THE 
ANNUAL ADDRESS 
DELIVERED BEFORE THE 
atioiraljf clitic jjjf (lipl^sso^iation 
AT CHICAGO, ILLINOIS, 
.rrnsTE loth, iqho, 
By MILBREY GREEN, M. D 
NEW YORK: 
ALBERT METZ & CO., PRINTERS, 
No. 60 John Street. 
1881. QUALIFICATIONS, DUTIES AND RESPONSIBILITIES OF THE 
MEDICAL PROFESSION. 
THE 
ANNUAL ADDRESS 
DELIVERED BEFORE THE 
|ational j|dedic Jcilicat Association, 
AT CHICAGO, ILLINOIS, 
JUISTBi 16th, 18@0, 
MILBREY GREEN, M. D. 
NEW YORK: 
ALBERT METZ & CO., PRINTERS, 
No. 60 John Street. 
1881. ANNUAL ADDRESS 
BEFORE THE 
NATIONAL ECLECTIC MEDICAL ASSOCIATION, AT CHICAGO. 
ILLINOIS, JUNE 16th, 1880. 
Milbrey Green, M. D., President. 
Fellows of the National Eclectic Medical Association : 
Our Association has abundant cause for congratulation in 
this auspicious opening of its annual meeting. The large at- 
tendance of delegates from every portion of our country aug- 
urs well for its success. These annual meetings are a source 
of pleasure in bringing together physicians, and enabling them 
to exchange fraternal greetings and confer on matters of per- 
sonal interest, but we know they do not come to these convo- 
cations year after year, from California, Nevada, Nebraska, and 
other distant portions of the West, and from States on the Gulf 
and Atlantic coast, from Maine to Louisiana, and from the 
Central States, leaving their practice and traveling such dis- 
tances merely for friendly greetings and business advance- 
ment. Their presence here is a convincing proof that they 
are laboring for the elevation of their profession and the good 
of humanity. 
THE OBJECT OF THE ASSOCIATION AND THE MEANS TO 
ACCOMPLISH IT. 
Our charter states that the object of our Association is “to 
maintain organized co-operation between physicians for the 
purposeof promoting the art and science of medicine and surg- 
ery, and the dissemination of beneficial knowledge and an im- 
proved practice of medicine.” 4 
It is for this object delegates have come together in previous 
years, and it is why they are here to-day. It is appropriate 
at this time to speak of what the Association has already ac- 
complished. Its published Transactions are sufficient evidence 
that it has interpreted its charter obligations in their broadest 
sense, and recognized the fact that the Association assumed 
not only a great duty to the profession, but to the community 
also. They contain not only able papers on every branch of 
medicine and surgery, but have a proportion of valuable es- 
says on sanitary and hygienic subjects, and matters of vital 
importance to the community. They also show that the Asso- 
ciation has been faithful to the object for which it has been 
organized, in laboring unremittingly to advance the standard 
of professional and scientific attainment, and elevate the pro- 
fession and the community morally, intellectually and physi- 
cally. It has progressively adopted a higher standard of in- 
struction and professional conduct, and taken a firm stand in 
maintaining the true dignity and worth of the profession. 
As one means of accomplishing this object it has been 
necessary for it to adopt a code for its government. That code 
is broad and liberal, requiring only that all physicians shall 
observe the ordinarily-recognized rules of professional con- 
duct, and of honor, truth, justice, morality and courtesy, in their 
intercourse with each other, and in their professional relations 
with their patients and the public. Its legislation has been 
solely for the purpose of promoting the object for which it was 
organized and advancing the best interests of the profession 
and the community. It claims no special control over med- 
ical colleges and auxiliary societies, but it requires from them 
a faithful compliance with its rules. It assures equal rights 
to all its members, but it demands from them a strict adher- 
ence and fidelity to its principles and regulations. This is 
absolutely essential, in order to maintain its character and ful- 
fill its duties. It has shown its determination to do this by the 
unanimous expulsion, within three years, of a college that had 
violated its code of morality, and of two members for unpro- 
fessional advertising, and for selling secret nostrums. It 
recognizes the right of its members to come before the public 5 
in an honorable manner, by an ordinary professional card, but 
it has given convincing proof that it will not allow any of its 
members to use the arts and devices of the charlatan. In this 
respect it requires no more than is demanded by most, if not 
all, of the State and district societies throughout the country; 
and there is certainly no member of the Association that 
would be willing to see any other course adopted. It is a uni- 
versally-recognized principle of medical morality, that no se- 
cret medicines or modes of treatment should be countenanced 
by the profession, and that no physician should keep from his 
professional brethren any knowledge he possesses of any bene- 
ficial application of medicine or method of cure. All such 
knowledge is the common property of the profession, and any 
physician who attempts to keep such knowledge to himself, or 
to keep secret any medicine or method of cure that can be 
made useful by others in the treatment of disease, should be 
held up to the contempt of the profession and the public. 
But in maintaining this principle of our Association we must 
be careful that no injustice is done to our fellows, and no per- 
sonal motives influence us. If any member is aware of any 
violation of this principle it is his duty to make it known ; but 
the honor of the profession and the welfare of the Association 
should be the only motives that actuate him in making the 
complaint, and he should have the consciousness that he is free 
from even the taint of the wrong with which he charges his 
fellow. In our crusade against wrong and wrong-doers, our 
motto should be that of the Paladin of old—Sotto Vusbergo del 
sentirsi puro. “Under the shield feeling oneself pure,” the per- 
formance of any duty, however difficult, is rendered possible. 
Our Association has accomplished much in its endeavors to 
fulfill the purpose for which it was organized, but there can be 
no end to such a work as it has commenced and carried for- 
ward. It must continue its work of “disseminating beneficial 
knowledge,” and it must give to the profession and the com- 
munity not only an “ improved practice of medicine,” but a 
constantly improving practice of medicine. It must continue 
to elevate the standard of medical education and character, 
and send forth medical practitioners who will not rest satisfied 6 
with anything short of the highest moral, professional, and 
scientific attainments and social standing. It must continue 
to “disseminate beneficial knowledge” among the people, and 
instruct them as to the causes and laws of disease, and what 
tends to promote, and what prevent, its propagation; and strive 
to make them understand the laws of individual health and of 
public health, and how inseparably they are connected; that it 
is impossible for them to violate physical, intellectual, or moral 
law, in the smallest degree, without some injury to health and 
danger to life ; that the “ cleanliness which is next to godli- 
ness” applies as much to moral and intellectual as to physi- 
cal being, and that “ all tilth (moral, intellectual, and physical) 
is absolute poison; ” that nature is inexorable, and violation 
of her laws, whether wilfully or ignorantly, surely brings a 
penalty, and that the ignorance as well as “ the sins of the 
fathers” is “visited upon the children unto the third and fourth 
generation.” 
In order to promote the object and continue the noble work 
of onr Association, every member must feel that a portion of 
this work devolves upon him. Every one can do something. 
