< c cc .< " C C c J^ <2 c c *? ■ <- «T ««cr * c C cT- *"C~ CC «1<-C ^ < ^5 c c « ■K_ c<- «. < JDC '• * Bel f c c >C «C < ' ^km^. c ' < t ^^SKL. c c* * < .c <<: X ^^~~ l c < c ^ •>, c c "r HI "?Etcc< 4t*r' ct 5= T' c< cc<< •< '•:*.'<:s- c^. A* r 70Q'OQOQ''OQ., PRESIDENT OF THE SOCIETY. PUBLISHED BY REQUEST OF THE SOCIETY. it to Hi* i New Jterk: BAIL LI ERE BROTHERS, PUBLISHERS No. 440 Broadway. 1863. J52v 1663 Associates of the Westchester County Medical Society :— At our annual gathering two years ago, when last I was privileged to meet with you, the government of our country had hardly commenced its life-or-death struggle with armed rebellion. True, a small portion of the country's militia force had been called into service to defend its threatened capital, but we none of us appreciated, as we do now, the ordeal by fire through which we were anxiously to pass. Soon, however, the echoes from Manassas compelled the reluctant belief that something more than a summer cam- paign awaited the national arms, and in the extent of re- newed preparation we saw it demonstrated that of national, as well as of individual life, it is true, that all that man hath will he give for it. The communities in which we dwell, have shared the sacrifices common to all the loyal populations, and have cheerfully given their sons, mayhap to die, so that surely the nation might live. This society has in the army, no trifling representation in posts of high professional responsi- bility. Nordquist, on the Rappahannock, and McMillan in Mississippi, have each a reputation as efficient staff surgeons, in which we, their brethren, may well feel pride. I do not offer to you to-day a consideration of the mani- fold lessons which, as citizens of the republic, or as Christian men, we have been reading through these two past years, but suggest rather, that, aside from our concernments, as mem- bers of the body politic, we have, as a professional body, a special interest in the experiences of this war, whereinsoever 4 they tend to educate the people in the laws of health, freshly illustrate them to medical scholars, or issue in reforms that increase the acquirements and promote the dignity and honor of the profession, which are so closely connected, more closely than most men will allow, or even all of us venture to claim, with that which is the measure of our value as a pro- fessional body, the physical progress of the human race. These experiences are doing their educational work. The private soldier who learns that fever is bred of uncleanli- ness, and the absence of ventilation to his overcrowded tent, is likely to infer that the same conditions will induce simi- lar diseases in his untidy home up the populous back alley. To intelligent soldiers, and you know how many such are enrolled among our legions, army life demonstrates the truths that personal uncleanliness and foul air, and damp- ness, and bad cooking, and mental depression, and badly policed camping grounds, and inadequate clothing, and in- temperauce regarding food or drink, all invite disease, and when they return to the more congenial pursuits of peace, they will from thousands of centres propagate these hygienic truths. The regimental surgeon, who finds that, by the use of pro- phylactics, he is able, in a malarious region, to protect the men under his care against miasmatic diseases, is very sure to carry home the conviction that the sallow inhabitants of the valley of his residence have hitherto been the unfortunate victims of ignorance. He who sees that gravely wounded men, compelled, by want of transportation, to be treated under the trees nearest to the spot on which they fell, or in rude sheds open at the sides, get well in larger proportion than their comrades who receive the protection (?) of ceiled 5 walls—sees that pyaemia and erysipelas and gangrene are more rarely found among them—will not forget the lesson when some severe casualty of civil life shuts up a single patient in his home, to await the doubtful issue ; and he who reads aright the lessons in practical surgery, which every battle-field furnishes, will learn so surely, that in no lifetime can he unlearn it, that, now only by prompt opera- tion, and now only by refraining from operations which half of his peers would deem essential to recovery, can he earn the position sought by his laudable ambition, can he claim to be the truly conservative surgeon, his haste and his slowness alike conservative of human life. Thus, the army is an educator as to the conditions of health and recovery, alike to the rank and file and their medical officers. Yea, even the pioneers of scientific medi- cine have found, amid the convulsions of war, new illustra- tions of their almost prophetic enunciation of truths, once perhaps deemed only assertions, now freely received as axioms. In considering the influence of the war on the popular dif- fusion of hygienic truths and the advancement of scientific medicine, we cannot fail to observe the operations of the organization that has done and is doing much for both—the Sanitary Commission. I do not suppose that any of you have shared the impres- sion, sometimes encountered, that its function is chiefly to dispense to disabled soldiers articles of hospital food and clothing supplemental to the governmental supplies ; but I think that I may, perhaps, with advantage, fill a portion of the hour, in calling your attention to those features of its work which entitle it to consideration to-day, while we are discussing the influence of the war on that branch of liberal culture to which we have devoted our lives. 