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 Address .. .President of the 
 American Medical Association 
 Delivered at St. Louis, 
 May 6, 1873 
 
 Thomas Muldrup Logan 


 
 .A. T) ID IR, IE S S 
 
 THOS. M. LOGAN, M. D. 
 
 DELIVERED IN ST. LOUIS (MO.), MAY 6TH, 1873.
 
 EX LIBRIS 
 
 SAX C^VRIX) S I/O 1) 
 
 ROBERT ERNEST COWAN
 
 .A. ID ID IR, IE S S 
 
 THOS. M. LOGAN, M. D. 
 
 IPRESIDEISTT 
 
 ;<* 
 
 OF THK 
 
 DELIVERED IN ST. LOUIS (MO.), MAY frrn, 1873.
 
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 .A. 3D 13 -&, IB S S 
 
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 TIT. 08. M. LOGAN, M. D 
 
 PRESIDENT OF THE ASSOCIATION. 
 
 ,, GENTLEMEN : .lust two years ago there was witnessed a spee- 
 ch tacle well worthy our contemplation! It was full of sigriifi- 
 - canoe, and stands forth, unparalleled, in the history of our divine 
 ^ art. from its earliest annals down to the present moment. 
 <EQ Along the Atlantic slope of this vast continent throughout 
 ^ the length and breadth of the land from Maine to Mexico 
 5 were seen, gathering together, one hundred and twenty-one 
 ^ living, aspiring intelligences,* moved by one thought, nerved 
 hv one impulse, animated by one hope the good of humanity! 
 Abandoning, for the nonce, the peaceful pursuits of their 
 chosen vocation, relinquishing its rewards, and exposing them- 
 selves to all the hazards incident upon velocity of locomotion, 
 westward they steered their beneficent course, borne along the 
 iron pathway cleaved across a continent ! 
 
 Annulling the opposing conditions of time and space, over 
 three thousand miles they went '-skimming over the valleys, 
 
 * These western pioneers of the Association ortrani/.ed themselves, in connect 
 with the ineinliers of the Pacific Const, into a society, al the last meeting in I'hil; 
 <leli>hia. by the. title of the " Kooky Mountain .Medical Society." and elected Was 
 in-rtoii L. Alice. M. !>.. of Philadelphia, President, and John .Morris, M. 1.).. of Halt 
 more. Secretary, to commemorate the auspicious event. All honor to the glorioi 
 oue hundred and twenty-one ! 
 
 .'570658
 
 thundering across the rivers, and panting up the sides or pierc- 
 ing through the hearts of the mountains." Science having 
 made subservient to their bidding those dynamic agencies, more 
 potent than the Genii of Arabian fable, they accomplished in 
 seven days the travel that once consumed more than as many 
 months; and thus they reached the city of the Golden Gate 
 the Mecca of their pilgrimage. 
 
 In the same spirit and with the same purposes with which 
 we this day come together, they met their confreres from dif- 
 ferent and widely distant regions. They met, not as the mere 
 reflexes of other men's opinions ; not to promote those objects 
 which centre in self-interest, but as the independent represent- 
 atives of a high-toned, liberal profession, to secure the benefits 
 which accrue from singleness of purpose and unity of action. 
 With views as comprehensive as the wide domain of science, 
 they labored with the same unswerving perseverance which 
 has characterized each and every session of this Association 
 during its entire history. 
 
 Having in four days accomplished the object of their high 
 mission, they returned, noiselessly, like the great forces which 
 control the universe, everyone to his allotted sphere in life, and 
 ere the lapse of another week, all were once more seen quietly 
 fulfilling the daily duties of their noble calling 
 
 Such a spectacle of moral grandeur, I repeat, never before 
 was witnessed in the history of our Association never in the 
 annals of medicine. Amazed and confounded, the disloyal in 
 our ranks looked on with staggering doubt; the faithful took 
 part with renewed trust trust in the power of our organiza- 
 tion, the power of its knowledge, and the power to make that 
 knowledge disinterestedly available to the Avholc profession. 
 As in that wondrous frame whose structure, functions, and 
 relations compose our constant stud}', the sentient nerves feel 
 keenest at the extremities, so we. the distant dwellers on the 
 Pacific, remote from former centres the ganglia of its gather- 
 ings continue still to thrill with quickening memories of the 
 benefaction, whose magnitude arid value cannot be computed. 
 Neither has the reflex action been lost upon the Association, 
 hut permanently stirred up to deepest depths, its members 
 flowed bade, the following year, into Philadelphia, like a tidal 
 wave of tenfold volume, in unprecedented numbers. Xoristhe 
 influence yet abated. Like yon mighty river, which sweeps with
 
 C 5 ] 
 
 ever-living, ever-moving waters along the wharves and by the 
 busy marts of this Empire City of the West, carrying rich de- 
 posits of fertility and plenty from State to State, in its annual 
 overflowings, to bless the dwellers upon its shores and throughout 
 the vast regions of its lengthened course, so we are here to-day 
 rejoicing in the strength of our numbers, to scatter far and 
 wide, along the pathway of humanity, the benign influences 
 and free-will offerings of our collective counsel and experience. 
 Herein lies the great catholic principle of our Association. 
 Having a common heritage and a common interest as Amer. 
 icans in each other's welfare and advancement, we throw our 
 portals open wherever we are welcomed, and by the introduc- 
 tion of new material, assimilate new elements into the common 
 mass. Migrating over our vast territory, as our Association 
 has done for more than a quarter of a century holding its 
 meetings first in the North, then in the South, next in the East, 
 and then in the West, it acts as the irrepressible light and air 
 of heaven, imparting its vivifying influence in all directions 
 and infusing fresh energy into the monotonous existence of the 
 medical practitioner. -But the great principle does not stop 
 here. By the influx and efflux of travel, and all the inter- 
 changing currents of social and professional relations, the 
 precious germs of our discoveries are engrafted, as soon as 
 known, upon the common stock, and the good fruit is spread 
 abroad in all directions without stint or hindrance. In every 
 city, county, and State, societies like ours are continually 
 springing up, based upon the same unselfish tenets, the indi- 
 vidual members, as well as the organizations themselves, being 
 bound together by the adamantine chain of a professional and 
 fraternal sympathy, which is destined to encompass the whole 
 land with its ameliorative and recuperative influences. Ever- 
 more urging a broader and more complete culture, our Associa- 
 tion calls upon all schools and colleges in the land, and upon all 
 who teach in and control them, to exact a high and liberal pre- 
 liminary education; not so mud: in ancient classics though the 
 grace imparted through them adds to the dignity and influence 
 of the physician -but in modern languages, philosophy, and 
 every department of physics and of knowledge; and thus, by 
 the li<;ht of general science, to illuminate the technicalities of 
 
