THE AMERICAN ACAD- 
EMY OF MEDICINE-ITS 
OBJECTS; ITS SIGNS OF 
PROMISE AND ITS OB- 
STACLES; ITS FIELD OF 
WORK; AND SOME SUG- 
\ GESTIOHS LOOKING TO 
' AN INCREASE OF ITS 
EFFICIENCY. 
BY 
LEARTUS CONNOR. M. D., A. B. A THE 
American Academy of Medicine, 
Its Objects; Its Signs of Promise and Its Obstacles; Its Field 
of Work, and Some Suggestions Looking to 
an Increase of Its Efficiency. 
THE PRESIDENT'S ADDRESS, 
Delivered al the Annual Meeting in Chicago, Ills., Nov. 13, i889. 
- BY - 
LEARTUS CONNOR, "A. B„ M. D., 
Ophthalmic and Aural Surgeon to Harper Hospital, and Children's 
Free Hospital. 
REPRINT FROM AMERICAN LANCET. 
DECEMBER, l88g. 
DETROIT, MICH. 
l88o. THE AMERICAN ACADEMY OF MEDICINE-ITS OB- 
JECTS; ITS SIGNS OF PROMISE AND ITS OB- 
STACLES; ITS FIE ID OF WORK; AND 
SOME SUGGESTIONS LOOKING TO AN 
INCREASE OF ITS EFFICIENCY* 
[REPRINTED FROM THE AMERICAN 1 ANCET, DEC. 1889.] 
LEARTUS CONNOR, A. B., M. D., DETROIT, MICH. 
FELLOWS of the American Academy of Medicine: 
By one of those strange freaks, that make the ac- 
tion of otherwise clear-headed people unaccountable, 
you last year elected me to the office of your chief ser- 
vant. As I was unavoidably absent from the session 
during which this action was taken, I did not learn of it 
until many hours after you had adjourned. Hence noth- 
ing was left me other than to endeavor to understand 
and execute your wdshes. Respecting the outcome of 
my service you are all in position to judge. The new 
plans of operation, proposed by Dr. Gerrish last year, 
and adopted by the Academy, called for the appointment 
of several new committees, whose reports speak for the 
wisdom of the changes and the faithful service of these 
committees. In general it seems to me that the changes, 
and the individuals who at much personal sacrifice have 
rendered them so successful, deserve the full approval of 
the Academy. 
For the first time in its history, this Academy holds 
a meeting in the West. For the first time, it comes into 
* Address of the President delivered at the annual meeting 
in Chicago, Ill., Nov. 13, 188g. 4 
personal contact with the mighty material forces cluster- 
ing about the Great Lakes, the vast rivers of the Ameri- 
can Continent, the boundless prairies, and the pure 
breezes that starting far up in the heavens by the tops 
of the Rockies, sweep for thousands of miles over 
fertile plains toward the rising sun. For the first 
time, it gazes upon the marvellous civilization that 
has sprung up, as if by a touch of Aladdin's lamp, 
in the vast garden bounded by the Great Lakes, 
the Gulf of Mexico, the Alleghanies, and the Rocky 
Mountains. Within this area is being developed a 
civilization having the largest and most favorable 
conditions for gigantic growth, untainted by the dis- 
disturbing influences of Europe or Asia, as the obstruc- 
tion of vast mountain chains separate it from ready ac- 
cess to the great ferries which ply the Atlantic and 
Pacific. Here, if anywhere, will appear the typical Ameri- 
can. Here, if anywhere, will be seen the greatest differ- 
entiation from all other peoples and races of the earth, 
and the most perfect blending of all types under the in- 
fluence of the governing Anglo-Saxon spirit. Here, if 
anywhere, will be seen the product of the richest soil, the 
most varied climate, the most perfect air, the purest 
water, the grandest forests, and the most majestic rivers.. 
Here, men and women do and dare all things in their 
efforts to bring under subjection the countless natural 
riches, everywhere found in such profusion. Into this 
atmosphere, most typically represented in this its largest 
city, the American Academy of Medicine for the first 
time comes. That it will grasp some idea of the medical 5 
needs of this superb region, and be able to initiate such 
schemes as will result in their early supply, is assured. 
That the Fellows will better appreciate the problems be- 
fore them, see additional grounds for encouragement, 
and appreciate more definitely the obstacles to be met 
and overcome, is our hope. Within this vast area is a 
teeming population, the parent of millions who within a 
short time will occupy these fat places. The medical 
profession throughout it is in a plastic state of develop- 
ment. Now better than ever after can it receive and ex- 
•ecute the lessons of its matchless opportunities, and the 
measures requisite for their best improvement. 
Some have said that the American Academy of 
Medicine is founded upon a new idea, a " fad " born of 
an aristocratic modern notion. As a fact, we find that 
Hippocrates, standing at the dawn of historic medicine, 
urged earnestly that " the preliminary training of medi- 
cal men be made as broad and as deep as possible." 
Farther, by precept and example, the same idea has been 
maintained by the most famous medical men, from Hippo- 
crates down to Alonzo Clark, as was abundantly shown in 
the eloquent and scholarly address of Dr. George Jackson 
Fisher, last year. We, the lineal descendants of these 
worthies, are simply endeavoring to maintain the faith 
once delivered to the " Fathers " thousands of years ago. 
Our mission is to Galvanize into life the truth of the im- 
portance and value of a preliminary education-a truth 
that has become obscured by the overshadowing influ- 
ence of commercialism. We strive to aid in the estab- 
lishment of such conditions as will insure the possession by every medical man of such general knowledge of 
literature, science, art, and trade, in their broadest as 
well as narrowest relations, that he may rank as a real 
teacher, companion, and friend, of the cultured and 
uncultured. We rejoice that the medical profession con- 
tains large numbers of such men; but the Academy 
would have them universal-the rule, not the exception. 
The change which the attainment of this end would 
make, is illustrated by the change which occurred in the 
classes of the Harvard Medical School during the inter- 
val from 1870 to 1880. On the former date, it will be 
remembered, this school raised its standard of prelimi- 
nary requirement, and proportionately its general cur- 
riculum. In brief, it began to teach modern medicine in 
a rational manner. President Eliot, in describing this 
change, says: "Until 1870, the students in the medical 
class of Harvard were noticeably inferior in bearing, in 
manners, and in discipline, to the students in other de- 
partments; now they are indistinguishable from other 
students." He adds: " A corresponding change in the 
medical profession at large would be effected in twenty 
years if all the medical schools of the country would 
institute a reasonable examination for admission. Under 
the present order of things, the American physician and 
surgeon may be, and often is, a coarse, uncultivated 
person, devoid of intellectual interests outside of his own 
calling, and quite unable to speak or write his mother 
tongue with clearness and accuracy. To set in oper- 
ation agencies which will enable all medical students to 
rank with any other professional students in gentlemanly 
6 7 
bearing, and to supplant the coarse, ill-bred, ignorant 
physician by one who ;can comprehend the intellectual 
forces operating in the community about him, and 
can meet on equal terms any individual who has become 
possessed with the intellectual training of his time-such 
is the mission of this Academy. 