We must keep constantly in mind that we do not exist of 
ourselves or for ourselves only. We must strive constantly 
to develop our resources and make use of every means in our 
power to advance our science. Upon the labors of our pro- 
fession depend the dearest interests of humanity, and in us 
inaction is a crime. Ours is no mere business of interest or 
feeling. Personal emolument and reputation has never been 
the primary object with the hundreds of our predecessors who 
have labored to subserve the cause of science and benefit 
mankind. 
THE SCIENTIFIC METHOD INDISPENSABLE TO THE PROMOTION 
OF MEDICINE AND SURGERY. 
One of the greatest obstacles to a more rapid advance ot 
medicine aud surgery has been the skepticism that has 
always existed in the profession. 
Until within a comparatively recent period medicine has 
been considered by many as a metaphysical and speculative 7 
instead of a positive science, and some medical writers and 
practitioners still talk of the uncertainty and unreliability of 
medicine, as though the uncertainty was relative to that 
science instead of their ignorance. But, as an eminent 
medical writer says “ In Nature’s operations, whether on the 
most minute or expanded scale, there is no uncertainty, in- 
definiteness or chance-play. Whenever, therefore, it is said, 
that, on any point, uncertainty exists, it merely shows that, 
on that point, our knowledge of nature is incomplete. In 
Medicine the physician’s assertion that anything is uncertain 
is in truth an acknowledgment that on that point his know- 
ledge is only partial. No disease occurs which has not a 
certain adequate cause, though of that cause we may be igno- 
rant ; which has not its chief seat in some definite part of the 
system, though of that seat we may be unable to satisfy our- 
selves ; which has not produced, at any given time, a precise 
amount of functional derangement or organic change, though 
our idea of that amount may be most erroneous; and for 
which there exist not, in the nature of things, a remedial 
course, the most appropriate that can be pursued, though 
we, in our ignorance, may honestly pursue a course much 
less efticacious, or which shall even aggravate instead 
of ameliorating or curing. The uncertainty, then, is not in 
nature or medicine, but is owing to the imperfection of exist- 
ing knowledge, our constitutional incapacities, our lack of 
such knowledge as exists and our inability to reduce to prac- 
tice such knowledge as we possess.” 
Much of the skepticism we find in our profession is the 
result of routine practice. Too many practitioners have been 
in the habit of relying on text-books, and following old 
authorities in treating disease, instead of making a careful, 
systematic study of every case, and forming their diagnosis 
and basing their treatment on their personal experience, 
observation and an intelligent study and interpretation of 
symptoms. Their reading is mostly confined to the books on 
theory and practice they studied while in college, and they 
naturally fall into the routine methods of practice instead of 
attempting to make an accurate diagnosis of the disease 8 
before them, and then a correct therapeutics, so as to ascertain 
the remedy adapted to the form and character of the disease 
and condition of the patient. They only take into considera- 
tion a few of the most striking symptoms, name the disease in 
accordance with the nosology of their text-books, and either 
follow the old prescriptions there given, or make a few reme- 
dies do duty for all possible conditions. They take no account 
of the modifications of types of disease, of climatic influences 
or the idiosyncrasies of their patients. They make no at- 
tempts to keep up with the medical improvements of the 
times. Although they call their profession a science they do 
not apply the scientific method to their practice, and their 
treatment of disease is largely empirical. Unreasoning skep- 
ticism is but a natural result of such empiricism. 
Medicine is a science and the scientific method is the 
only one that should be followed in its practice. The same 
adherence to a rigid method of logic and reasoning should be 
followed in medicine as in any of the other sciences. An 
accurate diagnosis, based upon a correct pal liology, should be 
the foundation of all medical treatment. The laws of disease 
are as definite as those of health and the physician should 
study unremittingly to understand them. In dealing with 
so complex a mechanism as man it is impossible to avoid 
errors; but the more closely the physician studies the laws 
of health and disease the more accurate will be his diagnosis 
and the more successful his treatment. Every fresh acquire- 
ment tends to enlarge our powers of insight. Just as in 
nature, the higher we ascend the more fully lies the view 
before us. Every year brings advancement to medicine in a 
greater accuracy and extension of its facts and a more inti- 
mate acquaintance with the phenomena of disease and with 
the whole range of rational and scientific therapeutics. Valu- 
able instruments to aid us in diagnosis are being constantly 
invented, and physiological and pathological conditions can 
be more closely observed than ever before. 
INSTRUMENTS FOR DIAGNOSIS INVALUABLE. 
Iii diagnosing and treating general and partial cerebral con- 9 
gestion, und cerebral anaemia, the opthalmoscope is as indis- 
pensable as in diseases of the eyes, and it is of great value, as 
a diagnostic means, in the various forms of sclerosis affecting 
the brain and spinal cord, the several varieties of cerebral 
meningitis, cerebral haemorrhage, chronic encephalitis, cerebral 
softening, meningeal haemorrhage, chronic hydrocephalus 
tumors of the brain, general paralysis, contusion and com- 
pression of the brain, atrophy of the brain, chronic myelitis, 
locomotor ataxia, tetanus, epilepsy, essential convulsions, 
insanity, and diseases of the nervous system. It is also a 
great aid in therapeutical diagnosis, as, for example, in dem- 
onstrating the effects of the bromides or ergot in cerebral 
congestion, thereby enabling us to pursue an active treatment 
until the condition is relieved, with the same certainty we can 
feel in watching the effects of some applications to the surface 
of the body. In cerebral anaemia it demostrates as clearly the 
effects of nitrite of amyl or spirituous liquors, and other reme- 
dies like phosphorus, uux vomica, etc. It is also a positive 
guide in both diseases in the use of the galvanic current, ena- 
bling us to decide with certainty the strength of the current 
and the length of time it should be used. 
How distinctly, too, the microscope indicates the pathological 
conditions existing in many forms of diseases of the kidneys. 
It also aids us greatly in our diagnosis of disease of the lungs, 
and of suspected malignant diseases of the liver and stomach. 
In like manner it gives positive aid in our diagnosis of the 
character of the secretions from the uterine cavity, the bladder 
and all the mucous surfaces. It is valuable, also, in sometimes 
giving us a clew to the causes of diseased action, by making 
optically demonstrable theabnormal cell-growths, and enabling 
us to make a successful study of the blood in health and dis- 
ease. With it we can decide positively as to the benign or 
malignant character of a section of any growth, and demon- 
strate whether it is fibrous, myxomatous, cartilaginous or bony. 
The sphygmograph and stethoscope enable us to make a 
comparatively accurate diagnosis of the condition of the heart, 
lungs and circulation. The clinical thermometer is now quite 
indispensable as an aid in the diagnosis aud prognosis of every 
form of disease. 10 
The laryngoscope, otoscope, the various specula, the aetlies- 
iometer and other instruments for diagnosis, beside those 
mentioned, enable us to decide with almost unerring certainty 
as to the conditions before us, when without them we should 
feel doubtful. 
QUALIFICATIONS OF PHYSICIANS. 
