Transactions of the Provincial Medical and Surgical Association/Volume 1/An Address delivered at the first Meeting of the Association

by Charles Hastings

AN ADDRESS,

DELIVERED AT THE FIRST MEETING OF THE

PROVINCIAL

MEDICAL AND SURGICAL

ASSOCIATION.

BY CHARLES HASTINGS, M. D.

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I CONGRATULATE you. Gentlemen, that the day for forming a Provincial Medical and Surgical Association has, at length, arrived. An association which, I trust, is destined to exercise no inconsiderable influence on the future progress of medical science. Feeling, as I have long done, the disadvantages under which the prosecutors of medicine, resident in English provincial towns have laboured, in consequence of the want of any system of co-operation, by which their separate exertions, for the promotion of our knowledge of the healing art, may be so united as to render them more influential, and more extensively useful; I cannot but hail this day, Hunc lætum medicis diem, as one of peculiar promise; as one likely to lead to the most important results.

When I see assembled around me some of the brightest ornaments of our profession; and when I call to mind the fact that, in addition to those now present, our association already numbers amongst its future members, a large proportion of provincial physicians and surgeons, who are, and have been, zealous and successful cultivators of our science; whose wishes, moreover, for the success of the association, are ardent and strong; and who are only detained, by paramount necessity, from being here this day, to express their conviction that such an association, as we are now about to form, is not only desirable, but loudly called for, as positively necessary, if we, in the present day, mean to avail ourselves of all the advantages which the stream of time has carried down to us. When, Gentlemen, I contemplate these promising omens, can I, for one moment, doubt the success of our enterprise? can I, for an instant, cease to devote my poor abilities to advance the progress of the good cause in which we are engaged?

Neither, Gentlemen, will I affect to hide, on the present occasion, the feelings of unmixed joy which I experience in the reflection, that the Infirmary of my native county has the honour of receiving within its venerable walls, the first meeting that is called for carrying into effect the admirable purposes we have in view: because I feel that the more subservient such institutions can be made to the advancement of medical knowledge, the more instrumental will they ever be, in relieving the afflictions of the sick poor who seek an asylum within their walls.

The benefits which arise from the association of men, for the advancement of general science, have been long felt and acknowledged. Witness, more especially, the recent establishment of the “ British Association for the advancement of Science, ” in which are enrolled the names of scientific men from all parts of Great Britain; a vast proportion of whom assembled together at their late meeting at Oxford. We may, therefore, infer, that the desire for such a combination of forces in the Medical Profession, though dormant, has existed. We may infer this from the avidity with which the proposition to form such a society, as we contemplate, has been, on all hands, received.

The facilities of communication, too, between distant towns, both personally and by letter, are so much greater than formerly, that the very distance at which many of the members may reside from each other, will oppose but a slight barrier to our undertaking. Every thing now conspires to make the present a fit time to begin our great experiment. Let us look, alone, to the numerous charitable, medical institutions which, to the honour of the provinces, flourish so vigorously in every direction. The means which they would afford, to increase our knowledge of the medical art, if they really were sanctuaries of science, as well as of sorrow, are incalculable! Again, I am far from thinking lightly of the influence which provincial medical men have in society; but I also believe that, as a body, provincial medical practitioners do not hold the rank in the community to which they may attain, and to which it will at all times be the effect of our association to stimulate them to aspire. To this end it is also of immense importance, that, as a profession, we should maintain a dignified attitude before the world; for, if we turn our attention to the members of the medical profession themselves, and observe the spirit of misrule and confusion with which some of them are actuated, and the attempts that have been made, and are making, in the metropolis, to bring about feelings of hostility between the cultivators of the different branches of medicine, we cannot but feel that this is the time in which the friends of peace and harmony should declare themselves. I hope, therefore, as a society, we shall never allow any opportunity to escape us of cultivating friendly intercourse, and of exalting, as far as we have the power, those favoured sons of science who have, by their life and conversation, shed a lustre around them, and whose example, reputation, and acquirement's, are calculated not only to stimulate their brethren to exertion, but also to raise admiration of our art in the public mind.

