FIRST 
Pan-American 
/AEDICAL CONGRESS 
Presidential Address 
BY 
William Pepper, n.D., LL. D. 
Printed by order op the international Executive CO/a/aittee. 
SEPTEMBER 6th, 1893. AN ADDRESS 
BEFORE THE 
First Pan-American Medical Congress, 
SEPTEMBER 6th, 1893, 
IN THE CITY OF WASHINGTON, D. C., 
By the President of the Congress, 
WILLIAM PEPPER, M. D., LL. D., 
Provost and Professor of the Theory and Practice of Medicine in the 
University of Pennsylvania. 
Printed by Order of the International Executive Committee. 
PHILADELPHIA: 
ALLEN, LANE & SCOTT’S PRINTING HOUSE, 
Nos. 229-231-233 South Fifth Street. 
1893. FIRST PAN-AMERICAN MEDICAL CONGRESS. 
Address delivered by Dr. William Pepper, 
President of the Congress, 
SEPTEMBER 6th, 1893. 
Gentlemen of the First Pan-American Medical Congress: 
This occasion is an unique one, and the thoughts which 
force themselves on the minds of all of us are, I am convinced, 
so similar that the briefest greeting might well seem the most 
fitting address. But when I reflect that I stand here to repre- 
sent the original committee appointed in pursuance of the 
resolution which was adopted unanimously on May 5th, 1891, 
at the meeting of the American Medical Association, and that 
this resolution extended a cordial invitation to the medical pro- 
fession of the Western Hemisphere to assemble here in a Con- 
gress, I realize the unusual dignity of the duty I must discharge. 
If anything could add to the dignity of this assemblage, 
which for the first time asserts formally the organic union of 
the physicians of all America, it is the fact that the Congress 
of the United States, impressed with the importance of our 
proposed meeting, passed a Joint Resolution (July 18th, 1892), 
requesting the President to extend those invitations in re- 
sponse to which we welcome the presence here of official 
Delegates from all the Governments of the Western Hemis- 
phere. In like manner are the several States of our own 
Union, the principal municipalities, and many of the leading 
educational institutions, both of North and South America, 
represented officially. You will not, then, think it strange 
that, called upon to address such an assemblage in this Co- 
lumbian year, it should seem less fitting to dwell upon any 4 
technical topic than to turn our thoughts to the state of 
this continent and of its aboriginal inhabitants at the time 
of its discovery by Columbus, and to the obstacles which 
opposed him and the great men who completed his work. 
For these have had a bearing on the racial developments 
which have since occurred here, and should be held in mind 
in any estimate of the progress we have made during the 
subsequent four centuries. The state of medical science in 
Europe at the time of the Discovery, and the spirit which has 
controlled its subsequent course, are fitly to be studied in con- 
nection with what we have accomplished during the samg 
period and with the opportunities which present themselve5 
to us at this time. 
The recognition of the appropriateness and importance of 
this great meeting has been immediate and universal. Jnter; 
national although it is, the basis of its organization a'ncl the 
special features which mark it, remove all possible suspicion 
of an imitation of, or of interference with, the great Intend 
tional Congress whose successive meetings form a crespendef 
scale of scientific and administrative triumphs which thonmed- 
ical profession of the world regards with justifiable priQe. 
Our Executive Committee, and our efficient Ge,njferal Secre- 
tary to whose unselfish energy and masterly power? of organ- 
ization we owe a great debt of gratitude, studiously .avoided the 
possibility of any such interference by delaying the selection 
of a date for our meeting until that of the Congress at Rome 
was announced, and by then adopting a date which not only 
permitted but encouraged the presence later at Rome of those 
who should gather here. I can only add my deep regrets that 
the unhappy reappearance of cholera in Southern Europe— 
striking example as it is of the urgent importance of the 
very work which calls us together—has necessitated a post- 
ponement until next spring, a postponement which, however, 
there is no reason to fear will lessen the complete success 
of the meeting on its newly-announced date. The Interna- 
tional Medical Congress is, indeed, a splendid demonstration 
of the solidarity of the profession and of the world-wide scope 
of the objects we pursue. 5 
This Congress represents much more, however, than our 
common interest in medical science and the common feeling 
of brotherhood which animates the entire profession. It is, 
indeed, it always has been, and forever may it so continue, the 
glory of the medical profession that their allegiance is one and 
undivided, for their service is solely in the cause of truth and 
humanity. Dynasties have risen and crumbled ; the map of 
the world has been changed times almost without number, but 
the march of medical science through the ages has been ever 
onward and upward towards those lofty goals—the preven- 
tion of disease, the relief of suffering, the improvement of the 
race. 
For us who meet here there is all of this glorious recollec- 
tion and animating purpose, and there is much more to unite 
and to inspire us. We meet under the shadow of giant concep- 
tions, as old as Aristotle, which agitated the minds of the great 
thinkers of antiquity, and were but slowly approaching a defi- 
nite form when the sublime faith and genius of Columbus 
solved the problem of the globe. 
It is true that this vast American continent, with its six- 
teen million five hundred thousand square miles of territory, 
already numbers one hundred and ten millions of inhabitants, 
embracing all types of human life, and many varieties of po- 
litical organization. But all that has yet been accomplished is 
but the feeble beginning of the development which awaits us. 
When Canning secured the recognition of the Republics of 
South America, he boasted that he had-called the New World 
into existence to redress the balance of the Old, and yet the 
luminous suggestions of Franklin, of Bolivar, and of Blaine as 
to the political and commercial relations of the countries of 
the Western Hemisphere are still only prophesies which must 
long await their fulfillment. 
The destinies of nations are slowly evolved, and occur- 
rences which fill the horizon of a generation appear to the 
broad gaze of history as mere features in the great panorama 
of the ages. 
Even a period of four hundred years is but a fraction of the 
history of Spain, of France, of England. Yet four hundred 6 
years ago this entire continent was not only undiscovered and 
unknown, but its very existence was unsuspected save in the 
ingenious speculation of philosophers. We recall the familiar 
but ever interesting lines of Seneca:— 
Venient annis saecula seris 
Quibus Oceanus vincula rerum 
Laxet, et ingens pateat tellus, 
Tiphys que novos detegat orbes 
Nec sit terris ultima Thule— 
and do not marvel that their strain of glowing conviction 
should have led Columbus to write them out twice over in his 
“ Profecias.” But all the same, this New World lay shrouded 
in the obscurity of the great Sea of Darkness, cut off, as 
we have since learned, from the known inhabited world, by 
changes wrought in remote geologic eras, and waiting the 
fullness of time which should lead the inspired genius of 
Christopher Columbus to seek the east by sailing west. 
We now know that in his quest of a western passage to 
Asia he reached the eastern shore of this continent on Oc- 
tober 12th, 1492, but even to the time of his death, on 
January 20th, 1506, neither did Columbus nor any voyager or 
writer have any conception of the vastness and real signifi- 
cance of his discovery. All that the geographical knowledge 
of the day enabled them to grasp was the belief that Columbus 
had found a new route to the Indies by sailing west. Within 
a few years, however, the daring sailors of Spain and Portu- 
gal, of Italy and of England, pushed their voyages along the 
coasts. The astonishing discoveries of Americus Vespucius 
on his celebrated third voyage in 1501-02, when between 
Lisbon and the Island of South Georgia he traversed an arc 
of ninety-three degrees, led him to apply for the first time to 
this continent (it really was South America of which he 
spoke) the title of New World (Mundus Novus). It concerns 
us not to consider further how, by no intent or design of 
Vespucius, portions of South America at first, and later the 
entire continent, came after his death to be named after him. 
