embracing a full statement of what has been accomplished by each.

II. That the faculties of the several medical schools within the limits of the United States be once more urgently requested to call a convention at some central point, for the purpose of consultation and the adoption of some more general and uniform system of medical education. That, in addition to a four years' term of study, the requirement of a preliminary education, including some knowledge of the classics, shall be suggested. Any school or college which shall refuse to enter into such an arrangement shall be excluded from all connection with the American Medical Association, and its alumni shall not be recognized as members of the regular profession.

The speaker said that he was aware that these suggestions embraced some very radical and seemingly impracticable changes. If these seeds fell upon barren soil, he would at least enjoy the consciousness of having honestly, conscientiously, and fearlessly met the great and pressing issue of the day.

Dr. Garnett then referred to the International Medical Congress in the following words: "It is with no little satisfaction that I can here refer to the successful meeting of the ninth International Medical Congress, which took place at the capital of the United States in September last. To my lamented and distinguished predecessor as President of this Association, the late Dr. Austin Flint, belongs the credit of having suggested, at the meeting in 1884, that this Congress, through the authority of the American Medical Association, should be invited to hold its ninth meeting in the United States. Through the ability and diplomatic tact displayed by the gentlemen intrusted with the mission of conveying the invitation to the meeting of the Congress at Copenhagen, Washington City was selected as the place for the meeting of the ninth International Medical Congress.

"Notwithstanding the defection of some of those who were identified with the movement at its inception, and who subsequently disassociated themselves from all connec

6

tion with the Congress, we entertain no misgiving that the verdict of the medical world will be, Equal, if not superior, to the work of any preceding medical congress.""

The speaker referred to the founding and naming of the city of Cincinnati,. just one hundred years ago, by Dr. Arthur St. Clair.

Reference was also made to the mortifying position in which the Rush Monument Committee has been placed by the apparent lack of interest and liberality on the part of the medical profession of the country.

He concluded the address by offering congratulations upon the proud and enduring position now occupied by the Association. It is to-day more powerful, more self-reliant, more progressive, and stronger in the affections of its members than at any former period of its existence.

A vote of thanks was offered to the President, and it was moved and carried that the address be referred to the Committee on Publication.

Dr. Lewis A. Sayre was invited to take a seat upon the stage.

Dr. N. S. Davis presented a petition from many members, that the various sections be allowed to hold sessions in the morning as well as in the afternoon. This request was granted,

Invitations were presented to the members of the Association to visit the Chamber of Commerce, the College of Music, and the Technical School.

Dr. N. S. Davis stated that the Secretary of the Judicial Council had been obliged to resign on account of ill health, and though, happily, there was no work for the Council to perform, the members were requested to meet in order to preserve their organization and be able to act in case of necessity.

In the evening the members met in the parlors of the Burnet House in an informal reception.

WEDNESDAY, MAY 9TH-SECOND DAY. The general session was called to order by the President at 10:30 A. M.

Dr. Roberts Bartholow, of Philadelphia,

delivered the address on General Medicine. The last International Medical Congress was, in some respects, the most important one that has ever been held, especially in regard to preventive medicine. To an unprejudiced observer it would seem that its proceedings ought to have received some consideration from the public press. Yet such was not the case, and this is the usual position of the press toward the medical profession.

Those organs of public opinion do not ordinarily regard medical organizations seriously, and they seldom notice matters of the utmost importance to the general welfare of the community which may be discussed at these meetings. A surprising amount of ignorance still exists in this latter part of the nineteenth century, and people still think that the therapeutic art is based on some 'ism or 'pathy. On the Continent of Europe homeopathy is nearly extinct; but here it still lives, being held up by social influences and by misrepresentations on the part of its advocates. The statistics upon which these men rely to win converts are often made up out of whole cloth, as was done by a Dr. Somers, whose pretended official figures showing the results of practice in the larger cities of this country seem to prove that homeopathic methods of treatment are fifty or sixty per cent more successful in curing disease than are those of legitimate medicine.

