^ VvuxAZ^
pz
ADDRESS
HARVEY    LINDSLT,
PRESIDENT OF THE ASSOCIATION.
           FROM THE MINUTES OF THE

TWELFTH ANNUAL MEETING OF THE AMERICAN MEDICAL ASSOCIATION,

     HELD IN THE CITY OF LOUISVILLE, MAY 3, 1859.
            PHILADELPHIA:
COLLINS, PRINTER, 705 JAYNE STREET.
                 1859. 
 
ADDRESS
HARVEY     LINDSLY,
PRESIDENT OF THE ASSOCIATION.
V-Wrm"-^
              FROM THE MINUTES OF THE

TWELFTH ANNUAL MEETING OF THE AMERICAN MEDICAL ASSOCIATION,

       HELD IN THE CITY OF LOUISVILLE, MAY 3, 1859.

                PHILADELPHIA:
COLLINS, PRINTER,  705 JAYNE STREET.
                       1859. 
 
ADDRESS.
GENTLEMEN OF THE AMERICAN MEDICAL ASSOCIATION:
  The flight of time, in its rapid course, has once more brought
together  the representatives of the medical profession, and we
again meet  in  that section  of our  favored land whose  history is
most vividly emblematic of the progress of American  power, its
magic increase, and its almost boundless extent.  This beautiful
city, now teeming with an  overflowing population, distinguished
by its wealth, enterprise, and commerce, connected by its railroads
and magnificent steamers with every part of the great  West—with
its refined society, its elevated educational institutions, its nume-
rous churches,  its noble charities—within the memory of many of
our  number was only  an inconsiderable village, unknown, and
without a place upon the map of the world.
  May our  profession keep pace—in respectability, progress, and
usefulness, with the unexampled growth of our  great  country—
and with the blessing of a superintending Providence, may we thus
continue to  meet in harmony and concord, as long as the Ohio and
the Mississippi shall roll their ceaseless floods in fraternal union to
the boundless ocean.
  My able  predecessor, in the last annual address, has told you
what our Association has  done, during  the  brief period  of its
existence, for the improvement of medical education, the advance-
ment of medical science, and the elevation of the medical  profession.
I propose to devote the  half hour, usually allotted to this exercise,
in discussing one or two points, in which changes  may, perhaps, be
advantageously made in our mode of transacting the business that
calls  us together—and  closing with some observations  of a more
general character.
  And I would first take the liberty of suggesting the great im-
portance of  adhering strictly to the order of business as-laid down 
4
in our Constitution.  That after  the preliminary arrangements,
relating exclusively to the organization of the Association, as the
election of officers, &c, have been completed, the chief object of our
meetings, viz., the reading of the reports of the regular committees,
should be commenced and  proceeded with, without interruption,
till all have been presented.  This certainly is the least that can
with propriety be given to  gentlemen, who have spent much time
and devoted earnest labor to the preparation of reports, honorable
to themselves and to the  profession, and calculated  to be useful to
the community.  It is earnestly to be  hoped  that the injustice
inflicted at the last annual meeting, of neglecting  to call for the
reports of several of the  most laborious  and valuable committees,
will never be repeated.
  Allow me, too, to invite attention to what seems a serious defect
in the mode in which the peculiar duties of the Nominating Com-
mittee are performed.  The practice of placing upon  that4committee
one member from each  State and Territory, with  an  equal  vote,
without reference to the  number of delegates he may represent, is
clearly in violation of the fundamental principle of representative
government. One  State, for example, may send  eighty delegates,
and another only one, and yet according to our present plan, in
the Nominating Committee, the former would have no more weight
or influence than the  latter.  I would  propose  that hereafter this
committee be composed  as  at present, of one member from  each
delegation;  but that when the committee is organized, each mem-
ber's vote be counted as  equal to the whole number present from
his district  or  territory.  The number  in attendance from  each
State, being certified by the Secretary, there need be no confusion,
delay, or uncertainty in  taking the vote.  With great  deference I
would submit, that this change would be both just  and expedient;
just, because in  all bodies the representation should as far as pos-
sible be in proportion to the number of the constituency; expedient,
because such an arrangement would be a strong inducement in the
various bodies represented to send a large delegation, thus increas-
ing the interest  and adding  to the  importance of our annual
meetings.
   In connection with this  subject, I would recommend that  it be
made the duty of  the Secretaries to prepare for the Committee of
Nominations a complete list of all the subjects referred to com-
mittees at former meetings, together with the names placed on such
committees.  This would greatly aid that important body in the 
5
discharge of its arduous duties, as  it would enable its members to
see at a glance what subjects had been acted on at all former annual
meetings, thus saving much valuable time, and  avoiding  the mis-
take of repeating the same questions and placing  the same indivi-
duals on committees where they  had previously served.  Some
complaint has already been made in relation  to such errors, which
seem unavoidable as matters have  been hitherto  managed, while
with the change suggested these errors need never occur.
   The grand object of  our Association, the elevation of the great
body of the medical  profession to  greater respectability and more
extended usefulness, is still far from being adequately accomplished.
While  much has been done—enough to encourage us  to more
earnest effort—a great deal remains to be done.  In this direction,
the great want is a more thorough  preliminary and professional
education.  This is admitted on all  hands;  but to find  and apply
the remedy is  a task at once  difficult and ungracious.   It is  not
my intention, however,  to discuss a subject upon  which the ener-
gies and acuteness of many of the  ablest minds in the profession
have already been expended, and,  I trust, not altogether in vain.
