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FORM NO. 6O9 : 5.28.51. 501

V

COUNSELS

AND IDEALS

FROM THE WRITINGS OF

WILLIAM OSLER

SECOND IMPRESSION

BOSTON AND NEW YORK

HOUGHTON, MIFFLIN & COMPANY

&fje 3&ibersi5e $ress, damfrttoge

1906

DEDICATED

TO

GRACE REVERE OSLER

IT is now generally recognized that an important,
very important, part of education, academic,
technical, and professional, is the personal infl^lence
of the teacher upon the taught. Be the building,
the laboratory, the equipment ever so perfect, there
yet must be this essential, personal contact between
teacher and pupil.

From personal association of teacher and pupil
follows that much talked of and sought for element
atmosphere. With an atmosphere an institution
becomes a seat of learning, at which both teacher
and taught gain knowledge, and establish principles
of thought and conduct, and to which they return
eager to breathe again its l inspiration.'

Such is the history of the Dutch, French, and
English Schools, whose power may be traced to
the individual influence of the Masters of the
Italian School. Close upon these, indeed almost
contemporaneous, follow the German and Austrian
Schools, and out of all these that composite pro-
duct the American School. In these Morgagni,
Valsalva, Morgan, Louis, Rush, Virchow, to mention
a very few only, were the * apostles ' through whom
this ' succession ' of influence passed.

Vlll

Scientific institutions have been tardy in re-
cognizing the importance of this power of influence,
which the artistic world has long considered its
corner-stone. In art or science, genius alone is
able to flourish on the Geist from within.

For my own purposes, in order to renew from
time to time the influence which, as pupils and
internes, we had come to depend upon, I have for
some years made extracts from Dr. Osier's Lectures
and Addresses *. I would like to share the benefits
of these with others. At Oxford, during the
summer of 1905, 4 Counsels and Ideals ' under his
guidance took definite form.

Those who know his personal influence, those
in and out of our profession to whose ' unmeaning
taskwork ' in their * brazen prison ' he has shown

a way to

* escape . . . and depart
On the wide Ocean of life anew,'

will welcome these pilot sayings to help grasp ' the
rudder hard ' and to see

How fair a lot to fill
Is left to each man still.'

C. N. B. CAMAC,

New York City, 1905.

* All of Dr. Osier's writings, including the seventeen col-
lected Addresses entitled Aequanimitas , have been consulted.
Forty-seven have been extracted for the present volume.

COUNSELS AND IDEALS

OXFORD : HORACE HART
PRINTER TO THE UNIVERSITY

CONTENTS

The selections, made almost exclusively from the less
technical Lectures and Addresses, are grouped under the
following general headings : —

PAGE

1. EXEMPLARY CHARACTERS IN MEDICINE . . i

2. HISTORY AND BIOGRAPHY 1 1

3. PIONEERS IN MEDICINE 51

4. THE HUMANITIES IN MEDICINE . . . -57

5. THE PRACTICAL IN MEDICINE .... 65

6. CATHOLICITY IN MEDICINE 69

7. HONESTY, TRUTH, ACCURACY, AND THOROUGH-

NESS IN MEDICINE 77

8. ENCOURAGEMENT AND INFLUENCE IN MEDICINE 89

9. SILENCE AND SELF-CONTROL .... 93

10. PATIENT DEVOTION TO DUTY AND HIGH IDEALS 99

11. CHARITY AND FRATERNITY IN MEDICINE . .113

12. MEDICAL EDUCATION 127

13. BOOKS, LIBRARIES, AND MEDICAL SOCIETIES . 157

14. VALUE OF TRAVEL 163

15. THE PRACTITIONER OF MEDICINE •. . .171

16. CUPID AND MARRIAGE 219

17. WORK 223

1 8. MAN'S YEARS OF USEFULNESS, AND HOW HE MAY

PROLONG THEM 239

19. RELIGION, DEATH, AND IMMORTALITY . . .247

20. VARIA 255

NOTE. — Each extract has a numerical reference to the
original. By following these numbers through, all the extracts
from one source may be gathered. It is strongly urged
however, whenever possible, to get the original and read it
throughout.

REFERENCES

1. John Locke as a Physician.

Lancet, 1900.

2. The Importance of Post-Graduate Study.

Lancet, 1900.

Aequanimitas and Other Addresses *.

3. Some Aspects of American Medical Bibliography.

Boston Med. and Surg. Journal, 1902.
Aequanimitas and Other Addresses *.

4. British Medicine in Greater Britain.

Montreal Med. Journal, 1 897.
Aequanimitas and Other Addresses *.

5. Medicine in the Nineteenth Century.

New York Sun, 1901.
Aequanimitas and Other Addresses *.

6. Internal Medicine as a Vocation.

Med. News (N. Y.), 1897.
Aequanimitas and Other Addresses *.

7. William Beaumont, a Pioneer American Physiologist.

Journal Am. Med. Assoc., 1902.

8. Rudolph Virchow : the Man and the Student.

Boston Med. and Surg. Journal, 1891.

9. In Memoriam, William Pepper.

Philad. Med. Journal (N. Y.), 1899.

10. The Functions of a State Faculty (Society).

Maryland Med. Journal, 1 897.

11. The ' Phthisiologia ' of Richard Morton.

Med. Library and Hist. Journal, 1904.

* Blakiston& Co., Philadelphia, and T.K.Lewis, London, 1904.

xii REFERENCES

12. An Alabama Student.

Johns Hopkins Hospital Bulletin, 1896.

13. After Twenty-five Years.

Montreal Med. Journal, 1899.
Aequanimitas and Other Addresses *.

14. Doctor and Nurse.

Johns Hopkins Hospital Bulletin, 1891.
Aeqiianimitas and Other Addresses *.

15. Nurse and Patient.

Aequanimitas and Other Addresses *.

16. On the Educational Value of the Medical Society.

Aequanimitas and Other Addresses *.

17. The Practical Value of Laveran's Discovery.

Med. News (N. Y.), 1895.

1 8. John Keats.

Johns Hopkins Hospital Bulletin, 1896.

19. Books and Men.

Boston Med. and Surg. Journal, 1901.
Aequanimitas and Other Addresses *.

20. Aequanimitas.

Aequanimitas and Other Addresses *.

21. The Leaven of Science.

Univ. (of Pennsylvania) Med. Mag., 1894.
Aequanimitas and Other Addresses *.

22. Teacher and Student.

Aequanimitas and Other Addresses *.

23. Chauvinism in Medicine.

Montreal Med. Journal, 1902.
Aequanimitas and Other Addresses *.

24. The Master Word in Medicine.

Montreal Med. Journal, 1903.
Aequanimitas and Other Addresses *.

25. Teaching and Thinking.

Montreal Med. Journal, 1 895.
Aequanimitas and Other Addresses *.

REFERENCES xiii

26. The Army Surgeon.

Med. News (N. Y.), 1894.

27. The Hospital as a College.

Aequanimitas and Other Addresses *.

28. Angina Pectoris and Allied States. New York, 1895.

29. On some of the Intestinal Features of Typhoid Fever.

Philad. Med. Journal, 1898.

30. Influence of Louis on American Medicine.

Johns Hopkins Hospital Bulletin, 1897.

31. Introductory Address— Opening of Forty-fifth Session

of the Medical Faculty, McGill University.
Canada Med. and Surg. Journal, 1877.

32. Science and Immortality.

Houghton, Mifflin &•» Co., 1904.

33. Richard Lea MacDonnell.

N. Y. Med. Journal, 1891.

34. Thomas Dover (of Dover's Powder).

Johns Hopkins Hospital Bulletin, 1896.

35. Alfred Stille.

Univ. (of Pennsylvania) Med. Bulletin, 1902.

36. Remarks on William Pepper at the Mahogany Tree

Club, Philadelphia, Nov. 15, 1898. Pamphlet,
Private Circulation.

37. Remarks on occasion of the presentation to the College

of Physicians (Philadelphia) of the Portrait of
Dr. S. Weir Mitchell, April 22, 1890.
Johns Hopkins Hospital Bulletin, 1890.

38. Oliver Wendell Holmes.

Johns Hopkins Hospital Bulletin, 1894.

39. The Problem of Typhoid Fever in the U. S.

Med. Afewj(N.Y.), 1899.

40. Jean Martin Charcot. Memorial Notice.

Johns Hopkins Hospital Bulletin t 1893.

xiv REFERENCES

41. Unity, Peace, and Concord.

Farewell Address to the Medical Profession of the U.S.
Journal Am. Med. Assoc., 1905.

42. Elisha Bartlett.

Trans. Rhode Island Med. Soc., 1899.

43. Remarks on Specialism.

Boston Med. and Surg. Journal, 1892.

44. Farewell Address to the Johns Hopkins University.

Journal Am. Med. Assoc., 1905.

45. The Student Life.

Farewell Address to American and Canadian Medical

Students.
Med. News (N. Y.), 1905.

46. Alcohol.

St. Elizabeth Parish Magazine (London), 1905.

47. Ephemerides.

Montreal Med. Journal, 1894.

EXEMPLARY CHARACTERS
IN MEDICINE

BIBLIOMANIACS, CHERISHERS OF
BIOGRAPHICAL RECORDS

The men I speak of (bibliomaniacs) keep alive in us
an interest in the great men of the past, and not alone
in their works, which they cherish, but in their lives,
which they emulate. They would remind us continually
that in the records of no other profession is there
to be found so large a number of men who have
combined intellectual pre-eminence with nobility of
character. x

2 EXEMPLARY CHARACTERS

John Locke Among- the great men of the seventeenth century
not one has more enduring claims to our grateful
remembrance than John Locke — philosopher, phil-
anthropist, and physician. As a philosopher his
praise is in the colleges. As the apostle of common
sense he may be ranked with Socrates and a few
others who have brought philosophy from the
clouds to the working-day world. Of his special
virtues and qualifications, as the typical English
philosopher nothing need be said, but were there
time I would fain dwell upon his character as a
philanthropist — in the truest sense of the word.
The author of the Epistle on Toleration, the
Treatise on Education, and the Constitution of
Carolina, the man who pleaded for 4 absolute
Liberty, just and true Liberty, equal and impartial
Liberty,' the man who wrote the memorable words,
' All men are naturally in a state of freedom, also
of equality,' must be ranked as one of the greatest
benefactors of the race. x

<$

For each one of us there is still ' a touch divine '
in the life and writings of John Locke. A sin-
gularly attractive personality, with a sweet reason-
ableness of temper and a charming freedom from
flaws and defects of character, he is an author
whom, liking at the first acquaintance, we soon
love as a friend. Perhaps the greatest, certainly,
as Professor Fowler says, the most characteristic
English philosopher, we may claim Dr. Locke as
a bright ornament of our profession, not so much
for what he did in it, as for the methods which he

IN MEDICINE 3

inculcated, and the influence which he exercised
upon the English Hippocrates. He has a higher
claim as a really great benefactor of humanity,
one of the few who, as was so finely said of
Isocrates, l reflected the human spirit always on the
nobler side.' One of Locke's earliest writings was
a translation for Lady Shaftesbury of Pierre Nicole's
Essays, in one of which, on the 'Way of Preserving
Peace with Men,1 Locke seems to have found a rule
of life which I commend to you : * Live the best
life you can, but live it so as not to give needless
offence to others ; do all you can to avoid the vices,
follies, and weaknesses of your neighbours, but
take no needless offence at their divergences from
your ideal.' J

^

You have been fortunate in having associated with Jonathan
your college (Medical Graduate College and Poly- Hutchinson.
clinic, England) a man with a truly Hunterian mind.
In the broad scope of his work, in the untiring zeal
with which he has studied the natural phenomena
of disease, in his love for specimens and collections,
Mr. Jonathan Hutchinson bears a strong likeness to
the immortal Hunter. No individual contributor in
this country has made so many careful observations
upon so many diseases. He is the only great
generalized specialist which the profession has
produced, and his works are a storehouse upon
which the surgeon, the physician, the neurologist,
the dermatologist, and other specialists freely draw.
When anything turns up which is anomalous or
peculiar, anything upon which the textbooks are
B 2

4 EXEMPLARY CHARACTERS

silent and the systems and cyclopaedias are dumb,
I tell my students to turn to the volumes of
Mr. Hutchinson's Archives of Surgery, as if it is
not mentioned in them, it surely is something very
much out of the common. It is very fortunate that
his collection will be kept together, as it will be of
great service to students from all parts of the world.
In one respect it is unique, pictorial and clinical,
not anatomical and pathological, and it will remain
a worthy monument to the zeal and perseverance
of a remarkable man, a man who has secured the
homage of a larger number of clinical workers than
any Englishman of his generation. 2

tf

Sydenham Sydenham was called * a man of many doubts,' and
(1624-89) : therein lay the secret of his great strength. 4
scepticism
in Medicine.