Then, if ever such time comes, will the degree of 
Doctor of Medicine be an introduction and passport to 
any and every class in any community. Then, medical 
men will take rank among the leaders in all things per- 
taining to the best interests of the communities in which 
they live. Until then the physician's diploma avails for 
naught except as a license to practice medicine in some 
States. Its general worthlessness becomes more and 
more apparent as State after State refuses to accept it 
because of the lack of uniformity of the knowledge which 
its possessor may have acquired. Until a change is 
brought about such as the Academy seeks, each doctor 
must introduce himself, pass his individual examination 
before the guardian Board of the State in which he 
desires to live, and before the cultured people of the 
community among whom he casts his lot. Having 
passed these examinations successfully, he occupies a 
place in the community such as his personal merit has 
won, just as does the blacksmith, or farmer. The 
London Lancet stated the case as follows: " If Medicine 
is to acquire and sustain a high respect for its member- 
ship such as is given men of science, art, and other pro- 
fessional callings, its membership must be equipped with 
all the richer learning which is required to hold its own 8 
in a world that is daily becoming more cultured, and will 
certainly demand more of its medical advisors. Its 
members must have large physical and mental energy, 
capacity for long-continued efforts, an unselfish devotion 
to their work, and a high moral life. The practitioner 
of the future must know more than his father knew, and 
know it in quite a different manner. Here and there one 
may leap over all obstacles, and in spite of unfortunate 
antecedents, mount to the front rank. But the vast maj- 
ority of the medical profession can reach that rank only 
by the most thorough and systematic cultivation of every 
physical, mental, and moral, faculty before they enter up- 
on the study of medicine. Then, if ever, the physician 
must make the acquaintance of the great world of litera- 
ture, philosophy, art, poetry, language, etc., which has 
been growing out of the labors of countless hosts who 
have lived and by their toils made it possible for us to 
accomplish more than they in the short span of human 
life. At such time, or never, the student must master the 
objects and forces beneath the earth's surface, upon the 
earth's surface and above the earth's surface. By micro- 
scope and telescope, and all other scopes, by retort and 
test tube, by heat, light, electricity, chemical force and 
gravitation, he must follow the great teachers into the re- 
vealed mysteries of Nature. Only thus can he come to 
know something of himself, and of the human beings 
whose ills he would learn to prevent, remove, or alleviate. 
Only by such training can he hope for a manly develop- 
ment which will rank him with the best educated men 
of the world." To increase the number of those who 9 
shall thus stand as the representatives of medical science 
and art, is the crowning glory of the Academy's labors. 
But the objection is made such development will 
not pay; it costs too much time, too much money, for the 
returns in fees. To this I reply that the history of med- 
ical men shows clearly: i. Those, who enter upon the 
study and practice of medicine for the fees they hope to 
receive, have made a fatal mistake. They had better, at 
once, devote their time and energies to some calling in 
which it is possible to accumulate large fortunes, for the 
pure tradesman has no more place in the temple of med- 
icine than in the temple of religion. He may don the 
lion's skin to cover his own, but the donkey's ears will 
stick out, and the "braying voice" reveal his identity. 
He may be sure that at some time the Master will enter 
and drive from the Temple " the money changers and 
those who sell doves." 2. The highest honors, the 
largest fees, the most enduring renown, the greatest 
glory, have, during all historic time, come to such phy- 
sicians as have, first and last, sought the uplifting of the 
profession to which they belonged. In the language of 
the Great Teacher, those who have "sought the King- 
dom of God," have also had added to them " all other 
earthly things." In brief, it is certain that medical men, 
developed and equipped as we have desired, would reap 
the very highest fees, the most distinguished honors that 
earth can give. We trust that this Academy may in the 
near future make plain to the world that its principles 
once fully enforced by the profession, would be attended 
by these results. 10 
It is fitting, from time to time, to look over the field 
in which we labor, to observe the progress made in its 
cultivation, and the signs of promise for the future. Of 
these I note a few for our encouragement. In truth it 
must be said, that the Academy is but one of numerous 
agencies, all striving toward the accomplishment of the 
same end, but by diverse routes. All these we cordially 
welcome and wisely seek to increase in efficiency and to 
multiply. 
i.-It will be remembered that last year the College 
of Physicians and Surgeons of New York, placed in 
active operation a preliminary examination of consider- 
able severity. The result shows that its classes main- 
tained a size entirely unexpected though gratifying to 
the friends of an increased preliminary education. In 
some other medical colleges the increase of preliminary 
requirement was attended with equally satisfactory re- 
sults. ' 
2. Better than this, because of larger scope and in- 
dicative of a wider interest in preliminary education, is 
the action of the last New York State Legislature in en- 
acting the following: " Before the Regents of the State 
of New York, or the Trustees of any Medical School or 
College within this State, shall confer the degree of Doc- 
tor of Medicine upon any person who has not received 
the Baccalaureate degree in course from a College or 
University duly authorized to confer the same, they shall 
require him to file with the Secretary or Recording Officer 
of their University or College, a certificate showing that 
prior to entering upon the study of medicine, he passed 11 
an examination conducted under the authority and in 
accordance with the rules of the Regents of the Uni- 
versity of the State of New York, in arithmetic, grammar, 
geography, orthography, American history, English com- 
position, and the elements of natural philosophy; and 
such certificate shall be signed by the Secretary of the 
Regents, and countersigned by the Principal or Com- 
missioner conducting the examination." This enact- 
ment shows that the principle for which the Academy 
contends has been adopted by the State of New York. 
The examination is low, and the enactment imperfect in 
some details, but as a whole, it is a great step in advance. 
We can rely upon the spirit which prompted, and the in- 
telligence which formulated the enactment, to eliminate 
imperfections, and advance the requirements as public 
sentiment shall demand. 
3. It is meet that the Academy should take heart, 
because the enemies of the Illinois State Board of Health 
failed to accomplish its ruin this year. Its position, that 
no diploma will be recognized as entitling its possessor 
to practice medicine in Illinois unless given by a medical 
college which requires a definite preliminary examina- 
tion, still remains the law of this State, and is enforced. 
The service of this Board in teaching the doctrine of the 
absolute necessity of some preliminary requirement of 
medical students before entering upon college training, 
has been of incalculable value. It is doubtful whether 
any moral suasion would have been so effective with the 
medical colleges, the medical profession, and the laity 
and other State Boards of Medical Examiners. As the pioneer of teaching this doctrine by law, it will ever re- 
tain the gratitude of such as are able to appreciate its 
difficulties. Profiting by its successes and failures, other 
Boards have been established upon a higher plan, but all 
cheerfully acknowledge their debt of gratitude to this 
Board. 