 o o / 
 
 their special pursuits. Nor lias its voice been raised in vain. 
 for every day are being witnessed the incipient symptoms <>l
 
 a tendency to that scientific training and discipline in induc- 
 tive reasoning whereby the American mind possesses itself of 
 knowledge at first-hand, without the intervention of European 
 authority. Thus it keeps ever before our ardent gaze the 
 speedy advent of the time foretold by the prescient Agassiz, 
 on the shores of the Pacific, when, instead of sending our youth 
 abroad to be instructed in narrow specialities and the ways of 
 fawning and servility, our home universities will rather be 
 thronged with students from the older nations, who, with the 
 
 O ' 
 
 arts and sciences on a broader plan, will be taught to think 
 and act as freemen, as active, independent live men, adapted 
 to the wants of a progressive, practical stale of society. 
 
 If, in aught that has just been uttered, I have seemed to 
 speak with the enthusiasm of the poet rather than with the 
 soberness of the physician, I know that the reality does not 
 justify the appearance. Of all the impressions derived from 
 the history of our Association, the most vivid, the deepest, the 
 most lasting is that expressed by the indirect results of its 
 meetings. 
 
 Organized more than twenty-five years ago, when the pro- 
 fession was in an almost chaotic condition when medical 
 books were, compared to our times, rare and expensive, and 
 when modes of communication were few and far between, it 
 has proved of incalculable value, as a medium for diffusion 
 of knowledge, for interchange of thought, experience and 
 criticism. More directly, in the several departments of the 
 profession at large, it has kept on duty a corps of volunteers 
 steadily engaged in exploring and defining all the topographical 
 bearings ot the scientific field. We may fearlessly assert, that in 
 earnest, enterprising movements of a progressive tendency 
 which is the distinctive characteristic of the age no calling 
 presents, more fully or honorably than ours, through these 
 committees, a better measure of advancement. This is made 
 manifest by the great variety and large scope of the reports 
 brought before the Association, and by the discussion of them 
 in the several and appropriate sections, during the last few 
 years. And whereas formerly we were entirely dependent 
 for on i 1 literature, in the various branches of the profession, 
 upon foreign authors, we now can boast of an American 
 supply, as various and profound in learning, as it is for the 
 most part correct, in literary and classical elegance. Jn mili-
 
 [ 7 ] 
 
 tary surgery, especially, the proud monuments of our achieve- 
 ments have quickened into activity the chirurgical world ; and 
 the invaluable stores of operative experience and practical 
 knowledge, derived from the recent lamentable civil conflict, 
 elevated the claims of American surgery, both North and 
 South, to an exalted pre-eminence. Our surgeons have 
 legitimized certain operations (as recorded in the pages of our 
 Transactions), notwithstanding European prejudices; while 
 religiously cultivating conservatism in the largest and fullest 
 application of the term. The same remark applies with equal 
 force to civil practice. I would specially instance ovariotomy. 
 Persistently denounced as "a surgical temerity," by some 
 European surgeons, one of our members,* in Philadelphia, 
 alone, has recorded 264 ovariotomies, with a success of about 
 70 per cent. Even in the young city of my adoption, contain- 
 ing between 16,000 and 17,000 inhabitants, twof successful 
 trophies have been added, within the last eighteen months, to 
 this triumph of chirurgical science. The recognition of all 
 this, as the fruit of our labors, may be tardily or unwillingly 
 admitted by those whose prejudices and long settled habits 
 are not easily overcome, and who have, more than once, 
 declared our Association to be a failure. But. sustained by an 
 enlightened public sentiment, and encouraged by the great body 
 of the profession, the American Medical Association has lived 
 to manhood, and will still live, not only for the maturing of its 
 great fundamental object reform in medical education but 
 also for the extension of its basis of operations, and the 
 furtherance of those means and instrumentalities, needed in 
 the advancement of the race towards the ultimate accomplish- 
 ment of its high destiny. My faith, at least, is high and 
 remains unshaken; and for all that has been done by the 
 eminent in talent, learning, and science, I have a heart that 
 overflows with admiration and with gratitude. While for all 
 that is now doing let us have the soul to realize the magnitude 
 of our objects and the import of our aims. 
 
 Let me ask who that ever attended the annual meetings would 
 not be willing to acknowledge that he did return home a wiser 
 and a better man'/ Who will dare deny that the status 
 
 *Washin.!_'t(.n L. Atlrc. M.I). 
 
 |0m- l.v.I. II. -\Vvtli.., !>.!>. M.D.. nn.l :m..th(-r l.y (!. (J. Tyrrell, L.R. C.S.I, a 
 K. Mini q.C.l'.l.
 
 [ 8 1 
 
 of the profession is greatly above what it was ^wenty- 
 five years ago, when (as quoted by my immediate prede- 
 cessor) the first President declared that " the profession to 
 which we belong, once venerated on account of its antiquity, 
 its varied and profound science, its elegant literature, its 
 polite accomplishments, its virtues, has become corrupt and 
 degenerate, to the forfeiture of its social position, and with 
 it of the homage it formerly received spontaneously and 
 universally." Would not the impartial observer now, in the 
 face of the sublime record to which I have just adverted, rather, 
 with the fur-seeing wisdom and stirring words of the same 
 gifted Chapman, hail this organization as an instrumentality 
 coming "forward in the majesty of its might to vindicate its 
 rights and redress its wrongs," and concur with him that, 
 " confiding in our resources, we shall through them maintain 
 the struggle till conducted to victory and triumph?" 
 
 But, gentlemen, il the estimate I have rendered of what our 
 Association has done be at all true if it has made better 
 physicians ot us and raised the dignity of the profession if it 
 be at all true that the infusion of clear and inductive thinking, 
 and the importation of scientific method and scholastic art, 
 have done so much to advance American medicine towards 
 that exalted station among its cognate sciences, to which it is 
 so justly entitled then so much the weighter are our present 
 responsibilities; so much t;ie louder is the call upon us to 
 sustain our lofty character and position, by increasing the 
 expansive circle of our usefulness, and by extending the range 
 of our scientific resources. 
 