But now that “medicine has developed into a symmetrical 
science, affiliated with the other natural sciences, studied by 
the same methods and the same appliances as they are, and, 
like them, has been planted upon the solid basis of fact and 
demonstration,” there exists a greater necessity for more 
thoroughly-educated physicians than ever before. Are our 
colleges doing all in their power to improve the standard of 
medical education, and graduate only men with such attain- 
ments as the present status of medicine demands ? 
Prof. F. H. Hamilton, of Bellevue College, and President 
of the American Academy of Medicine, for 1878, in his 
annual address, after speaking of the intelligence, educa- 
tion, experience, high moral character, etc., of the profes- 
sors in allopathic colleges throughout the United States, 
says: “Nevertheless, the fact remains, and is notorious, 
that these colleges graduate and license to practice, a 
great number of men who are totally unqualified; and you 
may find some difficulty in understanding how this fact can 
be made consistent with the reputation for honesty, intelli- 
gence and sagacity which I have accorded to a majority of the 
gentlemen who control these institutions. I am proud of the 
world-wide and merited reputations of many of my profes- 
sional brethren, but it cannot be denied, that in the enormous 
excess which the figures have placed before us—an excess far 
beyond the wants of the people—there are to be found many 
thousands who have never been subjected to the proper tests 
of their ability and from which sources the ranks of empiri- 
cism are mainly supplied; who are totally unqualified, and 
who ought not, in mercy to the people and in justice to those 
who honestly earned their diplomas, ever to have received a 
license to practice.” 11 
Oannot this portraiture of allopathic colleges and gradu- 
ates be accepted as true of a portion of our own colleges and 
graduates f 
But the fault is not entirely with the colleges. In looking 
at our Transactions we find it stated “ that this Association 
pledges its influence for the maintenance of the highest stan- 
dard of medical education consistent with law and the customs 
of the times;” and we have required our colleges, from time to 
time, to adopt a higher standard of education and qualifica- 
tion for candidates for the degree of Doctor of Medicine. 
Are we fulfilling this pledge of maintaining “the highest 
standard of education,” and doing our duty in sustaining our 
colleges, and thus enabling them to do what we require ? If 
we require a high standard of education from our colleges, and 
demand that they shall give us men of solid scientific acquire- 
ments, and only graduate those who have a competent know- 
ledge of medicine, we must sustain our colleges morally and 
pecuniarily, and send them the right kind of students. We 
must endeavor to sustain well the colleges now in operation, 
instead of trying to establish more. It would be better for 
the profession and for the country that no new colleges should 
be established, unless endowed, and the professors made in- 
dependent of students’ fees. The professors in all our 
colleges should be thoroughly educated and trained to teach. 
Without practical experience in the business of teaching the 
most scientific and finely-educated physician will fail in his 
attempts to instruct students properly. There are physicians 
who are willing to occupy a professor’s chair for one or two 
years, or until their reputation is established in their specialty; 
but as soon as a social and professional position is gained, and 
a paying practice secured, they are not inclined to make 
further sacrifice of their time. Every college in the country 
ought to be sufficiently endowed or sustained to be able to 
give all its instructors a fair compensation, and retain them 
as long as they are competent to teach. They would then be 
able to secure thoroughly-educated and properly-trained 
DUTY OF THE ASSOCIATION TO OUR COLLEGES. 12 
teachers, who would become more valuable every year, as ex- 
perience has proved that teachers need especial training as 
much as physicians. And this fact must not be overlooked, 
namely, that every instructor must possess a tact for teaching 
or he cannot impart information to advantage, although he 
may possess the most scientific education. It is possible for 
us to sustain our colleges and enable them to support their 
instructors properly, and thus remove the inducement to make 
a business of matriculating and graduating students, which 
has proved so demoralizing to some colleges that have de- 
pended entirely upon money received for tuition and diplomas. 
We should then have a right to require every college recog- 
nized by our Association to adopt the highest standard of 
education, and grant diplomas to only such students as 
reach that standard. 
OBLIGATIONS OF MEDICAL SOCIETIES TO COLLEGES. 
Our medical societies ought also to give support to colleges 
by refusing to license men to practice medicine who are not 
properly educated. The constitution and by-laws of nearly 
all State societies—Eclectic, allopathic, and homeopathic— 
contain a provision for licensing men to practice medicine 
who have never graduated. There was occasion for such a 
provision in the early days of medicine in this country; but 
now that there are such great facilities for obtaining a medical 
education, such a provision is no longer necessary. It is 
within the power of every person who has an earnest desire 
to become a physician to secure a proper medical education 
at some approved college. Some of our State societies have 
rescinded the provision above referred to, and examine no 
applicant for membership who has not graduated at some 
approved college, and all applicants are required to pass a 
rigid examination by the Board of Censors, in all branches 
of medicine, before being recommended to the society for 
membership. In the same States, auxiliary societies admit no 
one to membership who is uot a member of the State society. 
This provision does not debar any student or physician 
from participating in all the benefits and instructions to be 13 
obtained in these societies, as every society admits them to 
all such privileges until such time as they are prepared to 
comply with the requirements of the Constitution and by-laws, 
and become members. It would be for the advantage of all 
societies and the profession if such a provision was adopted 
by all State societies, as it would lead our colleges to maintain 
a higher standard of education, by showing them that the 
profession not only wished for it but demanded it. 
Professor Hamilton, in the address before referred to, in 
speaking of the low standard of education in allopathic 
colleges, says “ that the medical men at large do not feel a 
deeper interest in this matter than do the professors in 
medical colleges, and that they cannot be more safely intrusted 
with our educational interests than the colleges, unless other 
coincident changes are adopted, is sufficiently shown by the 
signal failure of county and State censors to do their duty 
when empowered to examine candidates and grant licenses. 
In this State they have never demanded a higher grade 
of qualification than the colleges; and the writer has seen 
more than one case in which a candidate, rejected by the 
colleges, has been forthwith admitted by the licensing boards. 
Neither county nor State censors are, in a majority of cases, 
chosen on account of any special qualifications which they are 
supposed to possess as examiners, and it cannot be thought 
strange, therefore, that they should license incompetent men. 
A stream cannot rise above its source.” 
What he says of these allopathic societies is also applicable 
to some Eclectic societies. Let us endeavor to remedy this 
evil throughout the country by having our boards of censors 
and committees on credentials examine carefully all applicants 
for permanent membership and the credentials of all delegates, 
and see that the requirements of our Constitution and by- 
laws are complied with. 
RESPONSIBILITIES OF PRECEPTORS. 
I have said that we must give to our colleges moral and 
financial support, and send them the right kind of students 
if we desired competent physicians. There are many stu- 14 
dents who wish to have preceptors. If we undertake to 
instruct students we must be conscientious in the performance 
of our duties, and possess the requisite qualifications to 
fulfill the responsibilities of our office. Misdirected or dis- 
proportioned studies may prove a great drawback, if they are 
not fatal to the success of even the most intelligent and 
earnest student. Preceptors sometimes send students to 
college with so much to unlearn that their first year is worse 
than wasted, because it is much more difficult to unlearn than 
to learn. The preceptor should form a plan of elementary 
study, and insist that his pupils should follow it in every 
particular. He should allow them to read only such books as 
he selects. Desultory reading is always injurious to students. 