Yet when a few days ago I held in my hands the little quarto 
published in 1507, in which Professor Martin Waldseemiiller, 7 
of the College of Saint Die in Lorraine, first suggests the 
name America, in utter ignorance that the coast explored by 
Vespucius was continuous with or even related to the land 
discovered by Columbus, I could not help smiling sadly at 
the frantic and fruitless efforts we make to secure immortality 
by our petty observations, while here Fame, in strange whim- 
sey, threw her laurels for the greatest discovery ever made 
around the head of one who neither had nor preferred a 
claim to it. 
Geology and paleontology have taught us that this so- 
called New World is in reality, in a scientific sense, better 
entitled to the name of the Old World. The oldest known 
strata have their widest development on its surface, and ani- 
mals, such as the horse, which are said to have been intro- 
duced after 1492, are shown to have had their original habitat 
here and to have migrated hence to Europe, so that Cortes 
and Pizarro only reintroduced them to their former home. 
It is more important to recall the fact that the entire stretch 
of North and South America was, at that date, 1492, peopled 
more or less thickly with the descendants of tribes who had 
resided here from very remote antiquity. A high authority 
assures us that the number of these aborigines was probably 
from twelve to fifteen millions, and in spite of considerable dif- 
ferences in physical appearance, as between the Iroquois of 
New York and the Aztecs of Mexico or the Incas of Peru in 
dialect and habits, it is generally conceded that this vast 
aboriginal population, of North America and South America 
alike, with the exception of the Eskimos, belonged to one 
great race of Red Men.* 
In regard to the Eskimos, the polysynthetic or incorpora- 
tive character of their system of word-building, in which they 
* It is evident that the word race is used here in its broad ethnical 
sense. The English, the French, and the Greeks are different branches 
of one race from this point of view. No doubt, as John Fiske observes, 
“the Mexicans encountered by Cortes differed from the Iroquois en- 
countered by Champlain as much as an Englishman differs from an 
Albanian or a Montenegrin,” but when we are contrasting aboriginal 
Americans with white men or yellow men, it is right to say that Mexi- 
cans and Iroquois belong to the same great red race. 8 
resemble the other aborigines of this continent, does not 
seem sufficient to counterbalance the marked dissimilarity in 
physical characteristics, and, still more, the strong chain of 
evidence which goes to identify them with the extinct Cave 
men of Western Europe. Professor Dawkins (“ Early Man in 
Britain ”) has especially developed this important argument. 
So striking is the resemblance of recent Eskimo remains to 
those in the Pleistocene caves of France and England, that 
they are pronounced by competent authorities to be indis- 
tinguishable. The extraordinary talent of the Eskimos for 
the artistic sketching of men and beasts is unique among 
savage peoples, with the single exception that among the 
remains of the European Cave Men many sketches, showing 
a similar talent, have been found. The musk-sheep, which were 
the inseparable attendants of the Cave Men, no longer exist 
save in subarctic America among the Eskimos, but the fossil- 
ized bones of these animals “ lie in a regular trail across the 
Eastern Hemisphere, from the Pyrenees through Germany 
and Russia and all the vast length of Siberia.” 
Eskimos and Red Men alike seem to have migrated to our 
continent at one time, or more probably in successive waves, in 
the remote past, either when the northwest corner of America 
was joined to Siberia by the elevation of the area now known 
as Bering Sea, or when the lofty submarine ridge which now 
passes from France to Greenland was elevated so that it would 
be possible to travel on foot from Europe to America. If the 
attempt be made to decide at what period of geologic time 
such immigration occurred, and whether in one great migra- 
tion, or, as seems most probable, in successive waves, problems 
of extreme if not insurmountable difficulty present them- 
selves. 
The aborigines who were living on this continent at the time 
of its discovery by Columbus presented, it is true, consider- 
able differences in the stage of development they had reached,, 
as well as in their language and even in their appearance. 
There are long intervals of social development evident be- 
tween the squalid sty of the California savage, the long-house 
of the Iroquois, and the great structures of Zuni, of Tlascala, 9 
or of Uxmal. Yet in them all can be demonstrated an un- 
derlying principle of adaptation to a certain mode of com- 
munal life such as all American aborigines are believed to 
have practiced. All attempts to distinguish the existence of 
special races, as of the mound-builders, have broken down 
in the light of critical study, and the powerful arguments 
of philology confirm the results of zoological study as to 
the essential unity of the American red race. The tribes 
in different parts of this vast territory certainly presented 
marked differences in physical appearance, and our ethno- 
logical collections show that as regards size and weight of 
frame and shape of skull considerable variety existed among 
them. But all possessed the cinnamon-colored or copper- 
colored complexion, the high cheek bones and small, deep-set 
eyes, the straight, black hair, with scanty or absent beard; 
and the conclusion of the most competent authorities is that 
no sufficient differences, physical, linguistic, or social, existed 
to invalidate the evidence in favor of the unity of the race. 
Fortunately we are not called on to attempt to read the 
geological record. For our purpose it is indifferent whether 
all the relics of the ancient Americans are of the neolithic type, 
or whether the apparently plausible claim be ultimately estab- 
lished that paleolithic remains are also found in various 
places. This at least we know, that the soil and climate had 
shown themselves favorable to the development of a popula- 
tion already numerous, vigorous, hardy, and enduring, and 
brave and warlike, though often cruel, and evidently advancing 
in social development, though at very different rates at differ- 
ent localities. Ignorant as we are of their primitive origin, 
it is doubtful if the most earnest advocate of the monogenist* 
view that all mankind was originally descended from one pair, 
will urge that our aborigines were descended from a single 
couple, or even from a few boat-loads of Asiatics accidentally 
*As is well known, the tendencies of natural science are strongly 
towards this view. Philologists seem disposed to agree that on account 
of the mutability of language, especially when unwritten and while in its 
earlier stages, no conclusion adverse to the monogenist doctrine can be 
drawn from the diversities of speech now existing, or that are known 
to have existed at any past time. carried to our Pacific Coast, or that we shall hear again 
the arguments drawn from the many striking resemblances 
between the myths, languages, customs, or hand-wrought 
objects of the aboriginal Americans and of various Oriental 
nations. The surprise which, I am sure, all of us have experi- 
enced at these resemblances must be checked by these two 
thoughts so well expressed by Fiske and by Lubbock 
respectively, that one of the most important lessons impressed 
on us by a long study of comparative mythology is that 
human minds in different parts of the world, but under the 
influence of similar circumstances, develop similar ideas and 
clothe them in similar forms of expression ; and again, that 
different races in similar stages of development often present 
more features of resemblance to one another than the same 
race does to itself in different stages of its history. 
An immense amount of sympathy has been expended upon 
the cruel treatment of the American aborigines by the Euro- 
pean invaders. Of course, it was the sad old story, so often 
repeated, whenever a better armed and more highly civilized 
power has come into conflict with a primitive, ignorant, and 
ill-armed people. Over the ghastly picture of Indian slavery 
one would indeed wish to draw a veil, though its darkest 
shadows are relieved by the splendor of the character and 
labors of the illustrious Las Casas, and by the enlightened 
action of those great men, Emperor Charles V., Pope Paul III., 
and Cardinal Ximenes. But it is a romantic extravagance 
to deplore the destruction of any system of government or 
society which existed in 1492 in any part of the continent.* 
* It may not be amiss to give here a brief abstract of the ingenious 
method suggested by the late Lewis Morgan, of Rochester, N. Y., for 
gauging the real status of primitive peoples in an ethnical scale. It is 
obvious that any such scheme will be open to criticism, and it is not 
surprising that archaeologists are divided as to the merits of this particular 
plan. 
