THE OBJECTS AND FUNCTIONS OF A -> COUNTY MEDICAL SOCIETY. Being the President's Address Delivered Before the Albany County Medical Society October, 1892. By Jtepry fiup, /!}. D. The Objects and Functions of a County Medical Society: BEING THE PRESIDENT'S ADDRESS DELIVERED BEFORE THE ALBANY COUNTY MEDICAL SOCIETY OCTOBER, 1892, BY HENRY HUN, M. I). It is certainly more appropriate to select as the subject of the "President's address" some topic directly related to the working of the society rather than one of. scientific or practi- cal medicine which can be better presented and discussed at an intervening meeting. In the light of the history of this society during the ten years that I have been a member of it, no subject seems to me so timely as a brief statement of the " Objects and Functions of a County Medical Society " in gen- eral and of this society in especial, and of the benefits to be derived from participation in its meetings. Were it not that a majority of the members are habitually absent from the meetings, it would hardly seem necessary to state to medical men the advantages which they might, but do not, obtain from their membership in a medical society. Whenever a number of men find themselves partially separa- ted from the rest of mankind by reason of their all doing the same kind of work, they, without much delay, certainly of late years, form themselves into a society whose membership shall include these special workers and exclude all others. Men engaged in manual labor have their trade unions and labor organizations, the clergy have their clerical clubs, the lawyers have their bar associations, and the doctors have their medi- cal societies which are so numerous that their very number implies how needful and desirable they are. We have only to remember the " guilds " in the middle ages and the "labor organizations" in recent times, to realize what great power such bodies may wield. 2 There are two great objects to which the power that such a society possesses is directed: ist. The protection of its members from injury and in- justice, under which may be included a constant struggle to obtain higher wages, and, 2d. The improvement of its members in the theory and practice of their profession or craft. These two objects of their existence assume a relatively very different importance in different societies. Sometimes the whole aim of an association is to secure for its members better pay for their work, which usually involves the attempt to secure the same pay for the services of each member with- out regard to his knowledge or ability. Thus it has often been attempted by medical societies to establish a uniform tariff of charges, assuming that the training and the ability of each member were exactly the same, and by means of a "black list" to compel patients to pay their doctor's bills. Both these things were done by this society in 1849 3, but were soon abandoned as impracticable. Societies, whether medical or otherwise, which exist only to accomplish this first object and seek only to obtain pecuniary advantage for their members, probably do more harm than good. On the other hand, societies the main object of which is the improvement of their members in the knowledge of their profession or life's work, can hardly fail to do good and can certainly do no great harm. Such is the object of the great majority of medical societies, and their very number shows how essential they are to the medical profession. Indeed it is hard to overestimate the value to its members of a properly conducted medical society. The art of the practice of medi- cine and the sciences on which it rests are changing so rap- idly that not even the best educated physician can rest con- tent throughout his life with the knowledge obtained in his medical school and can cease to study after graduation. Every physician admits this and subscribes to one or more medical journals and reads a new medical book occasionally. If he does merely this he need not hope to keep abreast of 3 the times but will soon fall hopelessly behind. Indeed, all will admit that besides the reading of medical journals, a physician must carefully study his own cases. The mere " reading up in a desultory manner some special form of dis- ease, even in connection with a case then under observation, although admirable as far as it goes, yields a knowledge which is usually in great part soon forgotten. By far the most satisfactory method of acquiring a knowledge of any dis- ease is to prepare on it a paper based on wide reading and on one or more cases of the disease that have been under careful personal observation. Anyone who does this faithfully can- not fail to be surprised by how little he knew of the subject at the outset and by how much knowledge he acquires during the course of his investigations. Moreover such a paper being a condensation of much reading and thought, cannot fail to be of value to the auditors if they try to make it so. As an incentive to the preparation of such papers an active medical society is of great value and cannot be fully replaced by a medical journal. Again the reading of medical journals often leads to very erroneous conclusions. An enthusiast hastens to publish a few ill considered observations and as the result of them strongly urges the employment of some drug or some mode of proced- ure more or less new. I think that I am safe in saying that the greater part of the space in our medical journals is filled with just such ill considered observations which will not stand the test of ten years' time, while the number of new drugs and of new combinations of drugs recommended each year is enor- mous. With the best will in the world one man's lifetime would not suffice to satisfactorily test a small fraction of them. But, as chance will have it, one man will be led to try one new drug, another another; so that a discussion in the so- ciety on the merits of some new drug will often save the members an expenditure of much time. Nowhere can one so easily and quickly form an opinion as to the merits of the constant additions to the pharmacopoeia as in a properly conducted medical society. 