ADDRESS BEFORE THE AMERICAN MEDICAL ASSOCIATION, FOURTEENTH ANNUAL MEETING, HELD IN THE CITY OF CHICAGO, ILL., On the 2d of June, 1863. WILSON JEWELL, M. D. ACTING PRESIDENT OF THE ASSOCIATION REPRINTKJJ-FROM THE TRANSACTIONS OF THE AMERICAN MEDICAL ASSOCIATION. PHILADELPHIA: COLLINS, PRINTER, 705 JAYNE STREET. 1803. * ADDRESS. GENTLEMEN OF THE AMERICAN MEDICAL ASSOCIATION: Since we last assembled in convention, two years ago, as the representative body of the medical profession in this country, the delightful union of our congress has been unexpectedly interrupted. Events, the most thrilling in the history of any nation, have trans- pired. The government of the United States, the mildest and most beneficent the world ever knew, has been plunged into an unnatural, causeless, and unprecedented rebellion. Our once happy and pros- perous country has been involved in distress and ruin. The most endeared relations in life have been severed. The strongest ties of parental and fraternal affection alienated, while our Union, the pal- ladium of our safety as one people, now trembles in the balance. Nor is it less unfortunate, or less to be deplored, that this fright- ful national strife should have found its way into the balls of science, embarrassing their movements, limiting their usefulness, and im- perilling their very existence; even our own cherished American Medical Association, an institution eschewing all politics, devoted exclusively to the lessening of human suffering, and the fostering of a friendly intercourse among physicians from the remotest sections of our glorious republic-kneeling at the same holy altar, and drinking at the same pure fountain—even here, has the blighting influence of this civil war been felt, endangering its claims to an unselfish nationality, and robbing it of the presence and the council of many of its warmest adherents. But I have hope that the struggle now going on in this Gov- ernment for its life, will be successful. My faith is strong, not only in the recuperative energy of the loyal people of these States, but in their Christian character and fortitude. 4 ADDRESS OK I take courage, and believe that our defence, based upon eternal truth and justice—proclaiming the sound doctrine of civil govern- ment and involving the rights of man—can never fail : these principles are as the salt, that shall conserve and save the life of the nation— " For o'er the blackness of the storm A bow of promise bends on high, And gleams of sunshine, soft and warm, Break through our clouded sky."—Longfellow. But let us turn from the contemplation of our national troubles— from scenes that make the heart heavy with sadness, and are not in harmony with scientific assemblies, while for a moment I offer words of professional consolation, and silverline the edges of the dark clouds of discord gathered around our country's horizon, by an allusion to the noble and active participation of our medical brethren in this fearful conflict. It was not to be expected that the members of a profession, so eminently blending science and moral courage with a disinterested nobleness of character, could remain idle spectators, when the exi- gencies of the times demanded the services of their calling. Leaving the comforts of the home circle; the rewards of a remunerative practice, and the peaceful pursuits of their chosen vocation, with a loyal and heroic faith in the justness of the cause, associated with an ardent love of country, they did not hesitate long, ere they were found enduring the privations of the camp, or risking more dan- gerous positions on the battle-field, and in the " imminent deadly breach." Wherever danger is the greatest, or the struggle the fiercest, there may be seen the surgeon, with a laudable and patriotic devo- tion, cheering the soldier or the sailor on to duty, or, administering aid and comfort to the wounded. When the smoke of the battle has cleared away, then with a noble heroism, and unshrinking firmness, surrounded by death, desolation, and the horrors following a san- guinary struggle of arms, he still remains at his post on the field, or around the couch of the suffering, the sick, and the dying; cool, firm, self possessed, amid confusion, and the turmoil of excitement, engaged in deeds of mercy and kindness; mitigating the havoc of the battle, preferring rather the risk of becoming a prisoner of war than abandoning the wounded in his care. Sirs, when the history of this atrocious rebellion is written out, an illuminated page will be reserved, in which shall be inscribed WILSON JEWELL. 5 in letters of gold, the loyalty, the courage, the self-sacrificing devo- tion, and the philanthropy of the Medical Staff of the army and navy, gleaning "in the ruthless and red-handed reaper's path" with a true heroism, facing death without glory, or encountering the grim antagonist in the silence and gloom of the hospital, minister- ing to the perishing, stimulated by no warrior's ambition, and claiming no laurels, save those arising from the consciousness of having discharged faithfully their high and holy mission. But, gentlemen, another sad event has occurred since our last meeting, in which, as an association, we are more immediately interested and aggrieved. There is a vacant seat here to-day. Our venerable President is not. Eli Ives has been gathered to his fathers, wearing the mantle of the highest professional honors and dignity attainable, while his " hoary head was a crown of glory, found in the way of righteousness." Who that witnessed his vene- rable form, bending with the weight of years, and listened to his trembling accents when he arose at New Haven to acknowledge his gratitude for the distinction conferred—did not feel they were listening for the- last time to the words of a medical patriarch, "whose days were dwindled to the shortest span," waiting patiently " to lay aside the worn-out tabernacle of the body, and consign it to the rest of the grave, and to the renovation of the resurrec- tion?" Length of days bad been vouchsafed to him, and no one had attained a higher eminence among his compeers. It will ever be a pleasant