PRESIDENTIAL ADDRESS 
BEFORE THE 
AMERICAN MEDICAL ASSOCIATION, 
AT ITS 
THIRTY-FIRST ANNUAL SESSION, 
NEW YORK CITY, June 1, 1880, 
BY 
LEWIS A. SAYRE, M.D. 
EXTRACTED FROM THE 
TRANSACTIONS OF THE AMERICAN MEDICAL ASSOCIATION. 
PHILADELPHIA.: 
COLLINS, PRINTER, 705 JAYNE STREET 
1 880. PRESIDENTIAL ADDRESS 
BEFORE THE 
AMERICAN MEDICAL ASSOCIATION, 
AT ITS 
THIRTY-FIRST ANNUAL SESSION, 
NEW YORK CITY, June 1, 1880. 
BY 
LEWIS A. SAYRE, M.D. 
EXTRACTED FROM THE 
TRANSACTIONS OF THE AMERICAN MEDICAL ASSOCIATION. 
PHILADELPHIA: 
COLLINS, PRINTER, T05 JAYNE STREET. 
1 880. ADDRESS. 
Gentlemen of the American Medical Association:— 
Before entering upon the duties of the high office to which 
you have elected me, I wish to return you my sincere thanks 
for the distinguished honor thus conferred, and to pledge you 
that I will endeavor to discharge its duties to the best of my 
ability. 
No one can feel more keenly than I do my own incapacity 
properly to fill the distinguished position to which you have 
elected me, or more sincerely regret that some other, more com- 
petent and more worthy of the honor, had not been elected in 
my place. But as your too partial personal friendship has thus 
elevated me to this- post, I must appeal to your generosity to 
overlook any of my shortcomings, and rely upon your mutual 
aid to assist me in the discharge of the important duties thus 
imposed. v 
Who can properly appreciate the value of this Association, or 
the immense advantage it has already been to the medical pro- 
fession throughout our whole country ? Contemplate for a mo- 
ment the difference in the morale, the devotion to scientific in- 
vestigation, the mutual respect and good feeling between its 
members at the present time, and the condition when this Asso- 
ciation was organized. At that time there were often envyings, 
jealousies, and heart-burning, fault-finding, and traduction; 
those who had achieved distinction were frequently slandered 
and abused by those who had not been so fortunate; the slight- 
est imperfection of a professional brother was magnified into 
such undue proportions as completely to obscure any really good 
qualities or attainments that he might actually possess; and 
thus the whole profession was injured in the estimation of the 
public by the rivalries, bickerings, and jealousies that existed 
among its members. Now, each one seems so engaged in en- 
deavoring to improve himself and elevate his own position in 4 
ADDRESS OF 
the profession, that he has no time to devote to studying his 
neighbor’s faults, much less to accurately scrutinize and pub- 
licly herald his seeming defects. 
The science of medicine has been so much enlarged in all its 
different departments by the minute researches now demanded, 
and by the great advance and rapid progress of many of its 
specialties, as to require that every moment of a man’s time be 
occupied in the closest study if he would keep himself abreast 
with the daily improvements in our profession. And he who is 
thus occupied has no time to study the defects of others. By 
this constant struggle to improve ourselves and advance our 
science, the whole profession becomes more elevated in tone; 
and we already see that physicians are becoming more and more 
respected by the community at large. 
Let us contemplate for a few moments what has been done by 
the profession in America for the improvement of medical and 
surgical science, and the relief of suffering humanity. Some 
years ago, Sydney Smith, one of England’s most popular authors, 
said in the Edinburgh Review: “ The Americans are a brave, 
industrious, and acute people, but they have hitherto made no 
approaches to the heroic, either in their morality or their charac- 
ter. During the thirty or forty years of their independence they 
have done absolutely nothing for the sciences, for the arts, for 
literature, or even for the statesmanlike studies of politics and 
political economy. ... In the four quarters of the globe, 
who reads an American book, or goes to an American play, or 
looks upon an American picture or statue? What does the 
world yet owe to American physicians or surgeons? What new 
substances luive their chemists discovered, or what old ones have 
they analyzed? What new constellations have been discovered 
by the telescopes of Americans? What have they done in 
mathematics? Who drinks out of American glasses, or eats 
out of American plates, or wvears American coats or gowns, or 
sleeps in American blankets?” 
It would seem to me that the very Declaration of Indepen- 
dence, and the willingness to Siicritice their lives to obtain it, 
was an act of heroism equal to any recorded in history. And 
the organization of the Government under constitutional law, 
which has yielded such results as were never before obtained, is 
an evidence of statesmanship and of knowledge in political 
economy which has been seldom equalled, and never surpassed. THE PRESIDENT. 