4. The results exhibited by the Minnesota State 
Board cf Medical Examiners, under the last phase of its 
development, are especially encouraging. Under the 
old Act, Minnesota licensed in 1885 one hundred and 
forty-six physicians. During the following two years 
the State rapidly increased in population, and yet under 
the last Act only one hundred and forty per year were 
licensed. At the examination held October, 1889, of 
seventeen applicants, only twelve were licensed. From 
this statement we are prepared to hear that Minnesota 
has but one physician to thirteen hundred, while in the 
rest of the States it is affirmed that one physician exists 
to every five or six hundred people. 
The last Act, in brief, requires all persons, desiring 
to begin the practice of medicine in Minnesota, to pass 
a scientifically practical examination by a Board that is 
independent of all medical schools. No candidate is ad- 
mitted to examination unless he presents a diploma from 
a medical school that requires a preliminary examination 
upon English grammar, composition, geography, algebra, 
physics, and natural sciences, together with one of the 
following languages: Latin, French, or German. In 
addition, the college must require attendance upon at 
least three full courses of instruction, each of not less 
12 13 
than six months duration, before conferring the degree 
of Doctor of Medicine. The practical results of this law 
have been, to restrict the number of new men who have 
entered upon the practice of medicine in Minnesota, and 
very greatly elevate the general and special training of 
professional aspirants. It has also given a stimulus to 
medical colleges in their efforts to advance the standard 
of preliminary requirement. It must be, that in the near 
future the profession of Minnesota will possess a higher 
grade of general culture and professional acquirement 
than in the past, or than is proposed by other States. As 
this accords with its aims, the Academy can rejoice in 
such tangible proof of progress. 
5.-In Montana, Virginia, North Carolina, etc., 
there are also laws bearing upon the increase of the pre- 
liminary requirements of*medical students. While these 
are less radical than the Minnesota Acts, they contain 
the seeds which are sure to grow until they have equalled 
if not surpassed the foremost. 
6.-At the late meeting of the American Medical 
Association, Dr. Millard, so long actively engaged in the 
reformatory work in Minnesota, presented a scheme 
of measures such as would result in the adoption by each 
State of the Minnesota Acts. His idea was regarded 
with favor by those present. That difficulties attend its 
speedy realization does not render it less appropriate 
that we should accept it as an indication of the develop- 
ment of our cherished principles. We are ready to grant 
that law cannot accomplish all the reform we seek, still 
we must admit that law can do much in numerous direc- 14 
tions otherwise unattainable. It can lay its heavy hand 
upon the wdful transgressor, and make him respect the 
forms of propriety. The discussion of such laws in each 
State, incident to their formulation and passage through 
the legislature and to their enforcement, compels atten- 
tion from millions of the laity, and thousands of the 
profession, who otherwise would not give the matter a 
moment's thought. Medical colleges would thus learn 
that they cannot with impunity, in the interest of trade, 
prostitute the profession to which they belong. The law 
can make it profitable for the colleges to adequately 
increase their preliminary and other requirements. 
7.-The pharmacists at their last annual meeting, 
bewailed the low condition of the general culture of 
their craft, and endeavored to formulate some plan by 
which such culture could be increased. They sought to 
have the professional side of their calling occupy a more 
prominent share of attention. The preliminary require- 
ment suggested as fitting for those who desired to enter 
upon the study of pharmacy compares favorably with 
that of most medical colleges, which enforce any pre- 
liminary examination. Thus in many directions the 
spirit of reform is abroad. While it works slowly it is 
surely coming to the front. 
Obstacles to the General Adoption of the Principles of 
the Academy.-We are compelled to admit the existence 
of another side of the picture. There are numerous 
serious obstacles to the rapid adoption by the medical 
colleges of a high grade of preliminary requirement from 
their students. Among these we note a few. 15 
i.-According to statistics collected by the late 
President Barnard of Columbia College, it appears that 
the proportion of literary college students has diminished 
from one in two thousand of the entire population to one 
in twenty-five hundred. During these fifty years the 
population has increased about four fold, and the number 
of colleges three fold, but. the aggregate number of 
students in all the colleges but little more than two fold. 
The causes that have thus diminished absolutely the 
number of Bachelors of Arts we cannot discuss, but the 
fact exhibits one reason why more Bachelors of Arts are 
not found in the medical profession, and why a high de- 
gree of preliminary requirement is not generally regarded 
as necessary for entering upon the study of medicine. 
Significant of the continuance of this tendency of the 
age is the election of Ex-Mayor Low, of Brooklyn, N. Y. 
to the Presidency of Columbia College. That a wealthy 
and successful business man, an able and astute politician 
with no practical training in the art of teaching, should 
be placed at the head of one of the most prominent col- 
leges in the United States, is certainly a spectacle 
worthy of most careful study. Has business so ab- 
sorbed the best brain of the land that from its ranks 
must be chosen the leaders of the intellectual and moral 
training of the country ? If so, then we have to meet an 
obstacle of the first magnitude in the prosecution of our 
work. In any event we are a part of that protest which 
every scholar must utter against any and every capitula- 
tion of intellectual and moral life to commercialism. 
At every turn we shall be opposed by the trade 16 
spirit of our country and our time. This trade spirit 
cripples the efforts of not a few members of this 
Academy. One of our distinguished members in his 
labors said that he was most discouraged because some 
of those having abilities refused to attempt certain work, 
for the reason that it would not aid in filling their offices 
with patients, and their pocket books with dollars. Re- 
cognizing our foe, we shall not be surprised at his unex- 
pected and unwelcome presence, but be ever prepared to 
do what we can to thwart his purposes. 
2. It is an historic fact that the medical colleges 
have constituted a powerful obstacle to any increase of 
the preliminary requirements. The history of the pro- 
fession of Ontario fully substantiates our proposition. 
The colleges there were finally compelled to yield, as at 
last they must in the United States. This action of the 
medical colleges is based upon the trade aspect of their 
work. Adequate preliminary education if exacted of all 
colleges would reduce the sum total of student's fees 
and other perquisites. The exaction by one school, hav- 
ing no other advantages than its rival, of a high admis- 
sion examination, would send a portion of its students to 
its rival. So, in a variety of ways, the principles of the 
Academy antagonize the trade interests of the medical 
colleges. Hence we can understand the efforts they 
put forth to defeat the enactment of laws adequate for 
the certain enforcement of an honest efficient preliminary 
examination and rational college training. That which 
has been made public is probably only a tithe of the an- 
tagonism already existing. Dr. P. H. Millard, in the re- 17 
port already referred to, says : "Only those who by their 
official positions have been compelled to enforce the 
Medical Acts of Minnesota, Illinois, Missouri, West Vir- 
ginia, etc., can appreciate the obstacles and intolerable 
embarrassments encountered in their execution. The 
most captious criticism and formidable opposition came 
from the profession itself. This criticism and opposition 
did not come from the narrow minded cynic alone, but- 
to the shame and disgrace of the profession-from a large 
number of our medical institutions, some of which, we 
regret to mention, were manned by men of eminence and 
learning, but carelessly, for financial reasons, gave cog- 
nizance to an opposition to a reform which was entitled 
to undivided support and encouragement from every 
member of the profession from the Atlantic to the 
Pacific. Of the nine attempts, at the last session of 
the Legislature of Minnesota, to repeal the present 
Minnesota Practice Acts, a majority of the professed 
amendments emanated directly from the medical col- 
leges themselves." The evidence is overwhelming of the 
open and covert opposition of the mass of medical col- 
leges to all enactments tending to limit the numbers of 
their students, and among these must be classed a proper 
preliminary education. They love large classes better 
than small ones or professional standing. Reforms that 
will benefit their individual interests, they will adopt, but 
all others must receive their condemnation. 
