diatory aoom Cfie ILffitarg of lift Ditit0ton of ^ealtl) affatr0 ([Inittetsitp of n^ottt) Carolina K^«f, ^^vr ftooiff fWl. ^^. m.m. Digitized by tine Internet Arclnive in 2009 witln funding from Nortln Carolina History of Health Digital Collection, an LSTA-funded NC ECHO digitization grant project http://www.archive.org/details/addressbeforemedOOstru AN ADDRESS BEFORE THE MEDICAL SOCIETY OF THE STATE OP NORTH CAROL.IXA, AT ITS FIRST ANNUAL COMMUNICATION. IN RALEIGH, APRIL, 1850. By EDMUND STRUDWICK, M. D. RALEIGH: WILLIAM W. HOLDENj PRINTER. 1850. ADDRESS. Gentlemen of the Medical Society: I feel a deep and proud gratification in seeing here so large and respectable an assemblage of Physicians. It is a favorable augury for our infant project. It is a bright and honorable omeu of future success. I bid you welcome. The flight of another year brings us together as an organized State Medical Society. Permit me to congratulate you on its first Annual Meeting, and to express the hope that we have met together with a united and honest determination to accomplish the purposes for which it was instituted; that we may bring to this work an energy commensurate with its importance — an ar- dor no circumstances, however discouraging, shall abate — a zeal that sliall never falter, until we shall have reached the de- sired goal liCt the fact that the medical reputation of North Carolina must be elevated by the success or suifer reproach by the failure of our undertaking, animate us with a sense of pro- fessional pride, which shall overcome every obstacle, conduct our Society to usefulness and dignity, and make it an honorable co-worker with the National Association, now actively engaged in asserting the rights of the medical profession and its high claims to public respect and confidence. When a movement so general in the profession had been made — when the fathers and teachers of medicine, with its able, en- terprising and successful practitioners, from almost every point of our widely extended country, had banded themselves together to testify their devotion to the honor and advancement of medi- cal Science, it was full time for us to wheel into the ranks of medical reform. To have lingered longer would have tarnish- ed our escutcheon, and have justly exposed us to reproach. Havmg grasped the plough, let us never look back ; let our watchword be '^oiitvard,^^ and by faithful and persevering ef- fort prove ourselves equal io the enlerprize. and worthy of the noble cause in which we have embarked. Let us bear constantly in mind the truth that our success must be the work of time, the result of long-continued and laborious effort. Let us then not be discouraged, but importunately invoke the co-operation and union of the medical talent of North Carolina; and if we can call it into exercise and bring it to bear on this subject with its full force and influence, a proud, and commanding success awaits us. Permit me now to make a few plain suggestions — to clear away some rubbish that mars and encumbers our profession — to clean off a place for the foundation of medical reform ; the task of erecting the edifice I resign to other and to abler hands. The idea that two of a trade cannot agree is a proverbial truth, which, I blush to say, is lamentably and too frequently illustrated in onr profession. So far as we are concerned let us strike it from the vocabulary of proverbs. Who has not known the best ex- ertions of medical skill to terminate in failure, and the want of success attributed by a cotemporary to a misapprehension of the disease and to its improper treatment ? When success rewards assiduity and skill it is sometimes attributed to a mere accident, or perhaps to some wise and potent suggestion made by the jealous detractor, or as resulting in spite of the treatment. Akin to this conduct of injustice and disparagement, is a spirit of boastful superiority which has no failures to record, but tells of danger- ous and a2:gravated cases innumerable, which yielded, as if by magic, to the rebukes of this wonder-working medical prowess. Honesty is the ornament of every vocation, and it is peculiarly the best policy as well as the highest privilege of the Physician ; and he who departs from its old-fashioned but honored maxims, is sure to meet with dishonor and disappointment. He who ex- pects to gain business or to acquire reputation by trusting to the meretricious tones of his own trumpet, occupies only a base and fancied vantao^e ground, and will sooner or later receive what he justly merits, the disgust of the community and the contempt of his fellows. Exhibitionsof disreputable medical character, I would fondly hope, are not of frequent occurrence; and I only mention them that we may place upon them the mark of disap- probation. Whenever symptoms of degeneration appear, threatening the vitality and purity of professional character, let us here, in a gen- eral consuUiitionj determine upon a bold and efficacious remedy — eradicate the moral seirrhus by the fearless application of the actual cautery ; lesser lesions or delinquencies let us correct by the milder measures of kindness and remonstrance; and if it becomes necessary to administer reproof, let the object be the re- formation of a friend and cotemporary, not the injury of a com- petitor. Let us, in a word, put on the mantle of a just, honor- able, and courteous brotherhood, and wear it like men faithfully discharging every duty it enjoins. Let the badge of medical profession, when rightfully worn, inspire us with mutual respect, command our