But there may be those who, though they allow the scheme of an association, for the advancement of medical science in the provinces, to be excellent in itself, do not admit that it can ever be made practically available to the furtherance of science, owing to the dearth of willing labourers to cultivate the new ground, which we are about to lay open. I feel satisfied that no one who can entertain so libellous a doubt, will venture to be present this day; but if there be any one who hesitates as to the probability of the provinces containing able writers, willing to devote themselves to the cause of our science, for the pure love of truth, and for that only, I would beg to call his attention to the publication of the Midland Medical and Surgical Reporter, which commenced in the year 1828, and of which, sixteen numbers have been published. In the prospectus of that Journal, the Editors observe, “ In reflecting on the state of medical science, and on the aid which it has derived from the opportunities of observation afforded by congregating the sick in hospitals, it has often struck us with surprise, that so little should be known of the many interesting cases that must have occurred in provincial hospitals. If, from the establishment of these institutions, faithful records of the valuable cases that have occurred in them had been handed down to us, our present limited knowledge of morbid anatomy, the only correct elucidator of disease, would have been greatly extended. We know well that great difficulties must present themselves in effecting an object so desirable as making public these instructive cases. The daily anxieties and fatigues to which those in general are subject, who have the professional care of these institutions, are such as to leave little time for literary pursuits, and appear to present an almost insurmountable barrier to such an undertaking. It is not, however, to be denied that, by zeal and industry, much may be effected”

Such were the anticipations with which the Editors commenced the publication of the Midland Medical and Surgical Reporter, and many were the responding forebodings with which the undertaking was greeted by some of their friends. But four years experience in conducting that work, has convinced those who were engaged in it,^[1] that provincial labourers are neither few nor of small value, and the knowledge of this fact was the circumstance which induced them to consider, that the more extended enterprise, on which we are this day entering, was not only feasible, but would almost certainly be crowned with success. It occurred to them that as the establishment of a Journal in the Midland Counties had been well received, and supported beyond their most sanguine expectations, there was no reason why a society of provincial physicians and surgeons might not be formed, to elicit valuable information, and to communicate it to the public, under the title of Contributions, Memoirs, or Transactions. They were moved to this consideration by contemplating the necessity that, in the yet imperfect state of our science, exists for the further collection of facts, which, in order to be abundant, must be derived from a wide field, and from numerous contributors. But the duties and the cares of life prevent many from paying their mite into the general treasury, except where arrangements are made for exciting industry, and facilitating communication. Association ministers to these ends more effectually than any other means hitherto devised; omnes trahimur et ducimur ad cognition is et scientiæ cupiditatem; and on this ground the proposition was made, to associate the Provincial Medical Practitioners of England, or, at least, as many as can be brought to rally round a common centre, in a comprehensive co-operating Institution, which, by collecting the results of individual experience, and bringing the energies of many minds to bear on those unsettled points which have subjected medicine to the imputation of being a conjectural art may contribute to redeem its character, and to give to its operations more precision and certainty.

I need not here relate how this proposition has been received by the profession at large, how gratifying this reception of it has been to those with whom the scheme originated, how honourable, truly honourable, to those who have agreed zealously to engage in this, what I must call, truly noble undertaking. Your presence here this day, stamps with your approval the general principle which is involved in our society, and shews that at any rate, the founders of this institution did not make a wrong estimate of the desire, which exists amongst provincial medical practitioners, to advance medical science, and to promote among themselves that harmony and social feeling, which ought ever to characterise a liberal profession.

It has fallen to the lot of the humble individual who is now addressing you, to communicate, either personally or by letter, with a very large proportion of physicians, surgeons, and general practitioners, resident in different provincial towns; and in the course of those communications, there has been but one wish expressed for the prosperity of so promising an institution, and, generally speaking, a desire entertained of being enrolled amongst its members; so that we actually have this day upon our list, 150 candidates for membership.

To attempt to express the feelings of gratitude which I experience towards those numerous friends who have, in so distinguished a manner, attended to my applications in behalf of the association, would be vain. I will only, therefore, declare that the impression made on my mind is such as time will not efface, and that my gratitude is too great for words to express. A committee has for some time been engaged, whose endeavour has been to take advantage of the suggestions made by our numerous correspondents, and the results of their labours have been for some time widely circulated amongst the members of the profession, in a prospectus, which recites the following as the principal objects to which the attention of the association will be directed.

1st.—Collection of useful information, whether speculative or practical, through original essays, or reports of provincial hospitals, infirmaries, or dispensaries, or of private practice.

2nd.—Increase of knowledge of the medical topography of England, through statistical, meteorological, geological, and botanical enquiries.

