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and inception. If nobody was allowed to commence the study of medicine except such persons as have good natural ability and a decent preliminary education, it is easy to see that the number of doctors annually graduated in this country would be very greatly diminished, and would be diminished by the exclusion of that class of doctors which it is most desirable to get rid of, namely, the class of ignoramuses and incompetents. We, therefore, recommend, very earnestly, that the county medical societies be advised to put at once into practical operation that article of the constitution which makes it the duty of the boards of censors of said county medical societies to examine all persons proposing to commence the study of medicine, and that no practitioner of medicine shall receive into his office as a student any one who does not hold a certificate of having passed this preliminary examination favorably. See Transactions of 1878, p. 88.


The record of the Medical Association of the State of Alabama is a Continuous record of earnest and unselfish work. The aggregate cost of this work since our reorganization after the war, in actual cash paid out of the pockets of the members of the Association, has not been less than forty thousand ($40,000) dollars. We have recognized from the beginning that in the economy of this world, individuals and socities can have whatever they want if they are able and willing to pay for it, and that nothing worth having is to be got on any other terms. There is no exaggeration in saying that we have achieved a very gratifying measure of success. We have saved the medical profession in Alabama from much demoralization. We have overthrown throughout the state, with the exception of a small section of country about Birmingham, where the fight is now going on, the pernicious system of contract practice. We have upheld and vindicated the beneficent authority of the ancient ethics of the profession. We have encouraged the study of the diseases incident to our geographical position and climate. We have obtained from the state the right and the power to regulate the standard of qualifications prerequisite to the practice of medicine in the state. We have been invested with the administration of the health laws of the state, and the selection of all health officialsstate, county, and municipal.

So much for the past. For the present and the future the line of policy which the Association ought to pursue, and which under the guidance of wise and prudent counsels it is to be hoped it will pursue with a resolution that shall never falter, stretches out before us so plainly marked that it will be our own fault if we fail to find it and to walk in it. And what that wise policy dictates is this: Not to weary of well doing; to continue in the same spirit and according to the same methods that have heretofore controlled our action, the work that has been so favorably begun; to seek always the public good and not our own; and always to recognize the great principle that union and organization involve strength and permanence and lead on from conquest to con

quest, while the assertion of individual rights and privileges, and the gratification of personal jealousies and ambitions are always the agents and instruments of disintegration and defeat. See Transactions for 1882, p. 139.


From time to time we have called attention to the immense fmportance in our organization of the college of counsellors. These counsellors constitute our regular army. We expect them to be always ready to spend their time, their money, and their influence in our service. They should, therefore, be able men, picked men-men who can in the largest measure command time and money and influence; because men cannot spend that which they have not got. Indeed, we might apply to our counsellors what Tennyson said of the famous six hundred

"Theirs not to make reply,
Theirs not to reason why,

Theirs but to do or die."

The ambition to be counsellor is an honorable ambition, and we have no fault to find with it, but it is our solemn duty to select for counsellors the very best material we can get the men that can do us the most good-and not to allow our votes to be controlled by personal and private considerations.

This is the main thing, to elect good men to the college of counsellors. But there is still another consideration that must not be forgotten, and that is the importance of having the counsellors properly distributed through the different sections of the State. The natural tendency is to concentrate the counsellors in the cities; and this tendency is easy of explanation. The doctors are much more numerous in the cities, and amongst the doctors of the cities are to be found a larger proportion of able men. Then it is easier for city doctors to leave their practice than it is for country doctors to leave theirs; and it is more convenient for city doctors to attend the meetings of the Association. For these, and for other reasons, it is inevitable, and it is right that city doctors should predominate in the college of counsellors, and this to an extent out of proportion even to their numbers. But it is a tendency, not indeed to be repressed, but one to be watched and restrained-in a word, to be kept within bounds, so that it may not swallow up every thing else. In the meantime, while the principle of geographical distribution, according to population, is not to be ignored, it will not do to act on it too rigorously; and any attempt to distribute the counsellors amongst the doctors of the several counties of the state in strict proportion to their numbers would, we are convinced, be unwise and inexpedient. But it seems to us that it would be wise to give formal recognition and sanction to this principle of geographical distribution of counsellors in some way; and the way that occurs to us as most expedient, all things considered, is to take the congressional districts of the state as the basis of the distribution, and to give to each congressional district a number of counsellors in proportion to the number of members of the Association resident in each of said districts.

We do not mean that this distribution of counsellors by congressional districts shall be made with rigorous numerical accuracy; but that the principle shall be accepted in good faith and carried out in practice as thoroughly as circumstances will reasonably permit.

