINE I

by Prof. Henry J. Bigelow, of the Y ligament, socalled, and its relations to dislocations at the hip-joint. We call this a discovery in Anatomy, as wellas an important contribution to Surgery ; for althougha partial description of this ligament has been here-tofore given in anatomical works, yet never beforehad its peculiar conformation and special uses beencomprehended and appreciated. Chemistry has be-come a new science. A treatise on tbis branch,published fifty years ago, is chiefly valuable as acuriosity, or as a relic of the past. Physiology is ina transition state ; but recent investigators, by theboldness and zeal with which they are carrying ontheir work, and the brilliant results which havealready crowned their labors, have indicated whatmay be expected in the future. Auscultation hasthrown a flood of light upon the diagnosis of tho-racic diseases, and so clear and important are itsrevelations, that we sometimes wonder how the worlddid without it so long. Surgery having enlisted inits service the anaesthetic power of sulphuric ether,is achieving new triumphs and gaining new laurels.Pathology aided by the microscope, and investigatedby Virchow, Eokitansky, Paget, Jackson, and a hostof others, has vindicated for itself a high position.In spite of the doubts of the sceptic, and the sneersof the scoffer, and notwithstanding its acknowledgeddeficiencies in certain directions,Medicine, as a whole,occupies a high rank among the sciences, and can layclaim to an honorable parentage and history. Letany one attempt a thorough acquaintance with eitherof the departments which have been named, and he


will find work enough to occupy his leisure hoursfor an ordinary life-time. Dr, James Jackson haspithily remarked, “ Imperfect as the healing art is,be assured of this, no one man knows all that isknown respecting it.”

But while Medicine, as a whole, can be shown tohave kept pace with other branches of human in-quiry, Therapeutics, obviously, have not kept pacewith other departments of Medicine. The treatmentof diseases, that part of it, especially, which relatesto the administration of drugs, is not in a satisfactorycondition, and is not creditable to the medical scienceof the nineteenth century.

There is a well-marked and clearly defined linebetween Medicine and Surgery. The specialties, socalled, belong, for the most part, to the latter, ratherthan to the former. The present discussion relateschiefly to Medicine proper.

Physicians cannot justly be charged with havingneglected to use medicines in sufficient quantity, orin a sufficient variety. The seventeen hundred close-ly printed pages of the United States Dispensatory,and the concurrent testimony of mankind, will tri-umphantly acquit them of any such charge. Theblame, if blame there be, lies in a different direction,and results from the apparent fact, that the customis too prevalent among them of administering, aftera prescribed routine, drugs of everykind, singly andin combination—without sufficient evidence, that, inso doing, they are benefiting their patients, but withfull Evidence that they are inflicting upon them muchpresent suffering. Medicines are not negative sub-

MODERN MEDICINE .'

stances : if they do no good, they usually do harm ;they should not be given, unless clearly indicated,and should not be persevered in unless they are insome degree fulfilling the purpose for which they areprescribed. It is to be feared that this rule is notalways borne in mind ; that medicines are often givenat hap-hazard, when it would be better to withholdthem ; that cures are sometimes ascribed to them, inproducing which they have little or no agency; thatnot infrequently they interfere with, or interrupt,the “ succession of processes ” whose natural ten-dency may be to a recovery; that, in fine, they, areoften used in an unscientific manner, without reasonor against reason, in conformity with the whim orchance-thought of him who dispenses them.

The present confused and unsatisfactory state ofthe science of Therapeutics must be ascribed in part,at least, to the loose, careless and thoughtless man-ner of administering drugs, which has prevailedlargely in times past, and which is not obsolete evennow. While appreciating the difficulties which liein the wT ay of estimating the exact effect of medicinesupon disease, the conviction has forced itself uponmany minds, not only that these difficulties havenever been fairly met, but that the importance ofmeeting and overcoming them has not been fullyrealized, and that, in consequence, the sick man hassuffered. Be this as it may, the treatment of diseaseis the weak spot in our profession, against which thearrows of the adversary are aimed with most effect.Justly or unjustly, there is an impression abroad,that medical treatment is not always of the greatest


value ; and the fact that a large proportion of sickpeople do recover under any treatment, and underno treatment, leads many persons to undervalue theresources of medical art, as well as the skill of themedical man.

Is it an exaggeration to say that the want of clearand exact knowledge, which exists, even in our day,as to the effects of medicinal agents in the treat-ment of disease, is a great evil, which calls loudly forreform \ Examine some of the works of establishedreputation, on the theory and practice of medicine.Take, for instance, Copland’s Medical Dictionary,printed by this Society for the instruction and edifi-cation of its members, during the quarter of a centurycommencing in 1834 and ending in 1859. The de-scription, causes and pathological anatomy of thevarious diseases are generally well given : but whata medley are the rules for treatment! Would astudent in medicine, or a'young physician, fresh fromthe study of this encyclopedic work, when called tohis first case, after making out his diagnosis, haveany definite idea as to what ought to be done \Would not emetics, cathartics, diaphoretics andmercurials rise like spectral illusions, and dance be-fore his bewildered eyes in fearful disorder 1 Andshould an older and more experienced practitionerhave occasion to consult this venerable compendiumfor light and guidance, might not the informationhe would gain in regard to treatment be condensedinto this general formula: Attack vigorously everydisease you may encounter, with every remedy atyour command ?

