the broader field, while, by no means, a lay public and for the credit of the profesminor interest would be for those engaged sion. As some of these pseudo-scientists in more special work. There has been no and fantastic therapeutists are quasisubject presented of such close limitations reputable practitioners, the evil which they that one, no matter how narrow his special do is correspondingly increased. Such subwork might be, could not profitably devotejects readily suggest themselves and very an evening for its consideration. The per- properly can be presented before this Assonality of those taking part in the discus- sociation for judgment which shall be final sions has received even more painstaking at the time of its presentation. The Year care. To limit the garrulous, to restrain Book of scientific work which the Associathe needlessly argumentative, to eliminate tion has published—if this last suggestion the repetition of statements already ac- be adopted and followed—will become even cepted, and, most important of all, that the more valuable and more eagerly sought discussion shall be representative and of a

after by those not members, than before. high order, and worthy of the paper, has This record compensates, to some extent, been by no means an easy task in its ac- the loss which unavoidable absence from a complishment. The medical or surgical ex- meeting entails, and will undoubtedly be ploitations, the extravagances of statement an additional attraction for those who are or of results, the conclusion based upon in- to comprise the new class of membershipsufficient premises or misinterpreted bases,

the non-resident. have been conspicuously absent. This As

The social features that have always been sociation has never been treated to a dis- prominent, not only in the regular, but as cussion

upon “how to sew up a gastric well in the special Borough meetings, have neurosis," which might be interpreted as a subserved a double purpose, not only to commentary upon the inefficiency of a com- promote a better acquaintance in our memmon school education or the unwitting bership and a consequently better underaudacity of crass medical ignorance. An standing of the man and his attainments, extension of the plan which has hitherto but to enable the distinguished visitors to prevailed and which the character and at- the Association to be more completely our tainment of the membership of this Associa- guests and feel themselves more cordially tion warrants the attempt, is the presenta- welcome. tion of the facts--what we really know Such have been our aims, and the imitaabout certain subjects. Such subjects tion of our methods by other medical ormight be those to which much attention is ganizations is certainly positive, if not engiven in the lay press. It is unnecessary tirely disinterested evidence of our success to mention that this exploitation of men and in attaining the present high standard of methods has often been hysterical, frequently this Association along the three lines which misleading and sometimes intentionally so, have already been indicated. generally but little, if any, better than that In reading recently the Journal Intime, of the advertising charlatan, and altogether under date of September 6, 1851, the inimproper for professional gentlemen. The imitable work of Henri-Frédéric Amiel, I purpose of this exploitation is obvious; its found the following impressions recorded results unfortunate for the health of the after a critical study of de Tocqueville's

us

Democracy in America: “This book has and multiply differences, will it afterward on the whole a calming effect on the mind, retrace its steps and obliterate them one but it leaves a certain sense of disgust. It by one? And equality, which in the dawn makes one realize the necessity of what is of existence is mere inertia, torpor, and happening around and the in- death, is it to become at last the natural evitableness of the goal prepared for us;

form of life? Or rather, above the ecobut it also makes it plain that the era of nomic and political equality to which the mediocrity in everything is beginning, and socialist and non-socialist democracy asmediocrity freezes all desire. Equality en- pires, taking it too often for the term of genders uniformity, and it is by sacrificing its efforts, will there not arise a new kingwhat is excellent, remarkable and extraor- dom of mind, a church of refuge, a republic dinary that we get rid of what is bad. The of souls, in which, far beyond the region whole becomes less barbarous, and at the of mere right and sordid utility, beauty, desame time more vulgar.

votion, holiness, heroism, enthusiasm, the “The age of great men is going; the extraordinary, the infinite, shall have a worepoch of the ant-hill, of life in multiplicity, ship and an abiding city? Utilitarian is beginning. The century of individualism, materialism, barren well-being, the idolatry if abstract equality triumphs, runs a great

of the flesh and of the 'I,' of the temporal risk of seeing no more true individuals. and of mammon, are they to be the goal of By continued leveling and division of labor, our efforts, the final recompense promised

