President's Annual Address.
J. C. HUBBARD, M.D., OKLAHOMA CITY, OKLAHOMA
Sixty-four years ago a body of far-seeing, courageous men of medicine joined their individual efforts in formulating the organization which we now represent. There were no national organizations with a leadership strong enough to attract the majority of physicians practicing in America. With the exception of the American Institute of Homeopathy, organization in medicine was in a chaotic state. Practice also was crude and purely empiric, while scientific medicine, as we know it today, was practically an unknown quantity.
It was obvious that if medicine was to progress and keep abreast of the times and become of real value, the time had come for the strong-hearted, progressive medical men of the day to organize themselves and dedicate that organization to the fulfilment of the ideal in medicine. The National Eclectic Medical Association was organized and today marks the completion of sixty-four years of splendid service to humanity.
The experiences of the past have taught us the value of honesty, courage, industry and devotion. In many periods during our career as an organization we have been faced with crises that appeared, at the time, to be insurmountable, but these crises were met with courage and overcome, and the fruits of our labors rewarded. We have weathered the storms of ignorant and vicious criticism from the outside together with the petty jealousies and sectionalism within our own ranks, and have always arrived a stronger, better and more valuable organization. Due credit for these accomplishments is given at this time, earnestly and without reservation to those great men who have laid down the burdens of this life and passed to their rewards, as well as to those who are yet with us, lending their enthusiasm and counsel. We, of this generation, appreciate the untiring efforts, the devotion, foresight and industry of those who have brought this heritage to us to enjoy and use. We place high value on the privilege of having a part in carrying on the splendid work of this organization.
We can not live on the valor of those who have gone before; nor is security for the present and future insured in the memory of the achievements of the past; but we can take our inspiration from the deeds of those who have brought our organization up to this time, and do our duty for the present and plan for the future.
We are facing rapid and tremendous change in our social, business and professional life; in fact, every department of human conduct of pure necessity is forced to adapt itself to this change, and we, Eclectic physicians, are not exceptions to the rule. We must with courage adapt ourselves to the new conditions in order to keep pace with necessary social changes thrust upon us in rapidly changing time.
The problem of the present is fundamental and must be solved if we are to continue as the Eclectic Section in Medicine. We must choose between being absorbed by the dominant section, our professional activities dictated and controlled, our policies subject to the approval of an unfriendly, prejudiced, self-constituted authority, and soon lose our identity as the Eclectic Section of American Medicine, or adapt ourselves to the general social change and retain the old Eclectic values of individual freedom of thought and action, independence in practice and the right to use that which has stood the test of experience in our service to mankind.
If we are to retain the heritage passed on to us by our Eclectic fathers, we must purge ourselves of the cowering fear of prejudicial criticism that comes from the uninformed and vicious contingent of the majority section in medicine. Rather should we listen to the voice of suffering humanity calling for physicians to relieve pain, restore and maintain health and efficiency; for institutions of intelligence and understanding dedicated and standardized for the purpose of rendering service.
Opportunity spreads before us like the unfolding rose. We can reach out, grasp it and use it. Or, in our imagination fear the thorns of criticism on its stem and cower and back away. The decision is ours. Shall we continue to go forward as leaders or follow the procession as a pitiful, tolerated minority? We can no longer run our institutions and meet modern competition in a modern world with antiquated and obsolete methods.
We are agreed that we are a minority—that we are honorable, that our integrity is unchallenged, that our ability is equal to the best, that our service to mankind is of distinct and unchallenged value, that for the past century we have dedicated ourselves to the progress of the art and ethical practice of scientific medicine; that we have held up the family physician and medical advisor as a standard and that our contributions are as valuable to organized scientific medicine as that of any other group of like number.
If the foregoing is true, is it not incumbent upon those of us who are to carry on for a few years the burden of this organization, to more earnestly lend ourselves to the advancement of those virtues peculiar to our group?
