The Widening Sphere of Medicine

1909 Boston Medical and Surgical Journal  
In accepting the honorable post of Shattuck lecturer before this Society it was with no idea that I could adequately comply with that part of the provisions of the bequest which stipulates that the incumbent should discuss historically or otherwise the climate of this commonwealth or the diseases of its inhabitants. The foundation wisely allows a broader outlook over the field of medicine than would be possible under these rather limited conditions, in that other subjects are permitted, " such
more » ... permitted, " such as," in the words of the bequest, " the said Society or its government may select." This permits me to draw your attention to certain matters of significance in the present condition of medical practice and medical education, which perhaps should be of special interest in this State, which has long stood for progress in intellectual affairs. My purpose, therefore, in what follows is to point out and attempt to estimate the significance of various well-defined tendencies in present-day medicine. In such a consideration the following facts demand our attention: First, the rapidly widening scope of medical theory and practice, with its new and unique opportunities; secondly, the apparent apathy on the part of men of promise and varied attainments to undertake medicine as a career; and finally, the possible explanation of and remedy for this seemingly anomalous state of affairs. These are all questions which should claim the earnest attention of those who have the welfare of the profession at heart and are viewing with interest and perhaps anxiety the curiously complex situation which is now presented alike to students, teachers and practitioners. The beginning of a profession is difficult to define ; it is commonly lost in myth and allegory, and becomes a definite factor in history only when a group of men so far impresses itself upon its contemporaries as to gain a definite hearing and prove the right of its ideas to continued existence. With few facts and much theory as a basis, such an infant profession must quickly assume a defensive attitude and be ready to meet the inevitable assaults of its detractors. The field is at first small, methods are naturally crude, empiricism prevails, a narrow point of view is encouraged if not cultivated. From such an origin the profession of medicine has grown to its present estate. Its vicissitudes have been many, and in its survival have descended the traits of its infancy and youth its frequent narrowness of outlook, its strict adherence to an arbitrary ethical standard, its jealousy of outside influences and a skeptical attitude toward innovation of any sort. Though primarily concerned with other interests, the development of theology, for example, has been entirely similar. The crudities of the early years have given place slowly and grudgingly to the liberalizing tendency of recent investigations. If we are at times impatient of conservatism in medical matters, it should not be forgotten that the strength of medicine, as of theology, lies in this spirit of intolerance to new ideas until they have demonstrated their worth. What has been accomplished for theology by the application of critical methods to the problems of interpretation has been done for medicine by the scientific revival of the last century, with its insistence upon demonstration as opposed to speculation. If the man of science has been slow to recognize the reality of other than material facts, it has been because the time was not yet ripe for the application of such knowledge, and certainly not because the scientific method was wrong and the speculative method right. This is perhaps a fitting time to analyze in some measure the conditions which have led up to the present perplexing phase of medical theory and practice, and, laying aside the somewhat complacent attitude of satisfaction at things accomplished, to see wherein the profession is failing to meet in fullest degree its opportunities and responsibilities. It is altogether superfluous to repeat the story of the discoveries which have rendered possible the relative success of modern medical and surgical practice. Ether, antisepsis, bacteriological research and the triumphs of the scientific method in general have been the theme of too many addresses of this character to permit their further exploitation. These factors in progress are recognized, and no added word before a gathering of medical men could fail to be superfluous. If we look rather at medicine as it is, we are forthwith impressed with its widening field, with the fact that whereas medical practice a few years ago was narrow and set about with definite restrictions, it is now broad and acknowledges no limitation in its methods of alleviating human suffering, whether of the mind or the body. It now ministers to groups and classes as well as to individuals, or, in the popular parlance of the day, it has become preventive as well as curative in its ministrations. In a recent notable address before the Aesculapian Club of Boston, former President C. W. Eliot, of Harvard University, drew forcible attention to his favorite theme of preventive medicine.1 Out of his experience of forty years of close association with the problems connected with the teaching of medicine, he was able to say: " I have seen an immense development of the natural forces and powers which can be applied in medical and surgical practice within the last fifty years, and the sight of the changes which have been has taught me that the changes to come will be still more prodigious. There is not a single subject now taught in any good medical school of the world which is taught in any considerable degree as it was fifty years ago, -not one." And further on in the same address, after referring to the widening recognition of preventive medicine:
doi:10.1056/nejm190907081610201 fatcat:type7t2ng5he5dsfukyhoeghs4