kindest offices, ensure our best wishes, and estab- lish among us a spirit of reciprocal confidence and friendship. He who pursues the profession not simply for its proper emolu- ments, but with a just appreciation of the claims of humanity, and for the glorious privilege of doing good, must form close and intimate friendships with its practitioners. And this is its fair and legitimate tendency. And when this state of things does not result from long association, it shows that improper in- fluences, and jealousies, and ignoble rivalries have been at work, which must be banished from our ranks. We recognize the principle of fellowship and communion as peculiarly appropri- ate to those who endure the toils, encounter the privations, incur the dangers, and share in the triumphs, disappointments and joys incident to the prcictice of a common and noble profession. This is not only honorable to the profession, but is as indispen- sable to the advancement of medical science, as the spirit of emu- lation and the habit of application to study, and of close and correct observation. It is also necessary to a faithful record of medical experience to guide and instruct us. Even an author or a teacher, of fame and established reputation, reluctantly publish- es mistakes by which he has sacrificed human life. Can it then be expected that a physician will impart knowledge of his own fatal errors in the practice, unless with a full confidence which an assured friendship and integrity can alone inspire — that it will be treasured and remembered only to protect others from a similar catastrophe? To cement this tie of mutual confidence, is demanded by considerations of self-respect as well as by obliga- tions of duty to the public. A free interchange of personal ex- perience, an unreserved expression of medical opinion — now at- tacked, now defended — for reasons frankly avowed, not only pro- motes tiie pleasures of social intercourse, but results in the exten- sion of medical knowledge, the establishment of truth, and the refutation of error. In this connection, I may be allowed to refer to instances of heroism, manifested by the profession, amidst the horrors and dangers of the pestilence, which recently spread death and deso- lation over many portions of our land. I allude, of course, to the Cholera. The Physician in this hour of dismay, when the public mind quailed with fear, maintained the post of honor and duty — he met the pestilence which walked in darkness and braved the destruction "which wasteth at noonday"; inspired, not like the soldier on the battle-field, by the strains of martial music, by his leaders example and word of command ; but ani- mated by a disinterested sense of duty, with a confiding trust in the protection of Providence, he promptly obeyed the call of ' distress, and with noiseless tread, as well in the hovels of the i poor and the crowded hospitals, as in the chamber of the opu- lent, fearlessly exposed himself to the thick and unseen shafts of the pestilence, to rescue his fellow-man from its remorseless grasp; and in the unequal conflict not unfrequently fell a vic- tim to his noble exertions in the cause of suffering- humanity. Recollections like these fill the medical heart with pride and sorrow. This dauntless devotion to duty challenges the admira- tion of mankind, and entitles the Physician to a greener laurel than ever decked the warrior's brow. Let us then be stimulated by these proud examples to be just to ourselves, and true to the public ; let us cherish a generous rivalry to make full and ample preparation for the discharge of the various duties we owe to the communities in which we may reside — for a summary of which I beg leave to refer you to our excellent Code of Ethics. But while we are ever mindful of the obligations of kindness, patience, and a strict integrity to the public ; while we are ac- tuated by an honest desire to promote their health and welfare, self-respect requires us to say that we suffer much wrong at their hands. It is not to be disguised that men, occupying the high places of the land, ornaments to society, and even Physicians, lend themselves to the vile imposture of empiricism and quack- cry. Man, with all his acquirements, civilization and religion, is a credulous being; and this credulity is exhibited in a remark- able manner ui his use of secret remedies of €ven the most ridiculous pretensions. It is not surprising: tli^'^t ignorant persons should be duped and deceived by nostrums, freighted with re- commendations which assert a power to cure every ill flesh is heir to, and attempted to be sustained by certificates as ingenious as false; but it is surprising, and justly merits indignation, that men of sense and character should patronize the authors of this system of fraud — these sordid hucksters, who violate every prin- ciple of humanity — these mountebanks, who have stolen the garb of medicine in which to practice their diabolical arts — ^jug- glers in medicine, who, in defiance of decency, with a miser's unscrupulous lust after gain, under the disguise of falsehood and secrecy, deal in public credulity and trafiic in human life. These charlatans are our acknowledged and sometimes preferred competitors, who attain not unfrequently to boundless wealthy while the upright and well-informed Ph^^sician languishes in poverty and obscurity. It is the pride and privilege of the medical profession to ren- der gratuitous services to the Clergy and their families ; yet this influential, honored and holy class, whose mission it is to