ANNUAL ADDRESS

OF THE

RETIRING PRESIDENT,

S. M. SMITH, M. D., OF COLUMBUS, OHIO.

GENTLEMEN-As time is an essential element for the development and completion of any great purpose or enterprise, I may congratulate you that our present meeting marks so auspicious an event as the ending of a quarter of a century in the life of our organization. In the rush of events that marks our age so characteristically, it is worthy of note that we have more than preserved our existence; that we have in some degree marched in tune with this progress; that we are not out of tune with the spirit of freedom, independence and power; on the one hand, not so chained to the obsolete past, as to carry it about "as a body of death," nor yet so intoxicated with a wild, reckless spirit of revolution, as to cut loose all the ties that bind us to its sacred memories, or anchor us surely to its unchanging truths. It has been the grateful and welcome duty of another to gather up these precious memories, and pass in review the important events of the first era of our existence. Again I congratulate you on a purpose so wisely designed, so completely carried out. If the miser, as he gloats over his glittering hoard that his wasting years of toil and self-denial have accumulated, has

a bated thrill of pleasure, may we not indulge in unchecked gratification. Our treasures are a free possession, whose title none may dispute, treasures that no rust can corrode, no thief break through and steal.

None will deny us the happiness conferred by this contemplation, but few, or none, would advise us to linger too long in this pleasing mood.

The very means by which this accumulated wealth of experience and research, certification of truth and refutation of errors, has been attained, suggest that we can in no way make this occasion so profitable, as to inquire wherein our progress has been impeded; where we have incorporated errors that vitiated our conclusions; how much of fruitless labor has wearied life that might have yielded great results if properly directed.

The student of elementary knowledge in our art is first directed to the contemplation of healthy organizations, and the normal performance of functions, to the great hygenic and nutritive influences that preserve and perpetuate these; and then he is asked to note the perversions of all these representative elements of health, and that, he is told, is Disease. In the practice of that art, in the daily routine of the physician, these perversions will occupy a large share of his study, and engross, with intense interest, his severest attention. To their arrest, correction and removal he will devote the vigor of his life. With habitudes thus acquired of consta tly looking at the faults and the follies, at the short-comings and the failures of the body, may we not be excused, if we should turn to the great Medical Body, and with no undue timidity, yet with no irreverent presumption, assume to inquire into some of its manifestations of disease, some of its foibles and follies, some of its short-comings and failures. This, I trow, we may attempt, with the same worthy purpose with which we contemplate the gaping wound, or search after the deep malady-that we may minister to the healing of the one and the cure of the other.

I propose then, gentlemen, with your indulgence, to exer

cise the less gracious, but, I trust, the not less profitable office, of inquiring into some of the faults and defects in the cultivation of our profession, that retard its progress, leaving to others the more pleasing duty of singing its triumphs and recording its grand achievements, but claiming an equal sympathy in their pleasing task.

Will the free and generous acknowledgment of our faults and deficiencies be less worthy of us, and lead to less important results, than the unhesitating recital of our aches and pains, of our deranged functions and sensations, or the marshalling for inspection our offensive sores and our repulsive secretions. We seek, in either instance, the aid of correcting skill and the restoring power of healing remedies. How can we take the first step without such a temper? How can we cultivate such a temper without a clear appreciation of our deficiencies and the great desirableness of their removal?

The necessity of reform has been from year to year, and time to time, a topic of discussion in all the great medical associations and societies of our country, and the discussion has been marked by a spirit as varied in the interests and impulses of the disputants. In many instances it has issued in valuable suggestions, made with honest intent and pur. pose, as to the best means by which to accomplish the great object. The usual drift has been to look to the schools to inaugurate these great changes, while, in many instances, they have been charged with being the great obstructing causes of their arrest and retardation. All acknowledge that great difficulties lie in the way, and many have the candor to share the blame of this slow progress, instead of rolling the whole responsibility upon the schools.

Let me briefly catalogue a few of the acknowledged defects and faults in the medical education in our new, but rapidly progressing country. Imperfect preliminary education, defective training in offices-too short and not sufficiently exclusive time given to elementary branches- too early entering upon the study of the practical and applied branches.

In the schools, no graded course of study according to the proficiency and advancement of the student, as example, a primary or preliminary, a secondary or junior, and a senior department, the first consisting of two years of faithful application to the elementary and related sciences; then a year to the great principles, or "Institutes," that uderlie and apply to the practice of our art; and then a fourth year, or more, to the clinical application of all this knowledge, thus carefully, regularly and thoroughly acquired; the curriculum of studies, not sufficiently comprehensive; an insufficient number of teachers; then too short lecture terms, the great superiority of eastern over western, of metropolitan over provincial schools-a supposed irresponsible power in the conferring of degrees, "with examinations to suit." Therefore, the necessity of dividing the teaching from the examining and the power of conferring of degrees. These and kindred topics have been included in the discussions on medical education and medical reform. They are of acknowledged importance, many essential to any successful progress. But a question, not less pertinent, is to find what can best be practically accomplished. The world abounds in impracticable reformers, who, accepting the uncontroverted idea of "a thing being right in itself," rush to the conclusion that therefore it must be applied without delay. The legis lator or reformer who consults only his own view of the fitness of things, or abstract moral rules, or philosophic laws, and then finds that his laws are not obeyed, or his reforms wholly inoperative, would more wisely ask what, with the difficulties inherent in the nature of things, is practical, and then spend his energies in doing that which can be done.

The honest, earnest searcher after good, who desires reform without destruction, may inquire where rests the responsibility of these defects and grave faults, and will probably come to the conclusion that it is a divided responsibility, and both colleges and the profession at large must each shoulder a share of the blame. His more earnest inquiries will be after the surest means of removing the obstructions, without reference to individuals or organizations.