In one of the large

cities of the West circulars were widely distributed, to which the claim, based upon these supposed official figures, was made that regular medicine would soon become extinct in this country. The speaker had taken pains to consult the proper authorities in regard to the sources of these alleged official figures, and had found that there were none, and that the statistics were pure fictions. No further argument was necessary to establish the falsity of a system which had to resort to such means to insure its success. The remedy for this which regular medicine has to offer, is to improve its art. The science of therapeutics should be made more certain. This is a branch of medical study which is not cultivated as it should

be, and a true knowledge of drug-action is not widely enough diffused. The acquisition of this knowledge is greatly hindered by the mass of old prejudices which still cling to this science and impede its progress like the barnacles on the hull of a ship. All this complexity and superfluity of olden times must be wiped away; at least two thirds of the pharmacopeial preparations could be dispensed with, and scientific therapeutics would thereby be the gainer.

The knowledge of a drug and of its various constitutents should be thorough, and only its active principles, or, if these have not been isolated, its strongest and most constant preparation, should be prescribed. In the alkaloids we have singleness and simplicity of action, and they may also be given in small doses and in a form most agreeable to the patient. This is a matter of no small importance. The speaker then referred to the dosimetric system of medicine, into the claims of which he had carefully examined, but which he did not consider as in any sense new. Furthermore, the system was crude, and its adherents did not usually base their modes of treatment on true scientific grounds.

A great objection to the employment of the crude drug was its uncertainty of action. In the case of jaborandi, for example, there were two alkaloids, pilocarpine and jaborine, whose action was dissimilar; and in prescribing the crude drug the practitioner could not be as certain of obtaining the desired result as when an alkaloid was exhibited. Many other drugs, such as opium and nux vomica, offered examples of this same complexity of action. The study of the physiological action of remedies, as a basis for their scientific use in the case of disease, is still young, and dates only from the early part of this century. It is a curious fact that, at the same time that the foundations of our knowledge of the physiological action of remedies were being laid, Hahnemann and Mesmer were imagining the spiritual essence. An illustration of the utility of the modern methods of the study of therapeutics is furnished in the employ

ment of the nitrites in the treatment of angina pectoris. It was through the knowledge of their physiological action, experimentally obtained, that they came to be employed therapeutically. Homeopathy, the speaker maintained, had nothing to do with the progress of modern scientific medicine. The true therapeutic action of drugs was one of antagonism.

Therapeutics also presses into its service the physical forces whose action is fixed and according to known laws. Even the most sceptical is forced to admit the effects of the galvanic current upon congestion and upon the products of inflammation, such as strictures. Electrolysis is comparatively new in its application, and it is full of therapeutic promise.

The address was referred to the Committee on Publication.

Dr. J. H. Hollister, Secretary of the Board, presented the report of the Board of Trustees on the publication of the Journal, showing that it was in a flourishing condition.

Dr. Woodbury presented the report of the Committee on Dietetics. He stated that this was intended to be only a preliminary report, and suggested that the original committee be enlarged, or that a section on dietetics be established. Thinking Americans, he said, are beginning to recognize the peril attending the use of bad food badly prepared. The young science of dietetics has joined hands with organic chemistry and with physiology. It has also taken the cook by the hand, and is raising the preparation of food to the dignity of a scientific pursuit. It has also entered the schools, and young girls are beginning to be proud of their ability to cook, and they now recognize that the humming of the tea-urn is sweeter music than the sound of the piano. Housewives are learning that a neatly laid table and a clean table-cloth are potent in keeping the men of the family from the grog-shop, and do more good for the cause of temperance than all the orations of professional lecturers. It is said that Americans are a race of dyspeptics, and this is partly true. But a dyspeptic race must inevitably deteriorate, and the

