Travel Notes

1905 Journal of the American Medical Association (JAMA)  
In view of the facts which I have presented, in view of many more facts of similar purport which might be presented, in view of the President's manifest and expressed wishes and their complete disregard by the commission, but more particu¬ larly in view of the vital interests at stake, I have the honor not only to submit the suggestion, but really to urge that the time has arrived when the President ought to redeem his word and as!; for the resignation of the commission. I have the honor to be,
more » ... very respectfully, When the great organization plan of the American Medical Association is carried out, the profession will have the power as it already has the disposition and intelligence, ultimately to compel legislation in the right direction. Should this power be wisely exercised, as doubtless it will be, we shall have in operation a plan of general government exactly and impartially suited to the necessities of medical men in the various im¬ portant external relations they virtually sustain to each other and to society. This means the eventual obliteration of interruptive state lines, and that every phase of medicine properly under statutory control will be made uniform in all the states and territories. This epitomization of our future model organ¬ ization, so universally helpful in its provisions and utilitarian in its purposes, is not the idle creation of a dreamer; its realiza¬ tion is clearly within the bounds of reasonable hope and ex¬ pectation, and within the reach and power of intelligent and organized effort. In the furtherance of its plans for a more suitable dwelling place, so to speak, the profession has an imperative duty to perform. With unanimity of purpose, it must build on the solid foundation already laid, a superstructure which shall vin¬ dicate the wisdom, necessity and impersonal authority of .< perfected organization. From the performance of this duty no one should shrink. A perfected organization, however, is not the only means of grace; it does not carry with it the assurances of profes¬ sional salvation. The increased facilities afforded men to do better work under the wiser provisions and uniformity of law. do not insure progress. When every right avenue is legally opened, and every wrong one legally closed, to the advancement of science, it will not of necessity utilize its powers for good in the world, and humanity may be no better off, when the old institutional stumbling blocks to medical progress are finally removed. The development of a profession, like the development of a nation, depends on the character of its individual members, and not on the character of external relations or conditions. Climate does not make the state; the house does not make the home. Individual principles determine the established course of things in both instances. The long use and abuse of power will eventually overthrow disciplined authority, and create general confusion and anarchy in the greatest kingdom of the earth, and a man may gratify swinish appetites in the splendors of a palace, perfect in all its appointments. On the other hand, the austere assumption and rigid exercise of right principles will prevail over a frowning climate and august despotism, just as a soul of lofty genius, scorning trifles and the adventitious circumstance, will work out the great problems of human life and destiny in the squalor of a hovel. These general observations apply with peculiar force and impressiveness to the science of medicine, which thrives or languishes, advances or retrogrades, under the dominion of individual faculties, sentiments and ideas. This fact com¬ prehensively grasped makes it plainly evident that the splendor of scientific achievement is not chiefly a question of organization, however admirable that may be, but of per¬ sonal loyalty to the intellectual and moral obligations im¬ posed on the individual. While, therefore, the structural changes-in our new plan of government are being arranged with so few apparent hin¬ drances, and our standards of intellectual culture are con¬ stantly raised and enforced to suit the increasing demands of scientific progress, would it not be wise and practicable to regard with deeper concern the moral aspects of professional life? Certainly no plan of government, or intellectual pro¬ vision, which dismisses with negative suggestions the great moral issues involved, will ever directly eliminate quackery, prevent the questionable practices of the medical politician, or practically discourage the disgrace and bitterness of petty and compromising personalities. These are moral questions and must be dealt with on moral grounds. Our moral stand¬ ards, like our educational standards, should be compulsory. (Concluded from page 736.) I have the hope that in America certain primarily clinical chairs, controlling, say, 25 or 50 selected patients each, com¬ bined with experimental laboratories, may soon be estab¬ lished. There is room for a medical chair, a surgical ch'air and perhaps for an obstetrical chair of this type. Young men thoroughly trained in physics, chemistry, physiology and path¬ ology, as well as in the clinical work proper, devoting all their time and energy to the work of the wards and the laboratories, supported by special assistants, ought to do much toward making applicable in clinical work many of the facts of the basal sciences which are at present sterile so far as practice is concerned. Such scientific clinical posi¬ tions would, I believe, have a greater influence for good than similar chairs designated by a pathologic or physiologic name. For it is in clinical work-medical and surgical-that we now need most the fructifying impulse of the scientific spirit, the productive results of wisely-chosen, well-directed scientific investigation. During the past four or five years I have given consid¬ erable thought as to the best mode of organization of such a scientific clinical institute should the funds therefor ever be made available. And it seems to me that in such an in¬ stitute, though the director should be a clinical man with unusual special knowledge and skill in the fundamental medical sciences there would have to be the co-operating activity of a number of special scientists. I do not believe that any clinical man, no matter how well trained he is, can at the same time be physicist enough, chemist enough, physiologist and biologist enough, pathologist and bacteri¬ ologist enough, to oversee and direct the work which should be done on all sides of a given problem, with equal cer¬ tainty; still less do I believe that a chemist or a pathologist can, in his spare hours, acquire that immense amount of clinical experience which the leader of such an institute should possess. A group of special workers in the same in¬ stitute is necessary. But the clinician should know enough chemistry and pathology and the chemist and pathologist enough clinical medicine so that the representatives of these different departments of the institute could talk intelligently on and work together toward the solution of the problem in hand. But it will be asked, "Is not the medical faculty of a modern university, taken as a whole, just such an institute as you have in mind?" A moment's thought will show that it is not. The departments of a university and their asso¬ ciated laboratories have their own work, first of instruction and second of original research dealing with the general scientific problems of the special sciences themselves. These Downloaded From: http://jama.jamanetwork.com/ by a Oakland University User on 06/10/2015
doi:10.1001/jama.1905.02500370066031 fatcat:chgytby72fa7xj4z3cfqnmlgda