Many years ago the speaker attempted to persuade 
a member of this Academy, known the world over for 
his great learning, splendid abilities and apparent devo- 18 
tion to the advancement of the medical profession, to 
exert his influence with his own college to establish a 
preliminary examination, and a three years graded 
course. He listened to me patiently and when my plea 
was finished said: " My dear doctor, I believe in the 
absolute truth of what you say. By no other means can 
medicine be properly taught. For more than two score 
years I have said to myself as I finished my course of 
lectures, ' another farce ended.' " "But," he said placing 
his hand upon his pocket book, "the real trouble lies just 
here. The doing as you suggest by my college would 
diminish its income and the salaries of its teachers. We 
cannot do it." He did not do it, nor has his college done 
it to this day. I suspect that it never will do it until it 
can be shown to pay in money. 
Admitting this hostility of the majority of medical 
colleges to the principles of this Academy, what can it do 
in the matter ? Its collective wisdom can most wisely 
answer this question, but it would seem evident, that the 
members of the Academy could cast their influence with 
such colleges 4s honestly do enforce an adequate pre- 
liminary examination. It could also assist in the enact- 
ment of. such State laws as will compel all colleges whose 
diplomas are recognized within its borders, to enforce 
proper preliminary training. In one or both of these 
ways it might finally be made profitable for the hostile 
colleges to join in the vigorous prosecution of our work. 
3. It is unfortunate for the cause of preliminary 
education, that so large a proportion of the professors in 
medical schools fail to possess the training needful for 19 
the acquisition of the degree of A. B. Not possessing 
this training, they are unable to comprehend its value to 
their students, and so are little likely to encourage 
them to obtain it. Naturally they oppose the requirement 
by their college of a higher general education than they 
individually possess. They became professors, because 
of the fact that they had money or push to invest in the 
business enterprise which was to enable them as pro- 
fessors to distance all their competitors in the profession. 
The more push ng physicians who were omitted from 
the ■ first college faculty gathered together, of the 
remaining doctors in the town, those having the most 
money and push, to the end that they might make as 
large an impression as their rivals, get as much or 
more business, make as much or more money, and 
so attain as extended a notoriety, and thus a second 
college was founded. It is beyond a question that 
most of American medical colleges originated in one 
of the two ways mentioned. From this origin it is clear 
that the general education of the professors was the least 
important item. Some colleges were organized in other 
and less mercenary ways, others have reconstructed the 
character with which they were born, so that there are 
now medical colleges whose teachers are all that can be 
•desired. Doubtless the remainder will be changed with 
the natural progress of events. It might be helpful in 
promoting this change if the exact number of Bachelors 
of Arts among the professors could be ascertained and 
published to the profession and the laity. We cheer- 
fully admit that many excellent practitioners and able 20 
teachers are found among the professors of medical col- 
leges, without the degree of Bachelor of Arts, men who' 
have supplied by later studies the deficiencies of their 
youth. These are men of commanding abilities and in- 
domitable energy who would have conquered all ob- 
stacles in any calling. But others in large numbers exist 
whose early defects have not been rectified in this man- 
ner, and whose presence in the lecture room of the col- 
lege is an offence to any well educated, well bred person. 
4. The lukewarmness of so many members of the 
Academy is another obstacle to the effective prosecution 
of our work. Those not members, notice and comment 
upon this state of things. They see members teaching 
in medical colleges which maintain no preliminary ex- 
amination; they see members taking students under their 
direction who have the merest smattering of general 
knowledge; they observe at the yearly meetings of the 
Academy only two or three score of members present; 
they rarely ever hear members speak of the Academy and 
comment upon it to the physicians about them; in all 
these respects they differ little, if at all, from non mem- 
bers. True, the Academy has ever had a remnant to 
whose faithful services it owes its continued existence. 
The remedy for this state of things is for ea.ch member 
to arise and enter upon his proper duties as a disciple 
and preacher of the doctrine of the advancement of gen- 
eral education in the medical profession. 
5. Lastly, our greatest obstacle is the extensive 
general ignorance throughout the medical profession. I 
had collected verbatim letters illustrating the degree of 21 
this ignorance, but from lack of time I will not read 
them. Nor can I dwell upon the prevalence of this 
ignorance. It is everywhere apparent to the annoyance 
of the well educated. Medical editors, secretaries of 
medical societies, and all having large correspondence 
with the profession, tell the same story of the constant 
exhibition of a vast amount of a actual illiteracy among 
members of the medical profession. It is a humiliating 
fact that the medical journals having the largest circula- 
tion are those who cater to this illiteracy 
An editor, himself a man of general and special cul- 
ture, in response to my expression of wonder that he 
could have any connection with a medical journal of 
this class said: I know well this element in the profes- 
sion. It regards a really good medical journal as a "kid 
glove" affair, fit only for the "aristocrats." It will 
not take, nor will it read, such a journal. Hence it is 
better to make a far inferior journal that it will take 
and read. This, he said, is the reason for the existence 
of those medical journals so offensive to the really intel- 
ligent practitioner. He then gave the following picture 
of such subscribers as he had found them: "The typi- 
cal doctor of this sort, spends much of his time gossiping, 
in the saloon or in the grocery. His office is as dirty 
•and unkempt as himself. While there, his favorite pos- 
ture is to sit in an old greasy chair with his feet upon a 
dirty, dilapidated table. With an old pipe in his mouth, 
he puffs and spits about, removing his pipe only when 
necessary for conversation with his patient. When the 
mood takes him he writes to his medical journal. With a lead pencil, and a piece of brown wrapping paper, he 
gives expression to his ideas, in language and forms of 
thought quite unknown to classical English." All will 
admit that the presence of such men in the profession 
constitutes a formidable obstacle to the work of the 
Academy. To limit additions to their ranks is one of 
the ends sought by the Academy. 
In seeking to understand the resources of the 
Academy, we are confronted with the question: What is 
the extent of the field whence the Academy must draw 
its membership? By the terms of our organization, this 
membership is limited to such practitioners as have 
earned the degree of A. B. or one representing a simi 
lar amount of college training. The exact number of 
such practitioners is not known, but we have certain da'a 
from which we can estimate the probable number. 
The report of the Commissioner of Education for 
1886-7 gives the following data concerning the students 
in the medical colleges: 
In 29 States there were 89 medical colleges, con- 
taining 9,806 students, 811 of whom possessed some sort 
of a literary degree. By investigations of the degrees 
held in Michigan, I find that more than one-third are 
degrees not recognized by this Academy. It is fair to 
suppose that one-third of these degrees are of the same 
sort, hence the students in all the regular medical col- 
leges for the year mentioned, hold but 541 degrees such 
as this Academy recognizes, or about 5 per cent, of the 
entire number. 
