Annual Oration 1838
By Ebenezer Alden, M.D.
Mr. President and Gentlemen:
We are assembled in circumstances of peculiar interest. Since the last annual meeting, sixty-five gentlemen have accepted the fellowship of the Society. At no former period have accessions been so numerous; nor has a more commendable zeal among the members ever been manifested to advance the interests of the profession. With two schools of medicine, favorably situated to give instruction to students resident in every part of the Commonwealth;—with a General Hospital and Asylum for the Insane, and a State Lunatic Asylum, models among similar institutions, and each a monument to the enlightened enterprise of the government, and to the philanthropy of their respective founders;—with numerous local establishments, public and private, for the relief of the various forms of disease to which humanity is incident;—with a weekly press devoted to medical intelligence;—above all, with a spirit of wakeful inquiry among the members of the profession, and with such a state of harmony, as excludes the pursuit of selfish, sordid interests; it may safely be affirmed, that the prospects of usefulness to those who practise the healing art, and of the rapid advancement of medicine, as a science, were never so flattering in this Commonwealth, as at the present time.
We have reason for special congratulation, also, that the last obstacle in the way of the honorable admission to our Society of every respectable member of the profession in the community, was happily removed by a vote of the last year, which conferred the same privileges and immunities on graduates of the Berkshire Medical Institution, as had previously been enjoyed by medical graduates of Harvard University and by our own licentiates. This object had been earnestly, but ineffectually, sought from the first establishment of the western school. Although the most implicit confidence was reposed in the fidelity and thorough instruction of the present incumbents of the several professorships, still it was the opinion of the majority of the Society, that in consequence of a material defect in the charter of that Institution, there was no sufficient guaranty, that unworthy applicants would be uniformly excluded from participating in its honors by those who should succeed them. In other countries, not to say in our own, medical degrees have sometimes been conferred on persons possessing very inadequate qualifications for the discharge of the responsible duties of the profession. The Society, therefore, charged as it is by the laws of the Commonwealth, with the duty of prescribing “such a course of medical and surgical instruction, and such qualifications, as they shall judge requisite for candidates for the practice of physic or surgery,” felt it to be an incumbent obligation, to guard the avenues to the profession, and to avoid any course which, however desirable on some accounts, would be liable, if pursued, to be misconstrued into a dangerous precedent, and thus eventually to defeat one of the main purposes of its organization. By an act of the Legislature, passed April 1, 1837, these difficulties were removed by the appointment of an independent Board of Overseers, invested with similar powers and authority in relation to the Berkshire Medical Institution, as belong to the Overseers of Harvard University, with respect to the medical department of that college: and the Society lost no time in responding, in a manner alike honorable to themselves and to the Institution in question. The resolution, unanimously and cordially adopted on that occasion, is adapted to promote and to perpetuate harmony among the members of the profession, scattered, as they are, over a wide extent of territory, and thus greatly to increase the facilities for accelerating the progress of medical science.
The benefits of medical association are not yet fully appreciated by the public, and perhaps not to their full extent, by the members of the profession. It is only when the energies of man are concentrated and united with those of his fellow-man, that he is able to accomplish most in a worthy cause. If the progress of medicine during the last half century has been rapid in this vicinity beyond any former parallel, this result has been produced chiefly by more cordial efforts among its professors to effect it during that period than before; and, if in time to come, medical science is to advance in correspondence with other departments of literature,—union, a free interchange of opinions and earnest cooperation, alone will achieve it.
It is a great mistake, to suppose that the benefits of medical association are limited, or even chiefly important, to the medical profession. There are duties which every practitioner owes to the individuals who seek his advice and confide in his skill; for the faithful performance of these, he alone is responsible. There are other duties, of a public nature, which belong to the profession in their associate, rather than in their individual, capacity. With reference to these the Massachusetts Medical Society was originally constituted. In granting a charter, obligations were imposed, as well as privileges conferred. Have the ends of the institution been attained? and have the reasonable expectations of the Legislature and of the public been realized? This inquiry is supposed to be peculiarly appropriate at the present time, and to this your attention is now respectfully invited. In prosecuting it, it is proposed to present a sketch of the origin and progress of the Society, so far as may be necessary in exhibiting some of the leading objects of its organization, and the practical influence that has resulted from the course of measures which have been adopted in securing them.
In all communities individuals may be found, who seem unable to appreciate the value of an object which promises no peculiar advantage to themselves. It is not strange, that such persons should be reluctant to admit that other individuals may be influenced by motives which transcend the limits of their own consciousness and experience. Hence association has been, not unfrequently, considered, as only another name for monopoly; and prejudice, if not hostility, has been awakened against the most philanthropic efforts and the most valuable public institutions. The principal design of the present investigation is, to show that the objects to which the Society has directed its attention are of great public utility; and that whatever of patronage or of reputation it has attained, has been fairly earned and worthily bestowed. One fact, it is believed, will be evident, in the progress of these remarks, and it cannot fail of being duly appreciated by members of the profession not yet associated, and by the public; whenever the Society has at any time petitioned the Legislature for an alteration of their charter, it has not been for the purpose of securing exclusive privileges to the members, but rather that they might diffuse the benefits of medical association more extensively in the community.
Medical Education
A leading object under the charter, and one to which the Society has ever devoted the most assiduous attention, is, to elevate and to fix, on a permanent basis, the standard of medical education: in other words, to provide a succession of well-educated physicians and surgeons, adequate to the wants of the community.
