ADDRESS 
DELIVERED BEFORE THE * 
AMERICAN MEDICAL ASSOCIATION, 
AT ITS 
TWENTY-NINTH ANNUAL SESSION, 
HELD AT 
BUFFALO, N.Y., 
June 4th to 7th, 1878. 
BY 
T . G . RICHARDSON, M . D ., 
OF NEW ORLEANS, 
PRESIDENT OF THE ASSOCIATION, GEJ 
EXTRACTED FROM THE 
TRANSACTIONS OF THE AMERICAN MEDICAL ASSOCIATION. 
PHILADELPHIA: 
COLLINS, PRINTER, 705 JAYNE STREET. 
1 878. ADDRESS 
DELIVERED BEFORE THE 
AMERICAN MEDICAL ASSOCIATION, 
AT ITS 
TWENTY-NINTH ANNUAL SESSION, 
HELD AT 
BUFFALO, N.Y., 
June 4th to 7th, 1878. 
BY / 
T . G . RICHARDSON, M . D ., 
OF NEW ORLEANS, 
PRESIDENT OF THE ASSOCIATION. 
EXTRACTED FROM THE 
TRANSACTIONS OF THE AMERICAN MEDICAL ASSOCIATION. 
PHILADELPHIA: 
COLLINS, PRINTER, 705 JAYNE STREET. 
1878. ADDRESS. 
Gentlemen :— 
However skeptical a large rnajorit}7- of the medical profession 
of the United States may have been thirty years ago in regard 
to the amount of vitality possessed by this Association, then in 
the first year of feeble infancy, its subsequent wonderful growth 
has dispelled every doubt, and its present great power for good 
is recognized by all. The vast benefits which it has wrought in 
uniting the interests of the profession in all the different sections 
of the country, the encouragement which it has given to a higher 
culture, the valuable contributions which it has made to some 
departments of medicine, and the dignified position which it has 
gained in the eyes of the whole nation, have been so often des- 
canted upon by my predecessors that it may seem somewhat trite 
and unprofitable to refer to them again; and yet there is one point 
which deserves to be brought to vour attention anew. 
MEDICAL EDUCATION. 
Although more than a generation has passed away since the 
first meeting of the Association in the city of New York, and 
only a few of the original members are now to be seen clustering 
around the venerable form of him whom we all delight to honor 
as its projector and the ever watchful guardian of its interests, it 
is a well-known fact that the most prominent objects in the minds 
of the earnest men who composed that assembly were the im- 
provement of the system of medical education in the United 
States, and the elevation of the standard of requirements for the 
professional degree. To these two great topics the thoughts of 
all were continually directed, and many of the utterances on that 
occasion evince a bold determination not only to initiate, but to 
press to a successful issue a movement of reform which should 4 
ADDRESS OF 
involve every medical institution in the land. It is equally well 
known that down to within a very few years past all the nume- 
rous efforts in this direction seemed to accomplish no permanent 
good, and the philanthropic and enthusiastic reformers, with the 
exception of a few hopeful and unconquerable spirits, had come 
to consider the cause as almost wholly lost. The measures pro- 
posed and adopted from time to time were sufficiently incisive, 
and, to all appearance, admirably adapted to the ends in view ; 
but unfortunately there was no power in the Association to carry 
them out, and they remained upon the record as mere mementoes 
of the praiseworthy zeal of their authors. 
In view of this discouraging result, a change of tactics was re- 
sorted to, and the medical colleges were invoked to correct the 
evils which were so patent to every one, and for which the}' were 
supposed by many to be alone responsible. With what little 
earnestness and consequently with what little effect these organi- 
zations responded to the appeal it is not my present purpose to 
inquire. I desire, on the contrary, to congratulate the Associa- 
tion evidences which are now developing that its work 
has not been in vain. It is true that the method of mixed teach- 
ing practised by the schools more than half a century ago is still 
generally followed; but it must be clear to all unprejudiced ob- 
servers that there is a growing dissatisfaction with the imper- 
fections of this method, and a disposition to adopt the only 
philosophic plan, known as the graded system, which prevails 
throughout all the other civilized nations of the world. In 
proof of this I have only to point to the fact that within the past 
year the Medical Department of the University of Pennsylvania, 
the oldest school of medicine in this country, one whose fame 
has never been eclipsed, following the example of the Chicago 
Medical College and Harvard Medical School, has changed her 
ground, and is now fairly on the new road to a still higher posi- 
tion than that which she previously held. 
This revolution which is taking place in the minds of medical 
teachers is, I am inclined to believe, almost entirely due to the 
public professional opinion which has been originated by the fre- 
quent discussions before this body. It is in thus creating and 
directing professional sentiment that the great power of the As- 
sociation lies, and I trust therefore that however wearisome this 
subject may have become to many of you, its agitation may not 
cease, as it is only in this way that the current of reformation THE PRESIDENT. 