2. The number of graduates for this year from all 
22 23 
these colleges was 2,048. Suppose that the proportion 
of A. B.'s who graduated was the same as among the 
entire list of students, and the number who would be 
available for membership in this Academy, from that 
year, would be about 147. But it is a well known fact 
that, while usually a person with little general education 
graduates in one or two years, an A. B. requires three or 
more years. This would probably reduce the number of 
A. B.'s entering the active profession yearly to or about 
100, or about 3 per cent of the entire number gradu- 
ating. 
3. It is worth remembering the States which are 
in this Report given as containing among the medical 
students of all their medical colleges no person having 
the degree of A. B. They are: Alabama, Arkansas, Col- 
orado, Kentucky, Louisiana, New Hampshire, Oregon, 
and South Carolina. It must be that some mistake 
exists here, but I give the facts as contained in the 
official volume. These eight States are credited with 
having within the halls of their medical colleges 1200 stu- 
dents, not one of which had any degree in the arts or 
sciences. 
4. Finally, for the year mentioned I find that the 
several veterinary colleges contained over twenty per cent, 
of those holding literary or scientific degrees, while, as 
already stated, the regular colleges had but about eight 
per cent, for the same year. In short, the veterinary 
colleges for that year contained more than twice as many 
students who possessed literary or scientific degrees. 
Horse versus man: horse ahead. 24 
5. It may be supposed that the year in question 
was an exception, and that former years exhibited a bet- 
ter showing. Hence I took the reports for the nine 
years preceding the one from which I have quoted, and 
I find that, while there is slight variation from year 
to year, the average for the entire ten years of all 
those holding literary degrees of all sorts, is six per cent, 
among the students of the eighty-nine medical colleges; 
or if we eliminate the degrees not recognized by the 
Academy, this ratio would be reduced to about four per 
cent. 
In an address before this Academy in 1882, our 
esteemed fellow, Dr. Charles Me Intire, presented some 
pertinent facts. He studied nine county medical 
societies located in New Jersey and Pennsylvania, in all 
having a membership of two hundred and twenty-two. 
Of these twenty eight had the degree of A. B., or twelve 
and six-tenths per cent. Seven per cent, had received a 
partial training, and over eighty per cent, no training at 
all. Unfortunately, he was unable to give us the propor- 
tion of A. B.s among the other physicians of these coun- 
ties, not members of these societies. 
He farther obtained the catalogues of fifty-eight 
literary colleges that gave the occupations of their living 
alumni, and found that about nine per cent, were said to 
be physicians. Incidentally, it may be mentioned that 
over nineteen per cent, were lawyers, and twenty per 
cent, ministers, showing that medicine did not receive 
half so many recruits from these colleges as did either of 
the two other professions. 25 
He also showed that the percentage of A. B.s 
among the graduates of Harvard Medical School had 
decreased from over sixty-nine per cent, during the 
period from 1788 to 1800, to thirty five per cent, from 
1826 to 1879. 
Knowing that our distinguished Fellow, Dr. Lowry 
Sibbet, had given much thought to this subject, I sought 
his assistance. He said that some time ago he took the 
register of the physicians of the United States, the cata- 
logues of the literary colleges, the catalogues of the 
medical colleges, and statistics collected by himself, and 
from these data he formulated the following: Prac- 
titioners in the United States, one hundred and twenty 
thousand. Twenty per cent of these are non-graduates 
or twenty-four thousand. Ten per cent, are sectarian 
practitioners or twelve thousand. Three per cent, have 
the degree A. B. making three thousand six hundred. 
Taking six counties surrounding his own, with the pro- 
fession of which he was familiar, he could reckon five 
hundred practitioners. Among these he could find but 
ten possessing the degree of A. B. This is but two per 
■cent. At the date of making this communication to me 
Sept. 7th, 1889, the doctor says that he can find but nine 
A. B.s in these same counties. He allows five per cent, 
for Philadelphia, and four per cent, for Pittsburgh, and 
then estimating the other states by Pennsylvania, he can- 
not reckon more than three per cent, of the A. B.s in 
the profession of the United States. 
By the aid of the Secretary of the Michigan State 
Medical Society, I sought to ascertain the actual number 26 
of Bachelors of Arts in that body. Arrangements were 
so made as to cause each member no expense and but a 
few minutes of time in order to furnish the requisite in- 
formation. The results are as follows: The entire 
number of members of this society is four hundred and 
forty-five, while the entire number of physicians in Mich- 
igan is three thousand five hundred and eighty-four. 
Two hundred and fifty-six replies were received from 
the members of the State society. Of these twenty-eight 
stated that they possessed the degree of A. B. Ffteen 
others possessed other degrees. Thus there was one 
Ph. B.; two Ph. M.; one C. E.; seven B. S.; four M. A. 
honorary. Two hundred and thirteen reported as hav- 
ing no literary degree or other educational equivalent. 
It is presumed that the Michigan State Medical Society 
contains four hundred and forty-five of the best edu- 
cated men in the thirty-five hundred physicians in the 
State. Yet of those who replied to our inquiry only 
about eleven per cent, are eligible to membership in this 
Academy, a result corresponding with Dr. McIntire's 
results in nine county societies. If we regard those who 
did not reply to the circular as not possessing the de- 
gree of A. B. (as is most likely to be the fact), then the 
percentage of A. B.s in this society is only about six per 
cent. 
But what can we say of the thirty-one hundred not 
members of this society? Possibly there are many hav- 
ing the degree of B. A., but I was unable to get any 
tangible evidence of the same. In conclusion, there is 
no reason to believe that the medical profession of 27 
Michigan contains even two per cent, of Bachelors of 
Arts. 
A fact worthy of note shown by this investigation, 
is that the A. B.s were more frequent among those who 
had practiced medicine a quarter of a century or more, 
than among recent graduates. This accords with facts 
given elsewhere, and indicates that the proportion of 
A. B.s in the profession is decreasing both relatively and 
absolutely. 
Finally, in estimating the entire medical profession 
of the United States from our present imperfect data, it 
would seem that two per cent, of A. B.s would be a large 
allowance. Granting that there are three per cent., the 
entire profession would contain but about three thousand 
Bachelors of Arts. 
But a portion of these are homoeopaths or eclectics. 
To ascertain this portion I secured the catalogues of 
seven literary colleges giving the occupations of their 
living alumni. My friends, Drs. Emerson and Heath, 
kindly, by the aid of Polk's Directory, sorted out the 
several varieties of physicians with the following results. 
The colleges whose catalogues were thus studied were. 