The one great thing that distinguishes man from others of the animal kingdom is his ability to adapt himself to the continual change about him. He has conquered the air, the depths of the sea and pushed back the mystery of science and made practical use of his discoveries. It is our responsibility—yours and mine—as individuals to reassert the old courage under new conditions, using new methods and go forward regardless of the opposition we may meet, and it can be done. Under stress of necessity, man can accomplish almost the infinite as has been demonstrated many times in this organization.
The association and the Eclectic physicians throughout the country for the past number of years have suffered from anxiety, neurosis and lethargy. Their pride and heritage has almost been lost to them. Many in our ranks have felt that the work of our group was finished, that it would be easier to join the majority and forget the struggles of the past. Others have felt that there was no use to fight on in the presence of apparent overwhelming odds; but again, as in the past, the courage of our leaders has asserted itself and we stand on the threshold of a "new deal" in Eclectic medicine.
Some thirty years ago, before the Flexner Committee, there were 168 medical colleges in the United States. From this number of colleges approximately 5,000 physicians were graduated yearly. Scholastic attainment as a preliminary requirement to enter upon the study of medicine was not enforced; there were no standard medical curriculi, but moral character, adaptability, physical and mental capacity, were necessary in order to meet competition in the medical world. To be a physician was a high honor and it was necessary in competition with others to maintain a reputation unchallenged, and moral and ethical conduct were prerequisites for successful practice; and, although the lack of standardized curriculi and the prevalent empirical teaching were deplorable, the people demanded and received men of character and good reputation as their doctors. It was during the period prior to the Flexner Committee that the great family physician was produced—that great soul whom everyone loved and adored and turned to with confidence. Almost from that date has the honored family physician been gradually "passing out of the picture," being replaced by specialists created by methods of mass production and concentration.
Let it be understood at this time that no criticism of standardization for the development and teaching of scientific medicine is meant, for no one appreciates more fully than I the wonderful advantages of standardized curriculi which forced the discarding of empiricism. But, with the advancement of standardization, economic and social abuses have forced themselves into the picture which tend to lower the morale and shatter the ideals of the profession. The physician of today is not required to be a man of high character with a reputation unsullied as a citizen and gentleman. It is not necessary that he hold unsullied the honor of the profession. Rather the requirements appear to be solely pure scholarship and definite skill in special fields of practice. These economic and social abuses that have developed together with the advance of standardized medical teaching have to be faced and solved, and we of the Eclectic group can well devote much time and energy to the solution.
I am old fashioned enough to believe that in our "new deal" in Eclectic medicine by looking into the work of the past we can find the solution in the selection and preparation of those who are to carry on the work of this organization after we are gone.
For the moment we will look at the condition of medical education as represented by the majority group, dictated by their central authority in Chicago and followed reluctantly, I hope, by their educators.
They have adopted the policy of drastic forced reduction of medical graduates by raising economic and material barriers preliminary to the study of medicine, by enforcing the rule of pure scholarship, by padding the pre-medical and pre-clinical years of study with courses that are of no value in broad fundamental education and have no bearing upon the study and practice of practical medicine, and by arbitrarily failing a certain percentage of each of the pre-clinical classes, following an apparent unwritten agreement among themselves.
A large portion of the first two years of a medical students life is spent in the study and investigation of irrevelant and unnecessary material with no sound reason except to create an obstacle for him to overcome. This serves to render the mind of the medical student chaotic and also kills initiative, the one great virtue, which should be the key of every medical practitioner's armamentarium. The present-day medical student for the first year lives in mortal dread and becomes an abject slave to his instructors for fear that he may be "busted." He realizes that there is an unwritten agreement among medical educators to fail 20 or 30 per cent. of each freshman class. He is forced to determine and report the "pH of Pigeon Blood" the chemistry of "rabbit dung" and spend hours upon the fanciful hobbies of men who know nothing and are untrained in the practice of medicine. The same conduct holds good for the second year where the student is burdened constantly with unnecessary and impractical courses, always living in fear of being expelled, not for an infraction of the code of honor, not for any fear of criticism because of his moral or ethical conduct, but for fear of his lack of attainment of pure scholarship in subjects which have no actual bearing on his chosen vocation in life and no value in broad fundamental education.