Linacre Linacre, as Dr. Payne remarks, ' was possessed
(1460- from his youth till his death by the enthusiasm of

learning. He was an idealist devoted to objects
which the world thought of little use.' Painstaking,
accurate, critical, hypercritical perhaps, he remains
to-day the chief literary representative of British
Medicine. Neither in Britain nor in greater Britain
have we maintained the place in the world of letters
created for us by Linacre's noble start. 4

tf

The man Come with me for a few minutes on a lovely June

and his day m X822, to what was then far-off northern

tunity. wilds, to the island of Michilimackinac, where the

waters of Lake Michigan and Lake Huron unite,

IN MEDICINE 5

and where stands Fort Mackinac, rich in the
memories of Indian and voyageur, one of the four
important posts on the upper lakes in the days
when the rose and the fleur-de-lys strove for the
mastery of the western world. Here the noble
Marquette laboured for his Lord, and here beneath
the chapel of St. Ignace they laid his bones to rest.
Here the intrepid La Salle, the brave Tonty, and
the resolute Du Luht had halted in their wild
wanderings, yits palisades and block-houses had
echoed the war-whoops of Ojibwas and Ottawas, of
Hurons and Iroquois, and the old fort had been
the scene of bloody massacres and hard -fought
fights, but at the conclusion of the War of 1812,
after two centuries of struggle, peace settled at last
on the island. The fort was occupied by United
States troops, who kept the Indians in check and
did general police duty on the frontier, and the
place had become a rendezvous for Indians and
voyageurs in the employ of the American Fur
Company. On this bright spring morning the
village presented an animated scene. The annual
return tide to the trading-post was in full course,
and the beach was thronged with canoes and
batteaux laden with the pelts of the winter's hunt.
Voyageurs and Indians, men, women, and children,
with here and there a few soldiers, made up a
motley crowd. Suddenly from the company's
store there is a loud report of a gun, and amid the
confusion and excitement the rumour spreads of
an accident, and there is a hurrying of messengers
to the barracks for a doctor. In a few minutes

6 EXEMPLARY CHARACTERS

(Beaumont says twenty-five or thirty, an eye-
witness says three) an alert -looking- man in the
uniform of a U. S. army surgeon made his way
through the crowd and was at the side of a young
French-Canadian who had been wounded by the
discharge of a gun, and with a composure bred of
an exceptional experience of such injuries, prepared
to make the examination. Though youthful in
appearance, Surgeon Beaumont had seen much
service, and at the capture of York and at the
investment of Plattsburgh had shown a coolness
and bravery under fire which had won him high
praise from his superior officers. The man and
the opportunity had met — the outcome is my story
of this evening. 7

Visit to In i884Pon returning to Berlin for the first time
W s*nce my stu<^ent days, I took with me four choice
xamples of skulls of British Columbian Indians,
knowing well how acceptable they would be. In
his room at the Pathological Institute, surrounded
by crania and skeletons, and directing his celebrated
4 Diener,' who was mending Trojan pottery, I found
the professor noting the peculiarities of a set of
bones which he had just received from Madeira.
Not the warm thanks, nor the cheerful, friendly
greeting which he always had for an old student,
pleased me half as much as the prompt and decisive
identification of the skulls which I had brought,
and his rapid sketch of the cranial characters of
the North American Indian. The profound expert,

IN MEDICINE 7

not the dilettante student, has characterized all of
his work in this line. 8

&

It will be acknowledged that in this country doctors the citiren.
are, as a rule, bad citizens, taking- little or no
interest in civic, state, or national politics. Let me
detain you a moment or two longer to tell of one of
us, at least, who, in the midst of absorbing pursuits,
has found time to serve his city and his country-
For more than twenty years Virchow has sat in the
Berlin City Council as an alderman, and to no
feature in his extraordinary life does the Berliner
point with more justifiable pride. It is a combina-
tion of qualities only too rare, when the learned
professor can leave his laboratory and take his share
in the practical municipal work. How much his
colleagues have appreciated his efforts has been
shown by his election as Vice-president ^ of the
Board; and on the occasion of the celebration
n 1 88 1, the Rathaus was not only placed at the
disposal of the committee, but the expenses of
the decorations, &c., were met by the council ; and
to-day comes word by cable that he has been
presented with the freedom of the city. 8

fc

In that noble poem Rugby Chapel, in memory William
of his father, Matthew Arnold draws a strong £|pp!r8).
contrast, on the one hand, between the average a strong
man, who eddies about, eats and drinks, chatters soulJ
and loves and hates, and then dies, having striven
blindly and achieved nothing ; and, on the other,
the strong soul tempered with fire, not like the

8 EXEMPLARY CHARACTERS

men of the crowd, but fervent, heroic, and good,
the helper and friend of mankind. Dr. William
Pepper, whose loss we mourn to-day, while not
a Thomas Arnold, belonged to this group of strong
souls, our leaders and masters, the men who make
progress possible.

There are two great types of leaders : one, the
great reformer, the dreamer of dreams with aspira-
tions completely in the van of his generation, lives
often in wrath and disputations, passes through
fiery ordeals, is misunderstood, and too often
despised and rejected by his generation. The
other, a very different type, is the leader who sees
ahead of his generation, but who has the sense to
walk and work in it. While not such a potent
element in progress, he lives a happier life, and
is more likely to see the fulfilment of his plans.
Of this latter type the late Professor of Medicine
at the University of Pennsylvania was a notable
example — the most notable the profession of this
country has offered to the world. 9

William Pepper began life under conditions which
are very often unfavourable to success. His father,
a distinguished physician, the Professor of Medicine
in the school in which his son was educated, be-
longed to a family of position and influence. For
the young man there were none of those tempering
4 blows of circumstance/ no evil star with which
to grapple and grow strong. Quite as much * grit '
and a much harder climb are needed to reach
Distinction from the top as from the bottom of

IN MEDICINE 9

the social scale, and to rise superior to the res
abundans domi has taxed to the uttermost many
young men in this country. We have heard enough
of the self-made men, who are always on top ; it
is time now to encourage in America the young
fellow who is unhappily born * with a silver spoon
in his mouth.' Like the young man in the Gospels,
he is too apt to turn away sorrowfully from the battle
of life, and to fritter away his energies in Europe,
or to go to the devil in a very ungentlemanly
manner, or to become the victim of neurasthenia.
To such the career I am about to sketch should
prove a stimulus and an encouragement. 9

?

In many ways the American is the modern Greek, a modern

particularly in that power of thinking and acting, ree '
which was the strongest Hellenic characteristic.
Born and bred in one of the most conservative
of cities, surrounded by men who loved the old
order, and who hated change or even the suggestion
of it, Pepper displayed from the outset an adapti-
bility and flexibility truly Grecian. He was pre-
eminently a man of felicities and facilities, to use
a somewhat flash but suitable phrase. Matthew
Arnold's comment upon the happy and gracious
flexibility which was so incarnate in Pericles has
often occurred to me in thinking of the character
of the late Provost : ' lucidity of thought, clearness
and propriety of language, freedom from prejudice, ^
freedom from stiffness, openness of mind, and amia-
bility of manner. lx "There was another Grecian
feature which must not be lost sight of. You

10 EXEMPLARY CHARACTERS IN MEDICINE

remember in the Timaeus how the Egyptian priest
said to Solon : l You Hellenes are never anything
but children ; there is not an old man among you
... in mind you are all young.'

To the very last there was a youthful hopefulness
and buoyancy of spirits about Pepper that supported
him in many trials and troubles. \ never knew
him despondent or despairing. The persistency
of this buoyant hopefulness often wore out the most
obstinate opposition ; in fact, it was irresistible.
Nor was it the hopefulness which we condemn
as visionary, but a resourceful hopefulness, based
on confidence in himself, and, most valuable quality
of all, capable of inspiring confidence in others. 9

HISTORY AND BIOGRAPHY

VALUE OF BIOGRAPHICAL STUDY

Of the altruistic instincts veneration is not the most
highly developed at the present day ; but I hold strongly
with the statement that it is the sign of a dry age when
the great men of the past are held in light esteem. I0

THE HISTORICAL METHOD

By the historical method alone can many problems in
medicine be approached profitably. For example, the
student who dates his knowledge of tuberculosis from
Koch may have a very correct, but a very incomplete,
appreciation of the subject. Within a quarter of a century
our libraries will have certain alcoves devoted to the
historical consideration of the great diseases, which will
give to the student that mental perspective which is so
valuable an equipment in life. The past is a good nurse,
as Lowell remarks, particularly for the weanlings of the
fold.19

12 HISTORY AND

Value of Editions of the Hippocratic writings appear from

t^me to t*me' anc* *n t^ie rev^va^ °f t^le stu(ly of the
history of medicine the writings of such masters as
Galen and Aretaeus reappear, but the interest is
scholastic, and amid the multiplicity of studies how
can we ask the student to make himself familiar
with the ancients? We can, however, approach
the consideration of most subjects from an historical
standpoint, and the young doctor who thinks that
pathology began with Virchow gets about the same
erroneous notion as the student who begins the
study of American history with the Declaration
of Independence. 3

4 In the present crowded state of the curriculum it
does not seem desirable to add the " History of
Medicine " as a compulsory subject. An attractive
course will catch the good men and do them good,
but much more valuable is it to train the mind of
the student to look at things from the historical
standpoint, and this can be done by individual
teachers who themselves appreciate the truth of
J Fuller's remark, " History maketh a young man
to be old without either wrinkles or grey hairs;
privileging him with the experience of age without
either the infirmities or inconveniences thereof.
Yea, it not only maketh things past present, but
enableth one to make a rational conjecture of things
to come. For this world affordeth no new accidents,
but in the same sense wherein we call it a new
moon, which is the old one in another shape ; and
yet no other than that hath been formerly. Old
actions return again, furbished over with some new
and different circumstances.'" — (B. M.J., 1902.)