It is a question whose importance it is impossible to overrate, and
I think on  that account attention should always be called to it, in
the hope that by keeping it constantly before the  profession some
progress may annually be made.  The lead in this great enterprise
should undoubtedly be taken by the medical schools, and the move-
ment which was inaugurated at the last regular meeting, of calling
a convention of these institutions to consider this subject,  we trust
will be attended with beneficial results.  Little can be done, except
by concert and a mutual understanding.   It has been said that  the
responsibility as to this subject rests with the profession at large;
that the preliminary education of students in particular, which in
importance is  hardly secondary to that which directly  prepares
them for the practice of their calling, must rest with the individual
physicians who receive  them as pupils.  But  the answer to this is
obvious;  and while we would earnestly impress upon all their duty
in this respect,  it is impossible there can  be any concert of action
among the forty thousand medical men scattered all over our great
country, whereas concert ought certainly to  be practicable among
thirty or forty  medical  schools.  I  will not attempt to  show how
this can best be done; but  I trust  I shall be pardoned for saying
that the American Medical Association  expects it to  be  done—
expects that those who are placed as sentinels at the great portals 
6
of our profession, will see to it, that none shall be allowed to enter
within its venerable halls, unless thoroughly prepared to discharge
all  its  important responsibilities with honor to themselves and
advantage to the public.
  It is the common cant of the charlatan and the empiric, that the
medical profession are opposed to improvement  and lag behind in
this age of  progress, because we  do not at once adopt every vague
theory or favor every wild scheme that the visionary or the enthu-
siast may attempt to thrust upon us.
  But I think every candid  and  philosophic mind that has studied
the history and observed the progress of medical science, particu-
larly for the  last fifty years, will  be satisfied that we have in  a
remarkable degree combined earnestness of research into  the value
of new  theories and  novel remedies, with  a  wise and  cautious
reserve as to their adoption  in practice.  We have illustrated the
possibility of the union of progress and conservatism, of the com-
bination of the ardor characteristic of youth  and the wisdom that
belongs to age.  We are emphatically what our  title denotes—and
we eschew every other designation—we are Physicians,1 students
of nature, and are ever ready and anxious to put under contribu-
tion every part of her wide domain, and draw from her ample store-
house whatever can add to the happiness or contribute to the health
of man.  Give us a fact, authentic and well attested, no matter what
its  source,  whether the result of accident, or the contribution of
ignorance, or brought forward  by any of the numerous claimants
to superior knowledge, who ever hang on the outskirts of our pro-
fession, like the marauding followers of a victorious army, no mat-
ter, I say, whence its  origin, give us a valuable  theory or a useful
fact, and we are prepared to adopt and  make the most of it.  The
diamond of truth we always welcome, even if found amid  the refuse
of  the gutter.
   Thousands of physicians,  among the ablest and most thoroughly
educated men  to be found  in any of the pursuits of life, are con-
stantly  employed  throughout Christendom in the earnest investi-
gation of medical science, and their discoveries are instantly made
known, almost with lightning speed, to the profession in every part
of the civilized world.  The quarterly, monthly, and  weekly medi-
cal journals, issued in every portion of Europe and this country,
are received and read by all intelligent members of the profession,
and thus every important discovery in  science or improvement  in
                           1 From <pvcnu 
7
practice, no matter where it may originate, whether on the  banks
of the Seine, the Thames, the Delaware, or the Ohio, is at once
appropriated by every scientific physician from St. Petersburgh to
Constantinople, and from Maine to California.   Of what other pro-
fession or pursuit can it be said, that the electric chain of sympathy
thus binds together in harmonious union its scattered members all
over the world?
   Indeed, medicine  is the only one of the so-called  learned pro-
fessions that can be said to partake of the onward movements of
the age.   In theology, the eternal  truths impressed on its every
page  forbid change or variation, and admit  only of  attempts at
new modes of illustration.  The grand principles of law, too, should
be as fixed and unchangeable as the  everlasting dictates of justice, of
right and  of wrong, though most  unprejudiced persons, perhaps,
would.be inclined to admit that a slight improvement  might occa-
sionally be made, as  to the way in which these principles are applied
to practice.   Its worst enemies, however, would not deny that
some amelioration has  taken place  since  the  days of  the English
judge who is said to have shed tears on learning that the law, in-
flicting the penalty of death  for stealing five shillings, had been
repealed.
   That our profession has been true to its  high and noble calling—
that it has deeply felt and wisely pondered its responsibilities to
itself and its obligations to society, a brief recital of some of the
useful and important improvements and discoveries that have been
made in every branch of medical science  during the last half cen-
tury, will  fully demonstrate;  and  perhaps a portion of the time
usually devoted to this annual address, cannot be better employed
than in bringing before the profession and the world its own claims
to public consideration.
   In looking back to the close of the last century, and tracing the
progress  of science, the march of intellect, the triumph of mind
over matter, we are lost in amazement, and bewildered by the very
splendor of the view that meets us  on every hand.  We feel proud
of our common humanity; we are disposed  to exclaim with  the
poet—
            " What a piece of work is man!
             How noble in reason! How infinite in faculties 1"