The ethnic stages, according to Morgan, are savagery, barbarism, and 
civilization, and in each of the lower two stages there are three subor- 
dinate periods. 
The distinction between savagery and barbarism is marked by the 
point where the manufacture of pottery is begun. In the lower status of 
savagery men lived in their original restricted habitat and subsisted on 11 
If the present state of the native Indian population in North 
and South America is far from satisfactory, and fails to fulfill 
the promise shown, especially in South America during the 
first century after the conquest, may this not fairly be attributed 
to unwise legislation by the ruling nations, to the absence of 
continued, effective religious instruction, and to the base 
cupidity which has led us to promote the fatal passion for 
stimulants, so common among barbarous people ? There seems 
no sufficient evidence to make us lose hope that the remains 
of the aboriginal Americans may, under more wise and equit- 
able treatment, gradually develop into useful citizens of our 
republics, and be capable of wholesome assimilation with the 
body of the population. 
It is easy to assert and hard to disprove that the develop- 
ment of the Red race on this continent was progressing slowly 
prior to 1492. As a matter of fact, we do not possess the 
fruit and nuts. Articulate speech may be supposed to have begun in this 
status. All existing races of men had passed beyond it at an unknown 
antiquity. 
In the middle status of savagery men had learned how to catch fish 
and to use fire. My friend Dr. Lumholtz lived many months among the 
cannibal tribes of Australia, who are in this status. The invention of the 
bow and arrow marks its close. 
The upper status of savagery, in which some of the lowest American 
tribes still continue, such as the Athabaskans, of Hudson’s Bay, and the 
Fuegians, ends, as above stated, with the invention of pottery. Such 
tribes as the above know nothing of horticulture, make no pottery, and 
depend for subsistence entirely on bread-roots, fish, and game. They 
have little or no village life. 
The lower status of barbarism exhibits the domestication of animals 
other than the dog. In 1492, except in Peru, the dog was the only animal 
domesticated by any of the aborigines. Indeed, the absence of domes- 
ticable animals is pointed out by Fiske as important among the causes 
which retarded the development of the American Indians. The horse, 
which is shown by fossil remains to have existed in six or seven species, 
had become extinct, and was reintroduced by the invaders. The regular 
employment of tillage with irrigation, and the use of adobe-brick and 
stone in architecture, marked the end of the lower status of barbarism 
in America. 
The middle status of barbarism was marked in the Eastern Hemisphere 
by the domestication of other animals than the dog, and there, as well 
as in the Western Hemisphere, by the development of irrigation in 12 
data, either about their early history or about the primitive 
condition and rate of development of any of the more civilized 
races, to permit us to institute a comparison. Our earliest 
knowledge of the ancient Egyptians, for instance, reveals 
them living in a state of civilization already advanced at least 
a full ethnical period beyond that even of the Aztecs. How 
many centuries had elapsed while the successive stages of 
savagery and barbarism were passing in Egypt can never be 
even surmised. There seems no reason to doubt that, had 
America not yet been discovered, there would have been 
going on here for the last four hundred years a slow and ir- 
regular approach to a higher social condition. There certainly 
is no doubt that during and since the conquest many sad 
mistakes, and not a few atrocious crimes, have been perpetrated 
in the name of civilization and of liberty. But, on the whole, 
the student of history is forced to admit the enormous ad- 
cultivation, and the use of brick and stone in building, by great improve- 
ment in the manufacture of stone implements, and, ultimately, by the 
introduction of implements of copper or of bronze. 
The middle status may be regarded as ending with the discovery of 
the process of smelting iron ore ; and this process becomes more and 
more important through the upper status of barbarism, and is finally 
associated with the production of written records by means of a phonetic 
alphabet or of advanced hieroglyphics. 
It is held by those who favor this classification that it renders the 
scientific comparative study of primitive peoples vastly easier than pre- 
viously. It assigns definite meanings and boundaries for the terms 
savagery and barbarism, and should dispel entirely the repugnance with 
which the latter term has often been sentimentally regarded. It is mani- 
festly impossible to determine in most cases the duration of the several 
periods above enumerated. It appears clear that certain races have 
passed through some of the periods more rapidly than others, and that, 
again, certain races have been more advanced in special points than 
would accord with the general level of their attainments by which their 
position in the ethnic scale must be determined. Among the influences 
which may have affected the more or less rapid development of races 
the following suggest themselves : The conditions of soil and climate as 
favoring or not the acquisition of ample and varied means of sustenance ; 
the existence or not of various animals suited for domestication, notably 
the horse, the sheep, and cattle ; the opportunities for contact, by migra- 
tion, commerce, or war, with races occupying a higher ethnic scale; 
inherent ethnological defects or advantages in special races. vantages which have resulted from the conquest by Europeans 
of the fifteenth and sixteenth centuries of tribes the most 
advanced of which were still in a very primitive state of 
civilization. 
I have ventured upon this rapid sketch of a familiar 
subject because it is well that we should be clear in our 
comprehension of the conditions which existed in America 
four hundred years ago, when the start was made to introduce 
the European races and civilizations. We meet here to-day 
to represent what these have accomplished in their new en- 
vironment during these four centuries in regard to certain 
highly important subjects. We cannot fail to be interested in 
considering what scientific acquisitions in these branches were 
actually brought here, what disadvantages were to be con- 
tended with, how far our progress may be regarded as satis- 
factory, what great questions there are which concern us all 
•deeply, and in what lines of research and work we may unite 
for the common good, and for the greater advancement of 
science. 
The words graven on the tomb of Ferdinand Columbus in 
the cathedral at Seville :* “ To Castille and Leon, Columbus 
gave a New World,” are indeed true, but they do not express 
the whole truth. John Fiske well says: “The discovery of 
America may be regarded in one sense as a unique event, but it 
must likewise be regarded as a long and multifarious process. 
The unique event was the crossing of the Sea of Darkness in 
1492, and no ingenuity of argument can take from Columbus 
and from Spain the glory of an achievement which has, and 
can have, no parallel in the whole career of mankind. It es- 
tablished a true and permanent contact between the eastern 
and western halves of our planet, and brought together the 
two streams of human life that had flowed in separate channels 
ever since the glacial period.” But to demonstrate the mag- 
nitude of this discovery, to determine the physical features of 
this Western Hemisphere, to plant firmly the seeds of Euro- 
pean civilization, demanded the heroic exertions of two full 
*A Castilla y d Leon 
Nuevo mundo di6 Colon. centuries. Not Spain alone, but Portugal, Italy, France, 
England, Holland, Denmark, Russia, played their part, and the 
names of Cabral and Pinzon and Magellan, of Cortes, Balboa, 
and Pizarro, of Ponce de Leon and Soto, of Champlain and 
La Salle, of Drake, Hudson, Baffin, Davis, and Bering, must 
remain associated forever with this stupendous and progressive 
work of discovery. Not until 1806 was the last step taken by 
Lewis and Clark, who then succeeded in crossing the conti- 
nent of North America from east to west, and thus completed 
the task undertaken by Champlain in 1608. And if the mere 
study of the outlines and dimensions of America occupied 
two centuries, what are we to say of the far greater obstacles 
opposed to the colonization of the vast territory, and to the 
determination and establishment of suitable forms of govern- 
ment, and of harmonious relations between the numerous 
States and countries into which America soon came to be 
divided ? 
