THE President’s Address--Eyolittion of Medicine. HENRY 0. MAECY, A.M., M.D., LL.D., BY PRESIDENT OF THE ASSOCIATION. OF BOSTON, MASS., Delivered at the Forty-third Annual Meeting of the American Medical Association, at Detroit, Mich., June 7,1892. Reprinted from the “Journal of the American Medical Association,” June 11,1892. PUBLISHED AT THE OFFICE OP THE ASSOCIATION 1892. CHICAGO; THE President’s Address—Evolution of Medicine. BY HENRY 0. MARCY, A.M., M.D., LL.D., OF BOSTON. MASS.. PRESIDENT OF THE ASSOCIATION. Delivered at the Forty-third Annual Meeting of the American Medical Association, at Detroit, Mich., June 7,1892. Reprinted from the “ Journal of the American Medical Association,” June 11, 1892. CHICAGO: PUBLISHED AT THE OFFICE OF THE ASSOCIATION. THE PRESIDENT’S ADDRESS —EVOLUTION OF MEDICINE. HENRY 0. MARCY, A.M., M.D., LL.D., OF BOSTON, MASS. History repeats itself. Generations come and go and the problems of life are outlined from age to age in the same general way, since the underlying factors must ever remain unchanged. Each individual life modifies in a degree, both in character and quality, the sum total of human existence, and the kaleido- scopic pattern of the present offers new problems, and intensifies the interest in each succeeding year. The wise student profits by the history of the past and draws inspiration from its pages, as he confronts the present and with earnest endeavor shapes the future. In this spirit we convene to-day from every part of our great continent, and devote our entire session to the consideration of the fundamental questions of life. In the egotism of the present, we often underesti- mate the wisdom of those who have labored before us, and in our generation this has been especially true in medicine. When we recount the victories won and the enormous strides in scientific attain- ment within the last two decades, we may well be proud, but we must remember that a more careful study of the lives and labors of the really great of every age reveals a just comprehension of much that 4 we claim as modern, and perhaps as our own indi- vidual discovery. The American Medical Association holds a posi- tion among the great medical societies of the world in many ways unlike that of any other. Born of a felt want among the members of a profession widely scattered, in a comparatively new and imperfectly developed country, it struggled along in the weak- ness of its infancy, conquering the disadvantages of great distances, compassed by comparatively slow, tedious, and expensive means of travel. In no profession is it perhaps more true that the physician, in the large share, is the representative citizen, and no matter how devoted he may be to his profession, he ever manifests a deep and earnest interest in the body politic, of which he is an inte- gral part. Under the stimulus of the civilizing and develop- ing forces of the present, the activities of life are intensified as never before, and wherever the Ameri- can citizen determines his residence, he immediately looks about him to ascertain in what way he can become an active, formative factor, and paints with roseate tint the horizon of the future, in the confi- dent belief that the new settlement is soon to be the town, the town the city, until the broad acres of unproductive pasture are mentally divided into cor- ner lots and, by some mysterious, unknown influence, populated by the leaders in the great subdivided interests of the world of trade. In close touch with the magnetic, electric influence of modern thought, it would, indeed, be the exception if the devotee of our art did not thus at once hold himself a co-worker upon terms of equality with his medical brother, no matter how favorably situated in the great centers of an older civilization and development. Indeed, he sometimes feels, and with reason, that there come to him advantages in his new surroundings which cannot pertain to the older conservative centers of thought and training. Why should not this be true? Less closely allied to the dead past, closely in touch and sympathy with the burning ambition of the enthusiastic spirit of the living present, no problem seems to him impossible of solution, since the press keeps him in touch with the world, and for him modern science shall work out greater marvels than the miracles of Sacred Writ. The early founders of this Association planted better than they knew, although he whom we shall always be glad to style the father of the American Medical Association, Dr. Nathan S. Davis, may well be called the seer and prophet of our profession. I voice with you a common sentiment may he long be spared to wield, as from the first, his dominating influence in this great National Organization. It was wisely enacted that our Association consist, in large degree, of delegated membership, since this makes it, as by no other plan, a representative body, and, as such, it is not too much for us to claim that we stand as the exponent of the medical thought and progress of our noble profession, represented in the United States alone by a membership of nearly one hundred thousand workers. Modelled in a considerable degree upon the con- stitutional principles of our popular Government, we are supposed to recognize the wants and necessities, and, from year to year, to be able to outline and, in a measure, formulate the ever-changing needs and requirements of the public welfare. Such an organization must have its own inherent law, styled “ Our Code of Ethics.” While you and I accept it as simple, sufficient, only determining in a very general way what constitutes the proper rela- tionship of the members of a great profession to each other and to the body politic, it has been for many years, and is likely to continue, a question of discus- sion upon which there is a difference of opinion among honest and able men. The laity refuse to 6 accept this as any other than a stupendous joke, with the criticism, “ When doctors disagree, who shall determine?” and regard the differences between the so-called schools of medicine quite in the light of the denominational lines in the Christian church. A closer, dispassionate view, however, clearly shows that the differentiation must be made alone between ignorance and knowledge, since it is only fair to grant that considerable classes of men, devoted to a common calling, must be adjudged alike honest, and that their own selfish interest, in the attainment of success in any given profession, must be determined by the adaptation of what they consider the best means to a given end. Judged from this standpoint, the question has no parallel in the world of theologi- cal belief, since the medical scientist is dealing with objective factors, now certainly in sufficient number largely to