reminiscence to us and bis bereaved family that the last of the numerous honors conferred upon him during his long and useful life, was by this Association, and one, that must have shed a rich halo around his declining pathway. It is this event that brings me before you to-day. With you, I sincerely regret the occasion, by which we are deprived of the presence and council of so distinguished an individual, whose gifted intellect and matured experience have been acknowledged and appreciated, not only by those who have sat at his feet and learned of him, but by those also who have enjoyed his fascinating society, or possessed a share of his warm friendship. To eschew the censure of obtrusion, or the committal of an over- act, by assuming the last official obligation incumbent upon the President, I would remind you that I could not disregard a prece- dent established at St. Louis, when the first Vice, in the absence 6 ADDKESS OF of the President, performed the duty of delivering the retiring address.1 The elevation of the standard of medical education and the gene- ral advancement of the science of medicine, constitute the two great leading principles, the "controlling motive power" for asso- ciated action, and have maintained a pre-eminence unabated during the entire history of the Association. Besides, they have formed the prominent leading topics for discussion in every preceding valedictory. Arrayed in impassioned language, they have been urged as the most potent incentives to an unshrinking perseverance in the work of medical elevation, until the proud mission of our organization be fully accomplished. It was the eloquent and learned Chapman, the first President of the Association, who, realizing the difficulties and dangers encir- cling the profession, which in his far-seeing wisdom he attributed to its decline in science and literature, bailed this organization as an instrumentality coming "forward in the majesty of its might to vindicate its rights and redress its wrongs," and that, "confiding in our resources, we shall through them maintain the struggle till conducted to victory and triumph." The highly gifted and erudite Southerner2 struck a similar cord, and bore a pleasing testimony to the future usefulness and aggran- dizement of the Association in the field of medical literature. In its early minority he peered into the future and proclaimed, in view of the imbedded wealth beneath the rough surface of the medical mind, that "the sinking of the grand shaft has been com- menced, the matrix of the vein has been already pierced, and the priceless ore sparkling with glittering gems, but still obscured by admixture with the less valuable material, is presenting itself for reduction and refinement." He continued: "When our shaft shall have penetrated further and deeper into its recesses; when our tunnels and adits are completed, our machinery arranged, and our furnaces in blast, the American Medical Association will proudly exhibit its ingots of mental gold, the rich result of its labors, and the glorious reward of its elevated and disinterested enterprise." Then was heard the voice of an experienced and welcome « At the Seventh Annual Mating, the President, Dr. Jonathan Knight, of New Haven, being absent, the first Vice-President, Dr. Usher Parsons, delivered the address. 2 13. II. Welford, M. D. WILSON JEWELL. 7 veteran1 in our science, from the "Providence plantations," insisting upon the adoption "of such measures as will promote and perpetu- ate among ourselves an esprit de corps" as a safe and certain means for elevating the character of the profession and advancing medical science. From the valley of the Mississippi, beyond the "father of waters," we hail the young and ardent rival surgeon of the West.2 We listen as he beautifully and truthfully alludes to the legislative duties of the Association. To "the propriety or impropriety of getting laws passed to regulate the practice of medicine." On this point be ventures no opinion, but adds, "Laws can make only mediocre physicians—the greater lights of the profession can- not be manufactured after any process of legislative enactment— thirst for knowledge, self-love, philanthropy, burning ambition, these make the great physician and surgeon." Another beacon light of the age,3 as skilful in didactics as he is renowned in authorship and amiable in deportment, looks abroad from the proud height he has attained, and proposes to take " a survey of the Association—a comparative glance from the present backward to the past," that we might " be better prepared to look forward intelligently into the future," and thus assisted by his keen- eyed wisdom, be assures us "that the spirit of improvement has breathed upon the masses of the profession, and everywhere scat- tered germs, which are now developing, and will hereafter continue to develop even in a still higher ratio, into earnest efforts for self- culture and general advancement." Keeping pace with the improvements of our science, the North- west, the " Great Water" State, speaks through one of her most brilliant, highly cultivated and vigorous minds.4 A comprehensive view is taken of " Medicine in its social and political relations," and we are taught " that the work of medical regeneration is to be commenced by the profession," and that this reform must be gradual; "that advances in science have also had their seed-time, their period of growth, and must ever have their fruition. When this is accomplished" by the American Medical Association, " the medical schools will rise in character as a correlative effect, and the profession establish for itself a legitimate claim to public con- fidence." 