To appreciate what has been done in the prosecution of this object, it must be recollected, that from the settlement of the country in 1620 to the time when the Society was organized in 1781, a period of more than 160 years, no systematic effort whatever had been made in New England to raise the standard of medical education, or to regulate the practice of medicine. A few able and highly respectable physicians, educated chiefly in foreign countries, were to be found in the larger towns; but in general, the profession was in a state of extreme degradation. The process of induction, in numerous instances, was something like the following;—A young man, who, from choice, ill health, or aversion to other pursuits, was desirous of being initiated into the “arts and mysteries” of healing the sick, commenced operations by pursuing the Latin Grammar, under the direction of the parish minister, as far as the first personal pronoun: he next apprenticed himself for a few months, more or less, as suited his fancy or convenience, to some neighboring practitioner; and with this slight preparation, entered upon the discharge of his responsible duties. No examination was had, nor was any license given or required. In some cases, a certificate was proffered by the instructer to the pupil at the expiration of his apprenticeship, but even this ceremony was often dispensed with. A skeleton, in those days, was a rare acquisition, and a human dissection created as much consternation among the people, as the appearance of a meteor. If the body of a malefactor was occasionally obtained for dissection, very little use was made of it, except boiling it in some obscure place for the sake of preserving the bones. Up to the close of the last century, Cheselden's compendium, with the small plates connected with the octavo edition, was the only text-book of anatomy used by many physicians in educating their pupils; and it was gravely contended, that a knowledge of anatomy was of little importance to a physician, whatever might be the case with respect to the practice of surgery, “Medical libraries had no existence” (in this country), and the few eminent men who had been educated abroad, demanded from students a compensation (often one hundred guineas), which far surpassed the means of those who expected to practise for ninepence the visit. In the metropolis, one shilling and sixpence, and afterwards two shillings, was the customary fee for an ordinary visit, until during the time of a general depreciation of the currency towards the close of the revolutionary war, an association of physicians who were accustomed to hold their meetings at the Green Dragon tavern, and were sometimes denominated the Green Dragon Club, raised it to three shillings. Up to the period of the formation of the Society, no public attempt has been made in New England to communicate medical instruction, if we except a course of lectures by Dr. William Hunter, an eminent physician and surgeon in Newport, R. I., in 1754, and the two succeeding years, and a short course of anatomical demonstrations in Boston, by Dr. John Warren, in the winter of 1780.
As an anatomist, Dr. Warren was self-taught, but it should be added, he was well taught. His talents as a lecturer were of the highest order of excellence. He possessed a happy faculty of communicating to others the results of his own original investigations, and of infusing his spirit into every subject which claimed his attention. His enunciation was rapid, yet distinct; his voice clear and musical, and of sufficient compass to be heard without effort in any part of a large assembly. His manner was deeply impressive; and with all the lights of modern science, it is rare to find an individual equally able, at his pleasure, to enchain the attention, and carry away the feelings of an audience.
To this gentleman, and a few others of a kindred spirit, the Society is indebted for its origin. In the progress of the arduous struggle for independence, the want of a competent number of well-qualified physicians and surgeons was severely felt. The Hon. Samuel Holten, an enterprising physician in Salem village, now Danvers, took a noble and decided part in behalf of his country, and early relinquished private practice, that he might more effectually subserve her interests. He was a member of the provincial Congress at Watertown, where he was a member of a Medical Board for the examination of candidates for the departments of medicine and surgery in the army. In 1777, he was one of the delegates from Massachusetts, who assisted in framing the confederation of the United States; in 1778, a member of Congress, and one of the original signers of the Constitution. For more than a year, being the only medical gentleman in Congress, “to him chiefly was committed the charge of the medical department of the army.” Such a man, in such circumstances, would not fail to perceive the in dispensable necessity of adopting some efficient measures for the promotion of medical education.
Dr. Warren, as his biographer informs us, relinquished his business at Salem, immediately after the memorable battle of Bunker hill, and, guided on his way by the blaze of Charlestown, reported himself at head quarters. In the ardor of his patriotism, he appeared with his gun and knapsack, prepared to enter the ranks as a common soldier. Other destinies, however, awaited him. He was immediately appointed a hospital surgeon, in which capacity he followed the fortunes of the army until 1777, when he was stationed in Boston, as superintendent of the military hospitals; an office which he continued to hold, with honor to himself, and advantage to his country, until the peace of 1783.
And is it possible, that a Society, originated by such men, is a monopoly? Is it an institution for the benefit of the few, with little regard to the public interests? Were Holten and Warren influenced by sordid motives;—men, who voluntarily relinquished lucrative employments and the joys of home, that they might aid in securing an honorable independence for their country? With them were associated the venerable Holyoke, Baylies, Tufts, Rand, Lloyd, Danforth, Dexter and others, who, if they were not all equally distinguished as patriots, were many of them possessed of wealth, at the head of the profession, and devoted to its interests. To exclude merit, or to degrade the profession of their choice, was no part of their design. Having just emerged from physical vassalage, they were desirous of uniting with eminent men of other callings, in establishing the empire of mind, and, through this instrumentality, to assist in laying the foundations of the future prosperity of their country, broad and deep, on the basis of intelligence and virtue.
On the first of November, 1781, the Society was incorporated; and on the twenty-eighth day of the same month, the charter having been accepted, it was duly organized, by the election of officers, pro tempore, and by the appointment of a committee to draft a code of by-laws. Under these laws, a Board of Censors was chosen, for the examination and license of such candidates as might apply, and the form of a diploma was agreed on, to be given to those who should be found worthy of the honor. In 1789, the Legislature, by a special act, empowered and required the Society to describe and point out, from time to time, such a course of medical instruction or education, as they should judge requisite for candidates for the practice of physic and surgery, previous to their examination before them, and cause the same to be published. The censors were under oath to the faithful performance of their duty, and any neglect subjected them to a heavy fine.