Our present method of managing the election of counsellors is perhaps as good as any that can be devised—the method of having a recess, and an informal convention to receive suggestions and make up an informal ticket, which is not binding on anybody, except that all who take part in getting it up ought to feel some moral obligation to support it, and they usually do. With the aggregate results of this method we think the Association has reason to be satisfied. We have sometimes made mistakes and elected men not fully up to the standard; and sometimes little outside combinations have been made and men have been elected who had no special claims to the position, and no special fitness for it. These things are to be regretted, but they can not be altogether avoided. In order to secure as far as possible all the ends that we have passed in review, it has been proposed to refer the nomination of counsellors to the board of censors. Doubtless the board of censors would almost always make good nominations; but for two reasons it does not meet our approval. (1.) It is open to most of the objections that may be urged against nominating committees in general; and, (2), it will have a tendency to break down the influence and usefulness of the board of censors itself. As long as the board of censors is confined to the consideration of measures and policies, it is to be hoped that it will remain above the suspicion even of improper motives; but it would certainly forfeit this immunity from suspicion if it had to make nominations for office.

In conclusion, and as a means of carrying out the plan suggested, we would respectfully recommend that in addition to the roll of counsellors as at present published, the Secretary be required to publish an annual summary of the counsellors by congressional districts; and to specify for each district the number of paying members resident in it. This to serve as a general guide to the Association in the election of counsellors. See Transactions of 1888, p. 140.


In the election of officers we should be governed by the same motives as those we have advocated in regard to the election of counsellors; one leading object should be to fill all the offices with the ablest and most competent men we can get to take them. In our Association the officers, if they come up to the full measure of efficiency, which we have the right to expect from them, have important and laborious work to perform duties very much more important and laborious than those devolving on officers of similar name and position in other associations --and duties, too, that require some considerable expenditure of money as well as of time.

Our organization, as its evolution proceeds under the incidental influences of times and occasions, approximates more and more to the

military type. Our President is the commander in chief; and the vicepresidents are, as it were, his lieutenant generals, while the presidents of the county societies are the colonels commanding the regiments. A suggestion occurs to us here which we feel assured can be made to bear good fruit in promoting the discipline of the organization and the thoroughnesss and efficiency of our work. It is this: That the President of the Association should regard the presidents of the county societies as his official agents in their several counties; should keep himself in constant communication with them; should, through them, keep himself informed as to the status of the societies, and shouldthe most important consideration of all-hold these county presidents up to the fullest possible measure of official efficiency. In the meantime the vice-presidents of the association might, each in his own district, organize an official staff of the vice-presidents of the county societies, and hold these county vice-presidents up to a reasonable standard of official usefulness; while the official staff of the Secretary of the Association would be composed of the secretaries of the county societies.

There can be no doubt that official efficiency is, other things being equal, greaily promoted by official experience; and this principle suggests to us that it is easy to push too far the practice of rotation in office. An army of trained soldiers is the highest example of efficiency of organization known amongst men; and in an army rotation in office is never thought of. It is not necessary for us to go to the miliatary extreme of keeping the same persons permanently in office; but all the same, if we will think of it dispassionately, we can not fail to see that it is often a dictate of wise policy to elect more than once to the same position officers who have distinguished themselves by the performance of good work. Indeed, the Association has, with regard to all the offices except three-the President and the two vice-presidents—already adopted the policy which we are discussing; and we bring the question up now in order to suggest that in our opinion it would be well to apply to some extent the same policy in the election of presidents and vicepresidents.

We desire it to be understood that we do not make this suggestion now with any special reference to the election of officers at the present session of the Association. We simply desire to call attention to the matter in a general way, with the purpose of promoting the general welfare of the Association.

We have said that to be an officer of our Association not only involves some expenditure of time and labor, but also some expenditure of money; and this naturally brings up the question as to whether the Association ought, or ought not, to refund to the President and the two vice-presidents the amounts expended by them in their official correspondence the money expenditure in question being almost exclusively for stationery and postage. We have considered this question with some care, and we have reached the conclusion that these officers had

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better be left to defray their own official expenses. The sums involved are not large-probably not more than twenty dollars a year for the President, and not more than ten dollars a year for each of the vicepresidents-sums too small to be felt as burthensome by anybody likely to be elected to these offices. But our principle reason for the conclusion reached is that little compensations tend to belittle the offices to which they are attached. To be President or vice-president of the Medical Association of the State of Alabama is already a distinguished honor, and will become more and more honorable as the years go by, and the Association increases in power and prestige. We have it on the highest authority that it is more blessed to give than to receive, and the Association can safely trust to the generous instincts of her sons. See Transactions of 1888, p. 142.

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