 The most formidable impediments which here beset our 
 progress, it is easy to perceive, all resolve themselves clearly 
 into OIK defective medical education. We see it in the edu- 
 cators, with a few honorable exceptions, persistently traveling 
 in the same deep ruts of the old. narrow road ; we see it in the 
 professorships, too often conferred on those who have never 
 be>towcd a single thought to the training of the intelligence; 
 we see it in the low standard ot fitness for the doctorate; we 
 .see it in an inverse ratio of povertv of results to the largeness 
 of the field of operations; and especially do we feel and see it 
 by the display of powers never before suspected, developed 
 late in lite, and under embarrassing deficiencies. So long as 
 this .state of things obtains, our medical education will con-
 
 [ 9 ] 
 
 tinue to be all but a confessed and palpable failure. In vain 
 may the cry of " Keform ! reform!" be rung with its many 
 changes round the circle of our schools, from Maine to 
 Louisiana, and be re-echoed from our colleges in California 
 and Oregon, so long as it is proclaimed in high places of the 
 profession, that the exigencies of the times and the require- 
 ments of humanity exact such a constant supply of medical 
 force, as will hardly permit the acquisition of any greater de- 
 gree of knowledge and attainments than such as will enable 
 the new-fledged graduate to turn them promptly to clinical 
 purposes. With an apparently reckless inconsiderateness of 
 what might entail a waste of professional intellect, that may 
 possibly be equivalent to the daily loss of threescore and ten 
 years of progress, it has been deliberately argued, in the pres- 
 ence of the assembled Association, that profundity of learning 
 is not essential for the discharge of the physician's function, 
 and that practically the more the sphere of his scientific re- 
 sources is expanded, so much the less ability does he seem to 
 exhibit in the use of therapeutics. Germany has been in- 
 stanced to substantiate this hypothesis Germany, where the 
 crowning glory of modern medicine is found, not only in its 
 minute and exact knowledge of general, special, and compara- 
 tive anatomy and physiology not only in those peculiarities 
 of the therapeutics of to-day, that one of the freshest and most 
 advanced thinkers of the age has termed Restorative Medicine, in 
 contradistinction to destructive and depressing medication but 
 rather in " that purer jewel of her crown," unblemished by the 
 slightest taint of selfishness Preventive Medicine; Germany, 
 where cellular pathology is sweeping into oblivion a long 
 catalogue of torturing and depressing agents, and where 
 an amount of research in the natural history of diseases, while 
 putting to shame our own shortcomings, is urging us, in com- 
 mon with the prosecutors of our science everywhere, to more 
 determined efforts in this respect there, in that " vater-land," 
 its therapeutics have been signalized as u something hardly 
 better than nihilism," and the practice of physic not much 
 more than a " meditation on death." 
 
 Now, while I admit that there may be some apparent 
 reasons apparent only on the surface, however for the im- 
 pression thus intended to be conveyed, that the advances in 
 our science have led to skepticism in regard to the remedial
 
 powers of medicine as an art, and especially as to the remedial 
 powers of drugs, at the same time I must be permitted to enter 
 my protest, boldly, against the false position which medicine is 
 thus made to assume in her scientific character. The caution 
 and care, the scientific spirit, and the truly scientific method 
 observed and exercised by the leading minds of our profession, 
 nowada} T s, are due, in a great measure, to the uncertainty and 
 want of precision in the therapeutic means we possess. Science, 
 being organized knowledge, rejects all probabilities, and in her 
 researches after truth, has found that a large number of acute 
 diseases, occurring in previously sound persons, have a tend- 
 ency to terminate in the restoration of health, even though no 
 drug be given. This is fact not skepticism, but knowledge. 
 Again, accumulated observations have established the fact that 
 certain acute diseases run a definite course, and end sponta- 
 neously at a certain period from their onset. Conclusions, 
 therefore, drawn from the formerly supposed indefinite dura- 
 tion of these diseases, as to the efficacy of drugs to cut shore 
 their duration, are thus proved to be founded on false premises 
 and consequently are not trustworthy. From these and simi- 
 lar advances in our knowledge, the physician, of expanded 
 mind, instead of being overwhelmed by the effect of such dis- 
 coveries, or regarding them as sapping the foundation of his 
 faith, looks abroad with a clearer vision, and, embracing in the 
 
 ' > O 
 
 sweep of his glance all that has led up to, and all that flows 
 from these revelations of science, he comes to entertain a more 
 restricted, and therefore more correct appreciation of the 
 action of drugs. Now, the expression of this scrupulous con- 
 sideration is takei. as evidence of skepticism by those who 
 jump at conclusions confusedly, clumsily and erroneously. It 
 is precisely on such garbled interpretations of what science has 
 ascertained, that empirics, mingling a crude smattering of 
 knowledge with a cloudy mass of ignorance, have erected their 
 cra/.y structures of infinitesimal nonsense. 
 
 Most emphatically do 1 condemn such false conclusions, and 
 repudiate the unmerited imputation of skepticism that has 
 been east upon the great masters of our profession, who. J 
 hold, are not less firm believers than myself as to the value of 
 our present modes of treatment. It is true that with those 
 who understand the real nature of disease the lesions pre- 
 and tin- mode in wliieli they have been produced in
 
 short, pathology; we find belief in the efficacy of the so-called 
 active (perturbative?) treatment, less strong than in those who 
 are not so well informed whose faith is without knowledge. 
 But this doubt can do no harm so long as it is entertained by a 
 cultivated intelligence, possessed of the proper kind of knowl- 
 edge. The danger lies in the effect of doubt upon ignorance 
 upon the unscientific, doubt of truth and belief in error; doubt 
 in opposition to knowledge, which may prevent the saving of 
 life; and belief, without reason or justification, which, embodied 
 in practice, may kill. Let me explain by a borrowed illustra- 
 tion from high authority*, whose arguments I have just been 
 adapting to my purpose : 
 