6 Passing by, then, with only an allusion, its works of direct beneficence to the soldier; its succor to him on every battle- field where the national armies have been engaged, and in every hospital where the nation's sick are gathered, asking no questions as to the state whence he came—enough that he enlisted to preserve the national life ; its careful transporta- tion of him in steamers made comfortable by liberal expendi- ture, or in hospital cars with fittings so nicely adjusted by scientific skill, that shattered limbs are hardly aware of the motion ; its maintenance for our armies, east and west, of accurate Hospital Directories affording freely to the soldier's friends information as to his location and condition; its es- tablishment of Homes, or Houses-of-call, for him in the principal cities at the rear of the army, to which, on his dis- charge from service, or while wending his way home on fur- lough, he may resort and receive gratuitous assistance in securing his pay, his pension papers, or mayhap obtain, for a few days, needed rest and medical attention ; its securing for him to his own home through tickets at reduced rates of fare, sending with him a tender nurse, in many instances, where his strength seems hardly equal to the fulfilment of his strong desire to once more look upon the faces of his dear ones ; its schemes to prevent our invalided soldiers becoming after their discharge a pauper class—passing these and a thousand simi- lar ministries of benevolence of which the summaries alone would weary you, should I attempt their statistical recital, I will attempt to answer your fancied questions : What claim has this Commission aside from its humane purposes and its benevolent agencies on the regard of phy- sicians ? What more is it to us who cultivate scientific medicine 7 than a model express company for our Soldiers' Aid Socie- ties, or a judicious almoner of our individual bounty? The Sanitary Commission appeals strongly to the approval of medical men, in that it has so steadily from the inception of its trust, inculcated the importance of the observance of the laws of hygiene. Recognizing from the beginning of its career the great truth that preventive medicine out-ranks in importance both alleviative and restorative processes, it has steadily promulgated it, in many publications, and by the urgent voices of its medical officers. " A Treatise on Hy- giene and Therapeutics," by two eminent members of the New York Academy of Medicine ; a compilation of " Rules for preserving the Health of the Soldier;" a monograph con- taining the conclusive evidence of the prophylactic virtue of the sulphate of quinine in warding off miasmatic disease; a tract of advice on camping ; another on the value of vaccination to armies—are specimens of what it has attempted through the press. These have been circulated to the extent of many thousand copies by the Commission's agents, to medical and military officers, to non-commissioned officers and privates. Meeting the requirements of its charter from the President of the United States, which constituted it a " Commission of Inquiry and Advice in Respect to the United States Forces," it has in all our armies set on foot a series of in- quiries almost exhaustive in their range, touching the many relations of hygienic law to life in camp, in bivouac, and on the march. These pertain to the character of the camp- site ; the arrangement, drainage, and cleanliness of the camp; the character, ventilation, and arrangement of the tents; the bedding and clothing of the men ; their personal cleanliness ; the quality and source of the water; the character and abun- 8 dance of the food, and the manner of cooking it; the recrea- tions and discipline of the men; the provision of the camp hospital; the sickness and mortality existing, or recent, etc., etc., to every condition, in short, that has an ascertained influence on the health of men in armies. These inquiries are made, and the facts sought for are gath- ered, by medical men, selected for their intelligent familiarity with the applications of hygienic laws, their tact, and their qualification for independent observation, so that their eyes and ears, and the inferior organs, even, of taste and smell, may correct and modify inaccurate, partial, or wilfully false state- ments of careless or reluctant informants. This system of minute inquiry has a two-fold object : First, to communicate information on subjects vital to the welfare of the army in an inoffensive way. The brigadier or colonel, who is asked whether military or sanitary considera- tions determined the selection of his camp-site, will not be likely, when next he chooses a camping-ground, to plant it, unless a military exigency so require, on the leeward side of a swamp or in a damp wood. The major, who is asked if the drains about the tents and through the camp are wide and deep and straight, and kept free from rubbish, will get an idea, if he never had one before, as to the importance of drainage. When the company captains are asked if they, or any of their subordinate officers, look after the ventilation of the tents at night, if they are struck at short intervals, for the thorough cleansing of both the canvas and the site, they are made to feel that these things are important; and when sub- altern officers and privates see careful inquiry made as to their habits of personal cleanliness, and the cleanliness of their 9 camps, regarding the water they drink, and the character and cooking of their food, concerning the sufficiency of their clothing and bedding, and the healthful conditions of their rest, they are incited to attend themselves to what seems to give so much concern to others, and henceforward can hardly fail to think more of the influences affecting health. Even the regimental surgeon, if not instructed, is often re- minded of neglected duties, by the detailed inquiries made as to the regime of his hospital, or his efforts to avert dis- ease from the whole command. The second object of this scheme of thorough inquiry is, the accumulation of a body of physical and medico-vital sta- tistics, which shall be susceptible of analysis, and form the basis of generalizations which unhesitating science shall utter as laws for solving many of the problems of military and state medicine. For, so long as man is a reasoning being, civil and military hygiene cannot be separated; or, rather, as they are based on the same underlying principles, the gain to the one of new