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The amount and kind of medication to which theauthor of a popular, and in many respects a valua-ble, treatise on the Diseases of Children (Dr. Condie)would subject the rising generation, are appalling.We often read of the dangers which encompass thepath of inexperienced and unsuspecting youth : thesedangers are in truth real and imminent. Take, asan illustration, Hooping Cough. In this disease,which all children are expected fo have, twenty ormore active medicines are recommended, to say noth-ing of such gentle auxiliaries as venesection, blisters,tartar emetic ointment, and frictions with turpen-tine. In contrast with these fearful prescriptions,stand the teachings of Dr. Jacob Bigelow, certainlyone of our wisest and most experienced physicians,originally uttered thirty-five years ago, and repeatedtwenty years after. They read thus : —“ Under thesimple self-limited diseases wr e may class hoopingcough. This disease has its* regular increase, heightand decline, occupying ordinarily from one to sixmonths, but, in some mild cases, only two or threeweeks. During this period, medical treatment, forthe most part, is of no avail. Narcotic appliancesmay diminish the paroxysm, but without abridgingthe disease.” Niemeyer, like Dr. Bigelow, is verychary in the use of drugs in this disease, advisingsimply soda-water and narcotics, with an occasionalemetic in extraordinary cases. He has faith in theefficacy of a “ slight but' continued perspiration ” inthe early stages; but the most remarkable featurein his treatment is the recommendation that * thechild should be directed to cease from coughing as


soon as possible, and that this harsh demand shouldbe enforced “ with wholesome sternness and severi-ty.” He quotes with apparent approval the opinionexpressed “ by the wife of a Prussian general, amost determined woman, but an equally tendermother, that hooping cough was only curable by therod ! ” These views of eminent men, in relation tothe management of a very common disease, are cer-tainly unlike, and it is important to know which planof treatment, if either, is correct.

Acute Rheumatism is usually supposed to requireprompt and active treatment. Venesection, mercu-rials, colchicum, lemon juice, alkalies of all kindsand in large doses; all these, with divers other re-medies, have from time to time been recommended,and have been supposed by their respective advocatesto have great influence in jugulating the disease.But, one by one, they have fallen into disuse, whilerheumatism goes on tormenting its victims, as in thedays of old. Latterly, some bold men have venturedto treat rheumatism without drugs. In a report ofcases thus treated in the London hospitals by L)rs.Gull and Sutton, the authors, after giving the detailsand statistics, sum up thus : —“ Our cases appear toteach that the rheumatic process runs its courseunder the expectant treatment, as favorably as underthe treatment by ylrugs.”*

In the Dublin Quarterly, Dr. Beatty and Dr. Stokespublish their experience. Dr. Beatty was afflictedin his own person. He had the care and attendance

* A similar result had been obtained previously in this country.—See Commit-nications Mass. Med Soc., Vol. x., No, v., p, 387. 186.5.

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of the most eminent physicians in Dublin. A varietyof treatment was of course pursued. “ But,” saysDr. Beatty, “ sad experience compels me to say thatin no instance did medicine appear to have any effectin controlling or shortening the disease.” Dr. Stokesdisbelieves in any of the proposed specific treatments,and says, “ the disease, like continued fever, will runits course.”

Is it not time, we ask in all earnestness, that someorder should be brought out of this confusionI I sit not time that the question were settled, whetherdrugs are really of use in controlling rheumatism ?When acids and alkalies are both urged as specificsin the same disease, may it not be a fair inferencethat neither is of much account ?

In regard to Syphilis, and its treatment by mercury,the views of eminent syphilographers may perhapsbe condensed into the following statements :—

1. Mercury is not a specific in syphilis, but it is thebest remedy we possess; it relieves the symptoms:but the disease remains, and the symptoms may re-turn.

2. Mercury is a specific in syphilis, and will cureit by removing its cause, i. e. the virus. Every effortshould be made to produce actual cure by prolongedmercurial treatment.

3. Mercury is not a specific, and ought not to beused at all, in syphilis. A tonic treatment is theonly proper one, and the apparent cures from mer-cury are due to its having been used in connectionwith tonics.

It may be added, that while the weight of testi-

ITS NEED AND ITS TENDENCY. 19

mony is in favor of the use of mercury in some form,its advocates are not agreed as to the proper time ordose of the remedy, nor the special way in which itshould be given.

Dr. Anstie, in a recent number of the Practitioner,sums up the latest results of treatment in cholera,thus :—“ The hygiene of the future may exterminatecholera in its Indian birth-place. But for actualcholera patients, as long as such are found, we can-not yet pride ourselves on being able to do verymuch.”

These illustrations might be multiplied, but this isnot necessary. The purpose in introducing them issimply to indicate the direction in which specialeffort is required.

The great need in Medicine, at the present time,is clinical study. Whatever else be done, or be leftundone, the treatment of disease should be thorough-ly investigated, and the effects of drugs and medi-cinal applications in modifying or relieving it shouldbe carefully tested.

