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ability and earnestness to do well what he undertakes. These qualities inspire confidence in those who have occasion for such service; and this mutual interchange of confidence promotes success. If envious rivals attempt to impugn him they are more liable to do themselves harm and fix attention on him more generally. The abused and slandered man is very often the best in the community. Our surgeon is likely to become more careful, more exact in his knowledge, and thus more apparently reckless but more surely certain, and in the end he is the king.
In our School of Practice, however, there is not so good an opportunity for the surgeon. We have the material, I doubt not; a Howe, a Gunn, a Younkin and others whom I might name, prove that conclusively enough. But there are difficulties hard to surmount. When a doctor acquires a superior reputation as an operator, his practice as a physician is very liable to diminish in consequence. Most of his patients will be too poor to afford him a just pecuniary acknowledgment for his services. The poor are not only in the majority, but they have by far the greater ratio of casualities, broken limbs. and maimings. Nor is that the only feature of trouble. If from any cause the injured part is not made as good as before, the patient is as likely to prosecute the surgeon for malpractice as to do any honorable thing. In the Old School a doctor can easily find professional brethren to swear him clear, right or wrong; but the Eclectic is seldom thus favored. There is often a conspiracy against him, against which only incontrovertible success can assure him.
Several years ago one of our ablest young practitioners in an Eastern State, and a member of the National Association, treated a case of fracture skillfully and with great faithfulness. He had a superior degree of ability. For his pains he was treated to a suit for malpractice. The pressure brought to bear against him was overwhelming; only a righteous cause and clear testimony carried him through. He was triumphantly acquitted, but the expenditures for defense crippled his finances. He gave up the practice of his profession and engaged in another business to recover the competency which a
malicious lawsuit had rifled from him. This tale has its moral; and it is one which reflects no credit on the dominant faction in medicine. It is of value, too, as a caution to others of our number who aspire to distinction in the practice of operative surgery. Yet to all who are thus ambitious I extend my heartiest sympathy.
There is an error, however, that surgeons are somewhat too liable to fall into. There are numerous cases that can be remedied by treatment, which a surgeon sees a short way to with his bistoury. It is a nice thing to be quick over with a difficulty, and he is more than others liable to the temptation. Yet it is a temptation which he ought to resist if he would indeed be delivered from evil. The motto of the National Association, Vires vitales sustinete, should be conscientiously heeded. The living tissues of the body recoil from incisions as an unnatural violence. Sensitive individuals do not for a considerable period of time recover from the shock inflicted by cutting. This, in many instances, more than counterbalances any benefit derived from the more expeditious, and, perhaps I should add, nicer, method of the surgeon. There is good reason to believe that practitioners who make no pretension to surgical skill are often more successful in their treatment of the sick. They depend on their remedial means which they employ, while the surgeon is a little too apt to become utterly unbelieving in regard to the utility of medicines and regimen. This would be very likely to limit their benefits in his hands.
Our laurels have been won in clinical medicine. Ours are the methods and medicines that effect cures. It is natural, perhaps political, that the majority of our young men shall engage in that branch of labor that better and more certainly rewards them than to venture into the field where there are more perils to encounter, more enemies to contend against, and less emolument for honest effort.
In saying this, I would not discourage any body's ambition. Let every one work out what is in him. It is his only sure way to live aright. I cannot praise too highly the Yankee boy who studied Greek while tending a saw-mill and afterward honorably wrought his way through Harvard University.
I am proud of him as our leading surgeon and teacher of Surgery; and I earnestly desire to have many more following his example. What he has done other young men can do ; and it is easier for them because he has done it. Besides, there is far less extenuation or excuse for any such to follow the example of another distinguished surgeon of our school and abandon the Eclectic ranks because there were not physicians who would act honorably in the treating of the patients on whom he had operated. Our colleges have done much and are doing more to obviate such a condition of things. While there may be more certainty of patronage and emolument in the field of clinical practice, the opportunities for distinction as a surgeon are becoming better.