5 
As to the questions of American manufactures and the nations 
that use them, we can safely refer to the reports of our Chamber 
of Commerce for a satisfactory answer. American science has 
no need to be ashamed of its Henry and its Morse, its Bache, 
Peirce, Newcomb, Draper, Marsh, Dana, Gray, Hall, and its 
adopted Agassiz. Nor has the American Journal of Science 
anything to fear by comparison with its European contempo- 
raries. 
But to the question, “ What does the world yet owe to Ame- 
rican physicians and surgeons?” we would venture a more full 
reply, although time will not permit us to revert to more than 
a few of our professional achievements. 
First among the greatest boons ever conferred upon suffering 
humanity stands “anaesthesia,” an American suggestion, and 
one that immortalizes the name of Morton. Who can overesti- 
mate the value of this discovery, or who can accurately describe 
the contrast between the former agony necessarily endured in 
many surgical operations, and the present absolute oblivion of 
all pain, the happy, tranquil, undisturbed sleep while the ffesh 
quivers under the knife? When we contemplate the millions 
of human beings on the earth, and consider the fact that at 
every moment of time, in some part of the civilized world, 
hundreds, if not thousands, are receiving the benetits of this 
great discovery, the mind becomes overawed at the magnitude 
of the blessing, and even imagination fails to comprehend fully 
its benetits. 
/ Ovariotomy, another American contribution to the medical 
profession, has done probably as much toward saving life as 
any other surgical discovery in the nineteenth century. It 
was first practised, in 1809, on Mrs. Crawford, in Danville, 
Kentucky, by Dr. Ephraim McDowell. Although honestly and 
modestly reported, eight years afterward, in the Philadelphia 
Eclectic Peperlory and Analytical Review, it still made no impres- 
sion on the professional mind, but was received rather with 
derision and scorn until Dr. Atlee, in 1844, revived the opera- 
tion, and by persevering effort, in spite of all opposition and the 
very general condemnation of his contemporaries, was enabled 
at last by his numerous brilliant successes to establish the opera- 
tion on a permanent basis. At the present time it is acknowl- 
edged as the proper operation to perform, in certain cases, by 
every medical school in the civilized world. Dr. Deaslee says 6 
A DURESS OF 
f that “in the United States and Great Britain alone, ovariotomy 
has, within the last thirty years, directly contributed more than 
v thirty thousand years of active life to woman, all of which 
would have been lost, had ovariotomy never been performed.” 
In Gynaecology, the whole professional world cheerfully and 
gratefully acknowledges the original and invaluable contribu- 
tions of Sims, Thomas, Emmet, Peaslee, Atlee, Kimball, Taylor, 
Fallen, Dunlap, Minor, and others in this department. 
The new operation of Litholapaxy, which consists in the 
prompt and entire fragmentation of calculous material in the 
bladder, and the entire removal of the debris by aspiration 
through a tube passed by the urethra at a single sitting, first 
performed and described by Dr. Bigelow of Boston, is one of the 
grandest triumphs of modern surgery, and of which any Ameri- 
can surgeon may well feel justly proud. 
In conservative Surgery, we certainly compare most favor- 
ably with any other nation. In the mechanical treatment of dis- 
eases of the joints, by which means the patients are able to take 
free exercise in the open air during the whole progress of the 
disease, thus acquiring power to overcome the constitutional 
dyscrasia better than by any means heretofore employed, and, 
when the disease has progressed beyond repair, then to perform 
the sub-periosteal exsection of the joint in such a manner as to 
leave the muscular attachments in their normal position, and 
hy judicious after-treatment to restore them with but slight 
deformity and almost perfect power of motion,—these certainly 
are triumphs in surgery, of which the American profession may 
well be proud. 
In the Lancet, of February 14,1880, Roderick Maclaren, M.D., 
Surgeon to the Cumberland Infirmary, in his Presidential 
address to one of the branches of the Medical Associa- 
tion, on “The Advances of Surgery during the past twenty 
years,” says: “Ko account of the recent progress in Surgery 
can justly omit the application of the principles of absolute rest 
to diseases of the vertebrae. It is done by inclosing the body 
in a plaster-of-Paris jacket. Though only introduced into this 
country about two years ago, it has established itself as an in- 
controvertible success.” This is another triumph for American 
Surgery, and is justly admitted not only in England, but in all 
parts of the civilized world. 
When we contemplate the misery and suffering of the un- THE PRESIDENT. 