physicians of the land, from motives of pure patriotism, if for no other reason, should put the axe to the root and seek to prevent it by inculcating in the minds of the people the necessity of good and well-prepared food. But in the treatment of disease, as well as in its prevention, the science of dietetics has before it a great work. It is often easier to lead the sick back to health by the food route than by the drug line, and it is a curious fact that he who relies least upon drugs has the greatest confidence in their action. Drugs often fail when relied upon exclusively, but may work wonders when combined with a proper diet. There is, however, one abuse which has crept into modern medicine, under the apparent sanction of dietetics, against which the committee desired to raise its voice in protest. That abuse was the too great reliance often placed upon vicarious digestion. The giving of nourishment in other ways than by the mouth may often be necessary, but it has its limits of usefulness. It can never be of any but temporary service, for it supplies only a low grade of nutrition. If it is employed for too long a time, or when not absolutely necessary, it makes paupers of the digestive organs and unfits them for the proper discharge of their functions.

Dr. Woodbury then read the report of the sub-committee on Infant Feeding. The committee had had the subject under consideration for only a short time, and was not yet prepared to make a final report, but it would offer the following as useful facts: (1) In the case of infants deprived of breast-milk, the artificial substitute should correspond as nearly as possible to the human milk. (2) Cow's milk corresponds to breast-milk in most respects, but its caseine should be broken up, so as not to coagulate in large masses in the stomach. The caseine of a portion of milk should be first peptonized, and then added to fresh milk. (3) Raw starch is inadmissible, and the practice of adding it to fresh milk to break up the caseine is wrong. The products of the complete digestion of starch, when taken in excess, cause indigestion. The administra

tion of fully digested food to either adults or infants is bad for the digesting organs. (4) All nursing-bottles should be boiled several times a day in order to destroy the germs of decomposition. Desiccated (partly peptonized) milk is often a convenient and efficient substitute for mother's milk. (5) Success in infant feeding depends largely upon the ability of the physician to individualize for each patient.

On motion of Dr. L. A. Sayre, of New York, amended by Dr. Lee, of Philadelphia, it was resolved that the Committee on Dietetics be continued, and be instructed to present a report at the next meeting of the Association, embodying the general principles to be observed in a rational system of dietetics.

The consideration of three amendments to the constitution, which had been proposed at the last meeting, then came up for discussion.

The first amendment was that the socalled members by application should be such members of State, county, or district societies as should present a certificate of good standing. They should have all the rights and privileges of permanent members, and should retain these privileges under the same conditions as the permanent members adopted.

The second amendment related to the Committee on Publication, and provided that the work of this committee should be undertaken by a board of trustees consisting of nine members, three of whom should be elected annually, to serve for three years. This board should have charge of all records, proceedings, memoirs, and other matters formerly referred to the Committee on Publication, and should also have power to appoint the editor of the Journal. This was adopted.

The third amendment related to the substitution of a general standing committee for the present Committee on Nominations. This committee should consist of two members from each State and Territory, elected by the delegates present at each meeting. One member should be chosen each year to serve

two years. The duty of the committee should be to present the names of the candidates for the various offices, but the committee could not present the name of any of its own members for any office.

The proposal of this amendment gave rise to considerable discussion, some of the speakers fearing that it would result in the formation of a ring, and in the eventual taking away from the members constituting the general body their political rights. It was finally moved, and carried, that the consideration of this amendment be made a special order for the next general session.

In the evening a reception was tendered the members of the Association by the citizens of Cincinnati in the Art Museum at Eden Park.

THURSDAY, MAY 10TH-THIRD DAY.

The general session was called to order by the President at 10 A. M. A communication was received from the Arkansas State Medical Society, containing a series of resolutions condemning the publication of quack advertisements in religious papers, which had been passed by that Society at its last annual meeting. On motion it was resolved that the American Medical Association indorse these resolutions and spread them upon the minutes of this session.

