Under the heading, “Vocation or Avocation,” Dr. George M. Gould, of Philadelphia, lets go a blast in the January issue of the American Journal of Clinical Medicine that is a veritable medical cyclone. Whatever else he is, Dr. Gould is honest and has the courage of his convictions. In years past he let fly at Homoeopathy, but his was a fair stand-up fight, and homoeopathy can stand all assaults of that nature. One feature in Dr. Gould’s latest effort, this time directed  against the high-up “regulars,” is that he holds, as did Hahnemann, that the physician’s highest and only duty is to heal the sick- not fatten on them. The paper is a long one- thirteen pages – but here is the gist of it, and the italics wherever they occur are Dr. Gould’s. (The paper is an address delivered before the Medical Department of the Syracuse, N.Y., University.) This is the beginning:

     “For professional education and medical progress one small medical college, especially if located in a little, instead of a large, city, is worth any two big medical colleges. As a rule, the greater the size of the classes, the more famous the professors, then the more untrue the teaching, the more immoral both teachers and taught. Success, ambition, politics, greed, conservatism, the dirty kind– are more certain to rule the minds and kill the hearts of the men in control of the huge institutions then those of the small ones. This is because the ambitions self-seeker and medical politician chicanes for and gets the professorship.”

“The Rich Should Help the Little Colleges.”

     “The duty of the rich and of the en-dowers is, therefore, to avoid helping the unwieldy and in ethical schools with their (often) ill-gotten wealth; they should help the little colleges. The more the money the less the therapeutics. Everyone who may influence a young man beginning the study of medicine should do his best to keep him out of the big college and to guide him into the small one. The greater the student body, the worse the teaching. The more pompous the professor, the quicker he should be laid aside. The greater the boast of ‘science,’ the more really unscientific. When professors are paid enormous salaries by lay commercial companies, their science is pretty sure to be in science. Did you ever hear of a professor in a huge political medical college making any valuable medical discovery? If you have heard of such cases, did you ever personally know of one? And, according to some of the members of the Council on Medical Education of the A.M.A., three-fourths of the 4,000 annual graduates of American medical colleges are too poorly taught to practice medicine intelligently. The chairman of the Council says 58 per cent. Of those who fail to pass the State boards ‘cram up, and pass the examination a few weeks later. Dr. Ingalls says that out of 150 American medical colleges 144 are to up to standard in their teaching. Possibly he meant the six were the six biggest colleges. If so, I beg leave to differ, absolutely.”

“The Charlatanism of the Strutting Professor.”

     “Of all amusing and yet disgusting things we see every day the most egregious is the fawning upon and adulation of the rich sick and the sick rich by our hysteria doctors and leading consultants. Thousands of these pitiful patients are being ‘rest cured’ out of their money and health with no attempt to learn the causes of their diseases, and with fear that the known causes will become widely known. As a profession we have catered to this gallery-beloved melodrama. Our professors and big-wigs have played the game of strutting before the groundings and of demanding many-thousand-dollar fees for cures that often never cured, and for operations that frequently were unnecessary. The medical profession should long ago have stopped this quackery of $5,000 fees. Every one of us knows it is charlatanism. The science and skill-of the surgeon and the great poseurs is no greater, is often not so great as the science and skill of the family physician who for weeks or months or years combats or conquers the common disease. The brokers and the experts are like unto the ‘great authorities’ and ‘professors.’ If you have a little hoarding to invest, do you ask the Jay Goulds and the Harrimans what to do with it? Whether in finance or in medicine, the safer rule nowadays is not, trust the expert, but is, rather, Distrust him!”

      He next turns his attention to “The Degradation of Specialism,” and this brings up the question: “Is it wise to have killed the family physician?” If you take from him everything from bellyaches to skin disease, “what is left poor devils which the medical. Colleges are turning out at the rate of four thousand a year?” We next come to

“Shall the Professor Pay or be Paid?”

     “Indeed, is it not becoming plain that the functions of a professor in a medical college, and especially in a big one, are so onerous that if he does his duty to the students and the hospital he should not have private practice? There is enough work connected with the hospital to keep him up to the mark in clinical and operative progress. He must read and study more than is usually possible for the non-teacher, and his lectures and instruction should be made over afresh each year. When I was a student we all had the same lectures repeated each year, and we knew exactly to a day and minute when that old story, effect joke, or eloquent admonition would invariably appear. Unless the professor is properly paid he cannot, of course, agree to drop private practice, but he may be sufficiently well paid. In how many colleges, even at present, do the professors pay the institution for the privilege of teaching? That’s the way, in fact, that much private practice was formerly obtained, and is the sorry custom entirely dead? The unimaginable infamy and deviltry not infrequently exhibited in the race for a medical professorship are not outdone even by our ward bosses and legislators.” The nest section is in a manner self-explanatory in its heading.