3rd.—Investigation of the modifications of endemic and epidemic diseases, in different situations, and at various periods, so as to trace, so far as the present imperfect state of the art will permit, their connexions with peculiarities of soil or climate, or with the localities, habits, and occupations of the people.

4th.—Advancement of medico-legal science, through succinct reports, of whatever cases may occur in provincial courts of judicature.

5th.—Maintenance of the honour and respectability of the profession, generally, in the provinces, by promoting friendly intercourse and free communication of its members; and by establishing among them the harmony and good feeling which ought ever to characterise a liberal profession.

As one great means of carrying into effect these objects, it is proposed to hold an annual meeting of the members at some one of the provincial towns, changing the place of meeting each year; which meeting will not only be instrumental in producing friendly intercourse between all the members of the Association, however separated by distance from each other; but it will also be dedicated to the promotion of medical science, as one of the members will be annually appointed to give a history of medicine during the past year, or an oration on some subject connected with medical science, or a biographical memoir of some eminent cultivator of medical science, who may have resided in the provinces. This retrospective view of medicine alone, will, I think, stamp a considerable value upon our proceedings, because nothing can be more proper than that, at stated periods, reports should be made of the advancement of a progressive science, and nothing can be more likely to stimulate to renewed exertions those who have been toiling hard in the field of knowledge, than to look back and discover, that a harvest, more or less abundant, has been reaped as the fruit of their exertions.

Various, indeed, are the means by which our annual meeting may be found advantageous in increasing our stock of knowledge. It has been suggested by a very distinguished individual,^[2] that a certain number of members shall be appointed each year; whose duty it shall be, to report on the state of medicine, in the several countries with which we have literary communication. Thus the state of the science in France, Germany, Italy, and America, would become familiar to each of us, and much interesting and valuable information could not fail thereby to be elicited. In this respect, also, the British Association for the advancement of science, may be imitated by us with great advantage. They have appointed committees of their body to select the points in each science which most call for inquiry, and endeavour to engage competent persons to investigate them; and they attend particularly to the important object of obtaining reports in which confidence may be placed, on the recent progress, the actual state, and the deficiencies, of every department of science.

On the last of these points, the collection of reports, an able and zealous member of the British Association, Professor Whewell, says, " A collection of reports concerning the present state of science, drawn up by competent persons, is, on all accounts, much wanted; in order that scientific students may know where to begin their labours, and in order that those who pursue one branch of science, may know how to communicate with the inquirer in another. For want of this information, we perpetually find speculations published, which shew the greatest ignorance of what has been done and said on the subject to which they refer." Additional energy may, therefore, be given to our proceedings, and the zeal of our members be increased, if a certain number of them be appointed, each year, to report at the following annual meeting, the progress of the distinct branches of medical science, during the year.

We shall not, then, find any lack of good employment for our time at the annual meeting.

The objects to which the attention of the members in general may be directed, are also of paramount importance.

Is there not a rich mine open to the labours of our members, in the department of essays, speculative and practical? There is scarcely a branch of physiological or pathological investigation, which may not be undertaken by means of essays.

In Physiology.—After all the laborious and minute researches of the anatomist, there are yet parts of the animal frame of which we know not the uses, scarcely the structure; and there are several functions of which the physiology is still very imperfect.

Of the blood, the chemical investigation has been minutely pursued. Has its physiological condition been investigated with equal care?

The actions of the heart have become the subject of much minute observation, ingenious speculation, and keen controversy. However the inquiry may terminate, the science of physic cannot fail to profit by the labour and intellect so meritoriously devoted to the research.

The respiratory process, and the changes induced by it, have been ably and zealously investigated; yet even here, there is room for more extended inquiry.

Of the brain and nervous system, the knowledge has been greatly advanced in modern times. The structure of the brain has been much more clearly demonstrated, since the mode of treating it, by transverse sections, has been exchanged for the more rational one, of unfolding its several parts, without injuring their texture, or rudely disuniting them.

Respecting the nerves, the brilliant discoveries of Sir C. Bell constitute an æra in anatomical science. They shed around his name a lustre of no common brightness, and will extend his fame to distant climes and remote ages. They open a field, too, for further investigation, for it is highly probable that the nerves perform other functions besides those of sensation, motion, and volition; and that there are special nerves devoted to several of the more intricate processes of the animal economy, which enlightened research may yet explore.