, society will become everything and man to the labors of our race? I do not believe nothing

it. The ideal of humanity is something dif“As the floor of valleys is raised by the ferent and higher.” denudation and washing down of the This comment upon de Tocqueville, at mountains, what is average will rise at the once a sympathetic and critical student of expense of what is great. The exceptional the conditions in our country, is today will disappear. A plateau with fewer and largely true,

largely true, in spite of the development fewer undulations, without contrasts and of a small but common plutocracy and an without oppositions, such will be the as- enormous and arrogant proletariat, both unpect of human society. The statistician dreamed of by that brilliant philosopher of will register a growing progress, and the 1840. moralist a gradual decline: on the one hand, The bearing of the conclusions here prea progress of things; on the other, a de- sented is not alone upon medical organicline of souls. The useful will take the zations such as this Association, but upon place of the beautiful, industry of art, po- the profession as a whole. As for this Aslitical economy of religion, and arithmetic sociation the time was opportune for an orof poetry. The spleen will become the ganization having for its purpose higher malady of a leveling age.

aims and a carefully chosen method for "Is this indeed the fate reserved for the their attainment. The brilliant results democratic era? May not the general well- achieved, place all questions of this sort bebeing be purchased too dearly at such a yond argument. price? The creative force which in the be- The profession at large, however, if one ginning we see forever tending to produce may so interpret the medical journals, is

ress.

by no means secure in attainment or com- is openly and successfully challenged. It fortable in existence. That the altruism, does not lie in any scheme whereby profesfor which the medical profession has always sional defectives may impede medical progbeen noted, has increased by leaps and

The Darwinian theories have been bounds, is evident to even the most super- largely accepted by the medical profesficial observer. That this altruism is abused sion as they should be applied by its memby those unworthy of it and by those who bers. The remedy lies in the adoption of are both unworthy and unappreciative, is such methods as will enable the profession equally apparent. The remedy is not easily

to give better service to the people; a servto be decided upon. Commercialism has

ice that is so eminently scientific that its been advocated in some quarters; it has results shall be apparent to all intelligent doubtless a respectable following in num

patients. From these, having received the bers if not in reputation. Its adherents seek

best of professional science, will come to dominate, in fact, do dominate some or

proper material appreciation.

The igganizations whose titles are misleading.

norant and unappreciative are properly satThus it is that some exponents of this the

isfied with the work of charlatans in or ory, and those especially whose livelihood is

out of the profession. It is true that combased on border lines in medicine or is

mercialism is rampant in the land. Its inclearly parasitic, have set themselves up as

fluence has been felt in our profession for leaders to extricate the practitioner from

the number of students entering the schools professional duties and lead him into com

is diminishing and, unfortunately, there is mercial ethics, as if this were either necessary or even desirable if necessary.

greater proportional loss in institutions Un

whose entrance requirements are highest, fortunately, for the lasting success of those

whose instruction is most advanced and self-styled leaders, their previous character and scientific attainments constitute a record

thorough, whose final tests are the most exwhich entails a constant warfare of de- acting, and, finally, whose equipment is of fense against the better elements in the

the best. But so long as medicine continues profession. It may be, and undoubtedly is

to be the noblest of professions, the best true, that the real value of professional

trained and equipped intellects and the services is today far greater than the ability

noblest characters will be attracted to it. of the patient to pay for them. It is a

When it becomes the most despicable of fact that the science and art of our prac

trades this Association will have ceased to titioners have been advanced in their prac

exist. tical application far more rapidly than has

This Association does not find the mothe financial condition of our patients. It

tive for its existence in the dreary level is also a fact that the proletariat is extra

of mediocrity, as de Tocqueville intimated ordinarily reproductive, and is becoming and Amiel concluded, but in an earnest and yearly a greater burden not only upon the

successful effort to create a medical aristocprofession but as well upon the State. But racy, in membership, scientific work and the remedy is not a trades union so earnestly social relations; an Association of scientific advocated by one whose right to be a mem- gentlemen for the uplifting of a gentlemanly ber, much less a leader, of the profession, science.

a

As an elective member of the Council of moving the mind. Mere eloquence of this Association for the past ten years, I speech requires nothing but a thinking and understand the assiduous attention and dis- feeling personality alive to some definite tinguished ability which my predecessors proposition and with the ability to thrust have given to and shown in this office. As I the thought eloquently forward into the am about to assume this office I appreciate, spoken word. as never before, the brilliant results which And much of that which is spoken is they have achieved. And while I am deeply

And while I am deeply lifted from the grade of the commonplace sensible of honor conferred upon me, I can- and elevated to the realm of eloquence by not but realize that I am the legatee of a the tone of the voice, the pauses, the gesremarkable past and the trustee of a promis- tures, the expression; in short, by the pering future. I know that the loyal and in- sonality back of the spoken word. Howtelligent co-operation of the Council has al

ever, the quality of moving the mind does ways been extended to its presiding officer, not depend upon the spoken word although and that the members of this Association articulate speech may be an important fachave always given it most earnest support. tor in the process. The sometime quoted

