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Complete Series, Vol. XVI.

the broader field, while, by no means, a minor interest would be for those engaged in more special work. There has been no subject presented of such close limitations that one, no matter how narrow his special work might be, could not profitably devote an evening for its consideration. The personality of those taking part in the discussions has received even more painstaking care. To limit the garrulous, to restrain the needlessly argumentative, to eliminate the repetition of statements already accepted, and, most important of all, that the discussion shall be representative and of a high order, and worthy of the paper, has been by no means an easy task in its accomplishment. The medical or surgical exploitations, the extravagances of statement or of results, the conclusion based upon insufficient premises or misinterpreted bases, have been conspicuously absent. This Association has never been treated to a discussion upon "how to sew up a gastric neurosis," which might be interpreted as a commentary upon the inefficiency of a common school education or the unwitting audacity of crass medical ignorance. An extension of the plan which has hitherto prevailed and which the character and attainment of the membership of this Association warrants the attempt, is the presentation of the facts-what we really know about certain subjects. Such subjects might be those to which much attention is given in the lay press. It is unnecessary to mention that this exploitation of men and methods has often been hysterical, frequently misleading and sometimes intentionally so, generally but little, if any, better than that of the advertising charlatan, and altogether improper for professional gentlemen. The purpose of this exploitation is obvious; its results unfortunate for the health of the

New Series, Vol. V., No. 3.

lay public and for the credit of the profession. As some of these pseudo-scientists and fantastic therapeutists are quasireputable practitioners, the evil which they do is correspondingly increased. Such subjects readily suggest themselves and very properly can be presented before this Association for judgment which shall be final at the time of its presentation. The Year Book of scientific work which the Association has published-if this last suggestion be adopted and followed-will become even more valuable and more eagerly sought after by those not members, than before. This record compensates, to some extent, the loss which unavoidable absence from a meeting entails, and will undoubtedly be an additional attraction for those who are to comprise the new class of membershipthe non-resident.

The social features that have always been prominent, not only in the regular, but as well in the special Borough meetings, have subserved a double purpose, not only to promote a better acquaintance in our membership and a consequently better understanding of the man and his attainments, but to enable the distinguished visitors to the Association to be more completely our guests and feel themselves more cordially welcome.

Such have been our aims, and the imitation of our methods by other medical organizations is certainly positive, if not entirely disinterested evidence of our success in attaining the present high standard of this Association along the three lines which have already been indicated.

In reading recently the Journal Intime, under date of September 6, 1851, the inimitable work of Henri-Frédéric Amiel, I found the following impressions recorded after a critical study of de Tocqueville's

Democracy in America: "This book has on the whole a calming effect on the mind, but it leaves a certain sense of disgust. It makes one realize the necessity of what is happening around us and the inevitableness of the goal prepared for us; but it also makes it plain that the era of mediocrity in everything is beginning, and mediocrity freezes all desire. Equality engenders uniformity, and it is by sacrificing what is excellent, remarkable and extraordinary that we get rid of what is bad. The whole becomes less barbarous, and at the same time more vulgar.

"The age of great men is going; the epoch of the ant-hill, of life in multiplicity, is beginning. The century of individualism, if abstract equality triumphs, runs a great risk of seeing no more true individuals. By continued leveling and division of labor, society will become everything and man nothing.

"As the floor of valleys is raised by the denudation and washing down of the mountains, what is average will rise at the expense of what is great. The exceptional will disappear. A plateau with fewer and fewer undulations, without contrasts and without oppositions, such will be the aspect of human society. The statistician will register a growing progress, and the moralist a gradual decline: on the one hand, a progress of things; on the other, a decline of souls. The useful will take the place of the beautiful, industry of art, political economy of religion, and arithmetic of poetry. The spleen will become the malady of a leveling age.

"Is this indeed the fate reserved for the democratic era? May not the general wellbeing be purchased too dearly at such a price? The creative force which in the beginning we see forever tending to produce

and multiply differences, will it afterward retrace its steps and obliterate them one by one? And equality, which in the dawn of existence is mere inertia, torpor, and death, is it to become at last the natural form of life? Or rather, above the economic and political equality to which the socialist and non-socialist democracy aspires, taking it too often for the term of its efforts, will there not arise a new kingdom of mind, a church of refuge, a republic of souls, in which, far beyond the region. of mere right and sordid utility, beauty, devotion, holiness, heroism, enthusiasm, the extraordinary, the infinite, shall have a worship and an abiding city? Utilitarian materialism, barren well-being, the idolatry of the flesh and of the 'I,' of the temporal and of mammon, are they to be the goal of our efforts, the final recompense promised to the labors of our race? I do not believe it. The ideal of humanity is something different and higher."