7 
fortunate “hump-back,” who, after years of torturing treatment, 
has for its termination only deformity or death; or, the patient 
with a bad lateral curvature, who, in addition to deformity, 
has for years suffered constant agony from the application of 
the cruel instruments of torture, intended for his relief but 
never successful, and compare his condition with that resulting 
from the present mode of treatment, which is void of all danger, 
perfectly painless in its application, allowing the freest exercise 
and enjoyment during its progress, always affording immediate 
relief even in cases that have passed beyond the hope of cure, 
—and in the majority of cases, when the treatment has been 
commenced at a proper time and judiciously carried out, ter- 
minating in a perfect result — frequently leaving no trace of 
deformity as an evidence of its previous existence,—we feel that 
American Surgery has a right to congratulate herself that she 
has contributed this great boon for the relief of human suffer- 
ing. 
In Laryngology, we can certainly claim Green as a pioneer, 
and we all know the censure he received, and the opposition he 
encountered: but the facts he then established are now ac- 
knowledged by the entire scientific world—and the improve- 
ments made in this department of Surgery by Cohen, Cutter, 
Bosworth, Elsberg,, Lincoln, Lefterts, Robinson, and many 
others in this country, entitle us to rank with other nations. 
Time will not permit us to refer to all our contributions in 
the different departments of medical and surgical science; but 
I have enumerated enough to justify the belief that if the dis- 
tinguished author before referred to was now to write, he would 
express very different sentiments from those above quoted. ISTot 
content, however, with what we have already achieved, let us 
still press onward, and, accepting the motto of our great State, 
constantly cry “Excelsior.” 
METRIC SYSTEM. 
It is the duty of this Association carefully to investigate 
every claim to improvement or advance in medical and surgical 
science; and, if such claim is found to be worthy of confidence, 
to lend such innovation or improvement the moral influence of 
its support. 
One of these innovations is the substitution of the “ Metric 
System of Weights and Measures” for our present uncertain 8 
ADDRESS OF 
“ formula.” As medical science is not sectional, or even national, 
but universal, we certainly should adopt some nomenclature and 
modes of expression for weight, measure, and form, that would be 
the same in all languages, and among all nations of the civilized 
world. This is what the metric system proposes, and it seems 
to me that this Association should immediately recommend its 
adoption. 
At the meeting of this Association in Buffalo, June 5, 1878, 
the following resolution was passed by the Section on Practice 
of Medicine, Materia Medica, and Physiology: — 
“ Resolved, That this Section, recognizing the value of the 
metric system for its uniform, international, indestructible, 
generally applicable, convenient, simple, safe, and scientific 
character, hereby recommends to all physicians the use of the 
same in their practice, and in their writings and teachings.” 
The passage of a resolution, even by unanimous vote, does not 
always imply that those who have favored it will take active 
measures to have it carried out in practice. There are few, if 
any, who make themselves practically familiar with the metric 
system without perceiving its great superiority to all other 
systems of weights and measures already in use. But no 
system, however perfect in theory, can become practically of 
much value until it has become so well known to the public 
that little or no special instruction is needed by those who 
are intrusted with its application. The present objectionable 
methods of dispensing medicine have the great advantage of 
prestige of habit. To overthrow this, and to secure for the 
metric system the mere opportunity to become generally known, 
will require persistent effort on the part of its friends, aside 
from such concert of action as may be implied in the passage of 
resolutions. 
To enter into a detailed discussion of the advantages to be 
gained by using the metric system, and of the difficulties to be 
overcome in discarding the old, would necessitate a separate 
paper, rather than a mere section of an address. It will be 
possible only to indicate very briefly some of the salient points 
that mark the new system, and to show what has been its suc- 
cess already when imposed by authority in hospital service. 
At the outset it may he observed that physicians are not put to 
the necessity of learning the entire terminology of the metric 
system, simple as this may be. The only unit of volume to he THE PRESIDENT. 
9 
remembered is the cubic centimetre, occupying the space of a 
gaming die, or of a cube whose edge is about, four-tenths of an 
inch. The only unit of weight is a gram, which is the weight 
of one cubic centimetre of pure water at its heaviest. Its Eng- 
lish equivalent is a little over fifteen grains. It may be inter- 
esting to trace the relation of these units to others in use among 
physicists; to know, for example, that the length of the centi- 
metre is a hundredth part of a metre, which in turn is the forty 
millionth part of the earth’s circumference; but practically there 
is little or no necessity for the measurement of length or surface 
in the dispensing of medicine. The various prefixes, of Latin 
and Greek origin, which are regarded by many as too learned 
in sound to be accepted in place of the more familiar, but less 
simple, English denominations now in use, will give no trouble 
to the physician, because he has no need to use them. 