The older political systems of Europe seem to require stills 
the assistance of considerable artificial support, and their oc- 
casional disturbances are of a decidedly unpleasant character. 
Is it strange that some of us still have our little unpleasant- 
nesses at home or with our neighbors, which indicate that the 
education of our people is as yet wofully imperfect in those- 
things that most nearly concern their welfare ? Of this, at 
least, we may be sure, that all that promotes free intercourse 
among us helps on mightily the solution of these hard prob- 
lems. It is a true saying that to know is to excuse, and,, 
more than this, in regard to nations if not strictly in regard to 
individuals, it may be added that to know is to love. We 
turn with quickened interest to the sage advice of the illus- 
trious Franklin, who, in 1749, embodied in his plan for the 
organization of the University of Pennsylvania an earnest ad- 
vocacy of the thorough teaching of the Spanish and Portu- 
guese tongues as likely to hasten the development of those 
close reciprocal relations which he foresaw would inevitably 
arise between the countries of the two Americas. The spirit 
of the age as it embodies itself in our educational systems and 
in our literature, the giant forces of steam and electricity, as they link together the most distant points of our territory, are 
working inevitably together for the enlightenment, the eleva- 
tion, the better mutual understanding, and the more cordial 
relations of all of us. 
The year whose four hundredth anniversary we now cele- 
brate found the world stirred as never before. A work of 
tremendous importance for the future of the human race had 
been going on amid the gloom of what are often called the 
Dark Ages. The more closely this period of absorbing inter- 
est is studied the more do we appreciate the magnitude and 
the necessity of the changes effected during those centuries in 
preparation for the splendid activities of the Renaissance. 
The mission of the Middle Ages had been really, though not 
obviously, a cosmopolitan one, and it was fitting that the noblest 
achievement of the Renaissance should be the discovery of 
America: The barriers between nations had been lowered, 
and there had been going on the process of blending and inter- 
penetration which was soon to be extended to this Western 
Hemisphere with such large results. The protest against 
mere dogma in religion and in philosophy; the revolt against 
usurped and abused absolutism; the demand for light and 
knowledge and the common rights of humanity, these awak- 
ened then to be stifled no more, but to swell forever in larger 
utterance until they shall, in some yet distant golden time, an- 
nounce universal liberty under equitable laws and universal 
peace through arbitration. It is not for us to taunt the glow- 
ing expectations of the men of 1492 with their long-postponed 
fulfillment. It ill becomes us of to-day to speak in other 
than tones of humility when across the brightest spots of 
the vaunted civilization of the close of the nineteenth century 
after Christ there still fall so many dark shadows lingering 
from the deep mediaeval night. 
How each generation turns aside with the restless impatience 
of children from the lessons of the past, and shuts its eyes 
to the truth which inexorable history calmly shows, that long 
periods of time are required for the accomplishment of each 
great advance in religious, or political, or social, or scientific 
truth. 16 
Yet though we smile somewhat sadly as we read the bursts 
of enthusiasm so plentiful at that time, we dare not challenge 
the fitness of that grand name, the Renaissance, to the age 
which, through its mighty discoveries and the master minds 
who used them, diffused among the nations the new concep- 
tions of the earth and the skies, of the church and the state. 
Only the pity of it that such long centuries of travail must 
ensue between this implanting of the seed of religious and 
political liberty and the mature growth for which we still 
wait. 
In no respect may the discovery of America be regarded as 
the dividing line between the Middle Ages and the Modern 
Era more truly than in regard to medical science. In spite of 
the prodigious learning of the most distinguished Arabian and 
Jewish physicians, such as Avicenna, the Prince of Physicians, 
of Albucasis, of Avenzoar, the Wise and Illustrious, of Mai- 
monides, their medical science was far too largely speculative 
and philosophic. Great universities were established, some 
of which, as those of Bagdad and of Cordova, possessed regal 
revenues and magnificent libraries. Numerous hospitals were 
founded, of which the large and wealthy one established at 
Cairo in 1283 merits special mention.* But the outcome of 
this long dominion of the Arabs and the Moors, so far as 
concerns medical science, was merely a marked advance in 
chemistry and pharmacy, the introduction of many new rem- 
edies, and the advocacy of the union of the natural sciences 
with medicine. Their chemistry was tinctured strongly with 
alchemy, their clinical teaching was elementary, their diag- 
nosis and treatment lacked the true Hippocratic force and 
directness. 
The endless speculations and metaphysical discussions of the 
schools had shown that it was not that way true progress lay. 
Unaided observation had scarcely gone further in eighteen 
hundred years than the point to which the immortal Hippo- 
*The first hospitals, in our sense of the term, were probably founded 
about 335 A. D. by Helena, the mother of Constantine, at Constanti- 
nople and Jerusalem. That at Antioch was founded in 360, and the 
famous Basilides Hospital, at Caeserea, in 373. crates had carried it. True medical science, which could not 
progress without precise methods and instruments of precision, 
was forced to wait until from very different quarters came the 
development of the natural sciences and the era of exact experi- 
mentation which alone rendered them possible. Harvey’s 
immortal discovery of the circulation of the blood was not 
announced until 1616, and his almost equally important and 
epoch-making discovery of the origin of the higher animals 
from the egg was published in 1651; yet it may be safely 
asserted that the work of this modest and truly scientific Eng- 
lishman did more to advance medicine than all the labors of 
all the schools from the days of Hippocrates. Not only were 
the facts demonstrated of infinite importance, but his method 
of patient, exact observation and experimentation until the 
truth was developed by cautious induction marks the intro- 
duction of a new era, and stamps Harvey as the father of 
modern medicine. 
Galileo first indicated the use of the thermometer in 
medicine about 1595. Sagredo, of Venice, improved it in 
1613, and Sanctorius, in 1625, urged its importance in the 
study of disease forcibly, but as yet ineffectually, and the 
last half of the present century is reached before the classic 
work of Wunderlich placed medical thermometry on an 
enduring basis of practical value. Just as the astronomer, 
Galileo, gave us the first rude thermometer, Kepler, an- 
other illustrious astronomer, gave, in 1604, the first record 
of an accurate count of the human pulse. But so slowly did 
the importance of this datum in the study of disease impress 
the medical profession that the acute Sydenham, who lived 
until 1689, nowhere mentions a single pulse count. It is hard 
to find anything which illustrates better the radical difference 
between the spirit of mediaeval and of modern medicine than 
the vast mass of obsolete literature upon the pulse, loaded 
with fanciful speculation and super-refined subtleties of descrip- 
tion, and yet wholly deficient in the only features which would 
give practical value to the study. What progress in exact 
medicine could be made without chemistry ? Yet scarce any 
development in this branch occurred between the eighth and 18 
seventeenth centuries. And it was Boyle, the father of mod- 
ern chemistry (not born until 1627—died 1691), who first 
succeeded in freeing from the trammels of alchemy this noble 
science. Not until the end of the seventeenth century did the 
value of quantitative analysis begin to be appreciated. Lastly, 
it was not until 1590 that we hear of the first compound 
microscope in the hands of Jansen. 