The immediate consequence of these measures was, that more time than formerly was occupied by students in qualifying themselves for the profession; all who were enterprising, and could possibly defray the expense, sought instruction by attending the medical lectures annually given at Harvard College; new and improved text-books for the use of students were adopted, and a class of young physicians was gradually introduced to business, far better qualified to perform the duties of the profession than those who had preceded them.
The medical department of Harvard University was organized the next year after the incorporation of the Society, and chiefly through the influence of the same individuals. At one period, however, no little collision existed between the Faculty of the College, and the Fellows of the Society, on the subject of conferring medical degrees; nor did it subside, until, by mutual conference and explanations, the Society obtained satisfactory assurances that the standard of medical education would not be lowered. Then graduates were freely admitted to all the privileges of licentiates examined by its own censors, and the two corporations have since moved forward on terms of reciprocity and good fellowship.
It is a reproach not unfrequently cast on our profession, that few comparatively of its members have availed themselves of the advantages of a public education before engaging in studies strictly medical. In a new country, just struggling into existence, many obstacles prevent young men from pursuing a course exceedingly desirable in itself, which neither their time nor their pecuniary circumstances will permit them to follow; obstacles which cannot be fully appreciated in later times, nor in countries where instruction in every science is abundant, and within reach of all who are desirous of obtaining it. The reproach, however, such as it is, cannot well be attached to our Society. As early as April, 1793, at a special meeting, it was voted that the Society earnestly recommend a University education to all designed for the medical profession; and to all students in physic an attendance on the medical lectures in the various branches, as taught in the Universities; and as most of the French authors upon physic and surgery have written in their own language, and many of them are very valuable, the Society also recommend a knowledge of that language.
The qualifications required of those who are admitted to practice, under the auspices of the Society, are “sound mind and good moral character,” a collegiate education, or a competent acquaintance with such departments of it as are supposed to hold a special relation to medical pursuits; a three years’ course of medical study, under the direction of competent instructers, and a satisfactory examination in all the prescribed branches. And the Society does not receive the diploma of any institution, as evidence of medical qualifications for practice, unless these requisites have been substantially complied with; nor do the Fellows lawfully consult with, aid, or abet those who commence business with less qualifications, or who fail to produce evidence that they possess them.
In consequence of the unwavering adherence of the Society to its original principles of insisting on a thorough and uniform system of education, to entitle any gentleman to be acknowledged as a member of the profession in good standing, and by the honorable cooperation of the medical colleges of the State in the same general views, the standard of medical education has been constantly advancing, not only in this Commonwealth, but throughout New England; and no further action, on the part of the Society, appears to be called for at present, than a strict conformity to the rules already adopted.
Some gentlemen have complained that the rule of the Society, demanding a fee of medical graduates, educated out of the State, on receiving license, while none is required of graduates from the medical colleges within the State, is invidious. The subject was brought to the notice of the Counsellors, by the Worcester District Society, at their statute meeting in February last, and it was voted to recommend to the Society to rescind the rule. I am happy to add, that, at the present meeting, the recommendation has been promptly complied with; so that no conceivable obstacle remains to the admission of every competent practitioner of medicine or surgery in the State, to fellowship and an honorable standing, aside from his own voluntary neglect seasonably to present his testimonials.
That some such system was necessary, to secure to the community a succession of well-educated and competent physicians, is manifest. On such a subject, the medical colleges in New England could scarcely be expected to act in concert, and if they should do it, they have no authority to prevent private individuals from thrusting upon the community half-educated pupils. Indeed, the necessity is imperious of a chartered institution, acting under the authority of the State, through the agency of which, as is well expressed in the act of incorporation, “a just discrimination may be made between such as are duly educated and properly qualified for the duties of their profession, and those who ignorantly and wickedly administer medicine, whereby the health and lives of many valuable individuals may be endangered, or perhaps lost to the community.”
Progress of Medical Science
Another leading object, in the organization of the Massachusetts Medical Society, is, “to increase the stock of medical knowledge, and to render the profession more and more useful to the public.”
In the prosecution of this object, the following measures were adopted at a special meeting held for the purpose at an early period, and the principles involved in them have been steadily pursued to the present time.
1. Every Fellow was requested to transmit to the Recording Secretary an account of the diseases most prevalent in his circle of practice, from one stated meeting to another.
2. A correspondence was opened with other bodies, devoted to similar pursuits, in this and foreign countries.
3. A committee was appointed in every county in the Commonwealth, to correspond with respectable physicians and medical associations within their limits respectively, and request the communication of all extraordinary and important cases.
4. Such communications were, if approved, read at the stated meetings, or at extra meetings held for the purpose, and afterwards numbered and filed.
5. From these, the most interesting papers were selected for publication, after due revision by a committee.
6. A committee was appointed to devise ways and means for the further diffusion of medical knowledge through the severed counties of the Commonwealth.
During the first ten years, the operations of the Society were conducted with vigor. Communications from the Fellows were numerous, so that extraordinary meetings were frequently held for the purpose of considering them. Particular inquiries were instituted, as to the state of the medical profession in the various parts of the Commonwealth, and the most distinguished physicians were elected to the extent which the charter permitted. The venerable Dr. Holyoke, in particular, annually transmitted an account of the diseases of Salem, together with a bill of mortality, state of the weather, &c., besides valuable papers on other subjects. In 1790, the first number of the Society's Communications was published, amounting to 128 octavo pages. It contained the act of incorporation, several original papers on medical subjects, together with an appendix, communicating a variety of interesting extracts from foreign publications. In the introduction, the principal objects of the Society are briefly stated, and the intimate relation which exists between medical association and the progress of medical science is distinctly noticed. The number of Fellows at that time amounted to sixty-seven, and of honorary members to twelve.