During the clinical years, the initiative of the student is further clouded by the long periods of assignment to duties of the technician and clerk. He is held in a state of absolute discipline wherein he is not able to use his own faculties nor apply his previous training, but is forced to become a servant looking for and finding the peculiar hobbies of his professors. Original thought and action is discouraged, he becomes a "boot licker" for those set over him and after his graduation he knows nothing whatever about the art of medicine. His next enforced step does not help. He goes to an approved hospital for a year to serve an internship, still doing the meager and minor duties of an orderly. He is not allowed to assume the responsibility of using his own mind and can not place himself in contact with the sick public as a physician. Finally, we have an individual who has spent seven to eleven years after graduation from high school in preparation for the practice of medicine, with initiative and independent action practically destroyed, unskilled in the art of medicine with little or no training in humanism or social science, with a vague idea as to the duties of citizenship and, in most cases, ignorant as to the functions of his government. He is just a highly trained, fundamentally uneducated specialist, wholly unfamiliar with the common problems of life and the social and mental causes of disease.
Compare the foregoing with the time-honored American Eclectic method where fundamental preparation and broad education are emphasized through an understanding, personal preceptorship that lends confidence, encourages initiative and promotes individual responsibility. Add to this the modern requirements of an understanding of the liberal arts, sociology and citizenship, a thorough technical training in the art and practice of modern medicine. where character, common honesty, moral capacity and industry are enforced as prerequisites to graduation. There can be no question as to which method to choose.
The opportunity is ours—our nation is calling for physicians in contradistinction to the specialist. Let us produce educated physicians, men of character and understanding who will not stoop to cunning as a measure to success; who, as physicians, do not need a fence of material barriers and enforced reduction of graduates as a defense against the competition of their colleagues, or the inroads of the narrow cults in healing. Let us feel secure in our "duty well done" and feel the responsibility of our trusteeship for the future. Let us be honest with ourselves and know that we need only to maintain our ideal to be successful.
The "new deal" in Eclectic medicine means a consecrated movement looking toward the permanency and individuality of our institutions. We must set a standard of medical education and preparation, truly Eclectic in character and embody within it the ideals of our association. Let us unite and support a standard of medical education that will insure the people the best trained, educated physician attainable. Let us rededicate ourselves to the ideal standard of American Eclectic teaching and not swerve from it regardless of the storms of opposition which we may encounter. Our requirements must be equal to the best, but beyond this we must require character and fundamental education. Let us build now for those of our group who are especially adapted to the work and assure them the privilege of broad research. We need not fear opposition or criticism if we carry on our ideals under the new conditions using new methods to meet the new changes of the rapidly moving modem world in which we live.
The time for decision is facing us. Do we still retain the courage of our Eclectic conviction ? Have we the bravery of a Scudder, King, Howe, Ellingwood or Lloyd to carry on to completion the glorious work planned and fostered by those great pioneers? Or will we listen to the voice of their enemy and cower in the face of "the bugaboo" of opposition and continue a pitiful, tolerated minority—a small alumni association of a second-rate medical school of practice, foredoomed to lose its identity and be destroyed in the jaws of the moloch of high finance and selfishness in medical education and practice? The choice is ours—the broad field of unobstructed opportunity lies before us to retain and foster individualism in education and practice essentially Eclectic in character, which our pioneers bought at the sacrifice of popular acclaim, social and professional ostracism and handed to us as our heritage and birthright.
National Eclectic Medical Association Quarterly, Vol. 26, 1934-35, was edited by Theodore Davis Adlerman, M.D.