ADDRESS

OF THE

PRESIDENT, J. H. BROWER, M. D.,

BEFORE THE

INDIANA STATE MEDICAL SOCIETY, MAY 1853.

THE return of the period of the annual assemblage of the State Medical Society, under circumstances so auspicious to its prospects of increasing usefulness, and the interest manifested by an attendance so large and intelligent, beyond what its early projectors could have anticipated, is a legitimate source of mutual congratulation.

Absorbed, as most practitioners of medicine necessarily are, by the daily drudgery of professional duties, no class of men have such infrequent opportunities for social re-union, and interchange of friendly intercourse; and none, perhaps, enjoy them with greater zest. The collision of intellect, the social greeting, the opportunity for testing mutually each others mental calibre, the strengthening the ties of brotherhood, which time and absence have served to weaken, the increased attachment to our noble profession, and the growing aspirations after its higher elevation and advancement, which are among the legitimate results of our annual convocations, are sufficient of themselves, as motives, to cherish and hail their return, as one among the bright spots in the dreary waste of daily toil, and should inspire every true physician, within the limits of the State, to aid by his counsel and presence, the design and objects of our association.

But these are not (pleasant and refreshing as they are,) the only, or the most important objects or results of our association. We owe much, not only to the Profession, whose honour and interests we are bound to cherish, and by every proper means to promote, but, placed as we are, by our peculiar position, as conservators of public health, to us especially belongs the duty to take cognizance of, and mature such measures as tend to the improvement of the Profession, and the

general sanitary condition of the community, and we are imperatively called upon, to consider seriously our present posi tion, and to call up for reflection, the principles of conduct which will contribute most certainly to establish the Profession in future upon an honorable and enduring foundation in the present age. Eminently distinguished by its progressive tendency, there is a rapidly decreasing tendency to reliance upon prescription and authority. Every thing is presumed to be capable of improvement, and consequently is made the subject of careful scrutiny: its foundations are examined, its truth is tested and if in any subject there exists, in fancy or reality, on the part of those connected with it, a disposition to oppose the operation of the spirit of progress-an inclination to cling too closely to the past-there will result, as a natural consequence, distrust and want of confidence. It is not surprising that there should be a special tendency of this kind, in regard to the public estimation of the state of medical knowledge, since the seeming, more than the real discordance, among authorities of any one time; the apparent opposition between the principles and modes of practice, prevalent in different ages, together with that uncertainty of much of our knowledge, as to the nature, causes, and treatment of disease, which the best informed among us are ready to admit, may with some reason induce the conviction that there can be no truth or certain knowledge, where so much disagreement and doubt exist, upon what seem to be essentials. But we believe that medicine will bear a comparison, in its history and in its present condition, not only as to the spirit of truth and humanity with which it has been pursued; but also as to the results which have been attained, with any branch of human enquiry, when the difficulties which surround its investigation, and the circumstances under which the comparison is made, are taken into consideration and duly weighed. If our art possesses solid foundations in nature, if it can be useful, if its consolations be necessary to the unfortunate sufferer, and if it be incumbent on public authorities to encourage and superintend our labors, too many means cannot be resorted to, in order to inspire with proper devotion and confidence, those who are destined to its exercise; to make them fully appreciate the dignity of their vocation, and excite in them a proper degree of enthusiasm; and it may be not amiss on this occasion, to enquire briefly into some of the principles and modes of reasoning upon which the claims of its votaries, for certainty and soundness are founded. It can not be cultivated with ardour, unless it is considered as consisting of sound and fixed principles founded upon a solid basis.

The cavillers against the solidity of medical science, have endeavored to justify their opinions on some of the following grounds: They maintain, that the principle of animal life is enveloped in so much mystery and darkness, as to elude the utmost force of enquiry; and that of consequence, we are left in hopeless ignorance of the subject on which we are called incessantly to operate, and the explanation of which ought to constitute the foundation of our knowledge. The secret springs of life, are in reality, concealed from observation, and we can form no precise idea, either of the power which animates our bodies, or of the means by which the influence of this power is exercised. This is indeed too evident from the slow progress hitherto made in the investigation of this principle, though men well qualified by their abilities, learning, and experience, have for more than 2000 years, been communicating to the world all they could add by means of just reasoning, to the mass of facts collected by diligent observation. The student of nature must own, we are yet greatly in the dark, in regard even to inert matter, and that we know but little of the properties and powers of the inanimate creation. But we have all this obscurity to perplex us in studying animated nature, with the addition of a vast deal more, arising from the unknown peculiarities of life, and the difficulties connected with the study of the laws and phenomena of the living organism. If an intimate knowledge of the nature of vitality were necessary to serve as the basis of the healing art, the art itself would fail in its essential and fundamental principle, and it is only necessary to enquire, whether it be absolutely necessary for the useful practice of Physic, to be enabled to penetrate into the essence of the vital powers, and to form a precise notion of their mode of operation upon the human body.