During the next ten years, the communications were frequent, and many of them at the time of great value, but the publication was not resumed. Towards the close of that period, unhappy personal alienations among some of the leading members existed; several of the most active of the founders had deceased or had become too infirm to take part as formerly in the meetings, and the Society languished. From 1794 to 1800, the Treasurer was directed not to call on the Fellows for the payment of their annual assessments.
In the original act of incorporation, it was provided, that the number of members resident in this Commonwealth should be limited to seventy. This provision might have been highly expedient in the infancy of the institution; but, after an experiment of twenty years, it became evident, that the most successful accomplishment of the great objects for which the Society was organized, would be more certainly attained by its repeal. The distinction of physicians into various orders and grades, of an arbitrary character, does not comport with the nature of our institutions, nor is it adapted to promote that harmonious action, which is essential to the most rapid improvement of medical science.
At a special meeting, held in January, 1803, a committee was appointed to take into consideration the state of the Society, and to report such alterations in the institution, as they might judge expedient to be adopted. The result of this measure was an application to the Legislature for an extension of the charter, and in March following, an act was passed, which placed the Society on the liberal and extended basis which it occupies at the present time. A new code of by-laws was formed: committees were appointed in every county, to report the names of such gentlemen, resident within their limits respectively, as should be thought worthy and desirous of membership; and accessions were numerous and highly respectable. And here it is worthy of particular notice, that the Society did not ask for its Fellows new powers or privileges, but only to be permitted to share those they possessed with the whole body of the worthy members of the profession in the Commonwealth. Surely, in this movement, there is no manifestation of a spirit of monopoly.
District Societies
To obviate the inconvenience, if not impracticability, of frequent meetings; to promote harmony and to encourage a spirit of inquiry among the members in their respective circles, and to extend, as widely as possible, the benefits of medical intercourse, provision was made, in the act of 1803, that on the application of any five members, the Counsellors may establish, within such districts and portions of this Commonwealth as they shall think expedient, subordinate societies and meetings, to consist of the Fellows of the corporation residing within such districts respectively. They may also appoint censors within such districts, who shall be authorized and empowered to examine and license such candidates for the practice of physic and surgery, as shall present themselves for examination and be approved by a majority of the censors. The members of such district societies are enjoined to communicate such cases, as may be selected for their importance or utility, and have authority to make their own by-laws, not inconsistent with the regulations of the general Society, to elect their own officers, and to purchase and receive by donation books, philosophical or surgical instruments, or other personal property, and to hold and dispose of the same, exclusive of any authority of the general Society.
Petitions were presented, at an early period, from members in Suffolk, Essex, Worcester, Berkshire, Hampshire, and some other districts, which were granted.
Some of the district societies, formed in consequence of these applications, particularly that in Essex county, went immediately into active operation, and have been highly useful. In other cases, it does not appear that any organization took place after authority was granted. Perhaps no measure could be adopted at the present time, better adapted to promote the progress of medicine, than some plan by which the Fellows, residing within a convenient distance, should be brought together for medical intercourse every month. The usefulness of such associations would be greatly increased by the establishment of libraries in each, embracing a selection from the most valuable medical periodicals of the day, and other works of standard value.
The Society for Medical Improvement in the City of Boston, is an honor to the State. Although of recent origin, its cabinet contains a rich depository of morbid anatomy, and is constantly accumulating, under the supervision of its judicious managers.
Annual Dissertation
In 1803, a resolution was passed, that a dissertation should be read at the annual meeting, by some member previously appointed. In 1804, that duty was performed by Dr. Rand, senior, and the dissertation was published. In 1806, Dr. Warren presented an interesting view of the mercurial practice in fevers. At that time he declined giving a copy for the press. Some years after, however, it was communicated to the Society in the form of an elaborate treatise, and may be found in the second volume of their Communications.
This measure has proved acceptable to the Society, and has been continued to the present time.
Publications
In 1806, after an interval of more than sixteen years, the Society resumed its publications. They have now reached to five volumes, of about 500 pages each, and one part of a sixth volume. They consist chiefly of the dissertations delivered at the annual meetings, communications from the Fellows on various topics of interest, and reports of committees. For some years past, the proceedings of the Counsellors and of the Society have been published annually, and distributed to the Fellows.
To awaken interest and elicit communications, in the year 1829, it was voted to offer a premium of one dollar per page, for such communications as should be judged worthy of publication. Several interesting papers were received in consequence of this vote, and were published under the auspices of a committee appointed for that purpose. It may be proper here to add, that since the year 1812, more than twenty volumes of the New England and of the Boston Medical and Surgical Journal have been published; a work, which, although it was undertaken and carried forward by individual enterprise, has from the beginning, been under the editorial supervision of members of the Society, and has been chiefly sustained by them, although open to communications from all respectable sources, and widely circulated beyond the limits of the Commonwealth.
Library
In adopting measures for the advancement and diffusion of medical science, great care has been taken by the Counsellors and by the Society, to suggest and employ those only, which were adapted to prove equally beneficial to all the members, in whatever part of the Commonwealth. For this reason, the Library, although valuable, has not been acquired by purchase, but wholly through the generosity of members, and of other public-spirited individuals.
The late Hon. John Brooks, of Medford, and Dr. Francis Vergnies, of Newburyport, each bequeathed to the Society their valuable libraries of medical books. There is a provision in the by-laws, that these books may be loaned to the district societies on application, so that all the members, however remotely situated from the metropolis, may enjoy the benefit of perusing them. It is to be regretted that applications for them are not more numerous. It was an excellent remark of the late Dr. Rush, that the mind of a medical man should always be “in an absorbing state.” Observation, without reading, is liable to become superficial; and, when a physician ceases to be a student, instead of doing any thing to promote the advancement of medical science, he degrades himself to the condition of a mere “routiner.”