Clinical study of course includes diagnosis as wellas treatment. Correct diagnosis is the only sure basisfor correct treatment. Our first duty is to find outwhat ails our patient, and then to cure or relieve himif we can. We can hardly overrate the importanceof diagnosis. The difference is great between lum-bar abscess and chronic rheumatism ; yet one hasbeen mistaken for the other. There may be pointsof resemblance between hysteria and organic diseaseof the brain ; but it will not redound to the credit of

,a physician to confound the two. Possibly, some

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remedies, which have had their day and are now for-gotten, originated with persons who mistook the dis-order, which they supposed they had cured. To cor-rectly diagnosticate disease will tax the best powersof the ablest physician. In doing this, he must de-rive aid from all departments of medicine. Thesenses must be educated to the highest degree ofperfection. The microscope, the laryngoscope, theophthalmoscope, and all other instrumental aids toobservation, must be called into requisition. Anato-my, physiology, chemistry and pathology must eachcontribute its share ; and happy is the man, who,with all the aid which science can furnish, is success-ful in becoming an expert in diagnosis.

But diagnosis, important though it be, is but apreliminary to “ the final and supreme stage of medi-cal study,” therapeutics. Our profession must vindi-cate its right to be, by proving its power to cure,relieve or prevent disease. This supposed powerconstitutes the hold which the physician has uponthe community, and imposes upon him the duty toqualify himself for the special work, which he is ex-pected, and which he professes to be able, to perform.He must learn his powers and his limitations; whathe can do and what he cannot do ; what diseases re-quire medication, and what will do better without it.Skill in treatment should keep pace with skill indiagnosis.

Clinical research, then, particularly in relation tothe effect of medication upon disease, is the chiefneed, and should be the special work of modernmedicine. The efficacy of supposed remedies can only


he tested hy well-conducted investigations at the bed-side. Reasoning a priori may suggest modes oftreatment; but these are not trustworthy, until theyhave been subjected to trial by persons competentto analyze symptoms, and to appreciate results.

The fact is not fully realized, that clinical medicineis a distinct department of medical science, and notincluded in other departments ; that it has its ownspecial work, and its own way of doing this work.A man may be an eminent anatomist, or physiologist,or pathologist, or chemist, or pharmacist, and yet notbe a practical physician. Dr. Gull well says, “ Itwould not be too much to assert that were it possi-ble to conjoin in one human intelligence all that isnow known of other sciences, such knowledge wouldbe compatible with entire ignorance of clinicalmedicine.” A medical school, without ample meansfor clinical instruction, is an absurdity.

Nelaton, not long ago, astonished the medicalworld by denouncing the microscope in surgicalstudy, and eulogizing “ la clinique.” The unquali-fied declaration of the learned French surgeon, in con-nection with the uncanonical way in which it wasuttered, has been severely criticized; and with jus-tice, if it is to be understood literally. But no onecan suppose that Nelaton would seriously condemnthe microscope, or its revelations. His meaningevidently is, that the microscope should not usurpthe place of clinical study, but that a proper equili-brium should be maintained in the various depart-ments of medical science.

The difficulties which attend the study of the

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treatment of disease are obvious. 1. The subjectof our investigations is a living human being, placinghimself under medical care to receive aid from theexperience and acquisitions of the past, and not to beexperimented on for the benefit of science or of pos-terity. 2. The doubt is ever present, whether im-provement or recovery in any given case is in conse-quence of treatment, or in spite of it, or wholly un-connected with it. 3. Observations must be care-fully made by competent persons, else they are oflittle value ; and it is not every medical man, whosemental habits and previous training have qualifiedhim for such work. False facts abound, and theyfurnish poor material from which to draw generalconclusions. 4. Hasty generalizations, even if found-ed upon trustworthy observations, are worthless,and have been the bane of medicine at all times.They have an air of truth about them which rendersthem all the more dangerous. They are the offspringof untrained and illogical minds, and cannot stand thetest of time and experience.

In view of such difficulties, and the list is not ex-hausted, the path to success in the scientific treat-ment of disease seems so beset with obstacles as todisincline us from any harsh criticisms of the past,and to moderate our anticipations of the future.

Let us in this matter do full justice to our prede-cessors. In all ages of our profession, the study oftherapeutics has engaged the attention of wise andsagacious men. Any disparaging allusions to thesemen would be, to say the least, in very bad taste.If the results of their labors are not all that might

ITS NEED 1ND ITS TENDENCY.

be desired, or might have been expected, still theydemand recognition, and should not be undervalued.Were all the knowledge we now possess in regardto the nature and uses of remedial agents obliterated,mankind would suffer a serious, an almost irrepara-ble, loss.

In prosecuting clinical study, we would suggestthat the prime duty is not to search through the veg-etable and mineral kingdoms in quest of new medi-cines. Life is short, and chemical combinations arenumerous. The Dispensatory contains a large num-ber of supposed remedial agents, many of wdiichmight be excluded at once without detriment to anybody. The first work may well be one of elimina-tion ; and it will be the part of wisdom to gain amore thorough knowledge than we now have of theeffects of drugs already in common use, before spend-ing much time in attempts to add to their number.

The method, recently introduced, of ascertainingthe physiological effects of drugs by careful observa-tions in relation to their absorption, their passage

the system, the changes they undergo dur-ing this passage, their modes of elimination and theirtherapeutic uses, promises valuable results. Whenthe same exhaustive investigations have been madein regard to all the articles of the materia medica,that have already been made concerning a few ofthem, therapeutics will assume the form of an exactscience. Such investigations require time; but thetime will be well spent.