Of the several abdominal viscera we have yet much to learn. The uses of the spleen, of the renal capsules, of the appendix cœci, are still conjectural, if not wholly unknown. The physiology of the liver is very imperfect. In fine, sedulously as anatomy and physiology have been cultivated for ages, there is still enough unascertained to excite inquiry and repay exertion.

Pathology.—In pathology, the field is still more ample, for this branch of science, can hardly be regarded otherwise than in its infancy. It presents but few truths which merit the name of principles, and even the series of morbid changes from which the special diseases, recognised by nosology, result, has been hitherto very imperfectly investigated. Between the first deviation from a state of health, and the generation of a special malady, a most important period intervenes, which has received very little attention.

The combinations of nervous and vascular derangements, too, their mutual influence on each other, and the modifications of treatment required, according as either obtains the ascendancy, furnish matter for observation and inquiry of the highest moment. In the present state of our knowledge, there is too much tendency to view these states as radically distinct from each other, if not directly opposed; to infer that if one prevail the other cannot co-exist; and, under the influence of an exclusive theory, to adapt the treatment to the partial character thus assigned. Diseases of inflammatory action require depletory treatment and anti-phlogistic regimen. Nervous excitement, when not dependent on increased vascular action, is, oftentimes, best allayed by stimulants and narcotics. To combine these opposite remedies, so as to obtain from each class its beneficial effects, is essential to successful practice. Experience teaches this; many practise it; and to this knowledge may be traced much of the tact by which the experienced practitioner is often distinguished. But theory has not yet developed the principles on which it is founded, so as to render them clear to those who are entering on the practice of their art, or who have not had opportunity for forming their own experience. There is reason to believe that the vascular and nervous derangements continually co-exist, and are intermixed in every conceivable proportion; and if, in the treatment, either be overlooked, the success will be less speedy and less complete.

Among the spinal diseases, are many of which our knowledge is very defective; several for which we have no rational mode of cure. The more prominent of these will readily present themselves.

Therapeutics.—The modus operandi of remedies, too, needs further elucidation. Were this more completely investigated, many of our most active and useful medicines might, through analogy, be extended in their applications, and far more safely used. Mercury, for instance, which, when administered according to its more immediate and physiological operation, is capable of extended and accurate use, of which they who judge only from its more remote and curative effects, have but a very imperfect notion. On this question, my friend. Dr. Barlow, of Bath, has thrown light, in one of his papers in the Cyclopædia of Practical Medicine, a work which, as far as it has gone, does honour to our country, and to which one is proud to see the names of so many provincial physicians attached.

All the subjects which I have above mentioned, (and they might be readily multiplied,) may be elucidated by good essays. They, moreover, have been the favoured method by which some of the brightest ornaments of our profession have given their thoughts to the world. Many, whose avocations and cares will not permit them to engage in the more regular and laborious task of a treatise, may render much service by this more convenient, and not less effective way, of communicating valuable information to their brethren.

The history of medicine confirms me in this recommendation of essays to the attention of the members. How much interesting and truly valuable knowledge has been thus communicated to the world. In our own country we may boast of much valuable literature of this kind. In London, the Medical Observations and Inquiries, Medical Communications, Medical Transactions, Memoirs of the Medical Society, and Medico-Chirurgical Transactions, bear ample testimony to the beneficial effects that may arise from the publication of well-selected essays. Since the foundation of the Medical School in the University of Edinburgh, that city has been the favoured seat of medical learning; and how much of the reputation for that learning in our northern brethren, may be attributed to the success of the publication of valuable essays, I leave others to determine: but thus much I may observe, that so long as a taste for Medical Literature shall continue, so long will the Edinburgh Medical Essays, the Essays Physical and Literary, Medical Commentaries, and Annals of Medicine, be read with interest and attention. These publications require, indeed, no commendation from me, as their character and merit are well known, and their utility has long been decided by the general suffrage of the profession. I may, however, be here permitted to observe, (and I make the observation solely with the view of encouraging the exertions of the members of this association,) that many valuable papers, both in the London and Edinburgh Transactions, have proceeded from the pen of provincial physicians and surgeons. Neither should it be forgotten, that we have already before us, in the brilliant success which attended the publication of the Memoirs of the Manchester Society, and the Essays which have appeared in the Midland Medical and, Surgical Reporter, an additional stimulus to engage us zealously in the present undertaking.

