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of which the members of our Association are specially devoted.Even in the presence of those who, by their co-operation inour proceedings, are about to shed a lustre over the celebrationof this our thirty-fifth anniversary, I may be permitted to saythat, though at all times, and in every department of profes-sional study, Ireland’s sons have ever occupied a foremostplace, at no period could she boast a nobler array of eminentmen than those who adorn our programme, and whose namesare destined to be transmitted to future generations as worthysuccessors of the greatest of those who have preceded them.Gentlemen, the Parliament of the United Kingdom is about to- conclude the most important session our common country hasever known. We, on the contrary, are entering upon thelabours-the agreeable labours-of the thirty-fifth session ofwhat may be justly termed the British Medical Parliament;and on no previous occasion has the profession been more fullyrepresented. Thanks to the energy and hearty goodwill ofour hosts; to the love and esteem felt for the veteran teacherwho is about to preside over us; to the fame and ability of thereaders of the addresses, and to others of our patres conscriptiwho have come forward to favour us with contributions; tocrown all, thanks to the warm welcome given us, and to thathospitality which is the national characteristic of Ireland,-ourpresent meeting promises to be truly the meeting of the Asso-ciation ; for our Irish brethren have at last heartily joined ourranks. The present session of the Imperial Parliament willconstitute an era in history; but with regard to the conse-quences of the great measure identified with it, with whateverjustice, grave doubts are expressed. The present session ofour parliament will also mark an era in the history of theBritish Medical Association. (Applause.) But with regard toits results no doubt can for a moment be entertained; for, be-yond all question, the information and conjoint action of theprofession throughout the three kingdoms, now for the firsttime realised, must herald a prosperous future of growth andincreasing beneficial influence. Gentlemen, my most pleasingduty yet remains (for it is not for me to occupy your time)-that is, to thank you for your forbearance with my short-

comings and for the consideration for my efforts which youhave evinced towards me during my year of office. The layingdown of honours is generally associated with something ofregret and something even of pain. Gentlemen, there is notone of you but must feel that on the present occasion I cansincerely declare that with unfeigned and unalloyed pleasureI resign my honoured seat; for I yield it to one who, throughhis benevolence, his courteous bearing, his acquirements, andhis broad philosophic mind, will really do honour to it. Mem-bers of the British Medical Association, it is my proud privi-lege to introduce to you as your president Professor Stokes.Loud applause.)



Mr. PRESIDENT OF THE COUNCIL AND GENTLEMEN.-My firstduty on taking the chair, which, during the past year, has beenso ably filled by Dr. Waters, is to return thanks for the honouryou have conferred on one personally a stranger to most of you,in naming him as your President, on the first visit of theAssociation to Ireland. Your Society is one altogether peculiarin its organization, and in which we recognise the union of theprofession in the three kingdoms for objects that are good andconsequently great. And so we are proud of our institution,proud of it as followers, and, therefore, as teachers of science ;for every man who practices medicine or surgery in a true spirit,is himself at once a learner and a teacher. Yet it is not on this

ground alone that the British Medical Association is to be con-

sidered ; for, from its very beginning, more than a quarter of acentury ago, it has kept other, and in a sense higher, objects inview. It has in good earnest sought to raise the social status ofmedicine, by the labours of science on the one hand, and thelabours of love on the other. And in this object the records andexperience of the past show that it has been successful. It has

largely added to the scientific reputation of British medicine andsurgery, and it has advanced the social concord of that greatbody of our brothers who are engaged in the Godlike art of

healing, which, like mercy, "blesseth him that gives and himthat takes." We seek to draw closer to one another all menwho in good faith and honour work for the sufferer in body orin mind, no matter what may be their respective stations, theirdegrees, or ranks in society ; no matter what may be the class orposition of those for whom they labour ; for to the true physicianI use the word in its widest sense. Sickness levels all ranks,

and we can affirm of our brethren that the friendless and thedestitute receive at their hands a sympathy and a care whichoften surpass those which station or wealth can command.These works are done, though as yet the world knows but littleof them, instinctively following the precept and example of thefounder of our religion, the right hand unknowing of what theleft hand doeth. They are done through a special influence, asyet not fully recognised, of the study and the practice of medi-cine upon the understanding and on the heart. Therefore, todraw closer the various members of the varied ranks of ourcommon profession, which, in one sense, is the most united, andin another and a lower sense, has been the most divided, is agreat and worthy end. It is to bring the force of the whole tobear on the common weal, and by union to strengthen the handsof the separate workers in the exercise of that power which isanimated by charity, guided by knowledge, and which obser.vation, rendered fruitful by study, makes every day more andmore an instrument of good.

Of the influence of the science of medicine on the under-standing, it may be said that that science has it in common withevery branch of knowledge which is based on observation andinduction ; but that it animates the heart is also true, for to dogood, even from necessity, moulds all so engaged unwittingly tothemselves to be more or less ministers of Christ’s work uponearth. It is plain that this result of the exercise of our profes-sion should work in all directions, and that in our relations toone another we should apply the same qualities of mind andfeeling, the same self-abnegation, the same enlightened andcatholic spirit, which are the great result of our special work.

In the earlier states of civilization, man gathered himself intofamilies or tribes, which from natural causes became mutuallyhostile, and therefore ignorant of one another; hence a state ofwar became their normal condition, and even now, when, by theconsolidation of tribes, great empires are founded, our peace,when it does prevail, is an armed peace.

