one hundred members, and the Club has subscribed to more journals for the Library than the Library Committee. This is an excellent way of helping ourselves. The club should next year have at least two hundred members, and present one thousand dollars worth of new books and journals. And lastly, many of you can help by filling out our imperfect sets of native and foreign journals. Will not one or two of our gynecological brethren take the trouble to look into the defects in the journals in their department? A little money spent quietly in this way will lighten their pockets and their hearts. There are gaping gaps which our surgeons might bridge over. A little personal interest on the part of the members will be much appreciated.

I envy Charles Frick the good fortune to go down to the future generations in this Faculty with his name linked to an important section of our Library. Posthumously and by proxy, as it were, thus to carry on, though dead, the work he was interested in while living is the nearest approach a man can make to cheating the great enemy; and in Charles Frick's case it is in a measure a compensation for the untimelinesss of his taking off. It is proposed to make the Frick Library the strictly medical section, in contradistinction to general surgery, and obstetrics and gynecology. How suitable it would be to connect also other departments with names of men who deserve such recognition. Than this there is no more appropriate way to perpetuate an honored name in our ranks. The College of Physicians of Philadelphia has set a good example in the Samuel Lewis and the S. D. Gross Libraries, which are so successfully kept up-the one in general medicine, the other in surgery.

To encourage others, I would like to refer to the splendid bequests which Nicholas Senn has made to the profession of Chicago. Many years ago he purchased the Library of Prof. Baum of Göttingen, containing some sixteen thousand volumes and pamphlets, which he presented to the Newberry Library for the use of the physicians of Chicago,

and now this year he has added the splendid scientific library of the late Prof. Du Bois Reymond.

Increased privileges and facilities bring necessarily increased responsibilities, of which the future holds for us a goodly store. Two years will bring around the centennial of the founding of the Faculty, an occasion which should be made memorable in a very special way. There is, as you know, a small indebtedness on account of this building, a mere bagatelle to the profession of a city of half a million. This must be met, and certainly the centennial celebration of this organization is an epoch important enough to demand a larger effort, for which the payment of the small debt will prove useful training. The Executive Committee has a plan, which it will bring before the members at an early date, asking them to subscribe. varying sums for the years 1897, 1898 and 1899, to pay off our mortgage. A few may be relied upon to give two hundred dollars a year for the three years, from a larger number we hope for one hundred dollars, others will give fifty dollars, some twenty-five dollars, and a large number ten dollars. We hope not only to pay off the debt, but to leave a balance.

May I say a word on the art of giving? The essence is contained in the wellknown sentence, "let every man do according as he is disposed in his heart, not grudgingly or of necessity." scriptions to a cause which is for the benefit of the entire profession should truly be given as a man is disposed in his heart, not in his pocket, and assuredly not of necessity, but as a duty, even as a privilege, and as a pleasure. Some of us, the younger men, cannot give. The days of travail and distress are not yet over, and to give would be wrong. It is sufficient for such to have the wish to give; the elder brothers will bear your share; only be sure to foster those generous impulses, which are apt to be intense in direct proportion to the emptiness of the purse.

Upon a second group we must chiefly depend-the men of moderate incomes, who have a balance, however small, at

the end of the year. To devote a fraction of this to the needs of the profession by which they live is, on the lowest motives, good policy, on the highest, a delightful privilege.

Beyond a modest competency the sen. sible doctor does not aspire, but in the profession of every State there is a third group, composed of a few men who, dry-nursed by us, sometimes by the public, have become prosperous, perhaps wealthy. Freely they have received, freely they should give. It must be acknowledged, however, that the admonition of Sir Thomas Browne "should your riches increase, let your mind keep pace with them" is not always regarded by the men of this group. We have seen a good deal of late years in the papers about the large fortunes left by doctors; but it has not been a pleasant feature to note, with scarcely an exception, either an entire neglect or a very beggarly remembrance of the profession in which these men had at any rate laid the foundation of their large fortunes.

The sum required is not large, and we may confidently hope that the Committee who will have it in charge will within a few weeks obtain promises more than sufficient to meet it. If we make this little effort ourselves, we can try in the centennial year to obtain a proper endowment for the Faculty from our friends among the citizens. We shall need a larger hall, more in keeping with the rank and work of the profession of this city-quarters as complete as our brethren enjoy in Philadelphia and New York; and an endowment yielding a few thousand dollars annually is absolutely essential for the proper development of the Library. I would offer as a suggestion that a committee on

BROMIDE OF ETHYL IN HYSTERICAL APHONIA.

ARSLAN (British Medical Journal) reports five cases of hysterical aphonia in women treated with success by bromide of ethyl. The patients were rapidly anesthetized with full doses (10 g.) of the drug, and as soon as they were

finance be appointed to take charge of the matter. It would be well subsequently to have a permanent finance committee.