Meanwhile the gross superstitions, combined with a blind 
dependence on the great authorities of antiquity, and especi- 
ally on Aristotle and Galen, which had so long dominated 
medical science, yielded slowly to the growing light of posi- 
tive knowledge. Fine-spun subtleties, drawn from meta- 
physical speculation; the fantastic notions of alchemy and 
astrology; the rank growth of impostures which flourished 
in the soil of ignorance, and the bigotry which placed every 
organ under the charge of a special saint and conjoined with 
every remedy a special form of supplication, still marked 
medical teaching and medical practice. But the bold, fearless, 
investigating spirit of the sixteenth century did its work for 
medicine as it did for other great matters. Vesalius (i 5 14- 
1564) and his cotemporaries created accurate anatomy. Pare 
(1509-1590) stamped imperishably on surgery the influence 
of his genius and lofty character. Paracelsus (1493-1541) 
hurled the shafts of ridicule and invective against the grovel- 
ing subserviency to ancient authority, and did a rough but 
important stroke of work toward the emancipation of the 
medical mind. The grand old Hippocratic method of careful 
observation and cautious reasoning was reasserted, the un- 
productive philosophy of Galen and his Arabian worshipers 
was discarded, and at last there begins to emerge from the 
darkness of so many centuries modern medicine, the medi- 
cine of loyalty to Nature and revolt against mere human 
authority; of reverent skepticism and reasonable faith ; the 
medicine of scientific experimentation and of humane vivisec- 
tion, that insists upon knowing the causes of disease and that 
looks to Hygiene as its noblest expression. 
The history of European medicine for more than three 
hundred years is a record of which we may well be proud, 19 
when the enormous obstacles to progress are held in view. 
It is not necessary to remind this audience of a single one of 
its great triumphs. Vesalius and Pare, Harvey and Syden- 
ham, connect themselves with Bichat and Laennec,and Hunter 
and Jenner, and Pasteur and Lister, and Virchow and Koch, 
and the torch of genius is passed down the line of these im- 
mortals and lights up the ages with the splendor of their 
achievements. But it is sad to reflect upon what has been 
done as contrasted with what might have been. The dense 
ignorance of rulers and masses on scientific questions, the 
slow progress of sound, useful education among the people, 
the huge claims of imperialism and of militarism, the wanton 
waste of luxury, have retarded research, have left but paltry 
sums available for the diffusion of knowledge, have hindered 
the embodiment in legislation and in actuality of much that 
would help the healing of the nations. It is an odd commen- 
tary on the vaunted civilization of to-day to contrast the sums 
doled out by the most enlightened governments of Europe 
for the promotion of higher education and original research 
or for the suppression of preventable diseases, with those lav- 
ished on the vast hosts of armed men and the huge fleets of 
unwieldy armored ships deemed necessary for the mainte- 
nance of peace and order. 
Within our own day we have seen the announcement of the 
grandest generalization reached by the human mind, in this 
century at least, and advanced in the most philosophic and 
inoffensive manner, received with a burst of intellectual 
skepticism and of religious intolerance, which showed that 
the old forces against which the Renaissance protested, and 
still protests, are yet alive, though happily shorn of most of 
their power. The marvelously rapid spread of the illumin- 
ating doctrines of Darwin, and their incorporation in the 
thought and speech of the world, and in the teachings of the 
churches, may indeed be pointed to as the crowning intellect- 
ual achievement of the nineteenth century.* 
*The grave of Harvey, in Hempstead Church, bears a plate which 
gives his birth April ist, 1578; his death June 3d, 1657. His immortal 
work, “ Exercitatio Anatomica de Motu Cordis et Sanguinis,” was 20 
If the actual progress of medical science was slow in 
Europe during the years which followed that annus mirabilis, 
1492, surely no word of reproach may be uttered against the 
early settlers in North and South America, because, amidst 
their heroic efforts to conquer this vast continent, it was long 
before they found time or energy to devote to the cultivation 
of that practical and essential subject of medical science.* It 
is true that in 155 1 Charles V. founded the University of Lima, 
in Peru, and in 1553 the University of Mexico. Yet it does 
not appear that medicine was taught at these universities until 
a little prior to 1700.! 
In North America, although Harvard College was founded 
in 1636, the title of university seems to have first been applied 
to the University of Pennsylvania, which in 1765 established 
the first school of medicine in the United States. The scattered 
handfuls of early settlers on our shores had, indeed, problems 
facing them more urgent than the promotion of science. They 
differed as widely in their motives for undertaking the appalling 
task of conquering and colonizing America, and in their fit- 
ness for the work, as they did in their nationalities. Separated 
widely from the mother countries, hampered very often by 
unwise and vexatious interference from the home govern- 
ments, they waged war against the powerful tribes of aborigines 
who swarmed over the country, and against the no less serious 
obstacles of untried climatic and political conditions. Bloody 
unable to pass the censorship of the press in England, and appeared, 
in his fiftieth year, in 1628, at Frankfort-on-the-Main. Although sus- 
ceptible of easy demonstration, this epoch-making discovery failed 
for years to influence medical thought or practice. Darwin rests in 
Westminster Abbey, with the sovereigns, the statesmen, and the warriors 
of a proud people. The inscription, “Born February 12th, 1809; died 
April 19th, 1882,” is to be taken in connection with the fact that his chief 
work, “On the Origin of Species,” published in 1859, in his fiftieth year, 
was, during his lifetime, translated into all modern languages, and 
reached in England itself six editions and seventy-two thousand copies. 
* The first printing press in North America is said to have been set up 
in 1639, the house of President Dunster, of Harvard College. 
t Dr. Billings tells me there is on record a complaint of the want of a 
cadaver at the University of Mexico to read the lessons of anatomy over. 21 
warfare raged promiscuously, and disease was rife. We have 
seen that the work of mere preliminary exploration occupied 
two centuries. The close of the third century found the early 
struggles approaching a successful ending, only to be followed 
by violent political changes, not accomplished save by long 
and costly wars. The English conquest of Canada in 1759-60, 
the achievement of independence by the United States in 
1783, the establishment of the independence of the South 
American Republics in 1810 and the ensuing twenty years— 
these are the events from which the future historian will 
date the Renaissance or the Decadence in America, and to 
which reference will always be made in estimating our 
•capacity for progress in politics, in literature, in art, and in 
science. 
For a long time it seemed even to friendly critics that the 
new races which strove for a foothold on American soil were 
unlikely to thrive as vigorously as in their accustomed 
habitats, and the impossibility of developing a genuine and 
lasting American type was freely asserted. To those of us 
who have considered this point with anxious care the last two 
decades have brought results that put to rest all apprehension. 
Whatever may be the future changes in the political organi- 
sation or relations of the countries composing America, it is 
a demonstrated fact that the European race in America, which 
already numbers over one hundred millions, will show no 
■decline in vigor or in energy, in physical or in mental strength. 
It is not on account of mere bigness in material achievement 
that we point to the millions who fought in the great civil 
war; or to the one hundred and seventy thousand miles of 
railroad in the United States—almost as much as in all the 
world besides, and the $10,000,000,000 of capital invested, 
and the army of nine hundred thousand employes ; or to 
that tremendous structure, the Canadian Pacific Railroad; or 
to the plans now under consideration, for developing a con- 
tinuous railway system for the entire continent, from Montreal 
or Puget’s Sound to Buenos Ayres. It is, even more, as 
•evidences of large imagination, of courageous resolution and 
dauntless tenacity of purpose, and of enormous power of 22 
physical endurance that we value the enterprises which have 
subjugated this continent so swiftly and are hastening its 
commercial consolidation. We may be assured that countries 
which have shown such sturdy love of independence and 
resistance to outside interference, which have displayed so 
much sagacity in adapting their political constitutions to their 
peculiar conditions, which liberate and enfranchise all who 
dwell within their limits and afford to all an equal chance 
of advancement, will work out their destinies to far larger 
and wiser plans of friendly co-operation than we can now 
foresee. 