No one objects to either the name or the use of dollars and 
cents; and no one on this side of the Atlantic would be willing 
to give up our decimal mode of counting money for that of 
pounds, shillings, pence, and farthings, in which reduction from 
one denomination to another is a perpetual source of annoyance. 
By the simple change in position of a decimal point we are able, 
without the change of a single figure, to express the fortune of 
a millionaire in fractions of a cent. No one experiences any 
difficulty in forming an estimate, clearly and promptly, of the 
value expressed by a given number of dollars and decimals of a 
dollar; nor does any one think of reading the amount as so 
many eagles, dollars, dimes, cents, mills, and tenths of a mill. 
Though these denominations are given in the books, we have 
practically discarded all except dollars and cents, because these 
two are found sufficient for most purposes. In like manner, 
most of the denominations of the metric system will not be 
employed, because they are not wanted, and because the nume- 
rical relation between the few which lemain in use is so very 
simple*and easily remembered. a 
The reasoning which has been applied to the dollar in con- 
trast with the British pound sterling, is equally applicable to 
the gram in contrast with the British ounce avoirdupois or 
ounce apothecaries’. A pound avoirdupois is made up of six- 
teen ounces, each of which weighs four hundred and thirty-seven 
and a half grains, making seven thousand grains in all. A 
pound apothecaries’ is made up of twelve ounces, each of which 10 
ADDRESS OF 
weighs four hundred and eighty grains, making five thousand 
seven hundred and sixty grains in all. The confusion resulting 
from this inconsistent use of the same name, for things of differ- 
ent value is interminable and unnecessary. Let the use of the 
pound and ounce he replaced hy that of the gram, which is per- 
fectly definite in value. In pharmacy it is neither difficult nor 
confusing to express any given weight in grams and decimals 
of a gram, any given volume in cubic centimetres and decimals 
of the same. By the use of a vertical line near the right edge 
of, the prescription paper, like that placed in an account book 
to separate dollars from cents, the danger of making mistakes 
is far less than where the arbitrary symbols of apothecaries’ 
weight are employed. To express ounces in scruples, or drams 
in grains, a mental calculation is necessary, not very difficult, it 
is true, but still implying just so much liability to error, and a 
loss of time, which may be avoided by the use of the decimal 
notation. 
For those who have not familiarized themselves with metric 
units, and who know what doses should be given when these 
are expressed in grains or fluidrachms, but would be at a loss to 
express the same in grams or cubic centimetres, tables of equiva- 
lents have already been printed and can easily be obtained. 
They have been in use for two years past in the U. S. Marine 
Hospital Service at Washington, where the employment of the 
metric system was made obligatory in the spring of 1878, by 
order of the Surgeon General. To this department, application 
was made a few weeks since, for information as to the success 
of the experiment, the object had in view being to place before 
this Association actual results rather than theoretic arguments. 
To the Surgeon General, Dr. John B. Hamilton, the following 
questions were put:— 
I. Was any serious difficulty encountered by dispensing clerks 
in laying aside the old system and substituting the new ? 
II. Have mistakes in dispensing occurred with any noticeable 
degree of frequency in consequence of lack of skill in the man- 
agement of' decimal points? 
III. Has any serious loss of time, or of accuracy, resulted from 
substitution of gravimetric for volumetric methods of dispen- 
sing liquid medicines? THE PRESIDENT. 
11 
IV. In case volumetric methods have been retained, have 
mistakes or difficulties arisen from the necessity of carrying in 
mind the specific gravities of the liquids measured, and allow- 
ing therefor? 
V. Is there any apparent disposition on the part of dispensing 
clerks, or nurses, to return to the old system? 
VI. Have you any suggestions to offer, based on the practical 
trial already given in the U. S. Marine Hospital whereby the 
adoption of the metric system by members of the American 
Medical Association, and by druggists in the country at large, 
may be facilitated ? 
The reply of the Surgeon General is so pointed, clear, and 
satisfactory, that no better service can be done in the cause of 
metric reform than by incorporating it, as a whole, in this ad- 
dress. 
Dear Sir :— 
Referring to your letter of the 3d inst., I have to say in an- 
swer to the questions submitted:— 
I. No serious difficulty has attended the adoption and exclu- 
sive use of the French decimal metric system in this service. 
II. No mistakes have occurred on account of the change, so 
far as known to this office. 