eliminate the unknown quantities in the earlier problems presented by disease. Formulated as axiomatic in its written law, the profession for centuries has welcomed every addition of fact by which mankind maybe less the sufferer from disease. But the warping of the judgment by conservatism and prejudice has oftentimes in medicine, as in the allied professions, retarded rather than encouraged independent original observation and research. Judged in the light of our present knowledge, it certainly does not require prophetic vision to deter- mine the lines of our future professional progress, since they must be based only upon scientific data. Such development, in no uncertain tone, means the abolition of ism and pathy, and there will be intro- duced in their stead, a more or less accurate inter- pretation of scientific laws, as to what constitutes the treatment of disease, of which year by year, there is the constantly increasing demonstration that the mere administration of drugs, no matter how valuable, is the least important part. The evolution of thought, first applied in a given 7 narrow direction by the founder of the so-called Homoeopathic School of medicine is an admirable il- lustration of modern progress. Born in a measure as a protest to indiscriminate heroic dosing with powerful drugs, based upon a wild theoretic fancy, it owes its present existence largely to two factors. The first and by far most important, an unreasoning pre- judice in the minds of a narrow conservative medical leadership, which by a kind of dogmatic ostracism persistently scouted the whole scheme as too prepos- terous for serious consideration, and hence aroused the active sympathy of the public for an ostracised minority, “ as for the under dog in the fight,” the critics themselves forgetting that in all diseased pro- cesses, nature is the physician’s best ally,and that the sick do often recover without essential medication. The second, a wise appreciation of the advantages obtained by public sympathy and the determination to make the most from a haughty supercilious as- sumption of superiority by their critics. Under a competent leadership, from a handful of disappointed unsuccessful men, there has developed the most popular Homoeopathic school of medicine, with a four years’ graded course of instruction with restrictive critical examinations in all the fundamental branches of medical science, until the Homoeopathic part is re- duced to a mere addendum to the section of materia medica, almost as attenuated as the dilutions which, at its inception, it recommended to the credulity of its followers, a shadow of a name, a trade-mark in medicine. A free government has its faults, its weaknesses. Under the fear that the individual right of the inde- pendent citizen will be interfered with by restrictive legislation as to who shall be considered competent to administer to the wants of a suffering public, laws regulating the practice of medicine, long recognized as necessitous in the great European governments, have slowly been enacted in most of the States of the 8 Union. When under State or General Government law, it shall be determined upon examination that men have been competently trained in the know- ledge of the chief branches of medicine, few of the five per cent, contingent, calling themselves Homoe- opaths will be content to remain so denominated, while the great body politic of our profession should institute measures to make it easy for such men pro- perly educated to enlist in the grand army of workers devoted to unbiased investigation and the practice of scientific medicine. “ The blood of the martyrs is the seed of the church,” the opposition even to a wrong is oftentimes the method by which it is developed into a monstrous evil. Note the different course of treatment which this ism received in Europe. The great Universities opened their doors to a willing demonstration of its real value and challenged the proof of its superiority in the treatment of disease in its general hospitals. The chairs of its professorships are vacant, and he who would learn of the development of the new art must come to the modern Athens of America, where the corner-stone of its temple was laid in the chambers of our Superior Courts of Justice by our own profes- sion, who thus thought to destroy by legal enactment that which alone could feed on opposition. As the indirect outgrowth of sectarian medicine and its influence upon the profession, in a general way, we have the anomaly of the New York State Medical Society, for so many years the supporter of this Association and foremost in its councils. Under the leadership of men who openly declared that the future progress of our profession demanded the abandonment of restrictive rules of polity, the very State Society from which the National Association emanated has withdrawn from affiliation with the general association upon the plea of restrictive and burdensome regulations,limiting official consultations to be held only with physicians properly educated. 9 In order that the American Medical Association might be free from any possible criticism of a narrow or illiberal spirit, the following resolution was unani- mously adopted at its annual meeting in 1885 : “Resolved, That clause 1, of article IV, in the Na- tional Code of Ethics is not to be interpreted as ex- cluding from professional fellowship, on the ground of differences in doctrine or belief, those who in other respects are entitled to be members of the reg- ular medical profession. Neither is there any arti- cle or clause of the said ‘ Code of Ethrics’ that inter- feres with the exercise of the most perfect liberty of individual opinion and practice.” We cannot question that this is in the true spirit of liberalism, and it should be accepted by the most radical expounder of the theory of evolution in medi- cal ethics. During the present year, I have made most careful study of the question in its various as- pects, especially as pertaining to New YqrkCity, and without exception I have heard only universal depre- cation of the present society relationships of the pro- fession, coupled with the pronounced opinion that the times were ripe for early re-adjustment and res- toration of harmony. It had been my confident be- lief that this year would have seen this much desired state of affairs consummated, and to have had in any degree an active part in the bringing about this re- sult would have been considered by myself the great- est honor pertaining to the high office to which you have elected me. I can only advise moderation in your councils, believing that at a very early date, harmony will be restored, and the medical leaders of our great commercial center, almost of necessity the most influential teachers of our