It was to remedy a similar state of things in medicine, whichat least in this country embraced many tribes whose interestswere held to be separate, and whose relations were mutuallyhostile, that, in founding the Association, Sir Charles Hastingsand the far-seeing men who worked with him, kept in view itsoperation, not only as a scientific body, but as a means of pro.moting friendly feelings by the personal interchange of kindlyoffices, a means of getting rid of prejudices and of neutralisingthose corporate jealousies so long the bane of our profession.Thus, they not merely hoped, but foresaw, that the time wouldcome when that profession would be bound together as a unitedbody, looking ever upwards and strong in mutual respect andmutual confidence.The experience of the working of the Association warrants us

in holding that, in a large measure, these anticipations havebeen fulfilled, and already we can see the proofs of a sounder

feeling amongst members of our profession. And this result hasa wider application than appears at first sight; for it must largelysubserve to the interests of society: this has been excellently putby Sir Dominic Corrigan, in a speech lately delivered at theinauguration of the statue of Sir Henry Marsh in the College ofPhysicians, in which he dwelt on the harmony and the mutualrespect which has so long distinguished the profession in Ireland,and on the advantages which thereby accrue to the public atlarge.

Looking at the great question of the social and scientificadvancement of medicine, we find that among the general desi-derata there are some dependent on conditions more or lessextrinsic to the profession. Many of these have been ablyhandled by Mr. Rumsey, and other writers on State Medicine;but to obtain them will be a work of time, depending first onthe education and consequent influence of the profession itself,and next on the progressive enlightenment of society and ofgovernment.The subject of State Medicine will be brought before you by

Mr. Rumsey ; and it behoves this Association to be foremost inadvancing this recent development of medical science-a develop-ment which, whether looked at in a scientific point of view oras a necessary element of the good government of the country,promises to attain to a great magnitude. And when we recollectthat, among the foremost labourers in this field, there are fourof or associates-Dr. Farr, Mr. Ransome, Mr. Rumsey, andDr. Symonds—we may have good hope that this body will takeits place in promoting the cause of State Medicine.

In the practice of medicine, in these countries, two methodsexist: one, that in which the trade element is a very prominent,if not the governing principle ; and the other the truly profes-sional-that is, the scientific spirit. The gradual elimination ofthe first and the consequent advance of the second, are great



objects for all who seek to raise the status of our calling in a socialand scientific point of view. Medicine is not any single science:it is an art depending on all sciences. Indeed, it may be saidthat there is no branch of human knowledge that does not in itsturn subserve to it; and, therefore, were there no other reason,its social status should be at least on the same level with divinityor law. Not so much by the possession of honours or titles hereor there distributed, as by the comprehensions of the generaleducation of those who enter it. If we look to the Medical

Register, we shall find that the number of individuals holdingsuch qualifications as imply a course of education in arts such asis the rule in the sister-professions, is very small, and this reactson the scientific character as well as the social rank of medicine.

In most cases a general cultivation of the mind is the best pre-paration for the pursuit of any special branch of knowledge. Itmay be held that it is unnecessary to insist on this. I am sorryto say that I hold a different opinion. It is most necessary toinsist upon it ; and I hold that the profession is deeply indebtedto Mr. Teale, who, in the early sessions of the Medical Council,advocated with great ability the surpassing importance of a largeand liberal general education as a preparation for the special train-ing, no matter whether the physician or surgeon is to practiseamong the rich or the poor. It may be said that compulsoryeducation interferes with the liberty of the subject; but does notignorance enslave and degrade for life ? 1Of the objects of good which are attainable by ourselves, I may

specify two among many. The determination of the laws of

epidemics, and the placing our knowledge of therapeutics onsomething of a scientific basis. It was held by Humboldt, aswe read in his "Cosmos," that the question of epidemics is oneof the most obscure and dimcult of inquiries. And here I mayrecall to your minds the proposition of Graves, that the differentgovernments of the combined world should unite in the establish-ment of medical observatories in their respective dominions inthe various latitudes of the earth, where a careful record of

every meteorological and terrestrial phenomenon should be kept,with all the accuracy of the latest science in connexion withobservations of the rise and progress of every epidemic. Thusa combined series of observations would, after a time, lead toknowledge, negative or positive, as the case might be, whichwould be invaluable.The second desideratum is to settle the therapeutic science

which, at present, is in a large measure traditional empiricism.Not the less valuable and trustworthy on this account ; for in alltraditions there is an element of truth. What is wanting, is tohave applied to therapeutics the same method of investigationwhich is used in other scientific inquiries. This all-important ques-tion has been raised in the Medical Council, which is charged with Ithe care of our national Pharmacopoeia, and it was proposed by Dr.Acland that a portion of the funds should be used to defray the ex-penses of scientific investigations as to the value of medicines. Theframers of the Pharmacopoeia can reject or admit this or that sup-posed remedy; and, untit the values of these medicines are esta-blished by severe investigation, we shall go on in the old way. Irefer you to the discussions in the last two sessions of the Council.Dr. Acland’s motion was lost, but it had the support of a strongminority. It is hoped that he will persevere. A similar coursewas taken by Professor Bennett at your last meeting; and asmall grant of money was made to him to initiate observationson the value of a single remedy. We all look forward withinterest to his report and to the debate which is to follow.But such investigations are always attended with great diffi-

culty ; and to determine the value of any one medicine, or anyspecial line of treatment, in any given case or set of cases, is avery complex p:oblem. When we consider the influence of the

epidemic constitution, as indicated by Sydenham, even in theso-called local diseases, it seems probable that, even if we suc-ceeded in determining the value of this or that remedy, theexpression of that value would be only good for the time duringwhich the epidemic constitution lasted. Again, the question ofchange of type of all diseases, local and general, sporadic orepidemic, becomes of great importance in settling the value of anyparticular mode of treatment ; and all these considerations bearon the object and purpose of the researches in question. Nor isit to be forgotten that, although we may arrive at a numericalexpression of the value of a remedy under certain circumstances,yet what the physician or surgeon wants to know is, not so muchthe treatment that will save the grea est number out of a givennumber, but what is best to be done in the cases of A, B, or C.The tendency to base our treatment of medical and surgicaldisease upon averages should be resisted, as not seldom leadingto a mischievous routinism, the more dangerous as it assumesthe garb of a scientific result.But these difficulties should only stimulate us to accurate

research in therapeutics, for the result can only be for good. Ifeel that the views of this meeting, as well as those of men ofscience in general, will go with Dr. Acland in the opinion that,as the Medical Council is charged with the care of the Phar-macopoeia, it should carefully consider the mode by which thisnational work has been created and has to be renewed ; and that,at all events, no additional drug or agent should be added to it,under the too prevalent system, until a severe scientific inquiry,made by unprejudiced and impartial observers, had been insti-tuted as to its amount of value.