5 
can be kept in motion. We have only just now found out that the 
plan which we formerly pursued of making war directly upon 
the medical colleges, endeavoring to compel them to conform their 
practices to our theories or else surrender the prerogatives to 
which they have been so long accustomed, was altogether a mis- 
take, and probably deserved the partial defeat which it encoun- 
tered. Indeed, I am not quite sure but that the many severe 
blows which these institutions received at our hands served rather 
to compact them together, and thus to increase their power of 
resistance. It is a well-established fact that the walls of old Fort 
Sumter were by no means impregnable until they had been bat- 
tered for weeks by the guns of the United States navy, and not 
until a successful diversion was made against the forces on the 
main-land were its casemates abandoned. In like manner it is 
only by capturing the grand army of the profession throughout the 
country, from which the colleges derive their material and moral 
support, that we can reasonably hope to bring these institutions 
to terms. It is by enlightening the minds of the professional 
public, by developing in those who have passed the novitiate of 
their studies a desire for something higher and better than can be 
supplied by the old system, and by awakening in the ranks of the 
profession a knowledge of the power which they can exert by 
combination and concert, that we can bring about that change in 
the requirements for graduation which we all so ardently wish. 
Let us then use our utmost endeavors to cultivate a spirit of 
scientific inquiry in the minds not only of physicians but also of 
the public generally, to arouse the ambition of our routine 
brethren, to stimulate in the scattered practitioners of the country 
a sense of their equal responsibility with those of the cities in 
carrying on the work of progress, and to open up avenues of 
knowledge to all who may desire to excel. Unless we succeed 
in elevating the tone and sentiment of the masses of the profes- 
sion, and enlightening at the same time the people in regard to 
the absolute necessity of protracted study and clinical observa- 
tion in every one claiming their confidence in his ability to treat 
disease, we have no right to expect support in our efforts to ad- 
vance medical teaching and to raise the grade of requirements for 
the doctorate. 
As a means of accomplishing all this it is necessar}' that there 
should be a more thorough organization of State, county, and 
district societies; and I would therefore suggest the adoption of 6 
ADDRESS OF 
some uniform plan by which the sixty thousand physicians in 
this country may be encouraged to unite in local organizations, 
and through their representatives establish a living connection 
with this the central legislative body. When in this manner the 
objects here proposed shall have been effected, no honest faculty 
will dare confer a diploma upon an unworthy candidate, and no 
one save an empiric will dare offer himself as a practitioner of 
medicine without documentary proof that he is grounded in the 
great principles of medicine, and that he has studied disease by 
the bedside of the sick under the guidance of competent and con- 
scientious teachers. 
ORIGINAL INVESTIGATION. 
Notwithstanding the very flattering and eloquent encomiums 
pronounced by our worthy representatives at the late Interna- 
tional Medical Congress in Philadelphia upon American physi- 
cians and surgeons, and their very encouraging account of the 
flourishing state of medical science and art throughout the 
United States, now that we are alone, and out of hearing of the 
distinguished foreigners who honored us on that occasion, would 
it not be well, at least for the sake of some whose consciences 
are perhaps a little over-sensitive, to confess to one another that 
“ original investigation,” in the sense in which the term is strictly 
used abroad, has not been, and is not now a marked feature in 
the professional work of this country ? Can we not count upon 
our fingers the names of those who have made undeniable and 
valuable additions to the common stock of knowledge in any one 
of the sciences or arts which come within the domain of medical 
and surgical study? I would not speak disparagingly of the 
quality, but only of the small quantity of the work which has 
been done. I am not behind the most ardent in my admiration 
of the few earnest, persevering, patient investigators of nature 
who, unaided by national, State, or other public patronage, have 
labored month after month and year after year in the pursuit of 
new facts bearing upon the structure, functions, and diseases of 
the human body, content if they succeeded in adding a single 
stone to the temple of knowledge. Nor am I ignorant of the 
fact that through the enlightened liberality of a few remarkable 
men of wealth, provision has been made for the diffusion of 
scientific knowledge by publication and otherwise, and, in one THE PRESIDENT. 
7 
noted instance,1 for the endowment of a medical school and hos- 
pital, in which ample arrangements are to be made for the prose- 
cution of original research. But such men as Smithson and 
Ilopkins and Boylston and Toner are not sufficiently numerous 
for the wants of our home science. I would inquire therefore 
whether it is not the duty of this Association to do something 
more than it has.done in the past to foster the spirit of investi- 
gation and discovery in those departments which relate directly 
to medicine. 
Two methods of effecting this present themselves to my mind. 