This comment upon de Tocqueville, at once a sympathetic and critical student of the conditions in our country, is today largely true, in spite of the development of a small but common plutocracy and an enormous and arrogant proletariat, both undreamed of by that brilliant philosopher of 1840.

The bearing of the conclusions here presented is not alone upon medical organizations such as this Association, but upon the profession as a whole. As for this Association the time was opportune for an organization having for its purpose higher aims and a carefully chosen method for their attainment. The brilliant results achieved, place all questions of this sort beyond argument.

The profession at large, however, if one may so interpret the medical journals, is

by no means secure in attainment or comfortable in existence. That the altruism, for which the medical profession has always been noted, has increased by leaps and bounds, is evident to even the most superficial observer. That this altruism is abused by those unworthy of it and by those who are both unworthy and unappreciative, is equally apparent. The remedy is not easily to be decided upon. Commercialism has been advocated in some quarters; it has doubtless a respectable following in numbers if not in reputation. Its adherents seek to dominate, in fact, do dominate some organizations whose titles are misleading. Thus it is that some exponents of this theory, and those especially whose livelihood is based on border lines in medicine or is clearly parasitic, have set themselves up as leaders to extricate the practitioner from professional duties and lead him into commercial ethics, as if this were either necessary or even desirable if necessary. fortunately, for the lasting success of those self-styled leaders, their previous character and scientific attainments constitute a record which entails a constant warfare of defense against the better elements in the profession. It may be, and undoubtedly is true, that the real value of professional services is today far greater than the ability of the patient to pay for them. It is a fact that the science and art of our practitioners have been advanced in their prac

Un

tical application far more rapidly than has the financial condition of our patients. It is also a fact that the proletariat is extraordinarily reproductive, and is becoming yearly a greater burden not only upon the profession but as well upon the State. But the remedy is not a trades union so earnestly advocated by one whose right to be a member, much less a leader, of the profession,

is openly and successfully challenged. It does not lie in any scheme whereby professional defectives may impede medical progress. The Darwinian theories have been largely accepted by the medical profession as they should be applied by its members. The remedy lies in the adoption of such methods as will enable the profession to give better service to the people; a service that is so eminently scientific that its results shall be apparent to all intelligent patients. From these, having received the best of professional science, will come proper material appreciation. The ignorant and unappreciative are properly satisfied with the work of charlatans in or out of the profession. It is true that commercialism is rampant in the land. Its influence has been felt in our profession for the number of students entering the schools is diminishing and, unfortunately, there is greater proportional loss in institutions whose entrance requirements are highest, whose instruction is most advanced and

thorough, whose final tests are the most exacting, and, finally, whose equipment is of the best. But so long as medicine continues to be the noblest of professions, the best trained and equipped intellects and the noblest characters will be attracted to it. When it becomes the most despicable of trades this Association will have ceased to exist.

This Association does not find the motive for its existence in the dreary level of mediocrity, as de Tocqueville intimated and Amiel concluded, but in an earnest and

successful effort to create a medical aristocracy, in membership, scientific work and social relations; an Association of scientific gentlemen for the uplifting of a gentlemanly science.

, 1910

, Vol. V.,

As an elective member of the Council of this Association for the past ten years, I understand the assiduous attention and distinguished ability which my predecessors have given to and shown in this office. As I am about to assume this office I appreciate, as never before, the brilliant results which they have achieved. And while I am deeply sensible of honor conferred upon me, I cannot but realize that I am the legatee of a remarkable past and the trustee of a promising future. I know that the loyal and intelligent co-operation of the Council has always been extended to its presiding officer, and that the members of this Association have always given it most earnest support. Relying upon the history of the past as rendering an assured future, in all humility, I pledge you that, to the best of my ability, I will maintain the high standards of this organization, working faithfully and conscientiously with the Council and for each member of this Association.