Before I conclude, I may ask your attention for a few minutesto allude to some details in connexion with the present meeting.It has appeared to the Council that, looking at the probableamount of work to be got through, it would be wise to adopt thesystem of sections ; and it was resolved that sections for MedicalSurgery, Midwifery, and Physiology, should be instituted, in thenomination of the Presidents and Secretaries of these Sections.It was the desire of the Local Committee that some of theseoffices should be filled by members from the other side of thewater, but in obedience to a wish generously expressed at themeeting of Council in Birmingham, at which I had the honour toattend, these offices have been filled by the profession in Dublin;and we think that the Association will not have cause to regretour election of these distinguished gentlemen.You will perceive, by referring to the programme issued by the

’ Central Council, that it has sought to remedy a defect admitted0 by many in our former meetings, namely, the introduction of ourl current or official business during the time which should be occu-! pied in the scientific labours of our body. It is recommendedJ that we should get through all the necessary and official work onthe first day, leaving the remaining days to be devoted to thet addresses in medicine and surgery, to the reports on questions for- debate, and to the working of the various sections. To ensure1 success to this project, it is manifestly necessary that membersf who address the meeting will condense whatever observations,, they have to make as much as possible.

To the inquiring stranger, Dublin presents many objects ofinterest, and one of the first of them is this great College, withinwhose walls we are now assembled, with its noble library, schools,and museums. The Museum of Geology in connexion with the

School of Engineers will well repay a visit, as well as the Schoolof Physic and its recently erected laboratory, dtsseoting-rooms,and museum of materia medica. The libraries of the Royal Irish

Academy, the Royal Dublin Society, that of Queen’s Inns, andof Archbishop Marsh, all are worthy of inspection.I have spoken of our Museum of Geology. The great Anat-

omical Museum of the Royal College of Surgeons, and thePathological Museum of the Richmond Hospital, created by theenergies of Professor Smith, contain many objects of interestsI may notice two more museums, though not of a medical char-r the Industrial Museum in Stephen’s Green, and theMuseum of Irish Antiquities in the Academy, a collection of

national antiquities only inferior to that of Copenhagen, and forthe foundation of which Ireland is indebted to her great antiquary,the late Dr. Petrie. The Botanic Gardens of Trinity College,

- and th of the Dublin Society, should be seen, as well as the! Zoological Garden, the grounds of which were once the plea-

saunce of the Knights of St. John.; It was long the wish of Sir Charles Hastings and those wholaboured with him, that the operation of this body should be

extended to Ireland. This wish was expressed at the EdinburghMeeting in 1856, held under the presidency of the illustriousAlison, and during the first session of the Medical Council SirCharles Hastings spoke on the subject with some of the Irishrepresentatives of the Council. At this time, however, it was.

considered that, looking at local circumstances connected withthe working of the new Medical Act, and the necessarily un-settled state of medical education, it was better to postpone thevisit of the Association to Dublin for a few years. In this viewSir Charles Hastings fully concurred ; he hoped that the timewas not far off when all difficulties would be removed, and theevent has justified the anticipation, and now in the name and bythe permission of the heads of the University of Dublin, it is myhappy privilege to bid you welcome. This University, long thefosterer of its Medical Faculty, and by whose wisdom, as inthe old English Universities, the academic-and therefore thesocial=rank of Medicine and of Surgery is kept on a footing of

. equality with that of Divinity and Law, has done its best to

. honour the Association, and to make its visit memorable int academic record by crowning with its highest honours our

; President of Council, Dr. Sibson, and some of the foremost; members of your body ; and so we meet in the halls of Usher

and of Berkeley, of Swift and Burke and Goldsmith, of Currans and Grattan, of Hamilton, Lloyd, and Graves.



The King and Queen’s College of Physicians, itself an offshootof the University, has followed its example in honouring some ofyour leading members ; and the Royal College of Surgeons hasgraced the occasion by conferring their honorary fellowship onProfessor Syme.The Address in Medicine will be given by the distinguished re-

presentative on the Medical Council of the Queen’s University inIreland. The President of the Royal College of Surgeons willtake the chair at the surgical lecture : and the committee of re-ception contains representatives of all the medical corporations.The visit of the Association has a special national significance, asbeing the first ever paid by it to Ireland ; and we rejoice to seeso many representatives of English and Scottish medicine andsurgery coming among us-the representatives of so truly anenlightened section of British society.

The history of Ireland is a singular one. More than a thousandyears ago, she was the centre of the Christian civilization ofWestern Europe. Once vanquished, though not conquered, by Ithe Northman—torn by internecine war, and exhausted by fruit-less contests with England, she is at last united with her : andthe two countries are now beginning to know one another better,and to excuse or forget what was wrol1S’ on either side, and toknow and estimate that which is right. According to the usethat is made of them, and according to the amount of truth oruntruth that may be in them, the traditions of the past may befruitful in evil or in good. But with the advance of education, ofintelligence, and, above all, of intercommunication, old igno.rances, old prejudices, old memories of wrong, and forgetfulnessof right, will fade away. This visit will hasten the time whenthe crown of our loved Sovereign will surround and embrace inits golden circle an united and a happy people. Ttiat day is’coming; and therefore it is clear that this meeting has a nationalas well as a scientific importance, which recommends it to all

loyal and all right-thinldng men.