He should examine his pupils every day, and encourage 
them to question him whenever there is any point they do not 
thoroughly understand. He should require systematic recita- 
tions in all the studies in which they are engaged. If he has 
not time for this he ought not to undertake their instruction. 
The physician who is so driven by his practice that he is 
obliged to question his pupils hurriedly or defer his recitations 
from day to day, as is sometimes the case, cannot do justice 
to them, and injures, instead of benefits, those under his 
charge. Preceptorship is not an unmixed blessing even in its 
best aspect, and, if improperly conducted, is a decided evil. 
We should use our influence as far as possible to send to 
our colleges students who are not only desirous to study and 
practice medicine, but possess the qualifications to make good 
physicians. There will always some enter every college who 
cannot even grasp the rudiments of medicine, and would 
never be able to comprehend the principles of the science, 
nor apply them correctly in the treatment of disease. Occa- 
sionally great development of mind has taken place in men of 
only moderate natural capacity when they have been subject- 
ed to a strict discipline and devoted themselves closely to 
study; but minds originally apathetic and sluggish are seldom 
aroused by even the most interesting studies. We should 
seek for students who are endowed with vigorous and inquir- 
ing minds, and who have the faculties of observation and judg- 15 
ment, and are industrious and persevering, and will devote 
themselves to their studies with a strong purpose and earnest 
will. 
A good preliminary education is indispensable to the student 
of medicine, and if he has already learned how to learn before 
he enters a medical college he cannot fail to make rapid pro- 
gress. A thorough course of preparatory education disciplines 
the mind, trains the faculties, inspires firmness of purpose, and 
generates a loveof knowledge. The habit of acquiring know- 
ledge is not attained at once, and it is not sufficient that the 
mind is open to receive it, as it never flows in spontaneously. 
Knowledge must be sought and actively appropriated, and the 
power of doing this to advantage can only be acquired by sys- 
tematic training. 
Formerly but little was required of medical students in the 
shape of preparatory education, but in the present state of 
medicine it cannot be overlooked. As every generation has 
brought vast accessions to medicine and its collateral sciences, 
and to practical knowledge of every kind, the medical student 
of the present day ought not only to possess a greater amount 
ot knowledge than those who entered the profession in former 
years, but should possess a more cultivated capacity for the 
acquisition of knowledge. Our common schools are now 
giving a more thorough education in the elementary branches 
which are preliminary to a study of the sciences than was 
formerly to be obtained in some academies and colleges, and 
even the children of the poor can have the advantages of 
mental discipline and intellectual training. The children of 
rich parents can have no excuse for not obtaining a liberal 
education, and there is but little for even the poor, or those 
of moderate means, neglecting it. A strong purpose, an 
earnest will, industry and perseverance, will bring even 
classical acquirements within the reach of all. Elihu Burritt 
studied the languages beside the forge of the blacksmith’s 
shop, Abraham Lincoln by the light of pine knots in a log- 
cabin, and Professor Dewees and many other distinguished 
NECESSITY OF PRELIMINARY EDUCATION. 16 
physicians obtained their preliminary and medical education 
while supporting themselves. Professor A. J. Howe studied 
his Greek while tending a saw-mill, and afterwards honorably 
wrought his way through Harvard University. 
Many eminent men never had the advantages of the school, 
the academy, and the college, but their indomitable will and 
perseverance enabled them to obtain the necessary classical 
and scientific acquirements, and they have always urged the 
value of these as an important means of acquiring success. 
It has been the universal testimony of those physicians who 
have acquired eminence in their profession without having 
had a good preliminary education, that the lack of it impeded 
and embarrassed them in every step in their attempts to 
acquire knowledge amidst the labors and responsibilities 
of their daily duties throughout their whole career. 
CONTINUED STUDY ESSENTIAL. 
After graduation the young physician ought to continue liis 
studies with but little respite, feeling that “ he has only passed 
through his novitiate, and that his diploma is only one of the 
series of honors which lies within his grasp.” The necessity 
of continued and careful study and observation cannot be too 
strongly urged. Some young physicians neglect their books 
as soon as they have obtained their diplomas, apparently re- 
garding it as an all-sufficient evidence of their qualifications 
to practice medicine, and a substitute for future attainments. 
No advancement in the profession can be reasonably antici- 
pated if such a course is followed. The true physician is a 
student to the end of his life. There is always time to be 
found for reading and reflecting even when a practice is es- 
tablished, if we methodize our business, as we can make 
leisure if we husband the minutes and hours, but the golden 
.hours for study for the young physician are the first years 
after his graduation. 
Many young physicians realize the importance of continued 
study, and intend to recommence it after a few months respite, 
but find various reasons for postponing it, and delay com- 
mencing from week to week and month to month, until at 17 
last habits of idleness are formed, and their leisure hours are 
passed in day-dreaming, smoking, riding, or the society of 
friends, and study gradually appears to them less indispen- 
sable and finally becomes repulsive. The physician who 
neglects his studies in this maimer very seldom ever resumes 
them. This is the greatest error any young physician can 
commit. The lost opportunities of youth can sometimes be 
regained, but those of manhood are beyond redemption. 
Letoumeur says : “Do not allow7 a single day to pass without 
increasing the treasure of your knowledge and virtue. The 
use of time is a debt we contract from birth, and it should 
only be paid with the interest that our life has accumulated.” 
The physician should realize that he cannot retain even the 
knowledge that he possesses without study, for as soon as he 
ceases to acquire he loses. This is true of his elementary as 
well as professional knowledge, and he ought not only to 
review, but constantly extend his studies. While in college 
the student can study but a very small proportion of the best 
books in any department of medicine, and scarcely glance at 
any of those relating to the collateral sciences. He should 
now take these up systematically, and read them in their 
proper connections. The auxiliary sciences are invaluable to 
the physician in connection with his own. 
With his first cases in practice comes new7 inducements to 
study. Each case should be made a study, and everything 
within his reach should be read that has any reference to it. 
He should have a note-book in which to record his cases, and 
make a memorandum of everything connected with each case. 
Then in taking up his various authors consecutively he can 
compare his observation in any disease under his charge with 
their description and become familiar with the disease in all 
its phases. But the greatest service this will be to him is in 
acquiring the habit of accurate and patient observation. 
A few years ago one of the most distinguished medical 
writers in this country stated that he had always followed 
this course, and that it had proved of inestimable benefit to 
him. He commenced making notes of clinical cases while a 
student, and he said that even now, after over forty years of 18 
practice, he occasionally glanced over the notes made of cases 
in the hospital, before his graduation, and found something to 
aid him in diagnosis and treatment of his obscure cases. 
