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ART. I. -Annual Address before the Erie County Medical Society. By J. R. LOTUROP, M. D., President.

(Published by vote of thc Society.) It has seemed to me that it will not be inopportune to speak of some things which relate to the public estimation of the profession, and its present position as to its aims, limits, and duties.

The profession has a standing of trust and honor with the public. This is true, even though there are those who doubt its methods, disparage its motives, and would deprive it of its just honors. They wish to bring it into discredit, because through ignorance and prejudice, they hold wrong opinions of its aims and its powers.

Even its true friends, while they give it honor, somewhat misjudge it. They do not rightly estimate its functions, or fully appreciate its limits; i. e. they do not form correct notions of just what medicine, as a profession ought to attempt or can accomplish. The physician is too much regarded in his relations to the cure of disease, and therefore as of service only to the sick. He is too little thought of as an adviser to those in health. They are apt to forget that, in his true function, he is a doctor; i. e. teacher of the laws of health, as well as those of disease. Moreover, in his relation to the sick, he is, almost always, expected to effect more, by his medicines, than can be reasonably hoped for,

VOL. 7, No. 7–31.

nay, even more than he is willing to promise, however prodigal of promises individuals of his class may be.

This arises from the fact, that there is in the popular mind, a wide-spread belief that diseases are cured only by medicines. This belief, in part well-founded, is in so wide a sense erroneous. Diseases are cured by medicines; no one will hesitate to accept this as a truth; but all diseases are not, neither are they curable by them. Therefore the prevalent feeling that they are curable only by medicines, is without foundation. Yet this belief has had a very important influence upon the practice of medicine. Physicians have often felt' compelled to use medicines, governed in doing so, more by the influence arising from this belief, than by any necessity created by the disease. They have not felt free to withhold them, even when to do so would have been the best course, because the feeling has almost always existed, that they were needed.

I do not mean to say that the belief has not had its influence on medical men, and does not now exert it. Without doubt there are many physicians who feel an unwise confidence in the curative powers of medicine. They are not influenced by any feeling of what the public may expect; they use them from a conviction of their necessity and usefulness. Such, however, are not the best minds in the profession. The ablest and wisest physicians know and teach, that medication has its limits, which must be regarded in practice. They feel that the office of the physician is higher and nobler than that of a mere dispenser of drugs, and that he does not cease to be wise and useful, because he does not propose them to the sick.

Whence arose ihis wide-spread belief in the powers of medicines? Whence came such a notion of disease; as if it were a devouring agent, only to be stayed within the body, by some antagonism brought into it from without? It may be answered, that the profession is largely accountable for it. It has sent it forth, and to its doors must it be brought back. Physicians, in all ages, have sought to inspire confidence in their medicines; partly because they believed in them, and partly because they were moved by the desire to be as helpful as possible. For, it is doubtless true, that benefit comes of having the beliefs of the sick on the side of the means the medical may employ, medicines among

error.

Hence the teachings of the profession, from the earliest times, have had the effect of fixing in the popular mind, faith in the curative powers of medicines. This belief, then, as it exists to-day, is the growth of centuries, and has become firmly rooted, too firmly to be easily removed. The wrong teaching and wrong learning of two thousand years cannot be corrected in a day. If truth exerts a power by appearing venerable, the same is true of

It is the more pernicious and difficult to correct that antiquity gives it a false value and currency.

The medical mind of today is largely emancipated from the old teaching and belief, but they will linger yet a long while in the popular mind, even under the better teaching which the best men of the profession encouragethat better teaching which is the imperative demand of to-day.

I have said that as regards just what he can accomplish by medicine the physician is placed in a false position in public estimation. This I said depends upon a wrong notion of the powers of medicines; a notion almost universal, but originating mainly in erroneous medical teaching. There is another feeling concerning the physician and his medicines, that operates, though in a less degree, to influence public judgment. It is, however, far from being universal, it affects only a portion of the public, and that not the educated or thinking portion. Partial as it is, it yet has its influence. It is but a remnant of old superstitions, which, in the early and rude ages of the world, when diseases were thought to have a supernatural origin, pervaded all minds. We cannot say that now any portion of a modern enlightened public, has the old belief in the power of incantations, charms, or magic to avert or cure disease. This, we trust, has ceased to exist, but there still remains a feeling which borders on it, enough at least to mark its traces. There yet lingers excessive and unwise credulity, a belief in something occult, something which lies just outside of the common experience of the working of natural laws. Hence medicine is much less likely than any other profession to get a candid judgment, and pass for just what it is really worth.