Dr. PAGET (of Cambridge) moved that the cordial thanks ofthe meeting be given to Dr. Waters for the able manner inwhich he had performed the duties of president for the pastyear, and that he be appointed permanent vice-president. He.said that in the midst of that brilliant meeting they shouldnot forget the meetings of last year, and they could not forgetthe ability and the courtesy with which Dr. Waters, the thenpresident, conducted the proceedings, and the hospitality hehad exhibited. (Hear.) He thought that with their thanksthey might reasonably add their congratulations to Dr. Waters.He had the honour and happiness of being elected president ofa successful and prosperous association, and on resigning office.he had perhaps the greater satisfaction of knowing that it hadbecome still more prosperous. (Applause.)Dr. STEWART (of London) seconded the resolution, which

was carried by acclarcation,Dr. WATERS then said that, at the expiration of this his

year of office, he had only to thank his brethren for the warmco-operation which he had received during his tenure of it.His labours had been really insignificant, for what with the Ilate president of their council, and their excellent committee,there had been but little left for the president to do. Asregards the last meeting, it was a subject of gratification to himto find that it had met with the approval of the members, butit was a higher gratification to him to know that it was suc-ceeded by the first meeting of the Association in the kingdomof Ireland. (Hear.) It had been long the ardent wish of theAssociation to pay a visit to this country, and its warm recep-tion would never be forgotten by the members. (Hear andapplause.) He had to return them his most sincere thanksfor the cordial vote of thanks which they had accorded to him.{Applause.)The report of the Council was then read by the Secretary, which

showed that 753 members had been added to the Association,making a total of 3085 on the books of the Association at thepresent moment. The Council had appointed a committee toconsider the possibility of obtaining a better representation ofthe general profession on the General Medical Council, andrecommended that eight registered members should be addedto the Council : four for England, two for Scotland, and twofor Ireland, to be elected by the profession by means of votingpapers. The committee also recommended that petitions toParliament, &c., should be undertaken by the parliamentarycommittee of the Association. The Medical Provident Societyin connexion with the Association had been dissolved, and thesubscriptions returned to the contributors. The Council re-gretted that no essay had been sent in for the Hastings Prize.The financial statement was of a satisfactory character.

RECEIPTS.9 s. d-

Subscriptions ............... 2137 16 0Arrears .................. 106 1 0Advertisements and Sales ............ 582 1 0Balance in hand, Dec. 31st, 1865 ......... 318 14 8!Balance due to Treasurer, Dec. 31st, 1866 ... 503 9 1½

X3648 1 10PAYMENTS.

JOURNAL EXPENSES :- 9 8. d.Mr. Richards (Printing and Stamps) -five

quarters ............... 2252 6 0Mr. Richards (Directing, &c.)-two years ... 100 0 0Mr. Honeyman (Office Expenses)-two years ... 208 13 5Mr. Davidson (Commission) ......... 147 0 6Mr. Orrin Smith (Engraver) ......... 212 9Editor of Journal ............ 200 0 0Dr. Henry (Sub-editor) ............ 50 0 0Contributors ............... 239 18 6

! Dr. Henry (Salary, for work at Office) ...... 5O 0 0EXECUTIVE EXPENSES :-Secretary ....., ...... 250 0 0Secretary’s Petty Cash ............ 41 12 6Branch Secretaries and Collectors ...... 25 13 5Reporting Proceedings at Chester ...... 16 16 0Mr. Moore (Hastings Medal) ......... 21 0 0Anniversary Expenses ............ 12 13 9Stationery .................. 14 15 6Sundry other Expenses ............ 14 19 6

£3648 1 10

Sir D. CORRIGAN moved that the report be received andadopted ; Dr. RADCLVFFE HALL seconded the proposition.

’ Dr. STEWART moved an amendment on the question of the. representation of the profession at the General Medical Council,, to the effect that the number of the Council ought not to be, increased. He considered that the increase of expense whichwould result would be a great tax on the profession, and that

, the Council would be too large to work.

Dr. MARKHAM seconded the amendment, as he consideredit utterly impracticable to increase the number of the Council,and he had yet to learn that the profession was not repre-sented. (Oh, oh !)Mr. HUSBAND (of York) said that the Council had recom-

mended the addition of eight members only on the suppositionthat the Crown members were to be reduced in number. Hemaintained that the general practitioner was in no sense repre-sented on the General Council; and that, as regarded expense,he believed that if the Council as then constituted had theconfidence of the profession, there would be no difficulty.

Dr. WATERS (of Chester) supported the original propositionof the Council, the credit of which he attributed to Mr. Hus.band. He said that the proposer and seconder of the amend-ment did not agree in their views; and he hoped the meetingwould support the Council.

Dr. LANKESTER supported the Council, and thought therewere plenty of ways of getting over the difficulty of increasingthe number of the General Council, and that the profession atlarge ought to be better represented.The amendment, having been put by Dr. Stokes, the pre-

sident, was lost, and the original report was carried in its in-tegrity.

Dr. SIBSON proposed the re-election of Mr. T. W. Williamsas secretary; and Dr. M’SWEENY having seconded the pro-position, it was carried unanimously.The SECRETARY then, in the absence of Dr. Broadbent, read

the following report of the Medical Benevolent Fund, whichwas received and adopted.In again presenting the yearly account of the operation of

the Fund, the Committee do so with increased confidence inits usefulness.