Professor Dewees commenced practice in a small village, 
poor and without patronage, and continued there four years. 
After his removal to Philadelphia, and when well established 
in practice, he formed the idea of preparing himself for a 
teacher of midwifery. His first step was to take the notes 
and observations he made on all the cases under his care 
during the first four years of his professional career, and read 
them carefully in connection with all the best European 
authorities. These observations formed the basis for his work 
on midwifery—a work which attracted attention and com- 
mendations in Europe as well as in this country. He always 
said that his four years’ study and observations in this obscure 
village, between the age of 21 and 24 years, was the founda- 
tion of his success in life. 
Another valuable aid to a physician is an “ Index Rerum ” 
—a book in which to condense any item of interest that comes 
to his notice, indexed in such a manner that it can be found 
readily. Extracts on any subject, from books, periodicals, 
newspapers, cases under treatment, etc., can be entered in a 
condensed form, and will always be ready for reference. 
Physicians who have adopted this method regard it as indis- 
pensable to them. A daily record of cases is important to 
every physician, if he acquires the habit of embodying an 
accurate account of symptoms, treatment, constitution, tem- 
perament, and every item calculated to throw any light on 
the case noted. If cases are noted in a precise, perspicuitous 
manner, they occupy but little space and take but little room. 
REGULAR ATTENDANCE ON MEDICAL MEETINGS. 
Another means of improvement to all physicians is as reg- 
ular attendance as possible on all meetings of county and 
State medical societies. Every physician should esteem it his 
duty to do his part to sustain these meetings, and, if necessary, 
make some sacrifice to attend them. In cities and thickly 
settled portions of the country there can be no excuse for 19 
physicians neglecting their societies. In thinly settled sec- 
tions of the country district societies often embrace a large 
territory and a regular attendance involves considerable sacri- 
fice. And yet, in several such locations, where the members 
of district societies are widely scattered, there are well-at- 
tended, instructive and interesting meetings. The members 
have found what a great source of instruction and improve- 
ment these meetings constitute, and are willing to make some 
sacrifice and arrange their business so as to spend a day, or a 
portion of a day, once a month, in attending them, even when 
obliged to ride many miles to do so. There is much benefit 
to be derived from a friendly criticism of essays, reports of 
cases, treatment, etc., by the members, and an intimate per- 
sonal acquaintance and free interchange of thought. 
Well-organized county and State societies are also of great 
value to the community as well as the profession, and are 
essential to the maintenance of the National Association. In 
connection with these district meetings, it is easy to arrange 
an exchange of medical books and periodicals, as clubs can be 
formed to subscribe for various periodicals and enable physi- 
cians to have access to a variety of medical literature at a 
small cost. This plan is of great value to young physicians 
who cannot afford to purchase many books or subscribe for 
more than one or two periodicals, aud are not located in cities 
or large villages where medical books can be obtained in 
public or society libraries. In all our cities, and in large 
villages, the public libraries contain many medical books and 
periodicals, and medical books of all schools of medicine are 
purchased by the librarians at the request of any physician 
who will take the trouble to fill out the blanks provided for 
that purpose. 
IMPORTANCE OF BOOKS AND INSTRUMENTS. 
The best investment young physicians can make of such 
funds as can be spared from their actual necessities is in the 
purchase of standard medical works and instruments of diag- 
nosis from time to time. In regard to the expense of micro- 
scopes, and many other aids to diagnosis and medical im- 20 
provement, there are erroneous ideas. There are microscopes 
costing from $20 to $1,000 or more, but Professor O. W. 
Holmes, of Harvard University, stated a year ago that he had 
accomplished his best microscopical work with a simple in- 
strument costing only about $30. If a physician can afford 
it, a microscope costing $100 or $150 is of great advantage, 
but for ordinary use a “ student microscope,” costing only 
from $20 to $40 will answer the purpose of most physicians. 
Many of the instruments for diagnosis before mentioned in this 
address can be purchased at a comparatively small cost. In 
the first years of a physician’s life a judicious outlay for books, 
and instruments for diagnosis, midwifery and surgery, will 
prove a much better investment than real estate or stocks. 
A HIGH MORAL STANDARD INDISPENSABLE. 
In considering the means that are essential to advance the 
standard of medical education and elevate the profession and 
the community, we must urge on students and physicians the 
vital importance of established and correct principles of 
action. “The principle of unyielding rectitude is of invariable 
and universal application.” Let all our graduates keep con- 
stantly in mind the sterling advice of Professor Mitchell to a 
graduating class in 1839: “Resolve to start in the race for 
honorable success under the guidance of just and proper 
views. The most important of these is an unflinching adher- 
ence to moral rectitude and duty. Be assured that if strict 
integrity be not always the shortest way to success and re- 
spectability, it is ever the most certain, the happiest, and the 
best. He who makes unbending rectitude his motto may ex- 
perience difficulty in his efforts to get business in the midst of 
dishonest competition and rivals. But mark his course; 
though slow in ascending the rugged steep, he gains at length 
the lofty summit. Around him gather the warmest patrons, 
the most substantial friends, and he rises steadily in the con- 
fidence of all who know him. Nor is this all. He respects 
himself, for he has a conscience void of offense. He feels that 
the motives by which he is governed are right and safe, and 
he escapes the self-degradation which the unprincipled man, 21 
sooner or later, realizes as the consequences of his uuworthy 
course. And if he fails to accumulate a large fortune, he 
feels that he has gained a more substantial portion. Without 
the consciousness of truth and honor a man is poor indeed, 
although he may possess all the gold he desires, and you can 
achieve no lasting reputation, no true success or happiness in 
life, unless you are true to yourself, true to humanity, true to 
God.” 
MEDICAL LEGISLATION. 
An important means to elevate the character of the profes- 
sion and the standard of medical science and practice, and 
which cannot fail to benefit the community, is the enactment 
of proper laws to regulate the practice of medicine, by the 
various State Legislatures throughout the country. 
It is notorious that colleges of all schools of medicine have 
granted diplomas to many incompetent men, and our National 
Association and State societies should still continue to manifest 
their disapproval of this great wrong. Our Association, early 
in its organization, denounced this evil, and on June 27, 
1873, passed the following resolution: 
“ Whereas, The correct treatment of the human body, when 
suffering from disease or accident, requires the highest degree 
of skill attainable by man; and 
“Whereas, The people are almost wholly incapable of esti- 
mating the scientific attainments of medical practitioners; and 
“ Whereas, Diplomas have been freely granted by medical 
colleges, of all branches of the medical profession, to men 
grossly incompetent, and have thus ceased to be sufficient 
evidence of the scientific attainments of their possessors ; 
therefore, 
“Resolved, That we favor the passage of laws by the various 
Legislatures of this Union, making it necessary for every 
person desirous to engage in the practice of medicine, surgery, 
or obstetrics, to pass a fair examination in the fundamental 
sciences, comprehending a course of study necessary for the 
acquirement of a full knowledge of the science of medicine 
in all its branches.” 