Turgot, in his memorable address in the Sorbonne, well 
declared, “ Tous les ages sont enchaines par une suite de 
causes et d’effets qui lient l’etat du monde a tous ceux que 
l’ont precede.” The discovery of America depended on the 
operation of causes which can be traced back many centuries. 
The present condition of our continent, four hundred years 
later, is the result of the action and reaction of mighty move- 
ments which involve every country of the world. Here is 
the new and probably the last great place of gathering and 
intermixture o.f all nations. Here as nowhere else are to be 
studied with all the aids of exact science the problems of 
ethnology and sociology.* Here are to be worked out to the 
* It was on this account that I was so anxious for the organization of 
the American Anthropometric Society, which was happily established in 
1891. The interaction between functional activity and cerebral develop- 
ment is attested by so many facts, and the methods of examining and 
recording the exact arrangement and minute structure of the nervous 
centres are so securely established, that the time seems to have come 
to begin, upon a broad and systematic basis, the study of the progressive 
anatomical changes effected in successive generations of individuals 
subjected to the stimulating and rapidly changing environment presented 
by our modern life. The full members of this Society engage to direct 
that a post-mortem examinatioii of the brain shall be permitted. The 
other members make no such pledge, but all are concerned in the promo- 
tion of anthropometric and ethnological research. The scope of the 
work undertaken by the Society is very broad and profoundly important. 
It is believed that nowhere else can its investigations be so profitably 
prosecuted as in America. The organization is, however, essentially inter- 
national in character. It is difficult to overestimate the value of a large 23 
best advantage the problems concerning the relations of man 
to his physical environment; and the demonstration that in 
spite of the apparent magnitude of the powers of nature, and 
in spite of the admitted influence of climate and physical con- 
dition upon the progress of civilization, the powers of man 
for intellectual and social advancement are incalculably 
superior. 
In all of this work a large share must devolve upon medical 
men, and fortunately our position in America is one which 
will enable us to work together with good effect. The high 
average intelligence of our people will make them prompt to 
appreciate results of solid utility or scientific value. The 
enormous wealth, present and prospective, of this continent 
should readily be diverted more and more bountifully to the 
promotion of learning and research—if, as maybe trusted, we 
shall strive more and more after peace among ourselves and 
abroad. 
We shall never cease to be proud of our lineage, or to 
acknowledge the immense debt we owe fo Europe. Its 
languages are ours; its glorious past is part of our heritage; 
its mighty names in art and philosophy and science are 
household words with us. Its rapidly advancing civiliza- 
tion incites us to loftier efforts. But the balance between the 
Old and the New Worlds is being redressed. 
All know how the examples of our young and vigorous 
communities have supplied and fed the infectious principles of 
series of exact portraits of the brain, in its macroscopic and microscopic 
features, obtained in successive generations during even so short a 
period as a thousand years. These records will be obtained from mem- 
bers of different races living under similar and under widely different 
physical conditions ; and it is hoped to secure such records from many 
successive generations of a number of individual families whose intelli- 
gent interest in such collective investigations may be sufficiently main- 
tained. The good work of this Society is already actively progressing. 
The records will be preserved in the strictly fire-proof buildings of the 
library and of the Wistar Institute of Anatomy and Biology connected 
with the University of Pennsylvania. Doubtless the medical profession 
of all America will be prompt to help, from their technical standpoint, 
the great work in ethnology and archaeology upon which all Americanists 
are now so vigorously entering. 24 
political liberty and of social equality.* In every struggle for 
the rights of man, from the terrible but beneficent drama of the 
French Revolution down to the present hour, our example 
and our assistance have been invoked. 
I cannot detain you by an enumeration of the services 
already rendered by America to medical science. Almost 
immediately after the Discovery important contributions to 
pharmacology were announced, chiefly from South America, 
and from the introduction of guaiacum, in 1508, until now these 
contributions have become more and more frequent. The 
entire medical world was agitated during the latter half of 
the seventeenth century by the struggle over the merits of 
cinchona bark,f introduced into Europe, in 1640, by Juan del 
Vego,and no more convincing tribute can be adduced as to 
the value of medical and sanitary science than the prominent 
place occupied by malarial diseases in the general and medi- 
cal literature of the seventeenth and eighteenth centuries as 
contrasted with the feeling of impunity with which they are now 
regarded. Among the results which may be anticipated from 
this meeting is, I trust, the adoption of some well-considered 
plan for systematic conjoint study of our American remedies 
and their pharmaceutical preparations, looking to their scien- 
tific classification, to greater uniformity in their preparation, 
and ultimately to a single pharmacopoeia for the entire conti- 
nent. 
The introduction of nitrous oxide (1844) and of ether (1846) 
into medical practice, with which the names of Wells and of 
Morton are so honorably connected; the establishment of the 
operation of ovariotomy by McDowell, of Kentucky, upon a 
* This is the only infectious principle we have communicated. The fable 
which assigned an American origin for European syphilis has been re- 
futed by conclusive evidence from many sources. 
t The motives influencing its opponents were borrowed in part from the 
■doctrine of qualities of the ancients, in part from the hatred of the Jesuits, 
who were especially active in extending the use of the drug, and in part, 
as malicious tradition asserts, from the fear that it would cure so speedily 
as to render the earnings of physicians precarious. One is reminded of 
the old Indian proverb : “ Various are the desires of men ; the wagoner 
longs for wood, the doctor for diseases.” 25 
secure scientific basis—these and hundreds of other achieve- 
ments of lesser brilliance are too familiar to need mention. 
Every one knows now how superfluous it is to say a word in 
defense of American literature, and certainly we who know 
how powerfully the opinions and practice of medical men in 
Europe and throughout the world are influenced by American 
writings may view our position with some complacency. Yet a 
survey of what America is actually contributing to medical lit- 
erature shows clearly how far we are behind the nations which 
lead in medical thought. In the year 1879 Rupprecht’s Bib- 
liotheca* gave as the total number of new medical books, ex- 
cluding pamphlets, periodicals, and transactions, 419, divided 
as follows, viz.: France, 187; Germany, no; England, 43; 
Italy, 32; United States, 21 ; all others, 26; and for 1891 I 
find the same Bibliotheca gives the total number as 1063, di- 
vided as follows, viz.: Germany, 360; France, 243; Great 
Britain, 141 ; United States, 80; Italy, 78 ; Austro-Hungary, 
70; Spain, 24 ; other countries (chiefly Switzerland and Den- 
mark), 67. 
On the other hand, in the more ephemeral forms of medi- 
cal literature the figures are very different. I have had a care- 
ful count made of the volumes of medical journals and trans- 
actions filed in the library of the Aimy Medical Museum at 
Washington with their respective places of publication,f and 
from this it is clear that of these classes of medical literature 
there were in 1890 and in 1891 published in America (includ- 
ing Canada, the United States, and Latin-America) about twice 
as many volumes as in Germany or France, and fully three 
times as many as in Great Britain. 
* J. S. Billings, M. D., “ Our Medical Literature.” Address before the 
International Medical Congress, 1881. He adds that these figures are 
too small, and especially so as regards Great Britain and the United 
States. 
t It gives me pleasure to acknowledge the assistance rendered in the 
preparation of these interesting statistics by the National Bureau of 
Medical Bibliography. This admirable enterprise, established at Wash- 
ington so as to have immediate access to the great library of the Sur- 
geon-General’s Office, merits the appreciative support of the profession. 26 
Totals. 
1890-1891. 
America, 
including 
Canada, 
United 
States, 
and Latin 
America. 
1890-1891. 
Germany. 
1890-1891. 
France. 
1890-1891. 