" During the year the sum of £1035 has been distributed ingrants for the relief of temporary distress, the largest amounthitherto given in any single year, the number of cases beingone hundred, and thirty annuitants are now maintained bythe permanent investments. The amount of suffering broughtto the knowledge of the Committee is but faintly indicated inthe brief abstract of cases given with this report, and it shouldbe remembered that this Fund stands alone in supplying with-out loss of time the pressing necessities of members of theprofession who are not of an age to be eligible for annuities,but who from ill-health, physical disability, or misfortune, are



in difficulty and distress. In addition to the care taken to

proportion the grants to the urgency of the case, every endea-vour is used o make the relief as effectual as possible, bycommitting the sum voted to the hands of a member of theCommittee or some medical man for distribution; and at timesa permanent provision is secured by the initiation of a sub-scription, which serves as a stimulus to the efforts of friends.

" The past year has been marked by painful losses. Thesudden and untimely death of Mr. Toynbee, for many yearsthe able and energetic treasurer, deprived the Fund of one ofits oldest and most useful friends and one of its largest contri-butors. The Committee bear willing testimony to the devotionand energy he displayed in carrying out the objects of thecharity. Sir Charles Hastings also, who died soon afterwards,took a warm interest in the Fund from its foundation, and wasone of the trustees."Dr. Sieveking has been appointed treasurer; and Dr.

Acland, F. R. S., James Paget, Esq., F. R.. S., with the newtreasurer, have been elected trustees. Considerable delay wasexperienced in effecting the transfer of the annuity fund,which, to the regret of the Committee, has retarded the issueof the annual report.

" The Committee, in the name of many sufferers, tender’ their thanks to the lady collectors, the honorary local secre-

taries, and other gentlemen who have co-operated with them,and again commend the Fund to the attention of the profes-sion, and urge its friends to renewed exertions, now especiallyneeded." The Rev. Dr. BELL (who was received with applause) said

that he had been one of the most determined supporters of theAssociation and of the medical profession. He considered thatit is inexpedient to make such extensive changes in the Journal,but declined to make a motion, feeling that he had been un-fairly prevented from converting his motion into an amend-ment on the report of the Council. After some explanatoryremarks by Dr. Sibson, however, Dr. Bell proceeded to movethe resolution, as follows :-" That it is inexpedient to make such extensive changes in the form and conduct of the Journalas have just been made, without the consent of the membersassembled at an annual meeting."

Dr. SEATON seconded the proposition, and remarked uponthe fact that within a few years two changes in the size of theJournal had taken place, and thought them very injudicious.He thought the general meeting of the Association should havebeen consulted.

Dr. STEWART explained that the committee of Council wasalone responsible for the conduct of the Journal and the ap-pointment of the editor. Personally be preferred the formersize of the Journal, but it was found that advertisers preferreda larger page, and it was thought commercially better to in-crease the size of the page.The motion was negatived.Sir DOMINIC CORRIGAN moved that Christopher C. Cox,

M.D., of Baltimore, and Dr. Polli, of Milan, be electedhonorary members of the Association.

Dr. SIBSON seconded the proposition, remarking upon thepleasure the Association had in receiving Lieutenant-GovernorCox last year at Chester.A grand banquet of the most recherche description was given

by the authorities of Trinity College this evening to a largeparty of the most distinguished members of the Associationat present in Dublin, this being one of a series of three similarentertainments which are to be given by the same liberal hosts.

Later in the evening a soirge was given by the ObstetricalSociety of Dublin in the rooms of the Rotunda, which werecrowded by the members of the Association, who passed a plea-sant evening in becoming mutually acquainted with each other.

SECOND DAY, WEDNESDAY, AUGUST 7TH.Dr. SIBSON announced that the Council of the Association

had received an invitation for the next meeting to be held atOxford ; and moved that this invitation be accepted, and thatDr. Acland be chosen president elect for the present year.

Sir D. CoRRIGAN seconded the resolution, which was carriedby acclamation.

Dr. ACLAND returned thanks, and said that Oxford couldonly attempt to rival Dublin in the reception it would offer.

Sir D. CORRIGAN then proceeded to deliver his Address inMedicine, which was very warmly received. It will be foundin extenso at page 169.

Dr. ACLAND moved a vote of thanks to Sir D. Corrigan,and expressed his personal satisfaction that the profession

would now be better able to appreciate the difficulties of theGeneral Council.

Sir J. SlasrsoN seconded the proposal, though he did notagree with all the views of the orator. He facetiously sug-gested that the General Council should itself undergo an ex-amination ; and doubted if many would pass it.The motion was carried by acclamation.The several sections of the Association then commenced

their sittings.The Medicine section met at one o’clock, Dr. Law in the


The author commenced by stating that his motive in writingthe paper was not so much to bring forward doctrines new tothe profession as to bring the subject of the treatment of con-sumption before the Association for discussion. He shouldpurposely omit all allusion to the origin and nature of tubercle,and confine himself, as far as possible, to the consideration oftreatment. Whatever the views entertained respecting theintimate nature of tubercle, it was generally admitted that itsdeposit in any part of the body was the result of defectivenutrition, itself the result of a lowered state of vitality, here-ditary or acquired ; its presence was a sign of vital decay andthe forerunner of eventual death, a mere mode of dying. Ina philosophic sense tuberculosis was not an inexplicable scourgeof the human race, but one of the means resorted to byProvidence to weed it of effete, worn-out organisations, inca-pable of perpetuating it in its integrity. Were the sickly, theaged members of the community to have the power of con-tinuing their race, it would soon become one of pigmies, ofmisshapen abortions. Thus, those who marry too young or tooold, diseased, worn out, have children who die of tubercularmeningitis, of scrofula, of pulmonary consumption; whilsteven those who have healthy youthful parents, and who areborn with the seed of life in them, may wear out their organicpowers in the struggle of life, and succumb to accidentalphthisis. Mr. Darwin has shown by his luminous researchesthat the struggle for life pervades animated nature. In theundomesticated animal kingdom the sickly and the aged diefrom want of power to secure their existence, or are extermi-nated by their natural enemies, so that the young and vigorousalone survive to perpetuate their race. With man it is different:his intellect enables him to lay by for the future, to preservehis own existence in old age, and to provide for his sicklyprogeny. Thus society is full of effete organisations, unfit tocontinue the species in its integrity. But the laws ofProvidence correct our errors, and the race is weeded throughthe sad influences of disease and death. If these views arecorrect, the treatment of phthisis must be essentially sthenic.Our remedies must be directed to invigorating an originallydefective organisation, or to renovating the constitutional