BIOGRAPHY 13

For countless generations the prophets and kings Science,

of humanity have desired to see the things which
men have seen, and to hear the things which men blessing.
have heard, in the course of this wonderful nine-
teenth century. To the call of the watchers on
the towers of progress there has been the one sad
answer — the people sit in darkness and in the
shadow of death. Politically, socially, and morally
the race has improved, but for the unit, for the
individual, there was little hope. Cold philosophy
shed a glimmer of light on his path, religion in its
various guises illumined his sad heart, but neither
availed to lift the curse of suffering from the sin-
begotten son of Adam. In the fullness of time,
long expected, long delayed, at last science
emptied upon him from the horn of Amalthea
blessings which cannot be enumerated, blessings
which have made the century for ever memorable ;
and which have followed each other with a rapidity
so bewildering that we know not what next to
expect. s

^

*Ib us in the medical profession, who deal with The gift of
this unit (the individual), and measure progress teentlTcen-
by the law of the greatest happiness to the greatest tury to
number, to us whose work is with the sick and mankmd-
suffering, the great boon of this wonderful century,
with which no other can be compared, is the
fact that the leaves of the tree of science have been I
for the healing of the nations. Measure as we may
the progress of the world — materially, in the ad-
vantages of steam, electricity, and other mechanical

14 HISTORY AND

appliances ; sociologically, in the great improve-
ment in the conditions of life ; intellectually, in
the diffusion of education ; morally, in a possibly
higher standard of ethics — there is no one measure
which can compare with the decrease of physical
suffering in man, woman, and child, when stricken
by disease or accident. This is the one fact of
supreme personal import to every one of us. This
is the Promethean gift of the century to man. 5

The vice of The fetters of a thousand years in the treatment of
authority. fever were shattered by Sydenham, shattered only
to be riveted anew. How hard was the battle in
this century against the entrenched and stubborn
foe ! Listen to the eloquent pleadings of Stokes,
pleading as did Sydenham, against authority and
against the bleedings, the purgings, and sweatings
of fifty years ago. ' Though the hair be grey and
his authority high, he is but a child in knowledge
and his reputation an error. On a level with a
child so far as correct appreciation of the great
truths of medicine is concerned, he is very different
in other respects, his powers of doing mischief are
greater ; he is far more dangerous. Oh that
men would stoop to learn, or at least cease to
destroy!'4

Weir
Mitchell.

Not in vain has he wandered amid green pastures,
and by the still waters in the Garden of the Gods,
and the Pierian roses which he has gathered have
the bloom and much of the fragrance of those which
deck the brows of our brother-craftsmen— of Gold-

BIOGRAPHY 15

smith, of Keats, and of Holmes. Heredity has done
much, environment has done more, in the career of
which I speak. Unlike the majority of those who
have ' passed the chair ' of this honourable Faculty,
the path along which Weir Mitchell trod to fame
led around, not through, Academic Halls. When
University positions are so coveted, and when the
ambition of every worker is to teach, it is a satis-
faction to be able to point to a man who has risen
from the ranks, so to speak, to the highest general-
ship and command. But may I allude — if only to
show the truth of Schiller's dictum,

'Des Lebens ungemischte Freude
Ward keinem Irdischen zum Theil' —

to disappointed academic ambitions on the part of
our distinguished fellow, now long past, perhaps
even forgotten by him? Truly the stone which
the builders rejected has become the chief stone
of the corner. For his sake I have always thought
that in so doing they 'builded better than they
knew.'

Again; in relation to this college (College of
Physicians), around which clusters so large a part
of all that is best in the history of the profession of
this city (Philadelphia), the man whom we delight
to honour has fostered its growth, widened its
influence, and stimulated its life. For this we
thank him best when we place his portrait in line
with those of Redman, Shippen, and Wood.

It is too weird a speculation to think that here
to-night in this hall amid the volumes of forgotten

i6

HISTORY AND

lore, a ghostly procession of our presidents who
have gone will pass verdict on this picture and will
greet as worthy one who, caute, caste et probe,
supported the traditions which they held so dear.
Amid the racket and hurly-burly few of us have the
chance to warm both hands at the fire of life. No
member of the profession in his generation, either in
America or Europe, has so pleasantly toasted hands
and feet before the logs as S. Weir Mitchell ; and no
one has been more ready to give a brother a place
at the glowing hearth. If asked for a scroll to place
beneath that frame I would write that he was one

4 Whose even balanced soul

Business could not make dull, nor passion wild ;
Who saw life steadily and saw it whole.'37

Charcot

(1825-93)

cosmopoli-
tan ;

Now and again there is given to medicine a man
whose life and work make an enduring impression,
and who, escaping the thralls of nationalism, becomes
a cosmopolitan teacher and leader. The latter part
of this century has had only three or four such
men: Lister in Great Britain, Virchow and Koch
in Germany, Pasteur in France — men who have
revolutionized medicine by brilliant discoveries and
by the introduction of new methods, and who have
moulded anew our works and ways, and have
widened the horizon of our thoughts. In this select
circle by virtue of extraordinary labours, the suffrages
of our Guild, the world over, had placed Jean Martin
Charcot, whose sudden death on August the i6th
last has been so universally deplored. 4o

BIOGRAPHY 17

A feature which helped not a little in Charcot's attractive
success was a personality attractive to young men. pfi^so.n"
. . . Charcot's method of teaching was in striking
contrast to that of his colleagues at other French
hospitals. . . . Half an hour before the lecture the
front rows were filled with enthusiastic students,
and by the time the lecture began there was standing-
room only. Without any attempt at display or effect, a teacher

interesting- cases were brought in, the symptoms without

attempt at
analysed, the diagnosis made, the anatomical condi- display or

tion discussed, usually with the aid of black-board and effect 5
chalks, folio wed, in conclusion, by a few general com-
ments. It was a clinical lecture in the true sense of a clinical
the term. Without volubility, Charcot possessed lecture-
in a marked degree that charming lucidity in the ^£011?
presentation of a subject so characteristic of his volubility,
countrymen. 4o

^

A finely tempered individualism, prone though it France

be to excess, is one of the glories of the French honours her
i ^i • T- j f great men.

character. The man in France stands for more

than in any other land ; his worth and work are
there more truly recognized, and there his relative
position in the history of art, literature, or science
is more justly gauged. Alone among the nations
of the world, France honours duly the mighty dead
of our profession. Not in the Pantheon only, but in
statues, in the names of streets, and in the names of
hospitals one is constantly reminded in Paris that
such men as Bichat, Laennec, Pinel, Trousseau,
Broca, Bernard, and others have honourably served
their day and generation. *°

C

i8

HISTORY AND

a cultured
Hellene ;

The medical profession in every country has pro-
duced men of affairs of the first rank, men who
have risen high in the councils of nations, but with
scarcely any exception the practice of medicine has
not been compatible with such duties. So absorb-
ing are the cares of the general practitioner or the
successful consultant that he has but little time to
mingle in outside affairs, and the few who enter
public life do so with many backward glances at
the consulting-room, and with well-grounded fore-
bodings of disaster to professional work. But Dr.
Pepper maintained to the end the closest relations
with the profession, both as a consultant and a
teacher. To me one of the most remarkable
features of his life is the conscientiousness with
which he attended to a large and exacting practice.
That amid such multifarious cares and duties he
should have been able to maintain an undiminished
activity in his calling is perhaps the greatest tribute
to his genius. As a teacher his forte was in the
amphitheatre, where he displayed precision in
diagnosis, great lucidity in the presentation of
a complicated case, and a judicious and thorough
knowledge of the resources of art.9

$

The tribute of words has already been paid, but to
us, of his circle, two aspects of his character may be
dwelt upon for a moment. William Pepper was
the embodiment of that happy and gracious flexi-
bility which distinguished the best of the old Greeks.
Matthew Arnold's portrayal of the cultured Hellene
can be transferred to him with singular appropriate-

BIOGRAPHY 19

ness : * Lucidity of thought, clearness and propriety
of language, freedom from prejudice, freedom from
stiffness, openness of mind, and amiability of man-
ner.' The greatest of philosophers has said that
a man's nature is best proved, not in the business
of life, but in festive intercourse ; and at our round
table we have all had opportunities of proving
how good was the best in the nature of our
friend.

For six generations this home of the medical
profession in America has never wanted broad-
minded representatives whose talents were not
restricted within the limits of their art. Such men
as Casper Wistar, Rush, Chapman, and Leidy — to
mentionpnly typical illustrations — have passed into
the history of this city, famous in literature or
science, pursuits peculiarly adapted to the retired
life of the physician. When the wider field of
public service has been sought, it has almost invari-
ably been at the loss of all active interest in medicine.
For the first time in this country the medical pro-
fession produced in the person of William Pepper
a man of affairs of the first rank, whose work as an an
organizer will compare with the very best, and this or£am
at a period of our history when the value of organ-
ization had become fully appreciated.

That amid multifarious duties and cares he should undiminish-
have retained to the last an undiminished activity in
his calling, is perhaps the greatest tribute to his
genius. To his native land and to her sons he gave
freely the splendid gifts of his time and energies,
but to us, his intimates, he gave of his buoyancy,

C 2

20

HISTORY AND

his hopefulness, and his courage — and they remain
to cheer us on the remainder of our way. 36

The nature-
physicians.

Richard
Morton
(1637-98).

miss now the quickening spirit and the wiser
insight that come with work in a wide field ; and in
the great cities of this country we look in vain
among practising physicians for the successor of
Jacob Bigelow of Boston, Holmes of Montreal,
Barton of Philadelphia, and others — men who main-
tained in this matter an honourable tradition, whose
names live in natural history societies and academies
of natural science, in the founding of which they
were mainly instrumental. 8

August 22, 1662 — Black Bartholomew's Day, as it
has been called — brought sadness and sorrow to
many English homes. The enforcement of the Act
of Uniformity called for subscription to the Thirty-
nine Articles, and enforced the use by all clergymen
of the Book of Common Prayer. Among those
ejected for refusal to subscribe — 2,000 in number,
it is said — was a young man, aged twenty-five, the
Vicar of Kinver, in Staffordshire, Richard Morton
by name. The son of a physician, born in 1637, he
had been educated at Oxford, where he took the
B.A. in 1656-7, became chaplain to his college and
took the M.A. in 1659, and in the same year was
appointed to the vicarage of Kinver. From the days
of St. Luke there have been many instances of what
has been called the angelical conjunction of physic
and divinity. In the seventeenth century many men
could sign 4>iAo0eoAoyiar/)oj>o'^o9 after their names, as

BIOGRAPHY 21

did Robert Lovell in his History of Animals and
Minerals (1661). Following Linacre's example,
clerical orders have been taken as a rule by the
physician late in life, but Morton, ejected from his
living, turned his attention to medicine at a com-
paratively early age. From Baxter's account, he
evidently was a loss to the church. He speaks
of him as l a man of great gravity, calmness, sound
principles, of no faction, an excellent preacher, of
an upright life.' "

fe

In one of Bassett's last letters there is an interest- Broussais
ing note about Broussais, who had just finished his (I772~l838)
course in phrenology :—