One is to endeavor to concentrate the influence of the entire pro- 
fession throughout the country upon the Federal Congress, and 
to convince its members of the great necessity of taking some 
steps in order to save the nation from the disgrace which must 
inevitably attach to her name if she should persistently maintain 
her present attitude of indifference to work of this kind, and 
should wilfully keep her eyes closed to the numerous scientific 
enterprises undertaken by all other enlightened governments. I 
need scarcely remind you of what Germany and France and 
England and Austria and even Russia are doing to advance the 
natural sciences, especially those bearing upon medicine ; of the 
great museums and scientific workshops which they have estab- 
lished ; of the liberal rewards which they offer to secure men of 
first-rate abilities; and of the large sums of money which they 
annually appropriate for these purposes. They recognize the 
fact that pure science, while it is a mine of wealth to the state, 
cannot remunerate the investigator ; that it cannot live upon it- 
self; that those who consecrate themselves to the pursuit of it 
must isolate themselves from the money-getting world around 
them; must be relieved from all care and anxiety as to their 
daily bread; and must be supplied with every necessary appli- 
ance while with concentrated thought and patient toil they seek 
to penetrate as it were with a diamond drill the flinty barriers 
which separate the known from the unknown. This is particu- 
larly true of those engaged in biological research, who, while 
they confer material blessings upon the whole human family, are 
obliged to depend upon extrinsic aid to enable them to carry on 
their work. 
I am not prepared to propose a plan sufficiently elaborated to 
1 The late Johns Hopkins, of Baltimore. 8 
ADDRESS OF 
justify submitting it to the Association with the view of having 
it brought before the authorities at Washington ; yet it seems to 
me that in the Army Medical Museum and Library the General 
Government has, unintentionally no doubt, already founded a 
school which through the influences just indicated, may possibly 
be made the nucleus of a great national institute in which origi- 
nal research in all the sciences upon which medicine more imme- 
diately draws shall be conducted with the same wisdom and 
efficiency which characterize its present management. Original 
work of a high order has indeed been already achieved within 
its walls in the preparation of the “ Medical and Surgical History 
of the War,” for which the distinguished authors deserve more 
than professional honors ; and one of the medical officers, Sur- 
geon J. J. Woodward, while off duty, has made valuable addi- 
tions to physiological and pathological microscopy; but I 
understand that no provision exists for experimental or abstract 
research. If the Government could be induced to appropriate 
even so small a sum as fifteen or twenty thousand dollars annually 
for this purpose, and to select from its able corps of medical offi- 
cers competent men who should devote their whole time to the 
work of investigation, the cause of science would be greatly ad- 
vanced, and the honor of the country proportionately sustained. 
The other method to which I would direct your attention is 
one which lies exclusively within the scope and ability of this 
Association, and would, if adopted, in no manner conflict with 
the one just alluded to. Although the possible results of this 
method are not to be compared with what might be effected by a 
great national establishment, it is nevertheless worthy of con- 
sideration, on account of its supposed merit and entire feasibility. 
I proceed to develop it. 
According to the “ Plan of Organization” of the Association, 
the Committee on Prize Essays have power “ to award two prizes 
of one hundred dollars each to the two best original communica- 
tions reported on favorably by them, and directed by the Asso- 
ciation to be published.” I would ask whether the operation of 
this by-law after twenty-nine years’ existence has proved entirely 
satisfactory. During this period no award has been made in 
thirty-one instances, mainly in consequence of' the want of suffi- 
cient merit in the essays presented. Twenty-five papers have 
been reported upon favorably, for which the Association has paid 
in prize-money and for publication some eight or ten thousand THE PRESIDENT. 
9 
dollars. I*t cannot be denied that many of the accepted essays 
possess decided literary and scientific value. Some of them, in- 
deed, reflect great honor not only upon their authors, but upon 
the profession in general. But after all that can be said in their 
praise, is it not true that a large proportion of them lack that 
singular quality which should entitle them, when strictly tested, 
to the designation of original researches, or even contributions 
to knowledge ? 
Without pressing this question, I assume that it is the sincere 
wish of all who feel an interest in the welfare of the Association 
that as it advances in age and experience it shall progressively 
improve in the quality of the work which from year to year it 
presents to the profession as its best production. I am confident 
that in this respect a change for the better may be made by 
designating the subjects for competition, requiring strictly origi- 
nal research, and giving more time for preparation. Under the 
present plan a committee of five members is appointed by the 
Association from among the physicians of the city in which the 
next annual meeting is to take place, to whom all competing 
essays are directed to be sent. As the period within which such 
papers are admitted extends to the very day of the assem- 
bling of the Association, the result is that most of them do not 
reach the chairman until a week or two, or sometimes a day or 
two before the meeting. The examination which he and his col- 
leagues can give them is therefore necessarily cursory and un- 
satisfactory. This is certainly a very serious objection, but a 
still graver one lies in the fact that in the large majority of cases 
there is not a single member of the committee who is fully in- 
formed upon any one of the topics of which the essays treat. I 
do not say this to the discredit of any one, but I submit to your 
judgment whether every city in which the Association has met 
during the past thirty years is so signally favored as to possess 
thorough experts in physiology, in therapeutics, in pathology, 
and in surgery. To remedy these palpable defects, to improve 
the scientific quality of the articles ottered for competition, and 
to bring these within the field of original investigation, I suggest 
the following plan :— 
1. Otter four annual prizes of not less than two hundred and 
fifty dollars each, to be awarded at the close of the second year 
after announcement, for strictly original contributions to medical 
and surgical progress. 