country,will be with- out exception in active co-operation with the National Association. However, the evil which we deprecate has had a resultant good in the formation of the New York State Medical Association composed in large share of active workers in this organization, and 10 which has adopted as a part of its organic law that, “ the Code of Ethics of the American Medical Asso- ciation shall be the Code of Ethics of this Associa- tion and shall form an integral part of their By- Laws.” This large body of active workers in our profession have already established a permanent society home in New York City, with a large medical library, and a beautiful hall for the accommodation of its meetings. The eighth annual volume of its transactions has recently been published, containing nearly seven hundred pages, consisting of many valuable contributions upon original investigations and research. The society has upon its roll of mem- bership, seven hundred and forty names. In a free discussion upon the subject with its leaders, as with those of the New York State Medical Society, I did not find a single individual who did not deprecate the existing division in the profession, and who would not welcome any honorable means by which reunion could be effected. The rivalry of the society inter- ests has stimulated both to the increase of scientific research, until the fruitage of each is greater than that of the society before its division. Ihe Relation of the American Medical Association to the General Profession in America.—There has arisen, even among the warm supporters of the American Medical Association, the inquiry if the larger service of the organization to the profession at large had not been accomplished, coupled with- the criticisms : that our country is far too great, and extending over too much area for any one central body; that the devel- opment of our art has grown beyond the possibility of personal compass; that this is the age of special- ism ; and that the evolution of the medicine of the future must of necessity be in the hands of the special societies devoted to the perfecting of certain lines of investigation. In the recognition of a common want, there have been formed National Societies, limited in member- 11 ship, covering all the special branches of medicine and surgery. Under the leadership of a few master spirits, it has been thought quite sufficient to bring these special societies together at repeated intervals under the attractive title of “The American Congress of Physicians and Surgeons.” All this personally meets my approval, when we consider the stimulating and refining influences of men meeting together bound by the common tie of special study and re- search. In the fruitage of such union of labor, the profession may well rejoice, but I cannot help think- ing that such an argument is founded on a false con- ception of our profession and its duties and relation to our life work; since, regardless of the specialistic: development to which we may subsequently attain, we must all begin upon a common level and master with greater or less fidelity and patience, the funda- mental branches of medicine, and he who does this well and perfects himself most broadly and deeply in a general way, in practice as well as theory, finds himself subsequently the better fitted for specialistic labor. In the general field of medicine the great rank and file of the profession must continue to work, and as the Representative Body of this vast army of workers, the American Medical Association, without fear or favor, must continue to be its exponent. Here, as upon a common altar, the most obscure may bring his offering, and find inspiration which will help him subsequently to develop into a leader in some one of the many fields of specialistic research and contribute to the resources of his profession in such away that we gladly entwine about his brow the laurels of immortality. The names of nearly all the great leaders of the American medical profession are engraved upon our own escutcheon, and he who recalls such men as Sims, Gross, Flint, Storer, Bow- ditch, Campbell, Richardson, Sayre, Davis, and a host of others, both dead and yet living, regards with a commendable pride the relationship and power which 12 these illustrious formative leaders have had in this great National Association. Let there be no jealousy aroused between the National Societies of our country. The field is large, the work is ample, and many there be who are thoroughly competent to labor in their respective departments, and yet remain foremost in State and National Organizations. The American Medical Association has its own peculiar and legitimate field of work; at touch with the great body politic which it represents, it is quick to receive and to reflect the latest and the best from whatsoever source it may emanate, and to it the entire country, for its labors in the promotion of the highest welfare of the nation in the scientific department of medicine and its allied branches, owes a debt of gratitude which it can never repay. Relation of the Association to the State Societies.— It has been my good fortune during the present year to attend several of the annual meetings of the State Medical Societies, and note the earnest work which is being locally accomplished. Although everywhere the privilege for associate labor in the National organization is recognized, the interest which the respective State Societies manifest, in this direction, is lacking in a general way, and very few compara- tively of their members, especially from the Eastern States, attend our meetings. The State Societies were intended to be, in fact, branches of the National Organization, and as such each should work together in harmony for the good of all. A unification of the State Medical Societies as integral parts of the Amer- ican Medical Association would go far toward mak- ing easy the solution of many questions by concert of action, and I would respectfully suggest that measures l;»e at once instituted for the development of a much closer relationship between the State and National Societies, and that the request be made to every State Society that the dates of their annual 13 meetings shall be arranged so as not to conflict with that of the National Association. I have long depre- cated this in my own State, where the annual meeting of the Massachusetts Medical Society occurs in June, the same week in which the Association convenes. It would be well also, if it is within the limit of our power, to stimulate the State Societies to a more general active cooperation within their own boun- daries, and I refer, as an illustration of this, to the Massachusetts Medical Society, with a present mem- bership of over seventeen hundred, who devote two days to the annual meeting and close with a grand banquet, at which more than one-half of its entire membership are in attendance. In this way much could be accomplished in increasing and strengthen- ing the influence and power of the medical profession and making its opinions felt in an ever-widening influence in our national polity. Journal of the Association.