III. & IV.—Volumetric methods were retained, and as liquids 
have always been measured in the dispensing of medicines in 
this country, less inconvenience and trouble must necessarily 
attend the adoption of the metric system referred to if measures 
be retained than if gravimetric methods be exclusively em- 
ployed, since the latter course would render it necessary to carry 
in mind the specific gravities of many liquids, and to make 
allowances accordingly in converting the terms of the old system 
into those of the new. 
V. The discipline in the Marine Hospital service would pre- 
vent any opposition on the part of dispensing clerks or nurses. 
VI. The suggestions I would make, based upon the experi- 
ence in this service, are the following:— 12 
ADDRESS OF 
In order to facilitate the general adoption of the new metric 
system in medicine and pharmacy, volumetric methods should 
be retained. On the one hand, this would save much labor, 
which would otherwise have to be done by prescription writers, 
and, on the other hand, it is fair to presume that whether liquids 
be prescribed in grams or in cubic centimetres, they will be dis- 
pensed quite generally by measure. The principal merit of the 
new system lies in the fact that, with nearly all liquids except 
syrups, glycerine, chloroform, and ether, the gram and the cubic 
centimetre will represent the same quantity practically. 
The terms used to designate the units of the metric system 
should be anglicized as far as practicable, and the units reduced 
to the smallest number requisite. Prominence should be given to 
the “gram” and the “cubic centimetre,” a3 being the only units 
with which it is necessary to be familiar. After the gram the 
centigram is the unit most applicable in medical and pharmacal 
gravimetry, and multiples and subdivisions of these two weight 
units are sufficient in my opinion. All the other prefixes used 
in the French system should be avoided in adopting that system 
for physicians and pharmacists, the “centi” alone being retained. 
The cubic centimetre seems to me to be a more suitable unit for 
use in medical formulae than any subdivision of the litre. 
In conclusion, it would be well if all friends of the metric 
system could agree to drop the fractions in the numbers which 
express the equivalents of the gram and the cubic centimetre in 
troy grains and minims, and to adopt the exceedingly simple 
rules for converting terms of the old system into those of the 
new, and vice versa, that have been found so useful in the prac- 
tical trial given the decimal metric system in the Marine Hos- 
pital Service, the medical officers of which are now prescribing 
in metric terms for over twenty thousand patients annually. 
These rules were adopted simply as an aid in learning metric 
posology, and their usefulness ceases as soon as the prescriber is 
familiar with the expressions in metric terms of the doses of 
medicines, and they are probably not now used to any extent 
by the officers of this service. 
I am, sir, very respectfully, 
JOHN B. HAMILTON, 
Surgeon-General, M. 11. S. THE PRESIDENT. 
13 
PUBLICATION OF TRANSACTIONS. 
For many years past there has been an almost annual com- 
plaint about the publishing of our Transactions. Sometimes it 
would be that publication had cost altogether too much money; 
at other times that they were not issued with sufficient prompt- 
ness, and the volume when received was almost useless, since all 
the important papers or discussions in it had already appeared 
months before in the various medical journals of the country. 
Upon considering carefully these objections, which have been 
increasing every year, it would really appear as if there were 
some just ground of complaint. And, since the matter is one of 
very grave importance, I would respectfully suggest that the 
Association give it very serious consideration, and, if deemed 
advisable, refer the subject to some proper committee, to report 
whether any plan can he suggested to bring the proceedings of 
the Association before the profession that would be better than 
the one now pursued. Certainly our present plan, besides being 
very expensive, does not give entire satisfaction ; and it is very 
questionable whether the mode pursued by the British Medical 
Association, in establishing their own journal, would not be an 
immense improvement on our present method. The British 
Journal is the exclusive property of the Association ; and by the 
liberal compensation of an accomplished editor, a weekly edi- 
tion is issued, instead of an annual volume. Certainly this plan 
implies great economy; for, instead of being an expensive bur- 
den, as at present, the work of publication would in a very short 
time be a source of direct emolument. 
The similarity of the two Associations in many respects, both 
in their organization and in their objects, is so great that we 
may possibly learn something to our advantage by carefully 
studying the history of the older association, and profit by her 
experience, and, if necessary, by her example. The importance 
of the subject must be my excuse for bringing to your attention 
many details which might possibly be regarded as superfluous. 