Library of Practical Medicine
Another method recently adopted for the diffusion of medical information, has been the publication of a series of volumes of valuable works, foreign and domestic, under the title of Library of Practical Medicine. This publication was commenced in 1831, and thus far has proved eminently successful. In its bearings and influences, it is worth more to the Fellows, individually and collectively, than the annual assessment twice told. There is an advantage in having the attention of the whole profession simultaneously directed to a particular topic of interest; it is peculiarly grateful to Fellows who have made some sacrifice to attend the annual meeting, to take with them, on their return, a medical book of sterling value. The importance of this measure can be best appreciated by members of the profession, living remote from medical intercourse and the sources of knowledge, to whom a new work on medicine is a luxury, and one in which their slender means allow them only an occasional indulgence. The invaluable Researches of Louis are to be found in the hands of every member of the Society, unless through gross, personal inattention; and the knowledge of the labors of the French pathologists is not, as formerly, confined to a few gentlemen resident in the cities and larger towns, but is widely diffused through the whole body of the profession. In consequence of this, a spirit of active inquiry and of cautious investigation has been awakened; numerous dissections have confirmed, the observations of Louis and his coadjutors, on the subjects of Typhus and Phthisis, and the foundations for future improvement are being laid, broad and deep, on the basis of pathological anatomy and exact analysis.
I am not insensible, that some individuals affect to think and to speak lightly of the labors of the French school, as if they were all expended on diagnosis. It is even said, that they manifest a greater solicitude to confirm a previous opinion by a post mortem examination, than to cure the patient by appropriate remedies; in a word, that the remedial measures they adopt, are either inefficient or expectant. These objections will have little weight with those who investigate and think for themselves. We may assuredly avail ourselves of the labors of others in acquiring a knowledge of disease, without a sacrifice of our own superior modes of treatment, if indeed they are superior. It is worth the inquiry however, whether, if a more exact method were observed in noticing the effects of remedies, some modes of treatment, now popular, might not fall into disuse, and more successful ones be substituted in their stead.
Pharmacopœia
At different periods, the Society has expended no small amount of labor to secure a uniform mode of compounding medicines, and to protect the community against the dangers incurred by the use of such as are spurious. At a meeting of the Counsellors, Oct. 3, 1805, a committee was appointed to draw up and lay before them a Pharmacopœia or Formulary, for the preparation of compound medicines, with names affixed to the same, to be called the Massachusetts Pharmacopœia. Drs. Jackson, and J. C. Warren, made a statement of the progress of the committee, in February, 1806, and again in the following June. It was then voted, that fifty dollars should be placed at their disposal, for the purchase of such books as might be needed in the prosecution of the work, and an advertisement was inserted in the public papers requesting members of the profession to furnish such formulæ, as they might judge useful to be introduced. The pharmacopœia was completed, under the direction of the gentlemen above named, and laid before the Counsellors, in June, 1807. After having been examined and approved, it was ordered to be printed. This, it is believed, was the first work of the kind ever accomplished in the United States. It was favorably received, here and elsewhere, and was brought into general use. Its leading objects were, to introduce a systematic nomenclature of medical substances, in conformity with the improvements in modern chemistry; to simplify medical prescriptions, by omitting obsolete and useless formulæ of foreign pharmacopœias; to bring into notice several indigenous articles in common use in some of the larger towns; to produce uniformity in the preparation and administration of medicines; in a word, to act as a convenient manual for the physician and the apothecary; and these objects were happily attained. In the following year, Dr. James Thatcher compiled a dispensatory, on the same general plan and arrangement, the manuscript of which was submitted to the Society, and, after having been revised by a committee of the Counsellors, was published in 1810.
On the 2d day of June, 1818, the Society concurred in the measures proposed for a national pharmacopœia, and appointed delegates to assist in preparing it.
Reports on Epidemics
Among the most useful of the publications of the Society, have been the Reports, which have been drawn up and widely circulated, during the prevalence of epidemic diseases.
In May, 1798, Dr. Jenner published his Inquiry into the Causes and Effects of the Vaccine Virus, with Cases illustrative of its prophylactic powers, as a Preventive of Small Pox. This work was favorably noticed in Dr. Duncan's Annals, of the same year, and excited great attention not only in England, but also on the continent, and in this country. Early in 1799, vaccine matter was collected, and vaccination was extensively practised in England; and in the spring of 1800 was introduced into Paris, from matter furnished by the London Vaccine Institution.
In July, 1800, Dr. Waterhouse commenced vaccination in this country, with matter obtained from Bristol, England. Soon after, a supply was obtained by Drs. Manning, Jackson, and others. The Medical Society made application in January following, and received fresh virus from the London Institution, and through the agency of its members vaccination was generally introduced, as a public benefit, rather than as a source of emolument to individuals. From that period to the present, no labor nor expense has been spared, by the Counsellors and Fellows, to diffuse the benefits of this noble discovery, and to prevent it from being brought into disrepute by the use of spurious matter, or by an imperfect introduction of such as is genuine. If the population of the State, at the present time, is but imperfectly protected against the ravages of small pox,—and that this is the case recent painful facts fully attest,—the fault does not lie with the medical profession, certainly not with this Society. As early as June, 1808, an elaborate report of a committee of the Counsellors was presented and read at the annual meeting, and was afterwards published for the benefit of the community. This report was an able one, and the positions of its distinguished author have most of them stood the test of time, and are now received as settled principles. The protective power of vaccination has been attested by an experience of more than forty years. Millions of persons, through its influence, have been preserved from death or disfiguration by one of the most painful and loathsome of human maladies.
