We do not forget the means that have been perfected for our assistance, nor the aids that have been placed in our hands. We do not forget all that we owe to the clinical thermometer, the use of which had never been suggested fifty, and scarcely forty years ago. We do not forget all that has been learned from urinary analyses, that were rarely thought to be essential then.

We do not forget the hypodermic needle, nor how opportunely or providentially the antitoxins have come to our aid. We do not forget the thyroid extract, by means of which the unsightly and distressing myxedema has been made to yield. We do not forget what the Röntgen rays are doing in making plain what was hitherto invisible, nor that their palliative, if not curative, action upon sarcoma and carcinoma and epithelioma are rapidly passing beyond the experimental stage.

We do not forget the improvement that followed when the indiscriminate use of the lancet yielded its place to milder measures or to gentler stimulation, nor the disgust that was avoided when the nauseating doses of a former period were so largely superseded by the triturate tablet and the sugar or gelatine coated pill.

And we do not forget the wonderful improvement in pharmaceutical preparations, that the progress of the times, as directed by medical science, has demanded, and that these latter days have ushered in; and contrasting them with the vile concoctions that were forced upon the sick and the suffering, in the days when crabs' eyes and blind puppies, earth worms and human skulls, had a place in recognized formulæ, in standard pharmacopeias of the period, and a commercial value as staple articles in the catalogue of pharmaceutical supplies, we felicitate ourselves with great joy and gladness that the lines have fallen to us in more pleasant places, and bless with sincerest gratitude our ancestral lineage that our existence was delayed to these later days.

And finally, we do not forget the great multitude of investigators that have so long been focussing their microscopic lenses upon every form of pathological condition, with the hope and determination of tracing the ultimate causes of every form of disease.

We do not forget that never in the history of medicine or of the world have the searchlights of science been cast more persistently or more determinedly upon these bewildering problems, to work out their solution, than in these later

years.

Never have clearer heads or keener intellects or braver hearts grappled with these perplexing difficulties, either to find the way to overcome them or to demonstrate the impracticability of the attempt. Indeed, so far has science already led us, that the personal element in the profession is being largely eliminated from the account, and the oldtime independent thought, self-reliant judgment and prompt, decisive action—not always without their errors, it must be admitted, yet useful in many ways-that belonged to a former generation, are rapidly and it is to be feared altogether, disappearing; and where once the way seemed clear before us, and pathognomonic symptoms clearly and sharply defined; we now hesitate and falter, if we do not positively decline - even while disease is rushing onward with increasing and dangerous rapidity to render a diagnosis, until the revelations of the microscope or the bouillon cup have either exploded or sustained the views we have entertained. And we do not question their conclusions. We only learn to distrust our own.

And if there are those among the older practitioners who ask if the best interests of the sick and the dying are always subserved in this way; whether the accuracy of a mathematical demonstration is always secured by methods like these; if there are those who claim that habits of lifelong observation and years of experience at the bedside are en

titled to some consideration still; if there are those who believe that the trained perception, the quick ear, the keen eye, the sensitive touch, that years of practice have intensified, if they have not perfected, are entitled to a place for practical purposes in the armamentarium of the physician that neither the exhibitions of the microscope nor the logic of the laboratory can fully supply, and that they will sometimes lead to just conclusions, before either the microscope or the laboratory can so prepare and adjust their specimens as to pronounce definitely upon the result; yet even these are willing to concede, when they do not conceal their misgivings, and while reserving to themselves the privileges of private judgment and independent action, do not hesitate to fall into line in the great procession that marches to the music of progression where the heralds of science blaze the way. And it is well. Heaven grant to these pioneers of science an unobstructed sway! Heaven grant to them abundant success to their labors! Heaven grant that their work may continue to prosper, until they shall find not only the germs of all diseases, but shall also discover the means that shall dislodge them from their place!

All honor to those noble men. All honor to those worthy ones who are denying themselves so many of the things that add to life's enjoyment, that they may devote their best years to this beneficent work. All honor to those who are teaching us the beginnings of disease. Let all encouragement be given them to continue in the paths they are pursuing, till they shall also teach us how to bring their work to a successful end. Let all praise be theirs for results already won. We honor them for their devotion to the work they have undertaken; we respect their conclusions; we follow their directions; we adopt their recommendations; we proclaim their fame while they are living, and rear monuments to commemorate and prolong their memories when they are gathered to their rest.

But the old conviction comes back to us still. If the purpose of study and of treatment is to cure disease, and so to promote the welfare of humanity, then the ultimate purpose of medicine is not yet in sight. When all our investigations are completed, when our studies and researches are done, when the improvements in management and the additions to our resources have either demonstrated their value or failed in our hands, the grand object of curing disease by medication, so far at least as many diseases are concerned, is not gained.

And

Tuberculosis remains the same unconquered and unconquerable foe to human life that it has been always. in cases where improvement has been noted, it has been accomplished less by medication than by hygienic means. Pneumonia swept away 5,282 victims in 1900, in Massachusetts alone. Typhoid fever remains typhoid fever still. And neither improved-or at least varied-methods of treatment, nor cold ablutions, nor chilling immersions, nor Widal tests, nor microscopic views, nor corpuscular computations, have perceptibly changed its character in any essential particulars, from the fatal and fearful affection that baffled the skill of the physician in the days of our predecessors, and that resists with equally stubborn obstinacy the best directed efforts of our own. It regards neither rank nor condition; it abates not one degree of its destructive energy, whether its visitation fall upon the heedless victim of his own carelessness and needless exposure, or on our own cherished and beloved governor, who relinquishes the chair of State and retires from the duties of the gubernatorial office long enough to come in here with us year after year, to honor us with his presence, and to speak to us words of encouragement and praise.

And the humiliating thought that adds the keenest pang to our affliction is that both the sanitarian and the medical profession are committed to the opinion that its place is in the

catalogue of preventable disease. There were fifteen diseases whose fatality was greater in Massachusetts, in both 1890 and in 1899. Whether its rank throughout the country in those years was higher we do not know. But in 1896, Dr. Bradford tells us, in the Annual Address* for 1899, that it claimed 75,000 victims in the United States.

We know not and are not now considering "whether disease is a part of the plan of creation," but we know that existence is hedged round with so many unfavorable conditions, that danger surrounds us like an atmosphere from life's beginning to its close. In whatsoever paths our feet are guided, disease is everywhere present with us still.

cure.

We do all that medical science in the present state of its development suggests and all that experience teaches, to counteract the ills that beset us, that we are obliged to acknowledge we cannot prevent at present and do not always We build hospitals in every city, and furnish them with every convenience and necessity for the care of the helpless and the sick. We secure to them the best attendance that the medical profession can supply. We build expensive laboratories, and equip them in liberal fashion with every useful appliance, in the hope that every new aspect as it makes its appearance, as well as every structural change, may be noted and assigned to its appropriate place in the etiology of disease. We exhaust our knowledge of the pharmacopeia and the products of the earth, the sea and the atmosphere in devising new antidotes for the relief of whatsoever maladies afflict the children of men. We experiment with every new remedy or combination of remedies that is commended to our attention as possessing special adaptation to special diseases or uses, to the end that we may thoroughly test their virtues, and when they have disappointed us sufficiently we cast them aside. We invoke

* Medical Communications, Massachusetts Medical Society, vol. xviii, No. 1, 1899, Annual Address, p. 33.