Great 
Britain and 
Depend- 
encies, not 
Including 
Canada. 
1890-1891. 
Italy. 
1890-1891. 
Spain. 
1890-1891. 
Austro- 
Hun- 
GARY. 
1890-1891. 
Bel- 
gium. 
1890-1891. 
Other 
Countries. 
1890-1S91. 
Number of volumes of jour- 
nals 
985, 1021 
278, 297 
r59> 
168 
153, 160 
8r, 87 
106, 103 
36- 37 
39, 38 
23, 21 
no, no 
Number of volumes of trans- 
actions 
3X9> 3oo 
104, 84 
48, 
48 
CO 
CO 
10 
CO 
36, 33 
27, 27 
b 1 
4, 6 
10, 10 
54- 52 27 
Of course we must not forget the fact that in the hurry of 
our life of to-day many observations and investigations of great 
value are published in journals, instead of being reserved to 
become part of more serious and complete volumes. But it 
will not be doubted, I think, that the great excess of medical 
journals in America, as contrasted with the comparatively 
small number of new medical works, is entirely consistent 
with the admitted leadership of Germany, France, and Great 
Britain in medical science. The fact that during the past 
twelve years Germany has risen from a place in this list second 
to France, no as against 187 in 1879, to the first place at 
present, with 360 new medical works in 1891 as against 243 
published in France, speaks eloquently of the strenuous effort 
with which newly-united Germany is straining forward in 
science as in other fields. The truth is that the apparently ex- 
traordinary number of medical journals in America is due 
chiefly to a substantial reason, and one which influences equally 
the existence of very numerous medical schools and medical 
societies. The vast extent of territory, and the relatively sparse 
population render it impossible to serve the country with as low 
an average of medical men, schools, societies, or journals as is 
possible in more densely-populated countries. As to other and 
less satisfactory reasons which have operated, especially in the 
United States, to produce a great growth of ill-equipped med- 
ical schools and of poorly-supported medical journals it is 
not necessary to speak here. Indeed, the rapid rise in the 
standard of scientific requirements, both of medical men and 
medical literature, and the increasing appreciation on all sides 
of the fact that the higher medical education is the true in- 
terest both of the profession and of the public is accomplish- 
ing the much-needed work of checking the ill-considered 
establishment of new medical enterprises, and of stimulating 
those in existence to more earnest life and more lofty aims. 
So true is this in regard to our medical journals in particular 
that no one who has occasion to consult regularly the files of 
any number of them can fail to have been struck forcibly 
with the steady and decided improvement in the tone of their 
management and in the scientific quality of their contents. 28 
This Congress meets at a period of peculiar and critical in- 
terest in medical education, and I am glad to say that for the 
first time in the medical history of the United States we may 
feel proud to have such a meeting convened here, and to in- 
vite a close examination of our educational standards and fa- 
cilities. I should fail in courtesy and in candor alike were I 
not to acknowledge the great value of the example which has 
been so consistently set by Latin-America and by Canada in 
the maintenance of a high standard of qualifications for 
medical practitioners. 
Fifteen years ago the medical profession of the United 
States arraigned severely the management of their over-nu- 
merous medical schools.* While Canada then exacted a rea- 
sonably strict entrance examination and a course of medical 
study extending over four years, with one session of six months 
in each year, and while every country in Latin-America exacted 
a collegiate degree or a rigid entrance examination, and a 
course of medical study extending over six years, it was 
the general custom with the medical schools of the United 
States to grant a diploma conveying the full right to prac- 
tice medicine to applicants who had been admitted with- 
out preliminary examination, and had attended without term 
examinations two courses of lectures covering about five 
months, and had passed a single and final examination con- 
ducted by their own teachers, whose emoluments were derived 
solely from the fees of such students. This discreditable prosti- 
tution of a great educational trust had been gradually brought 
about by large causes upon which I may not now comment. 
But it is with justifiable pride that we may point to the ad- 
mirable and sweeping reforms that have since been instituted. 
It remains true that the laws of many of the States allow 
charters for medical schools to be secured without any guar- 
antee of the standard of education that shall be maintained. 
But the awakened sentiment of the profession and of the 
community has in a rapidly increasing number of the States 
insisted that medical graduates before being admitted to 
* Regular schools, 65; Homoeopathic, n ; Eclectic, 4 ; total, 80, in 1877. 29 
practice shall pass a State examination conducted by an im- 
partial board of examiners appointed by the Governor. The 
medical schools, to their honor be it proclaimed, have, with 
few exceptions, been foremost in the struggle to secure this 
wise and beneficent legislation. They have done much more. 
In advance of these laws which will ensure a far higher standard 
of medical qualifications in the States fortunate enough to be 
so protected, the faculties of a number of the leading schools 
have forced their standard up at first to three years of obliga- 
tory study, and now to four years of eight months’ study 
each, with a carefully graded curriculum and with strict exam- 
inations before entrance, at the close of each term, and finally 
before graduation. 
When we recall that this has been done without the slight- 
est governmental aid, and, further, that owing to the prevalent 
view that medical schools have been sources of large profit 
to their faculties the streams of private benefaction had not 
yet been directed in their favor, you will appreciate the high 
sense of duty and the devotion to science which have led 
these faculties to assume greatly increased labors with an ex- 
pectation of considerably diminished remuneration owing to 
reduced attendance of students and to augmented expendi- 
tures. 
The Committee of Arrangements of this Congress has wisely 
provided for a tour of inspection of some of these institutions. 
It is trusted that all of our foreign delegates, and as many as 
possible of the members of this Congress, will avail them- 
selves of this opportunity to examine the equipment of some 
of our leading medical schools. They will be gratified to find, 
in hospitals, in laboratories, and in libraries and museums alike, 
facilities which bear comparison with those of Europe. They 
will find an arrangement of studies, and, above all, an organ- 
ization for the conduct of daily thorough bedside instruction 
in all branches of medicine, which leave little to be desired. 
It is easy to foresee, as another of the desirable results of such 
meetings as this held successively in various parts of America, 
such increased acquaintance with and confidence in our re- 
spective methods of medical education and medical treatment as will retain on our continent many of our students and 
many of our invalids who have been in the habit of going 
farther to fare no better. 
A broad field opens before us for the study, with the aid of 
collective investigation, of the distribution and course of 
phthisis and rheumatism and other important diseases as in- 
fluenced by race and locality. The endemic fevers, other than 
malarial and typhoid and yellow fever, which are said to pre- 
vail in various parts of North and South America, have long 
demanded systematic investigation to complete the study 
which the illustrious Drake began. We shall now have the 
opportunity of studying, equally by means of collective inves- 
tigation, the relative effects of various climates on the numer- 
ous races now represented in America, and of determining 
more accurately the scientific and practical questions con- 
nected with our extensive series of health resorts which em- 
brace the finest examples of every type. There are, indeed, 
none of the sections provided for in this Congress from whose 
work more valuable results should follow than from those on 
medical pedagogies, on hygiene and climatology, and on 
quarantine. It was a sense of the urgent importance of these 
latter subjects, especially at the present time, and of the valu- 
able results sure to follow their consideration by such a body 
as this, which led the Government of the United States to ex- 
tend the cordial invitation which has been uniformly accepted 
on the part of the Pan-American Governments. I feel that by 
this action there has been secured for the subject of Hygiene 
and State Preventive Medicine a formal recognition never be- 
fore accorded on this continent, and one which must surely 
be followed by the willingness of the respective governments 
to use their influence to secure the enactment and efficient 
administration of proper legislation in accordance with the 
recommendations of this body of eminent experts. 