But let it never be forgotten, that a long debt is owing from the medical officers of Provincial Hospitals, Infirmaries, and Dispensaries, in the shape of reports of those institutions. It is manifest that, if the valuable results of hospital and dispensary practice, throughout the kingdom at large, could be brought before the public in an authentic shape, the measure would be attended with the greatest possible advantages. At present, little has been done in this way, to which we can appeal with any satisfaction. The Midland Medical and Surgical Reporter has, in this respect, claims to consideration, in affording valuable reports of the Birmingham Town Infirmary, by Mr. Parsons; the Birmingham Eye Infirmary, by Mr. Middlemore; and the Worcester Dispensary, by Dr. Streeten. It is much to be desired that this line of inquiry should be assiduously followed up; for thence would, in future, arise most valuable documents, that, at any rate, would be authentic and impartial evidence, from which conclusions might be drawn or improvements suggested, that might lead to very favourable results in every branch of the healing art. I cannot press too strongly upon the members, the necessity of attention to this subject, and I do so the more earnestly, because I feel that, by the sacrifice of a small portion of time, the medical officers attached to the several charitable institutions of this kind, might furnish tabular records, giving an account of the principal cases under treatment; and also of every peculiar occurrence, as endemics and epidemics, &c.; any remarkable accident or operation; any particular mode of treatment; any particular formulæ not in general use; and, above all, accurate descriptions of the morbid appearances in all fatal cases. Annals of this kind would not only afford most valuable information to the public, but they would also materially tend to improve the discipline of hospitals, infirmaries, and dispensaries, and lead to a much more systematic arrangement of the respective duties of the officers of these establishments.

Medical Topography, again, is a subject on which we are particularly called upon to exert ourselves. It yet remains as a reproach to Englishmen, that they have done much less than their continental brethren in this very important branch of Medical Learning. To provincial practitioners we must look for the supply of this deficiency. They, alone, in their different localities, have the means of remedying this defect, and of supplying a more perfect system of Medical Topography than we at present possess.

" That great and numerous obstacles," to use the language of a learned author, in an excellent article in the Edinburgh Medical and Surgical Journal, " exist, to a general medical topography of this or any other country, we are most ready to admit; but, we have little hesitation in saying, hat the greatest of all is to be found in the apathy of the resident medical men;, from whose cordial co-operation alone any thing of the kind can be expected. Any voluminous work, whether systematic or empirical, must, unavoidably, contain much useless, and some erroneous, matter. To after times it must be left to correct these errors, and prune these redundancies; but we cannot help expressing our regret, that even the germ of a general medical topography of our island has not yet appeared among us, and that we are left with little more than the bills of mortality, from which we can extract any information on the state of public health, of a vast proportion of our most populous cities and counties. From these empirical sources, we have reason to suppose that the loss of human life varies in different proportions, from 1 in 36, the average rate for Middlesex, down to 1 in 73, the calculation for Cardigan; but, for many of the causes of this striking difference, we are consigned to the obscurities and intricacies of conjecture."

I cannot help entertaining the cheering hope, that the members of this Association may, by directing their attention to this highly important investigation, no longer permit it to be said that, whilst the physicians of France, Italy, Sweden, Denmark, Holland, Germany, and other continental states, have all contributed, more or less, to the formation of a national medical topography, England alone has done nothing, or next to nothing, on this subject.

In a densely populated and manufacturing country, where the elements for this sort of inquiry must abound almost more than in any other, it is somewhat marvellous that this should be the case, and particularly since the importance of the information to be obtained, has been often stated to the public. For it is but justice to the medical periodical press of this country to state, that its conductors have repeatedly endeavoured, but hitherto with not much success, to awaken the profession to the necessity of cultivating this branch of knowledge. The London Medical and Physical Journal, the London Medical Repository, and the Edinburgh Medical and Surgical Journal, have each of them, at times, loudly called for assistance of this kind; and in the latter Journal, particularly, several valuable contributions of this nature will be found, especially in the 67th number, where there is given a very able sketch of a plan for Memoirs on Medical Topography. The Editors of the Midland Medical and Surgical Reporter, also, have devoted attention to this point, and the fruits of it are important. The 1st, 2nd, and 4th numbers of that Journal, contain an account of the medical topography of Worcester; the 2nd and 3rd numbers, a topographical account of Birmingham, by Dr. Darwall; and another number, observations on the population returns of the manufacturing districts, by Dr. Walker, of Huddersfield. Nor must we forget to mention that, in one branch of this inquiry, there seems, of late, to be much promise of advancement. The work of Dr. Hawkins, on Medical Statistics, is, in itself, of great value. The learned author has brought to the subject much zeal and industry, and the result of his researches is a work replete with valuable information upon the duration of human life in every quarter of the globe, and even in all the cities of any considerable size. Nor must it be forgotten that the profession owes much obligation to Dr. Clarke, who, in his work upon Climate, has faithfully and closely investigated the general physical characters of the milder parts of England, and his researches have proved eminently useful in directing the attention, and guiding the judgment, of medical men, in the application of these situations to the prevention and cure of disease.