x\nd in all this progress, in all these splendid triumphs, in all that
tends to  ennoble human  nature, to  elevate  human  character, to 
8
 correct physical evils, and lessen human suffering, our profession
 has  always borne a prominent and leading part.   Even in other
 departments of knowledge not immediately connected with medical
 pursuits—in the cultivation of all the natural sciences especially—
 we have done more than  others.  A large  proportion of the most
 valuable papers contributed to the Royal Society of London,  and
 published in its Transactions, have been furnished by physicians.
   Look  at the splendid array of discoveries, inventions and  im-
 provements in chemistry,  in surgery, in midwifery, in therapeutics,
 in practical medicine, and first on the long  roll of professional
 triumphs, examine with a scrutinizing eye Jenner's claims to  the
 gratitude and veneration  of the world; for although this  matter
 has been discussed so often, its overwhelming importance is  not
 yet fully appreciated by the public.  See the medical philosopher
 in his  secluded  country home,  carefully studying this subject
 through many tedious years; for his discovery was not the result
 of a lucky  accident—not the inspiration of  an electric flash of
 genius, but was perfected  by cautious experiment, by accurate ob-
 servation, by rigid scrutiny, by careful induction, until the mighty
 truth was fully evolved, that smallpox—the  direst scourge  of  the
 human race, the despoiler of beauty, the destroyer of vision—was
 shorn of its power, and might be banished from the world.  It  has
 recently been stated by the chief director of the Imperial Hospital
 for the Blind at Paris, that before the discovery, of vaccination one-
 half  of the children sent  to that institution lost their sight as a
 consequence of smallpox.  Some faint idea  of the incalculable
 value of vaccination  may be obtained from the fact that, before
 1805, when  it had  become  pretty general,  16 out of every 100
 deaths were caused by this disease, which, with the present record
 of mortality of London, would give us the enormous number of
 10,000 annually in that city alone.  How much nobler might  be
 the boast of Jenner than  that  of the celebrated architect who ex-
 claimed, in looking at the towering walls  of the great cathedral:
 " Si  monumentum requiris,  circumspice,"  for  he could say, u My
monument is the WHOLE WORLD, wherever disease has existed
and science triumphed. ' It shines in every fresh and healthy face;'
its glories are embalmed in the record of every family Bible; it is
not in one cathedral, but around every hearthstone."
  But, alas! how has the  world  manifested its  appreciation of
benevolence and  genius?  The British  government bestowed
£30,000 on  Jenner, the saviour of many millions of human lives, 
9
and £400,000 on Wellington, the successful victor on a few battle
fields.
  While the benefits derived from controlling the ravages of small-
pox are perhaps more striking from its fatal and loathsome cha-
racter, than those  arising from any other single improvement or
discovery in medicine, yet there are many others almost as im-
portant, which have contributed greatly to the health, comfort, and
happiness of man.  Of these, the history of scurvy furnishes one of
the most striking examples.  In times as recent as Captain Cook's,
a confinement of a few months on shipboard  invariably led to the
prevalence of this dreaded scourge,  laying prostrate one-half of the
crew, proving fatal to one-fourth, and enfeebling the whole. While
now, owing to more accurate knowledge of its pathology, its causes
and means of prevention, it is  of very rare  occurrence, is readily
controlled, and  is  seldom  if ever  fatal.   The improved  sanitary
condition of the English navy is clearly exhibited in the  fact that
in 1779, one in  eight  of those  employed died annually, while in
1811, the ratio was reduced to one in thirty-two, and in  1836 to
one in seventy-two.
   In  the treatment of insanity  and  the management of the insane,
what  a vast improvement has been  made within the last few years!
Contrast the chains, the dungeons, the confinement, the violence,
the beds of straw, or, what was more usual, the  bare floor of mud
or stone, the deprivation in fine of all the decencies and all the
comforts of life; contrast all this with the kindness,  the watchful
care, the freedom  from undue  restraint, the  skilful medical treat-
ment,  the  palatial  residences arising all over the civilized world
for this  unhappy class, and then estimate, if you can, how much
they owe to the medical profession.
   The importance of  ventilation to comfort, health, and  life, can
hardly be overrated, and to medical science is almost exclusively
due whatever improvement  has been made in this respect in our
public and private edifices.   A vast deal, to be sure, yet  remains
to be  done, but this  must rest with architects,  builders,  and the
people themselves, after the evils of breathing impure air have been
so often  and so thoroughly exposed by the  profession.   A single
illustration on this subject must suffice.  In  the Dublin Lying-in