This measure has been adopted in some of the States, and 
during the past year many of our members, in all parts of 22 
the conn try, have urged its adoption in all States where no 
such law exists. Its importance is evident to every thought- 
ful physician, and although we may differ as to the details of 
such enactments in various States, we should all unite in our 
endeavors to secure the passage of such laws as will prove the 
greatest benefit to the profession and the community. There 
ought, also, to be laws enacted imposing penalties for the sale 
and use of fraudulent diplomas. The country is flooded with 
such diplomas from allopathic, homeopathic, and so-called Ec- 
lectic colleges. Our National Association and our State socie- 
ties have done what they could to suppress this evil. In 1878 
a college was expelled from our Association for granting a di- 
ploma to a student who had not attended the full course of 
lectures required by our by-laws, and it has shown a determi- 
nation to rigidly enforce its regulation, not only against the 
sale of degrees, but also against granting them to incompe- 
tent men, which is as great a wrong as the direct sale of 
diplomas. The Secretary of the Association has held a cor- 
respondence with General Eaton, the Commissioner of Educa- 
tion at Washington, in relation to the sale of bogus diplomas in 
Europe, of so-called Eclectic colleges in this country, which 
will be laid before you. General Eaton assured him it was not 
a question of diploma-selling by any particular school of medi- 
cine, as diplomas had been sold in London and Berlin that 
were fac-similes of those issued by some leading allopathic, 
and one or two Eclectic colleges in this country, both in 
parchment and in signatures. 
A prominent physician of New Haven, a graduate of a 
New York college, was informed by a friend in London that 
American diplomas could be purchased there, and that an 
agency was advertised by a “Doctor (?) E. A. Sturman, No. 
145 Packington street, London, N. ” He was incredulous and 
called to see him, when the man stated to him that he could 
procure him a diploma from almost any college in America for 
a consideration. 
Last year I was shown what purported to be a diploma of 
one of our colleges, that a government official at Berlin had 
sent to a commissioner in New York, for the purpose of ascer- 23 
tabling whether it was genuine. It contained the names of 
but two physicians who had ever been connected with the col- 
lege, and the signatures bore not the slightest resemblance to 
their handwriting. The other names appended to the diploma 
were those of physicians who had never been connected with 
the college, and two notorious New York politicians who were 
not physicians. What purported to be the seal of the college 
was an impression made by a trade dollar. After a thorough 
investigation the commissioner returned it to the authorities 
at Berlin, with the indorsement that it was a forgery through- 
out. 
The investigation into the sale of American diplomas abroad, 
commenced by our representative at Berlin, ought to be pros- 
ecuted, and steps taken by our government to put a stop to 
this disgraceful traffic. 
All of our State societies that have held their annual meet- 
ings have taken action in this matter in the right direction, 
and I trust that all will support the National Association in 
its efforts to aid the Commissioner of Education in his endeav- 
ors to put an end to the traffic, which is a stain on the whole 
medical profession of the United States. 
Papers on a great variety of topics will be presented to the 
Association during the next three days. The special reports 
will embrace synopses of progress in every department of 
medicine, by physicians who are recognized as experts in the 
branches assigned them, and will be not only interesting and 
instructive now, but valuable for future reference when pub- 
lished in our Transactions. The subjects selected for addresses 
are of vital importance to the profession and the community, 
and are designated for general discussion by the Association. 
All members are desired to give a concise statement of their 
views on these subjects, and any new and valuable informa- 
tion in relation to them in their possession. The essays em- 
brace many important medical and surgical topics, although, 
like the addresses largely devoted to Preventive Medicine. 
The study of sanitary medicine for twenty-five years, with 
PREVENTIVE MEDICINE. 24 
observation in private practice, and in hospitals and asylums 
in all parts of this country and portions of the continent, has 
impressed me profoundly with the importance of the subject. 
Although not desiring other important questions to be su- 
perseded, the attention of the Association is earnestly request- 
ed for the topics to be presented connected with preventive 
medicine—mental and physical hygiene in the broadest sense. 
The subject is not new to this Association, as our school of 
medicine has always devoted much attention to it, but its im- 
portance cannot be over-estimated, or its claims upon us too 
strongly urged; and I trust that all our colleges will soon 
make Public Hygiene a part of their curriculum, so that all 
our graduates shall enter the profession with as thorough 
knowledge on this subject as it is possible to obtain. 
Hygiene is of very ancient origin. The Hermetic books, the 
Vedas, the Zend-Avesta, the Jewish and Babylonian Talmuds, 
the Bible, the writings of Confucius, and the Koran, all con- 
tain valuable hygienic, as well as moral, maxims. 
The Chaldean Magus, the Indian Brahmin, the Egyptian 
priest, Moses and Mohamed, could exact compliance wi th 
their hygienic and sanitary precepts, because they united 
spiritual and temporal authority. Many of the maxims in the 
Hermetic books, the Vedas, and Zend-Avesta, are repeated 
in the Bible and Koran. Moses summed up the esoteric 
knowledge of the Egyptian priests in the sanitary and hygien- 
ic laws he framed for the children of Israel, the influences of 
which are still to be seen in the vital statistics of the Jews. 
Mohamed asserts that “The practice of religion is founded on 
cleanliness, which is one-half the faith and the key of prayer.” 
The writings of Hippocrates abound with sanitary and hy- 
gienic maxims and precepts on public health, and contains 
sound advice on even such matters as the selection of locali- 
ties for cities and dwellings. His writings evince a wonderful 
sagacity and almost intuitive wisdom in the knowledge of the 
nature and seat of diseases, and he made vast accessions to 
medicine, establishing it as a science founded upon observa- 
tions and rational deduction. Many of his sanitary precepts, 
and observations on meteorology and climatic influences, are 25 
accepted with little change at the present day. The writ- 
ings of Oelsns are largely devoted to hygiene, and frequent 
reference is made to this topic in the writings of all the great 
medical teachers in the early history of medicine. The sixth 
(folio) volume of Galen (edition of Ohartier) is devoted en- 
tirely to the preservation of the health. But the individual 
contributions of these writers to sanitary medicine was com- 
paratively small, and many of their maxims were the out- 
growth of centuries of observation and experience. 
There were physicians in the early history of medicine, as 
there are at the present day, who assumed that the medical 
profession was constituted to cure and not to prevent disease. 
As such men ignore tin* claim of preventive medicine, and only 
aim at giving medicine during a disease, the community are 
justified in looking on them as simply the administrators of 
drugs. But fortunately for the honor of the profession there 
have been physicians from the earliest existence of medicine 
as a science to the present time, who recognized a higher 
duty pertaining to it than the administration of drugs, and 
considered the prevention of disease as one of the highest and 
noblest of their duties. 