In the last report of the national vaccine establishment, in England, signed by the presidents of the colleges of physicians and surgeons respectively, it is stated, “that of more than 70,000 persons vaccinated in descent, with successive portions of matter originally collected by Dr. Jenner, thirty-eight years ago, vaccination has manifested its peculiar influence in all; and that of this number, some hundreds have been subjected to the severest trials, by exposure to small pox in its most fatal form.”
Of what avail, however, is a remedy, if it be not applied at all, or applied too late? It is well known that certain eruptive diseases, and probably some others, render the body insusceptible for the time of an effectual vaccination. It is, therefore, important,—perhaps it should be said essential,—to the public safety, that the operation should be entrusted to none but skilful hands. This is the more necessary since the repeal of former laws, which made it incumbent upon the municipal authorities to remove those persons, who were laboring under small pox, to hospitals remote from human dwellings. The law itself was of little use, and in some cases positively injurious, inasmuch as it induced persons to rely upon it for protection, to the neglect of vaccination, the only adequate remedy. The repeal, therefore, was expedient and highly proper, and had the full sanction of the Society; nevertheless, the public should understand that there is no place in the community safe from the ravages of the small pox, and no protection against its dangers, except by a general vaccination, under the inspection of persons competent to conduct it in a suitable manner.
Spotted Fever
In March, 1806, a disease of a peculiarly fatal character appeared at Medfield, in this State, a description of which, by Drs. Danielson and Mann, was published in the second volume of the Society's Communications. In succeeding years, it extended in various directions. In 1810, it broke out with great violence in Worcester county, and was present simultaneously in not less than sixteen towns. In March of that year, the Counsellors, at a special meeting, appointed a committee to investigate the causes, history and mode of treatment of the disease, which was familiarly known as the “petechial” or “spotted fever.” In performing this duty, a circular was addressed to every Fellow of the Society, and to other reputable physicians in whose vicinity it had prevailed, requesting such information as they might be able to communicate in relation to it. Letters in reply were received from twelve gentlemen, all Fellows of the Society, and an able report, extending to 128 pages, was prepared, published and distributed, at the expense of the Society.
This report presented a history of the disease, an account of its symptoms in different years and localities, together with suggestions as to the appropriate treatment, and was at the time a document of great value. Before the appearance of this pamphlet, the treatment had been in many places empirical, and of course, in those instances, prejudicial. Active stimulants, opium, brandy and steaming, were too often indiscriminately used, and it was the opinion of intelligent and cautious observers, that not a few of the individuals attacked died of the remedies, rather than of the disease. After a full and careful investigation, it turned out, as might have been anticipated, that the disease was a highly congestive form of fever, varying exceedingly in its type, in different places and seasons, and requiring, like other forms of fever, an eclectic rather than a specific mode of treatment.
Spasmodic Cholera
The doings of the Society, before and during the prevalence of the epidemic cholera in this country, in 1832, are too recent to require an extended notice. At the February meeting of the Counsellors in that year, the following preamble and resolves were adopted, viz.:
“Whereas the disease, called the Epidemic or Spasmodic Cholera, has prevailed in various parts of Asia and Europe, and may hereafter appear on this side of the Atlantic Ocean, so that it is expedient that the physicians of this country should be prepared to meet this disease; therefore,
“Resolved, I. That a committee of seven be chosen by the Counsellors of this Society, whose duty it shall be to investigate the history of this disease, and especially the best mode of treating it; and carefully and without prejudice to consider whether it be or be not a contagious disease.
“II. That the sum of thirty dollars be appropriated to defray any such expenses for the purchase of books, as may be thought necessary by the committee.
“III. That this committee be authorized to make public the result of their deliberations, at the expense of this Society, at any period they may think most conducive to the public good.”
In May following, the Report, a volume of 190 pages, was put to press. By awakening public attention, and causing the necessary precautions to be taken before the onset of the disease in this country, this publication was instrumental in preventing the panic which would otherwise have been produced, and the number of deaths was comparatively few, and chiefly among a class of persons, whom no dangers can deter from yielding themselves willing victims to depraved passions and appetites.
It is perhaps proper to add, that most, if not all the reports which have been referred to, are understood to have been drawn up by the same individual, a gentleman to whose indefatigable industry and entire devotion to the interests of the profession, more than to any other person, the Society owes its prosperity, and the high and honorable standing it has attained.
In presenting even a sketch of the operations of the Society, it appeared necessary to allude to the foregoing facts, in order to repel the unjust imputation, that they have always been of a character adapted to promote the interests of the profession, rather than those of the community. The truth is, the Society has never declined to engage in any enterprise of public utility, appropriate to its organization, because it would involve labor, sacrifice or expense on the part of its members. If further proof were wanting, it would be only necessary to allude to a recent vote, offering a premium of five hundred dollars for discovering a successful mode of rearing leeches having a foreign origin.
Legalizing the Study of Anatomy
Perhaps the importance of medical association to the public good cannot be better illustrated, than by referring to the success which has crowned the labors of the Society in its efforts to secure the legalizing of the study of anatomy. It was the remark of an eminent statesman, that most great conceptions are simple. The passage of a law, legalizing anatomy, is apparently an affair of very small importance; yet, in its remote influences, it is adapted to lengthen the mean term of human life, and to relieve an untold amount of human suffering. It is only about thirty years, since it was seriously doubted whether a limb could be preserved, provided the principal artery should be tied, and few surgeons, comparatively, could be found bold enough to venture upon the operation. And yet, it is a very simple operation, is attended with but little hazard, and requires but a moderate share of skill in its performance, for a person well acquainted with the anatomy of the parts. Hundreds of persons also in this country, no doubt, have died from strangulated hernia, who might have been saved by the timely performance of an operation by no means difficult.