2. Empower the chairman of each of the four sections designated 10 
ADDRESS OF 
numerically in the plan of organization as 1st, 2d, 3d, and 5thl 
to appoint annually (and if possible before the adjournment of the 
session) a committee of three members of acknowledged ability 
and wisdom who shall, as soon as practicable, select and publicly 
announce for competitive investigation and report a subject be- 
longing to one or other of the branches included in the title of 
the section. 
3. Let it be also the duty of each of the chairmen mentioned 
to appoint annually a committee of three experts who shall care- 
fully examine the essays presented, and if any one shall be found 
worthy of the prize, to recommend its award by the Association. 
4. Require all competing essays to be placed in the hands of 
the chairmen of the respective committees of award on or before 
the first day of January preceding the meeting at which the 
prizes are to be announced. 
5. All prize essays shall be considered the property of the 
Association. 
6. The names of the competitors shall be kept secret from the 
committees of examination. 
7. Membership upon either of the two committees shall not 
debar from membership on the other, nor shall membership of 
the first exclude the member from becoming a competitor. 
By some such scheme as this, of which only the salient features 
have been here presented, there is reason to hope that original 
investigation may be stimulated, and contributions of a superior 
character obtained. The objection, which I fancy has already 
suggested itself to nearly every one who hears my voice, is the 
want of funds. To this I reply— 
1. It can be clearly demonstrated that by the practice of only 
a very little economy in current expenses there will be an ample 
balance in the treasury for this and other important measures. 
2. It is not very likely that all four of the prizes will be 
awarded every year. 
3. If the receipts from annual assessments should prove inade- 
quate, the rate may be increased to eight or ten dollars, as was 
proposed at the meeting of lb73. 
4. I am quite confident that money will be voluntarily contri- 
buted for these and other similar objects, provided the Association 
shall place itself in a legal attitude to receive and disburse such 
1 1. Practical Medicine, Materia Medica, and Physiology. 2. Obstetrics and Dis- 
eases of Women and Children. 3. Surgery and Anatomy. 5. State Medicine 
and Public Hygiene. THE PRESIDENT. 
11 
gifts. Upon this point, which I deem of no small importance, I 
beg leave to make a few remarks. 
So long as the Association remains unincorporated, it is, of 
course, an organization entirely unknown to the laws of the land. 
It cannot legally accept or hold property of any sort whatever, 
and is therefore prohibited from entering into any formal engage- 
ment-involving the payment of moneys for any specified object. 
It has no authority to collect its dues, nor can it be compelled to 
pay its debts. As it cannot hold property it of course cannot 
receive bequests, nor even donations with limiting restrictions as 
to their use. Now I would ask whether it is not within the 
bounds of reasonable expectation that if this disability should 
be removed, funds would from time to time be committed by 
will or otherwise to the Association for immediate use as prizes, 
or for the endowment of research. I should be greatly disap- 
pointed if we should not witness before long the gift of consider- 
able sums of money for specified purposes by persons without as 
well as within the circle of the profession. This has been the 
result elsewhere, and there is reason to believe that as the Asso- 
ciation shall continue to gain upon the confidence of the people 
the same will occur here. The large prizes which are yearly 
offered by the great societies of London and Paris, amounting to 
many thousands of dollars, are derived mainly from such sources, 
and I sincerely believe that it has been for want of opportunity 
that this Society has not been made the recipient of similar gifts. 
Moreover, if the Association should be incorporated, and its 
funds be placed in the control of administrators, would not this 
insure economy in expenditures, and thus secure not only the 
insignificant sums proposed for prizes, but enable us to double 
the same within a very short time? 
An act of incorporation can be readily obtained from any one 
of the States without restricting the Association as to its place of 
meeting. It will only be necessary that the trustees or adminis- 
trators shall reside, or at least hold their meetings, within the 
bounds of the State granting the charter. 
STATE MEDICINE. 
Undoubtedly the most important question which lias ever been 
considered by this Association is that of State Medicine. Although 
so frequently the'subject of protracted discussions and elaborate 
reports, it loses nothing of its freshness and interest by repeated 12 
ADDRESS OF 
presentation, and will probably continue to claim your serious 
attention as often as you may assemble together in these annual 
meetings. It is true that as mere citizens we are not more nearly 
concerned in the development and application of its great power 
for good than are all others, for it touches every class and every 
individual in the community. It is of as much importance to the 
high as to the low, to the rich as to the poor, to the educated as 
to the unlettered, and bears with no light pressure upon those 
who make and those who execute the State and municipal laws. 
Nevertheless it devolves upon us as philanthropists and the self- 
constituted instructors of the people in regard to health and dis- 
ease, to awaken the public mind to the fact that as matters now 
stand human lives are daily sacrificed at a most fearful rate, and 
that by concerted and well-directed efforts this sacrifice may be 
materially arrested. As humanitarians, as moralists, as Chris- 
tians, we cannot wilfully shut our eyes to the unnecessary sick- 
ness, suffering, and death which are taking place around us. We 
cannot quiet our consciences by ex cathedra enunciations of the 
natural laws by which health may be preserved and the spread 
of sickness prevented. We must continue in the lead of all pub- 
lic movements directed to this end, and endeavor to draw to our 
aid all the influence of the people and all the powers of the state. 