 " J was one of three who met in consultation concerning 
 a case of apoplexy." (The case was one of degenerative 
 changes retrograde metamorphosis of the arteries. One had 
 become so rotten that its wall had given way, its contents had 
 escaped, a clot had formed, and by its mechanical effects had 
 given rise to the symptoms. The heart shared in the degen- 
 erative changes. The bleeding had stopped.) " in the opinion 
 of one of rny colleagues and myself, the only treatment to be 
 adopted was as follows : To place the patient in the recumbent 
 position, with head and shoulders raised; to enforce absolute 
 rest; to keep the bowels so far loose as to prevent excitement 
 and straining; to apply cooling substances to the head in the 
 event of any heat of the part occurring; to support the patient 
 with light nutritive food, having regard to his habits. The 
 third gentleman protested against the modern system of doing 
 nothing; he was anxious to bleed, to purge, to blister; and 
 when opposed, was not sparing of the term skeptic, etc. * * ^ 
 Now, the difference in opinion in this case was not due to 
 skepticism on the one side, and justifiable faith, /. e., faith 
 justified by knowledge, on the other, but to knowledge on the 
 one side, and absence of knowledge on the other." 
 
 imbued with the conviction that the beginning of wisdom is 
 the knowledge of ignorance, and conscious of the difficulties, 
 which, on every hand, beset him, the. scientific physician ex- 
 plores cautiously, doubts judiciously and determines slowly. 
 Hut while he rejects the hastily conceived and immature specu- 
 lations of the self-satisfied empiric, he does not stand idly iv, 
 and let disease run its course unmodified. Knowing that the 
 
 Sir \VilliMMi.leimrr, l!:irt., M.D.D.C. L. . K. U.S.
 
 [ 12 ] 
 
 Creator has established certain relations between cause and 
 effect, and that all the phenomena which we witness around us 
 are the result of certain antecedents and not of chance, he 
 seeks to fathom the causes of diseases, and by his knowledge 
 of their course, and of the dangers which threaten the life of 
 the patient, at each stage of their progress, he interferes to 
 prevent, to control and to counteract any untoward conse- 
 quences, and by the judicious employment of all the rational 
 means at his command, among which pure air, food and stimu- 
 lants are included, he saves the patient from death. Now, I 
 deny that this treatment can be regarded as nil or expectant; 
 it is positive, nay, active. 
 
 Believing, as I do. that medicine is destined, if her votaries 
 only prove true to their allegiance, to reach that " Ultima 
 Thule" in its history, when the stigma of uncertain shall be 
 wiped away from its deductions, and it shall take its rank 
 among the exact sciences. I cannot but think, that so long as 
 it may well be doubted if any fact or principle yet obtained in 
 regard to therapeutic agency, in resisting morbific influences, 
 can claim the rigidity and the universality of a positive law,* 
 so long must scientific medicine continue her unwearied efforts 
 
 o 
 
 after truth, through the realms of physical research so long 
 widen perpetually her range, through the vast compass of sub- 
 jects with which it is linked, by the prtgress of science and the 
 fluctuations of human requirements. A little reflection will 
 show how the profession, which has always assiduously pur- 
 sued natural knowledge, cannot separate itself from the indi- 
 rect any more than from the direct influence of science. As a 
 branch of natural science, consisting of an investigation of es- 
 tablished laws, medicine must he studied with the same care 
 and caution as other departments of science. There is this 
 difference, it is true, that while the natural philosopher can 
 bring mathematics to his assistance, and the chemist can re- 
 
 :: " Physiology and pathology afford little or no assistance in the adaptation of 
 medicinal agents to particular disc-uses, nor explain the mode of their operation : 
 /.-. in the euro of an a^ue. No means, yet recognized, inform us whether 
 
 its, oper 
 its furtl 
 
 
 tion i.- to neutrali/.e the uiortijii- iiiinxm, or merely to protect the body against 
 er noxious influence, while Nature's resources repair the injury done. 
 iin it is, that the atmosphere and saturated waters of the Cinchona forests do 
 ipt their human inhabitants from aipie. The same remark applies to every 
 the Ion;: catalogue of therapeutical agents, as regards the maladies in which 
 lias p roved their efficacy .".1 )<,</ ///,/;,* be/arc tin- Mi-di<-al Society of 
 ' \r l < }',/.: f-',- 1, run,;/ -<!,. I Slid. /,_;/ I/,-,,,-,, W.'l/can, M./>., of R,,<:hest>:r,
 
 [ 13 ] 
 
 Hort to analysis and synthesis while the ideologist ami zoolo- 
 gist have their starting points of observation and comparison, 
 and the astronomer ean weigh and measure the heavenly 
 bodies, predicting phenomena that will transpire in the future, 
 the physician has no such definite powers. These all deal with 
 what is, and has been. Their principles, once determined, are 
 not to be disturbed. But with the physician, instead of fixed, 
 inanimate masses that can be weighed and measured and tested 
 with accuracy, he has to deal with something intangible a 
 living, moving body, constantly changing, and animated by a 
 spirit, where all the ordinary laws which govern matter are 
 disregarded. Still, the phenomena of organization are equally 
 capable, with those of the inorganic world, of being system- 
 atized and brought into correlation, and there is no depart- 
 ment of scientific investigation no province of human thought 
 from which something may not be extracted and pressed into 
 the service of our all-embracing calling. 
 
 Viewing nature, then, with an eye to the discovery of truth, 
 the scientific physician finds an identity of design and correla- 
 tion of structure in all creation. Step by step he traces this 
 from the minutest microscopical cell to the complex organiza- 
 tion of the most perfect animal, just as the biologists and phys- 
 icists of the day are seeking the true cause, each in his own sphere, 
 " from the causes of twining in the delicate tendril to the 
 causes of variation in the human species; from the causes and 
 local conditions of atmospheric changes to the causes and 
 pln T sical consequences of the combustion of a fixed star."* 
 
 If such, then, be the ambitious aims of our profession, such 
 its exalted character, and such its capabilities, how incumbent 
 is it on us to strive without ceasing to enlarge the circle of its 
 usefulness and influence by encouraging and sustaining a sys- 
 tem of medical education so high in its requirements and so 
 comprehensive in its scope, that it shall keep pace with the 
 advancement of its kindred sciences, to whose possible con- 
 quests no bounds can now be set. 
 