Any one who has attended the meetings of the British Medi- 
cal Association, and who is acquainted with its journal for the 
last ten years, may have observed that the extraordinary growth 
of that Association in power, wealth, influence in the profession, 
and influence in the State has been coincident with the develop- 
ment of a weekly organ of communication between the members, 14 
ADDRESS OF 
the property of the Association, the Journal of the Association, 
and edited by a member of the profession appointed for the pur- 
pose by the council of the Association. This history, as told 
by these gentlemen, and as any one can confirm for himself by 
examining the facts, is extremely instructive in establishing at 
least one solid base for prosperity for any similar institution 
such as the American Mvedical Association. Briefly to sum- 
marize the facts, it may be stated that the British Medical 
Association was founded forty-six years ago by Sir Charles 
Hastings, a country physician, mainly for the purpose of ad- 
vancing the professional interests of country physicians. Its 
growth was rapid, and in time it became British rather than 
provincial. The greatest men in England became annual presi- 
dents; its meetings were held in London, Edinburgh, and Ox- 
ford, and as a body it was highly respected. It soon appeared, 
however, that there was a comparatively narrow limit to its 
powers of extension. At each meeting considerable accessions 
of new members joined, but they soon fell off again. Then it 
was found necessary to convert.the annual volume of Transac- 
tions into a weekly journal. It was noted that the Provincial 
Transactions, admirable as they were, formed a volume which 
did not appear for some months after the annual meeting; that 
such a volume was put upon the shelves and occasionally re- 
ferred to, but rarely read through; that it did not appear until 
the interest of the meeting had faded away and until a good 
deal of the freshness had been taken off the papers by short 
abstracts and piecemeal reports, and that on the whole it was 
impossible to expect the Association to spread unless means 
were provided for more constant intercommunication between 
the members, and for the more rapid publication of their con- 
tributions to medical science and the more continuous discus- 
sion between the members of subjects of medical, social, and 
ethical interest in the intervals between the meetings. The pub- 
lication of this journal had at once a favorable influence on the 
fortunes of the society. The numbers grew from 1000 to 2000, 
and the Society continued to make slow and steady progress,add- 
ing definitively about 30 new members a year to its total numbers. 
Twelve years ago, however, upon the resignation of Dr. Mark- 
ham, a new editor was appointed, Mr. Ernest Ilart, who was 
at that time co-editor of the Lancet, accepting the office of editor 
of the British Medical Journal on condition that he was allowed THE PRESIDENT. 
15 
considerably to increase the size of the Journal and to conduct 
it in a thoroughly energetic, and independent manner, in such 
a way as to make it worthy of being the weekly organ of a 
powerful Association. Under his direction the Journal was at 
once doubled in size. It was brought into a state of scientific 
and social activity, and made an organ of the most recent sci- 
entific and professional work, and its editorial departments con- 
ducted with vigor and literary skill. The effect upon the 
fortunes of the Association was magical. Five hundred new 
members joined that year, and for each successive year since 
that time, from five hundred to six hundred new members have 
been added to the list by the simple process of sending out 
throughout the country once or twice in the year copies of the 
Journal and forms of application for membership. The result 
has been that whereas for the thirty-six years that the Associa- 
tion had existed, it had only slowly crept up to about two 
thousand, it has, during the ten years that Mr. Ernest Hart has 
edited the Journal, risen in numbers until it now includes 
eight thousand members of the profession, and, according to the 
statements printed in the Journal, it circulates another fifteen 
hundred copies outside the profession. It gives forty pages of 
printed matter every week, so that the Lancet has felt itself called 
upon to enlarge the number of its pages in order to bring them 
up to its now formidable rival; but the Journal, by reason of the 
closeness of its type, still gives about one fourth more matter 
than its senior rival. The circulation of the Journal is now al- 
leged to be some thousands more than that of the Lancet, and 
larger than that of any other medical paper in the world. Cer- 
tainly the British Medical Association has in this way become 
the most powerful medical association in the world. The way 
in which the Journal has done this has been by converting all 
its subscribers into members of the Association, by a very 
simple process. When the extra numbers of the Journal are is- 
sued, which takes place at the beginning of every year, a circu- 
lar which goes by post informs the person receiving it that the 
subscription of the Association, including the weekly supply, 
post free, of the Journal, of which a specimen copy has been 
sent by the same post, is five dollars per annum ; but the sub- 
scription to the Journal alone to others than members of the 
Association is six-and-a-half dollars. Thus the Journal offers 
a bonus on membership in the British Medical Association. 16 
ADDRESS OF 
From three to four hundred new members are thus added each 
January. Having thus created large nuclei of members in the 
various counties, the editor appoints a correspondent of the 
Journal in any part of the country in which no branch exists, 
and this correspondent presently makes it his business to ar- 
range a local meeting of members and to form a branch of the 
Association. In this way, the number of branches which, 
when the Journal first took its new start under the editorship 
of Mr. Hart, was only ten, has risen now to twenty-seven. 