powers of the accidentally debilitated. If we can do this the

progress of the lung disease will stop of itself, and the lungmischief becomes a mere sore or wound which nature can andwill limit, and even heal. In this view of pulmonary tubercu-losis the inflammatory affections which accompany its evolutionbecome epiphenomena. Although they have their importance,and may be the eventual cause of death, it is with the tuber-cular diathesis principally, with the lowered organic power,that we have to deal. Such being the case, it is mainly byappealing to the laws of healthy life, of physiological hygiene,that we are likely to succeed in renovating exhausted organicvitality and in prolonging life. Medicines are of greatuse, no doubt, in restoring damaged functional action,in helping, assisting our hygienic efforts, but alone theycannot renovate an organization early exhausted anddrawing gradually through tubercular disease to its naturalclose. They cannot renew an organisation worn out bythe social infringement of hygienic laws. Thus if a

shrub planted in a city square were dying from bad air,smoke, defective drainage, and bad soil, the horticulturist,anxious to save it and restore it to health, would not merelyadd a little bone-dust, guano, or manure to the soil, and waitthe result. He knows that the unfavourable influences to

. which the plant is still exposed are too powerfully antagonistic,and that his plant would die. He therefore transplants it to

. the country, in pure air, in good soil, exposed to genial sun-shine ; and, under influences favourable to plant life, he findsa gradual, perhaps a permanent, recovery takes place. Under

. these more favourable circumstances he may also often findhis manure really beneficial. Such should be our conduct.We must remove consumptive sufferers from all unfavourable

L influences, and apply in their behalf all the laws of hygiene,



which are too well known to the profession to require enume-ration. Some points, however, respecting which there may bedifference of opinion, require notice. Ventilation should befree; air should pass in and out of the room in which con-sumptive patients live, night and day; and they should keepall day, if possible, in the open air. Free ventilation is notonly most advantageous to the invalid, but also diminishes thedanger of the consumptive patient’s attendant getting the dis-ease, if such a danger exists. The late researches on the inocu-lation of tubercle appear to show that this danger, which is aconviction with the inhabitants of Southern Europe, reallydoes exist. The author had certainly met with several casesthat appeared to substantiate it. The action of the skin shouldalso be encouraged by cold or tepid sponging, and friction.Such sponging, with proper care, is altogether without risk,whatever the state of the patient, the stage of the disease,and the complications that exist. Active exercise shouldbe very limited, as debility is at the root of the evil;passive exercise should, however, be resorted to. To carryout fully this hygienic treatment, both rich and poor shouldbe located, as far as is possible, in the country. Consump-tion hospitals should be established also in the country.Those who have the means increase their chance of recoveryby migrating in the winter to a warmer winter climate. For-

merly, when consumption was considered akin to inflamma-tion, warm moist climates were recommended, such as thetropics and Madeira. Now we are aware that such climatesrelax and debilitate, and are not generally suited to a diseaseof debility. To send consumptive patients to such climates isto treat the epiphenomena of the disease, and not the diseaseitself. Dry, cool, bracing, sunny climates, such as that of thenorth shore of the Mediterranean, are more appropriate tothem. By the combined influence of these agencies the authorhad saved his life and that of many others. Eight years agohe abandoned practice, and went to the Genoese Riviera (ashe and others thought) to die in a hopeless state of advancedphthisis; but, thanks to hygiene, climate, and medicine, hehad regained a tolerable share of health, as had many otherswhom he had observed. He had thus learned to place muchmore confidence in the power the physician has in thus arrest-ing the progress of this dire disease than his previous Parisand London experience had given him.

Dr. RADCLYFFE HALL bore testimony to the value of issuesto combat local inflammatory mischief.

Dr. MORTON (of Portland) said that Dr. Graves, in his" Clinical Medicine," had sketched a similar plan.Dr. SIBSON testified to the advantages of passive exercise,

such as by a sea voyage.Dr. MORE MADDEN, in advocating Malaga as a climate for

phthisis, called attention to the great efficacy of change ofclimate in the cure of consumption. He said that, after longpersonal experience of foreign southern winter climates, heconsidered that it was a great mistake to send phthisicalpatients to Mentone and the Riviera, as Dr. Bennet recom-mended ; and that from experience he could say the best cli- lmates were Upper Egypt and Malaga. I.In the section of Surgery-Sir HENRY THOMPSON read a paper entitled, " Considera-

tions suggested by the Study of 100 Cases of Stone in theBladder of the Adult, recently Operated on," in which hestrongly advocated the operation of lithotrity as the properoperation in the case of adult patients, and expressed a beliefthat in a few years lithotomy would be abandoned in thesecases.

Dr. C. FLEMING then narrated a case of Fibro-CalcareousTumour of the Uterus communicating with the Bladder, whichhe had submitted to operation with a fatal result.Mr. GEORGE SOUTHAM narrated three cases of Spontaneous

Fracture of Urinary Calculi in the Bladder. The first casewas in a boy aged twelve years, in whom part of the calculuswas found in the urethra and part in the bladder. The secondcase was in a boy aged seven years. The third case was fromthe practice of Mr. Luke, and occurred in an adult.Mr. MEAD, of Bradford, mentioned a case of Fractured Cal-

culus which had occurred in his own practice.Dr. BATEMAN, of Norwich, and Dr. LEE, of Dublin, made

some observations on lithotrity, and congratulated Sir HenryThompson on his great success.Mr. SouTHAM remarked upon the occasional benefit derived

from the injection of dilute nitric acid in cases of lithotrity.Mr. HUSBAND remarked upon the duty of the surgeon in

attempting, at all hazard to his reputation, to give relief to his ipatient. I.