Williams, Yale, Amherst, Bowdoin, Pennsylvania and 
Dickinson colleges, and Michigan University. From the 
living alumni of these institutions eight hundred and 
ninety two persons were found practicing medicine. Of 
these six hundred and thirty nine were found to be reg- 
ulars; forty-two homoeopaths; two eclectics, and one 
botanic, and two hundred and eight could not be differ- 
entiated. These latter we shall drop from our calcula- 28 
tions, though various reasons iead to the belief that 
nearly all are regulars. This leaves us with about ninety- 
four per cent, regulars, and about six percent, irregulars. 
There is little doubt that the extension of this inquiry to 
all the literary colleges of the United States would give 
substantially the same results, as these seven. 
Admitting this, and that the medical profession of 
the United States contains three thousand A. B.'s it 
will follow that the so-called irregulars take from this 
number one hundred and eighty persons. Our field of 
possible members, is now reduced to two thousand eight 
hundred and twenty. But farther reduction must be 
made. A considerable number are disinclined to work; 
others are in bad repute among their neighbors; so that 
it is quite safe to say that for these and allied reasons 
one thousand more are removed from our field. This 
leaves one thousand eight and twenty from which we 
may hope to increase our ranks. At present we include 
about six hundred leaving over twelve hundred more 
to be gathered into the fold. 
Incidentally I desire to call attention to the fact that 
but about six per cent, of the holders of the degree of 
Bachelor of Arts are homoeopaths, while about ninty-four 
per cent, are regulars. It would scarcely seem the part 
of wisdom to enact any change in our constitution offen- 
sive to the ninety-four per cent, in the hope of pleasing 
the six per cent. The same facts seem to show that the 
best prophylactic against quackery of any sort is the 
rigid requirement of the degree of A. B. from every per- 
son who proposes to begin the study of medicine. 29 
Our membership must be recruited from the field 
already described, but our materials for work, and our 
aids, must be largely derived from the rest of the profes- 
sion, from medical institutions, from State Boards of Ex- 
aminers, from medical societies, and from the laity. We 
shall in the end utterly fail of our purpose unless we are 
able to convince the laity of the correctness of our posi- 
tion, and persuade it to support such laws and social 
customs as shall render it extremely difficult, if not im- 
possible, for those not possessing a good preliminary 
education to receive a license to practice medicine, or 
having obtained one to secure sufficient patronage to 
render their practice adequately renumerative. The in- 
tricate problems connected with our work demand for 
their solution a high degree of such education of the 
laity as will enable it to comprehend the requirements 
needful for the attainment of proper professional skill. 
When once this is accomplished, all physicians, will want 
to become members of the American Academy of Medi- 
cine, all medical colleges will emulate each other in their 
haste to comply with its standard, because forsooth, it 
will have on its side the sovereigns of the land-the 
laity. 
Thus far in the history of the Academy, efforts have 
been largely directed to the securing of a larger mem- 
bership. The unconscious thought has been that we 
need first to enlist our soldiers, then train them for the 
conflict. Indirectly through the medical journals, and by 
private means, others have been reached and interested. 
The method introduced last year by Dr. Gerrish for 30 
the enlarging of our membership is familiar to you all. 
Its success renders its continuance desirable until its 
possibilities have been exhausted. By it we shall be 
enabled to add to our list the doctors just entering the 
profession. If perfectly qualified in all other respects, I 
see no reason why we should not admit those who have 
just completed their college work. But even on our 
present plan, a considerable number are yearly entitled 
to enter the lists as candidates for membership, It is to 
be hoped that the method, by its repetition, will at least 
secure many who thus far have refused to consider an 
application for membership. I suggest that the Com- 
mittee on New Members begin its work early in the 
year, so that its results may be gathered in before the 
annual meeting. Another method, suggested by Dr. 
Sibbet, works from the standpoint of the literary college. 
A Fellow of the Academy secures a list of the living 
alumni of his college, with their addresses and occupa- 
tions. The physicians, by the aid of Polk's Directory, 
are sorted into the regulars and irregulars. To the regu- 
lars he writes, asking e'ach one to consider the subject of 
applying for membership in the Academy. If for any 
reason he is in doubt as to an individual's standing, he 
ascertains it by the readiest channel, and acts according 
to information received. As a fellow alumni, he will 
often secure the attention of individuals when all other 
persons would fail. 
Another method works from the standpoint of the 
State or local society. The names of those eligible can 
be obtained by circular letter, and then the individuals 
solicited, as already indicated. 31 
Other methods have been devised by the Committee 
on New Members, and additional ones will be suggested 
as they continue the prosecution of the work. By the 
combination of all these, and pushing them with persist- 
ent effort, it would seem that at a not distant day there 
should be gathered into the Academy the majority of 
those eligible for membership. 
This end being attained, it will be possible toxieter- 
mine what proportion of the advanced work in the pro- 
fession is done by those possessing the degree of A. B.; 
what their relative standing is in the profession and 
among the intelligent laity. With these data at hand, it 
will be easy to demonstrate the difference between the 
possession by a doctor of a good preliminary education, 
or a poor one. Should such a comparison unmistakably 
show that the advantage was largely upon the side of 
those possessing the degree of A. B., the lesson to the 
medical profession, medical colleges, and the laity, would 
be a most important one. The effects of such a lesson, 
thoroughly taught, would be far-reaching in all respects, 
which time forbids me to even indicate 
Of additional methods by which the Academy could 
effectively preach its gospel to the profession and the 
people, I cannot even speak. It will certainly uphold 
all legal enactments tending to require of students a 
higher preliminary training; it will encourge all medical 
societies local or National, general or special in their en- 
deavors to advance medical art and science, and to fur- 
ther the higher training of medical students and medical 
men; it will give the right hand of fellowship to all Health Boards who directly or indirectly teach the people that a 
high grade of knowledge and special training is called 
for by one who would practice medicine in accord with- 
his time; it will sustain all medical institutions that dare 
to maintain an honest efficient preliminary examination; 
in short it will seek to learn the ways by which the 
gospel of preliminary education can be effectively 
taught and made to bear good fruit. With an organiza- 
tion including the majority of college-bred men in the 
profession, all earnestly promoting the best interests of 
general culture, it must be that the American Academy 
of Medicine shall become an increasing power in the 
land. 
During the year I have carefully studied the 
mechanism of the Academy, and duty compels me to- 
frankly state the results. 
The amendments before the Academy, were fully 
discussed last year by President Gerrish, and are to be 
reported upon by a special committee at this meeting. 
Respecting those relating to modifications of the terms of 
membership, it seems to me better to leave them in abey- 
ance until we have fully worked our present field. The 
regulations for admitting members are quite strict and 
tedious enough. It cannot be that the Academy will 
suffer harm from the admission of gentlemen who have 
all the present requirements and are endorsed by a Fel- 
low of this Academy. The trouble is not with our 
machinery in these regards, but rather in the lack of 
energy and forces moving this machinery. 