679 Madison Avenue, New York City.

THE ELOQUENCE OF INFANCY.1

BY

LEGRAND KERR, M. D.,

Visiting Pediatrist to the Methodist Episcopal (Seney) Hospital; to the Williamsburgh Hospital and to the Swedish Hospital in Brooklyn; Consulting Pediatrist to the E. N. Y. Dispensary.

In the standard dictionary, one of the definitions of "eloquence" is the quality of being eloquent or of moving the mind. We

are then concerned with a definition which embodies two propositions; the quality of using eloquent speech and the quality of

'Read before the Medical Association of the Greater City of New York, on February 14th, 1910.

moving the mind. Mere eloquence of speech requires nothing but a thinking and feeling personality alive to some definite proposition and with the ability to thrust the thought eloquently forward into the spoken word.

And much of that which is spoken is lifted from the grade of the commonplace and elevated to the realm of eloquence by the tone of the voice, the pauses, the gestures, the expression; in short, by the personality back of the spoken word. However, the quality of moving the mind does not depend upon the spoken word although articulate speech may be an important factor in the process. The sometime quoted "eloquence of silence" is more than mere poetic license, it is the recognition of a most powerful factor in eloquence and may become the direct stimulus which "moves the mind."

This power of moving the mind depends not alone upon the effort put forth to accomplish that object but is influenced to a very large extent by the receptivity of the mind that is to be moved. No degree of eloquence can successfully move the mind that through ignorance, disinterest or antagonism sets itself above such influence and even in those instances in which there is an attempt at co-operation, there must also be an adaptability of the mind receptive to impressions through the influences of a knowledge sufficient to appreciate and understand the full import of what is expressed.

the infant, an intimate knowledge of how and why such expression differs from that of adult life.

The diagnosis of disease in infancy offers difficulties and peculiarities which are not patent in the adult. The idea that the infant is an adult in miniature is a false one; the infant bears to the adult a relation of

potentiality; nothing more. A complete description of all the changes in the economy which mark the infant from the adult would include each element of mental

Of

must interest us, for it is this that leads to the varied expression of disease. prime importance in the study of any disease is the accuracy with which a diagnosis. may be made. In infancy this entails that we must be acquainted with facts about the infant which have no direct bearing upon the disease present, but which must often modify or entirely change our usual interpretation of symptoms. For instance, we are always conscious of the insignificant influence of the mind upon disease in in

knowledge of these differences shows to one the error of attempting to apply exactly the same methods of diagnosis as are suited to adult life.

The clinical manifestations of disease in infancy and in maturity are vastly different; it is this difference that makes the appreciation of disease in the infant difficult. The familiar things which are used as the foundation for building up the superstructure of diagnosis in the adult are in infants entirely absent, or are so totally different that they are misleading. In approaching the infant the inexperienced are at once confronted with a sense of loneliness similar to that which overcomes the stranger in a strange land; a land in which there are few familiar scenes and none to guide.

It would be impossible in the time allotted to me to consider in detail all of the phases of this subject but the purpose of this paper will be conserved if I am able to attract practical attention to the fact that "Babies talk, but few understand the language."

While there are many of the diseases which are peculiar to the period of life known as infancy, it is the peculiarity of the patient as much as the disease which

preciably limited by the fact that psychic neurotic influences are almost excluded.

The various tissues may also be incapable of exhibiting phenomena which are the result of certain etiological factors, or in their immaturity they may respond more easily. and certainly to other factors. And again, even in the presence of a definite symptomatology, the reasoning and deduction as to its cause must be entirely distinct from the same processes as they apply in adult life. For instance, the very young infant is comparatively free from convulsive seizures, because during the first three months of life, the acute systemic bacterial toxaemias, which are potent factors in the etiology of convulsions, are infrequent. Then again, stimulation of the cortical motor centres and of the convulsive centres at the base of the brain does not excite convulsive movement easily, because the nerve force discharged from these centres is hindered in its dissemination by the underdevelopment of the myelin sheaths of the fibres of the pyramidal tracts. These sheaths are gradually developed so that about the third or fourth month of life the pyramidal tracts have their functions sufficiently developed to bring the spinal cells and the cerebral convulsive centres into close touch.