A communication was received from the Philadelphia County Medical Society, inviting the Association to hold its meeting next year in that city. The chairman then presented the report of the Committee on Nominations, in which the following candidates were proposed for election: President-W. W. Dawson, of Ohio; First Vice-PresidentW. L. Schenck, of Kansas; Second VicePresident-Frank Woodbury, of Pennsylvania; Third Vice-President-H. O. Walker, of Michigan; Fourth Vice-President J. W. Bailey, of Georgia; Treasurer-R. J. Dunglison, of Pennsylvania; Secretary-William B. Atkinson, of Pennsylvania; LibrarianC. H. A. Kleinschmidt, of the District of Columbia; Trustees (to fill vacancies)-E. M. Moore, of New York; J. H. Hollister, of Illinois, and J. M. Toner, of the District of

Columbia; Members of the Judicial Council-W. A. Phillips, of Kansas; A. M. Pollock, of Pennsylvania; W. C. Vanbibber, of Maryland; J. F. Hibbard, of Indiana; C. S. Wood, of New York; J. M. F. Gaston, of Georgia; W. H. O. Taylor, of New York, and G. L. Porter, of Connecticut. To deliver the Address on General Medicine at the next annual meeting-William Pepper, of Pennsylvania; Address on General Surgery-P. S. Connor, of Ohio; Address on State Medicine-W. H. Welsh, of Maryland. For the Committee on State Medicine one member was appointed from each State. Sub-committee to fill vacancies that might occur-J. B. Hamilton, William Brodie, and A. Garcelon. The candidates proposed were unanimously elected. It was announced that the Association would hold its next annual meeting in Newport, R. I., on the second Tuesday in June, 1889. Dr. H. R. Storer, of Rhode Island, was appointed Chairman of the Committee of Arrangements.

Dr. E. M. Moore, of Rochester, N. Y., then delivered the annual address on Surgery. He reviewed the history of surgery from the earliest times, showing that many of the supposed novelties were in reality only revivals of the methods of the past. But in one particular more than any other the progress of modern surgery was most remarkable, and it was one of prime and vital importance, upon which the success of operations in greatest measure depends; this was in the treatment of wounds. Progress in the management of amputation wounds may be said to have begun with Paré and his ligature of arteries. At first a limb was amputated by a circular incision, the soft parts and the bone being divided at the same level; then it was thought advisable to cover the bone with integument, and this gave rise to the multiplicity of flaps of all shapes and sizes. The surgeon always had to meet and control hemorrhage, and it was strange to see how nearly the ancients approached the modern methods of hemos tasis without reaching them. A cord was tied tightly around a limb, but it was long before the tourniquet was devised. A num

ber of bandages were wound around a member to expel the blood from it, yet it is only in our own day that the method of bloodless operation has been perfected by Esmarch.

Before the introduction of the ligature amputation wounds were necessarily left open, and the exposed surfaces were covered with all sorts of ointments. Galen, however, favored the application of a coldwater dressing, and Liston revived this method many centuries later, urging its general adoption in vigorous and characteristic language. After the employment of ligatures had superseded all other methods of controlling hemorrhages from the large vessels, attempts were made to secure primary union by immediate closure of the wound; but they were of very doubtful success until the introduction of antiseptic methods. As regards the question of amputation for gangrene, the speaker favored the selection of the red line of demarkation for the site of operation, when possible, and he believed the success was far greater in such cases than when the limb was removed at a higher point. In this he differed from most surgical teachers of the present day, the method being a return to that of ancient times. Gunshot wounds were formerly regarded with the utmost dread, it being supposed that the leaden bullet was an active poison; but, since the adoption of thorough antiseptics in wound treatment, surgeons had lost much of their fear in dealing with these injuries. In the matter of operations upon the abdominal cavity the same changes had taken place. It was no longer thought that the surgeon who dared to remove an ovarian tumor was no better than a murderer, for to such a degree of perfection had the methods of dealing surgically with the peritoneum been brought, that the mortality following laparotomy was now below that attending any other capital operation. Surgeons no longer dreaded to touch the peritoneum, for they had learned by experience that it was not injury that this membrane resented so much as it was dirt. Thorough and absolute cleanliness was the