Considerable progress has been already made. Looking cur- 
sorily over the whole country evidences of an awakening inte- 
rest in the cause are visible in every quarter. Ten years ago 
not a single State board of health existed. Now there are 
twenty such organizations in operation, collecting facts, distri- 
buting information, and urging forward the necessary legisla- 
tion. Nine of these boards have been created since this Associa- 
tion, by formal action in 1875, made its first appeal to the execu- 
tive officers of the different States to take action in reference to 
this matter.1 Compared with what has been accomplished by 
1 The first “ State Board of Health” was established by Massachusetts in 1869 ; 
however, Louisiana created a Board of Health for the protection of the State by 
quarantine in 1855, and extended the power of this Board in 1870. 
State Boards of Health in the following nineteen of the thirty-eight States and 
in the District of Columbia were created at the dates mentioned : — 
Alabama, 1875. 
California, 1870. 
Colorado, 1876. 
Connecticut, 1878. 
District of Columbia, 1871. 
Georgia, 1875. 
Illinois, 1877. 
Kentucky, 1878. 
Louisiana, 1870. 
Maryland, 1874. 
Massachusetts, 1869. 
Michigan, 1873. 
Minnesota, 1872. 
Mississippi, 1877. 
New Jersey, 1877. 
North Carolina, 1877. 
Tennessee, 1877. 
Rhode Island, 1S78. 
Virginia, 1871. 
Wisconsin, 1876. THE P RESIDE NT. 
13 
other enlightened nations this may appear to some trifling, but 
nevertheless small as the beginning is, it furnishes fit cause for 
congratulation, for it is the beginning of hope. No one indeed 
can read the reports made to the sanitary section of this Asso- 
ciation, and the valuable papers contributed to the American 
Public Health Association, and to some of the State organizations, 
without, feeling a strong desire to take an active part in the great 
crusade which is now preparing for the recovery of that which 
to this people is far more holy than any earthly Jerusalem. But 
let me urge upon each one who proposes to enlist in the service 
that he first fully satisfy his mind of the true nature of the work, 
and ascertain for himself the best means to be employed under 
the circumstances which surround him. I fear that the opinions 
in regard to these matters, held even by a large number of our 
medical men as well as by the public in general, are rather in- 
definite and misty, and I beg leave therefore to inquire briefly 
what is really meant by state medicine in the full acceptation of 
the term ; what is its essential nature; and what are the principal 
objects which it proposes to the medical profession, to the people, 
and to the several municipal, State, and federal authorities. 
As I understand it, the objects of state medicine are threefold. 
1. The prevention or arrest by official measures of all diseases 
which are not in their nature strictly limited to the individual, 
but which from external causes or from their specific characters 
have a tendency to spread throughout, families, institutions, and 
communities, and which cannot be otherwise controlled. This 
is the aim of public hygiene, which is the first grand division of 
state medicine. 
2. The qualification of men by suitable education for the duties 
involved, not only in the practice of medicine, but also of public 
hygiene; the state not only directing the studies which they 
shall follow, but determining by examination when they have 
reached the standard of acquirement necessary for the perform- 
ance Of their great trusts. 
3. The enactment and enforcement by the state of such laws 
as shall secure to every citizen the benefit of the services of the 
best professional experts in all questions of a medico-legal 
character. 
In brief, state medicine may be considered to include public 
hygiene, medical education, and medical j urisprudence, to which 14 
ADDRESS OF 
majr be added also the establishment, control, and sustentation 
of public institutions for the sick and the infirm. 
If this statement of the subject is a fair one, how vast is its 
domain; and what a multitude of duties is demanded of those 
who make it their great pursuit in life! And yet, notwithstand- 
ing its extent and the numerous branches into which it naturally 
divides,'it is susceptible of reduction into a complete system in 
which there shall be no clashing, and each part command the 
attention which it deserves. This has been already done to 
some extent in England, where public hygiene at least occupies 
its true position in the organic law of the land. There the prin- 
ciple is recognized that the private citizen, however humble, is 
as justly entitled to protection by the state against the public 
enemies of his health and life as against highway robbery and 
murder. The same is true of Prussia with reference to medical 
jurisprudence, where the most obscure plebeian, when brought 
before a court, can command the ablest counsel in the state upon 
all questions' of a medico-legal character. What has been done 
in England and Prussia, where political power is concentrated in 
the hands of a few enlightened statesmen, may not be so fully 
accomplished here, where federal authority extends but a little 
way beyond the arena upon which the political relations of the 
several States are adjusted; nevertheless, by adapting our 
methods to the peculiarities of our system of government, much 
more may be realized than at first sight appears probable. 
It is of course impossible in a discourse like the present to 
propose in detail a plan for the elevation of state medicine to its 
rightful place as an important factor in national legislation. 
Such discussion is more appropriate to the Section to which this 
subject is assigned, but I may Jje allowed to point out the funda- 
mental principles upon which all schemes for this purpose must 
necessarily rest, at least as far as public hygiene is concerned, and 
to indicate what seems to me to be the only road upon which we 
may reasonably hope to make any decided advance. 