Over-medication has been the besetting sin of themedical profession; and while .clinical researches are

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going on to ascertain the influence of drugs, letit ever be borne in mind that nature is a kindmother, and that her healing powers are great;that she may be able to perform greater things thanshe has as yet been supposed capable of doing; thatinterference with her operations is a delicate matter,which should not be rashly undertaken. If it be afact that there are diseases, now supposed to requirevarious and powerful medicines, which will do equallywell with less medicine than is commonly used, orwith none at all, medical science will be as truly ad-vanced by observations and experiments tending toprove this fact, as by those which establish the effi-cacy of a new drug, or the beneficial effects of a newmode of treatment.

It is to be regretted that the pressure upon medi-cal men to polypharmacy is so strong, that he is abrave man who can resist it. Many persons seem tobelieve that for every disease, and for every symptom,there is, either in the earth or on it, a remedy in theform of a drug; and if the patient does not get thisremedy, that the fault lies with the doctor. In fact)(,the only idea some people have of a physician is thathe is a man who gives medicine ; should he make amedical visit and not give medicine, they would thinkhe had mistaken his calling, and would probably seekother advice.

Clinical study would be facilitated were we tho-roughly acquainted with what may be called thephysiology of disease. Much has been accomplishedin this direction during the last twenty-five years,but more remains to be done. How can we decide

25ITS NEED AND ITS TENDENCY.

with confidence upon the result of treatment, if wedo not know the natural course of disease, uninflu-enced by treatment ? And without such knowledgeare we not in constant danger of running counter tocurative processes which nature may have initiated %In surveying the past history of medicine, it is sadto see the fearful ordeal through which the sick manhas been forced to pass, the nauseous doses he hasbeen made to swallow, and the disgusting appliancesto which he has been subjected; and all, too, in thename of so-called science, and in conformity withtheories since exploded. In reviewing the practicesand prescriptions of former days, it is easy to per-ceive that the unfortunate patient, though well caredfor in many respects, had to bear more than the painsand discomforts incident to his disease. Is it notpossible that in succeeding times a similar criticismmay be passed in regard to some of the modes ofpractice of the present day 1

But however important it may be to know thenatural history of disease, this is a kind of know-ledge very difficult to get; it must be had chiefly byaccident or indirection. The results, however, ofthe treatment by mint water, and other placebos,have not been so disastrous, as absolutely to forbidfarther trials in the same direction. Patients treatedhomoeopathically do not always die ; and, once in awhile, some stubborn individual positively refuses tobe doctored secundum artem, and yet strangely re-covers. We have the right to utilize the knowledgethus surreptitiously obtained, and to make such useof it as its character may suggest; and should the

26 MODERN MEDICINE !

result be that certain heroic remedies, once deemedindispensable, are turned adrift, and float off into thesea of oblivion, let us endeavor to survive the shockand to preserve our equanimity.

The modern views in regard to the nature ofdisease must modify modes of treatment. It is noteasy to define the word, disease. No two persons,perhaps, would give precisely the same definition.A collection of such definitions, as given by men ofnote, would constitute a curious page in medicalliterature. But the notion that disease is a distinctentity, to be cast out of the system, as we would ex-tract a bullet from a wound, or expel a tape-wormfrom the intestinal canal, can no longer be maintained.“ Disease,” says Virchow, “ is a vital process ; not anentity, but a process, running through a series ofstates or conditions, one state or condition being re-lated to the others as cause to necessary sequence.”The same eminent authority, in noticing the wonder-ful faculty of accommodation possessed by the body,gives us the means of drawing the boundary linebetween health and disease: “Disease,” says he,“ begins at the moment when the regulatory functionof the body is insufficient to neutralize outward dis-turbances.” Disease, then, being a series of “ per-verted life-processes ” :—not a thing added to theanimal economy to be driven out, nor a thing sub-tracted from it, leaving a void to be filled—theseprocesses being as yet, after all our boasts, but im-perfectly understood :—is to be managed carefully,with all possible knowledge and study, through itsseveral stages. The sick man is to be taken care of


so as best to endure the changes he is undergoing ;and the object in any serious illness being usuallynot so much to drive disease out of the body as tokeep life in it, whatever else be done, or be not done,let his strength be supported by proper nourishment,supplemented, if need be, by tonics and stimulants,so that he may be kept alive till the disease has runits course, and the natural forces have restoredhealthy, in place of diseased processes. Thus much,at least, reason indicates, and experience sanctions.

Simplicity in prescription is obviously essential toan accurate knowledge and correct appreciation ofthe properties and effects of medicines. The policycannot be commended of administering in combina-tion a variety of drugs, with the hope, apparently,that some one of them will hit the enemy, and puthim to rout.* If the result be successful, and thepatient recover, howr can it be known what relievedor cured him ?

Diseases, which can be “ cut short” or “ brokenup ” by medicine, are few in number, and may becounted on the fingers. They are the exceptions tothe rule. Prof. George Johnson, of King’s CollegeHospital, writes thus ; —“ Most of the diseases, thatare curable by any means, are curable by the unaidedpowers of nature ; and the chief art of the physician,as of the surgeon, consists in regulating and directingthose natural forces, which will cure a fever or an

* “ Whenyou know not what to do, he careful lest you do you know notwhat.” This sententious aphorism, attributed to the late President Kirkland,has a practical medical application.