Branches have been formed, not only all over England, but 
throughout Scotland and Ireland ; and new branches are being 
formed of members of the Association, who have emigrated to 
Australia and India and still desire, by the branch organization 
of the Association, to maintain close relationship with the pro- 
fession in the mother country. 
It is unnecessary to say anything in praise of the British 
Medical Journal. It has by far the largest circulation of any 
English medical journal, and its reputation is such as to make 
it independent of commendation on that subject. What is to 
the point is to refer to the balance-sheet, which is published 
every year and distributed at the annual meetings of the Asso- 
ciation, as well as in the pages of the Journal. There it may be 
seen that the Journal becomes not only a powerful means of 
attracting new members to the Association, and of keeping 
them in it by maintaining their interest and connection with 
the Association and giving them “value for their money,” but 
that its advertising columns contribute largely to increase the 
funds of the British Medical Association, bringing in an income 
of something like twenty-five thousand dollars a year. The 
total income of the British Medical Association is about seventy 
thousand dollars, of which twenty-five thousand are from adver- 
tisements in the paper, and the balance from subscriptions of 
members and sales of the Journal. Out of this income are de- 
frayed the salary of the secretary—not a medical man but a 
business man—who acts as business manager of the Journal and 
general business secretary of the Association at a salary of 
twenty-five hundred dollars a year, giving his whole time to the 
work; also the rent of a building, centrally situated, which 
serves as the printing and publishing office for the Journal, and 
also as a gathering place for the committees of the Association 
throughout the year. There are, further, defrayed the expenses THE PRESIDENT. 
17 
of the various standing committees appointed for special pur- 
poses, such as, last year, “the promotion of legislation for habit- 
ual drunkards;” the standing committee for the examination 
of bills brought into parliament affecting medical interests, and 
for the promotion of clauses beneficial to medical interests or 
the opposing of provisions considered likely to be injurious to 
them; and other similar committees. There is a further pay- 
ment out of funds of the Association for the promotion of 
researches in medicine and the collateral sciences. A thousand 
dollars were voted in this way to Professor Hughes Bennett 
and Professor Rutherford, of Edinburgh, for the expenses of 
their famous researches “On calomel and other agents having a 
reputation as promoting the flow of bile.” In all, about fifteen 
hundred or two thousand dollars a year are voted in this way. 
Certain contributions are made towards expenses of the annual 
meeting, especially the printing expenditure, and, from time to 
time, special grants are made towards specially important medi- 
cal objects. The editor of the Journal is paid about five thousand 
dollars a year, including payments for his editorial writing, and 
the sub-editors about twenty-five hundred dollars each. The 
literary expenses for payments to writers on the staff for editorial 
articles, reviews, criticisms, and the like, amount to about another 
five thousand dollars a year. After all expenses are paid, there 
remains now an annual surplus of from three thousand to five 
thousand dollars, which has been accumulated into a reserve 
fund. 
If, then, we review the position of this powerful Association, 
we shall see that it has a formation which includes, first of all, 
a strong central executive; this is elective, mainly from its 
twenty-eight branches, who each send one delegate to the cen- 
tral council, generally the honorary secretary of the branch. 
This central council includes all past presidents, and twenty 
members elected at the annual meeting; and it meets once a 
quarter at least, or more often under special emergency. The 
central council is a powerful executive institution. It delegates 
the business conduct of the Journal to a “Journal and Finance 
Committee,” which meets also once a quarter, occupies itself 
chiefly with passing accounts, and general questions of finance 
and business management, and communicates with the editor 
upon any subjects which may have arisen during the quarter. 
There are also a considerable number of standing committees, ADDRESS OF 
appointed at the annual meeting, to consider special subjects, 
whose powers are strictly limited by the terms of reference, but 
who work throughout the year, and who derive their funds 
solely from special grants by the central executive committee. 