That the public in general are not only ignorant of hygienic 
laws, but wilfully indifferent to an- acquaintance with them is 
evident to the most careless observer. We see daily lamentable 
proofs of the fact, not only in the personal habits, vices, and sur- 
roundings of the poor, but also in the dissipations, dress, arid 
dwellings of the rich; not only in ill-ventilated factories, mines, 
jails, and poor-houses, but in churches, hospitals, hotels, asylums, THE PRESIDENT. 
15 
and school-houses; not only in the filthy streets and sewers of 
cities, but in the malarious swamps and stagnant ponds of the 
country. It is clearly then of the first importance that the people 
who, in this “ land of liberty,” not only make, but practically 
execute the laws, should be educated in the elements of physi- 
ology and sanitary science to a sufficient extent to enable them 
to appreciate the necessity of making and enforcing such regula- 
tions as are known to promote health in general, and arrest the 
progress of endemic and epidemic diseases. Properly directed 
public education is, I insist, essential to public health, and every 
scheme for the promotion of the latter, which is not founded 
upon the former, must inevitably fail. This is true, not only 
with reference to this democratic republic of ours, in which, by 
a political fiction, every citizen is declared to be a sovereign, 
but in dear old monarchical England, with its threescore steps 
between the curbstone and the foot of the throne, where, in a 
recent address, Professor Tyndall broadly asserts that “ if any- 
thing is to be done in the way of really great sanitary improve- 
ment it must be from the people themselves.” But admitting the 
undeniable necessity of instructing the masses, I ask, in the lan- 
guage of the apostle Paul, “IIow shall they hear without a 
preacher, and how shall they preach except they be sent?” Be- 
fore endeavoring to answer these questions in reference to the 
subject before us, am I not justified in applying with a single 
change the ensuing words of this unequalled master to a few 
who stand here? “ IIow beautiful are the feet of them who preach 
the gospel of health (peace), and bring glad tidings of good 
things!” 
It is a trite theory that knowledge penetrates society from 
above; that starting from the limited mountain-top occupied by 
the educated few it slowly percolates through the subjacent strata, 
and after a while perhaps, in a greatly diluted state, it reaches 
the minds of the many who form the lowest stratum. I admit 
the truth of the illustration in so far as it expresses the direction 
which knowledge takes, but I deny the inference that the latter 
descends by its own weight; that those who possess it have only 
to open their mouths and their words shall, by their specific 
gravity, filter through all intervening grades, and refresh the 
thirsty souls of those who are at the bottom. This is certainly 
a very comfortable doctrine for those who live nearest the 
heavens, but unfortunately it is not true. Knowledge “abides 16 
ADDRESS OF 
alone,” unless it be forced into tlie ranks below, and it is the 
bounden duty of those who possess it to make provision for its 
diffusion. “No man liveth to himself alone,” and the author of 
all truth has pronounced dire maledictions against those who 
hold the key of knowledge and refuse to open the door to those 
who are without. Sanitary science is no exception to the rule. 
It must be taught in the family, in the infant school, in the 
academy; taught in the workshop, in the factory, in the church; 
taught in the university, in the forum, in the legislative halls; 
taught in the city, taught in the country, taught everywhere. 
We have our Bowditches and Shattucks and Bakers and Cabells 
and others of like wisdom and zeal to direct the great work, but 
we need missionaries and colporteurs who will go into the streets 
and byways and proclaim the truths of the new way, persuading 
all who will listen that health and longlife are possible to multi- 
tudes of those who now sicken and die before they attain the age 
of maturity. And whence are these teachers to come? I answer 
that, for the present at least, they are to be furnished chiefly by 
the medical profession. Indeed every physician should be a wor- 
shipper at the shrine of rosy-cheeked Uygeia, the daughter of his 
old god Esculapius, and should exert his utmost influence to 
spread abroad the knowledge of the elementary truths which 
underlie the whole system of sanitation. By so doing we will 
prepare the way for the enactrpent and execution of sanitary 
laws. « 
Band in hand with the physician should be seen the minister 
of the Christian religion, who, like the former, is brought by his 
calling into closest relations with all grades of society, and thus 
far is equally fitted to become a messenger of health not only to 
those who belong to his pastoral charge, but to all who come 
within the circle of his personal influence. I do not know what 
the theological seminaries are doing with this question ; but I do 
know that the oldest system of public hygiene of which we have 
any record was formulated and enforced by Moses, the divinely 
appointed head of the church under the old dispensation, and the 
type of Him who sixteen hundred years afterwards assumed in 
person the leadership for all time to come. If that great religious 
teacher in those far away times considered it his duty to protect 
the members of his flock from preventable diseases by enacting 
wise sanitary regulations, it seems to me that his successors, 
although not possessed of his extraordinary authority, might at THE PRESIDENT. 
17 
least preach the doctrine and endeavor to practise it. If con- 
sulted by them, I should therefore certainly advise that as a pre- 
paration for engaging in the duties of the pastor the theological 
student should pursue a course of study in sanitary science as a 
means of doing much good in a moral as well as in a material 
sense. 