Mr. Thackrah has also ably exhibited the effects of the principal arts, trades, and professions, and of the civic states, and habits of living, on health and longevity: with a particular reference to the trades and manufactures of Leeds: and has suggested means for the removal of many of the agents which produce disease, and shorten the duration of life. To which may be added a very ingenious article in the Cyclopædia of Practical Medicine, on the diseases of artizans, by my friend. Dr. Darwall. All these contributions, interesting as they are, can only be considered as incipient labours in this branch of knowledge.

To any one who is inclined to engage in the duty of collecting materials for increasing our knowledge of Medical Topography, I would wish strongly to recommend a careful perusal of the paper in the 67th number of the Edinburgh Medical and Surgical Journal, to which I have before alluded. The author of that paper divides the objects of inquiry into four general heads, and these again he sub-divides into specific subjects. Under the first head he includes the physical geography of the place to be described, comprising notices on its botany, mineralogy, and natural history. The second head he refers to the inhabitants, including an account of their food, habitations, customs, &c. Under the third head are classed such subjects of inquiry as are connected with diseases, either endemic, epidemic, or sporadic, which appear under the form of epizootics amongst the lower animals, or which affect the products of vegetation. To the fourth head are referred miscellaneous objects of inquiry, or such as could not be arranged under any of the preceding.

The advancement of medico-legal science, to which it is proposed that the labours of the Association shall be directed, is of the highest importance. The superiority of our continental brethren over British medical men, in their knowledge of forensic medicine, has been long painfully felt by those who are emulous of their country's fame. Dr. Christison, an eminent authority on this question, says, " I have often had occasion to regret that so little attention has been paid in this country, to preserving, in sources accessible to medical men, the interesting medico-legal inquiries which are annually made throughout Britain. The want of authentic documents, embracing the medical facts and disquisitions which have been brought forward on trials in our own country, has obliged our medico-legal authors to illustrate the doctrines they have laid down, by referring to the proceedings in foreign courts of judicature. Valuable, however, as are the records which have been published of these proceedings, particularly by the medical jurists of Germany, they want, in the eye of the English reader, the interest possessed by domestic occurrences; they are apt, sometimes, to convey incorrect impressions of the scope of medical jurisprudence, and its influence on the administration of British law; and I cannot help adding that, in point of authenticity, the facts recorded must generally fall short of those determined in the course of judicial inquiries in this country; for, however imperfect our preliminary investigations may often be, the facts eventually brought out in evidence are in no other country so fairly stated, so minutely inquired into, and so completely put to the test as by the form of trial in Britain." The members of our Association will, I feel assured, maturely weigh the advantages to be derived from their devoting themselves to supplying this defect of medico-judicial facts in our own country; and, as we have already members, on the list for enrolment, from many and distant parts of the kingdom, there can be no doubt but that, by a moderate degree of industry, succinct reports may be published by the Association, of whatever instructive cases may occur in the provincial courts of judicature.

Medical Ethics, also, will claim some attention from an Association like ours. It is strange that, with the exception of a few meagre essays, no attempt has been made to establish a code for the guidance of those who need such direction. In a well organized profession, there could be no difficulty in adapting to its exigencies the doctrines of general Ethics, the principles of which exist in every well governed mind, and are identical in all circumstances, however variously they may be applied. Except the brief tracts of Gregory and Percival, we have no guidance furnished to us in this respect; and a well-digested code, adapted to the complex and much altered condition of the profession, is yet a desideratum.

It is, likewise, admitted, on all hands, that the organization of the profession which obtains is not what it ought to be; for the whole system of medical polity in this country, is both defective and erroneous. Opinions differ widely as to the evils and remedies, but few are found to commend the existing state of things. This subject is closely connected with the advancement of science, for, if the profession were constituted as it ought to be, and as reason and sound principles dictate, the harmony that would be thus established among the several departments, could not fail to prove a direct means of their co-operating more cordially and efficiently in extending the science and improving the practice.