—The Journal of our Association has already advanced to a position of influence, second to that of no other medical publi- cation in America. With a circulation of over six thousand copies it is now a source of independent income. Under a wise leadership and editorial man- agement it has steadily improved and gives promise of a much greater development. It should be a weekly interchange of thought and the distribution of the latest and best, at a very early future, to a membership of three or four times its present num- ber, an ever increasing bond of union between our members, with whom it should be the pride, as it is at present within our power, to make it the leading journal of the world. Our Annual Meetings.—The best disposition of the limited time at our disposal, at the annual meeting, has recently been a subject of active discussion. Much valuable time is wasted in our general sessions in the discussion of questions of minor importance. It seems to be within the nature of things, if you 14 would arouse most earnest discussion in an Ameri- can convention, to bring up some minor clause of a by-law, upon the differences of which there will be found ready champions to fritter away hours in use- less debate. To this criticism our organization has often been open, but happily less at each succeeding meeting, until now the especial addresses have justly become a noteworthy feature of the latest and the best. Section Work.—We are glad to note the persistent effort which is being made for the better develop- ment of the Section work, along the lines of which the really great good comes to the profession from our Convention; not only is this noteworthy in the large number of very valuable original communica- tions, but equally in the discussions which they evoke. Every encouragement should be given to the still further improvement of the Sections, and I earnestly enjoin upon all our members to come to the annual meetings with the purpose of spending, as far as possible, the entire week, that we may take time for our deliberations, and, by our example, offer an earnest protest to the great American fault of hurry, which too oftentimes is a synonym of imper- fect work. Dr. Leartus Connor, of this city, gave a vigorous address last year before the Section of Ophthalmology, in the advocacy of better work in the Sections, which' should be read by every member of the Association. If in any department of learning deliberation should be encouraged, it is certainly in that of the great issues of life with which we must necessarily deal. In this connection, it is not invid- ious to make reference to the objects and interests of that other National body which has just closed its ses- sion in this city, the American Academy of Medicine, which we believe has acted wisely in holding its meeting in conjunction with that of our Association, the objects of which are antagonistic to none, and should receive the cordial sympathy and support of 15 all. It has already accomplished much in elevating the standard of medicine in America, by demanding a more careful preliminary education and thorough training, and by its influence and power, it has aided largely in establishing State Examining Boards and having laws enacted for the protection of the people from incompetent and ignorant practitioners of med- icine. In the furtherance of this work our Associa- tion, without dissent, should earnestly enlist, and demand from each individual member of our profes- sion fitting qualifications for the discharge of the highest responsibilities in the welfare of our race; and that, so far as possible, the great body politic be instructed that their vital interests shall be protected from ignorance and imposture. We cannot but deprecate the too frequent publish- ing, in the daily papers, of sensational reports of start- ling operations performed by men who are justly famous operators. This parading of their skill, served up with all the ghastly horrors of the imagi- native reporter, may be conducive to a cheap notoriety, but it is certainly false to every sense of propriety and professional etiquette. State Medicine.—Within the last few years State medicine has assumed an importance and magnitude never before appreciated, until it is now admitted that a very general class of interests incident to the public welfare should be relegated to men especially trained in the various departments of Sanitary Science, and it is not too much to believe, in the early future the citizen will demand of the State, as one of his inalienable rights, no matter how poor or obscure, or where located, that he shall be able to breathe an air free from infection, to live upon an uncontaminated soil, and be furnished with water ample in quantity and of a quality free from defile- ment. Under the restrictive laws of such wise supervision, the infectious diseases will be curtailed, and it is to 16 be hoped ultimately they will be stamped out of existence. In this connection I would call your attention to the great public necessity of the revision and re-organization of the so-called Coroner Laws in the different States, a subject upon which, as chairman of a committee appointed for this purpose, I have for several years made annual reports in extenso to this Association, pointing out clearly many defects of the existing system. The different State Boards of Health feel the necessity for immediate action in the correction of this, perhaps the most defective of all our methods of securing justice, a want which the legal profession recognize as much as our own. This, as well as the question of expert testimony in our courts of justice, as to who shall be considered com- petent to discharge this important branch of public service, are subjects well worthy of your early and careful consideration. Intemperance.