And lastly, I would call the attention of the members to the fact that we are working under a somewhat antiquated and very much patched up set of bylaws. If you turn to the last year's transactions you will find between five and six pages of resolutions, amendments, etc., affecting the Constitution, from 1885 to 1896 (inclusive). There are also anomalies in the constitution which might be amended; thus the examining boards for the Eastern and Western Shores, respectively, have no longer any vital status in our organization since the license is no longer granted by the Faculty. They might be replaced by a committee for the examination of the credentials of candidates for membership. I would suggest that a committee take charge of this whole matter, to report next year on the necessary changes, and give notice of motion for any alterations in the constitution which are deemed advisable; then in 1899, our centennial year, the constitution, by-laws, etc., could be all clearly and definitely presented for discussion and adoption and distributed. to the members.

In conclusion, may I paraphrase those noble words of Aristotle, in which he laid down the duty of the citizen to the State, as also peculiarly appropriate in defining the obligations of the doctor to his calling. No physician has a right to consider himself as belonging to himself; but all ought to regard themselves as belonging to the profession, inasmuch as each is a part of the profession; and care for the part naturally looks to care for the whole.

partly insensible, it was suggested that they should shout loudly their name, count numbers, etc. The results obtained by this method were satisfactory. In four of the cases there was evidence of disease in the naso-pharynx. In three cases influenza was an exciting factor.

WHAT is the true object of the practice of medicine?

To prolong life.
To relieve suffering.
To prevent disease.
To cure disease.

If we contrast the life of our day with the life of any previous period we can safely say that people live longer, or have a chance to live longer; that pain is more remediable; that many diseases can be prevented, or avoided, but can we say that more sick people are cured? Does medicine advance?

The answer varies according to the four objects to be attained. What has this century given us that is wholly new?

In 1840, the law of zymosis, or fermentation, by Dr. Farr.

In 1846, anesthesia, by Dr. Morton. In 1850, the demonstration of a bacillus (of anthrax) by Davaine.

In 1858, the law that fermentation and putrefaction are due to micro-organisms by Pasteur.

In 1865, antisepsis, by Lister.

Later the differentiation of germs by Koch; the cultivation of germs; the study of their noxious products, or ptomaines; the antitoxines; the migration. of the white cell in inflammation; the leucocytosis of suppuration; the functions of the elements of the blood; subcutaneous therapeusis; sanitary science; the conquest of epidemics. Why lengthen the list?

And all this in fifty-seven years. Hippocrates advocated pure air, pure water and a pure soil, as the requisites of health. Now we have learned why air may become impure, how water becomes infected with water-borne diseases; by what means to cleanse the soil. Does medicine advance? Our medical ancestors based their practice on, first, observation; second, experience.

The modern physician relies on, first, experiment; second, observation.

As the science of medicine advances thus and thus only, may the art progress. What is the science of medicine? What does it grow from? Chemistry, anatomy, physiology, pathology, bacteriology.

What constitutes the art of medicine? Therapeusis, chirurgery, obstetrics. Who can question the advance of chemistry; of microscopic anatomy; of physiology by vivisection; of pathology and bacteriology and the flood of light they shed upon the nature and the study of disease?

The Roman physician described the dates and the varieties, the habitat and the peculiarities of malarial diseases as accurately as we can now. The use of arsenic, or the Jesuits' bark, was well known to control them. But why some were quotidian, some tertian and some quartan, we were as ignorant of as the Roman, until the microscope discovered the germ of malaria in the blood and showed that its periods of growth by fissure marked out the access of chills into one, three, or four days interval. What are the eras of medicine? Observation by Hippocrates. Polypharmacy by Galen.

Experiment by Bacon and Hunter. A reliance on nature by Sydenham. The school of precision by Louis. Prevention by Jenner. Aggressive therapeusis by modern. scientists.

When men depend on observation, unaided by scientific instruments, they remain acute observers. The eye of the savage has a range of vision beyond that of the civilized man. The microscope prolongs our sight, but dulls the natural power. Hippocrates observed the phenomenon of disease and gained

probably as good an idea of practical facts as we do now. From Hippocrates to the Humoralists of the Middle Ages the blood has been accused of being the focus of disease. Bleeding, coup sur coup, was supposed to eliminate the materies morbi, although the often irremediable loss of fibrin and red corpuscles was soon replaced by serum from the tissues. Now, transfusions of blood or of salt solutions indicate the turning of the scale upwards rather than downwards, and a new supply takes the place of depletion.

The modern study of the elements of the blood and the counting of corpuscles mark the change which the microscope has introduced into this part of our art. These are the greatest improvements since the demonstration of the circulation by Harvey.

Polypharmacy has had a long reign and is still vigorous in its old age. Synthetical remedies supplied by modern chemistry tend to keep up the delusion that many drugs will do more than few, or none; and the search for specifics still continues.

Experiment, the vexatio naturae of Bacon, has induced a great advance in medical practice. To Bacon is due the inductive method of reasoning. While. While the study of medicine is wholly by observation, the practice of medicine is the result of experiments. Medical science is then strictly inductive. But theories of medicine may lead to deductions and often to false ones. Observation is what we learn by using our

senses.

Experiment is the trial of anything. Induction is to generalize from observation and experiment. For example: Watt observed that boiling water turned into steam; that steam lifted the cover of a kettle; he experimented to see if it would move other objects; by induction he generalized the law of the expansion of steam. John Hunter was an earnest advocate of experiment. All theorists. say to the practitioners at the bedside: "Do not try, but think, reason, deduce." Empirical Hunter said: "Do not think, but try." Pasteur and Koch, aided by vivisection, have carried ex

periment farther than its authors could have deemed possible.

