PAPERS OF THE HEALTH DEPARTMENT.

I. RELATION OF THE PHYSICIAN TO THE COMMUNITY, AND OF THE COMMUNITY TO THE PHYSICIAN.

AN ADDRESS BY GRACE PECKHAM, M. D., OF NEW YORK CITY.

(Read September 7, 1888.)

Dr. Oliver Wendell Holmes writes: "Medicine, professedly founded on observation, is as sensitive to outside influences, political, religious, philosophical, imaginative, as is the barometer to the changes of atmospheric density. Theoretically it ought to go on its own straightforward path without regard to changes of government or fluctuations of public opinion." Dr. Holmes also shows that when an age is great in literature and art it produces great and learned physicians. In the time of Pericles, of Socrates, of Phidias, Hippocrates, the father of medicine, appeared. At the time when Luther overturned the religious world, Vesalius broke through the old traditions in the search for truths. Harvey, the great discoverer of the circulation of the blood, had Bacon as a teacher and a patient. While Napoleon was fighting his battles, Bichat revolutionized the science of life. The same spirit of inquiry and investigation which animates the students of politics, literature and art at once prevails in science and medicine.

The physician of today is the product of centuries of varying circumstances. Like wind and weather, heat and cold, ebb and flow, acting upon the face of nature, so the community has acted upon him and made him what he is.

Surgery, the elder brother of medicine, was recognized in the early ages when contending nations waged wars against contending nations, and humanity was often wounded in the strife. A wound, external and palpable to the eyes, called out practical methods of dealing with it; but the sickness which came from within and wasted the vital forces was mysterious and hidden, and only to be relieved by an appeal to the supernatural; hence the priests of the people were the healers, and their methods of cure were rites and ceremonies. It was thus the ancient Hebrews

and Egyptians received medical care. Cleanliness and the prevention of contagion were the doctrines inculcated by the priests. The Greeks called in the philosophers as well as the priests to be their medical attendants. Esculapius was the saving divinity. His temples were erected everywhere. His descendants, the Asclepiades, practiced the healing art and transmitted its secrets, compelling those who received them to swear by Apollo, Esculapius, Hygeia, Panacea, and all the other gods and goddesses of the healing art, not to profane its secrets and to reveal them only to the children of their masters or to those who bound themselves by the same oath.

The Grecian community esteemed their physicians. The successful practitioner of those days was voted a golden crown, was initiated with all splendor into the Eleusinian mysteries, and was kept at the public expense. Their lustre and renown illumined their slaves, of whom they kept a number, and these were in demand among the lower orders.

The early Romans believed in the "faith cure" most emphatically, and thought that diseases were only overcome by the direct intervention of the gods. Their first physicians were augurs and aruspices, and their remedies in all cases consisted, for the most part, in religious rites and magical chants. If a plague fell upon them, they instituted dramatic sports; if overcome with a pestilence, they erected a temple to Apollo Medicus. We are told that once on such an occasion they solemnly escorted a serpent, who represented to them Esculapius, from Epidaurus to an island in the Tiber. They deified diseases and offered divine honors to them. But when their ailments increased in number and virulence they employed Greek slaves. Medicine was almost entirely in the hands of foreigners. Cato, who had himself written a book on domestic medicine, said: "If the Greeks impart to us their learning, we are ruined, especially if they bring hither their physicians; they have sworn together to destroy all the barbarians with their medicines." In the time of the Emperors, some physician having been especially successful with these royal personages, obtained for himself and those who were to come after him, especial privileges and honors including the rights of citizenship. Books then were written by physicians, and schools of different pathies had their adherents. In fact, affairs began to assume a

modern aspect.

It was in the Middle Ages that the title "physician," meaning natural philosopher, was first used. At this time the priest was the physician and the barber was the surgeon; a third class came in for recognition in medicine, namely, the apothecaries.

This sketchy outline of medical history is intended further to illustrate how the community has moulded and formed the physician; at times exalting and deifying him, then making him a high priest, next degrading him to a slave and a barber, or calling him a philosopher. Does not this also typify the beliefs held today, by different members of the great social fabric, in regard to the healing of their maladies? Turning aside from regularly educated physicians, some think religion will cure, some think the mind will, some think quacks and charlatans will. The great mass of the public loves quackery and always has. Ignorant of the laws which govern physiology, ignorant of anatomy, setting at defiance all hygiene,- when sick it turns to all sorts of strange gods. The mysterious and the miraculous appeal to the community; even many of the most educated and cultured display a marvellous credulity with reference to subjects connected with medicine. In olden time the people flocked to touch the king to cure them of their scrofula; in the Middle Ages they anointed the weapon which inflicted the wound with ointment, to cure the wound itself. Centuries ago they doctored themselves with the powder of burnt toad, which they would do today if its merits and magical effects were sufficiently blazoned forth upon the housetops and in long letters upon rocks and fences. It is estimated that thousands of children die annually because dosed with quack medicines, and the ailments and afflictions which have followed the inordinate use of advertised nostrums are among the unwritten chapters of the world's history.