The amendment relating to the admission of the so- 
32 33 
called irregulars seems to me ill-timed. I have already 
shown that of all the A. B.'s in the United States there is 
not more than six per cent, of irregulars, while ninety-four 
per cent, are regulars. Why should we do anything to 
offend the ninety-four per cent, in the hope of attracting 
the six per cent? To my mind this settles the question 
fairly in so far as we are concerned. Ethical questions 
affecting the entire profession should be relegated to 
societies adapted for this purpose. When such societies 
representing the majority of the medical profession of 
the United States shall, after fair and full discussion, 
decide to change their ethical rules, then it will be in 
order for us to decide whether or no we will accept their 
decision. It seems to me that the wisest method of dis- 
posing of this amendment would be indefinite post- 
ment. All our energies are needed for the gathering to- 
gether of our forces and using them for the advancement 
of preliminary education. 
In correspondence with members of the Academy, 
and other intelligent individuals in the profession, I have 
been impressed by the general ignorance respecting the 
Academy, its nature, its aims, its constitution, its mem- 
bership, its time and place of meeting, what it had done, 
what it was trying to do, and what it proposed for the 
future. In fact, my own knowledge of the Academy has 
been acquired through great tribulation, and I fear I am 
still densely ignorant. However, ignorant as I was, 
others were still more so, and together we have floun- 
dered along as best we could. The lesson from this 
state of things is obvious; the Academy should so make 34 
itself known to the profession that all essential facts re- 
specting it would be in such shape that any physician 
can readily obtain them. Thus far, all will agree, but 
when we ask how this shall be done, there is ground 
for difference of opinion. In accordance with the sug- 
gestion of Dr. Gerrish, last year, a committee was ap- 
pointed to ascertain the practicability of publishing a 
full volume of transactions. Possibly the report of this 
committee will solve our difficulty and provide for our 
wants. He also suggested, and the suggestion was 
adopted by the Academy, that a list of Fellows, with 
brief notes of their history, be collected and published 
shortly after this meeting. I. understand that this work 
is in such shape as to be speedily issued from the press. 
Possibly these measures will suffice; certainly they will 
be a marked advance upon the past. But it strikes me 
that we ought to make more use of the medical journals. 
There are two ways of doing this. One is to make the 
needful arrangements with some existing journal that has 
a large circulation, and is friendly to our organization; 
the other is to establish a journal of our own. If we 
choose to use the first method, arrangements could be 
made by which the minutes of the meeting could be re- 
printed and distributed to the members, and so each be 
kept familiar with all that has transpired. Doubtless, 
the papers could also be reprinted in a single volume, at 
small expense, and distributed to the members for per- 
manent keeping. Whatever method is adopted, a full 
account of our meetings, with papers read, should appear 
at as early date after our meeting as practicable-cer- 35 
tainly not later than two months. In any event, each 
paper should be placed in the Secretary's hands imme- 
diately after reading, so that his work need not be de- 
layed. 
The plan of the Academy establishing its own 
journal, for the publication of its own transactions, and 
such other material as would promote the objects of the 
Academy, is worthy of consideration, but not of adoption 
until all sides have been fully considered. When editor 
and publisher are found entirely satisfactory, and the 
financial portion of the enterprise fully provided for, then 
the Academy can make the change. There is no rea- 
son why a journal on preliminary education should not 
find a field of usefulness as well as any other journal on 
any special subject. Its very existence would, monthly 
or quarterly, place the Academy and its work prominent- 
ly before the profession. All living questions could be 
discussed as influencing, or influenced by, the prelimi- 
nary training of medical students. 
The vigorous prosecution of the work of the Acad- 
emy calls for money constantly and in not inconsiderable 
amounts. Its present income is small and uncertain; its 
sources of revenue are the initiation fee and sale of 
diplomas. Because we have spent little we have got 
along, but any considerable branching out of effort to 
make the Academy a power in the direction of increas- 
ing the preliminary requirements of medical students 
will necessitate some additional source of income. As I 
have said, we live in a commercial age, a " trade " age, a 
" business " age. Money, as well as brains and persist- 36 
ent energy, is necessary for the promotion of reformatory 
as well as other enterprises. In accord with the age, if 
the Academy intends to conduct an aggressive campaign 
in behalf of preliminary education, it must have more 
cash. Hence it seems to me worthy of considering the 
question of so changing our law as to make annual dues 
imperative. It will be said that such a change would 
drive from us many members. Doubtless this is true; 
but, after all, it does not appear that non-fighting sol- 
diers ever won a hardly-contested battle. On the other 
hand, it is certain that large numbers would be attracted 
by seeing that the Academy was aggressively pushing its 
principles to their logical application, so that our loss 
would be more than compensated by our gain. I pre- 
sent the matter, not for immediate action, but for such 
consideration as will enable the Academy to adopt the 
wisest course to increase the effectiveness of its work. 
The time and place of meeting deserve a moment's 
attention. In general, these should be fixed at least for 
a year in advance. Such fixation would enable each 
member to plan his work so that without too great sacri- 
fices he might attend the meeting and contribute to its 
interest. 
The fixing of the place and date by the Council and 
Fellows, will be influenced by their deciding whether it is 
best to meet in relation to some other larger organiza- 
tion, or to continue, as we have in the past, to meet with- 
out reference to any other body. If, as in the past, we 
decide to meet at a time and place distant from other 
medical meetings, there are obvious advantages for fix- 37 
ing our meeting on the second Wednesday and Thursday 
in November. At such time all State and National or- 
ganizations have held their annual gatherings, so that 
the Academy cannot conflict with any. 
On the other hand if we decide to meet near the 
time of meeting of some other large organization and at 
the same place, we have a large number of societies to 
choose from. There are all the State, bi-State, tri-State, 
quator-State, quinque-State, all the various river valley 
medical societies, the several National special societies, 
separate or combined in the triennial congress, and lastly 
the American Medical Association. It is not proposed 
that the Academy shall blend its organization with any or 
all of these bodies. It is simply suggested that the 
Academy meet in the same city as one of them and end 
its sessions before that of the other society begins. Held 
in this manner I see no valid objection to the meeting 
before any one of these. But on the whole I am 
inclined to think that the gain to the cause of prelimin- 
ary education would be greater by fixing our meetings 
so they would close just before those of the American 
Medical Association began, and at the same city. Per- 
haps I will be pardoned for stating briefly the grounds 
upon which I base this judgement. Since 1874 I have 
been an active participant in the meetings of the Ameri- 
can Medical Association. With it I have visited most of 
the large cities east of the Missouri river and learned by 
personal contact the profession of those several cities 
and adjacent country. I have seen the membership of 
the Association grow from five hundred to over five 38 
thousand. I have seen it adapt itself to the wants of 
the East, the South, the West, and the North, to a re- 
markable degree maintaining a uniform character 
throughout-simply that of an assocation of American 
physicians. I have seen it struggle to adjust itself to the 
changing elements of membership; its conflicts over med- 
ical colleges, over medical education, over preliminary ed- 
ucation, over ethical differences, over the International 
Congress; have seen it establish and maintain an excel- 
lent medical journal in spite of powerful and unscrupul- 
ous opposition. As I look back over its forty years of 
history I find written on every page a sturdy devotion to 
steady professional advancement, and a constant preach- 
ing of our doctrine of preliminary education. At its 
first inception I was placed upon the Board of Trustees 
of the Journal, and have been kept there ever since. 