* The pupils of '36 have struck off his head. It
is in bronze, a little less than our old Washington
and Franklin in wax. Broussais is a genius, and
when he entered life he saw that something was to
be done, or rather that he must do something, and
he seized the science of medicine as a good old
doctor would a bottle of lotion, and shook it man-
fully ; France, Germany, all Europe, parts of Asia,
and America have felt the agitation. But younger
men also feel the necessity of doing something, and
they are now endeavouring to quiet the commotion
he has raised, and in France they have measurably
succeeded. When the giant dies I doubt if he will
find a successor — his conquests, like Alexander's,
will be divided and then fall into insignificance.
He fights well while in the ring against awful odds,
for the truth is against him, but some of her brightest
geniuses he has put to rout or silence. Time is
now about to enter the field, and I have no doubt
will place a splendid monument over him, to prevent
him from being forgotten.' "

22 HISTORY AND

Linacre Linacre, the type of the literary physician, must
(1460-1524). ever h^d a uniqUe place in the annals of our
profession. To him was due in great measure the
revival of Greek thought in the sixteenth century
in England; and, in the last Harveian oration,
Dr. Payne has pointed out his importance as a fore-
runner of Harvey. He made Greek methods
available ; ^through him the art of Hippocrates and
the science of Galen became once more the subject
of careful, first-hand study. 4

t

American What would attract us all is the study of the
medicine. growth of the American mind in medicine since the
starting of the colonies. As in a mirror this story
is reflected in the literature of which you are the
guardians and collectors — in letters, in manuscripts,
in pamphlets, in books, and in journals. In the
eight generations which have passed, the men who
have striven and struggled — men whose lives are
best described in the words of St. Paul, ' in journey-
ings often, in perils of waters, ... in perils in the city,
in perils in the wilderness, in perils in the sea, . . .
in weariness and painfulness, in watchings often, in
hunger and thirst, in fastings often ' — these men, of
some of whom I have spoken, have made us what
we are. With the irrevocable past into which they
have gone lies our future, since our condition is the
resultant of forces which, in these generations, have
moulded the profession of a new and mighty
empire. From the vantage-ground of a young
century we can trace in the literature how three
great streams of influence — English, French, and

BIOGRAPHY 23

German — have blended into the broad current of
American medicine on which we are afloat.
Adaptiveness, lucidity, and thoroughness may be
said to be the characteristics of the Anglican, Gallic,
and Teutonic influences, and it is no small part of
your duty to see that these influences, the com-
bination of which gives to medicine on this continent
its distinctively eclectic quality, are maintained and
extended. 3

&

One of the most complicated problems of the first Fevers,
half of the century related to the differentiation of
the fevers. The eruptive fevers, measles, scarlet
fever, and small-pox, were easily recognized, and
the great group of malarial fevers was well known ;
but there remained the large class of continued
fevers, which had been a source of worry and
dispute for many generations. 5

&

Louis clearly differentiated typhoid fever, and
by the work of his American pupils, W. W. Gerhard
and Alfred Stille of Philadelphia, and George
Shattuck of Boston, typhus and typhoid fevers were
defined as separate and independent affections. 5

fc

Relapsing fever, yellow fever, dengue, &c., were
also distinguished. The work of Graves and Stokes
of Dublin, of Jenner and Budd in England, of Drake,
Dickson, and Flint in America, supplemented the
labours of the French physicians, and by the year 1 860
the profession had reached a sure and safe position
on the question of the clinical aspects of fevers. 5

24 HISTORY AND

Eryxima- Nowhere in literature do we have such a charming
picture illustrating the position of a cultivated
physician in society as that given in Plato "s Dialogues
of Eryxima^is, himself the son of a physician,
Acumenus. In that most brilliant age the physician
was the companion and friend, and in intellectual
intercourse the peer, of its choicest spirits. 23

Evolution. In no way has biological science so widened the
thoughts of men as in its application to social
problems. That throughout the ages, in the gradual
evolution of life, one unceasing purpose runs ; that
progress comes through unceasing competition,
through unceasing selection and rejection ; in a word,
that evolution is the one great law controlling all
living things, 4 the one divine event to which the
whole creation moves,' this conception has been
the great gift of biology to the nineteenth century. 21

The past. In the continual remembrance of a glorious past in-
dividuals and nations find their noblest inspiration. 2I

Tyranny of The ideal has been reached, so far as organization
Democracy. js COncerned, when the profession elects its own
Parliament, to which is committed the control of all
matters relating to the licence. The recognition
in some form of this democratic principle has been
one great means of elevating the standard of medical
education, and in a majority of the States of the
Union it has secured a minimum period of four
years' study, and a State examination for licence to
practise. All this is as it should be. But it is high

BIOGRAPHY 25

time that the profession realized the anomaly of
eight boards in the Dominion and some scores in
the United States. One can condone the iniquity
in the latter country more readily than in Canada,
in which the boards have existed for a longer
period, and where there has been a great uniformity
in the medical curriculum. After all these years
that a young man, a graduate of Toronto and
a registered practitioner in Ontario, cannot practise
in the province of Quebec, his own country, without
submitting to vexatious penalties of mind and
pocket, or that a graduate from Montreal and
a registered practitioner of this province cannot go
to Manitoba, his own country again, and take up
his life's work without additional payments and
penalties, is, I maintain, an outrage; it is pro-
vincialism run riot. -That this pestiferous condition
should exist throughout this Dominion and so many
States of the Union, illustrates what I have said of
the tyranny of democracy, and how great enslavers
of liberty its chief proclaimers may be. 23

&
My feeling on the subject of international, inter- Interpro-

colonial, and interprovincial registration is this —

a man who presents evidence of proper training, national
who is a registered practitioner in his own country, JJjj£ a"
and who brings credentials of good standing at the
time of departure, should be welcomed as a brother,
treated as such in any country, and registered upon
payment of the usual fee. The ungenerous treat-
ment of English physicians in Switzerland, France,
and Italy, and the chaotic state of internecine war-

26 HISTORY AND

fare existing on this continent, indicate how far
a miserable Chauvinism can corrupt the great and
gracious ways which should characterize a liberal
profession. 23

$

Back to Like everything else that is good and durable in
the Greeks. ^s world, modern medicine is a product of the
Greek intellect, and had its origin when that wonder-
ful people created positive or rational science, and
no small credit is due to the physician who, as
Professor Gomperz remarks (in his chapter, * On
the Age of Enlightenment,' Greek Thinkers, vol. i),
very early brought to bear the spirit of criticism on
the arbitrary and superstitious view of the pheno-
mena of life. If science was ever to acquire ' steady
and accurate habits instead of losing itself in a maze
of phantasies, it must be by quiet methodical
research.' * It is the undying glory of the school
of Cos that it introduced this innovation into the
domain of its art, and thus exercised the most
beneficial influence on the whole intellectual life of
mankind. Fiction to the right ! reality to the left !
was the battle-cry of this school in the war which
it was the first to wage against the excesses and
defects of the nature philosophy.' (Gomperz.) The
critical sense and sceptical attitude of the Hippo-
cratic school laid the foundation of modern medicine
on broad lines, and we owe to it: first, the
emancipation of medicine from the shackles of
priestcraft and of caste; secondly, the conception of
medicine as an art based on accurate observation,
and, as a science, an integral part of the science

BIOGRAPHY 27

of man and of nature ; thirdly, the high moral
ideals expressed in that * most memorable of human
documents ' (Gomperz), the Hippocratic oath ; and
fourthly, the conception and realization of medicine
as a profession of a cultivated gentleman. 23

&

The most distinguishing feature of the scientific Experi-
medicine of the century (nineteenth) has been the J?entts in
phenomenal results which have followed experi- boratory.
mental investigation. While this method of re-
search is not new, since it was introduced by Galen,
perfected by Harvey, and carried on by Hunter, it
was not until well into the middle of the century
that, by the growth of research laboratories, the
method exercised a deep influence on progress.
The lines of experimental research have sought to
determine the functions of the organs in health, the
conditions under which perversion of these functions
occurs in disease, and the possibility of exercising
protective and curative influences on the process of
disease. 5

&
Not only has experimental science given us clear

and accurate data upon the localization of certain
functions of the brain, and of the paths of sensory
and of motor impulses, but it has opened an entirely
new field in the diagnosis and treatment of the
diseases of these organs, in certain directions of
a most practical nature, enabling us to resort to
measuresof relief undreamedof even thirtyyears ago.5

fc

The study of physiology and pathology within

the past half- century has done more to emancipate

28

HISTORY AND

Experi-
ments :

clinical.

medicine from routine and thraldom of authority
than all the work of all the physicians from the
days of Hippocrates to Jenner, and we are as yet
upon the threshold. 5

tf

As clinical observers we study the experiments
which Nature makes upon our fellow creatures.
These experiments, however, in striking contrast
to those of the laboratory, lack exactness, possess-
ing as they do a variability at once a despair and a
delight — the despair of those who look for nothing
but fixed laws in an art which is still deep in the
sloughs of empiricism ; the delight of those who
find in it an expression of a universal law transcend-
ing, even scorning, the petty accuracy of test-tube
and balance, the law that in man, * the measure of
all things,' mutability, variability, mobility, are the
very marrow of his being. 26

Laennec The discovery by Laennec of the art of auscultation,

(1781-1826). ,,.,,,, . j

by which, through changes in the normal sound

within the chest, various diseases of the heart and
lungs could be recognized, gave an immense impetus
to clinical research. The art of percussion, dis-
covered by Auenbrugger in the eighteenth century,
and reintroduced by Corvisart, contributed not a
little to the same. Laennec's contributions to the
study of disease of the lungs, of the heart, and of
the abdominal organs really laid the foundation of
modern clinical medicine. 5

medicine in The reformation which started at Harvard shortly
America.

BIOGRAPHY 29

after 1870 spread over the entire country, and the
rapid evolution of the medical school has been one
of the most striking phenomena in the history of
medicine in the century. University authorities
began to appreciate the fact that medicine was
a great department of knowledge, to be cultivated
as a science and promoted as an art. Wealthy men
felt that in no better way could they contribute to
the progress of the race than by the establishment
of laboratories for the study of disease, and hospitals
for the care of the sick poor. The benefactions of
Johns Hopkins, of Sims, of Vanderbilt, of Pierpont
Morgan, of Strathcona, of Mount- Stephen, of
Payne, and of Levi C. Lane and others have placed
scientific medicine on a firm basis. 5

*
With the invention of the microscope we can Microscope,

mark the first positive step towards the gral to-day. the in-
AT- • T>" i • * i r vention of

A Jesuit priest, Kircher, in 1671, was the first to (1671).

investigate putrefying meat, milk, and cheese with
the crude microscope of his day, and left us in-
definite remarks concerning 'very minute living
worms ' found therein. Four years after Kircher a
Dutch linen merchant, Antonius von Leeuwenhoek,
by improving the lenses of the microscope, saw in
rain-water, putrefying fluids, intestinal contents,
and saliva, minute, moving, living particles, which
he called ' animalculae.' In medical circles of his
day these observations aroused the keenest interest,
and the theory that these ' animalculae ' might be
the cause of all disease was eagerly discussed.
Plenciz, of Vienna, after much observation of various

30 HISTORY AND

fluids, putrefying and otherwise, wrote, in 1762,
that it was his firm belief that the phenomena of
diseases and the decomposition of animal fluids
were wholly caused by minute living things. 5