Hospital, the deaths of new-born infants between the  ages of one
and fifteen days, amounted, in  the  course of four years, to 2,944
out of 7,650 births, which were at once reduced to only 279 deaths
during the same period, after a new and  improved system of ven- 
10
tilation had been adopted.  Thus, more than 400 lives per annum
were saved in a  single institution.
   Even consumption, the most fatal of all diseases, causing one-
sixth of all the deaths north of the tropics, seems destined to yield,
before  the triumphant march of modern medical science.  At least,
it can no longer claim to be the resistless conqueror, before whom
human skill and human power  must flee away abashed and  dis-
comfited.   The hectic flush on the cheek of youthful beauty shall
no longer be regarded as  the certain presage of an  early and un-
timely grave—shall no longer be  dreaded as  Death's  crimson
banner, waving  in  triumph over  the  prostrate hopes of parents,
relatives, and friends.
   More correct views of its pathological conditions, and more skil-
ful adaptation of therapeutic measures, recently introduced, lead us
to hope that  the day is  not far distant when consumption will be
shorn of its terrors, and take its  humble place along with other
curable diseases.
   The discovery and application of anaesthetic agents marks another
important era in the history of professional progress.   If this great
boon to suffering humanity has not  accomplished all that its san-
guine advocates  at first claimed for it;  if it has not  smoothed for-
ever the knotted brow of agony, it has yet prevented  many a pang,
soothed the anguish of many a pillow, and been the means of saving
many a life.
   The triumphs of auscultation and the stethoscope  belong to the
early part of the nineteenth century.  These have now become so
familiar to the profession and the public, that we are apt to forget—
though older physicians have cause enough to remember it—what
a  vast improvement they have effected  in  the diagnosis, and, of
course, in the treatment  of diseases of the chest.
   The careful examination and thorough chemical analysis of the
blood and the various secretions of the human body, entirely un-
known fifty years ago, have thrown a flood of light on an extensive,
obscure, and most important class of diseases.
   The skilful application of medical chemistry in aid of medical
jurisprudence, has  been of incalculable value in  the exposure of
crime and the detection  of criminals, so that even the secrets of the
grave are brought  to light and no longer afford protection to the
midnight assassin.
   Public hygiene, the proper drainage and sewerage  of  cities, and
the prevention and control of infectious diseases, have all received 
11
careful attention from  medical men, to the  great advantage of the.
public health.
  The application of the microscope to the study of anatomy and
the minute examination of diseased structure is of recent introduc-
tion, and has already furnished a rich harvest of important discovery
to the earnest student.
  The treatment of affections of the throat has been greatly im-
proved  by the novel  use of local applications—a valuable contri-
bution to  medical science by an American physician.
  Our intermittent, bilious, and congestive fevers have been placed
under almost complete control by the use  of large doses of quinine,
an  improvement hardly second in  importance  to  any which has
adorned the  present  century.  To our country belongs  the credit
of this invaluable addition to our therapeutic resources.
  The education, development, and improvement of the cretin, the
idiot, and the demented, are  almost wholly owing to the nobly dis-
interested and skilfully directed efforts of  physicians; and  in no
form of philanthropic labor has there been a greater success achieved
or greater good .effected.
   Midwifery, in all  its various departments, bears witness to the
successful labors of medical  science.  New and valuable instru-
ments,  operations before unknown, remedies and remedial appli-
ances recently introduced, have rendered  the pathology and  treat-
ment of the accidents and diseases of this important branch of the
profession much more exact,  thorough,  and reliable than  those
resorted to by our predecessors.  Among these great improvements,
perhaps the most important of all, the only  successful treatment of
vesico-vaginal fistula  is due to the  genius, skill, and  perseverance
of a member of this Association.1
   In surgery, time would fail us in  the attempt to particularize the
changes, the  improvements, the discoveries, the  inventions  that
meet us on every side.   Since the commencement of the  present
century, the  art has not merely been revolutionized, it has been
created anew.  The old  landmarks have been swept away, so that
scarcely a vestige of the labors of our predecessors remains.  There
is hardly  an  instrument or an operation  that has  not undergone
some material change or  been superseded  altogether, while new
instruments and new operations are continually being introduced,
so that surgery, as now practised, may be said to be a modern art.

