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and manage disease, being the superstructure to which all medical “ologies” are but foundation-stones and adornments, the very fruitage of the tree of life, the sole beneficent application of all medical science, its importance to humanity and therefore to the physician, can not be overestimated.
Efforts to elevate the standard of medical requirements are worthy of commendation. Owing to the fierce rivalry of schools and the facility with which incompetence secures a diploma, it has been deemed very important, by many reformers, to have the licensing power placed in the hands of an independent board of examiners. Should such a board be constituted, it may properly require a thorough preliminary training, and it may be so comprehensive in its demands and so vigorous in its examinations that no one guilty of ignorance regarding the fundamental branches of medical and other cognate sciences shall be able to gain admission to the ranks of a noble profession. But if, in these exalted demands and these exacting examinations, therapeutics be ignored or belittled ; if therapeutics be not elevated to the highest position and regarded as the one thing needful, the very vital principle without which everything else is but dead and useless science, and with which alone the physician does all his skillful deeds of benevolence; then the ordeal to which the candidate is subjected is delusive and beggarly. It may even deserve reprobation. The object of a board of examiners should be to protect the community from the ravages of additional incompetency. Its action must of necessity be prospective. It can not hope to uproot a professional ignorance which, associated with length of years and engaging manners, has become popular and almost sacred. But it can determine the minimum amount of knowledge which must be possessed by every candidate who shall gain admission to the medical fraternity. If its examinations shall be comprehensive and searching, and at the same time not so narrow and technical as to regard an error in orthography less excusable than a gross blunder in medical practice, it may accomplish a good purpose. But if it tithes, rigorously, the mint, anise, and cumin, and neglects the weightier matters of applied medical science; if it shows partiality,
allowing Vitreus Cæruleus, who believes the radiance which filters through blue glass to be the only and omnipotent remedy for all diseases; and the gushing Aquarius, who dotes on and swears by magnetized spring-water as a panacea; and the innocent Credulus, who puts all his faith in faith alone; and the oily and plausible Sinbad, who pretends to be under the guidance of disembodied spirits; if the board allow these to shirk entirely the examination in therapeutics and materia medica to which plain, unpretending Medicus, who recognizes the importance of these sciences, is subjected, then when it puts these five on the same high level before the public, giving to each the same indorsement and the same license, it inflicts a wrong on Medicus, places an unnecessary and useless burden on Cæruleus, Aquarius, Credulus, and Sinbad, and perpetrates a fraud on a confiding and misled community.
To serve the public wisely and well, the board should subject every applicant, whatever his callow crotchets, prejudices, or intentions may be, to the same examination in every branch of medical science, as understood by the vast majority of the profession. Possessing the learning required to pass this examination, and endowed with his credentials, the tyro should be at liberty to adopt and practice any special delusion or idiocy which his fancy may indicate or the credulity of the public may make profitable. For, as he can never entirely divest himself of his useful knowledge, the community will have all the protection it is possible for an examining board to furnish.
Some of the general principles of therapeutics are worthy of the most careful preservation. Many of the measures employed in preventing and stamping out various so-called zymotic diseases are fairly successful; and constant research is adding largely to their numbers and potency. The importance of iodine and mercury in certain diseases; the palliative and curative effect of opium in a variety of complaints; the efficacy of Peruvian bark in miasmatic affections; the desirability and possibility of preventing and subduing high temperatures in fevers and inflammations; the wonderful results secured by certain heart tonics; the neutralizing and eliminating measures which
have shortened the term of rheumatism from six weeks to six days; the undiminished power for good of ferruginous preparations in suitable cases; the occasional utility and even saving power of the once abused and now as much maligned venesection; these are examples of therapeutic principles and practice whose truth is attested by countless critical, intelligent observers throughout the whole world.
New discoveries in ætiology, pathology, and materia medica will modify our views and constantly increase our ability to overcome disease. They will show us when to interfere actively, and when to watch and wait. And, while we hold fast to well-founded principles of treatment and to remedies whose value has been established, we give a hearty welcome and testing to every new measure and to every new medicine, which has a satisfactory indorsement. We are hampered by no dogma; so that, while we are not seduced by utopian theories, while we make no experiments with obvious and gross delusions, and while we set our faces like flint against fraudulent pretenses and practices, we carefully consider every promising suggestion, by whomsoever made, and we gladly adopt every useful discovery and every tested new application of old principles and remedies.