This has compelled me to most closely study the Asso- 
ciation, that for better or worse the Journal might be 
made to represent its wishes. In this periodical the effects 
of a lack of preliminary training can be studied with ad- 
vantage. Hence it was necessary for the Trustees of the 
Journal and all connected with it, and all the better men 
in the Association, to seek for a higher grade of pre- 
liminary requirement. Frankly I confess that oft-times I 
become discouraged at the obstruction of ignorance, and 
selfishness, but the work goes on, and will go on because 
there still remains enough leaven in the Association for 
its preservation. 
Some of the advantages of the cause of preliminary 
education by the Academy meeting just previous to the 
Association meetings are: 39 
First.-Those who desired to attend both meetings 
would be saved the expense of one trip, the loss of time 
in making such trip, and the difficulties in making ar- 
rangements for two breaks in actual practice. 
Second.-Some, who otherwise could afford to at- 
tend but one meeting, would be persuaded to attend both, 
so that either the Academy or the Association, or both, 
would gain in attendance. 
Third.-Members of the Academy to some extent 
would remain to the sessions of the Association, and 
carry with them to the Association some of the enthusi- 
asm for preliminary education they had absorbed at the 
Academy meeting. Not a few members of the Associa- 
tion would come early, attend the Academy meetings, 
and also be filled with the ideas there forcibly impressed 
upon their minds. 
Fourth.-Both Academy and Association would be 
more widely advertised, in medical and secular journals 
alike. As does not happen now, the members of the 
Academy would be brought more fully before the in- 
telligent people in the cities in which the meetings were 
held, and so the doctrine of preliminary education be 
preached to a larger audience. 
Fifth.-We should expect to persuade members of 
the Association, eligible to membership in the Academy, 
to join in our work. Misunderstandings could be re- 
moved by personal explanation to the benefit of all con- 
cerned. 
What objections can there be to such an arrange- 
ment ? 40 
Possibly some enemies of the Association would be 
offended. And yet, as the Academy would have no con- 
nection with the Association other than such as might 
arise from the members intermingling, it is difficult to 
imagine a valid objection. But suppose some were 
offended ? It is more than possible that more would be 
pleased, and so the Academy be better off in the end. 
Another objection lies in the supposed difficulty of 
obtaining sufficient papers for two such meetings so near 
each other. It seems to me that owing to the increased 
stimulus, it would be far easier to secure the needful 
papers than under present arrangements. The stimulus 
of an increased audience would rouse to greater intellec- 
tual effort, and I believe both meetings would reap 
the benefits of an enlarged intellectual activity. 
On the whole I regard the arrangement as affording 
a splendid opportunity for the Academy to exert an in- 
fluence in behalf of increased preliminary education 
among the profession outside of its membership, and up- 
on intelligent people throughout wide areas. To my 
mind, if it be right for the Academy to exist and hold its 
present doctrines, then it is right for it to utilize every 
opportunity or agency by which these doctrines may be 
scattered and made a living reality among all our people. 
When we shall have convinced others that we are in 
dead earnest, our influence will be enlarged a hundred 
fold. Enemies will arise, but friends will also spring up 
to meet them, and we shall calmly perform our work for 
our profession, for medical art, for medical science, and 
for humanity. 41 
Since our last meeting, the Academy has lost several 
of its members by their journeying to that country which 
persistently receives but never returns its visitors. Pre- 
eminent among these was Dr. J. L. Cabell, for fifty-two 
years a teacher in the University of Virginia. During 
this entire period he was known as a typical gentleman 
of culture and refinement, a teacher of living medicine 
able to inspire his pupils with that enthusiasm impera- 
tive for attaining the best results; a learned scholar 
who from time to time gave of his labor for the benefit 
of his fellows, freely, fully, and without price; a Pro- 
fessor whose counsels aided in establishing and main- 
taining a sound system of training for medical students 
-a system peculiar to the University of Virginia; a sani- 
tarian high in the councils of his fellows; not to particu- 
larize further, a man typical of the best development of 
his race, who, like a ripe sheaf, was gathered to his 
fathers when his life had been fully rounded out. Last 
January I wrote, asking him to assume the duties of 
Chairman of the Committee on New Members. I knew 
that his name would carry great weight among both old 
and young, in all groups of physicians, in every portion 
of the land. Almost by return mail I received a long 
letter from him, explaining in detail, that forborne years 
he had been compelled to forego the pleasure of en- 
gaging in such work, though often solicited by gentle- 
men whom he specifically mentioned. He said that he 
wrote thus in detail lest the Academy might think that 
he desired to shirk any duty to the profession he loved 
so well, or to the Academy whose principles had been 42 
his life-long standard. Had his physical condition ad- 
mitted, he said, this service to the Academy would have 
been performed with the greatest delight. As President 
of the Academy, I responded to to his touching letter in 
terms such as would have sprung from the heart of any 
member. To this he replied on Feb. ist, thus: "I have 
this moment received your very kind letter of the 29th 
ult., and I cannot resist the impulse to tell you how 
much gratified and touched I am by your generous ex- 
pressions of sympathy and regard, not to speak of your 
too flattering estimate of the little work I have done 
with a view to the elevation of the standard of medical 
education, and to the furtherance of all enterprises look- 
ing to the improvement of our common profession." 
Dr. Stephen Weeks, of Orange, N. J., one of the 
early members of the Academy, and Dr. William Elmer, 
of Bridgeton, N. J., have also passed to the unknown 
shore. The first was born in 1813, and the other in 
1814. Both came of stock distinguished for culture 
and largely impregnated with the pursuit of medicine. 
Dr. Elmer was formerly a Vice-President of the Academy. 
We also note the deaths of Dr. Theodore I. Wing, of 
Susquehanna, Pa.; Dr. James Foultes, of Oakland, Cal.; 
Dr. James»Kerr, of York, Pa.; and Dr. J. I. Miner, of 
Wilkesbarre, Pa. 
Our meetings are marked with two acts typical of 
human life. We record the admission of members into 
our ranks, and we note their departure to the land of the 
majority. In the narrow space between this advancing 
and that retreating column, we must complete our earthly 43 
work. In full view of these, we will ponder the problems 
before us, decide upon our line of action, and joyfully 
march to the conflict. Our battle is but a portion of the 
conflict of ages, and its winning by the forces with which 
we are affiliated will usher in the dawn of " Peace 
on earth, good will to men." As physicians, we are 
bound to cherish and keep bright the golden thread of 
professional truth, honor, and progress, which links us 
with that portion of our army already sunk behind the 
Western hills, so that as we rejoin it, a still brighter thread 
will be left behind us to guide our successors. As men 
representing high intellectual and moral culture, we 
will ever exhibit that kindly courtesy, manly independ- 
ence, and tireless energy, characteristic of the highest 
manhood, so that as in turn we join the departed throng, 
we shall have the individual consciousness that we have 
done what we could for the uplifting and ennobling of 
our race.