1 Usher Parsons, M. D. 2 Charles A. Pope, M. D. » Geo. B. Wood, M. D. 4 Zina Pitcher, M. D. 8 ADDRESS OF Again, we listen with delight to the pleasing farewell address of another distinguished public teacher on the eve of his retirement from the presidential chair,1 who, from a favorable stand-point re- calls the achievements of the Association, and concludes "that no similar institution has ever been more successful in carrying out its chief object, the promotion of science," but that "much territory still remains to be redeemed." The highly distinguished and ripe scholar,2 from the seat of our national government, having presented us, and with great perspi- cuity of language, a review of the improvements in our science, trusts that the future will be equally successful, and that the friends of the American Medical Association will "be able to say, we found it with the education of its members too much neglected, we left it with the medical schools of the highest character, and physicians in the foremost rank of science and learning." The controversy between "the lay members of the profession and the professors in our medical colleges" did not fail to awaken the generous efforts of a "daysman" betwixt these gladiatorial parties. A retired teacher,3 keenly alive to the interests involved on either side, and as eminent for his experience as he is distinguished for his zeal and truthfulness in science, holds out a peace-offering for the adjudication of the difficulty, and portends that, until settled, "the turbid tide will continue to flow into the schools, and its an- nual reflux continue to bring forth broods of inchoate doctors." These glowing extracts, gentlemen, furnish only a glance at the stirring appeals and the enthusiastic predictions that have so often inspired eloquent pens, both as to the present and future of the American Medical Association. If, peradventure, I direct your attention into another channel for thought and investigation, it will not be because these important themes have been overrated, or their valued interests exhausted. The faithful manner in which they have been so repeatedly re- viewed and illustrated by these distinguished lights of our profes- sion, who have preceded me on occasions like the present, and the belief that they are already photographed upon your minds in living colors—lead me to another, and, I trust, an equally inter- esting and important field. Not, however, that "I love Caesar less, but Rome more." 1 Paul F. live, M. D. 3 Henry Miller, M. I). Harvey Liudsly, M. D. WILSON JEWELL. 9 The subject to which I have reference is Hygiene—the science of health. A department of philosophical research unsurpassed; a cardinal principle in the broad science of medicine; a study above every other of a physical nature to which the human intellect can be made subservient, and the most philanthropic in which the heart of man can engage. A science of no modern discovery—its history dating far back into the Archaeological Ages, and coeval with the sorrows to which the human family were predestined, when the Supreme Lawgiver revealed the consequences from eating " Of that forbidden tree, whose mortal taste Brought Death into the world"— when the original destiny of man fell from the glory of his Creator to a type of degenerate existence, subject to disease and pain, decay and death. With those who have been actively engaged in contributing to the cultivation of the science of hygiene, the sentiment is so forcibly indoctrinated as to have ripened into a sanitary aphorism, that the vocation of the medical man is not bounded by the narrow con- fines of curing the sick, but embraces a far nobler work—a work of illimitable extent—the prevention of disease, and the prolonga- tion of life; a field of science "where the harvest is truly plenteous, but the laborers are few." It is everywhere acknowledged by those who have examined carefully this great question of the day, that it possesses a world- wide interest, and is destined to record its healthful influence and scatter its choicest blessings, wherever man in the exercise of his social relations, erects his home or establishes a community. As it has been elsewhere well said, it "involves every relation- ship of man to the world—and it has now become the imperative duty of every physician to be a preacher of the gospel of life and health, if he has any exalted appreciation of the aims and ends of his calling, or realizes the high and noble functions of his sphere, as the destroyer of pain and suffering, and the creator of health and happiness."1 Without a comprehensive understanding of this indispensable keystone in the sublime arch overtopping the unity of medicine, we despoil it of its beauty and impair its strength. The scope of observation with all intelligent physicians should 2 1 Mountain, p. 550. 10 ADDRESS OF be, not only the investigation of those essential causes that produce the varioifs derangements of healthy action in the human system, and disturb the harmony of its organism, but, as the conservators of public health, as faithful sentinels on the watch-tower, guarding against the inroads of disease and protecting the outlets to human life, we should be stimulated, in view of the fearful responsibilities of our calling, to employ all our resources of judgment and reason, in fulfilling its sublime mission—the preservation of health, the physical improvement of our race, and the prolongation of life. This imperative duty justly claims, as it richly deserves, an un- bounded share of our professional energy; for it has been observed, that "in the science of health there are more exact, demonstrative truths, than in the science of disease; and the advantage of 'prevention' over 'cure' requires no proof."1 I regard it, therefore, as an established principle, that the true aim of the physician—and it should ever constitute his highest, most exalted ambition—is to avert those evils, sanitary and moral, physical and mental, within reach of science, that are destructive to health and dangerous to life. The evils that underlie disease should be sought out, encountered, and arrested at the fountain-head. If neglected, and their insidious approach overlooked, the infectious current, swollen by a thousand tributaries, distilling and scattering its lurid .streams of pestilential poison through the atmosphere of luxuriant fields, redolent with health and life, will in time ferment into a devastating epidemic, and like another destroyer, carry in its fearful trail to every family,' desolation and death. It was contemplated by the founders of this Association, as set forth in the original circular, " to cultivate and advance medical knowledge." For the attainment of this high and laudable object, the brightest and best talents in our profession have been enlisted' The ability, the erudition, the originality of thought and sagacity' with the professional enthusiasm displayed in various fields of research and investigation for its accomplishment, present an enduring monument of the progress of American Medical Science and afford a guarantee that the future, in this enterprise will be wreathed with a success that shall know no rival, and consum- mate a reform in the science of medicine, when compared with the glorious evangelical light that burst forth from the cell of the 1 Shattuck, p 230, Reg. Gen. Rep. WILSON JEWELL. 