When the International Medical Congress met in Philadel- 
phia in 1876, the address on Hygiene and Preventive Medicine, 
delivered by the distinguished Bowditch, himself a pioneer in 
sanitary science, was one of the most impressive utterances 
on that important occasion. The review there given of the 31 
work of the previous century in this country in sanitary 
science was not flattering, but with the fine enthusiasm 
which marked that gifted man he predicted the immediate 
opening of the grandest epoch yet seen in the history of 
medicine. His closing appeal must be quoted: “ Our present 
duty is organization, National, State, municipal, and village. 
From the highest place in the national council down to the 
smallest village board of health we need organization. 
With these organizations we can study and often prevent 
disease.” These stirring words were in accord with the spirit 
of the times and with the developments of science. When 
the brilliant discoveries of Koch brought to light the specific 
bacillus of tuberculosis and of cholera, and pointed out the 
scientific method to be pursued in similar investigations in 
the future, an unanswerable argument was provided against 
skepticism or indifferentism or official penuriousness. It re- 
quired courage and showed rare breadth of view in Lord 
Palmerston to issue his celebrated reply to the Presbytery of 
Edinburgh on the occasion of the threatened outbreak of 
cholera in 1853, in which he urged that the weal or woe of 
mankind so far depends upon the observance or neglect of 
the natural laws by which the affairs of the world are regu- 
lated, that if the local causes of disease were not removed 
before the return of the hot weather, the pestilence would be 
sure to return in spite of all the prayers and fastings of a 
united but inactive nation. 
Much was accomplished, it is true, in preventive medicine 
between 1853 and 1876, when Bowditch spoke; but it is 
scarcely an exaggeration to say that the progress in the past 
twenty years has been greater than in the preceding twenty 
centuries. We have not, indeed, yet detected the specific 
poison of every infectious disease; even in regard to the 
familiar and much studied yellow fever, the latest publica- 
tion of the distinguished Surgeon-General of the United 
States Army shows that this point is still unsettled. But the 
position of the whole matter is changed radically. Hypoth- 
eses have given way to facts. Every one now knows, or 
ought to know, that the most dreadful diseases are inseparably 32 
connected with definite organisms, that these organisms have 
special laws of development and distribution, that to destroy 
or exclude them is to avoid the disease, and that to tolerate 
conditions which favor their development is to encourage 
and invite the attack of the disease. When these simple, 
demonstrable propositions are considered in connection with 
such scourges as cholera and yellow fever, and typhus and 
typhoid fever, and scarlatina and diphtheria, and epidemic 
meningitis, it needs no further argument to prove the value 
and the necessity of quarantine, and of efficient medical in- 
spection and protection. Nor does it need further argument 
to show the wisdom of establishing laboratories of hygiene at 
many points over the country, of equipping them amply with 
the ablest men and the finest apparatus, and of endowing them 
liberally, so that the search after the yet unknown causes of 
disease, and after the best methods to prevent the development 
of such causes as are known, may be prosecuted with cease- 
less vigor. 
It is easy now to get a hearing for these views, when public 
comfort is disturbed, the public purse threatened, and the pub- 
lic conscience awake and sensitive. At this moment our 
great comrtiercial communities are reposing in confidence 
upon the sanitary measures adopted by our governments, in 
accordance with medical advice, for the restriction and ex- 
clusion of two dreaded pestilences, cholera and yellow fever. 
Recall with me the popular terror of last summer. Recall 
the hideous loss of life and the disastrous effects on commerce 
caused by former invasions of these diseases when the com- 
munities afflicted were smaller and less wealthy than are ours 
at present. We do not have to seek back to the Middle Ages 
for pictures of desolation wrought by infectious disease. Re- 
call that tragic story of the great yellow fever epidemic in 
Philadelphia just one hundred years ago, as told by Rush. 
Try to estimate the result if cholera had effected a lodgment 
in New York City in July, 1892, and having found favoring 
local and climatic conditions, had, as on former occasions, 
spread its deadly germs to the North and South and West. 
The fair White City that was rising by that distant lake, under 33 
the magic wands of Art and Industry, would have been 
stricken with a fatal blow. No computation can well exceed 
the loss that would have fallen on this country. The entire 
people gazed with bated breath at the struggle waging in New 
York Harbor, and universal thanksgiving arose when the 
dread invader was finally repulsed by the vigorous and sus- 
tained efforts of the sanitary authorities. That we in America 
are not to-day witnessing the aggravated recurrence of the 
epidemic, in accordance with unvarying precedent, can be 
due only to the continuance of these same efforts, reinforced 
with large authority, and aided by more efficient local sanita- 
tion. When this gratifying result is associated with the suc- 
cess which for some years has attended our efforts for the 
exclusion of yellow fever, no further argument can be needed 
to urge the adoption of such uniform measures as will for the 
future afford most sure protection against these diseases. 
These instances exhibit in the most striking manner the need 
and the value of the international sanitary agreements this 
Congress may do much to promote. But there will occur to 
all of us many other important questions to be solved only by 
earnest and united work. Nor can this work be accomplished 
until Bowditch’s cry for organization is far more fully answered 
than it yet has been. Nothing but organization and co- 
operation, and, yet more, the establishment in the gov- 
ernment of every civilized nation of a department of pub- 
lic health, will secure the continuous and forcible attention 
which the magnitude of this enterprise demands. There 
should be, and the day cannot be far distant when there shall 
be, in the cabinet of every government here represented a 
Secretary of public health, of rank, influence, and prerogative 
equal to that of any other cabinet officer. 
Here, then, is the last and greatest service to be rendered 
to science and to the nation by our Congress. Our combined 
influence will be irresistible when used in advocacy of higher 
education; in carrying out large plans for the scientific study 
of our national life, as affected by social and climatic influ- 
ences ; in the adoption of remedies and remedial measures 
of demonstrated merit, and in the insistance upon a fuller 34 
recognition of the lofty function of preventive medicine, 
“ Salus Sanitasque Reipublicae, suprema lex.” Let us acquire 
here a closer touch with each other, a deeper faith in our pro- 
fession and its noble destiny, and a stronger determination to 
labor in brotherly co-operation for the loftiest ideals of service 
to science and the race. 
It would be improper to omit an acknowledgment of the free use that 
has been made in the preparation of this address of various authorities. 
Especially must be mentioned Fiske’s Discovery of America; Baas’s 
History of Medicine (translated by Handerson, 1889) ; The Discovery 
of North America, by Henry Harrisse (Paris and London, 1892) ; The 
History of the New World, called America, by E. T. Payne (vol. 1, 
Oxford, 1892) ; Buckle’s History of Civilization in England ; Draper’s 
History of the Intellectual Development of Europe; Fisher’s Outlines 
of Universal History ; The Early History of Instrumental Precision in 
Medicine, by S. Weir Mitchell, M. D.; Historia Bibliogr&phica de la 
Medicine Espanola, by A. H. Morejon ; Publications and Unpublished 
Letters of Dr. Daniel G. Brinton ; Report on the Etiology and Prevention 
of Yellow Fever, by George M. Sternberg, 1890 (now Surgeon-General 
U. S. A.) ; Lubbock’s Origin of Civilization, and also Prehistoric Times ; 
Tylor’s Anthropology, and also, Researches into the Early History of 
Mankind ; Lewis Morgan, Ancient Society, New York, 1877. 
It gives me much pleasure to acknowledge also the assistance re- 
ceived from Dr. R. P. Robins, especially in the examination of the 
History of Early Spanish Medicine.