Medicine in It may be interesting to take a glance at the state

America at of medicine in this country at the opening of the

opening of _ . J f

nineteenth century. [At the opening of the nineteenth cen-

century. tury] there were only three schools of medicine,
the most important of which were the University
of Pennsylvania and the Harvard. There were
only two general hospitals. The medical education
was chiefly in the hands of the practitioners who
took students as apprentices for a certain number
of years. The well-to-do students and those wishing
a better class of education went to Edinburgh or
London. There were only two or three medical
journals, and very few books had been published
in the country, and the profession was dependent
entirely upon translations from the French and
upon English works. The only medical libraries
were in connexion with the Pennsylvania Hospital
and the New York Hospital. The leading prac-
titioners in the early years were Rush and Physick
in Philadelphia ; Hosack and Mitchill in New York ;
and James Jackson and John Collins Warren in
Boston. There were throughout the country, in
smaller places, men of great capabilities and energy,
such as Nathan Smith, the founder of the Medical
Schools of Dartmouth and of Yale, and Daniel
Drake in Cincinnati. 5

BIOGRAPHY 31

The well-known effect on angina pectoris of John
mental emotion has never been better expressed ^S^ \
than by John Hunter, who used to say that * his life
was in the hands of any rascal who chose to annoy
and tease him.' And yet some of the victims of
angina have not found mental excitement to be the
most serious exciting cause. Thus, in Mr. Summer's
case, ' a sudden turn in his easy chair, while quietly
reading at night, would start up the most tearing
agony, while at other times an exciting speech in
the Senate, accompanied with the most forcible
and muscular gesticulations, would not create even
the suggestion of a pain.' (Taber Johnson.) 28

&

Harvey and Sydenham, types of the scientific and Harvey
the practical physician, though contemporaries, (I578~
were uninfluenced, so far as we know, by each other's
work or method. Harvey had little reputation as
a practical physician, and Sydenham cared little for
theories or experiment. Modern scientific medicine,
in which these two great types meet, had its rise
in France in the early days of this century. True,
there had lived and worked in England the greatest
anatomist and medical thinker of modern times ;
but John Hunter, to whose broad vision disease
was but one of the processes of nature to be
studied, was as a voice crying in the wilderness to
the speculative, theoretical physicians of his day. ^

*>

The chief facts in Louis's life may be thus briefly Louis
stated. He was born in 1787 at Aif. He began the toSy-
study of law, but abandoned it for that of medicine.

32

HISTORY AND

but re-
turned to
the hos-
pitals for
six years
for clinical
study ;

He seems not to have been of a very strong con-
stitution, as he did not pass the inspection for
military service. He began the study of medicine
at Rheims, and completed his course in Paris, where
he graduated in 1813, in the twenty-seventh year
of his age. While waiting at home, hesitating what
he should do, M. le comte de Saint- Priest, who
occupied an official position in Russia, happened to
stay for a few hours in the town of A* to see Louis's
family, and it was suggested that the young physi-
cian should accompany him to Russia. He con-
sented, and in St. Petersburg obtained a diploma
to practise. For three years he seems to have had
no settled abode, but wandered about with his
friend, who was governor of one of the provinces.
He then settled in Odessa, where he remained for
four years and practised with great success. In
the last year of his stay in Odessa he was very
much disturbed by the high rate of mortality in
children with diphtheria, and this appears to have
determined him to abandon for a time the practice
of medicine and to devote himself to study. With
this object in view he returned to Paris, and for
six months attended the practice at the Children's
Hospital. Among the younger physicians in Paris
he found an old fellow pupil, Chomel, physician to
La Charite, who offered him opportunities for work
in his wards. Louis was at this time thirty- four
years of age. Here for six years uninterruptedly
he set himself to work to study disease in the wards
and in the post-mortem room. At first he appears
to have occupied the position simply as a voluntary

BIOGRAPHY 33

assistant and friend of Chomel, but subsequently he
became his chef de clinique, and during this period
he occupied a room in the entre-sol of the hospital.
He was a voluminous note- taker and collected in
this time an enormous number of important facts. ^

*

This remarkable feature in Louis's life has scarcely
been dwelt upon sufficiently. I know of no other
parallel instance in the history of medicine. It is
worth while reading- the brief extract from Dr.
Cowan's introduction to his translation of the work
on Phthisis : —

4 He entered the hospital of La Charite as a
clinical clerk, under his friend, Professor Chomel.
For nearly seven years, including the flower of minuteness
his bodily and mental powers (from the age of of inquiry
thirty-three to forty), he consecrated the whole and ac'
of his time and talents to rigorous, impartial description-
observation. All private practice was relinquished,
and he allowed no considerations of personal emo-
lument to interfere with the resolution he had
formed. For some time his extreme minuteness
of inquiry and accuracy of description were the
subjects of sneering and ridicule, and CMI bono } Cut
was not infrequently and tauntingly asked. The boao?
absence of any immediate result seemed for a time
to justify their contempt of a method involving too his method
much labour and personal sacrifice to be generally spoken of
popular or easily imitated ; and M. Louis himself, x

at moments, almost yielded to the increasing diffi-
culties of the task he had undertaken. No sooner,
however, were his facts sufficiently numerous to
admit of numerical analysis than all doubt and
hesitation were dissipated, and the conviction that
the path he was pursuing could alone conduct him
to the discovery of truth became the animating

34 HISTORY AND

but later motive for future perseverance. Many of the
applauded results at which he arrived soon attracted general
*nd*nii" attention, and among those who had formerly
derided his method while they admired his zeal,
he found many to applaud and a few to imitate.
From this moment may be dated the presence of
that strong impression of the necessity of exact
observation by which the school of Paris has been
since so distinguished, and which is now gradually
pervading the medical institutions of the continent
and our own country ; it is undoubtedly to the
author of the present volume that we ought to
ascribe the practical revival of that system, which
had for ages been verbally recognized, but never
before rigorously exemplified.' ^

tf

the Numeri- Louis introduced what is known as the Numerical
cal Method, M^O^ a pian wnich we use every day, though
the phrase is not now very often on our lips. The
guiding motto of his life was Ars medico, tota in
observationibus, in carefully observing facts, care-
fully collating them, carefully analysing them. To
get an accurate knowledge of any disease it is
necessary to study a large series of cases and to go
into all the particulars — the conditions under which
it is met, the subjects specially liable, the various
symptoms, the pathological changes, the effect of
by which is drugs. This method, so simple, so self-evident, we
f bcte"e^>n owe lar£ely to Louis, in whose hands it proved an
which the invaluable instrument of research. He remarks in

edifice of one place that the edifice of medicine reposes
medicine . \ f .

must rest ; entirely upon facts, and that truth cannot be elicited

but from those which have been well and com-
pletely observed. ^

BIOGRAPHY 35

American medicine felt the influence of Louis Louis's
through two channels, his books and his pupils.
Let us speak first of the former. No French writer
of the century has had such a large audience in this
country ; all of his important works were translated
and widely read (Louis). The work on Phthisis,
the first important outcome of five years' hard work
at La Charite in Chomel's wards, was published in
1825. Much had already been done by physicians
of the French school on this subject. Bayle's im-
portant Recherches had been issued in 1810, and
Laennec had revolutionized the study of phthisis
by the publication of his treatise on auscultation.
I cannot enter into any detailed analysis of the
work, but it is one which I can commend to your
notice as still of great value, particularly as a model
of careful observation. The work was based upon
the study of 1 23 cases observed in Chomel's clinic.
The lesions observed at autopsy are first described
under the different organs, with great accuracy and
detail, and then summarized, following which is an
elaborate description of the symptomatology. I do
not know of any single work on pulmonary tubercu-
losis which can be studied with greater profit to-day
by the young physician. The fifty years which have
elapsed since its publication, and the changes which
have taken place in our ideas of tuberculosis, detract
naught from the value of his careful anatomical and
clinical presentation of the subject. 3o

fc

Oliver Wendell Holmes said that he had learned ^s tea!?h-

ing and
three things in Paris : * Not to take authority when influence ;

D 2

HISTORY AND

in Paris
between
1830 and
1840.

I can have facts, not to guess when I can know,
and not to think a man must take physic because
he is sick.' It seems to me that this group of
young fellows brought back from Paris, first, an
appreciation of the value of method and accuracy
in the study of the phenomena of disease ; secondly,
a profound, and at the time a much-needed, dis-
trust of drugs ; and, thirdly, a Gallic refinement and
culture which stamped them, one and all, as un-
usual men. Let me name the list over as given to
me by Stille * himself : —

his Ameri- * From Boston : James Jackson, Jr., H. I. Bow-
can pupils ditch, O. W. Holmes, George C. Shattuck, Jr., John
C. Warren (then past middle age), John Mason
Warren, and John D. Fisher. From Philadelphia :
George W. Norris, William W. Gerhard, Casper
W. Pennock, Thomas Stewardson, Alfred Stille,
Thomas L. Mutter, E. Campbell Stewart, Charles
Bell Gibson, John B. Biddle, David H. Tucker,
Meredith Clymer, William P. Johnston, W. S. W.
Ruschenburger, Edward Peace, William Pepper, Sr.
Baltimore : William Power (see biography of
Charles Frick, in Gross's Lives). Charleston :
G. S. Gibbes, Peter C. Gaillard, Pryce Porcher.
Virginia : J. L. Cabell, L. S. Joynes, — Selden, and
— Randolph. New York : John A. Swett, Abraham
Dubois, Alonzo Clark, Charles L. Mitchell, —
Punnet, Charles D. Smith, Valentine Mott, Sr.,
[and] John T. Metcalfe.'

There were many others, of course, some before
Louis's day, as Samuel G.Morton, who was Laennec's
most distinguished American pupil, and some of
those mentioned, as Meredith Clymer (ultimus

* Died April 20, 1902.

BIOGRAPHY 37

Romanorum) and Metcalfe, just gone (1902), who
did not come so directly under Louis's influence,
but were pupils of Chomel and Andral. 35

&

'And many more whose names on earth are dark' —
men of the stamp of Dr. Bassett of Alabama, who
felt the strong impulsion to know the best that the
world offered, every one of whom has left a deep
and enduring impression in his sphere of work. 3o

*

As Sir Thomas Browne remarks in the Hydrio- Thomas
taphia : l The iniquity of oblivion blindly scatter- /Jgg^
eth her poppy, and deals with the memory of 1742):

men without distinction to merit of perpetuity.'
Thus it happens that Thomas Dover, the doctor,
has drifted into our modern life on a powder
label (to which way of entering the company of
posterity, though sanctified by Mithridates, many
would prefer oblivion, even to continuous im-
mortality on a powder so potent and palatable
as the Pulvis Ipecacuanhae compositus) ; while
Thomas Dover, the buccaneer, third in command,
one of the principal owners, and president of the
council of the Duke and Duchess — privateers of
the ancient and honourable city of Bristol — dis-
coverer of Alexander Selkirk (the original Robinson
Crusoe), in spite of more enduring claims on our
gratitude, has been forgotten. 34

a good

Doubtless the old buccaneer, described as * a man fighter and

of rough temper, who could not easily agree with

HISTORY AND

discoverer
of ' Robin-
son
Crusoe '^

Dover's
Powder.

those about him,' was a striking figure as he passed
along the Strand to the Jerusalem Coffee House,
where he saw his patients. A good fighter, a good
hater, as alas ! so many physicians have been, his
weaknesses and evil behaviour we may forget, but
Captain Thomas Dover, who on the 2nd of February,
1710, found 'Robinson Crusoe,' the world should
not forget ; and we also of his craft have cause daily
to remember with gratitude the student and friend of
the great Sydenham, who had the wit, in devising
a powder, to remember his master's injunction :
Sine papaveribus, sine opiatis et medic amentis, ex
iis confectis, manca et clauda esset medicina. 34

Oliver
Wendell
Holmes
(1809-94) :

' one-boss
shay';

Very fitting indeed is it that he who had lived to
be * the last leaf upon the tree ' should have fallen
peacefully in the autumn which he loved so well.
Delightful, too, to think that although he had, to
use the expression of Benjamin Franklin, intruded
himself these many years into the company of
posterity, the freshness and pliancy of his mind
had not for a moment failed. Like his own wonder-
ful ' one-hoss shay,' the end was a sudden break-
down; and though he would have confessed, no
doubt, to ' a general flavor of decay/ there was
nothing local, and his friends had been spared
that most distressing of all human spectacles, those
cold gradations of decay, in which a man takes
nearly as long to die as he does to grow up, and
lives a sort of death in life, ita sine vita vivere, ita
sine morte mori. 38

BIOGRAPHY 39

He has been sandwiched in my affections these the Ameri-

many years between Oliver Goldsmith and Charles

Lamb. More than once he has been called, I think,

the American Goldsmith. Certainly the great

distinction of both men lies in that robust humanity

which has a smile for the foibles and a tear for the

sorrows of their fellow creatures. The English the English

Oliver, with a better schooling for a poet (had he Goldsmith;

not learned in suffering what he taught in song ?),

had a finer fancy and at his best a clearer note.