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inflamed lung, as they will heal a wound, or mend abroken bone.” This comprehensive statement maybe regarded as expressing the present state of know-ledge in regard to the treatment of disease. If weaccept its truth, our course will be shaped in accord-ance with its suggestions. With less confidence indrugs than had our predecessors, but with more skillin the use of them; with a better knowledge of thenature and course of disease, and with increasedfacilities for correct diagnosis, we may reasonablyhope that, by well-directed effort and careful study,therapeutics may, in time, occupy with honor theposition which belongs to them, as “ the ultimateend and aim of all medical work, the crowning pointof medical knowledge.”

But whatever be the degree of perfection to whichmedical treatment may attain, its limitations are in-evitable. Despite human efforts, death cometh toall by a divine decree. By a decree nearly as abso-lute disease cometh to all, and will continue to comewhile the earth lasts. The doctrine enunciated inthis place, five years ago, that “ disease is a part ofthe plan of creation,” though at times assailed, hasnever been invalidated, and, better than any otherstatement, comprehends and explains the facts apper-taining to human ailments. The primal causes ofdisease are manifold, hidden, and mysterious. Asthey existed in the beginning, so do they now exist,and probably will continue to exist. They lurk, un-known and undetected, in the food we eat, in thewater we drink, in the air we breathe, in the earthon which we tread, it may be in planetary influences


all about us. The “ dust in the sunbeam,” shownby Prof. Tyndall to consist of organic matter, andexisting in the air of the city, the country, and theisles of the ocean, has been breathed by humanlungs ever since man was created, and will continueto be thus breathed, despite all efforts of science, untilman ceases to live upon the earth. It will be hardlypossible to pass the whole atmosphere over the flameof a spirit lamp, or through a red-hot platinumtube; neither is it probable that all mankind willever use respirators charged with cotton, howeveruseful such contrivances may be under certain cir-cumstances. While impurities of various kindsexist in the air, which we are constantly breathing ;while one of its essential elements, oxygen, seemsto be allotropic, and to be convertible into ozone, andpossibly other gaseous substances ; while these ad-mixtures and changes are universal, and apparentlyinevitable ; while the earth and the waters are full ofmatters possibly detrimental to health, we need notsurely be surprised that diseases come, and we maywell despair of being able to annihilate them. Wecan hardly resist the conclusion that they were in-cluded in the original plan of creation, and are de-signed to fulfil some purpose of the Creator. Theproximate aerial, terrestrial, and aqueous causes ofdisease, we may not be able to demonstrate, but theirexistence can hardly admit of a doubt.

But while primal causes of disease are probablybeyond our reach, secondary causes, many in numberand disastrous in their effects, set into operation byhuman ignorance, carelessness or wickedness, may

30 MODERN MEDICINE

be discovered, and their consequences perhaps beaverted. The prevention of diseases thus originat-ing offers a broad field for scientific research andpromises a rich harvest. The line between primaryand secondary causes, like that between sanity andinsanity, is shadowy and ill-defined ; but it is not, onthat account, the less real. Our expectations evenhere, however, should be reasonable, and modifiedby the teachings of history, the facts of experience,and the imperfections and depravity of mankind. If,by any chance, all present existing cases of syphiliswere cured or annihilated, would not the disease re-appear, and commence anew its ravages ? Undoubt-edly, unless the millennium had begun: and whatwill be the condition of disease, and of doctors, whenthat blissful period arrives, it is not wise to attemptto prognosticate.

Mr. Emerson, from the stand-point of the philo-sopher and scholar, gives another view of the originof disease. “ All men carry seeds of all distempersthrough life latent, and we die without developingthem ; such is the affirmative force of the constitu-tion ; but, if you are enfeebled by any cause, someof these sleeping seeds start and open.”

The purpose of the foregoing remarks has beento show that the great need in medicine at the presenttime is Clinical Research , more particularly in rela-tion to the treatment of disease ; that therapeuticsare behind the other departments of medical science,and deserve increased attention from those who arecompetent to conduct scientific investigations ; andthe suggestion has been ventured, that the results of


such investigations will be to simplify medical treat-ment, to incline physicians to trust more to natureand less to drugs, and to lead them in their remedialmeasures to consult the comfort, and to sustain thestrength of the sick man, rather than to use violentmeasures to oust his disease. Believing in the ex-istence of this need, and in the truth of this sug-gestion, it is gratifying to perceive that the tendencyof medical thought and practice is in the directionthus indicated. The contrast between the treatmentof the sick, as laid down in the medical books of to-day, and as approved by our leading physicians, withthat of half a century ago, is sufficiently marked toattract notice. Active medication is less commonthan formerly ; the rules of procedure are more sim-ple, exact and philosophical; the heavy artillery ofthe Pharmacopoeia is not in such constant action;restorative agents are gaining precedence over thoseof an opposite character. A few illustrations willnot be out of place.

1. Venesection is becoming one of the lost arts.Formerly relied on as an instrument of great good,it is falling into disuse. Once regarded as in manydiseases the only means of saving life, it has now solost its prestige, that many wise physicians seldomor never practise it. Cases were not uncommonthirty or forty years ago, of strong, burly men, goingto their doctor in the opening spring, for the sanitarypurpose of “ losing a little blood ” ! And did notthe doctor accede to their wishes, and deliberatelybleed them, until they sometimes sank fainting to thefloor! Such sights are hardly seen at the present

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day. Cases perhaps exist in which venesection is ofservice, but they are rare.