11 Wittenbourg student, shall enlighten the world and endure while time lasts, " Surpassing all around, even as the sun, In morning splendor, shines above the stars."—E. C. .Tucson. But these glorious expectations are not to be realized until Hy- giene, the science of health, upon which the entire structure of this reform is to be erected, comes to be fully understood, and its regen- erating influence appreciated; "until we explore and pursue to their very sources, those multitudinous agencies, whether physical, whether moral, whether born of earth, of air, or of society, which are either openly or insidiously degenerating the human race."1 I would not, however, have you understand that I made choice of my subject from any preconceived idea that its mighty interests have been disregarded by the Association, or that, from fruitful fields, rich harvests of information have not been gathered and garnered in its Transactions, as contributions to science. On the contrary, the evidence is manifest upon the pages of its history, that from its earliest inception, measures were introduced to give it a formal recognition in the proceedings of the Convention, as a sub- ject eminently congenial to the object of the call. While it is unnecessary to conceal the historical fact that the original design, the " great fundamental object" that was made the prominent element for associated action, and that led eventually to the organization of the American Medical Association, was a higher standard of medical education, it should be enshrined in memory, that when depositing the corner-stone, over which has been raised a superstructure, designed to secure the honor, advance the know- ledge, and extend the usefulness of our profession,.the expediency of inscribing thereon, simultaneously with medical education, Hy- giene, the handmaid of medicine, received the unanimous approval of the Convention. Nor is it a less gratifying reminiscence, that the initiatory scien- tific reports received on the first day's meeting of the Convention in 1847, and which engaged the attention of that body, were for the enactment of uniform and efficient laws for the registration of births, marriages, and deaths, as well as for a general nomencla- ture of diseases. Both of these systems being primordial, and valuable departments of the science of hygiene, and indispensable adjuvants preparatory to an exact and comprehensive understand- 1 Ordronaux. 12 ADDRESS OF ing of those laws which govern, to a great extent, the physical and moral condition of the human family, and from whence are secured reliable data for the causes of disease and premature death. Besides, an outside influence had already been awakened in be- half of the physical well-being of man at that period, and the at- tention of philanthropists was at once directed to this organization, as a suitable instrumentality to take the initiative, in the improve- ment, and successful accomplishment of this special department of their reformatory labors. At its first 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 de- liberations, and recommending the appointment of a permanent committee on hygiene. This intelligent appeal was heard with profound interest, and the Association at once appointed the com- mittee. It would, however, be incompatible with the time allotted to this address, were I to present a detailed account of the many valuable facts and observations that have been brought to light, bearing upon sanitary science, through this Association. Every annual gathering has been a faithful witness of the energy, devotion, and mind displayed in the reports on hygiene, and sent forth to the world through our published Transactions. They possess intrinsic merit, are valuable documents for practical reference, and claim the evidence of accuracy, an essential element in all sanitary records. Nevertheless, with all the labor that has been bestowed upon this subject by the Association, there remains a far more intrinsically important work to be achieved, before the science of hygiene and its corollary—preventive medicine—are perfected. With no disposition to ignore the amount of information already secured through these reports, or even to undervalue its influence, I cannot withhold the opinion that, as a cultivated science, hygiene is almost, if not quite, an unexplored theatre of action. We have not advanced a single step beyond its stately vestibule. We have neither penetrated its broad aisles, surveyed its lofty arches, nor measured its spacious periphery. We are not prepared therefore to comprehend its immense proportions, nor even to approximate the brilliant results that are to be accomplished through the prac- tical application of its life and health-giving principles. The prominent motive that has influenced me, in presenting this WILSON JEWELL. 