Address in Medicine

JAMES F. GOODHART
1901 Boston Medical and Surgical Journal  
FRIENDS IN COUNCIL. To be honored by the request to give this address before the British Medical Association is an opportunity that comes only once in a man's lifetime. How shall I utilize it ? It might be thought perhaps that an almost unlimited scope is here given to the lecturer, but in the selection cf a subject there are indeed several sharp limitations to his choice. In the first place, it being an address in medicine, the only thing that I must not lecture upon is medicine in detail. In
more » ... cine in detail. In the next place, as I understand it, this is an occasion on which in some measure we sit in open session ; when men other than medical have in years past sought and found topics of common interest in the subject-matter of the address ; and then the lecturer himself is in, to him, a unique position ; for once in his life he becomes for the moment, at the invitation of our great brotherhood, the mouthpiece aye, even the priest sometimes, if he be happily inspired of the temple of our most sacred longings, of our strongest feelings, our highest aspirations. Is not he then indeed under the most strict of limitations to whom it comes, to have to put as a duty, with all the authority that such an opportunity offers, his view of the position of medicine at the present day, of its weakness or its strength, as it enters into the life of the English-speaking peoples. There is, however, this much of freedom in my choice : " For what can a man do that cometh after the king, even that which hath been already done." Many of you must have often thought and said before what I shall say tonight, but I conceive that to express the concensus of your thought, to " watch what main currents draw the year," is the duty upon which you would wish me to embark. The position of medicine, then, today as I see it is this : The living body, the clay between the potter (the doctor) on the one hand, and the wheel (the blind guidance of animal life) on the other. The living body ! Think of it, if you can, with that freshness and plasticity of mind, that awful wonderment, that first came to you when out of the darkness you first began to peer into your dawn, and think about the phenomena of life. Think of it brain, spinal cord, heart, lungs, and so on. All separate, yet all one. All separate, so that each has its individual wants, each its own special food which it needs to draw selectively from a common stockpot (I beg pardon of our juices), each with its own methods of work and times of rest ; each so individual that if you take the imprint of one's finger creases, the intonation of man's speech, the general character of his handwriting, and no doubt, too, if one could take it by some unconscious graphic ¡method, the action of our muscles, the flow and method of one's thought, and so on, there are probably in the whole universe no two living beings exact in counterpart. I take this to mean that if we could see into the minute details of the working; of the machine, not only that no two men thin k alike, but no two men have hearts alike, as "expressed by function ; no two men have a liver that pours out its bile exactly alike ; that is, at the same rate and in response to exactly similar impulses, or in which the ultimate elements are not individualized. There are, of course, certain rough results which have to be obtained as a necessity of the organic combination. Without some universal gauge the machine could not work, and the body with its respective organs would perish; but I take it that though these results are common to us all, the function that produces them is as much different and peculiar to the individual as the varions impulses and motives differ in men and women whose output of action is a common one, and directed to the good of the body politic. THE VITALITY OF LIFE. And yet all our parts are one. So absolutely one that it is impossible to suffer bad pain in two separate parts of the body at the same time one comes and the other goes. So absolutely one that when you think hard your feet grow cold, so one that when one member of the body suffers, ail the members suffer with it ; so one that the temporary failure to lock or unlock the points at the many junctions and sidings will disarrange the whole. So much so that to any thinker sufficiently detached from himself it may well seem that the harmonics of the song of life are so extremely intricate as to be impossible of performance. And yet the song of life is sung, and on the whole to most of us the result is beautiful. And then behind all, or rather before it, is this curious unfathomable mystery, " the boon of life." " I needs must live," the body seems to say. Sonic cynic asks where is the necessity. But that is life, or all we know about it. The " needs must " live, an unconscious, blind, unquenchable energy that carries on the being irrespective of his will, and which, blending with his conscious will, renders the clay at once so plastic, and yet, too, at one and the same time so unimpressionable. Ah, that living energy, let me dwell upon it a while, for it supplies the motive of much that is to follow. As yet we know it not, whence it cometh or whither it goeth, but at least this may be said of it : that it rolls on from the cradle to the grave dominating the man with an absolute domination; and of it he is in some measure the unconscious slave. Take the case of a man who is so extremely ill that you think there is no hope. You turn your back and he recovers completely. Instead of saying there is no hope it would have been nearer the mark to say that man cannot die, so dominant is that force in him that called him 1 Read before the annual meeting of the British Medical
doi:10.1056/nejm190108151450701 fatcat:cmjo3ocoybcfvdu5s3qqn7hlsa