In the section of Midwifery—Dr. BEATTY, the president of the section, delivered a short

address on the Lying-in Institutions of Dublin.Sir JAMES SIIIIPSON then read a paper " On the Cephalo-

tribe," and was followed by Dr. BRAXTON HICKS and Dr.RINGLAND on the same subject.At the third general meeting the Report of the Committee

of Registration of Disease was read by Dr. PHILIPSON, ofNewcastle.

Dr. AQUILLA SMITH proposed the acceptance of the report.Dr. LANKESTER, in seconding it, remarked upon the present

unsatisfactory state of death certificates, which were mostloose and irregular. He also mentioned that in England alonethere was no compulsory birth registration.Mr. RUMSEY then read his paper on


, The author said that but a few years ago the idea of StateMedicine was ridiculed. Medical men were employed occa-1 sionally for State purposes; but irregularly, and without sys-- tem. He proposed to call attention to some of the defects of. the present system of registration of deaths and diseases. Ar good nomenclature, such as that lately brought out by the- College of Physicians, was essential; for without it vital sta-- tistics were impossible. A great advance had been made in, the registration of the causes of death, attributable to Dr.! Farr, though this was necessarily imperfect. The present, system of death certificates was most defective, and the

grouping of fatal diseases most incongruous and perfectlyuseless for purposes of comparison. Certificates of death

, were occasionally given while the patients still lived, owingto the fact that the medical practitioner was not obligedto certify super vis us. But the medical certificate was notabsolutely necessary, much less was it necessary to certify thecause of death. Of this latter Mr. Rumsey approved, as itwas impossible for a medical practitioner always to be certainof the cause of death. With regard to coroners’ verdicts, hebelieved that the system in Scotland was much more satisfac-tory. A coroner may suppress an inquiry at the request ofinterested parties, and he held that in but few instances wasthe coroner qualified by education to direct the deliberationsof a jury. An inquest without a post-mortem examinationwas a delusion and a mockery. The wretched manner in whicha medico-legal inquiry was conducted by those unaccustomedto such proceedings tended to defeat justice; and the necessityof experts to conduct examinations, make analyses, &c., was

sufficiently obvious. A pra ctitioner called upon to give medico-legal evidence was perfectly justified in refusing to commithimself to an opinion upon a subject with which he was un-acquainted. Medico-legal evidence should not be that of anadvocate, though it was difficult under the present system toavoid advocacy of one side of a question. A scientific witnessshould be allowed to give evidence independent of the bar, andafter investigating and considering both sides of the question.The demoralisation of experts under the present system couldhardly be doubted. Special study of special knowledge, to betested by special examination, should be demanded of everyexpert, and the judges should appoint special medical assessorsfor special cases. [Mr. Rumsey was obliged to stop here,owing to the expiry of the time allowed, but by the request ofthe meeting he continued.] There was no principle upon whichofficers of health in England were appointed, there being norelation between the districts and the registration of birthsand deaths ; whereas in Ireland this was the case. Out of 92provincial officers, no less than 63 were to places with a popu-lation under 12,000 inhabitants, and some had as few as 3000inhabitants. All arrangements ought to be independent of

parochial management. The ordinary medical practitioner,twenty-one years of age and duly registered, was legally re-garded as in every way fitted to undertake the most responsibleduties of a sanitary character. An extra preparation wasnecessary after the ordinary medical education was completed.Mr. Rumsey referred to Dr. Stewart’s paper regarding emolu-ments, and noticed the statement recently put forward inTHE LANCET respecting "medical scavenging." Tenure ofoffice should not depend on ignorant local authorities. Themedical officer ought to be debarred from private practice, bothfor his own sake and that of others. Mr. Rumsey denied thenecessity for calling in metropolitan assistance for every localmischief. The medical officer of each district would give avalue and tone to local action, and investigate local phenomenain a manner which would be impossible to a central authority.It was not necessary for the lecturer to prove to his audiencethat the plan proposed would not damage, but on the contrary



benefit, the practitioner. His evidence would be as necessaryas ever in legal investigations to supplement that of the scien-tific investigator, who would relieve him of many disagreeableduties. Mr. Rumsey concluded his paper by reading the re-port of the Committee of the Association appointed to considerthe whole question of State Medicine.

Dr. LANKESTER would confine his observations to the officeof coroner. He did not agree with Mr. Rumsey respecting thecoroner’s court and his preference for the Scotch system,and he believed that many Scotchmen preferred the Englishsystem. He thought a great deal of the capacity of the Britishjuryman, and he believed that the system could not be altered.Much might be done to improve the registration of deaths,and certainly there should be no certificate without someinspection. Death certificates were often obtained as means ’,for begging. He was obliged to say that a great deal of in-efficient medical evidence was given before the coroner; butthis was no disgrace to the practitioner. True, justice thus oc-casionally failed, and on this ground he had advocated theappointment of experts. He believed that such appointmentswould be both beneficial and agreeable to the mass of theprofession. He thought medical witnesses ought not to becalled on one side, but should give all the knowledge theypossess.

Dr. DAvis, of Swords, coroner for the county of Dublin,made a few observations on the practical working of the regis-tration of Ireland. He believed that in thinly populated dis-tricts a medical assessor would be impossible, and thought itunfair to take the investigation of causes of death out of thehand of the local practitioner.Mr. HASTINGS, though not a medical man, took the greatest

interest in the question as a lawyer. There was a great dis-tinction to be drawn between medical evidence and medicaladvocacy in the witness-box, and the same was the case in allscientific evidence, whether in courts of law or committees ofthe House of Commons. But he did not see how an alterationwas to be effected, though he thought there should be trainedscientific assessors to the judges, as in the Court of Admiralty.He could not see why this plan should not be adopted in poison-ing cases, &c. He thought there was a tendency to too greatcentralization on sanitary matters, which he deprecated.