With both writers one is at a loss to know which

to love the better, the prose or the poetry. Can

we name two other prose- writers of equal merit,

who have so successfully courted the 4 draggle-tailed

Muses,' as Goldsmith calls them ? Like Charles Holmes and

Lamb, Holmes gains the affections of his readers LambJ

at the first sitting, and the genial humour, the

refined wit, the pathos, the tender sensitiveness

to the lights and shadows of life, give to the

Breakfast Table Series much of the charm of the

Essays of Elia. 38

^

A few years later, however, he contributed an
article which will long keep his memory green
in our ranks.

Child-bed fever was unhappily no new disorder puerperal
when Oliver Wendell Holmes studied, nor had feverJ
there been wanting men who had proclaimed
forcibly its specific character and its highly con-
tagious nature. Indeed, so far back as 1 795, Gordon,
of Aberdeen, not only called it a specific contagion,
but said he could predict with unerring accuracy

40 HISTORY AND

the very doctors and nurses in whose practice the
cases would develop. Rigby, too, had lent the
weight of his authority in favour of the contagious-
ness, but the question was so far from settled that,
as you will hear, many of the leading teachers
scouted the idea that doctors and nurses could
convey the disorder. Semmelweis had not then
begun to make his interesting and conclusive ob-
servations, for which his memory has recently been
greatly honoured.

In 1842, before the Boston Society for Medical
Improvement, Dr. Holmes read a paper entitled
* The Contagiousness of Puerperal Fever,' in which
he brought forward a long array of facts in support
of the view that the disease was contagious, con-
veyed usually by the doctor or the nurse, and due
to a specific infection. At the time there certainly
was not an article in which the subject was presented
in so logical and so convincing a manner. As
Sydney Smith says, it is not the man who first says
a thing, but it is he who says it so long, so loudly,
and so clearly that he compels men to hear him —
it is to him that the credit belongs ; and so far
as this country is concerned, the credit of insisting
upon the great practical truth of the contagiousness
of puerperal fever belongs to Dr. Holmes. The
essay is characterized in places by intenseness and
great strength of feeling. He says he could not
for a moment consent to make a question of the
momentous fact, which should not be considered
a subject for trivial discussion, but which should
be acted upon with silent promptitude. l No nega-

BIOGRAPHY 41

live facts, no passing opinions, be they what they
may, can form any answer to the series of cases
now within the reach of all who choose to explore
the records of medical science.' Just before the
conclusions the following eloquent sentences are
found, portions of which are often quoted : —

* It is as a lesson rather than as a reproach, that I an historic
call up the memory of these irreparable errors and paragraph ;
wrongs. No tongue can tell the heart-breaking
calamities they have caused ; they have closed the
eyes just opened upon a new world of life and
happiness ; they have bowed the strength of man-
hood into the dust ; they have cast the helplessness
of infancy into the stranger's arms, or bequeathed
it with less cruelty the death of its dying parent.
There is no tone deep enough for record, and
no voice loud enough for warning. The woman
about to become a mother, or with her new-born
infant upon her bosom, should be the object of
trembling care and sympathy wherever she bears
her tender burden, or stretches her aching limbs.
The very outcast of the street has pity upon her
sister in degradation when the seal of promised
maternity is impressed upon her. The remorseless
vengeance of the law brought down upon its
victims by a machinery as sure as destiny, is arrested
in its fall at a word which reveals her transient
claims for mercy. The solemn prayer of the liturgy
singles out her sorrows from the multiplied trials
of life, to plead for her in the hour of peril. God
forbid that any member of the profession to which
she trusts her life, doubly precious at that eventful
period, should regard it negligently, unadvisedly,
or selfishly.'

The results of his studies are summed up in puerperal
a series of eight conclusions, and the strong ground fever> not

HISTORY AND

a misfor-
tune but a
crime ;

essay on
Puerperal
Fever, and
the Cham-
bered
Nautilus.

which he took may be gathered from this sentence
in the last one: 'The time has come when the
existence of a private pestilence in the sphere of
a single physician should be looked upon not as
a misfortune but a crime.' Fortunately this essay >
which was published in the'ephemeral New England
Quarterly Journal of Medicine, was not destined
to remain unnoticed. The statements were too
bold and the whole tone too resolute not to arouse
the antagonism of those whose teachings had been
for years diametrically opposed to the contagious-
ness of puerperal fever. 38

tf

Some years ago in an editorial note I commented
upon a question which Dr. Holmes had asked in his
Hundred Days in Europe. Somewhere at dinner
he had sat next to a successful gynaecologist who
had saved some hundreds of lives by his operations,
and he asked, 4 Which would give the most satis-
faction to a thoroughly humane and unselfish being,
of cultivated intelligence and lively sensibilities : to
have written all the plays which Shakespeare has
left as an inheritance for mankind, or to have
snatched from the jaws of death more than a hun-
dred fellow creatures, and restored them to sound
and comfortable existence ? ' I remarked that there
was nobody who could answer this question so
satisfactorily as the Autocrat, and asked from which
he derived the greater satisfaction, the essay on
Puerperal Fever, which had probably saved many
more lives than any individual gynaecologist, or
the Chambered Nautilus, which had given pleasure

BIOGRAPHY 43

to so many thousands. The journal reached Dr.
Holmes, and I read you his reply to me, under date
of January 21, 1889: —

4 1 have been rarely more pleased than by your
allusion to an old paper of mine. There was a time
certainly in which I would have said that the best
page of my record was that in which I had fought my
battle for the poor poisoned women. I am reminded
of that essay from time to time, but it was published
in a periodical which died after one year's life, and
therefore escaped the wider notice it would have
found in the American Journal of the Medical
Sciences. A lecturer at one of the great London
hospitals referred to it the other day, and coupled
it with some fine phrases about myself which made
me blush, either with modesty or vanity, I forget
which.

4 1 think I will not answer the question you put me.
I think oftenest of the Chambered Nautilus, which
is a favourite poem of mine, though I wrote it myself.
The essay only comes up at long intervals. The
poem repeats itself in my memory, and is very
often spoken of by my correspondents in terms of
more than ordinary praise. I had a savage pleasure,
I confess, in handling those two professors — learned
men both of them, skilful experts, but babies, as
it seemed to me, in their capacity of reasoning and
arguing. But in writing the poem I was filled with
a better feeling — the highest state of mental exalta-
tion and the most crystalline clairvoyance, as it
seemed to me, that had ever been granted to me —
I mean that lucid vision of one's thought and all
forms of expression which will be at once precise
and musical, which is the poet's special gift, however
large or small in amount or value. There is more
selfish pleasure to be had out of the poem — perhaps
a nobler satisfaction from the life-saving labour.' ^

44

HISTORY AND

Very few men have entered upon the race with
greater advantages than did Dr. MacDonnell. To
a fine physique and presence, and a charm of
manner which is so often continued in this country
in the second generation of Irishmen of the Brahmin
class — to use an expression of Oliver Wendell
Holmes — there were added those mental gifts which
alone assure success — industry and perseverance.
Very early in his career circumstances in connexion
with the accidental death of his father altered his
surroundings and threw upon him responsibilities
that were faithfully and courageously met, and
that gave an unmistakable stamp to a character
naturally refined and noble. Success came, cares
lightened, and, with domestic, social, and profes-
sional relations of the happiest possible kind, the
future could not have looked brighter ; but — es hat
nicht sollen sein, and a devoted wife, an aged
mother, and a loving sister, with colleagues, students,
and friends, mourn his untimely union with

4 The inheritors of unfulfilled renown.' 33

In my early days I came under the influence of an
ideal student-teacher, the late Palmer Howard, of
Montreal. If you ask what manner of man he was,
I would refer you to Matthew Arnold's noble
tribute to his father in his well-known poem, Rugby
Chapel. When young, Dr. Howard had chosen
a path—4 path to a clear purposed goal ' — and he
pursued it with unswerving devotion. With him
the study and the teaching of medicine were an

BIOGRAPHY 45

absorbing passion, the ardour of which neither the
incessant and ever-increasing demands upon his
time nor the growing years could quench. When,
in the summer of 1871, as a senior student, I first
came into intimate contact with him, the problem
of tuberculosis was under discussion, stirred up by
the epoch-making work of Villemin and the radical
views of Niemeyer. Every lung lesion at the Mont-
real General Hospital had to be shown to him,
and I got my first-hand introduction to Laennec,
to Andral, to Graves, and to Stokes, and became
.familiar with their works. . . . An ideal teacher be-
cause a student, ever alert to the new problems, an alert to
indomitable energy enabled him, in the midst of an
exacting practice, to maintain an ardent enthusiast^
still to keep bright the fires which he had lighted
in his youth. Since those days I have seen many
teachers, and I have had many colleagues, but I
have never known one in whom were more happily
combined the stern sense of duty with the mental
freshness of youth. 45

fc

To one of my teachers I must pay in passing the James
tribute of filial affection. There are men here ?°vell ,

( IoI7~oO )«

to-day who feel as I do about Dr. James Bovell —
that he was of those finer spirits, not uncommon
in life, touched to finer issues only in a suitable
environment. Would the Paul of evolution have
been Thomas Henry Huxley had the Senate elected
the young naturalist to a chair in this University
(Toronto) in 1851 ? Only men of a certain metal
rise superior to their surroundings, and while Dr.