inves- tigate, cherish, and dispense a truth more glorious than that eman- ating from the lamp of science, are often so far forgetful of the dig- nity of their station, and of their obligations to society, as to sanc- tion by their approval, and encourage by their patronage, men who discard the patient pursuit of a profession and embark in a trafiic of deception, for the sole and sordid purpose of money-making, as must be obvious, upon mature reflection, to every candid and intelligent Minister of the Gospel. The press and the legislation of the country contribute to the advancement of quackery, and invest it with a false consequence. To grant patents for secret remedies is a palpable prostitution of the powers of legislation. It is the duty of the public to appreciate and patronize medical talent and worth, wherever found ; and when the profession shall clearly present these qualifications, and manifest their own appreciation of moral worth and ability, we may then expect public confidence and respect, and not till then. We must not tolerate those who are so unmindful of the distinction the medi- cal badge confers, as to sully it by unprofessional conduct ; nor must we countenance secret compounds of high-sounding claims, though they come to us endorsed by the dignitaries of the land, and recommended as possessing powers to establish the bloom ot* health upon the ravages of every form of disease. There are articles of acknowledged efficacy, prepared by apothecaries and others, whose ingredients are known ; they are useful and con- venient to the profession, and form exceptions to this just pro- scription of rank and ridiculous impostures. The American Medical Association has established a Board to analyze quack remedies and nostrums, now palmed upon the public, and publish the result of their examinations, with comments upon the na- ture and dangerous tendency of such remedies. Every Physi- cian must have been called on to rescue cases of disease from the aggravation and sometimes dangerous modifications pro- duced by their use. If the Board shall succeed in its Herculean task, and deprive these nostrums, now fillins^ and pillaging the land like swarms of locusts, of their chief charm and power — secrecy — it will have conferred a benefit upon society, as well as the medical profession, and the public will be amazed at the ex- tent to which they have been humbugged. The medical pro- fession have been contending for years with a species of impo- sition at once inhuman and piratical — the adulteration of drugs and medicines by unprincipled manufacturers, who have flooded our country with spurious and inert articles, thus blunting the very weapons with which we encounter disease, disappoint- ing the just expectations of the Physician, and blighting the dear, est hopes of his patient. I am happy to be able to say that this disgraceful trafiic has been checked, if not entirely broken up. Dr. Edwards, for his able and patriotic agency in procuring the proper legislation on this subject, and Dr. Bailey, for his effi- ciency and independence in giving practical effect to that legisla- tion, deserve from the country and profession lasting honor and gratitude. There is, however, to some extent, a home adultera- ation, and it is dilTicult to reach the perpetrators of this'fraud by law, but the vigilance of the profession will deter them from pro- secuting this disgraceful scheme. They will find it as ruinous to their interest as it is destructive to their character. And the dealer in drugs who may be detected in this infamous proceed- ing, will be published and branded as an impostor; and thus disappointed in his speculation and deprived of the power to deceive and injure, he will abandon his inhuman vocation. And while the national legislature has properly consigned adult- erated drugs to destruction, ouffht not North Carolina to forbid. by a legislative act, the sale of secret compounds within her limits, and to require the authors of the whole tribe of nostrums, under proper penalties, to liave the name and proportions of the articles of which they are composed, to be written out on the label in plain, vernacular English? While the Physician, who exposes the name and nature of his remedial agents to public view — who unsheaths and exhibits his weapons — cheerfully pays a tax for the privilege of practising his profession — shall the stealing trickster, who envelopes his nostrums in profound secrecy, be permitted to pursue unheeded his course of craft and treachery; and the Legislature, by its silence, confer upon him immunities denied to the regular practitioner? Judicious regu- lations exist on this subject in some of the States of the Union. - Permit me to allude to a few of the extravas^ant appendages of the medical profession — Homoepathy and Hydropathy — sys- tems containing some truth, though largely diluted with error. The inappreciable doses of Homoepathy is a pretty apt illustra- tion of the expectant plan of treating disease, and operate like doses of confidence, which are often of signal advantage. Who would at this day renounce cold water as a Therupeutic agent? Yet how vain the attempt to invest it with the virtues of a pana- cea — vainer still the attempt to dignify Hydropathy with the appellation of science ! Heat and Steam are also valuable agents, but admit not of that universal application in the practice af medicine, which is claimed for them by the misguided and fa- natical Thompsonian. I turn now, with pleasure, to the consideration of a more pleasing and useful subject. One