13 subject, is the earnest desire to have it assigned a far higher posi- tion—a far more authoritative recognition in the deliberations of the Association, than has been awarded it. That it shall not only hold a place in our esteem, upon a level with medical education, but be held aloft and heralded abroad as one of the fundamental ob- jects of associated action; receiving all that deliberation and dis- passionate attention from the profession, to which it is entitled by its daily increasing importance in the world of science. If this humble and immature contribution shall in any degree infuse an influence that will lead those who compose this assembly to stand up unitedly in a whole-souled systematized cultivation of the principles entering into this too much neglected department of professional research, I shall feel that my effort has not been in vain. It is not my purpose, however, by an elaborate argument, to re- enforce you with motives beyond those with which you are no doubt already familiar, why there is a necessity for more liberal exertions in this sanative field of science. To map out for your in- formation the extended area that requires cultivation, with its un- improved soil and its barren wastes. To tell you of the close rela- tionship existing between sanitary science and rational medicine. To illustrate, either by figures or facts, the sad, every-day ravages from premature death upon whole communities by preventable disease, the result of a non-conformity to the laws of hygiene. To point you to the overwhelming darkness and distress, both physi- cal and mental, social and moral, that prevail in those haunts of depravity, where the light of the science of sanitary reform never has been allowed to shed its luminous rays, either through public ignorance or dereliction of duty, with municipal or legislative bodies. ° Neither do I consider it necessary to institute a comparison from statistical records of the ratio of deaths to population, where sani- tary improvements have been made, and those where they have been wholly neglected. With these principles and laws, drawn from observation, you are already conversant; indeed, the incentives that from year to year have been so ably and so clearly illustrated and ur2ed upon you by those who have labored in the cause, together with the recorded matter in our own Transactions, ought to prove eminently conducive to increased thought and investigation. Nothing is more obvious to my mind than the existence some- where, orln some way, of a lack of efficiency, or a hidden obstruc- tion, ever frustrating the efforts of the friends of this reform, that u ADDRESS OF discourages their exertions, hinders the production of a healthy tone of action in the public sentiment, and hence, operates as a serious drawback to the progress of sanitary science. It is from no distrust as to the value of this subject, or to its ultimate suc- cess in contributing to health and life, all, and even more than has been awarded it, that I have alluded to circumstances, both dis- couraging and unpropitious in their character. In view of the mighty import of hygiene upon the prosperity and happiness of society, and a knowledge of the fact, that the efforts already at- tempted by the Association have not been seconded and followed up by a standard of attainment in the profession itself, commensu- rate with the exertions made, nor by the adoption of co-operative measures by the people themselves, or, through legislative enact- ments to any extent, for overcoming the obstructions that stand in the way of public health—1 have felt constrained to allude in this plain manner to the prevalence of causes operating as hin- drances to the onward progress of sanitary reform. At the same time, with the view of counteracting the influence of these embar- rassments, I submit for your consideration a twofold proposition as a remedy, which, if not found equal to the demand, will, I trust, prove of more than ordinary value for the advancement of the science of health. I propose, first of all, to elevate Hygiene, as a branch of scien- tific study, to a separate and distinct chair in our medical schools, independent of physiology, and constituting it a requisite curricu- lum, preliminary to that diploma which confers one of the highest honors of the profession. Then, again, the adoption of some more effectual measures for interesting and enlightening the public mind with the revelations and results that have already been effected, together with the ines- timable advantages that are destined to flow therefrom, in relation to health and length of life. These, or similar plans for elevating the character of hygiene in the scale of medical learning, and placing it more prominently before the world, are equally demanded, ere a more successful in- duction of its inestimable advantages can be effectually secured. The necessity for them as indispensable agents of the health, hap- piness, prosperity, and life of the masses of mankind under all circumstances, in all places, and at all times, must be presented in the strongest possible colors, while the fearful array of evils, the natural and invariable result of its neglect, must be shown in oppo- WILSON JEWELL. 15 site, though equally attractive tints, if society is ever to realize the blessings from sanitary reform. I should be false to my convictions were I not to say, that to understand distinctly the etiology or cause of disease, or attempt to establish important practical deductions therefrom, we must study, and study profoundly, the science of Hygiene. Nor will it require an apology, if I define the etiology of disease to be the basis of preventive medicine, a knowledge of which is infinitely more important to communities than curative medicine ; nor shall I be called extravagant upon this subject, if I venture to add, that without its inestimable teachings, as a distinct branch, medical education is defective. This opinion, however, is not new. Ten years ago, the admirable Shattuck announced that "sanitary professorships should be estab- lished in all our colleges and medical schools, and filled by com- petent teachers. The science of preserving health and preventing disease should be taught as one of the most important sciences.'" Dr. Richardson, an eminent English sanitarian, has also observed: " In every school of medicine there ought to be, and we have reason to believe there soon will be, a professor of hygiene, holding a po- sition as important as the professor of physiology or of practical medicine. In every collegiate or university examination for licenses and degrees, a knowledge of