In former times there was no scientific study of the laws of 
disease as they affect large masses of men, and there was 
some excuse for physicians confining themselves to the cure 
of disease; but there is no excuse for any practitioners of the 
present day pursuing such a course. The last thirty years 
have brought vast accessions to the knowledge of the laws of 
health and disease, and immense progress is being made 
every year in this direction. The mode and means by which 
various infections are propagated, the conditions which favor 
their diffusion, and the best methods for arresting their spread, 
have been carefully investigated by physicians in every part of 
the world, and followed by a success that often surprised the 
most sanguine sanitarians. With rare exceptions, infectious 
diseases can be prevented from assuming the proportions of 
an epidemic. It seems but a few years ago that the commu- 
nity, and even many physicians, ridiculed the assertion that 
small-pox could be “stamped out,” in any city or town where 26 
it appeared. To-day there is not a physician in the country 
who does not believe it possible. The same is true of typhoid 
fever, diphtheria and all infectious diseases, and the power to 
discern and extinguish infectious foci, and defend the com- 
munity from the insidious approaches of the causes of such 
diseases, is in the hands of physicians everywhere, if author- 
ized by municipalities to use it. But the time to “ stamp 
out ” infectious diseases is when they first appear, not when, 
after weeks of criminal neglect, they have assumed the pro- 
portions of an epidemic; although even then they can be sup- 
pressed, but not until after much needless suffering and great 
loss of life. In every municipality there should be a board of 
health authorized to fulfill this important duty. They should 
not be composed of political favorites, needy recipients of 
public assistance, or professional men only capable of carry- 
ing out existing police regulations, as is sometimes the case, 
but they should be men who have shown that they bear the 
real welfare of the community at heart, and are possessed of 
the necessary foresight, judgment, and accurate scientific 
knowledge to enable them to meet any emergency that may 
arise in the district under their control. Koutine methods 
are as unsuccessful in sanitary medicine as in general prac- 
tice, and as typhoid fever, diphtheria, cholera, etc., extend 
their ravages through wholly different media and assume a 
variety of forms in various sections of the country—each 
outbreak having its peculiar mode of propagation—peculiar 
methods must be adopted to meet, control, and stamp them 
out. 
Your special consideration is requested for the addresses 
and essays on such subjects as defective drainage as a cause 
of disease; disposal of sewage; sewer-gas poisoning ; water 
supply of towns; impure water as a cause of disease; drain- 
age of rural dwellings; building ground in its relation to 
health; the nature and consequences of malarial poisoning; 
zymotic diseases; public and school hygiene; influence of 
inebriety on vital and criminal statistics; political economy 
of health ; the effects of poverty on the vital statistics of the 
United States; the homes of the poor in our cities; infant 27 
mortality; impure milk as a source of disease; the adultera- 
tion and impurities of food; physiological and hygienic in- 
struction of patient; ventilation; influence of civilization on 
the duration of human life; suppression of syphilis; impor- 
tance of sanitary legislation, and some others indirectly con- 
nected with sanitary medicine.- 
Among the writers are practitioners who have served for 
several years as city and dispensary physicians, and others 
who have accomplished much good as members of boards of 
health, sanitary commissions, school boards, and directors of 
dispensaries, hospitals and various public institutions, and 
have a practical knowledge of the subjects assigned them. 
But it is not essential that all physicians should occupy 
such positions, or be experts in sanitary science, in order to 
understand and reduce it to practice, although in it, as in 
other branches of medicine, special study develops superior 
skill. 
On every board of health there should be, if possible, a 
sanitary engineer, or some expert in sanitary science; but 
with the knowledge of the auxiliary sciences now acquired in 
a preliminary education, there are few well-educated physi- 
cians but what are capable of becoming competent health 
officers, and all ought to be able to comprehend and practice 
sanitary medicine. There are in our ranks many ripe scholars 
and skillful physicians, who have been educated in this country 
and abroad, and there are thousands who have as thorough 
theoretical and practical knowledge of their profession as can 
be obtained in this country, and who are well qualified by 
their solid scientific acquirements and common sense to ac- 
complish inestimable good in advancing sanitary medicine. 
Of its vital importance I need not speak. Every physician 
present knows the incalculable amount of suffering and death 
which is produced by the prevalence of diseases which might 
be prevented by observance of sanitary and hygienic laws. 
The venerable Professor Gross asserts “ that millions of people 
die every year from preventable diseases, due for the most part to 
man's ignorance or man's criminal neglect." 
Professor Kedzie says: “ Preventive medicine is now press- 28 
ing its claims with an emphasis never before heard. The race 
demands of the profession not only to repair the ravages of 
disease, but to save them from its power. Follow the phal- 
anx of human life as it marches on, and see how fast its ranks 
are depleted by deserters, till we arrive at three-score years, 
only to find a body-guard left. Admit that there are fixed cli- 
matic conditions unfavorable to long life ; that accident and 
unavoidable conditions destroy a certain per cent.; pass over 
all the victims whom human foresight and prudence could not 
save, and what a fearful host still remains, cut off in their vigor 
and prime by preventable causes. See consumption like the 
hovering wings of the angel of death overshadowing the race ; 
cholera and yellow fever sweeping over the land and sowing 
the earth thick with graves; intemperance sending body and 
soul to the demon’s hell; typhus and typhoid gathering the 
sheaves of the harvest of death; consider these and a score 
beside, and then tell me if there is no work to be done in the 
fields of preventive medicine. 4 Lift up your eyes and look on 
the fields, for they are white already to harvest.’ The old 
superstitions which connected unusual sickness with the wrath 
of offended Deity have faded in the light of science. The black 
death, cholera, typhus, scurvy, etc., are as truly the penalties 
of violated sanitary laws as is death by submersion in water. 
As science sheds more fully its light upon these dark and per- 
plexing questions we see more and more clearly that sickness 
and pain are the fruits of our own misdoings. The ‘ myste- 
rious providences ’ about which we have heard so much are 
resolving themselves into 4 defective drainage,’ 4 sewage con- 
tainiuation,’ ‘unwholesome food,’ 4 poisoned walls,’ 4 no ven- 
tilation, ’ etc. The school-rooms, the lecture halls, the court 
rooms, the temples of religion, the halls of legislation, the hos- 
pitals, the prisons, and even our secret bed-chambers, are full 
of subtile poison. Go into our cities and villages and see the 
festering graveyards pouring their literally deadly contents 
into every well in the vicinity; the cess-pools pouring rectified 
death through all the subsoil. An epidemic of dysentery or 
typhoid fever sweeps over the afflicted community, and men 
bow themselves before 4 the mysterious providence,’ and roll 29 
up their eyes as though they were objects worthy of deepest 
pity. Away with the impiety which would bout our tilth in 
the face of Deity, and say that these afflictions come from 
His hand. The voice of God thunders as of old: ‘Wash you, 
and be ye clean,’ if you expect His favor—clean in your per- 
son, and homes, the food you eat, the wateryou drink and the 
air you breath; clean in thought and in life. ” 
DUTIES OF PHYSICIANS. 