of the highest objects of our Society is to ascertain the true nature and treatment of disease, as it occurs among us. However highly we may estimate the observation and experience of Physicians in foreign countries— however much we may prize the learning, research, and varied information which comes to us from native Physicians, whose talents, ability, and integrity adorn our profession — and, how- ever useful and indispensable all this knowledge may be, yet there is a local knowledge of disease which every Physician must acquire for himself — a modification of disease, which ac- curate observation at the bedside alone can teach him. Habits of life — age — condition in society — sex — peculiarity of consti- tutiou — seasons — epidemic influences — and particularly climate^ 10 are some of the circumstances which produce such modifica- tions, as to occasion in works of the highest authority, in regard to symptoms and treatment, a discrepancy of opinion, a dissimi- larity of views, constituting a fruitful source of confusion and medical skepticism. That we may have clear and satisfactory views of the correct treatment of diseases, peculiar to the diver- sified climate in which we live, we must learn then- true char- acter hy our own observation as well as by the teachings of the books. This study and observation of disease, with every at- tending and modifying circumstance, as well in relation to its theory as its practice, should be embodied and reported to this Society; that we may thus establish a standard of ripeped opin- ion and experience for our guidance and instruction in the treat- ment of disease, as it occurs in our several locations. To pro- mote this object, let every Physician keep a note-book, and reg. [ister his cases. This is a drudgery, but nevertheless a duty, and every Physician ought to perform it. He will then be fur- nished with important and practical information. Patient and correct observation, though humble and unpretending in its character — though deficient in the power to charm like the dis- covery of a new theory, which inventive genius weaves into a plausible and beautiful web— will stand out as a beacon light to direct the practitioner safely in his course, whilst the most inge- nious speculations are forgotten, or only remembeted as brilliant fancies. Extending the plan of forming an accurate acquam- tance with the diseases of the South, Dr. Fenner, of INew Or- leans, proposes to publish an Annual Volume, devoted to the ad- vancement of Medical Knowledge in the Southern States. If the plan of the "Southern Medical Reports" shall be fully car- ried out and properly patronized, it will collect and present in a durable form the experience and observations of the Physicians of the South, and will exert a more decided and salutary influ- ence in promoting medical education and forming the medical history of our own region than the Establishment of a Medical College. The accounts of the Meteorology, Medical Topography, and prevailing diseases of the year, with reports of important cases from all parts of the Southern country— an annual expression of medical opinion upon the diseases of the South, with an ex- position of their true character and proper treatment, can but 11 prove hio^hly interesting and instructive to the profession. The plan and objects of this work commend it to the patronage and support especially of every Southern Physi^-:ian. And as the accomplished Editor is a native son of Nonh Carolina, will we not feel a just pride and si.:cere pleasure m extending to him every encouragement, and in putting forth our best exertions to promote the success of his noble enterprise? It is not to be expected that I shall review and discuss the various recommendations of ihe American Medical x\ssociation. They are all entitled to our highest consideration ; and we should manifest our admiration of them by rendering a cheer- ful obedience to their important requirements. The transactions of the Association present much useful and valuable information. It is a volume of which every xAmerican Physician must feel proud. It is a rich contribution to medical science, and exhibits in pleasing relief the progress and digni- ty of our profession. I sh:dl purposely abstain from making many specific recom= mendations. I leave their adoption, as well as the cirrangement of the order and nature of our duties, to the wisdom and pleas- ure of the Society. Permit me, however, to call your attention to a few particulars in which we must all feel a deep interest. It is the very foundation stone for improving medical character, and imparting hig:her respectability and more extended useful- ness to the profession, that we should require of those who enter our offices to study medicine, to furnish evidence of a sufficient geneial education and of good moral character. From a strict observance of this rule, with an honest determination on the part of the practitioner to impart the fullest office iiistruction to his students, and to impress upon ihrm the n.ojal dignity of the mission to heal the sick — that it requires, not only that the head should be clear, but that the heart should be right — the standard of medical education v/ill be elevated, and inestimable advanta- ges will accrue to the profession. Additional efficacy will be imparted to this rule by lengthening the peiiod for the delivery of the lectures in all our Medical Colleges, thereby affording time for study and profitable attendance on well-conducted institu- tions for the reception and treatment of the sick. It