—This generation, as none other, has witnessed the discussion of topics of great moral re- form, prominent among which is the question of intemperance, until, under an aggressive leader- ship, were it possible many would abolish the very law of fermentation. It has assumed national importance, in many localities placing the distribution of intoxicating liquors under legal control, and we now behold a political party as its outgrowth, with an active organization which would assume national supremacy. Many of our own profession are found within its ranks. This is not the place to discuss the question of temperance, or its political issues, but no class of citizens are so well qualified to instruct the public upon the uses and abuses of intoxicating liquors as the members of our own profession, and in this direction a greater responsibility rests upon the physician than upon any other citizen. I am glad to commend to your favorable support the organization of our own frater- 17 nity for the study of this subject and the best methods for its suppression. We are indebted to them for the demonstration that intemperance should not be regarded as a vice, but rather as a disease, and that appropriate measures should be instituted for its cure. Dr. T. D. Crothers, of Hartford, is a vigorous advocate of this modern view of intemperance as a disease, and shows by ample statistics that more than one-third of all who have been the inmates of asylums for the treatment of the intemperate, have remained permanently cured. “The curability of the inebriate is far more certain than that of the insane, the liberty of both is equally dangerous; one is recognized, the other is seldom restrained until he becomes a criminal. * * * The inebriate is men- tally and physically sick and needs the same help as the insane, and the question of care is simply one of adequate means and remedies to reach the disease.” One of the most remarkable phenomena, widespread as the human race, disseminated alike among savage and civilized, is the demand for artificial stimulation. The maddening influences of drink and its attend- ant crimes have already been greatly lessened, but diminished as are the uses of the stronger alcoholic preparations, in a somewhat corresponding ratio that of the lighter wines and malt liquors have increased, while the consumption of tea and coffee has enor- mously outgrown that of any previous time. Men struggling under the felt power of alcohol are never without a desire to find relief, which fact has been singularly overlooked, when adjudged from the stand- point of bad-habits and the intemperate zealot who would correct them. Whatever may be thought of the imposture and illusive hopes of “ The Golden remedy,” the hundreds of intemperate men who, in the last year, have voluntarily sought relief in it attest the fact that the victims of this great evil desire a cure, and they should legitimately turn to 18 our profession and find under their wise administra- tion, its mastery, as that of any other disease. National Board of Health.—The advocacy of a National Board of Health is no new subject, in this Association. It seems but the corollary to the prop- osition in the organization of our governmental polity, that, if State Boards of Health have proved so efficient in the protection of the great public wel- fare, a National Board of Health would be equally necessitious in dealing with questions of widespread and general importance to the whole government, as also in the centralization and dissemination of valu- able knowledge. It has been urged with reason, and I trust also it is soon to be carried into effect, that not only such a wisely selected Board of Commis- sioners should be reestablished by the general govern- ment, but also that it should find its exponent in a specially appointed member of the Presidential Council to be known as Secretary of the Public Health. A committee was appointed by the Associa- tion last year to petition Congress for the establish- ment of a Department of Public Health with a chief Secretary, which will doubtless report at this meeting. In the United States such an organization is not only more necessary than that of any other country, on account of its wide-spread geographical area and population, existing under more diverse conditions, but also because the medical officers of our govern- ment in both the Army and the Navy Departments are much less in number than those of the European nations. However, great honor is to be accredited to our country from the very valuable services of the medical corps of both the Army and the Navy to which that of the Marine Hospital Service is no exception. We are deeply indebted to the American Public Health Association for the exceptional work which has been accomplished under its auspices in the advancement of sanitary science and the prac- tical application of public hygiene. Its publications 19 have proved a very efficient means for the dissemina- tion of valuable knowledge. In 1879 a National Board of Health was appointed consisting of seven members, selected by the Presi- dent from civil life, and four ex officio representing the Army, Navy, Marine Hospital Service and the Department of Justice. For three years this National Board had an active existence, and I have yet to hear any serious criticism of the very valuable work effected under its direction. Yet under the plea of economy, appropriations were denied and little is left of this public service except a name. Although we cannot criticise too severely the action of our government in this direction, we have little to blame except ourselves, since the public are not edu- cated to recognize its occult and unseen foes and are necessarily dependent on the medical profession for the dissemination of such knowledge. During the last decade it has been demonstrated as never before, that the causation of most of the infectious diseases that sweep over the country are particulate vital organ- isms, which infect the individual, reproducing to a possible harvest of death. Such knowledge makes clear certain outlining of rules for precaution and prevention, upon which are based the so-called Quar- antine Laws against the invasion of foreign pesti- lences, as cholera, yellow fever, etc. This is really a small part of the public service in the protection of the community. A National Health Department must be neces- sarily in part educational, and the diseases which cause the great harvest of death in a community, as diphtheria, typhoid and scarlet fever, and consump- tion are pests which the public have a right to de- mand of the government should be held in control, and it is not too much to believe that the foreshad- owings of modern science point to their ultimate extinction. No greater economy can be exercised by our people than the endowment of such a Board with 20 every needed scientific appointment, with fully equipped laboratories for the careful study of all the sources of disease, which shall take in the surround- ings of the individual and the means best adapted for his subsistence, so as to make him in the largest possible degree a healthy working member of the body politic, contributing his full share toward the public welfare. In effect, everything dependent upon the develop- ment and continuance of a long life of the individual should fall legitimately within the scope of inquiry. Upon demonstration of the need, no nation is so quick to respond and utilize its advantages as our own, and the real remedy must be found, not in com- plaint concerning the government when compared with that of other nations, where the enlightenment of the few serves to direct the conduct of the masses, but rather in the dissemination of knowledge broad- cast among our people, and if each member of our profession would avail himself of that which is already known, and instruct those with whom he comes in daily contact, in a very brief period, in answer to a popular demand, emanating from the people, educated to perceive their great need, the advance in sanitary science in the United States would surpass the wildest dream of its present most enthusiastic devotee. The Department of Agriculture.