The writers on rhe subjects to which I have called attention 
will describe the hidden sources of disease and death that sur- 
round us on every side, and will doubtless give much valuable 
practical information as to the best methods of preventing 
much unnessary loss of health and destruction of life. There 
is not one of our Association but who can do something in 
this work; there is the same necessity for its prosecution in 
the country as in the city. The evils described exist every- 
where; and in every house to which physicians are called, in 
cities, villages, or hamlets, it is as much a part of their duty 
to investigate the causes of preventable diseases, and take 
measures for their prevention, as to examine and prescribe for 
their patients. 
In some of our cities physicians are compelled to notify the 
boards of health of any cases of small-pox, scarlet fever, diph- 
theria, typhoid fever, etc., that are under their care, and, 
although not held responsible for the sanitary condition of 
the places in which their patients reside, they are expected 
to understand the approved methods of proceeding in such 
cases. Some physicians who comply with the requirements 
of boards of health in the cases they are called to attend, do 
not attempt to remove sources of disease that come to their 
notice accidentally, where they are not called upon profes- 
sionally. They assert that such matters are no more their 
business than that of any citizen. The notification of the 
board of health or other proper authority, of any city or town, 
of all sources of disease that come to their notice, is certainly 
an imperative moral obligation on all citizens, and all should 30 
be legally obliged to perform this duty. But this duty de- 
volves especially upon physicians from the nature of their 
education and profession, and they who neglect or ignore it 
commit a crime. If an accident occurs in the street or high- 
way, and any physician stands silent in the crowd or rides by 
on his professional rounds without stopping, when his services 
might lessen suffering or save a single life, he would be de- 
nounced as inhuman, if not morally guilty of manslaughter. 
Non-professional citizens who are present are not expected to 
do anything except such little service as experience or common 
sense enables them to perform; but every one expects the 
physician to exercise his best professional skill, whether he is 
called upon or not, because his position has qualified him for 
that service. The medical profession are the guardians and 
conservators of the health of the community, and whenever 
they neglect or ignore any opportunity to prevent the germa- 
nation or spread of disease, they commit a much greater 
crime than when they leave a victim of an accident to suffer 
or die. In the latter case only one life is involved, in the 
former the health and lives of hundreds, and sometimes thou- 
sands, are endangered. 
Another duty that devolves upon us is not only to give our 
patieuts sufficient knowledge of physiology and hygiene to en- 
able them to take proper care of themselves, but also to awake 
a consciousness in them of the necessity of sanitary measures. 
Communities are generally apathetic toward general causes 
of disease, except so far as they are personallj' concerned, and 
they need to be taught that private and public health are in- 
separable, in order to make them submit willingly to what- 
ever sanitary laws may be enacted for their benefit. Our 
people make the laws, and we must endeavor to educate the 
public mind to the necessity for sanitary measures before they 
cau be enacted and sustained. That this is practicable is 
evident from the readiness with which the people have com- 
plied with the ordinances in some of our large cities in rela- 
tion to various infectious diseases, and restrictions on tene- 
ment-houses, drainage, plumbing, etc., for the prevention of 
disease, when, a few years ago, they complained of their rights 31 
as citizens being infringed, on the passage of ordinances to 
prevent the spread of small-pox. They understand now that 
sewer-gas, bad drainage, crowded and filthy tenement-houses, 
and other like causes, propagate disease, and are as dangerous 
to health and life as infectious diseases, and are willing to 
sustain the ordinances issued to remedy these evils with the 
same alacrity that large communities have submitted to quar- 
antine regulations during the prevalence of cholera and 
yellow fever. 
We must persevere in our work of enlightening the com- 
munity, and show them that there is more danger to health 
and life from infectious diseases that are always lurking in 
their midst, and from bad drainage, sewer-gas, poor ventila- 
tion, etc., than from cholera and yellow fever epidemics, and 
that these can be prevented by sanitary measures. 
The people can be educated until they will demand laws to 
protect their health and life from the danger of preventable 
diseases as they now7 demand protection from outlaws. The 
State makes municipalities responsible for damage to health, 
life and property, from defective streets or highways; and it 
ought to make them responsible for all suffering, sickness, and 
deaths, caused by pestilential emanations from filthy streets 
and alleys; badly-constructed sewers, whose stagnant accu- 
mulations of corruption exhale poisonous gases from every 
street-opening and house-connection; crowded tenement- 
houses, reeking with corruption, and from intemperance, 
prostitution, and every source of preventable diseases. 
The State enacts and enforces prohibitory law7s regulating 
places for the sale of liquors, requiring all persons purchasing 
to register their names aud residences. It has the same right 
to regulate houses of prostitution, and require men aud women 
who frequent them to be registered, and submit to certain 
restrictions when they become diseased. Intemperance is a 
great evil, but syphilis is a greater source of suffering, disease 
and death in every community, and every effort should be 
made to suppress it, as well as intemperance. 
The protection of life and health is one of the most sacred 32 
functions of the law, and we should demand of the State such 
sanitary enactments as will best accomplish this result. 
In pursuing this work of sanitary reform, it is not expected 
that physicians will devote themselves to it to the exclusion 
of all other business, or that any one physician can fulfill all 
the duties here mentioned. But every practitioner can do 
something every day, during his rounds in city or country, to 
advance sanitary medicine, and benefit the community in 
which he lives. This work does not preclude physicians from 
acquiring a competency, but it demands some sacrifice of time 
and money. This sacrifice we should all be willing to make, 
instead of devoting all our energies to the acquirement of 
wealth, and living only for ourselves. 
The imperfect outline I have given of what I consider 
should be the qualifications and duties of the members of 
this body, and of all physicians, is no mere ideal. There are 
thousands of just such conscientious, earnest, studious, and 
practical physicians, throughout this country. They may not 
achieve eminence, but they will have the consciousness of 
having performed their duty. Few, even of our best physicians, 
ever acquire more than a local reputation, as their duties and 
labors seldom give them the notoriety or prominence that 
attaches to men of some other professions; but everywhere the 
faithful physician is respected and esteemed, and none stand 
higher in the community. 
Of the work I have pointed out for our Association, much 
can be accomplished by those in middle life, and some by the 
aged; but the work of the future, and some of the present, 
will devolve largely upon the younger members of the profes- 
sion. 
If any feel that these duties and responsibilities are too 
arduous, remember that the practice of medicine involves all 
these, and more, and you assumed them in choosing your pro- 
fession. Noblesse oblige. 
If the demand upon your time and services seems great or 
difficult, then use your best endeavor to perform each day the 
duty lying nearest you. 33 
If life seems too short to accomplish the work assigned you, 
he assured that the longest life is short, if we live only to 
ourselves, and that the shortest life is long, if passed in labor- 
ing for the good of humanity. 
'* We live in deeds, not years ; in thoughts, not breath ; 
In feelings, not in figures on the dial. 
We should count time by heart-throbs, when they beat 
For God, for man, for duty. He most lives 
Who thinks most, feels the noblest, acts the best. 
Life is but a means unto an end—that end, 
Beginning, mean, and end to all things—God. ”