At a meeting of the Counsellors, in February, 1829, a proposition was introduced, that a committee should be appointed to prepare a petition to the Legislature, asking for a modification of the laws then existing, which prohibited the procuring of subjects for anatomical examination, and report the same to the Society for consideration at the annual meeting. The proposition was sustained. At the annual meeting in June following, the committee reported, that they had prepared a petition to the Legislature, as directed by the Counsellors; but as the subject was beset with difficulties, and of vast importance to the community; and as time and effort would be required to prepare the public mind for so great a change as was contemplated, they recommended the appointment of a large committee, to whom the whole subject should be referred, with instructions to consider what measures it would be expedient to adopt, and to report to the Counsellors in October following. The committee issued a circular to the Fellows on the subject, and the Counsellors, at their meeting in October, appropriated one hundred and fifty dollars for its distribution, not only to the Fellows, but to other intelligent and influential individuals. Subsequently, a large edition of the Report was widely circulated, and a petition was presented to the Legislature. In June following, the subject was favorably noticed by the Governor, in his opening message to the Legislature, and the petition was referred to a committee, who, after a patient hearing, reported favorably. The Report was an able document, and does honor to the head and the heart of the chairman, the late J. B. Davis, Esq., as well as of the other members associated with him. The result was, that on the 28th day of February, 1831, an act was passed, legalizing the study of anatomy in this Commonwealth; “an act which has brought honor on our State, as the first to set an example of such enlightened legislation;” which has done much in this and other States to remove unfounded prejudices against anatomical inquiries, and no doubt has saved many valuable lives.
Suppression of Quackery
The Legislature has, in an important sense, constituted the members of the Massachusetts Medical Society guardians of the public health. In granting a charter, it was contemplated that something would be effected towards the suppression of quackery, or, as it is expressed in the act of incorporation, “to prevent the administration of medicines by ignorant and wicked persons.”
The task imposed on the Society, in relation to this subject, is a difficult one. When a regular physician speaks against empirics or their appliances, many persons suppose that he is actuated by mercenary motives; not reflecting, or perhaps ignorant of the fact, that a large item in his business, as things now are, consists of an effort to relieve sufferings produced by patent medicines and the use of nostrums. The power the Society exerts, on this subject, is a moral power. They can present motives, but cannot insure their success. They can indicate the path of safety, but have no authority to coerce men to walk in it. And this is as it should be. If any will persist in violating the laws of the human constitution, after having been duly warned of the danger of such a course, there is no power on earth that can prevent the infliction of the penalty which nature has provided, in the shape of physical suffering. Some years since, “the Legislature enacted that irregular practitioners should not be permitted to collect their fees by aid of the law;” but this provision was not sought for by the Society; on the contrary, it was in consequence of a representation made by members of that body, that it was repealed, on a revision of the statutes in 1835.
The measures that have been adopted for the suppression of empiricism, have been, 1st, To establish and maintain a sufficient standard of medical education. 2d, To make public all useful discoveries in medicine, to the extent of their ability, particularly in relation to prevalent epidemics and unusual diseases. 3d, To exclude from their fellowship irregular practitioners of every grade, and maintain among the members a system of correct professional conduct.
Empiricism is the offspring of ignorance, or wickedness, or of both. The legitimate method of counteracting its influence is, to diffuse, as widely as possible in the community, a knowledge of the structure, functions and laws of the human body. The first principles of anatomy and physiology should constitute an important part, not only of a classical, but also of a common school education. Such works as Paxton's Illustrations of Paley's Natural Theology, and the more recent and excellent manual of Physiology, by the late Corresponding Secretary of this Society, which have already been introduced into several of our best academies and seminaries of instruction, are adapted to do more for the suppression of quackery, than volumes of denunciation and the most severe acts of prohibitory legislation. When public opinion shall become so far enlightened, that the conductors of the periodical press shall refuse to furnish a mouth piece, through which the venders of secret medicines may trumpet their falsehoods; when respectable apothecaries shall cease to become panders and factors for those whom they know to be practising the most gross imposition on the public credulity, the lives of multitudes, now annually sacrificed on the altar of charlatanism, will be preserved, and millions of money, worse than lost, saved to an unsuspecting and outraged community. Every person, in placing his signature beneath a recommendation of a secret medicine, should feel, that in so doing, he may be signing the death warrant of some member of his species; the vender is an accessory to the crime before the fact, and the administrator, however unwittingly, the executioner. It is no palliation of this offence, that death is not always the immediate result. The tendency of a line of conduct is the rule by which we decide on the expediency of pursuing it, and every member of the profession, now present, will bear witness, that he has been frequently called to prescribe for diseases, in their nature curable, which have passed the period of recovery, under the use of inert or injurious secret medicines.
To a person feeling himself indisposed, no more salutary advice than this can be given:—Abstain from the usual quantity of food; rest awhile from your ordinary pursuits; take, if you judge it expedient, some simple medicine, with the properties of which you are acquainted; and, if relief is not speedily obtained, decide on one of two things: either call a physician well skilled in his profession, and implicitly follow his prescriptions, or trust to the powers of nature alone. Few constitutions can sustain the shock of disease and nostrums at the same time.