True as this is of medicine itself as a profession, it is even more true of individuals. The estimate of particular men is partial, or exaggerated. One gets more credit than ano:her from the feeling that in some way he has got possession of the hidden things of nature, not by having wrung them from her, through force of mind and study, but by special insight or peculiar endowment. As in times past the superstitious beliefs so ruled minds that something more than simple truth was needed to gain faith, so under this modern feeling, plain truth is not always the most likely to be received. Truth, in her simplicity, has much less the look of reality than ingenious error.

The error underlying such notions is very apparent. The successful practice of medicine is a matter of mental capacity, not of special gifts, or accidental discoveries. One man, more than another, may have a mental aptitude for the physician's work. Doubtless a fitness, more or less peculiar, exists in some men for any one business or calling, above another. When the calling and the man are mutually suited, we see the best achievement. But, except with genius, whose powers are exceptional, this is much less than is often supposed. The physician forms no exception to this general statement. Any man of such force and abilities, as would give him success in other professions, will, with equal effort, secure the same success in the practice of medicine. No one man of good capacities has, above another, the special power to wring from nature a secret which shall fit him to deal with diseases. Good original powers, thorough study and experience, are the physician's best gifts. Therefore the best men ought to secure the grea‘est confidence and success. I am not prepared to deny that they do, but still it is true, in a measure, that a belief in the possession of special gifts, or of some secret of nature hidden from most men, has an effect, small it may be, and unjust it must be, on the popular judgment of a physician's merits.

This must not be taken in too broad a sense. Yet there is in it a partial truth.

It has its influence in medical matters to such an extent, that the choice of a physician or some one having the relation of physician, by men of good judgment, is not made with the same sagacity that they show in other affairs of life. In ordinary business they do not place trust, or give credit for ability, without evidence that they are justly due. But for dealing with their diseases they require little or no evidence of fitness for the

Confidence is.given often to him of whom they know least, and of whose fitness for the important work they entrust to him, they have no proof whatever. . When they bring the same common sense to bear upon the treatment of dis

important work.

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ease that they do upon business affairs, the physician will be more truly judged and more justly honored. For what is the office of the physician, let me say of the well-instructed and honest physician—not every one who undertakes to treat the ills of fleshbut as he is called, the regular physician. This can be best answered by stating the aim of medicine, I may say its practical aim, for it has its scientific side, seeking to prove what is true for truth's sake.

The statement can be briefly made. It is all comprised in this, that it seeks to prevent and cure diseases. Prevention has been less prominent than cure, for the reason that medicine has had more authority in the latter. Its teachings for preventing disease have had much less weight, than its measures for its relief, and very wrongly so, for its office of prevention is equally important. It is as important to know the laws of health as those of disease. This has not happened, because medicine has been untrue to its noblest function. It has happened, because men have chosen rather to persist in unhealthy modes of living, and call upon the medical art to rescue them from the result, than to heed its teachings. They have been much less inclined to be at the trouble to avoid the causes of disease, than to avail themselves of the means of cure. Advice has been much less welcome than medicines. It is not to be expected that medicine can have much weight in private hygiene, till it is tolerated. If men will not be told that they eat and drink improperly, wrong sleep, and construct and beat badly their houses, it must not be charged upon medicine that diseases come. It should not perhaps be broadly stated that in these respects men always consciously err, for there is much ignorance as to what is best, and men ought to be willing to be taught how to gain and keep that health. which once lost, medical treatment may never restore.

But it is largely true, that if medicine has been wanting to its highest trust, it has been due to the slight authority which has been given it.

These observations do not bear equally upon public hygiene. In this noble science, medicine has wrought most worthy achievements, and secured its purest and best triumphs. It has lifted up its voice for all sanitary measures likely to promote public healthpure water, drainage, healthy food, pure air, and cleanliness. It has cleared up the mystery which shrouded the source and nature

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