4 Finally, as a means of bringing about and maintaining a good feeling towards, and a correet estimate of the ability of other practitioners, a medical society may serve a very useful purpose. We all not infrequently hear from patients' very distorted accounts of the sayings and doings of other practi- tioners and we often see cases in an advanced stage of a dis- ease when diagnosis is really very easy that we think should have been recognized by other physicians earlier, and finally we sometimes hear criticisms of ourselves put in the mouths of physicians who either never said them or said them in an entirely different spirit from that in which they are reported. From these causes there is gradually built up in us on very uncertain foundations a distrust of and contempt for many of our fellow practitioners. If in a medical society we hear one of these same physicians read a paper we can form a truer estimate of his ability and if in the course of a discussion he opens our eyes to an error, in which we believed, our con- tempt for him disappears. Doctors cannot set themselves right with each other by free and open discussion, as lawyers do in court, or clergymen in the pulpit, or literary men in print. The nearest approach which they can have to such a discussion before a wide tribunal is in a medical society, and surely if it were only for the promotion of good fellowship among doctors, a medical society would be worthy of cordial support. Of course it is undoubtedly true that after a hard day's work it is more comfortable to remain at home or give one- self up to enjoyment rather than prepare a paper for or attend a meeting of the society. A busy practitioner in full practice may think himself excusable if he does nothing else but at- tend to his practice and gives up the study of scientific medi- cine. But he cannot very well do this. If he attempts it he will steadily become a less and less competent physician, he will find that his practice is dwindling and that his patients are going to other and better informed physicians. As a matter of fact we do not find in any community that the doc- tors with the largest practice are those that conspicuously 5 neglect attendance on medical societies. Certainly we younger members who are not excessively driven by a large practice have no excuse for neglecting the society and follow- ing a course which will never lead to any real success in our profession. I would strongly urge the younger members to make such contributions as they can and not be in the least deterred by the fear that these contributions may not prove of interest to the other members. If they will do so I can assure them even out of my own very limited experience that they will be rewarded for their labor a thousandfold. It is the easiest, and I believe the only way, to attain real and last- ing success in our profession. Thus far I have considered the uses and advantages of medical societies in general. The same remarks apply to county and state medical societies with this one exception, that these societies stand in a certain sense as representative bodies of the medical profession and hence office in them be- comes, of value for advertising and other purposes. Many physicians, who are more anxious to have than to deserve honor and who can find no other path to eminence, desire be- fore they die to become president of their county society. To accomplish this they resort to all methods of political intrigue. In consequence of this we occasionally see elected to the presi- dency men who have begged the favor of a vote from every- one's hand, who have no interest in the society beyond their own election, and who are not sufficiently in touch with medical work and medical thought to guide the society into any profitable line of work. Naturally under such manage- ment the society deteriorates and holds only a few irregular, uninteresting meetings. But even in spite of incompetent officers the society would thrive if the members were inter- ested in its success, and I beg you all to-night, for your own sakes as well as for that of the society, to devote your best en- ergies to its meetings during the coming year. During the past year seventeen meetings have been held, at which twenty-four papers were read and thirty-eight short summaries of topics to open discussions were prepared. These 6 papers and discussions I think I can honestly say were practi- cal and good. Of the attendance at all the meetings, except the first three, the less that is said the better. Twice we have been called together to mourn the death of a member. First for Dr. Steenberg, a man ripe in years and in the honors and rewards of a long and useful professional life. Then for Dr. Fleischman, whose brilliant mind and untiring industry gave promise of such an eminent professional career as can only be obtained by a chosen few. Death seems doubly cruel when it steps in at the very outset of such a professional life and prevents the fulfillment of such bright and well founded hopes. It has been the custom of the retiring president to make some suggestion to the society, based on his year's experience in office. In conformity with this custom I would suggest an amendment to our By-laws to the effect that no one shall be eligible for election as delegate to the State Medical Society who has not previously read three papers before this county society. This would be a strong inducement for our members to take part in the proceedings of this society and would re- sult in our sending to the state society delegates who would be likely to take part in the proceedings of that society. I cannot conclude without thanking the members for their kindness in electing me president, for the courtesy with which they have treated me, and for the aid which they have given me in making the meetings attractive.