2. Emetics are useful in evacuating the stomachof substances which do not belong in it, and some-times in mechanically relieving the oppressed lungs.But as a means of breaking up fevers, and of stirringup the system generally, so as, in some unknownmanner, to exert a salubrious influence, they arenearly obsolete. In the Cyclopoedia of PracticalMedicine, a standard work not many years ago, re-peated emetics are recommended as a means of ex-pelling tuberculous matter from the lungs, and thuspreventing its localization in these organs ! No men-tion is made of this remedy in the recent work ofNiemeyer on Practical Medicine.

Tartarized Antimony, not in emetic but in nau-seating doses, was formerly a favorite remedy inPneumonia, and other diseases. It is not muchused now ; and the startling heresy has been broach-ed, that this drug should, in the treatment of the sick,be dispensed with, rather than dispensed.

3. Blistering in acute inflammations, a practiceonce almost universal, is now regarded with suspicion.Vesication is usually a torture to patients; and whenwe add to this, that in the opinion of many intelligentobservers, it does not diminish the duration of acutedisease, that it increases febrile excitement, and thatby developing a fresh inflammation near an inflamedpart, the original trouble is more likely to he aggra-vated than to be lessened, the propriety of continu-ing to employ it in such cases becomes, at least,questionable.


4. What shall be said of Mercury ? In its variedforms, especially in its classic form of Calomel, ithas long ruled right royally. Supposed to possessremarkable powers in controlling fever and inflam-mation ; to act as an efficient alterative in variousmaladies ; to be a specific in iritis and syphilis, andindispensable in the proper treatment of these dis-eases ; to have a marked and beneficial influenceover the secretions generally, and over that of theliver in particular; it was administered largely andunhesitatingly, with full faith in its many and pro-tean virtues, and with undoubting confidence in itsbeneficial action. But the faith of our fathers inthis drug has been rudely shaken in these latter days.Its effects are frequently bad, and sometimes disas-trous ; its benefits are often questionable. Feversand inflammations get well without it. Iritis, as ourassociate Dr. Henry W. Williams has clearly shown,can be cured better without it than with it. Its anti-syphilitic powers have been disputed ; and some ofthe bad results, occurring during the course of syphi-lis, have been ascribed to its use.

The belief, however, that mercury has a specificaction on the liver, has survived until the presenttime, and is very general. Whether there be anexcess or a deficiency in the hepatic secretion, thisdrug in some mysterious way is supposed to have thepower of setting every thing right. But the icono-clasts of the age will not suffer even this cherishedopinion to be held in peace. A committee appointedby the British Medical Association have publishedan elaborate report on the cholagogue action of raer-

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cury. By conclusive experiments they found thatwhether given in large, small, or gradually increaseddoses, mercury did not increase, or influence in anyway, the biliary secretion, until the subjects beganto suffer in health, and then the secretion wasdiminished.

Calomel will retain its place as a valuable.purga-tive, particularly in diseases of children attendedwith vomiting. It is eliminated through mucousmembranes, and may therefore sometimes have abeneficial effect upon them. The weight of evidenceseems to be in favor of mercury, as a remedy in cer-tain forms and stages of syphilis; but it can no longerexercise the despotic sway which it once did; itssceptre has departed, and it must henceforth hold asubordinate position.

It will be remembered that, during the war, acircular was issued by the Surgeon-General, direct-ing that calomel and tartar emetic be struck from thesupply-table of the army. Some of our brethrenwere indignant, regarding this action as an insult tothe medical profession. Perhaps it was; neverthe-less, many persons experienced a sensation of reliefwhen the circular was issued, and felt that it wouldincrease the chances of life to the soldier, and ofdeath to the rebellion.

While certain medicines and modes of procedurehave thus been passing away, others of real and ac-knowledged value have been introduced into medicalpractice. A few may be named.

1. Anesthesia. The first operation at the Massa-chusetts General Hospital on a patient insensible


through the inhalation of sulphuric ether, must befresh in the memory of many who are present. Itmarked an era in the history of our profession, asimportant as that of the discovery of the circulationof the blood, or of vaccination. The man, to whom

twe are mainly indebted for the introduction intomedicine and surgery of sulphuric ether as ananaesthetic, has gone to his rest. No civic honorswere conferred upon him: no appropriation fromthe national treasury cheered his last days. Hisname does not appear on the monument erected inBoston, “ to commemorate the discovery that theinhalation of ether causes insensibility to pain.” Hedid not discover the possibility of producing anaes-thesia ; this was known before his day; but he diddiscover and prove that the production of entire an-aesthesia by sulphuric ether is a practicable and safeprocedure. This fact was not known until he re-vealed it, and without this latter discovery the formerwas practically worthless. Time corrects errors andreverses false judgments ; and posterity will do jus-tice to the memory of the man, by whose boldness,sagacity, and perseverance this priceless boon wasconferred upon the children of men.

The value of ether as an anaesthetic cannot be over-stated : the same cannot be said of chloroform. Thecontinued use of this agent by inhalation can hardlybe justified. It has killed its hundredsj and everymonth is adding to the number of the slain. Thatwise and good men persist in using it in preferenceto ether, the danger from which is almost infinitesi-mal, is to many persons a great mystery.