The standing “Committee on Parliamentary Bills” consists, like 
the Executive Council itself, of a representative of every branch 
and ten members appointed by the annual meeting, and is a 
most powerful protector of all medical interests. With this 
organization the Association possesses in the weekly Journal 
the means of keeping all its members in constant communica- 
tion, one with another. The addresses given at the annual 
meeting by appointed orators in each subject, are at once printed 
in full in the Journal. Every paper read is printed in abstract, 
together with a report of the discussion excited by it. Thus, 
the Association secures for itself a full, rapid, and responsible 
report, which comes at once into the hands of all its members, 
and of all those in the profession, or out of it, who choose to 
subscribe to the Journal, week by week. Any subjects of dis- 
cussion, which arise at the meeting, can be continued and are 
continued from week to week by communications in the Jour- 
nal. Work arising out of the meeting is reported throughout 
the year in the Journal. The quarterly meetings of the execu- 
tive committee, the proceedings of the standing committees, and 
of the branches, are all continuously brought to the knowledge 
of the members, and discussed by them in their weekly Journal. 
Fresh subjects of interest and of public moment, occurring 
throughout the year, are discussed, dealt with, and reopened 
for debate and final settlement at the annual meeting. 
Not all the papers read at the annual meeting are published 
in full, but full discretion is given to the editor to publish or 
not, according to his estimate of the importance and interest of 
the papers to the members at large. The rule of the Association 
is that the interest of the individual must be subordinate to the 
common welfare, and although, no doubt, the discretion of the 
editor, in publishing in full, or in rejecting individual papers, 
may be often questioned by the individual, yet his action has 
from the first remained entirely unfettered; no instance of any 
abuse of that power is considered by any member to exist, and 
it has worked admirably for the general welfare in securing for 
the Journal the best of the papers read, and in making it under- 
stood that the Journal of the Association would never be allowed THE PRESIDENT. 
19 
to become a “ waste basket” for inferior literature, but that a 
rigid power of selection would be exercised in respect to the 
publication of the full text of any papers offered for that pur- 
pose. 
These details are of importance to the American Medical 
Association, for they include the germs of an organization pecu- 
liarly adapted to American ideas. It is essentially democratic, 
and entirely representative. It is dependent for its success on 
the intelligence, union, and good-will of the members. It is 
decentralizing, inasmuch as it tends to the formation or the 
strengthening everywhere of the local societies, which have thus 
throughout the year the means of making themselves heard in 
metropolitan centres, and of communicating with each other. 
Above all, it is a most successful and influential means of in- 
creasing the membership, enlarging the power, and widening 
the basis of the Association, and of making it a living organism 
during the intervals between the annual meetings. Finally, it 
has the great advantage of securing the largest amount of value 
to each and all of the members, for the smallest possible sub- 
scription. The Journal becomes, in fact, a co-operative enter- 
prise in which the profits resulting from their subscriptions go into 
their own pockets, instead of those of any individual proprietor. 
They own their own paper. They are able to get the advantage 
of a powerful organization, and of a first class medical paper at 
the same annual subscription as that of a medical paper by it- 
self, and with the surplus they find funds for a place of meeting 
for their committees, and for the promotion of public and scien- 
tific objects, and the creation of a reserve fund for future public 
uses. There seems no reason why an experiment so essentially 
accordant with American instincts and traditions, and one 
which has succeeded so well in England, should not have at 
least as great, if not a greater, success in America. 
One point, however, that is specially worthy of note is, that 
the success of the British Medical Journal has been largely de- 
pendent upon the manner in which it has been conducted. The 
weekly Journal did little for the Association until it fell into 
the hands of an experienced editor, whose ability is so generally 
recognized that there is no need to dwell upon it, and to whom 
a large and unfettered responsibility is left, although he remains, 
of course, personally responsible to the executive of the Associa- 
tion for the right use of the power entrusted to him, as every 20 
ADDRESS OF THE PRESIDENT 
editor does to those who appoint him. It will be necessary to 
find for any organ which this Association may publish an editor 
of recognized position, whom the Association would accept as 
its worthy officer and representative in so responsible a post, a 
man of literary skill, scientific knowledge, and journalistic ex- 
perience, or, at least, journalistic instincts and tact. He should 
be paid liberally, he should be treated with respect, and from 
him ought to be expected a serious determination to use the 
powers entrusted to him with courtesy and fairness, and with 
one sole object, the elevation of the standard of professional 
knowledge and interests, the maintenance of a high order of 
professional dignity and mutual courtesy. It is impossible to 
doubt that such a man can be found; possibly there may be 
many; and the question is one which appears to be well worthy 
of thorough examination by the council and members of this 
Association, because it seems tolerably certain that, if for the 
present bulky, tardy, little read, and unproductive volume of 
Transactions there could be substituted an active, vigorous 
weekly journal, read everywhere, and with a large income, such 
as would naturally come to it from its advertising sheet, there 
would be in such a change the earnest of a rapid and important 
growth in the numbers, influence, and usefulness of the Ameri- 
can Medical Association.