With regard to the management by which the labours of the Association are to be regulated, I may notice that, for the first year, it is proposed to adopt the following provisional constitution, to be afterwards modified in whatever manner the first Annual General Meeting shall decide.

The Association to have a President, two Secretaries, and a Council.

The several officers to be appointed annually, by a general meeting of members convened for that purpose, at whichever of the provincial towns may be appointed, the place of such meeting being prospectively notified each year.

At this meeting shall be presented a report, prepared by the secretaries, of the general state of the Association, its proceedings, and pecuniary accounts; the report to be afterwards printed, and a copy supplied to every member.

The office of president to be honorary, and conferred on some senior physician or surgeon of eminence, resident in any of the provincial towns comprised in the circle of the Association.

The two secretaries to be resident in Worcester, the place of publication, their duties being to attend to the printing of the transactions, and correct the press; to be present at the meetings of the council, and keep the minutes thereof; correspond with the individual members, and to receive, and submit to the council, all papers transmitted for publication: also to keep the financial accounts of the Association.

The council to consist of ——— members, to be selected from the principal provincial towns; who may be considered as representatives of the Association in their respective districts.

The council, with whom must rest the chief responsibility of publication, to have full power of deciding on all papers transmitted for publication; and the consent of three of its members must be obtained before any paper can be published. It shall also be the duty of the council to receive the subscriptions, when due, in their respective districts.

Each member of the Association to pay one guinea on admission, and the same amount annually afterwards. The subscriptions to become due on the 1st of January each year.

I may here, also, remark, that if, from the subscriptions being numerous, our funds will admit of such a measure, we have it in contemplation to have a medal struck, to be conferred by the council on any successful prosecutor of medical science.

You must perceive, gentlemen, it is no ignoble service in which I wish to engage you. Neither is it one of which the benefits can be doubtful. I do not require you to embark with me in the endeavour to build up some hypothetical system of medicine. I do not wish to entice you into some labyrinth of conjecture, where you may be lost in the mazes of fancy. I do not desire to lead you into useless theoretical disquisitions; but I call upon you in the true spirit of inductive philosophy, to be vigilant in the collection of facts, and cautious in drawing conclusions from them; " At non solum, (if you will permit me, on this point, to use the words of the immortal Bacon) copia major experimentorum quœrenda est et procuranda, atque etiam alterius generis, quam adhuc factum est; sed etiam methodus plane alia, et ordo, et process us, continuandæ et provehendæ experientiæ, introducenda. Vaga enim experientia et se tantum sequens mera palpatio est, et homines potius stupefacit quam informat. At cum experientia lege certa procedit, seriatim et continenter, de scientiis aliquid melius sperari poterit."

What, then, can hinder us from devoting ourselves to the rational, the scientific investigations which it is the object of our Association to institute? Shall we say that we have no leisure for these pursuits? that the practice of our profession and the cares of life, too much engross our attention for us to engage in so useful an exercise as this which I am proposing to you? Has it not been said by the very highest authority on this question, that " the most active or busy man that hath been or can be, hath, no question, many vacant times of leisure, while he expecteth the times and returns of business, (except he be either tedious and of no dispatch, or lightly and unworthily ambitious to meddle in things that may be better done by others:) and then the question is, but how those spaces and times of leisure shall be filled and spent; whether in pleasures or studies."

Gentlemen, you will, at any rate, admit, that the objects I have thus hastily introduced to the notice of the meeting, are worthy of deep meditation. The contemplation of them appears to me, indeed, to open to us, a vast and unbounded prospect, and to beget high and lofty thoughts of our future proceedings. I may be sanguine in my expectations, but I cannot help indulging the gratifying, the cheering, the delightful thought, that, if we engage in this undertaking, as we are bound to do, by the obligations which our profession imposes upon us, with the zeal and alacrity of men anxious for the good of mankind, the Association must be of some use; must have a direct tendency to extend the empire of knowledge, and to increase our power over disease.

" Valeat quantum valere debet."

1. I gladly avail myself of this opportunity of recording the names of my fellow Editors in this work, and of expressing my gratitude to them for their valuable assistance. They were my friends Dr. Malden, James P. Sheppard, Esq. and John Rayment, Esq. all of Worcester; Dr. Darwall, of Birmingham; and Dr. Burne, of London.
2. Dr. Conolly, of Warwick.