Man knows the essence of nothing: neither of matter which is always before his eyes, nor of those secret principles which actuate and determine all the phenomena of the universe. He is often occupied with the consideration of causes, which he flatters himself, he has discovered, and of others which he feels and laments his inability to ascertain but first causes, are entirely withheld from his sight. He sees effects, or rather, he receives impressions; he is constantly observing new relations; he arranges them, in order to fix the recollection of them in his mind, to appreciate them better, and to draw from them whatever may contribute to his preservation, or afford him additional enjoyment: this is the sum and substance of human knowledge.

Is it necessary for the mariner to possess a scientific theory

of the winds, or a knowledge of their first causes, to enable him to obtain the full effect of their impulse, in traversing the ocean? or must he understand the cause of the tides, in order to avail himself of their aid in ascending a river? Must the brewer, the baker, and the tanner, understand the doctrines and hidden arcana of chemistry, on which their respective arts are founded, before they are enable to conduct them with practical success? Is it indispensable that the principles of vegetable life and nutrition should be extorted from nature and distinctly understood, before agriculture can be practiced with advantage, or made to yield sustenance to the animal world? This surely can not be asserted. It is allowed to man in his present state, to observe and arrange facts, and to make the best inductions he can from them: this is sufficient for himhe knows nothing of the nature of causation.

The phenomena of health and disease, the effects of aliments and remedies, all come under the cognizance of our senses, and we deduce rules from them, which are necessary for the practice of our art. We may therefore conclude, that this objection to the certainty of firmness of principles is not well founded. As the want of knowing causes is not peculiar to medical science, if the reproach of uncertainty and conjecture can thence be applied to it with any truth, the principles of almost all the other sciences are exposed to a similar charge. The same objection to the certainty of medical principles is sometimes presented in a different form, by the assertion that our knowledge of the nature and proximate causes of disease is so limited and obscure, as to render its treatment vague and unsatisfactory. The precise changes which the principle of vitality undergoes, in taking on a morbid disposition, are necessarily involved in all the obscurity which belongs to the vital principle in the state of health; but the causes and circumstances, which are obviously connected with the disease, and make up its history, are facts, positive and definite, and within the powers of observation they may be discovered, and laid hold of by our senses; they may be communicated by faithful relation, and as they occasion certain definite phenomena in the animal economy, we accustom ourselves to recognize them and to draw from them inferences to guide our practice.

It has again been urged, that diseases undergo so many modifications from age, sex, temperament, climate, seasons, states of the atmosphere, modes of living, occupation, previous maladies, and are so much influenced by the state and sions of the mind, that it is impossible, amidst so various and conflicting causes, to assign to each its proportionate agency,

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to attribute to each phenomenon its just value and natural connection, or to form a suitable plan of treatment, or to draw inferences so certain and conclusive as to be worthy of that dignity and importance which the healing art has always claimed. Every reflecting physician, who understands and candidly appreciates the difficulties of his art, will be ready to acknowledge that there is some force in this objection: aware of these difficulties, he seeks to devise the best means to obviate and remove them. We are obliged, indeed continually, to admit exceptions to the general rules laid down to guide our conduct. The whole process by which an enlightened practitioner directs his treatment, the examination of the symptons, the comparison of the state of the disease with that of health, the determination of the nature of the disordered condition and of the probable course it will follow, together with the selection of the remedies indicated, implies knowledge, guided by reason and science; while conjecture implies ignorance, its suggestions having no better foundation than is afforded by that blind faith, which begins where reason ends. All legitimate medicine is a practical art, arising out of the two sciences of Pathology and Therapeutics; and in propor tion as these sciences are perfected, will the rules of the art founded upon them be simplified, definite and certain. The practical skill of the physician appears chiefly to reside in an instinctive acuteness, improved by observation and experience. It requires a vivid conception to penetrate a disease at a single glance, and to seize on all its characters at once; the principal morbid phenomena may be reduced to a few, resulting from their combination and different degrees of intensity; the order of their occurrence, their relative degrees of force and importance in the animal economy, are sufficient to give rise to all the varieties of disease. A few signs produce the finest compositions of music, and a small number of sounds make up all the wonderful complications of language.

The objectors to the certainty of medical principles, have also contended that the nature and properties of substances employed as remedies, and their modes of operation upon living bodies, are but little understood, and that there is but little probability of clearing up this obscurity. In answer to this it may be maintained, that there appears to be no necessity, and indeed, but little advantage, in knowing the peculiar properties of cinchona, in order to observe its specific virtues in the cure of intermittents, and that it would probably avail us but little to ascertain the nature of antimony and mercury, so far as to explain in what manner the former executes vomiting and the later destroys the poison of syphilis. We gain a