is necessary to the success of the plan, that there should be a union and co- operation of all the M^^lical Colleges of the country. There 12 is too iiiuch matter crowded upon the medical classes in a term- much too short to study, digest, and retain the knowledge and facts which are taught with signal ability. If the present ar- rangement for public medical instruction is objectionable — if it be true — and candor compels me to admit that it is to a great extent — that the Doctorate is too cheap and of too easy attain- ment — the fault is not alone chargeable to the Colleges, but is also found to lie at the door of the practitioner, who receiv^es, without proper discrimination, the Student into his office, and fails in his duty to prepare him for attendance upon the lectures. The American Medical Association recommend, as the only practicable check on the too general right to practice, conferred by the diploma, that each Legislature shall establish an Examin- ing Board of disinterested Physicians, whose certificate shall confer the privilege of entering upon the practice, regardless, of the diploma. This plan Avould work no injury to the worthy and well qualified graduate, but would exclude the deficient. This sys- tem is in operation in the Army and Navy, and has been emi- nently successful in establishing a high order of professional acquirement in their Surgeons and Physicians ; and wherever introduced it has produced the same gratifying results. There is a strong impression on the mind of the profession in favor of its adoption in this counti}^ Whether we shall ask any action from the Legislature on this subject, I leave to you to determine. The popular and indigenous remedies of the State merit the care and attention of the Society. I recommend that the Legislature be memorialized by a com- mittee of your appointment, to pass a law which shall compel the registration of the marriages, births, and deaths. This law, once in operation, would furnish a fund of statistical informa- tion, important in a civil and political point of view, and useful to the legal as well as the medical profession. It is a reproach to any State to be without registration laws, which lead ulti- mately to the adoption of sanitary measures, now claiming an interest and attention, which the preservation of public health and the prolongation of human life must sooner or later com- mand. There is a means of improvement which the Legisla- ture ought by law to confer upon the Physicians of the State — the right to dissect the bodies of executed criminals, and those I'' o who die in iiistitulions of public charity. Unless friends or re- lations claim the bodies for burial, they should be delivered uj\ oil demand, to any Physician, for the purposes of dissection, preparation, or experiment. Allied to this subject, and one of vital import to the medical profession and to the public, is the privilege of making post mortem examinations of the bodies of our patients. This pro. ceeding the public invests with a species of horror. Friends regard it as a heartless liberty with the remains of the honored dead — as a violation of the sacred immunities of sorrow — as an invasion of the rights of affection. These impressions are natur- al — they command our sympathy and respect, but they spring from bosoms wruna-with an aguish, not from the convictions of a calm and undisturbed reason. There is a false delicacy on this subject, which we should seek to correct, by kind remonstrance and conciliatory appeals. We should familiarize the public mind Avith the necessity and importance of such inspections; we must impress upon it the truth that they involve no indignity to the dead — no disrespect, but a high and positive duty to the living. The public do not realize the fact, that, without these opportunities, the science of medicine would now be slumber- ing in its infancy ; nor do they reflect that these investigations increase our knowlec)o;e of disease and qualify us for its more enlightened and successful treatment. These things are palpa- ble to us, and we ought to persevere in our efforts to render this source of improvement accessible to the profession. I would call, especiall}^ upon the younger members of the profession, to come up to the work of reform and advancement. Upon them chiefly rests our hopes. Ti.ey have the time — the advantages of the recent improvements and discoveries in the science of medicine. Whatever of aid those of us who have grown grey and dim of vision can render, will be cheerfully contributed. While we will endeavor to* shed the light, beam- ing from the lamp of experience, upon the path of medicine, the young and rising must illuminate that path with the Drum- mond-light of learning. I now bespeak your kind indulgence for the many imperfec- tions of this hasty sketch. My apology must be, frequent in- terruptions, and especially my utter disuse and want of taste in the arts of composition. Accept my sincere acknowledgement^^ 14 for the honor you have conferred upon me of presiding over the deliberations of the first Medical Society of my native State. I will cherish it as one of the proudest recollections of my life. Here, on thisinterestinof occasion, let us pledge ourselves to each other upon the altar of immutable brotherhood, to accomplish whatever our hearts and hands find to do — to adorn and unite the medical profession — to promote its true glory — to brighten the pasfeof its history — to record its triumphs, and to contribute to the fulfilment of its high and holy mission to mankind.