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It is said that chloroform is more . speedy andpleasant in its action than ether. Undoubtedly ; but“ cito et jucunde ” are not worth much if the“ tuto ” be wanting.

Are we told that chloroform kills comparativelybut a few people 1 But what right has the medicalprofession to kill even “ a few people ” ?

“ Its banner bears tlie single line,‘ Our duty is to save.’ ”

2. Cod Liver Oil is virtually a new remedy,although occasionally used in former times. It hashardly fulfilled the expectations of its early andzealous friends, but there can be no question as to itssuperiority in pulmonary consumption, and in someother diseases, to the drugs which it has super-seded.

3. Bromide of Potassium , like other new reme-dies, is in danger of being overrated : still, it is avaluable medicine. It will sometimes induce sleep,when other hypnotics fail. It stands preeminentamong the drugs supposed to be useful inthe treatmentof epilepsy. If not directly curative in any disease,it holds the system quiet, so that nature’s reparativeprocesses may go on without interference.

This is one of the drugs, the course of whichthrough the system has been clearly ascertained bythe method to which allusion has already been made.“It is absorbed readily by all mucous surfaces, butmost readily by the stomach ; and it is passed bythat organ into the blood in the course of fifteenminutes. It goes into the blood as the bromide of


potassium, and is not changed there. It is eli-minated chiefly by the kidneys, moderately by mucoussurfaces, slightly by the skin. Elimination is com-plete in less than twenty-four hours after the inges-tion of the last dose. While in the system, itdiminishes the reflex sensibility of the cerebro-spinalsystem by a sedation of the circulation of the nervouscentres. This is accomplished through its actionon the vaso-motor system. This action explains itspower of producing sleep.”

4. Chloral is knocking loudly at the door anddemanding admission. It comes highly recommend-ed, but time is required to test its claims before itcan be admitted into full communion.

5. The spray-produci7ig Atomizer, recently intro-duced into practice, is an admirable invention, andfor the purpose of applying medicated solutions tothe mucous membrane of the throat and air-passages,vastly superior to swabs and probangs. In scarletfever, diphtheria, membranous croup, and otherdiseases involving the throat and lungs, this instru-ment, especially that form of it which is operated bysteam, is almost invaluable, and may in a doubtfulcase turn the scale between life and death.

6. Hypodermic Medication is coming iilto generaluse for various purposes. As a means of relievingpain, the effect of the subcutaneous injection ofmorphia is instant, and sometimes almost magical,succeeding when the same substance taken into thestomach fails. This mode of practice has its dan-gers, but, judiciously employed, is legitimate andefficacious.

MODERN MEDICINE I

A comparison of these two lists of remediesshows a change in medical practice during the lastquarter of a century, and indicates clearly enoughits direction.

The tendency of modern practice is also seen inthe increased attention now given to the subject ofdietetics.

One of the most important remedies in sickness isfood. Life cannot continue without it. Propernourishment is as essential in disease as in health.The system must be supported while healthy pro-cesses are supplanting unhealthy ones.

The sick are better fed now than formerly. Here-in treatment has improved. “ A wide field of labor,”says Graily Hewitt, “ presents itself in the regula-tion and adaptation of food, with the object of effect-ing radical and curative changes in the diseased tissuesof the body.” Much has been accomplished of lateyears in this direction; more remains to be done. Ifany physician fear that, by the minimizing of drug-treatment, his occupation will be gone, let him dili-gently contemplate this field of labor ; he will findit broad enough to afford full scope for his bestenergies.

Be it ever remembered, that if an article of foodbe palatable, this fact alone is not sufficient reason forwithholding it from the sick. It sometimes seems as ifthe same system were adopted in the sick-room, as issaid to prevail in certain boarding-houses : “Findout what your boarders do not like, and give, themall they want of it.”


Under the head of food, may be included drink.In olden times, sick people were not allowed todrink cold water when they were thirsty, for fear itwould hurt them. This antediluvian notion is notyet dead. It occasionally crops out, even withinthe profession. It is time that its final obsequieswere solemnized.

As communities have progressed in civilization,there has been a gradual increase in the length ofhuman life. The truth of this statement has’ beenclearly shown in a series of carefully prepared papersby our associate, Ur. Edward Jarvis, in the AtlanticMonthly Magazine. From statistics collected byhim, we learn that the average rate of mortality inEngland and Wales was, in the first forty years ofthe eighteenth century, 340 in 10,000 living: from1821 to 1860, it was 207 in the same population.In Boston, from 1728 to 1752, the deaths were 1 in21.65 of the living; from 1846 to 1865, they wereonly 1 in 42.08 : —about half as numerous as ahundred years before. Dr. George Derby, Secretaryof the Massachusetts State Board of Health, reportsthe average death-rate of Boston from 1850 to 1870to be 1 in 39.29.

From a comparison of ancient and modern longe-vity, it appears, that, in the middle of the nineteenthcentury, the life of all classes in England and theUnited States was fifty per cent, longer than that ofthe best among the Homans at the beginning of thethird century.