. Relying upon the history of the past as "eloquence of silence" is more than mere rendering an assured future, in all humility, poetic license, it is the recognition of a I pledge you that, to the best of my ability, most powerful factor in eloquence and may I will maintain the high standards of this become the direct stimulus which “moves organization, working faithfully and con- the mind." scientiously with the Council and for each This power of moving the mind depends member of this Association.

not alone upon the effort put forth to ac679 Madison Avenue, New York City. complish that object but is influenced to a

very large extent by the receptivity of the

mind that is to be moved. No degree of THE ELOQUENCE OF INFANCY.1 eloquence can successfully move the mind

that through ignorance, disinterest or an

tagonism sets itself above such influence and LEGRAND KERR, M. D.,

even in those instances in which there is an Visiting Pediatrist to the Methodist Episcopal (Seney) Hospital; to the Williamsburgh

attempt at co-operation, there must also be Hospital and to the Swedish Hospital

an adaptability of the mind receptive to imin Brooklyn; Consulting Pediatrist pressions through the influences of a to the E. N. Y. Dispensary.

knowledge sufficient to appreciate and In the standard dictionary, one of the

understand the full import of what is exdefinitions of "eloquence” is the quality of

pressed. being eloquent or of moving the mind. We

Then if we are to secure the full benefits are then concerned with a definition which

of the quality that moves the mind, there embodies two propositions; the quality of

must be application of the laws of adaptausing eloquent speech and the quality of

tion, co-operation and definiteness. This

entails upon the physician who would 'Read before the Medical Association of the Greater City of New York, on February 14th,

properly understand and correctly interpret 1910.

the inarticulate expressions of disease in

BY

a

the infant, an intimate knowledge of how must interest us, for it is this that leads and why such expression differs from that to the varied expression of disease. Of of adult life.

prime importance in the study of any disThe diagnosis of disease in infancy offers ease is the accuracy with which a diagnosis difficulties and peculiarities which are not may be made. In infancy this entails that patent in the adult. The idea that the in

we must be acquainted with facts about the fant is an adult in miniature is a false one;

infant which have no direct bearing upon the infant bears to the adult a relation of

the disease present, but which must often potentiality; nothing more. A complete

modify or entirely change our usual interdescription of all the changes in the econ

pretation of symptoms. For instance, we

are always conscious of the insignificant omy which mark the infant from the adult would include each element of mental

influence of the mind upon disease in inand physical growth. But even a general fancy for the diagnostic possibility is ap

preciably limited by the fact that psychic knowledge of these differences shows to one

neurotic influences are almost excluded. the error of attempting to apply exactly the

The various tissues may also be incapable same methods of diagnosis as are suited to

of exhibiting phenomena which are the readult life.

sult of certain etiological factors, or in their The clinical manifestations of disease in

immaturity they may respond more easily infancy and in maturity are vastly different; it is this difference that makes the appreci

and certainly to other factors. And again,

even in the presence of a definite sympation of disease in the infant difficult. The

tomatology, the reasoning and deduction as familiar things which are used as the foundation for building up the super

to its cause must be entirely distinct from

the same processes as they apply in adult structure of diagnosis in the adult are in

life. For instance, the very young infant infants entirely absent, or are so totally dif

is comparatively free from convulsive seizferent that they are misleading. In ap

ures, because during the first three months proaching the infant the inexperienced are

of life, the acute systemic bacterial at once confronted with a sense of loneli

toxaemias, which are potent factors in the ness similar to that which overcomes the

etiology of convulsions, are infrequent. stranger in a strange land; a land in which

Then again, stimulation of the cortical there are few familiar scenes and none to

motor centres and of the convulsive centres guide.

at the base of the brain does not excite conIt would be impossible in the time al

vulsive movement easily, because the nerve lotted to me to consider in detail all of the force discharged from these centres is phases of this subject but the purpose of hindered in its dissemination by the underthis paper

will be conserved if I am able to development of the myelin sheaths of the attract practical attention to the fact that fibres of the pyramidal tracts. These "Babies talk, but few understand the

sheaths are gradually developed so that language."

about the third or fourth month of life the While there are many of the diseases pyramidal tracts have their functions sufwhich are peculiar to the period of life ficiently developed to bring the spinal cells known as infancy, it is the peculiarity of and the cerebral convulsive centres into the patient as much as the disease which close touch.