Not only do people use these things themselves, but they recommend them to and prescribe them for others, with a fearlessness which is born of ignorance. They recommend the most potent drugs and pass about physician's prescriptions, which are oftentimes very ill suited, to say the least, to the persons for whom they were not intended. This all happens from the laudable desire of the community to relieve suffering. It is a spontaneous expression of good will and fellow feeling, and perhaps an outcome of an hereditary instinct, since in the early ages, when doctors were unknown, it was the custom to carry the sick

upon their beds to the highways leading to the great cities, and there expose them to passers by, who would look upon them, and if they recognized a disease which they or their friends had had, they would tell what had been helpful. It is indeed a cold blooded person who can sit calmly by and hear of aches and pains and not suggest something for relief. "Take this, it helped me when I was feeling just as you do, and I am sure it will help you," is the usual formula employed. There is scarcely a physician who has not seen the evil results of this meddlesome medicine.

The community has its body, its soul, and its estate to look after. Its soul it commits to the clergyman, its estate to the lawyer, its body to the physician. Clergymen complain sometimes of our indifference to the soul; the physician knows we neglect the body; but the world very seldom neglects its possessions, and, in its selection of a lawyer, uses its uttermost endeavor to find one who will show wisdom and acumen. Yet the real, tangible thing which represents existence in this world is, after all, the body. It is the corporeal entity of muscle and bone, skin and nerve, which, at least for this life, so long as I am I and you are you, represents the individual. Without the preservation of its health and integrity, what were the wealth of the Indies? When it is enfeebled, how little enjoyment of mind or soul!

Unfortunately, in the selection of a physician the community are at a disadvantage; since to judge accurately of the merits of the physician would require a special education. Equally is the physician at a disadvantage; since his reputation is in the hands of the community, and his reputation is his stock in trade. It is all that he has; the instruments in his surgical case will get rusty, his medicines will become stale and evaporate, he will be seedy and out at the elbows if the community fail to appreciate him, or with a breath blow away his reputation. It often happens that a physician's reputation is at the mercy of his fellow practitioners. Professional jealousies, though perhaps less fierce in the medical profession than in others, do still prevail; since all doctors are not saints. No words are necessary, when a patient coming from another physician, tells what were the opinion and treatment of his case. An upward turning of the eyes, a spreading out of the palms of the hands, a shrug of the shoulders,- and the patient feels that the worst thing possible has been done for him, and that his former medical attendant if not a fool, is then what is worse,

a knave for giving such treatment. How easily a reputation is destroyed!

A certain portion of the community feels its power in this direction; it vaunts itself of its judgment, and says:- "You must employ my doctor." Over two hundred years before Christ, one Archagathus, a free born Greek came to Rome. He allowed the sick people to partake of their favorite dishes and drink wines. His popularity was immense, and the Senate conferred upon him the gift of citizenship and an apothecary's shop; but then he took to giving bitter medicines, and his treatment was severe, and, if we can believe the ancient historian, he was on this account stoned to death. You see it is but another illustration that the community wish to be doctored according to their own notions. The physician too, often meets Madame Dill, the subject of this witty epigram:

Madame Dill does not hesitate, in her turn, to pull in pieces the reputation of the doctors whom she has whimsically set aside, or other people's doctors. How she lifts her hands, as she says: "Poor old Mrs. So-and-so! She did not live out half her days! I do not care what others think,-I know Dr. B. killed her." Madame Dill knew neither the name nor the nature of her friend's malady. With equal readiness does she extol Dr. A., because successful in the simplest exhibition of professional skill that could be given.

I am far from intending to convey the impression that the community never metes out justice to a physician; but I do wish, most emphatically, to call attention to how easily a reputation is destroyed, how unjustly, how recklessly it is done.

In the days of the Puritans, the offices of physician and clergyman were often united in one individual, and both offices were held for a life time. We are fast getting out of the good, old-fashioned way of having a family physician who knows each individual of the family, and his peculiarities. He knows the diseases which have occurred, and the effects they have left upon the system; he