—The department of agriculture of our general government has been most efficient in the public service and has contributed to its welfare far beyond what has generally been sup- posed. As a broadening of its field of labor, a bill is now pending in Congress introduced by Senator Pad- dock, of Nebraska, which has for its purpose the pro- tection of the public from the adulteration of food products and drugs in the United States. It is an important subject, an effort made in the right direc- tion, for the protection of the people from stupendous frauds and imposture, resulting in great injury to 21 the community, oftentimes fraught with the gravest dangers to life, and it should meet with the heartiest approval and active support of our entire profession. The food products presented for sale in our markets should be reasonably safe for public consumption, as assured by government inspection. It is now demonstrated that our milk supply is often the means of dissemination of typhoid fever, and of the bacillus tuberculosis. The diseases of our domestic animals require much more careful study, and the public necessity demands that the meat of only healthy animals should be per- mitted to be sold for consumption. The wise restrictive legislation of European Gov- ernments, interdicting the sale of non-inspected meat, has been the subject of many public protests in our country, and the appeal to the necessities of our commercial interests appears to demand the inspec- tion of all meat products for exportation. It is but just that our own citizens should be in this direction equally protected, as those of other nations, with whom we deal. Tuberculosis may be transmitted to man by the ingestion of tuberculous meat. Other diseases, as the transmission of the tape worm and trichinae are illustrations much better known. Dr. Abbot, Secretary of the Massachusetts Board of Health, informs me that since the middle of Febru- ary more than fifty cases of trichinosis infection with five deaths, have been reported in Boston. He gives it as his belief that at present a considerable proportion of the pork offered for sale in the Boston markets is infected with trichinae. The Massing of the People in our Cities.—The pres- ent is a generation of city builders, and in our own country our great centers of population have been intertwined within a half century with nearly 200,000 miles of iron ways, distances so vast that they can be appreciated only by com- parison ; more than sufficient to bind the continent 22 from ocean to ocean by eighty great highways of rapid travel, or, if projected in a single line, quite long enough to reach the moon. This wonderful system of steam communication has in its service a great force of workmen, a moving army in time of peace, ever subject to exposure and danger. This large factor of the body politic demands of our gov- ernment a special supervision to minimize, as far as possible, their perils. The ease of inter-communica- tion has greatly increased the movements of our ever restless people, while the demands of trade alone has organized under its banners an army of three hun- dred thousand professional travellers. Few of us can appreciate the activities of the present age. The railway systems of the United States alone have ex- pended in the last ten years, in their development, an average annual sum of five hundred millions of dollars. In the year of 1889, in our country alone, one religious denomination erected over four thou- sand new churches, an average of over eleven each day. “Put them in line on the first day of January, when the sun went across the country on the light- ning limited at the rate of a thousand miles an hour, his light would have fallen on a new church roof every third second as the sunrise flashed over hill and dale.” The complex questions of city living are ever becoming more and more difficult of solution. Can a million of people be massed together, and each live better, accomplish more, suffer less, and lengthen their existence? It is given to you alone to answer the question in the affirmative. Our Relations to the Medical Profession in Foreign Countries.—ln geometric ratio with the years our influence in the great body politic of the medical world increases. That which, a generation ago, seemed like the wild chimera of a scheming brain, an International Congress of Physicians and Sur- geons, has been now ten times triennially repeated, 23 and the influence of each International Medical Con- gress has deepened and intensified. The day may be far distant when a universal language, now the Utopian dream of many, shall see its fulfillment, but in medicine it is an accomplished fact. No longer is its science written in the language of the few and buried in ponderous tomes for the resurrection of the coming centuries. Any discovery of real value almost at once, after its publication, is read through- out the civilized world. Wherever medicine is the better taught, there gather devoted students. In large numbers our representative youth are found in the great medical centers of learning in England, in France, in Germany; and even far-off poverty- stricken Italy is resuming again something of her former prestige and the mantles of the great masters of the sixteenth and seventeenth centuries are fall- ing upon worthy shoulders of the sons of this present generation. The relations of our Association with the great Societies of Europe have been in unbroken harmony until within the last two years. We have been delighted to receive from and send delegates to all the foreign Societies, and the unflagging interest and devotion of the American physician to his profession was illustrated in the enrolling of over six hundred and fifty delegates from the United States to the International Medical Congress, held in Berlin, in 1890, the largest number representing any nationality, excepting that of Germany. The great majority of these were delegates from