All who thus distinguish themselves will render an invaluable service to their profession and their fellows. They make it more necessary to be thorough in their study. The average practitioner is somewhat too apt to prize the diploma of a medical college more than medical knowledge. The surgeon can not get on with any omission. He must be thorough in his scholarship; and his proficiency is certain to reflect credit and honor on those with whom he may be identified. The few always cast their light over the many.
Perhaps it is well to call attention to another matter. We are without reputation or acknowledgment in the military or naval service of the country. We cannot regard ourselves as honored citizens of this Republic, with such a stigma or disqualification. It is a brand of dishonor. We owe it to our cause, to Science, to justice itself, to procure its removal. The first step to secure such an end is to make sure of our own deserving. It would come with an ill grace for us to ask appointments as army surgeons or naval surgeons, when we were not really surgeons at all. Let us therefore make sure that we are right in this essential. We can then afford to wait. It would be for the Government itself to seek justification if its Executive officers should refuse the services of an honorable and competent man, solely because he chanced to be proscribed for no moral or proper reason by a partisan medical association. Such a man as a standing witness of public injus
tice would do more to break down the partition-wall now shutting us out, than if he held the highest medical appointment in the hands of the Government.
It seems clear to me therefore that the field occupied by this Section is most important to the professional standing and future existence of our School of Practice. Let us occupy it with enthusiasm and determination. The departments of Practice and Materia Medica are ours already, to hold and make good. Let them not be wrested from us. But let us not stop to boast over any old victories. They are only steps toward the achieving of new ones, or else they are little better than defeats. The glory of the Eclectic cause consists in its advancing, rather than in Fourth-of-July orations about what we and our fathers have done. What has been accomplished will perish and come to nothing, when we stop and stand still or venture to compromise with what has been left behind.
I hope that the reports and papers of this year will occupy broader and higher ground than ever before. There are many disorders which surgical appliances ought to remedy, which still remain our opprobrium. Any advance toward their improvement or successful eradication is an achievement that should enroll the discoverer's name among the heroes of the century. We read of a masterly operation by which ExGovernor Chamberlain, of Maine, has been made a sound man comparatively, when death from uræmic poisoning seemed inevitable. I would honor the man who performed it. Yet it is hardly time to be reckless, certainly not to be rash. I have read of an excision of a lobe of the lungs to get rid of a phthisical affection, and that it did not succeed. Except the patient desired it to be done, and speedy death was otherwise inevitable, I do not see how it could be justified. Yet, if dissolution from disintegration was so near, there could be no hope from operating. Amputations for cancer are still sufficiently precarious; not to include those made to remove goitre. Only success can assure the palm to the surgeon in either of these. The same feeling was entertained in respect to ovariotomy, and some of our Eastern friends remember when the late Dr. Walter Burnham was denounced in a Physo
pathic Medical College for ripping women's bellies open. But in his case success vindicated the work; and the principal resource left for crushing him was found in the Code of Ethics of the American Medical Association. Old-School physicians would not attend patients on whom he had operated, because he was an Eclectic. Better, according to that Code, to let women die than receive benefit by one who bore not the label of regular.
The excision of internal organs of the body involves responsibility which a surgeon may hesitate to assume, where adversaries are on the alert to make him trouble. It is for the privileged school to remove a diseased lobe of the lungs, the patient dying after it; or a segment of the liver as being a diseased kidney as was done in the New York Hospital. Such practice, which was hushed up, because by self-named regulars, would be the ruin of a member of this Association. Yet even in these matters, there is much that may be done, well and safely, which will reflect infinite credit on the skilful and expert operator; and we may confidently direct effort in this direction.
In the way of Orthopedic Surgery there is much that can be explored with profit. If we could effect something in the way of prevention, it would be better. The crooked limbs, deformed spines, and other malformations, constitute a distinct feature in practice, which has not received sufficient attention.
Much as has been said and written about Cancer, there has not enough been learned or accomplished to entitle it to be set down as actual scientific knowledge. There is far more hope for the physician to arrest a malignant growth than for the surgeon to remove it with success. The same may be said of other affections which come within the surgeon's province, but I will not now attempt to enumerate them. Enough has been written to point out the broad field that opens before us; and I am sanguine enough to believe that the young surgeons whom we are educating, not to leave out the accomplished teachers in our colleges, and the President of this.