hygiene should be demanded."2 Another beautiful and classical author forcibly remarks, that "medical study points to two grand divisions, etiology and hygiene," and concludes the paragraph with this valuable sentiment: "In a complete and systematic course of medical study, these subjects are unsurpassed by any others in utility and interest. If they were more thoroughly studied, we might have less reason to mourn the mortality occasioned by disease."3 The lamented and estimable Dr. Edward Barton, by whose recent death the world of science has been deprived of a distinguished writer upon hygiene, taught a similar doctrine. He represents, and truly, that it is through the study of "the prevention of disease—the great and all embracing subject of gene- ral and special hygiene—that the exalted value of a medical edu- cation becomes appreciated." And more recently, in a valuable and popular report on medical 1 Shattuck's Sanitary Commission. Boston, 1850, p. 229. 1 Journal of Public Health, 1855, p. 7. 3 A. Stille, M. D. 16 ADDRESS OF education, this association has been faithfully admonished that there is "a demand for a higher and more exalted course of med- ical education," and special reference is made to the fact, that in some of our schools at least, "hygiene," which was taught in the last century by Boerhaave and Cullen, and in the early part of the present by Rush, has been entirely forsaken, and it earnestly in- sists that "sanitary science should be separately taught."1 But I forbear to enlarge on this point, confident there are none within the sound of my voice who are not pledged by the strength of their attachment to the science of medicine, to elevate its time- honored standard, until its heaven-born folds shall wave triumph- antly over every city, town, village, and neighborhood, throughout the civilized world, and thus answer to the demands that are re- quired of every intelligent physician at the present day. It is therefore only a question of time and manner, as to when and how our profession shall be educated in these ennobling principles, " the hygienic condition of the nation, of such immense interest to our people; that first, all important question ever before the pro- fession—the prevention of disease."3 It is justly due to the cause of sanitary science, I should remind you that within the past few years a new and important direction has been given to its study and pursuit. You will anticipate that I refer, and I do so with pride, to the National Quarantine and Sanitary Convention. Many now present have not only taken an active part in its deliberations, but are also cognizant of the fact, that among its warmest advocates are intelligent members of other professions, together with zealous philanthropists, who have en- gaged with a laudable earnestness .in this work of reform, and who have given to the world the results of their earliest investi- gations on points of immense interest, that are destined to accomplish important and praiseworthy innovations, both in external and internal hygiene. If I rightly interpret the views and regulations of this scientific congress of sanitarians, who have embarked in a crusade against physical corruption with an energy that cannot fail to enlist confidence, they look for earnest sympathy and hearty co-ope- ration from physicians; and among other considerations that invite medical men to more direct and liberal exertions in further- ing the cause of the physical condition of society, is the growing 1 M. Reese, M. D., 1860. 1 Eve. WILSON JEWELL. 17 interest with which this question is now regarded by those untiring spirits beyond the pale of our profession. Let it, however, be'remembered that "asense of duty, far more than the mere force of example, ought to enlist every medical man in this holy warfare." The study of his profession should not only teach him the value of hygiene in its broadest application, but his daily avocations should make him familiar with its wants, and therefore, "if he who knows so much—should speak slightingly of this higher work of prevention, and carp at the efforts of others—society would soon catch his tone of thought and feeling; while a cause which, on serious reflection, he would be constrained to support, must suffer irreparable injury."1 But if, on the other hand, he should be induced to give himself earnestly to the promotion of this reform, and bring his influence to bear on those with whom his professional avocations place him in communication, it is impossible to over- estimate the good he may be the means of effecting. Let it not be urged through any narrow and selfish policy that sanitary science is not germane with that of medicine ; is only ap- proximative, and does not legitimately belong to the province of the physician. The excellence of our dignified calling can only be attained or estimated by our faithfulness and devotion in protecting human health and life, from the influence of those injurious agencies that are constantly undermining the physical strength of the people, either by personal efforts or by advising the enactment of judicious sanitary laws. Recently a new and important field has been presented to the sanitarian, growing out of the internecine war in which the country is involved. No sooner had the storming of Fort Sumter echoed its treasonable peals over the land, and the spirit-stirring drum was heard, calling to the field an immense volunteer army, than military hygiene became at once a familiar theme. It awakened anew the enthusiasm of the sanitarian, aroused the attention of the medical staff of the army and navy, and of our profession in civil life as well as the philanthropist in the home circle. To our profession belongs the honor of introducing to the government the necessity for a plan of organization, adapted to the hygiene and comfort of the soldier. Urging upon the war depart- ment the appointment of a civil commission, whose province should ' Medico-Chirurg. Review, Jan. 1848, p. 32. 