46 HISTORY AND

Bovell had that all- important combination of bound-
less ambition with energy and industry, he had that
fatal fault of diffuseness, in which even genius is
strangled. With a quadrilateral mind, which he
kept spinning like a teetotum, one side was never
kept uppermost for long at a time. Caught in
a storm which shook the scientific world with the
publication of The Origin of Species, instead of
sailing before the wind, even were it with bare
poles, he put about and sought a harbour of refuge
in writing a work on Natural Theology, which you
will find on the shelves of second-hand book-shops
in a company made respectable at least by the
presence of Paley. He was an omnivorous reader
and transmuter upon anything in the science of the
day, from protoplasm to evolution ; but he lacked
concentration and that scientific accuracy which only
comes with a long training (sometimes, indeed,
never comes !), and which is the ballast of the boat.
But the bent of his mind was devotional, and early
swept into the Tractarian movement, he became an
advanced Churchman, a good Anglican Catholic.
As he chaffingly remarked one day to his friend,
the Rev. Mr. Darling, he was like the waterman
in Pilgrim's Progress, rowing one way towards
Rome, but looking steadfastly in the other direction
towards Lambeth. His Steps to the Altar and his
Lectures on the Advent attest the earnestness of
his convictions ; and later in life, following the
example of Linacre, he took orders, and became
another illustration of what Cotton Mather calls the
angelic conjunction of medicine with divinity. 24

BIOGRAPHY 47

But what shall I say of Leidy, the man in whom the Joseph

leaven of science wrought with labour and travail ^|id^ N .

for so many years ? The written record survives,

scarcely equalled in variety and extent by any

naturalist, but how meagre is the picture of the

man as known to his friends. The traits which patient

made his life of such value— the patient spirit, the fy

kindly disposition, the sustained zeal — we shall not tion, sus-

see again incarnate. The memory of them alone tamedzeal;

remains. As the echoes of the eulogies upon his

life have scarcely died away, I need not recount to

this audience his ways and work, but upon one

aspect of his character I may dwell for a moment,

as illustrating an influence of science which has

attracted much attention and aroused discussion.

So far as the facts of sense were concerned, there

was not a trace of Pyrrhonism in his composition,

but in all that relates to the ultra-rational no more

consistent disciple of the great sceptic ever lived.

There was in him, too, that delightful 'ataraxia,' ataraxia;

that imperturbability which is the distinguishing

feature of the Pyrrhonist, in the truest sense of the

word. A striking parallel exists between Leidy Leidy and

and Darwin in this respect, and it is an interesting Darwin '•>

fact that the two men of this century who have lived

in closest intercourse with nature should have found

full satisfaction in their studies and in their domestic

affections. In the autobiographical section of the

Life of Charles Darwin, edited by his son Francis,

in which are laid bare with such charming frankness

the inner thoughts of the great naturalist, we find

that he too had reached in suprasensuous affairs

48

HISTORY AND

that state of mental imperturbability in which, to
borrow the quaint expression of Sir Thomas
' stretching Browne, they stretched not his pia mater. But
the pia while acknowledging that in science scepticism is

advisable, Darwin says that he was not himself very
sceptical. Of these two men, alike in this point,
and with minds distinctly of the Aristotelian type,
Darwin yet retained amid an overwhelming ac-
cumulation of facts — and here was his great supe-
riority— an extraordinary power of generalizing
principles from them. Deficient as was this quality
in Leidy, he did not, on the other hand, experience
'the curious and lamentable loss of the higher
aesthetic taste1 which Darwin mourned, and which
may have been due in part to protracted ill-health,
and to an absolute necessity of devoting all his
powers to collecting facts in support of his great
theory.

When I think of Leidy's simple life, of his
devotion to the study of Nature, of the closeness of
his communion with her for so many years, there
recur to my mind time and again the lines : —

'He is made one with Nature; there is heard
His voice in all her music, from the moan

Of thunder, to the song of night's sweet bird ;
He is a presence to be felt and known

In darkness and in light, from herb and stone,
Spreading itself where'er that Power may move

Which has withdrawn his being to its own.'21

The early _

American r or many years there was in this country a group

peripatetic of peripatetic teachers, who, like the Sophists of

BIOGRAPHY 49

Greece, went from town to town, staying- a year or
two in each, or they divided their time between
a winter session in a large city school and a summer
term in a small country one. Among them Daniel
Drake takes the precedence, as he made eleven
moves in the course of his stirring and eventful
life. Bartlett comes an easy second, having taught
in nine schools. Dunglison, T. R. Beck, Willard
Parker, Alonzo Clark, the elder Gross, Austin
Flint, Frank H. Hamilton, and many others whom
I could name, belonged to this group of wandering
professors. The medical education of the day was
almost exclusively theoretical ; the teachers lectured
for a short four months' session, there was a little
dissection, a few major operations were witnessed,
the fees were paid, examinations were held, and all
was over. No wonder, under such conditions, that
many of the most flourishing schools were found
amid sylvan groves in small country towns. In
New England there were five such schools, and in
the State of New York the well-known schools of
Fairfield and Geneva. As there was not enough
practice in the small places to go round, the teachers
for the most part stayed only for the session, at the
end of which it was not unusual for the major part
of the faculty, with the students, to migrate to
another institution, where the lectures were repeated
and the class graduated. 42

fc

Compare the picture of the ' sawbones ' of 1842, as The new
given in the recent biography of Sir Henry Acland, student-
with the representatives to-day, and it is evident

E

50 HISTORY AND BIOGRAPHY

a great revolution has been effected, and very
largely by the salutary influences of improved
methods of education. It is possible now to fill
out a day with practical work, varied enough to
prevent monotony, and so arranged that the know-
ledge is picked out by the student himself, and not
thrust into him willy-nilly, at the point of the
tongue. He exercises his wits, and is no longer
a passive Strasbourg goose, tied up and stuffed to
repletion. 24

PIONEERS IN MEDICINE

OUR DUTY TO BETTER OUR TIMES

In the dedication of his Holy War Thomas Fuller has
some very happy and characteristic remarks on the
bouiiden duty of a man to better his heritage of birth
or fortune, and what the father found glass and made
crystal, he urges the son to find crystal and make pearl.16

E 2

52 PIONEERS

Volte-face Even in well-known affections, advances are made

often from time to time that render necessary a revision

necessary. *

of our accumulated knowledge, a readjustment of

old positions, a removal even of old landmarks.
Perhaps the most remarkable illustration of this
is offered by the discovery of a tubercle bacillus.
What a volte-face for those of us who were teachers
before 1881 ! Happy those who had ability and
wit sufficient for the summersault! Scarcely less
important has been the revolution in our knowledge
of malaria since the researches of Laveran, in 1881,
on the parasite of the disease. l7

The pioneer By temperament or conviction there are a few men
in every community who cannot bow to the Baals
of the society about them, and who stand aloof, in
thought at least, from the common herd. Such
men in small circles tread a steep and thorny road,
and of such in all ages has the race delighted to
make its martyrs. The letters indicate in Dr. Bas-
sett a restless, non-conforming spirit, which turned
aside from the hollowness and deceit of the life
about him. As a student he had doubtless felt
a glow of enthusiasm at the rapid development
of the science of medicine, and amid the worries
and vexations of a country practice his heart burned
with the hope of some time visiting the centres of
learning. As the years passed, the impulse grew
more and more urgent to go forth and see the
great minds which had controlled his hours of
study. All students flocked to Paris in the fourth
decade. Nowhere else was the pool so deeply stirred,

IN MEDICINE 53

and Laennec, Broussais, Louis, Andral, Velpeau, and
others dominated the thoughts of the profession. 12

*>

You do well, citizens of St. Louis and members William
of our profession, to cherish the memory of William Beaumont
Beaumont. Alive you honoured and rewarded 5~X
him, and there is no reproach against you of merits
neglected and talents unrecognized. The pro-
fession of the northern part of the State of Michigan
has honoured itself in erecting a monument to his
memory, near the scene of his disinterested labours
in the cause of humanity and science. His name
is linked with one of your educational institutions,
and joined with that of a distinguished labourer in
another field of practice. But he has a far higher
honour than any you can give him here — the
honour that can only come when the man and
the opportunity meet, and match. Beaumont is
the pioneer physiologist of this country, the first
to make an important and enduring contribution
to this science. His work remains a model of
patient, persevering investigation, experiment and
research, and the highest praise we can give him
is to say that he lived up to and fulfilled the ideals
with which he set out and which he expressed
when he said : * Truth, like beauty, when " un-
adorned, is adorned the most," and, in prosecuting
these experiments and inquiries, I believe I have
been guided by its light.' 7

&
The century now drawing to a close has seen the The

realization of much that the wise of old longed for,

54

PIONEERS

Virchow
(1821-1902)
the
sanitarian.

much of which the earnest spirits of the past had
dreamt. It has been a century of real progress — a
time of the loosening of bands and bonds ; and medi-
cine too, after an enslavement, ecclesiastical and
philosophical, received its emancipation. Forsaking
the traditions of the elders, and scouting the Shib-
boleth of schools and sects, she has at last put off
the garments of her pride, and with the reed of
humility in her hand sits at the feet of her mistress,
the new science. Not to any one man can this
revolution be ascribed : the Zeitgeist was potent,
and like a leaven worked even in unwilling minds ;
but no physician of our time has done more to pro-
mote the change, or by his individual efforts to win
his generation to accept it, than Rudolf Virchow. 8

<#

Virchow's life-work has been the study of the
processes of disease, and in the profession we
revere him as the greatest master that has appeared
since John Hunter. There is another aspect of his
work which has been memorable for good to his
native city. From the day when, as a young man
of twenty-seven, he was sent by the Prussian
Government to Upper Silesia to study the typhus
epidemic, then raging among the half-starved
population, he has been one of the most powerful
advocates in Germany for sanitary reform ; and it
is not too much to say that it is largely to his
efforts that the city of Berlin owes its magnificent
system of drainage. His work in this department
has been simply monumental, and characterized by
the thoroughness which marks the specialist. 8

IN MEDICINE 55

Bi chat's Anatomie generate laid the foundation Bichat
of the positive or modern method of the study of (i77i-I8o2).
medicine, in which theory and reasoning were
replaced by observation and analysis. Laennec,
with the stethoscope, and with an accurate study
of disease at the bedside and in the post-mortem
room, almost created clinical medicine as we know
it to-day. 3o

THE HUMANITIES IN MEDICINE

QUALITIES OF HEART AND HEAD

A physician may possess the science of Harvey and the
art of Sydenham, and yet there may be lacking in him
those finer qualities of heart and head which count for
so much in life. 4

Biology
humanities

58 THE HUMANITIES

Pasture is not everything, and that indefinable,
though well understood, something which we know
as breeding is not always an accompaniment of
great professional skill. Medicine is seen at its
best in men whose faculties have had the highest
and most harmonious training. 4

tf

The Lathams, the Watsons, the Pagets, the
Jenners, and the Gardiners have influenced the
profession less by their special work than by
exemplifying those graces of life and refinements
of heart which make up a character. 4

<t

But by the neglect of the studies of the humani-
ties, which has been far too general, the profession
loses a very precious quality. 4
I tf

And the men of this stamp in Greater Britain

have left the most enduring mark — Beaumont,
Bovell, and Hodder in Toronto ; Holmes, Campbell,
and Howard in Montreal ; the Warrens, the Jack-
sons, the Bigelows, the Bowditches, and the Shat-
tucks in Boston; Bard, Hossack, Francis, Clark,
and Flint of New York ; Morgan, Shippen, Redman,
Rush, Coxe, the elder Wood, the elder Pepper, and
the elder Mitchell of Philadelphia — Brahmins all,
in the language of the greatest Brahmin among
them, Oliver Wendell Holmes : these and men like
unto them have been the leaven which has raised
our profession above the dead level of a business. 4

tf
Biology touches the problem of life at every point,

anc* ma^ c^m> as no otner science, completeness

IN MEDICINE 59

of view and a comprehensiveness which pertains
to it alone. To all whose daily work lies in her
manifestations the value of a deep insight into her
relations cannot be overestimated. The study of
biology trains the mind in accurate methods of
observation and correct methods of reasoning, and
gives to a man clearer points of view, and an
attitude of mind more serviceable in the working-
day world than that given by other sciences, or
even by the humanities. 2I