But to return to the main question : I would call your attention 
to the fact that a very large proportion of the members of our pro- 
fession, all of whom should be teachers of the laws of health, need 
themselves to be taught, they having never given the subject suf- 
ficient systematic study to enable them to speak with authority 
upon any of its most important points. If we turn to the medical 
schools we find some explanation of this state of ignorance in the 
fact that very few of these institutions mention it in their prospec- 
tuses, and only two or three have a special professor of state medicine 
in their faculties. It is true that in all the schools the professors 
of physiology necessarily teach the fundamental laws of personal 
health; but far more than this is required to enable the student 
to comprehend even the outlines of the study. Trusting that the 
medical colleges may soon correct this serious defect in their 
system, we are still confronted by the question, what is to be 
done toward enlightening the tens of thousands now engaged in 
the practice of medicine all over the land who have received no 
such instruction, and are not fully aware of the important bearing 
of the subject upon the welfare and prosperity of the nation. 
What can this Association do more than it has done with refer- 
ence to this point? The question is one which demands the 
most serious consideration, and I confess to }mu that I approach 
it with no little diffidence, not only on account of its great im- 
portance but of the difficulties by which it is beset. The subject 
presents itself, however, to my mind somewhat after the follow- 
ing manner: A comparatively small number of philanthropic 
gentlemen, most of them physicians, imbued with a deep sense 
of the inestimable value of systematic hygiene for the prevention 
and arrest of disease, have by protracted study and investigation 
become possessed of certain information which if generally known 
and acted upon would not only save the lives of nearly one-half 
of those who now die before middle age, but also prevent a vast 
amount of sickness, and greatly promote the well-being and good 
morals of society at large. These learned and noble-hearted 
persons desire to impart their knowledge to their professional bre- 18 
ADDRESS OF 
tliren and others through whom it may be distributed broadcast 
over every State in the Union. Their first difficulty is to reach 
the ear of the professional public, and the second is to convince 
their hearers of the great importance of their message. If the 
grand army of physicians scattered over our immense territory 
could by means of the telephone or otherwise be brought within 
hearing and persuaded to listen attentively for an hour or more 
to the spoken words of one or other of the masters referred to, 
the first part of the problem would be solved, and possibly the 
second also. In a very little while the seed thus sown would ger- 
minate and bring forth fruit for the saving of human life,, some 
thirty, some fifty, and some a hundred fold. But as this method 
is impracticable, at least in the present state of physical science, 
may not the end in view be otherwise attained? There is but one 
other way that I know of, and that is for this Association to 
speak, and by means of the press and the post send its words to 
every physician in the land. I suggest, therefore, that a special 
committee of leading sanitarians be appointed to prepare a some- 
what elaborate address to the profession and the public setting 
forth the transcendent importance of the subject, presenting a 
summary of sanitary science, pointing out the best methods of 
studying and teaching the same, and demonstrating the great 
benefits to be derived therefrom by the individual and the com- 
munity in general. Without attempting to portray the special 
features that should appear in such an address, I take the liberty 
of saying that it should not omit to insist upon the great necessity 
of teaching the young not only the laws of health, but the ele- 
ments of physiology which are essential to a proper comprehen- 
sion of the principles of hygiene. In my opinion such instruc- 
tion cannot be commenced too early in life, and should progress 
pari passu with that in geography, grammar, and history, so that 
a boy or girl ten years old should feel as much disgraced by 
ignorance of the principal organs of the body and their functions, 
as by ignorance of the differences between an island and a lake, 
or a mountain and a valley. I am not unaware of the serious 
difficulties to be encountered in the attempt to introduce these 
studies into schools for the young, of the objections arising from 
want of competent instructors, and of the strong repugnance 
which many parents feel at the bare thought of instilling such 
knowledge into the minds of their children. The last was brought 
home to me most forcibly not long ago when a gentleman of THE PRESIDENT. 
19 
average common sense and good position in society, withdrew 
his daughter, a girl of twelve or fourteen years of age, from a 
first-classschool with which I am acquainted, because a human 
skeleton was brought into the class-roOm by a well-known pro- 
fessor of physiology who had kindly volunteered to teach the 
pupils a few facts in regard to respiration and circulation. But 
I am sure that by the publication of facts, and by patience and 
perseverance on the part of medical men all this sort of opposi- 
tion will be overcome, and that before another generation shall 
grow up into manhood and womanhood no school or seminary 
will be considered-complete in its appointments without a special 
teacher of sanitary science. 
Such an address as I have in view might possibly be com- 
pressed into sixty or eighty pages. Twenty or thirty thousand 
copies divided among the State medical societies, with instruc- 
tions to distribute them throughout every county, would prove 
of incalculable benefit to the great cause which we are endeavor- 
ing to promote. 