18 ADDRESS OF be, in conformity with the civilization and humanity of the age, to apply to military life the ripest teachings of sanitary science, in order "to prevent the evils that England arrd France could only investigate and deplore." I need not enter into the details of the operations of the United States Sanitary Commission. It is familiar to all of you, and while it is "doing a work that ought to be done by the government, and carrying out a plan of operations that should be inseparably asso- ciated with the original creation of the army and the whole manage- ment of the war," its mission of faith, and labor of love, are known and felt, and appreciated, and sympathized with, and cherished throughout the entire land. It is proving itself the "one thing needful" for the sanitary salvation of the army. It is the good seed sown which will germinate, and spring up, and grow, until it brings forth its legitimate flowers and fruit, bearing the impress of a re- form in the entire system for the preservation of health and for the comfort of the soldier. In a word, its two vears' actual observation has brought to lio-ht many valuable facts in hygiene, designed, not only to preserve the health, and vigor, and morale of the army, but indirectly to promote a spirit of subordination and obedience to a thorough plan of mili- tary discipline. Military discipline and military hygiene are twin brothers in the army. The enforcement of the former is essential to the efficient application of the latter. Every military surgeon should be a mili- tary sanitarian, while every military officer having a command, should co-operate with the surgeon by inaugurating a strict and uniform military discipline consistent with official propriety, in order to secure the health and efficiency of their troops, through the instituted laws of hygiene. Every surgeon should be thoroughly educated in all medical subjects, especially those affecting the health of the soldier, adapted for the prevention of disease in the army. They must not only have a knowledge of the laws of hygiene, but be able to comprehend where and how to administer those laws, thereby making their information on sanitary subjects practically useful. As an illustration of the incalculable value of a knowledge of the science of hygiene to an army surgeon, and its importance as a separate and distinct branch of medical education, qualifying the physician for greater usefulness in his vocation, I have on!y to refer you to the published opinion of the Surgeon-General of the WILSON JEWELL. 19 United States Army, who recently issued an order requiring "from candidates entering the medical staff of the army, that they shall have attended at least one course of lectures on hygiene," and recommending to medical colleges to add to the faculty of their schools a professor of hygiene, while be assures them that, " not only will the general education of candidates for graduation be advanced, but the U. S. army medical service will be the gainer in having more competent men present themselves for admission."1 It is an encouraging thought, that of late this subject has not only enlisted an increased attention among the medical staff of the army and of our profession in civil life, but that it has in a practi- cal way attracted the attention of officers in the army as well as the philanthropists at home. Nor can the fact be too widely spread, that we are deficient in literature on military hygiene, and that there should be no lack of zeal with those who have opportunity for the collection and preservation of materials from the rich and inviting fields of ob- servation daily presenting themselves in the present crisis, that they may be made available to the profession, and conduce to the advancement of the science of hygiene. It is gratifying to learn that already a work of this kind has been authorized by the government, under the direction and at the suggestion of the Surgeon-General, on a scale both elaborate and magnificent in its character. It is designed to furnish the medical history of the war, embracing under this general title the moral and sanitary condition of our armies, the causes of disease, and the frequency of death, and will no doubt recommend measures for the alleviation of those destructive influences that prejudice the health of an army.2 It would carry me far beyond the limits of an address, to lay before you, in a manner worthy its presentation, the subject of state medicine, a term new to many, but as understood by a highly gifted co-adjutor in the cause, "is the application of the principles of medical science to the administration of justice and the preserva- tion of public health—the alpha and omega, the beginning and the end—the opening and the closing chapter of its whole institutes." ' Wm. A. Hammond, M. D. * We learn that Dr. Hammond, the Surgeon-General, has a work in press on Military Hygiene, which is destined to throw much light upon this interest- ing subject, and will prove of great value to the profession. 3 Ordronaux, 4th vol., Trans. Quar. and San. Con., I860. 20 ADDRESS OF And I would take pride, did time permit, in elucidating this momentous question of State prophylaxis, to urge upon your at- tention the value of an accurate sanitary survey of every State, to ascertain their physical, mental, and moral force, the nature of those causes which favorably or unfavorably affect the body politic, and to investigate the statistical, topographical, and jurisprudential condition of each; but I can only name these scientific interests that belong specially to state polity. At the same time I cannot forbear to urge upon your attention the importance of adopting measures recommendatory in their character, but adapted to the exigency of the occasion, setting forth in bold relief the advantages that would follow to the vital prosperity of every state where laws of health, preventive and palliative, are enforced by legislative enactments. Indeed, the attention this subject is beginning to attract, almost warrants the conclusion that the period is not far distant in the future, when the government of every com- monwealth in our country, fully awake to its responsibility, will "demand that the same provident care of the legislature should be