 Having said this much in the hope of vindicating our profes- 
 sion, in its relations with modern science, from the charge of 
 skepticism or inefficiency. I must, tit the hazard of being 
 tedious to you, lest 1113- motives be impugned, disclaim the 
 
 Dr. Aokland : General Relation* of Medicine in Modern Times, whose line of 
 argument has been adopted above.
 
 [ 14 ] 
 
 slighest intention of taking any undue advantage, or commit- 
 ting the least injustice or a misrepresentation of what I am 
 willing to believe are the honest convictions of those who differ 
 from me, and who, doubtless, are possessed of a common inter- 
 est in the honor and usefulness of our calling Possibly I may 
 have misconceived the import of the arguments i have just been 
 combatting, or I may have misapprehended their significance. 
 But when I am made painfully observant of the irregular and 
 imperfect system of training under which the medical student 
 is educated in our country; when J am witness of the superfi- 
 cial qualifications attaching to tl'O conferring of the diploma 
 in some of our colleges; and especially when I hear that sys- 
 tem and that practice not only defended but advocated, I feel 
 that 1 should prove recreant to the duties of the high position 
 I now hold, were I not to give a just expression of my disap- 
 probation, lest silence might be construed into an endorsement 
 of what 1 conceive to be a most dangerous and demoralizing 
 doctrine. And I am the more strengthened and confirmed in 
 this opinion when I reflect that this Association, whose glorious 
 record I have just sketched, and whose name has already ex- 
 tended far beyond the continent of its origin, was organized 
 chiefly to elevate and ennoble the medical profession. 
 
 It is far from my purpose, however, to speak disparagingly of 
 those leading minds in our ranks who have been and still are 
 honorably engaged in teaching professors who, tried by anv 
 standard. which the older civilization of Europe may set up, are 
 entitled to the fame they have honestly won and to our lasting 
 gratitude. These men have ever been among the foremost and 
 most earnest- in demanding that upon every son of America the 
 blessing of education should be bestowed, and that the blessing 
 be made as thorough and liberal as possible. Were it not that 
 it, might appear invidious, J could cite a long list of living. 
 honorable physicians, from evcrv State of our extended terri- 
 tory, tit successors of Chapman, and Stevens, and Drake, and 
 \Varren.and Moultrie. and Wellford, and Dickson, and Pitcher, 
 and Pope, and other departed worthies; men whose reputation 
 is bounded by no geographical limits; citizens of the universal 
 republic of letters, who have labored, in season and out of sea- 
 son and on all occasions, in advocacy of the broadest and coin- 
 pletest education, in the hands of such men who may be 
 styled the trustees of our Association in this particular I
 
 [ 15 ] 
 
 repose every confidence. We may safety acknowledge them 
 to be fully competent to inaugurate the reformatory measures 
 so imperiously required. Their experience as professors ren- 
 ders them peculiarly sensitive to the evils now existing and to 
 the urgent need for their removal. Their cor. potency in every 
 particular for the undertaking is undeniable, whether in the 
 abstruse and comprehensive, or in the refined and {esthetic; 
 whether in the profound and logical, or in the powerful and 
 commanding; whether in practical wisdom, moral, inter- 
 national or civil, social or medical, in those arts which employ 
 while they improve and bless the people; whether, in a word, 
 in all that makes man useful, virtuous, and happy, and that 
 prepares him for the service of his Creator on earth, or of his 
 fellow men, or of posterity. 
 
 May I be pardoned for declaring that such is my creed, and 
 that I glory in it. And I speak with well grounded assurance 
 that, before the close of the present decade, we shall witness a 
 total revolution in our system of medical education. The 
 achievement of this object, as of every other great and good 
 work among men, can only be accomplished by time and pa- 
 tience, by rational inquiry and enlightened perseverance ; by 
 a spirit of wisdom equally removed from rashness and hesi- 
 tancy; from the blindness of self-interest and the spirit of wild 
 innovation. 
 
 If I am asked the reason of the faith that is in me, I will 
 point to Old Harvard ! Worthy of its ancient prestige and 
 true to its Athenian culture, it has set an example of self-sacri- 
 ficing devotion, and to day it says to all the medical colleges 
 and schools : '-We are resolved that the republic of medicine 
 aliall receive no detriment from a low standard of admission 
 to or emission from our halls."* Cease, therefore, to ridicule 
 and scoff at our alleged conceit, for the day i^ fast coming, aye, 
 is already come, -'when it will l>e important for a man to know 
 how he was born into the medical world." If Harvard only 
 keeps on as it has began (and we know too well the material 
 of which it is composed to doubt this), not only will its initial 
 appendage to the M. I), of its diploma be sought after, but it 
 will become a power in the land to incite all the schools to set 
 about the revision and extension of their respective curricula, 
 
 * Modern Medicine: Its Status in Modern Society. ]>y Homer 0. Hitchcock, A.M. 
 M.D.. Michigan.
 
 [ 16 ] 
 
 and every college will haste to elevate itself, after the manner 
 adopted, to a footing of perfect equality, with a diligence and 
 effectiveness such as our Association has been laboring for years, 
 but in vain, to induce. After such reconstruction, the principle 
 of competition would work wonders. Each college would emu- 
 late the other by putting forth all its powers to insure, in its 
 graduates, the best possible education. Each would flourish 
 and become influential in proportion to the public favor be- 
 stowed upon it, and consequently they would all appeal to the 
 public to judge of the comparative excellence of their diplomas 
 as tests of scientific acquirements and thorough qualification. 
 The public, awakened from indifference concerning the educa- 
 tion of those to whose keeping the}' entrust their very exist- 
 ence, would gradually become accustomed to scrutinize more 
 and more closely the working and effects of the medical schools; 
 would learn to assign to the diploma its exact worth and no 
 more; and finally, be led to investigate the character, ability, 
 knowledge, and experience of individuals before placing the 
 bodily comforts and lives of themselves and families in their 
 keeping. 
 