Many causes have conspired to produce this

MODERN MEDICINE '.

result: among them may certainly be includedan improved medical treatment of disease. Thatthe progress of medical science has been oneof the factors in lengthening the days of men andwomen upon the earth is rendered probable by hos-pital records. In the Massachusetts General Hospi-tal, the proportion of deaths to admissions, from1860 to 1870, was eight per cent.; for the precedingforty years it was ten and two-tenths per cent. Thepercentage of the number “ discharged well,” on the“ total admitted,” from 1860 to 1870, was 56.6 ; forthe preceding forty years it was 46.5. The statisticsof the New York Hospital in New York City, andof the Pennsylvania Hospital in Philadelphia, are ofa similar character.

The annual report of the State Board of Healthfor 1869 contains a table, giving the mortality fromconsumption in Massachusetts during each of thesixteen years from 1853 to 1868, inclusive. Fromthis table it appears that consumption in this Stateis diminishing in fatality. Comparing the first groupof five years with the last group of five years, theannual gain in each 100,000 of the population isfifty-four lives ; giving, as the actual saving of lifein the last five years, 3,440 persons, or 688 in eachyear; and the improvement seems to be going on.

In the practice of Midwifery, there has been signal improvement during the last two hundred years.It has been shown from the mortality bills of Londonthat for twenty years, ending in 1680, one in everyforty-four delivered, died; while for twenty yearsending in 1820, only one in every hundred and


seven died. So that the number of parturientmothers lost during the last years of the seven-teenth century was about double the number lostduring the first years of the nineteenth century.In St. Bartholomew’s Hospital, London, from Jan. 1,1862, to Dec. 31, 1868, there were 5,734 deliveries,with but 21 deaths, being one death in every 273delivered. It is fair to infer that the medical statis-tics of London, in this matter, will not differ mate-rially from those of other cities and towns in Europeand America.

In view of statistical records, tending to showthe favorable results, in recent times, of medicalcounsel and practice ; in view of the great advancethat has been made during the last half century inmedical science; in view of the fact, that never be-fore has so devoted a band of earnest and competentmen been engaged in investigations appertaining toevery department of medicine, as at the present day,with means and instrumentalities to aid them in theirwork such as their predecessors never dreamed of;in view of a bright future thus dawning on our pro-fession, let us reverently “ thank God and takecourage.”

Mr. President and Gentlemen :Since the last annual meeting twenty-six of our

number have died. I can speak of but a few ofthem from personal acquaintance, and I much regretthat from want of such acquaintance others equallydeserving must remain without special notice. But

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of this we may rest assured,—no worthy physicianever dies without leaving behind him, outside of hisimmediate family circle, many sad hearts, that willlong and tenderly cherish his memory. The rela-tions between the sick and their medical attendantare often of the most interesting and sacred char-acter. The family physician, who is at the sametime the confidential friend, occupies a position alikegratifying and honorable ; and when called from hisearthly work, his loss will be felt and mourned.

In the death of Dr. Solomon D. Townsend, theMassachusetts General Hospital lost its senior sur-geon, and the medical profession of Boston one ofits most valued and honored members.

Dr. Francis C. Ropes, at the time of his deceasethe youngest member of the surgical staff of theBoston City Hospital, was a physician of rare pro-mise, and, at an early age, had gained professionaleminence.

Many of us retain pleasant recollections of Dr. E.D. G. Palmer, of Boston ; a man of quiet and unas-suming manners, highly respected and esteemed byhis brethren and his patients.

Dr. Jeremy Stimson, the excellent and belovedpatriarch of Dedham, “ was an unassuming gentle-man, worthy, and full of good works*

Dr. Ebenezer Stone, of Walpole, “ was a man ofdelicate, refined organization, and of great mentaland moral balance. Interested to the last in hisprofession and in public affairs, he lived a completelife in all its parts.”

Dr. John C. Hayden, of Cambridge, retired from


active practice many years before his death. Ilismanly form and dignified bearing, his kindness ofheart, his ready sympathy and cheering words, werean inspiration and benediction in the sick room.Said a patient of his once, “ I would rather die un-der his care, than get well under the care of any oneelse.” Strong language was this ; but it indicatesthe confidence that was reposed in him by those whoknew him best.

Dr. Anson Hooker, of East Cambridge, died atthe age of three score and ten, after an active andlaborious practice of forty years. Possessing in aneminent degree the respect and esteem of his profes-sional brethren, he was regarded by the communityin which he lived, not only as the good physician,but as the wise counsellor and the kind friend. Atvarious times he was called to fill many importantoffices of trust and responsibility. He lived and diedliterally without an enemy. His reputation was goodin all branches of the profession. In midwifery he■was an expert, and his practice in this departmentwas very large.

The scene at his funeral was impressive. Thechurch, in which the services were held, was crowd-ed, and the countenances of those present indicatedclearly the sadness of their hearts. Places of busi-ness were closed, and the whole population seemedto unite in offering a last tribute of affection to onewhom they so loved and honored. A fitting monu-ment has been erected to his memory by the con-tributions of his townsmen.

The record of the lives of such men should awaken

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within us fresh love and zeal for our profession! In-spired by such examples, let us here and now pledgeourselves anew to labor for its honor and advance-ment.

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Modern medicine, its need and its tendency · 2017. 1. 12. · Modern Medicine—its Need anditsTendency. THE ANNUAL DISCOURSE BEFORE THE MASSACHUSETTS MEDICAL SOCIETY, MAY 25, 1870