Dr. DAVEY, of Bristol, upheld the principle of medical arbi-tration, and believed that by "pegging away " the publicwould be converted. He instanced the case of Smethurst asan example of reference to a medical arbitrator-Sir BenjaminBrodie. He alluded to the efforts of the late Mr. Wakley toobtain medical coroners, and believed that when this idea wasfully carried out a great step would have been gained.

Dr. STEWART moved that a committee be appointed to con-sider the question of State Medicine, and take evidence uponit. He thought that the Association and its branches werespecially suited to the work.The King and Queen’s College of Physicians gave a brilliant

80irée in the evening, in the course of which the honoraryfellowship of the College was conferred by the President,Dr. Stokes, upon the following gentlemen :-Dr. HughesBennett, Dr. Waters, Dr. Falconer, Dr. Stewart, Dr. Markham,Dr. Gream, Mr. Spencer Wells, Dr. Polli (of Milan), and Mr.Lockhart Clarke.


Professor R. W. SNIITH delivered a most eloquent addressin Surgery, deprecating the present neglect of old authors,and showing that many modern inventions were found in theirworks. The special subject of the lecture was the separationof epiphyses of long bones, and was illustrated by numerouspreparations, drawings, and casts.

Mr. SYME proposed and Mr. BOWMAN seconded a vote ofthanks to Professor Smith, which, after a few words by Dr.ACLAND, was carried by acclamation.

Papers by Dr. Gordon, Dr. Buchanan, Mr. Pirrie, Mr. Mac-namara, Dr. Mapother, Dr. Murray, Mr. Laurence, and Dr.Kidd were read.The honorary degree of M.D. Dublin was conferred on Dr.

Acland, Mr. Bowman, Dr. Paget (of Cambridge), Mr. Rumsey,Dr. Sibson, Sir J. Y. Simpson, Mr. Syme, and Mr. Teale.The honorary Fellowship of the College of Surgeons was

conferred on Mr. Syme and Mr. Bowman.At the fifth general meeting Dr. Hughes Bennett read a

report of the Committee on the Cholagogue Action of Mercuryin Animals.A banquet took place in the Exhibition building at seven




" Audi alteram partem."

To the Editor of THE LANCET.SIR,-The letter from Mr. N. Heckford which appears in

your journal of the 3rd inst. contains such grave imputationson the general management of our prizes and appointments,that, as the official representative of the school, I am obligedto ask you to permit me to reply to it.The impression which anyone, a stranger to our institution,

would derive from that letter would, I think, be, that our ap-pointments are not made so freely open to our students as isdesirable. I will briefly mention the facts on this generalquestion first, and then come to one or two of the special com-plaints which Mr. Heckford makes. If, in what I say, it mayseem that I indulge in laudation of the institution which Irepresent, it must be remembered that I am writing in replyto charges.The London Hospital yields precedence to none in the libe-

rality of the scheme under which its appointments are awarded.It has for long been the earnest endeavour of its staff, and inthis the House Committee has zealously co-operated, to putthe clinical appointments within reach of the greatest possiblenumber. They have been regarded as means of education,and have been thus allotted. Every student who enters abinitio has the right, without any extra payment, to one year’sdressing of the in-patients, including, in turn, residence in thehospital, with board. Every student who passes his examina-tion at the College of Surgeons acquires the right, withoutfurther payment, to become house-surgeon, provided there beno special reason known to the surgeons why he should notbe so appointed. It thus comes to pass that all our men gothrough the invaluable training which in-patient dressing insuch a large hospital affords; and, with but few exceptions,all our men go through the yet more responsible office of

house-surgeon. The latter office is tenable for three, six, ornine months, at the discretion of the surgeons ; the usualperiod being six months. These appointments are obtainableas a mere matter of rotation, and no accusation of favouritismcan possibly be brought regarding them. The very heavywork to be done amongst the out-patients offers an unlimitedfield for the surgical zeal of our students; and not only arethe appointments here open to all without favour or selection,but money prizes to the value of £60 annually are offered bythe House Committee to those who work well in it.On the medical side the appointments are necessarily fewer,

and here selection must of course be made. We have a residentmedical officer, an assistant resident medical officer, and aresident accoucheur. The first of these offices is tenable fortwo years; it is a highly responsible one, and has a salary.The other two are unsalaried, and are tenable for three and sixmonths respectively. All three include board and commons.The election to these is made by the House Committee, actingon the recommendation in the one case of the physicians, andin the other of the obstetric physician. These gentlemen havebut one object in making their recommendations-that -ofsecuring the man whom they believe to be best fitted for thepost; and, other things being equal, they always allow

seniority its due weight. That seniority should constitutethe only claim would, they believe, be prejudicial to the in-terests of the institution, of the patients, and of the studentsthemselves ; nor can they view with favour the suggestionthat a small clique of the latter should be allowed to judge ofthe merit of the rest. It is an unavoidable result that cancli-dates must be sometimes disappointed, and a very natural onethat those not successful should sometimes believe that talenthas passed unrecognised. This cannot be helped, but the nonomnia omnibus consolation might perhaps be found sufficientto most, and might save them from casting ungenerous asper-sions upon the motives of those whose duty it is to performthe delicate and responsible function of selection.In the out-patients’ medical department the assistant phy-

sicians are allowed to nominate two clinical assistants, whoreceive salaries. The recent nominations to these importantoffices are one of the grounds of Mr. Heckford’s complaint. I

must claim, however, on the part of the assistant-physicians,