 Thus, when the people, who, with our present popular form 
 of government, have become the inveited repository of sover- 
 eignty, formerly confided to but one, shall take the control of 
 medicine and its institutions into their own hands when, by 
 their enlightened numerical force, they shall again build up 
 the barriers of distinction, which monarchy, in the olden 
 times, and the oligarch}' of our more modern governments, 
 have ever defended between the true physician and the hypo- 
 critical pretender, but which, in the first flush of popular 
 absolutism, have been rashly swept away then, and not until 
 then, will the standard of medicine be raised to the height of 
 contemporary knowledge only then will the departed dignity 
 of the profession, the humiliating consequences of which 
 aroused its members to form this Association, be fully rein- 
 stated. If, then, we would take the initiative in this great 
 work, by a discriminative decision, with regard to the admis- 
 sion of new members, in favor only of such as shall possess 
 the diploma of those colleges whose curriculum of studies is 
 most complete and most in accordance with the advanced 
 state of our science ; and if, instead of carping and fault-finding, 
 every well-wisher of his profession would become identified
 
 [ 17 ] 
 
 with our Association and work with it, and thus by throwing 
 its whole mental and moral force into the scale, and by bring- 
 ing to bear its extraordinary and exclusive possession of 
 information information and knowledge that can be at once 
 subordinated to the grander requirements of humanity we 
 shall be enabled to bring an amount of pressure of an intellec- 
 tual kind to bear on the Government, that will inevitably end 
 in making this Association the instrument of the public good, 
 rather than the machinery to advance solely the immediate 
 worldly interests of the profession. 
 
 This leads me to the consideration of a department of our 
 science, which, having in view the greatest good of the greatest 
 number, is peculiarly adapted, by bringing us into immediate 
 communication with the people, thus to supply one of the great- 
 est wants of the age. The department to which I now have re- 
 ference is Public Hygiene, or State Medicine a department of 
 philosophical research, possessed of a world-wide interest, and 
 which, laying its scientific claim upon more exact, demonstrative 
 truths than the science of disease, is, therefore, worthy of a far 
 higher consideration a more authoritative recognition than 
 has yet been awarded it, and should hold a place, in our estima- 
 tion, upon the highest plane of medical education. For these 
 reasons, and in accordance with my official duties as Chairman 
 of a Committee of this Association on "a National Health 
 Council," I submitted, at the last meeting in Philadelphia, a 
 report, suggestive of what might be accomplished through 
 the instrumentality of such State Boards of Health as are now 
 established or arc in course of construction, when brought into 
 co-operation with a Central Sanitary Bureau, to be inaugurated 
 by the Government under the auspices of this Association. 
 Whatever may be the ultimate decision in regard to the 
 important issues therein discussed, and which, with your kind 
 indulgence, 1 now propose to reopen, it has been acknowledged 
 by some of the leading journals of our profession that the 
 whole scheme embodies one of the grandest designs to which 
 our Association has yet aspired. From the temper manifested 
 at the time, however, in regard to the proposition of bringing 
 this Association into immediate relations with the Government, 
 I was induced to believe that if the profession was not yet 
 educated up to u true appreciation ot the prospective benefits. 
 so much the less prepared would the laity be to comprehend
 
 [ 18 ] 
 
 its immense proportions, or to approximate a just conception 
 of the results that are to be accomplished through the prac- 
 tical application of its life and health giving provisions. 
 Accordingly I then accepted the amendment striking out the 
 clause respecting governmental co-operation. Only one ye&r 
 has elapsed since the question was thus disposed of by the 
 conservative element of this body, and already has the profes- 
 sional interest therein increased to such a degree, and the 
 store of collateral information become so accumulated and 
 urgent, that there has been a general awakening of the public 
 mind throughout the whole United States in favor of the 
 proposed scheme. In evidence of this I have only to point 
 to the recent formation of a Public Health Association, 
 organized by leading scientific as well as medical men, 
 who have especially devoted themselves to sanitary studies 
 and, also, to the recent introduction in Congress of a 
 bill for the establishment of a National Bureau of Sanitary 
 Science, to be located in Washington. 
 
 With all due deference to the opinions of those who opposed 
 the project suggested by me, at the meeting in Philadelphia, I 
 still think that this Association is the most suitable medium to 
 inaugurate the movement, because, in the language of its 
 eloquent historian,* " when depositing the corner stone, over 
 which has been raised a superstructure, designed to secure the 
 honor, advance the knowledge, and extend the usefulness of 
 our profession, the expediency of inscribing thereon, simul- 
 taneously with medical education. Hygiene, the handmaid of 
 Medicine, received the unanimous approval of the convention. 
 At its n'r-t annual meeting in 1848, a communication 
 was received from the Medical .Department of the National 
 Institute, enforcing upon the attention of the Association the 
 immense and growing importance of hygiene, claiming for it 
 an influence second to none other which could occupy their 
 deliberations, and recommending the appointment of a perma- 
 nent committee on hygiene. This intelligent appeal was 
 heard with profound interest, and the Association at once 
 appointed a committee." Thus an outside influence was 
 awakened at an early day in regard to hygienic measures in 
 connection with this organization, and the attention of philan- 
 thropists directed to it as a means for the improvement and 
 
 U'll-un .l,.\v.-ll. .\I.I).. I'rr-i.li-ntiiil A, Mi-ess. 18(',:i.
 
 [ 19 ] 
 
 successful accomplishment of this special department of their 
 reformatory labors. Nor have the expectations in this respect 
 been disappointed. It is a gratifying fact that the prestige 
 attaching to the Association, for the valuable reports, com- 
 mencing with a programme for the enactment of uniform and 
 efficient laws, in the several States, for the registration of 
 marriages, births and deaths, and followed up by similar 
 important measures down to the present complete and ex- 
 haustive nomenclature of diseases, continues to increase in 
 force and influence. Who so well qualified, therefore, to 
 develop the reformatory schemes now contemplated as those 
 who initiated the movement, and whose labors in this direction 
 for a quarter of a century u afford a guarantee that the future 
 in this enterprise will be wreathed with a success that shall 
 know no rival, and consummate a reform in the science of 
 medicine, which, when compared with the glorious evangelical 
 light that burst from the cell of the Wittenburg student, shall 
 enlighten the world, and endure while time lasts."* 
 
 " Surpassing all around, even as tliu sun, 
 
 In morning splendor, shines above the stars." E. C. JUDSON. 
 