“Surgery Should Be Appealed to Only When Therapeutics is Impossible.”

     “When I was studying medicine, and also while an assistant in an out-patient department of the hospital, I found my fellow students were always interested in operations. They would crow about the operator, while I was left with the patients who had pain or organs action badly: functional diseases did not interest them much. When I asked what caused the surgical disease I was stred at as in I were ‘cracked’ When I asked if the surgical disease couldn’t be prevented it was evident that I was stark mad. Surgery is the despair of curative medicine, and must be appealed to only when therapeutics is absolutely impossible.”

But this is to-day not the rule.

“Using Your Position to Feed Your Fame.”

     “Not with standing this and without my solicitation I was offered two hospital positions which were avidly sought by others. After accepting one, I found men were using their positions to feed their surgical fame, and that the ‘clinical material’ of hospitals was considered as vivisection material, stuff to practice upon to turn over to the underlings if not wanted by superiors, etc. Indeed, I was advised by my superiors to have the poor dispensary patients come to my office and sit about the halls and waiting rooms to make an effect upon private patients, and the rest. Moreover, I could get some money out of the poor if I worked the affair cunningly. My answer to all that was my resignation! And later I resigned a higher position as visiting surgeon because I found that there was here no attempt at discrimination between the needy poor and those who could pay.

     Dr. Gould next takes up “Common Hospital and College Croft,” and has some horribly bitter things to say, but let them pass. Here is the key-note to much of it- that which isn’t pelf: “Indeed, for a long time, now, the Medusa head of therapeutic pessimism has been peeping out from under the wig of anatomic pathology and medical atheism. The pathologists have long ago settled it that there is really no functional disease, and that it is only our microscopes that are at fault when we cannot discover the bug of senility, the lesion in foolishness, or the tumor in megalomania. The gastrologists practically admit that the surgeons should get their patients after they have thoroughly pumped their stomachs and purses. But at last the neurologists have come into the open and have flung away their wigs. Snakes instead of hair are not pleasant to look upon! ‘Neurasthenia,’ it seems, has ‘passed,’ and with it hysteria- all the thousand forms of habitual peculiarities in many women and children. Such patients, one and all, are simply insane, and there’s an end on’t! What a world, when all but a few Americans will be in asylums commanded by the only sane men, the neurologs! And nobody curable”

“Leaders Do Not Lead, But Oppose Medical Progress.”

One specimen of this will suffice:

“A rich patient recently paid, in all, some $20,000 to have removed, what one of the consultants told me was ‘as pretty a little healthy pink appendix as he had ever seen|’”

Here is a rap at some of the medical journals:

“And these official medical journals- what a farce they are! If any of you are troubled with insomnia or optimism you should subscribe for, say, The British Medical Journal. Such journals are carried on for the benefit of the select few who arrogate to themselves a knowledge which has been outlived, a science which is almost as hopeless as that of Mother Eddy, and an egotism which outdoes that of this wonderful lady. Try to get into the columns of these defenders of the faith an article which advocates progressive advances in medicine, and see how you will be ‘turned down,’”

Here is what is needed:

“What above all needed is physicians who are not afraid of traditional prejudices and entrenched authorities, men who can not be intimidated either by their own ambitions and selfishness or by the tyranny of conservatism and medical politics, medical societies, organizations, or fashions; men who will speak out and act as their own consciences demand upon all professional questions.”

      “Live to your ideals and cure your individual patient in your individual way of his individual disease. And of all unholy stupidities do not believe there is no cure. The cure and the prevention of disease, of most all the diseases which curse our would is possible. Perhaps not by the methods you suspect or have tried, but still, really, by some method.”

“If You Do Not Believe Diseases Are Curable- Get Out.”

      “Over all and above all, cling to the ideal of your profession being a calling, a vocation, from a source higher than the love of success and fame and money. Cling to the idealism and religious purity of your youth, to the love of your suffering fellowmen which lingers in the silent depths of your soul as all that makes your soul valuable and breeds its immortality.”

     Such is the tenor of Dr. Gould’s address. It applies to the “regulars” only, for he does not recognize the homoeopaths, though his cry for curing the patient is distinctly in tune with the belief and practice of the true homoeopath. The whole is a savage revolt against therapeutic nihilism that obscures those who rightly or wrongly occupy the seats of the medical mighty, and a call to the family physician to hold up his head.