PRESIDENT'S ANNUAL ADDRESS.-RELATIONS OF THE STATE TO MEDICAL SCIENCE.

By JOHN P. GRAY, M. D., of Oneida County.

November 17, 1885.

AMONG the important functions of the State is that of securing education to the body of the people. This is both a moral duty as well as a principle of polity. The educational policy of the State of New York is confined chiefly to the maintenance and supervision of the system of common schools for primary education, and of normal schools for the education of teachers for these same common schools, through the agency of its Board of Regents. The State also exercises a fostering supervision over the higher educational institutions, including the colleges and academies which are established and maintained by private funds and endowments. The charters of our universities, colleges, and academies emanate from the Board of Regents, and may be altered or amended through its agency. To this body, also, is intrusted the distribution of the so-called literature fund of the State, and of the proceeds of the United States deposit fund, which are appropriated by law for the benefit of the academical institutions, both public and private. The Board of Regents does not attempt to interfere with the internal management, methods, or discipline of these private educational institutions, except when appealed to for that purpose. It concedes to them and their trustees the complete control over their funds and earnings; confers upon them the power of granting diplomas, and awards to them all the privileges and powers, except in the matter of support, that would enure to them if they were a part of the public educational system of the State.

Beyond this, the State has transferred grants of land of the United States domain, for educational purposes, to Cornell University, that institution acting as trustee in the public use of these funds, while all other colleges in the State stand upon their own endowments and resources, as corporations whose trustees discharge their duties and responsibilities in the care of funds the same as in other trusts under statutory provisions.

Schools for special education, such as law and medical schools, theological seminaries, polytechnic institutions for teaching mechanics and engineering, schools of mines, institutes of technology, business colleges, etc., are, like the colleges for higher learning, conducted as corporations sustained by private contributions and earnings, or exist as individual private enterprises. These schools, as above designated, receive no privileges or grants from the State, but are sustained wholly by those who voluntarily seek their advantages, and by the munificence of private citizens.

What, then, should be the proper limits of legislative interference in this class of institutions, representing scientific education and research, is a proper inquiry. Whether the State should undertake such a function of education as a public measure is a problem in political economy which, as far as New York is concerned, for the present at least, is answered adversely.

Medical colleges do not ask pecuniary assistance of the State, and they have not only sustained themselves, but have steadily grown in property rights and educational facilities, and have developed a constantly increasing corps of instructors and widened the scope of scientific research. The medical colleges of the city of New York have so commended themselves in their services to the public in educating young men, that that city has become a great center of medical learning, not only in didactic instructions, but in all resources for practical, clinical study and scientific investigation.

Within a year a private citizen, Mr. Andrew Carnegie, has presented fifty thousand dollars to Bellevue Hospital Medical College for a suitable building, with conveniences for pathological research, which has been erected. Mr. William H. Van

derbilt, a private citizen, has given half a million of dollars to the College of Physicians and Surgeons of New York, to erect suitable buildings, and place that institution on an independent footing.

That Johns Hopkins University should have to come to New York for a teacher of pathology-one of the most difficult fields of scientific work-and did select a young man developed in Bellevue College, is no mean compliment to the system and thoroughness of instruction in the metropolitan schools.

The text-books of which the professors of these schools are authors are among the standard works in all departments of medical practice throughout the land, and stand in the front rank wherever medical science is taught and practiced.

The number of students in the several medical colleges of New York city for the past five years has averaged about fifteen hundred, not gathered from the State of New York alone, but far more largely from other States and countries. Taking a single instance, in 1884-'85, in one of the schools (Bellevue), there were three hundred and sixty-five matriculants, but only ninety-five of these were from New York, and of one hundred and thirty-four graduates but twenty-three were from the State of New York.

It would seem, then, as if there were no immediate call for legislative interference in the interest of medical schools, or for the advancement of medical science, or, indeed, to maintain the honor of the medical profession, or, the most important of all, to secure the highest good of the people of the State of New York.

The spontaneous growth of science left untrammeled will undoubtedly advance human interest far more rapidly and surely than if put under governmental supervision. Science is not made; it grows and develops by the action and discerning judgment of individuals in the research into the laws of nature. The government of France did not make or develop Pasteur. His researches were his own-were spontaneous. All that the government did was to afford the opportunity, in the end, for the demonstration and utilization of his vast knowledge and scientific investigations.

The greatest works in medical science, and in science and mechanics generally, have been wrought by men under difficulties, not only without fostering support, but often under antagonisms of power.

While the State has always fostered medical science it has never undertaken the task of organizing or of regulating schools of medicine, or developing what is called by some "State medicine." For instance, it is conceded that medical science can not exist without a knowledge of anatomy-of all the parts of the human structure, and their relations one to another. The State, under certain prescribed limits, grants and legalizes the use, by medical colleges, of human bodies for this public good. It is equally essential to medical science to understand physiology, the function of vital action of each part, their relations to each other and the whole organism, and their functions and limitations in maintaining life. The State permits observation and experimentation on various lower animals in respect of such investigations, as they are essential, and yet dangerous or fatal to human life, and this because of its public utility. Medical science can only be developed and taught successfully by the organized efforts of men through schools or colleges of medicine. The State provides for such organizations under corporate laws, and taxes the property of such colleges as other property is taxed, and this for the public good. The State has so far indorsed medical colleges as to declare that a diploma, or certificate of completion of a course of study prescribed, and a certain degree of efficiency attained in study, shall entitle the possessor to practice the art of medicine as a profession or calling in life, and has established as a guarantee that infringements and willful neglects of such practice, which may result in injury to any one, shall be punished by penalties, in the nature of damages or imprisonments, or both.

While it is not intended to dispute the power of the Legislature to "regulate medical education," and to declare what shall constitute a "doctor in medicine," the fact remains that the Legislature has exercised only that measure of power necessary to foster and protect the interests of advancing medical science,

as has been stated, by giving the best opportunities to the schools for this end, and has maintained, at the same time, as far as possible, the individual freedom of the citizen to seek such special culture as he may see fit to pursue or obtain. Nor has the State undertaken to declare what medical science is, or what the methods of teaching shall be, or what degree of proficiency shall constitute a medical practitioner, nor has the State undertaken to decide as between differing schools of practice, in respect of the theories of science maintained in the various schools, or the merits of either.

The State can not adopt any particular school or system of medicine as against another. This the Legislature has settled by opening the way for all systems, without respect to supposed or real scientific merits, and this is essential in developing a science which is so intimately interwoven with human interests, and in every sense so important to the life of the State. It is the part of wisdom to give the widest latitude to discussion wherever matters of opinion are either opposed or seem to be in conflict. The State has acknowledged the legal equality of graduates of all schools, but exacts evidence of this attainment. For instance, the State authorizes a graduate of any incorporated medical college of the State, who is certified by a judge to be such graduate, and to be of reputable character and a permanent resident of the State, and of at least three years' practice, to be a medical examiner in lunacy, to determine the sanity or insanity of persons who are to be admitted to treatment in State or corporate institutions, or licensed private houses, requiring at the same time that all such medical certificates shall be judicially certified before they can have any legal or binding force.

I use this illustration, because the State could not delegate a higher or more sacred function than that of determining in any individual case whether or not a citizen was or was not in a mental condition demanding the interference of the State for his protection against the disastrous consequences of his disease, if left to himself or to his family. This endowment of physicians with a judicial function is certainly the highest indorsement the State could grant to a profession, and is the most