Unfortunately, one of the effects of disease is, to weaken the mind, as well as the body. This is peculiarly the case in nervous affections. Hence, persons devoted to literary pursuits, and in other respects of highly cultivated intellects, are liable, in a state of disease, to be carried away by the professions of boasting empirics, and transfer their confidence where it will be abused to their own ruin, and the destruction of their fellow-men. On this principle, we account for the disgraceful fact, that gentlemen of education, clergymen even, have, in some instances, lent their names to be attached to useless nostrums, which have been spread from one extremity of the land to the other. Still more rarely, a physician is to be found, indiscreet enough to recommend a secret medicine, ordinarily, to be sure, with a proviso, that from his knowledge of its composition, he deems it safe and useful. If so, then let the formula for its preparation be published, for the benefit of the world. It is morally wrong, for a medical man to sanction by his name the use of an article the composition of which is concealed. This principle has been seldom infringed in this Commonwealth; I wish it were in my power to add, never by a member of this Society.
Objects of Philanthropy
The interest, which the medical profession has manifested in several great objects of philanthropy, has done much to promote those objects, and through them the public happiness. Members of the profession, and of this Society, contributed not influence only, but funds, towards the establishment of the medical schools connected with Harvard University and Williams College. Our noble hospitals owe their existence to their efforts, although philanthropists out of the profession have contributed largely to their endowment and support. The Asylum for the Blind, and the Institution for the treatment of the diseases of the Eye and Ear in this city, may be traced to a similar influence.
The reform with respect to the use of intoxicating drinks as a beverage, so honorable to our country and so beneficial to man, if it did not originate with the medical profession, has found among its members able and efficient advocates. Nor has the Society, in its associate capacity, been inactive in promoting this reform. At the annual meeting in 1827, resolutions were adopted, expressing, in unequivocal terms, the views of the members as to the deleterious influence of these liquors, and their determination to discourage their use, and to use their skill in ascertaining the best modes of preventing the evils they occasion. At the same meeting, a premium of fifty dollars was offered for the best dissertation on the subject, which was afterwards awarded to William Sweetser, M.D., and the dissertation read at an annual meeting, and published at the Society's expense. The reform was further promoted, by the well-known declaration of seventy-five physicians in Boston, and by the publication of similar views of many respectable members of the profession, resident in other parts of the Commonwealth.
The only additional benefit of our medical association, to which I have time to allude, is, its moral influence in promoting harmony and kind feeling among the members. It is now comparatively a rare occurrence, to find a well-educated physician and Fellow of this Society, who cherishes a hostile spirit towards other gentlemen of a similar character in his vicinity. “Live and let live,” is a maxim more uniformly recognised by the fraternity than heretofore; and its increasing influence is to be traced chiefly to the intercourse which grows out of medical organization. Indeed, the sentiment is becoming universal, that it is unwise to degrade a liberal profession in the estimation of the public, by alienation among the members.
It has been objected to our Society, that we waste a portion of our funds in public entertainments. It is true we dine together on the day of the annual meeting; and it would be a sad mistake, to labor during the whole year to promote the public health, and on the only occasion when, as a body, we are permitted to suspend our labors, to hold a public fast. But seriously, the public dinner is a bond of union to our Society. Whatever collisions may arise, in the private intercourse of individual members, they are banished from the social board. There we meet as brethren, and the cordial greetings of the occasion are as really important to our prosperity, as they are grateful to our feelings.
I have thus presented an outline of the objects of this Society and of the measures which have been adopted in prosecuting them. It has been shown, that the conditions of membership are such only as are essential to enable it to attain those objects. Its by-laws and rules of police embrace only great principles essential to its prosperity. Its benefits are equally diffused, as far as the nature of the case admits, throughout the Commonwealth. As the design of its organization contemplates a union on terms of equality of the whole body of the worthy members of the medical profession in the State, so it is hoped all such will be disposed to accept its fellowship, and aid in promoting its usefulness. The whole number of Fellows admitted, since the organization of the Society, is nine hundred and nineteen. Of these, two hundred and forty are deceased; removed from the State, fifty-one. The whole number of physicians in the State, as nearly as can be ascertained, is about eight hundred and fifty. The present number of Fellows living within the State is six hundred and twenty-eight, of whom sixty-two have retired, leaving five hundred and sixty-six acting members.
During the last year, the following deaths occurred among the Fellows. It is remarkable that, with one exception, they were all gentlemen far advanced in life, who had retired from the active duties of the profession.
Among the honorary members, science mourns the loss of the late Philip Syng Physick, M. D., of Philadelphia, who died on the 15th December, 1837, æt. 70. His name is deeply engraven on the rolls of fame, and his history will long occupy a bright page in the annals of our profession.
It does not become me, nor is it fitting to the occasion, to attempt his eulogy. That duty has been performed by other and abler hands. Nevertheless, as it was my privilege at one period to attend on his instructions, it may not be improper to notice some of the more prominent traits of his character. A favorite pupil of John Hunter, he early acquired a strong predilection for anatomical pursuits. His knowledge of anatomy was accurate and practical. Although highly esteemed as a physician, in the circle in which he moved, his fame rests chiefly on his surgical skill. He was for a long period esteemed the first surgeon in Philadelphia, and perhaps it would not be too much to say, that for many years he was the first, or equal to the first, in the United States. He was deliberate in forming his judgment; but when his opinion was formed, he did not readily swerve from it. It was a favorite maxim with him, that the perfection of surgery consisted in preserving a patient without resorting to a painful operation. When, however, it became manifest that a sacrifice of life would be involved by abstaining from the ultimate resources of the art, he resorted to them without hesitation. With every preparation previously made, even to the last pin that was to confine his dressings, and with a self-possession never surpassed, and rarely equalled, he proceeded, steadily, calmly, and apparently without emotion, to the performance of his duty. No conversation could divert his attention from the interests of his patient, which for the time absorbed all his feelings. As a teacher, his instructions were plain, practical and lucid. As a friend, although somewhat reserved, his feelings were sincere, ardent and uniform. In a good old age he was gathered to his fathers,—ripe and full of honors, and has left an example of devotion to the interests of the profession, worthy of universal imitation.
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