extended into the field of human life, to encourge, and to watch over, and protect the vital machine, by which alone all other interests, public and private, are created, sustained, or made of any value,"1 as are now recognized and extended in favor of agriculture, commerce, and manufactures. In view of this good time coming, it " behooves every member of the profession to see that he is no laggard in the road towards a full knowledge of the science of public hygiene, even though he may not choose to engage in its practical application; for the time is approaching when the sup- pression of every health impairing cause will be demanded by the public voice, and the medical practitioners of every vicinage will be the authorities for magisterial action."2 The organization of sanitary associations in cities, towns, and neighborhoods, led by members of the medical profession, should be encouraged. The investigations and discussions in which their members will engage, must contribute largely to the diffusion of information on the laws of health and life, and arouse the public mind to an interest in sanitary reform. Already have these life-saving and health-preserving societies been organized in two of our principal cities. They have entered upon their " work of faith and labor of love" under favorable aus- Jarvis. 2 J. H. Griscom. WILSON JEWELL. 21 pices. Inquiries upon the best means for securing the objects pro- posed have been instituted. Practical questions relating to improve- ment in many departments of hygiene have been freely discussed. Valuable scientific papers have been read, and committees appointed to investigate and report upon subjects involving personal, domi- ciliary and public hygiene. In short, spirited measures are in operation to enlighten public opinion, and diffuse useful informa- tion for the improvement of health and the prolongation of life. In this connection it is honestly due to the young but vigorous and enterprising Garden City, in which we are to day assembled, to acknowledge that she holds, deservedly, a pre-eminent position among her older sister cities in this country, enjoying a priority claim for leading off, in the right way and at the right time, for the prevention of disease and the unnecessary expenditure of human life, through the introduction of an efficient and comprehensive reform in the sewerage and drainage of their city. I refer to the appointment of an experienced civil engineer, on a liberal scale, to visit " Great Britain and the continent of Europe, for the purpose of examining the various methods of sewerage adopted there." The report of this commission is a document of uncommon interest and value, replete with important details. The information already secured, and, I trust, to be applied in the construction of their sewerage, will, I doubt not, yield an ample reward for the labor bestowed, by overcoming the tendency to ac- cumulation of a putrescent sewer atmosphere, which has ever proved an active poison in large cities, deteriorating the air, swelling the amount of preventable disease, and contributing to premature mortality. Massachusetts has also distinguished herself among the Ameri- can States, by authorizing and carrying out,a sanitary survey of the commonwealth, and initiating the first law for the public registration of births, marriages, and deaths. The inauguration of these philanthropic systems is worthy of all praise, and commend themselves to other States for imitation. As on the pages of Massa- chusetts' history are recorded the noble deeds which have given her a good name and rendered her glorious in the cause of hygiene —so may I with propriety, and in equally exalted terms, refer to the noble and illustrious page in the history of the sauitary police of cities, to be found upon the calendar of this emporium of the west—Chicago, where, a few years ago, stood the primeval forest, a dreary wilderness, tenanted only by a savage race, who revelled in 22 ADDRESS OF WILSON JEWELL. the enjoyment of their hunting-grounds, and danced around their council-fires, undisturbed by the tread of the pale-face, and far re- moved from the haunts of civilization. When I contemplate the mighty wave of transformation that, within the past half century, has swept over the fascinating spot where we now congregate, and remember that " westward the star of empire points the way," it gives me an earnest for the future— while the advent of its impress in the cause of hygiene, furnishes a hopeful assurance of continued energy and perseverance in this great reformatory movement of the age. To further this work of sanitary reform is not only the privilege but the province of the American Medical Association. For its improvement, it enjoys peculiar facilities, and is possessed of infor- mation best adapted to promote the objects contemplated. I would, therefore, as a legacy, invoke you, as the only true and legitimate conservators of health, and by all the stirring claims of duty, of humanity, and of professional pride, by which as an asso- ciation you are held firmly and conscientiously together, and as good citizens, to "be ever ready to give council to the public in re- lation to subjects of medical police, public hygiene, and legal medi- cine."1 It is somewhere recorded that the ancient Greeks cherished a single sentence, which they believed had descended from heaven, and they caused it to be printed in letters of gold, and inscribed in a conspicuous place on one of their august temples, that all might read and be enlightened. Imitating this innocent, yet significant custom of an ancient nation, I would recommend that the inscrip- tion, "Hygiene, the science of health," printed in flaming letters of gold, should adorn the escutcheon of the Association, to be "known and read of all men.',' That its brilliant display and its talismanic fascination shall seduce multitudes of earnest inquirers after the truths of science, to advocate the claims of its irresistible influence in exterminating those principal evils, which are ever busy en- tailing upon the human family, disease, decay, and premature death. 1 Medical Ethics.