laws and new experiences soon finds its appli- cation in the other. This constantly-accumulating mass of facts is submitted to careful revision, comparison, and analysis, by a skilled actuary of repute, through his previous contributions to science, even with European statisticians, and is already furnishino- mathematical demonstration of the effects of the observance and of the violation of the laws of hygiene, thus providing the most secure foundation for a code of pre- ventive medicine. You do not fail to see how much sci- ence is likely to be benefited, as series of facts accumulate, and new laws are, by careful generalizations, educed from them. This actuarial work of the Commission is also extend- 10 ed over the data afforded by the records of the adjutant-gen- eral's office and that of the medical bureau, which, from the official and confidential relation existing between the govern- ment and the Commission, are freely open to it. The Commission has called into its service, or, rather, has claimed the service for humanity, of distinguished medical scholars and writers, for the preparation of practical mono- graphs on the diseases, or surgical injuries most liable to arise amid the vicissitudes of war. The names of Flint, and Metcalf, and Mott, and of the present Surgeon-General of the United States army, Brigadier-General Hammond, assure you that work intrusted to such men is not feebly performed. The sixteen monographs already printed have received a wide circulation in the army, and, besides their immediate benefit, can hardly fail, in due time, of a reflex influence on public health. Another method in which the Commission is applying its resources to promote a knowledge of applied science, is by sending to each of the United States general military hos- pitals in the country, a surgeon or physician of recognized distinction, and wide experience in hospital management, who has had practical acquaintance with the needs and the deficiencies of hospital construction, who is familiar, as with his alphabet, with the conditions which invite disease or prolong convalescence, whether pertaining to construction and interior arrangement of the buildings, to the regimen or professional treatment of the patients, or to external circum- stances, as the vicinage of swampy grounds or the neighbor- ing nuisances of a populous suburb. You receive the names of Bowditch, and Buck, and Draper, and Post, and Reid, fallen, alas! at the post of duty, as those of experts whose 11 judgment must be influential with the chief of the medical bureau, could he avail himself of it. It was on consulta- tion with Surgeon-General Hammond, and by his advice, that this corps was engaged, six being kept in the field, successively, east, west, and south, and their reports, or the portions of them calling for remedial action or making recommendations, are by the chief of the corps, Dr. H. G. Clark, well known as a scientific sanitarian, transmitted in confidence to him. This inspection will prove of advantage not only to the occupants of the ninety thousand beds in the hospitals thus visited, in effecting improvements in hospital architecture and management, but by the final publication of such portions of the reports as may properly be given to the public, new light will be thrown on many points of hos- pital economy, and fresh illustrations be supplied of the laws of sanitary science. The medical profession, in common with the whole country, have reason to thank the Sanitary Commission for its suc- cessful efforts to promote a reorganization of the medical bureau of the army. I doubt whether all else that it has done will bear as much fruit for science as this. When the war began, the requirements of law provided that the senior surgeon of the army should be the Surgeon- General, an arrangement that was liable to result in placing at that post an officer whose chief qualification for its varied duties of large responsibility was a good constitution care- fully preserved. There was no bureau of medical inspection established by law, nor any legal requirement in this corps for its maintenance. There was little incentive, aside from natural taste, considerations of pride or conscientious impulse, to professional improvement, or especially zealous devotion 12 to duty. Promotion, being by seniority of service, could not follow as a result of high qualification, nor, after the junior officer had passed his examination for a surgeoncy at the end of five years' service, was it retarded by incompetence or sloth. The tendencies of the system repressed the prompt- ings of professional ambition and favored contentment in the dry path of old routine. It was no merit of the system that so many medical offi- cers rose above its debilitating influences, and made for themselves and for their corps a reputation going far to justify, by scientific attainments, as well as by manly and honorable bearing, the designation I once heard applied to them by an officer of another staff—" the corps d'elite of the a:my." The commission felt that such a system was inade- quate to the demands of the country—that the highest talent and the most interested devotion should be given to the dis- charge of the multiform duties of the medical bureau. It urged its views upon the President, the Secretary of War, and upon Congress, and brought to bear on legislators, the organized sentiment of thoughtful men throughout the coun- try. It met the objections of Prescription and Routine, and pointed out a more excellent way than ever their feet had trodden. By the influence of Public Opinion, moulded and organized and directed by the Commission, it is not too much to say, Congress, in April, 1862, passed a bill which, approved by the President, became law on the 16 th of that month, and which introduced new features of the greatest value into the organization of the medical bureau. Besides increasing the number of officers in the lower grades, it added an Assistant Surgeon-General and a Medical Inspector-General, with the rank of colonel