Experimental physiology, by proving the effects of drugs on the lower animals aided by, experiments on the normal respiration, temperature and digestive powers of such animals, has enlarged the list of remedies, defined and limited their use. Chemistry, too, has rendered valuable aid in therapeusis by separating the cleanly and active alkaloid from the useless bulk of nauseous drugs.

A reliance on nature's restorative powers, advised by Sydenham, gave rise to the expectant treatment. To wait and watch; to do no harm, if no good; therapeutic nihilism were still more enforced by the teaching of the elder Bigelow on self-limited diseases. That disease was not an entity distinct from ordinary life, but a process capable of a spontaneous return to health, in time, and in a more or less certain time. Such doctrines, carried farther, considered disease a part of the plan of creation, as Cotting suggested. "Naturâ duce" was the motto of the expectant school.

The natural history of disease and diagnosis assumed the chief importance. These were the prevailing methods when the writer entered the profession. Drugs were of doubtful utility; experiment was not stimulated by such doctrines. The medical atmosphere of those times was cloudy and not encouraging. Now arose the school of precision headed by Louis and his statistical methods.

Statistics have, however, been shown to be not free from fallacy. The personal equation of the observer is often fatal to the accuracy of statistics. The eye sees only that which it has the power of seeing. Previous knowledge and particular training, as well as common sense, are necessary to the correct observation of any class of phenomena. We are the standard by which we must judge of external nature, and observation must always vary with the character of the observer.

Two instruments of precision had now appeared and were destined henceforward to exercise the most important influence on medicine. One was the com

pound microscope; the other the clinical thermometer. The microscope revealed disease in the tissues; the thermometer measured accurately fever and chill. All doctors could learn the tongue; all could estimate the pulse; but bodily temperature has proved to be a more definite guide. The stethoscope, the laryngoscope, and, above all, the ophthalmoscope, displayed fields. before unseen and revealed changes which before must be guessed at.

Prevention of disease was a brilliant thought and a long stride forwards. To Jenner must be freely accorded the first successful attempt at prevention by his discovery of vaccination. Many others have followed with antitoxines, or serum therapy, as Pasteur, Koch, Behring.

Prevention by sanitation, or hygiene, comes forward next into view. The pure air, water and soil of Hippocrates are again studied and the most assured improvements in longevity have been brought about by purifying the air, filtering the water and draining the soil. Freeing the food from adulteration and from the germs of disease are best exemplified in the care of the milk supply and of pork.

All this is new. It was unheard of in the middle ages and even later, when one disease, due to heat and overcrowding, arose, the "sweating sickness," or miliary fever. This malady has disappeared under modern sanitation. It is, I believe, the only disease which has vanished out of human existence. All the other germs and poisons remain, even the bubonic plague of Thucidydes, Bocaccio and DeFoe.

The miliary fever raged epidemically. In this disease there was a natural sweat; and this was seized upon as the grand indication of treatment.

Who

ever, when seized, wished to escape death, must perspire for twenty-four hours without intermission. Hecker, in his "Epidemics of the Middle Ages," thus states the treatment :

"So they put the patient instantly to bed, covered them with feather beds and furs and whilst the stove was heated to the utmost, closed the doors and win

dows with the greatest care, to prevent all access of cool air. In order, moreover, to prevent the sufferer, should he be impatient, from throwing off his load, some person in health likewise lay upon him, and oppressed him to such a degree, that he could neither stir hand nor foot; and, finally, in this rehearsal of hell, being bathed in an agonizing sweat, he gave up the ghost." This pestilence, miliary fever, visited almost every puerperal chamber, for there a like hot regimen was carried out.

Immunity now appears as a new treatment of disease. Syphilization, inoculation of rabies; of tetanus; of diphtheria. The last named so general and so fatal a disease, that prevention, or abortive inoculation, has already secured a more brilliant success than any measure since the days of Jenner. Antisepsis and germicides also come in to play an extremely important rôle in sanitation.

Finally, aggressive therapeusis, as we will term it, has taken the place of expectancy. True, we still wait on nature, but we also attack disease. We explore the cell for the germ; we isolate, locate, abort, eliminate the germ, which is present in each malady and which affects, if it does not wholly cause it. It is evident that chemistry and bacteriology must here do far more than drugs. We can destroy the vitality of the comma bacillus, the milk or waterborne typhoid germ, and the trichina of pork by simple heat. Other varieties we attack by chemical solvents, and by inoculations of their products in socalled antitoxines.

It is questionable, however, whether all our modern methods are sanative. Antifebrin, antipyrin, and the long list of febrifuges, aim to reduce fever rapidly. On the other hand, nature's method is to cause, first, perspiration, which may eliminate morbid elements; and, second, evaporation, which cools. gradually. Some contend that fever is a germicide and hence salutary; while the rapid reduction of temperature by the drugs alluded to is accompanied by depression of the heart and the vitality.

Can we cure more diseases? Let us