this organization, a very considerable number of whom were also sent as dele- gates to the British Medical Association, which held its annual meeting in Birmingham. Unfortunately, many of these felt themselves deeply aggrieved at a seeming neglect on the part of the local committee. By vote at the last annual meeting, the appoint- ment of delegates to the British Medical Association wTas left to the President and Secretary General, with 24 full powers. My first act as your chief executive was the presentation of the subject to the Council of the British Medical Association; a copy of the cor- respondence is herewith appended. The result is all that could be asked and is embodied in the following resolution: “Resolved, That the President of the Council he requested to inform Dr. Marcy that it is not proposed to deprive of any rights they may have acquired those American citizens who have been elected members of the British Medical Association, but as such elections have been found to be illegal, no more can be permitted to take place. Further, that the honorary membership of the Association is only given honoris causa to a few specially distinguished persons by vote at the Annual Meeting of the Association. And lastly, that the officers of this Association will always be pleased to receive and show every consideration and hospi- tality to all properly accredited American visitors.” The International Medical Congress to be held next year ip Rome, already gives promise of renewed activity in the medical world of Europe, while ener- getic measures have been instituted in the Western Hemisphere for a successful meeting of the first Pan- American Congress, to be inaugurated in our own country the coming Columbian year. If our nation fulfills its apparent destiny, the early future will see no longer the necessity of our advanced pupils mak- ing European pilgrimages for original research and study in foreign languages, but the rather that our own great centers of learning will be selected as the Meccas of the best modern thought, where students of all nationalities shall gather for instruction. The South American continent is emerging from its ruder state of semi-development and its far too long delayed civilization, and is undergoing a trans- formation, which promises much for the immediate future. Another century should make it the home of one hundred millions of prosperous peoples, and its vast resources should be utilized, not alone for more than fullfilling the golden dreams of its first 25 conquerors, but the adding of untold millions to the world’s wealth and resources. Professor Virchow, in his Presidential Address before the last International Medical Congress, con- gratulated the Surgeons of America as, at present, representing the best attainment of surgical teaching and practice in the world. It is not too much to claim that we are now equipped to compete success- fully with any of the great centers of European learning for the teaching of medicine in all its numerous branches, and few more potent measures can be advocated, for the better union of all our western interests, than the moulding of the scientific thought, in its various branches of learning, of the leaders in this coming civilization of our great Southern Continent. But I will not weary you with further detail as to possible obligations and duties, arising from our special knowledge and our relations to the general public, of whose interests, both of health and disease, we are the acknowledged custodians. We are a pro- fession, oftentimes belittled and decried as fattening upon the public misfortunes, from the attendance upon whose ills we derive our direct support, but the broader view of our field of labor is the prevention of the very ills we are supposed to cure. From this standpoint, no profession, not even excepting that of the clergy, has a more noble vocation. The last two decades have witnessed a revolution in the surgical art, until it is now founded upon the great principles of a sure science, and is practiced with a certitude, and with results more remarkable than the tales of Aladdin. The battles over the best methods of modern wound treatment have oftentimes waged fiercely at the meetings of this Association, and if not “fought to the finish,” have certainly won glorious victories in behalf of humanity and the establishment of scien- tific truth. The new demonstrations upon the cans- 26 ation of disease have already revolutionized the teach- ings of medicine and introduced a brilliant era in the practice of our art. Sanitary science, the prevention of disease, has largely curtailed the whole class of zymotic affec- tions, with a possible future promise of their eradi- cation. Small-pox, which once swept as a pestilence unrestrained over continents, destroying over half of its victims, has, by the simple method of vaccination, been placed within such limits that it is practically expunged from the death roll even of our great cities. Consumption.—The fell destroyer, consumption, is the greatest scourge of the human race, counting its victims, in the United States alone, over one hundred thousand annually. We have the clear demonstra- tion of its cause, as a particulate morbific entity, with its life history and development now clearly established; how it enters the human organism and by its propagation and development, results in the death of the individual. The discovery is sufficient honor to one man, we might almost say to one gen- eration, since based upon such knowledge, there must develop means for its control, if not its extirmination. “A nation’s health is a nation’s wealth,” a nation’s happiness. The application of the principles of modern science, as already known to you, introduced into the practice of daily living, would diminish sick- ness and suffering one-half, and the death rate by at least one-third. Sorrow and mourning thus lifted from the race would make the future of our existence almost Utopian and change the whole aspect of life. Remove this burden, the expense attendant upon sickness and death would be lessened to the extent of hundreds of millions of dollars annually, and the income of the race would be doubled. Whatever those untaught in medicine may think, you and I well know that we are not giving an 27 unbridled rein to an illusive fancy in imaginary spec- ulation. It is a scientific demonstration, formulated in general terms, “the survival of the fittest.” Through the long lines of scientific research, dating back since man has knowledge of the intro- duction of life upon our planet, this law has held good. In its far reaching effect the individual of the present is no exception. Life itself may be denominated a battle for existence. The invisible vital organisms with which we