 Besides, the people are rife for the movement, and have 
 come to look upon our organization with favor and confidence. 
 In alluding a few moments ago to the social and political 
 relations of medicine, it was stated with general accuracy, 
 though perhaps not with strict regard to literal historic truth, 
 that this Association was formed in part to repair the evils 
 resulting from that equalizing spirit, which, while, with a 
 profound knowledge of political philosophy, it set up our 
 admirable system of popular government, at the same time, 
 working in the shadow of an ignorance of a medical 
 philosophy, equally profound, tore down every protection 
 which the subordination of cusfc society formerly afforded. 
 That this object, at least, of its mission has been accom- 
 plished is evidenced by the popular appreciation of san- 
 itary organizations throughout the nation. Legislators are 
 now turning their attention to the framing of laws bearing 
 
 o & 
 
 upon questions connected with medicine, and Boards of 
 Health for States and municipalities are rapidly multiplying 
 everywhere. What seems to be. therefore, required in the 
 
 '* Jewell, op. t_-it.
 
 [ 20 ] 
 
 premises is to eft'ect un union of views as to the method of 
 action, so as to bring every State into immediate communica- 
 tion, by means of State Boards of Health, with a central office 
 in Washington, to be presided over by a Commissioner or 
 Secretar3 T of Public Health, to be elected every four years or 
 often or by the Association, subject to the approval of the 
 President of the United States, and who shall have power to 
 make all necessary sub-appointments. The connection thus 
 established between Federal, State and Municipal Boards of 
 Health would cause the spread of all the latest acquisitions of 
 science, and bring every State to a recognition of what prac- 
 tical measures have succeeded best in reducing sickness and 
 mortality to a minimum, and which have the highest sanitary 
 influence in preventing disease. Such connection would also 
 make it an object of ambition with our best qualified members 
 to enter on the public service, provided a sufficient pecuniary 
 consideration be appropriated by the Federal and State Gov- 
 ernments, to render them independent of private practice. 
 The reasons for this provision are, first : because the claims of 
 such practice would be constantly adverse to those of public- 
 duties, especially at times of epidemic disease, when official 
 activity would be most needed ; and secondly, because the 
 personal relations of private practice might render it difficult 
 for an Officer of Health to fulfill with impartiality his frequent 
 functions of complainant; and thirdly, because, with a view to 
 the cordial good will and co-operation of his medical brethren, 
 it is of paramount importance that the Officer of Health should 
 not be their rival in practice, and that his opportunities of 
 admonitory intercourse with sick families should not be liable 
 to abuse for the purposes of professional competition. These 
 views arc not entertained by me alone, but are in accordance 
 with a Report of the Koyal Sanitary Commission of Great 
 Britain, which further recommends that there should be estab- 
 lished and maintained by the public authorities in all the large 
 cities, where scientific mid medical schools exist. Public Health 
 Laboratories. In them, not only points bearing on the general 
 pathology of man and animals would be from time to time in- 
 vestigated under the best guidance, but persons would be 
 trained to be thoroughly qualified in all medico-legal questions. 
 Hereby some of the scandal of ex parte scientific witnesses 
 might be checked or removed. These and many other interests
 
 that relate specially to State polity will naturally suggest them- 
 selves, such as accurate sanitary surveys of every State, annn- 
 ally, to ascertain their physical, mental, and moral force; the 
 nature of those causes which favorably or unfavorably aft'ect 
 the body politic, and to investigate the statistical, topo- 
 graphical, and jurisprudential condition of each. Time will 
 not permit me to dwell longer on the momentous questions 
 involved further than to hint at some of the preliminary steps 
 required to set the machinery at work for carrying into effect 
 the measures proposed. 
 
 Now, while I would premise that I have no wish, even if the 
 power were inherent, to change our organization, or to advise 
 any essential departure from our plans of operation, I must be 
 permitted to remark, that I believe the time has come when 
 we must place ourselves in a more intimate relationship with 
 the people than has hitherto ruled ; in other words, the people 
 are looking to us to utilize the capacity which this Association 
 actually possesses, for the general welfare. The world moves 
 fast nowadays, and however correct may be the statement 
 already made, that this organization was created to counteract 
 the degrading influence which the unrestricted distribution of 
 political power, through all ranks of society, exercised upon 
 the profession, it is certain that this state of things no longer 
 prevails. With the extension of political liberty, and the cor- 
 responding advancement in political philosophy, the want of 
 faith in the value of pursuits not obviously connected with 
 mercantile gains is passing away. As civilization progresses 
 the people become more and more convinced that science does 
 pay the nation, and the tendency increases to turn the central 
 power in every direction that will be likely to inure to the 
 common good. Given this higher tone of public sentiment to 
 deal with, it remains for this Association to take the initiative 
 in bringing about concerted action on the part of the people. 
 I cannot see cause for the alarm which was manifested at the 
 time already alluded to, when the subject was introduced at 
 our last meeting, lest the Government might exhibit a prefer- 
 ence for erroneous theories and irregular practitioners, or 
 require that the selection of requisite officials should depend 
 upon political opinions. Nothing inconsistent with individual 
 rights has occurred in England, France, Germany, or in any 
 other nation where great co-operative societies have already
 
 [ 22 ] 
 
 been organized for facilitating the diffusion and operation of 
 hygienic knowledge and sanitary measures. With our civil 
 service system properly administered there ought to be no fear 
 of investing our popularly constituted government with too 
 much power of being useful, if we do our duty by enlightening 
 the masses in the fundamental principles of the calling for 
 which we solicit their aid and support. Just as long as society 
 is ignorant of the knowledge which will enable it to rightly 
 judge of the fitness of a profession to its wants, so long will 
 there be impertinent interferences and quackery. Especially 
 so in a country like ours, where everyone is left to exercise his 
 own judgment and choice. But let the people fully comprehend 
 the laws by virtue of which they live, move, and have their 
 being, and there will be no danger of their tampering with 
 matters which pertain to their highest earthly interests. Now 
 it is just here, to this point, that I desire particularly to draw 
 your attention. It has been conceded that one of the greatest 
 wants of the profession is some suitable and adequate means 
 of communication between itself and the people. The science 
 of hygiene is not nbocc the people, but for them. Who will do 
 in the interests of the masses, for sanitary science, what Hux- 
 ley, Tyndall, Carpenter, Herschell, and others are doing for 
 other departments of science, with better grace than the mem- 
 bers of this Association ? Let us throw away all puerile no- 
 tions about the dignity of our calling, and approach the people 
 through the only channels by which they can be reached -the 
 newspaper and the lecture room. This is our work for the 
 future to educate the people. 
 
