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considerably to increase the size of the Journal and to conduct it in a thoroughly energetic, and independent manner, in such a way as to make it worthy of being the weekly organ of a powerful Association. Under his direction the Journal was at once doubled in size. It was brought into a state of scientific and social activity, and made an organ of the most recent scientific and professional work, and its editorial departments conducted with vigor and literary skill. The effect upon
the fortunes of the Association was magical. Five hundred new members joined that year, and for each successive year since that time, from five hundred to six hundred new members have been added to the list by the simple process of sending out throughout the country once or twice in the year copies of the Journal and forms of application for membership. The result has been that whereas for the thirty-six years that the Association had existed, it had only slowly crept up to about two thousand, it has, during the ten years that Mr. Ernest Hart has edited the Journal, risen in numbers mutil it now includes eight thousand members of the profession, and, according to the statements printed in the Journal, it circulates another fifteen hundred copies outside the profession. It gives forty pages of printed matter every week, so that the Lancet has felt itself called upon to enlarge the number of its pages in order to bring them up to its now formidable rival; but the Journal, by reason of the closeness of its type, still gives about one fourth more matter than its senior rival. The circulation of the Journal is now alleged to be some thousands more than that of the Lancet, anil larger than that of any other medical paper in the world. Certainly the British Medical Association has in this way become the most powerful medical association in the world. The way in which the Journal has done this has been by converting all its subscribers into members of the Association, by a very simple process. When the extra numbers of the Journal are issued, which takes place at the beginning of every year, a cireular which goes by post informs the person receiving it that the subscription of the Association, including the weekly supply, post free, of the Journal, of which a specimen copy has been sent by the sanie post, is five dollars per annum; but the subscription to the Journal alone to others than members of the Association is six-and-a-half dollars. Thus the Journal offers a bonus on membership in the British Medical Association.
From three to four hundred new members are thus added each January. Having thus created large nuclei of members in the various counties, the editor appoints a correspondent of the Journal in any part of the country in which no branch exists, and this correspondent presently makes it his business to arrange a local meeting of members and to form a branch of the Association. In this way, the number of branches which, when the Journal first took its new start under the editorship of Mr. Hart, was only ten, has risen now to twenty-seven. Branches have been formed, not only all over England, but throughout Scotland and Ireland; and new branches are being formed of members of the Association, who have emigrated to Australia and India and still desire, by the brauch organization of the Association, to maintain close relationship with the profession in the mother country.
It is unnecessary to say anything in praise of the British Medical Journal. It has by far the largest circulation of any English medical journal, and its reputation is such as to make it independent of commendation on that subject. What is to the point is to refer to the balance-sheet, which is published every year and distributed at the annual meetings of the Association, as well as in the pages of the Journal. There it may be seep that the Journal becomes not only a powerful means of attracting new members to the Association, and of keeping them in it by maintaining their interest and connection with the Association and giving them “value for their money,” but that its advertising columus contribute largely to increase the funds of the British Medical Association, bringing in an income of something like twenty-five thousand dollars a year. The total income of the British Medical Association is about seventy thousand dollars, of which twenty-five thousand are from advertisements in the paper, and the balance from subscriptions of members and sales of the Journal. Out of this income are defrayed the salary of the secretary-not a medical man but a business man—who acts as business manager of the Journal and general business secretary of the Association at a salary of twenty-five hundred dollars a year, giving his whole time to the work; also the rent of a building, centrally situated, which serves as the printing and publishing office for the Journal, and also as a gathering place for the committees of the Association throughout the year. There are, further, defrayed the expenses
of the various standing committees appointed for special purposes, such as, last year, “the promotion of legislation for habitual drunkards;" the standing committee for the examination of bills brought into parliament affecting medical interests, and for the promotion of clauses beneficial to medical interests or the opposing of provisions considered likely to be injurious to them; and other similar committees. There is a further payment out of funds of the Association for the promotion of researches in medicine and the collateral sciences. A thousand dollars were voted in this way to Professor Hughes Bennett and Professor Rutherford, of Edinburgh, for the expenses of their famous researches "On calomel and other agents having a reputation as promoting the flow of bile.” In all, about fifteen hundred or two thousand dollars a year are voted in this
way. Certain contributions are made towards expenses of the annual meeting, especially the printing expenditure, and, from time to time, special grants are made towards specially important medi. cal objects. The editor of the Journal is paid about five thousand dollars a year, including payments for his editorial writing, and the sub-editors about twenty-five hundred dollars each. The literary expenses for payments to writers on the staff for editorial articles, reviews, criticisms, and the like, amount to about another tive thousand dollars a year. After all expenses are paid, there remains now an annual surplus of from three thousand to five thousand dollars, which has been accumulated into a reserve fund.