are surrounded make up in numbers that which they lack in individual force. They utilize what seems the dead and decay- ing albuminoid products for their own development, thus separating into their ultimate elements the very material of existence and in its changed relations fit and prepare it for new and higher uses. Thus nothing is lost, nothing is wasted, simply changed, reformed to undergo anew its part in the great drama of life. This vital principle, the factor of existence, which has not yet been given to man in the equation of life, to be represented in known terms, permeates every living individual cell, and thereby gives it a vital inherent resisting power. Devitalize this below a certain standard, and it becomes the prey of other living forces. This, in the individual, we denominate disease. In the struggle for existence, the higher vitalized organism survives, and, when the various functions of the extremely complicated machine which we call man are working together in harmonic rhythm, we denom- inate it health. Such a complex machine, like every organic thing, should have its function, its little part in the world’s drama, and evidently was intended to wear out through the exhaustion and decay of its own formative processes, and when applied to man means the rounding out of a long life, subject to the infinite possibilities of subsequent immortality. The accidents to such a complex machine, the infractions of construction, we have been wont to 28 call surgical. When, however, by the aid of a better armamentarium, we are enabled to trace the devel- oping colonies of anthrax, until considerable portions of the circulatory system are impeded by the pres- ence of these minute, invisible organisms, or large portions of tissue are robbed of their nutrition and become devitalized by the growth of the bacillus tuberculosis and the attendant changes, who shall declare that these too are not objective, and should, in the broader sense, be considered accidental, and never a part of normal environment? If this be true, it becomes us as a great high priesthood of the most sacred calling, veritably as Moses to an enslaved people, to point out the way of life, its dangers, and how to avoid its accidents, and to direct in the great highway of human endeavor the development and fruition of the human race; a training of the soul’s pupillage for immortality. Mens sana in corpore sano. We pause a moment in grateful remembrance of our honored dead. During this year our entire coun- try has again been swept, as with a tornado, by the all-pervading epidemic from which, on account of the exposure and hardship incident to our profession, it has been especially a sufferer. Its death-dealing in- fluence has very naturally fallen most heavily upon the aged and the infirm, although its victims have been taken unsparingly from the young and vigorous of all vocations and all professions. In no one year has our Association been called upon to mourn so large a loss of its members, among whom its distin- guished presidents Dr. Campbell, of Georgia, Drs. Storer and Bowditch,of Massachusettes, and now only just added to the list Dr. Richardson, of Louisiana, have been gathered to the “great majority,” each a master in his own special department of professional labor, all distinguished as teachers and authors, especially wise and skilful and famous in the public service which they so freely rendered for the welfare, 29 not alone of their respective communities, but also for the nation. In the ripe maturity of years each had lived the recipient, in a very large degree, of public honors and emoluments, with the happy consciousness of a just recognition, not only at the hands of a noble profes- sion, but also of a generous public, of the faithful discharge of disinterested duties. All honor to such names; if our young men require illustrious examples of the-full fruition of noble lives, well spent in earn- est, unselfish labor, let me point them to the careers of our noble chieftains whose loss to-day we mourn, whose memories we honor, and whose examples we emulate. In the many subdivisions of labor, each is natu- rally wont to consider his part therein as the more important. To the politician, representation with its attendant possibilities and power seems the high goal of ambition, and to its attainment he bends all his energies. To the statesman, the adjustment of the great principles of government so that they may be con- ducive of the greatest good to the largest number. To the lawyer, the principles of justice and equity as worked out in the experiences of the centuries for the harmonic relationship of individuals to and with each other. To the clergy, the divine mandate, declared in the so-called Revealed Word, vivified in the flesh, until it permeates all mankind, and each receives and is quickened by its spirit the evolution of the higher theology—God in us working out his grand purposes, as the foretaste of the immortality beyond. He reads it in the Revealed Word which has been trans- mitted through the generations, as having emanated long ago from Divinity itself. He points out to you a highway of escape from the penalties of the trans- gressions of Divine law. You and I are, in no less degree or kind, a high 30 priesthood of ano less sacred profession. We read the mandates of the Creator by no uncertain trans- mission of revealed word. We see them repeated and revivified in every succeeding generation. In letters of living light we read the law in no uncertain lan- guage, and we note that its transgression is irrevoca- ble, and oftentimes means death to the organism. There is no mediatorial highway for the escape from its penalties, and no remission of its judgments under plea of ignorant infraction of its mandates. If this is true, the vital interests of the individual rest upon a better knowledge of, and obedience to its laws. In the evolution of medicine and sanitary science lie in large measure the resulting happiness and destinies of the human race. In the broader view, the differentiation of life’s factors becomes difficult, and perhaps they were never intended for ultimate analysis. In the ever-changing kaleidoscopic pattern, the indi- vidual factors of man’s personality should intertwine and blend as the colors in the hand of a great master, in perfect harmonic symmetry and relationship. To you and I at least it is given to render in no uncer- tain tone the fiat of God’s own law, unchangeable, repeated from age to age, from generation to genera- tion. To us it is given to contribute our part to the symmetrical development of the great tripod of human existence the mental, the moral, and the physical nature of man, upon the harmonic action of which must ever rest the destinies of the human race.