  1 In obstetric practice, fifty years since, one in sixty died ; while now, according
to the most reliable estimates, only one in two hundred and fifty. 
12
  Dislocations are reduced by simpler and less  painful manipula-
tions ; fractures are healed by apparatus and appliances more skil-
fully adapted  and more successfully employed; amputations and
other operations are performed with instruments of novel design
and improved  construction ; wounds are treated by dressings and
applications better suited  to their nature, and more likely to  effect
a rapid cure; deformities,  congenital and accidental, which formerly
were allowed to harass and disfigure the patient for life, are more
promptly and  effectually removed;  the  blind are restored to  sight,
the deaf are enabled to hear, and the lame to walk;  life is daily
saved from the aneurismal flood, from the bursting tumor, from the
mortifying extremity, from impending tetanus;  and, above all, the
great glory of modern surgery is its conservative character, that
life is often preserved and deformity removed or prevented, not by
the use of the knife or the scalpel, but by avoiding both, and by
waiting on nature with greater patience and aiding her with greater
skill.1
  If the next  half century shall witness a progress as rapid,  disco-
veries as important, and improvements as striking,.as have marked
that we have just left behind us, we shall richly deserve the thanks
of the  world and the gratitude of posterity.
  It was the boast of Augustus, that arch-traitor to the liberties of
his country, "that he found Rome  of brick and left it of marble,"
and  of Buonaparte, "that he found France without law and left it
the 'code Napoleon,'" a monument to his matchless ability,  before
which the splendid triumphs of Austerlitz and  Marengo sink into
comparative insignificance.  How much nobler might be the boast
of the American Medical Association, if we, in future years, should
be able to say—though we found  the profession the  prey of the
charlatan and  the empiric, we left it distinguished by science and
ennobled  by virtue—found it chaotic  and discordant, we   left it
organized  and harmonious—found it with the education   of  its
members too much neglected, we  left it with medical schools  of the
highest character and physicians in the foremost rank of science
and  learning—found it without its due weight or influence  in
society, we left it  honored by the rich and  sustained by the bless-
ings of the poor.

  1 The records of the Parisian hospitals  show that  in 1805 one in seven died,
while now the ratio is reduced to one in  twelve, a gain  of 71 per cent,  in fifty
years.
T.Vi. 1\ 
k