respectively, eight 13 Medical Inspectors, ranking as lieutenant-colonels, and pro- vided that these officers—as well as the Surgeon-General, who ranks as a brigadier-general—should be hereafter selected for merit and eminent qualification from the whole number of medical officers in service, whether of the regular or volunteer army. This is the first instance, so far as I am aware, in which legislation inspired the ambition of members of the medical staff, by associating their efficiency with the rewards of a laudable ambition. The assistant surgeon, ranking as lieu- tenant, could heretofore only expect to attain a captain's rank at the end of five years. Five to seven years more found him enjoying a surgeoncy, with a major's dignity, and there he felt that he must abide during his whole army life, for few men could rationally dream of surviving to a septuage- narian enjoyment of the only colonelcy, when he should be- come the senior surgeon and so Surgeon-General. A striking illustration of what was to be expected from the new law was given nine days later, when the President commissioned Assistant Surgeon William A. Hammond to be Surgeon-General of the army. It is well known, I believe, that the Sanitary Commission urged this appointment, but not on personal grounds, for only one of its members had ever seen him when their decision was reached that this would be the best appointment possible. But they presented his claims to the President and Cabinet, from his well-known devotion to science, his energy and executive ability, his com- prehensive view of the great questions sure to arise in the administration of his office, and his evident readiness to meet boldly great responsibilities. His administration has justified the selection. He has introduced liberality and promptness 14 into the purveying department of his bureau. He has greatly enlarged the supply table ; has substituted for old hotels and seminaries, airy and ample hospital buildings, conformable to improved architectural models ; has raised, by providing more rigid examinations, the scientific standard for admis- sion into the army medical service; has sought legislation to enlarge the hospital fund, to improve the system of nurs- ing, to provide for more extended inspection of camps, bar- racks, hospitals, transports, and stores ; to establish a legal- ized and humane system of ambulance, and to render, by other enactments, the corps more efficient and the system more complete. By these efforts, by the just exercise of discipline, by his encouragement to scientific investigation, his fostering of army medical societies, his establishment of a museum of pathology, and his detail of accomplished members of the medical staff, to write the medical and surgical history of the war, he has kindled afresh, in the medical service, a zeal and an esprit-du-corps which can hardly fail to reach an enthusi- asm noble in its aims, and, to scientific progress, fertile in result. It is barely a year since the medical bureau was fully re-organized by the President's appointment, and their con- firmation by the Senate, of the corps of Medical Inspectors, the prime helpers of its Chief in securing an exact knowledge of the field before him. But the experience of this year in- dicates the increasing gain likely to accrue to science from this measure of reform. For, under such guidance, reform is not likely to go backward. Let us thank God and take cour- age.* * For its influence on scientific progress, not less than from its sense of justice, it is to be hoped that Congress will, hereafter, open still wider 15 You may, gentlemen, have deemed my language extrava- gant, when I named this service of securing for the medical bureau of the government its present organization as the chief claim of the Sanitary Commission upon the regard of medical scholars. But a consideration of the fact that, with- out this, all else that it proposed or executed would have been narrowed in its extent and influence, or rendered of no effect, will, I think, justify me to your judgment. Thrice happy may we be that insane jealousy and blind misunder- standing come not confusingly between the President's com- missioners and his chief medical officers, to render inharmoni- ous their common work for the republic and for science. I have thus, gentlemen, called your attention to some of the relations which the present war and its attendant de- velopments bear to the progress of our science. Adopting the sentiment of a recent French writer, who has somewhat pithily said, " War is a sanitary problem," can we even by the aid of such a forerunner, expect with the final crowning victory of our national arms, to see the statue of Hygeia set up among us, upon every high hill and under every green tree ? No ! we, her Priests, shall have to preach other crusades before that coming day. But whether in the order- ing of His Providence, striking at treason against the polit- the door for meritorious service in the medical staff to win the honors of promotion. The service cannot hope to retain, after the close of the war, its best medical officers, unless, equally with the other staffs of the army, it receive, for distinguished service, the recognition of increased relative rank ; and, during a period of war, a just government ought not to dis- criminate against those who, from patriotic impulses, cheerfully serve it at a discount. I hope, also, that this reform will be offered as justice, rather than granted as a boon to importunate applicants. 16 ical government ordained for us of God, or at rebellion against His code of hygienic precepts revealed to us by reason, we can not fail, as we steadfastly move on, to reap the ennobling rewards which always flow from hearty public service. Illations of t\t Mar to gjtbital Sritnu. THE ANNUAL ADDRESS DELIVERED BEFORE THE WESTCHESTER CO. [N. Y.l MEDICAL SOCIETY, JXJ3STE lSTH, 1363, BY J. FOSTER JENKINS, M . I) .. PRESIDENT OF THE SOCIETY. PUBLISHED BY REQUEST OF THE SOCIETY. 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