Is not this platform broad enough to afford standing and working room for every one who seeks to know and practice truth?
It is fashionable in certain quarters to decry the medical schools of our country, to censure their practice of so oiling their portals that the grossest ignorance can find an easy and welcome admission, to inveigh against their methods of teaching, and to condemn the facile, if not farcical examinations which permit incompetence to seize a title and go forth to prey upon the community. Indiscriminate and unmixed reprobation, however, is not only unjust, it defeats its purpose. For whatever may be the deficiencies of our great schools, however far they fall short of what they can and should be, they have excellences which should not be ignored. They have given to the profession men renowned throughout the world for their
wisdom and skill. In their corps of teachers, are many whose aptness, industry, and ability are unsurpassed. They afford clinical opportunities so rich and varied as to leave nothing to be desired. If their requirements for entrance and exit have been too low, is it not because the profession have not demanded that they be higher? If the terms have been too short, the years required too few, and the methods unnatural and deficient, is it not because the profession have given little practical encouragement to the hearty, even if too speedily abandoned, attempts which some of the schools have made to secure needful reform?
Can it be doubted that the accomplished and devoted teachers in the schools are always ready and willing to respond to any earnest call of the profession for a higher standard ? Shall this call be made? Will those who make the demand prove their sincerity by pledging their influence, their aid and comfort to those schools which, at whatever labor and expense, shall eliminate the faults of the present system and bring it into harmony with the teaching in all other institutions of learning and with the law of mental evolution and growth? That brilliant results have been achieved under the prevailing system of medical teaching, has not been and can not be denied.
Would they not have been still more brilliant and satisfactory under a better system?
The native Ceylonese, with instruments which would hardly be tolerated in an American blacksmith's shop, sits on the ground and patiently fabricates jewelry and filigree which are marvels of exquisite delicacy and beauty. Retaining his present artistic taste and skill, how much more and better work could he do with the perfect instruments of his civilized brother!
The superiority of the graded system of medical training is not universally acknowledged. At least one prominent teacher and one good medical journal openly profess, not simply a contentment with the present unnatural system, but an admiration for it and a desire to have it conserved. The attempts to reduce chaotic elements to order they denounce as impracticable, and they kindly predict and counsel their early abandonment.
Proposed reforms always provoke some opposition. The attempt to introduce into Mexican farming such modern implements as the steel plow, the cradle, the reaper, and the thresher is earnestly combated by many of the native workers. They not only adhere to the sickle and to the old one-handled Palestine plow (an iron-shod stick which barely scratches the soil), and to the threshing-floor, where oxen and mules tread out the grain, but they insist that this clumsy system is the best. They hill their corn as our own farmers did fifty years ago. They use a hoe in the operation, but the hoe has no handle, and the native partly creeps and partly jumps, like a kangaroo, from hill to hill, as he goes through the field. Still he loves and reveres the old ancestral implement. He denounces the handle as a device to promote laziness; and he asserts that, with a primitive hoe in each hand, he can do more and better work. It was only by compulsion that these earnest Mexican conservatives could be brought to use wheelbarrows on the public works. They preferred to carry their loads of stone and dirt on their backs and heads; and such was their devotion to their ancient method, that at first they actually shouldered the wheelbarrow, dirt and all, and then vociferously condemned the new notion as a fraud and nuisance.
Honest differences of opinion should be treated with respect and tenderness. And, since these differences exist regarding medical education, it may not be unprofitable briefly to compare and contrast the antique with the modern system.
Most of you know, from personal experience, that in the large majority of medical schools in this country the student, at the very outset, is expected and required to hear lectures on all the branches taught (the most advanced as well as the elementary) every day. Although not usual, the occurrences to be described are by no means impossible. An ingenuous youth, full of zeal, industrious, ambitious, but with scant knowledge of the elements of the most moderate education, is received without question at the grand old conservative college. He matriculates. He attends a lecture on anatomy, the first he ever beard of this important subject. He is delighted. He