If, then, we review the position of this powerful Association, we shall see that it has a formation which includes, first of all, a strong central executive; this is elective, mainly from its twenty-eight branches, who each send one delegate to the central council, generally the honorary secretary of the branch. This central council includes all past presidents, and twenty members elected at the annual meeting; and it meets once a quarter at least, or more often under special emergency. The central council is a powerful executive institution. It delegates the business conduct of the Journal to a “Journal and Finance Committee,” which meets also ovce a quarter, occupies itself chiefly with passing accounts, and general questions of finance and business management, and communicates with the editor upon any subjects which may have arisen during the quarter. There are also a considerable number of standing committees,
appointed at the annual meeting, to consider special subjects, whose powers are strictly limited by the terms of reference, but who work throughout the year, and who derive their funds solely from special grants by the central executive committee. The standing “Committee on Parliamentary Bills” consists, like the Executive Council itself, of a representative of every branch and ten members appointed by the annual meeting, and is a most powerful protector of all medical interests. With this organization the Association possesses in the weekly Journal the means of keeping all its members in constant communication, one with another. The addresses given at the annual meeting by appointed orators in each subject, are at once printed in full in the Journal. Every paper read is printed in abstract, together with a report of the discussion excited by it. Thus, the Association secures for itself a full, rapid, and responsible report, which comes at once into the hands of all its members, and of all those in the profession, or out of it, who choose to subscribe to the Journal, week by week. Any subjects of discussion, which arise at the meeting, can be continued and are continued from week to week by communications in the Journal. Work arising out of the meeting is reported throughout the year in the Journal. The quarterly meetings of the executive committee, the proceedings of the standing committees, and of the branches, are all continuously brought to the knowledge of the members, and discussed by them in their weekly Journal. Fresh subjects of interest and of public moment, occurring throughout the year, are discussed, dealt with, and reopened for debate and final settlement at the annual meeting.
Not all the papers read at the annual meeting are published in full, but full discretion is given to the editor to publish or not, according to his estimate of the importance and interest of the papers to the members at large. The rule of the Association is that the interest of the individual must be subordinate to the common welfare, and although, no doubt, the discretion of the editor, in publishing in full, or in rejecting individual papers, may be often questioned by the individual, yet his action has from the first remained entirely unfettered; no instance of any abuse of that power is considered by any member to exist, and it has worked admirably for the general welfare in securing for the Journal the best of the papers read, and in making it understood that the Journal of the Association would never be allowed
to become a “waste basket” for inferior literature, but that a rigid power of selection would be exercised in respect to the publication of the full text of any papers offered for that purose.
These details are of importance to the American Medical Association, for they include the germs of an organization pecu. liarly adapted to American ideas. It is essentially democratic, and entirely representative. It is dependent for its success on the intelligence, union, and good-will of the members. It is decentralizing, inasmuch as it tends to the formation or the strengthening everywhere of the local societies, which have thus throughout the year the means of making themselves heard in metropolitan centres, and of communicating with each other. Above all, it is a most successful and influential means of increasing the membership, enlarging the power, and widening the basis of the Association, and of making it a living organism during the intervals between the annual meetings. Finally, it has the great advantage of securing the largest amount of value 10 each and all of the members, for the smallest possible subscription. The Journal becomes, in fact, a co-operative enterprise in which the profits resulting from their subscriptions go into their own pockets, instead of those of any individual proprietor. They oun their own paper. They are able to get the advantage of a powerful organization, and of a first class medical paper at the same annual subscription as that of a medical paper by itself, and with the surplus they find funds for a place of meeting for their committees, and for the promotion of public and scientific objects, and the creation of a reserve fund for future public
There seems no reason why an experiment so essentially accordant with American instincts and traditions, and one which has succeeded so well in England, should not have at least as great, if not a greater, success in America.
One point, bowever, that is specially worthy of note is, that the success of the British Medical Journal has been largely dependent upon the manner in which it has been conducted. The weekly Journal did little for the Association until it fell into the hands of an experienced editor, whose ability is so generally recognized that there is no need to dwell upon it, and to whom a large and unfettered responsibility is left, although he remains, of course, personally responsible to the executive of the Association for the right use of the power entrusted to him, as every