Following immediately in the path of and acting as a support- 
ing column to the professional army engaged in overcoming the 
numerous obstacles which society presents at every step should 
be found the State and municipal authorities occupying every 
foot of ground that is thus gained, and placing it under suitable 
sanitary laws. This seems to be the way in which all the great 
movements of civilization progress toward a successful issue; 
nevertheless, it has been proposed by some of the wisest members 
of this Association not to wait the necessarily slow march of 
sanitary intelligence among the people, but to petition the Federal 
Legislature at once to create a Sanitary Department of the gen- 
eral government, with an officer at its head, who shall be the peer 
of the Secretaries of State, War, and Finance, and be assisted 
in the performance of his duties by a National Council of Health, 
composed of members from every State in the Union. However 
startling such a proposition may have appeared to the politicians 
at Washington and to a very large proportion of the medical 
profession who are not yet quite educated up to this point, ema- 
nating as it does from such a well-known master in state medi 
cine as my distinguished predecessor in this chair, and advocated 
by so many others whose opinions in such matters are worthy 
of the highest consideration, I commend the question to your 
serious attention. I do not propose to discuss the subject here 20 
ADDRESS OF 
further than to say that nearly all the plans suggested for secur- 
ing federal control of public hygiene seem to me to be con- 
structed too much upon European models, and are therefore not 
easily adapted to our democratic-republican system of govern- 
ment. To my mind there are but two great questions in state 
medicine which we can reasonably hope to have solved by fede- 
ral legislation. One concerns sea-board quarantine and the other 
the pollution of water-courses. It is doubted by many eminent 
statesmen whether even these can be brought under federal con- 
trol, and yet the recent passage by Congress of “An act to pre- 
vent the introduction of contagious and infectious diseases into 
the United States,” encourages us to hope that something may 
be expected from that quarter. It is true that the act referred to 
mainly contemplates giving assistance to the quarantine authori- 
ties of the sea-board States, but it also provides for the establish- 
ment of quarantine stations where none exist, but where in the 
opinion of the Secretary of the Treasury it shall be deemed 
necessary, provided there shall be no interference with State laws 
and regulations in regard to such matters. The assumption by 
Congress of the authority to enforce such laws under any cir- 
cumstances is a most important and significant movement in the 
direction of a general sea board quarantine. If the federal 
government has the right to establish such stations within the 
bounds of any State, she undoubtedly has the right to do the 
same in ail, and let us therefore hope that it will not be long be- 
fore she shall extend her jurisdiction, so far at least as preven- 
tive medicine is concerned, along the entire coast from Maine to 
Texas. The abuses of the present system of quarantine of sepa- 
rate States, arising mainl}'- from the fact that its officers are for 
the most part appointed from political considerations, and with 
no reference to their fitness or unfitness for the positions, are so 
flagrant as to demand the attention, and if possible the redress 
of the central government. The Forty-fifth Congress therefore 
deserves the sincere thanks of the medical profession throughout 
the Union, and especially of this Association, for this its first 
formal acknowledgment of State medicine since 1799, thanks 
to which might well be added without detraction the earnest ex- 
pression of the hope that still larger powers of the same nature 
may be granted to the Secretary of the Treasury, and through 
him to the Surgeon-General of the Marine Hospital Service. 
The inauguration of a uniform sanitary police, with reference to THE PRESIDENT. 
21 
maritime commerce, would be hailed with delight by all the 
citizens of the coast States, save and alone by individuals who are 
politically and pecuniarily interested in perpetuating the present 
unequal and unjust system. It would not only protect the people 
from the impositions already referred to, but would relieve them 
from an onerous tax from which there seems to be otherwise no 
escape. 
"Whatever doubts there may be as to the extent of the authority 
possessed by the central government, there seems to be no dispute 
that within the limits of each separate State resides a power 
which with reference to all such matters is practically supreme. 
It is to this power represented by the Legislature and Executive 
of each State that we must look for the enactment and enforce- 
ment of such laws as state medicine demands of a wise govern- 
ment, economical not less of the lives and health of its citizens than 
of its material resources. It is therefore upon this power that 
the State medical societies should concentrate all their influence, 
professional and social, to effect the necessary legislation. They 
should employ their best endeavors to have State boards of 
health created where these do not exist, and they should by all 
means secure the right of nomination for appointment upon such 
boards; otherwise positions which demand men of peculiar quali- 
fications and sterling integrity will be conferred, as is too often 
the case, upon mere office hunters, who have no interest whatever 
in the matter beyond its pecuniary return. In this connection I 
would call special attention to the plan adopted by the State of 
Alabama, where the State Medical Association has been consti- 
tuted the State Board of Health, and the county societies subor- 
dinate local boards, with powers to select all the officers necessary 
to carry on the work, including that of quarantine. Whatever 
plan, however, these societies may adopt let them bear in mind, 
in recommending legislation, that while it is true that a people 
ignorant of even the elements of hygiene cannot be brought 
under sanitary regulations except by restraint, such restraint 
should be used with the greatest caution and moderation, and be 
sustained by an appeal to the common reason of those to whom 
it is applied. I therefore repeat, with added emphasis, the senti- 
ment already expressed, that the hope of true progress in stale 
medicine lies in the education of the people.