 Too long for our interest and that of our race have medical 
 men ignored this important duty. " With dull apathy we have 
 seen the followers of most other professions seeking to avail 
 themselves of these elements of power, some for good, some for 
 evil. The clergyman has not trusted alone to supernatural 
 power in keeping alive the truths of revelation and arous- 
 ing in the people a due ropect for its lessons. They have 
 watched with -jealous care' the education of the young, and 
 from the Sabbath school to the universitv they exercise the 
 greatest control. And legislators, through their political or- 
 ganizations, public speeches, and control of the pi-ess, hold the 
 masses, as it were, in the hollow ot their hands." 1 ' 
 
 - Michipm l',,irei*ity Mli<-,il J,,,,n,,i/. July, ]S71. Review ul' Dr. BarthulumewV 
 aiKln^, a.- 1'rcMik-iit uf the Medical Society of that State.
 
 [ 23 ] 
 
 Besides, there seems to be a spreading impression among the 
 members themselves that our Association is not advancing, 
 pari passu, with the progress of society, and that it fails to meet 
 the requirements of the times. 
 
 Now, I have given much thought to this subject, and de- 
 liberately pondered all the proposed schemes for the widening 
 of the sphere of our operations, or the heightening of our influ- 
 ence, and have come to the conclusion that in no other way, 
 than that I have pointed out, can the co-ordinate interests of 
 the profession and the people be better subserved. I believe 
 that, being a representative body, it is exactly suited to the 
 tastes and habits of Americans, and has much more influence 
 than would be exerted by a more exclusive and less demo- 
 cratic body, as has been suggested in some of our late medical 
 journals. I further believe that it represents as fully and com- 
 pletely the profession as it is possible for any organization to 
 do. This is shown by the lively interest the great mass of 
 practitioners take in it everywhere ; they are proud of the 
 privilege of ingress proud of the privilege of working for its 
 honor. And to the question, Who shall be greatest among us? 
 they will, 1 am sure, as suggested by a writer just quoted,* 
 respond with one heart and one voice, " in the memorable words 
 spoken among the hills of Judea by Him, who was the embodi- 
 ment of all that is gracious, pure and noble in our profession : 
 ' Let him that would be chief among you, be your minister.' " 
 
 Service service for humanity will evermore in medicine, as 
 in all other departments of human pursuits, be the certain key 
 to lasting honor and high reward. 
 
 Gentlemen of the Association: The period, in my opinion, 
 has arrived when, in order to carry out fully the measures I 
 have proposed, it will become necessary to make some altera- 
 tions in the working of our organization; and if you so agree 
 with me. J. at least, pledge myself to exert all my influence 
 that the alterations be made cautiously, wisely, and with de- 
 liberate forethought as to consequences. 1 do not wish to be 
 understood as advocating any measure in contravention of the 
 spirit of our code. When 1 recommend, as one of the means 
 of widening the usefulness of the Association, the judicious in- 
 struction of the community in the knowledge of the science of 
 life, I do not wish it to b^ understood that we are to do more 
 
 * Hitcln k, up. cit. 
 
 ! $71)658
 
 [ 24 ] 
 
 than spread abroad such sound ideas of enlightened hygiene as 
 will enable the people to co-operate with us in correcting all 
 those formidable obliquities physical, mental and moral 
 which are insidiously polluting the stream of humanity, so that 
 the race may move onward and upward, in purity of type, to 
 a higher and nobler manhood. In the furtherance of this end, 
 I believe our Association will exert a powerful influence. Such 
 publications as your President now proposes cannot be miscon- 
 strued they cannot be tortured into violations of the code. 
 If by an} T means they can, then let us amend our platform 
 add a new clause to our ethics so that we do not prove 
 recreant to that duty which even our very title of doctors, 
 teachers, implies. No wisdom, however mature, could at once 
 have originated a system competent to meet all the exigencies 
 time and progress ma}* give rise to. As our Association ad- 
 vances towards the consummation of its purposes, it must be 
 expected that new necessities will arise, and experience in the 
 working of the plans laid out at first will demonstrate the na- 
 ture of the changes for adaptation to existing circumstances. 
 
 In conclusion, I would also respectfully suggest whether it 
 would not be in accordance with the best interests of the Asso- 
 ciation to return to the practice of holding biennial meetings 
 at the National Capital, and alternate ones, as now, at different 
 points of our common country. \Ve might thus secure all the 
 advantages of a fixed location, for the better organi/ing and 
 working of such sanitary measures as may be deemed advisable 
 in connection with the government, and the preserving of our 
 archives, books and other collections. At the same time, by 
 meeting at various places every two years, we could not fail to 
 keej) up the wide-spread interest amon<r the masses of the pro- 
 fession, which now prevails. 
 
 A popular writer* of the day has happily said : 
 
 'I)o we desire to be strong'/ 1 we shall be so on one condi- 
 tion that we resolve 1 to draw for strength upon the common 
 fund of thought and feeling stored up within us and without 
 us. We euti only liuve the highest happiness by having wide 
 thoughts and much feeling for the rest of the world as well as 
 for ourselves, because our souls see it is good." 
 
 l>ut. gentlemen, whatever course you may think proper to 
 pursue. I am sure that your objects will be the advancement of
 
 [ 25 ] 
 
 science, the good of humanity, and the honor and glory of our 
 beloved profession, which for a continuous period of more than 
 two thousand years has numbered among its votaries many of 
 the wisest and most benih'cent of the long roll of sages and 
 philanthropists. I feel, therefore, that I cannot better con- 
 clude than by bidding you, in this connection, barker)! to the 
 utterances of Missouri's honored son. Cut mm at vein- nib He 
 iK/men,* pronounced eighteen years ago before this Association, 
 and now echoed back, from his sepulchral couch, in the Capital 
 of France. 
 
 On the eve of the battle of the Pyramids. Napoleon ex- 
 claiir.ed : 'Soldiers! from the height of yon monuments forty 
 centuries look down upon you.' (.Tentlemen, from the heights 
 of past ages countless worthies of our (rod-like profession point 
 and beckon to a goal more elevated than ever attracted legis- 
 lators and conquerors, Solons and Caesars ! " 
 
 * Charles A. Pope, M.D.. of St. Louis (Mo.), President of the American Medical 
 A..iii-ia!i<>n '" '^5. and who died in Paris in 1871.
 
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