&

After ten years of hard work I left this city Incorrup-
(Montreal) a rich man, not in this world's goods, *r^ures
for such I have the misfortune — or the good fortune the heart.
—lightly to esteem, but rich in the goods which
neither rust nor moth has been able to corrupt —
in treasures of friendship and good fellowship, and
in those treasures of widened experience and a
fuller knowledge of men and manners which con-
tact with the bright minds in the profession

But there is a still greater sacrifice which many Culture.
of us make, heedlessly and thoughtlessly forgetting
that ' Man does not live by bread alone.' One
cannot practise medicine alone and practise it early
and late, as so many of us have to do, and hope to
escape the malign influences of a routine life. The
incessant concentration of thought upon one subject,
however interesting, tethers a man's mind in a
narrow field. The practitioner needs culture as
well as learning. The earliest picture we have in

60 THE HUMANITIES

literature of a scientific physician, in our sense of
the term, is of a cultured Greek gentleman ; and
I care not whether the young1 man labours among
the beautiful homes on Sherbrooke Street, or in
slums of Caughnawauga, or in some sparsely
settled country district, he cannot afford to have
learning only. In no profession does culture count
for so much as in medicine, and no man needs it
more than the general practitioner, working among
all sorts and conditions of men, many of whom are
influenced quite as much by his general ability,
which they can appreciate, as by his learning of
which they have no measure. The day has passed
for the * practiser of physic ' to be like Mr. Robert
Levet, Dr. Johnson's friend, ' obscurely wise and
coarsely kind.' The wider and freer a man's
general education the better practitioner is he
likely to be, particularly among the higher classes,
to whom the reassurance and sympathy of a culti-
vated gentleman of the type of Eryximachus may
mean much more than pills and potions. But
what of the men of the type of Mr. Robert Levet,
or 'Ole Docteur Fiset,' whose virtues walk a narrow
round, the men who do the hard general practices
in the poorer districts of the large cities, in the
factory towns and in the widely scattered agri-
cultural regions — what, I hear you say, has culture
to do with them ? Everything ! It is the bichloride
which may prevent the infection and keep a man
sweet and whole amid the most debasing surround-
ings. Of very little direct value to him in his
practice — though the poor have a pretty keen

IN MEDICINE 6l

appreciation of a gentleman — it may serve to pre-
vent the degeneration so apt to overtake the
over- worked practitioner, whose nature is only too
prone to be subdued like the dyer's hand to what
it works in. If a man does not sell his soul ; if he
does not part with his birthright of independence
for a mess of pottage to the Ishmaelites who harass
our borders with their clubs, and oppress us with
their exactions ; if he can only keep free, the con-
ditions of practice are nowhere incompatible with
St. Paul's noble Christian or Aristotle's true gentle-
man. 23 (Sir Thomas Browne.)

$

Professional work of any sort tends to narrow the The leaven
mind, to limit the point of view, and to put a hall- of
mark on a man of a most unmistakable kind. On
the one hand are the intense, ardent natures,
absorbed in their studies and quickly losing interest
in everything but their profession, while other
faculties and interests * fust ' unused. On the other
hand are the bovine brethren, who think of nothing
but the treadmill and the corn. From very dif-
ferent causes, the one from concentration, the other
from apathy, both are apt to neglect those outside
studies that widen the sympathies and help a man
to get the best there is out of life. Like art,
medicine is an exacting mistress, and in the pursuit
of one of the scientific branches, sometimes too
in practice, not a portion of a man's spirit may be
left free for other distractions, but this does not
often happen. On account of the intimate personal
nature of his work, the medical man, perhaps more

62 THE HUMANITIES

than any other man, needs that higher education
of which Plato speaks, — * that education in virtue
from youth upwards, which enables a man to
pursue the ideal perfection.' It is not for all, nor
can all attain it, but there is comfort and help in
the pursuit, even though the end is never reached.
For a large majority the daily round and the
common task furnish more than enough to satisfy
their heart's desire, and there seems no room left
for anything else. Like the good easy man
whom Milton scores in the Areopagitica, whose
religion was a 'traffic so entangled that of all
mysteries he could not skill to keep a stock going
upon that trade,' and handed it over with all the
locks and keys to ' a divine of note and estimation,'
so it is with many of us in the matter of this higher
education. No longer intrinsic, wrought in us and
engrained, it has become, in Milton's phrase, a
4 dividual movable,' handed over nowadays to the
daily press or to the haphazard instruction of the
pulpit, the platform, or the magazines. Like a good
many other things, it comes in a better and more
enduring form if not too consciously sought. The
all-important thing is to get a good relish for the
good company of the race in a daily intercourse
with some of the great minds. Now, in the spring-
time of life, pick your intimates among them, and
begin a systematic cultivation of their works.
Many of you will need a strong leaven to raise you
above the dough in which it will be your lot to
labour. Uncongenial surroundings, an ever-present
dissonance between the aspirations within and the

IN MEDICINE 63

actualities without, the oppressive discords of human
society, the bitter tragedies of life, the lacrymae
rerum, beside the hidden springs of which we sit
in sad despair — all these tend to foster in some
natures a cynicism quite foreign to our vocation,
and to which this inner education offers the best
antidote. Personal contact with men of high pur-
pose and character will help a man to make a
start — to have the desire, at least ; but in its fullness
this culture — for that word best expresses it — has
to be wrought out by each one for himself. Start
at once a bedside library and spend the last half-
hour of the day in communion with the saints of
humanity. There are great lessons to be learned
from Job and from David, from Isaiah and St. Paul.
Taught by Shakespeare you may take your in-
tellectual and moral measure with singular precision.
Learn to love Epictetus and Marcus Aurelius.
Should you be so fortunate as to be born a Pla-
tonist, Jowett will introduce you to the great
master through whom alone we can think in certain
levels, and whose perpetual modernness startles and
delights. Montaigne will teach you moderation
in all things, and to be 4 sealed of his tribe ' is a
special privilege. We have in the profession only
a few great literary heroes of the first rank, the
friendship and counsel of two of whom you cannot
too earnestly seek. Sir Thomas Browne's Religio
Medici should be your pocket companion, while
from the Breakfast Table Series of Oliver Wendell
Holmes you can glean a philosophy of life
peculiarly suited to the needs of a physician.

64 THE HUMANITIES IN MEDICINE

There are at least a dozen or more works which
would be helpful in getting wisdom in life which
comes only to those who earnestly seek it. *4

V

The ^ The physician needs a clear head and a kind

neart 5 h*s work is arduous and complex, requiring
the exercise of the very highest faculties of the
mind, while constantly appealing to the emotions
and finer feelings. 25

THE PRACTICAL IN MEDICINE

THE PRACTICAL ANGLO-SAXON

Thucydides it was who said of the Greeks that they
possessed 'the power of thinking before they acted, and
of acting, too.' The same is true in a high degree of the
English race. To know just what has to be done, then
to do it, comprises the whole philosophy of practical
life. ^

Ac

practical
Anglo-
Saxon.

Wisdom.

The high
mission of
the
physician.

66

THE

ICAL<

Bichat, Laennec, and Lo%is laid the foundation of
modern clinical medicine ; Virchow and his pupils
of scientific pathology ; while Pasteur and Koch
have revolutionized the study of the causes of dis-
ease; and yet, the modern history of the art of
medicine could almost be written in its fullness from
the records of the Anglo-Saxon race. We can
claim every practical advance of the very first rank
— vaccination, anaesthesia, preventive medicine, and
antiseptic surgery, the * captain jewels in the car-
canet ' of the profession, beside which can be placed
no others of equal lustre. 4

<#

And finally every medical student should remember
that his end is not to be made a chemist or physio-
logist or anatomist, but to learn how to recognize
and treat disease, how to become a practical phy-
sician. Twenty years ago, during the summer
session, I held my first class in clinical medicine at
the Montreal General Hospital, and on the title-
page of a notebook I had printed for the students
I placed the following sentence, which you will find
the alpha and omega of practical medicine, not that
it by any means covers the whole field of his educa-
tion : —

c The knowledge which a man can use is the only
real knowledge, the only knowledge which has life
and growth in it, converts itself into practical power.
The rest hangs like dust about the brain or dries
like rain-drops off the stones.' (Froude.) l3

tf

'Tis no idle challenge which we physicians throw
out to the world when we claim that our mission is

IN MEDICINE 67

of the highest and of the noblest kind, not alone
in curing disease but in educating the people in
the laws of health, and in preventing the spread of
plagues and pestilences, nor can it be gainsaid that
of late years our record as a body has been more
encouraging in its practical results than those of
the other learned professions. *5

*

But take the other view of it — think of the Nemesis Pain.
which has overtaken pain during the past fifty
years! Anaesthetics and antiseptic surgery have
almost manacled the demon, and since their intro-
duction the aggregate of pain which has been
prevented far outweighs in civilized communities
that which has been suffered. Even the curse of
travail has been lifted from the soul of women. *5

*

The processes of disease are so complex that it is The new
excessively difficult to search out the laws which sc*1001-
control them, and, although we have seen a com-
plete revolution in our ideas, what has been accom-
plished by the new school of medicine is only an
earnest of what the future has in store. 2S

&

The student must be allowed full freedom in his Cut boao ?
work, undisturbed by the utilitarian spirit of the
Philistine, who cries, Cui bono P and distrusts pure
science. The present remarkable position in applied
science and in industrial trades of all sorts has been
made possible by men who did pioneer work in
chemistry, in physics, in biology, and in physiology,
F 2

68 THE PRACTICAL IN MEDICINE

without a thought in their researches of any prac-
tical application. The members of this higher
group of productive students are rarely understood
by the common spirits, who appreciate as little
their unselfish devotion as their unworldly neglect
of the practical side of the problems. 45

CATHOLICITY IN MEDICINE

THE CURSED SPIRIT OF INTOLERANCE

Breathes here a man with soul so dead that it does not
glow at the thought of what the men of his blood have
done and suffered to make his country what it is ? There
is room, plenty of room, for proper pride of land and
birth. What I inveigh against is a cursed spirit of
intolerance, conceived in distrust and bred in ignorance,
that makes the mental attitude perennially antagonistic,
even bitterly antagonistic, to everything foreign, that
subordinates everywhere the race to the nation, forgetting
the higher claims of human brotherhood. 23

70 CATHOLICITY

Chauvinism. At any rate, whether he goes abroad or not, let
him early escape from the besetting sin of the
young physician, chauvinism, that intolerant atti-
tude of mind which brooks no regard for anything
outside his own circle and his own school. 6

tf

Need of the R>st-graduate study is needed in all classes among
us* ^e sch°°l ^or t^ie y°ung practitioner is a
general practice in which the number and variety
of cases will enable him at once to put his methods
into daily use. A serious defect may warp his
course from the outset. Our students study too
much under one set of teachers. In English and
American schools they do not move about enough.
At a tender age, four or five years give a man
a local attachment to place and teachers which is
very natural, very nice, but not always the best
thing for him. He goes out with a strong bias
already in his mind, and is ready to cry, * I am of
Guy's,' 4 1 am of Bart.'s,' or c I am an Edinburgh
man.' To escape from these local trammels, which
may badly handicap a man by giving him an arro-
gant sense of superiority often most manifest when
there is least warrant, is very difficult. I knew
three brothers, Edinburgh men, good fellows at
heart and good practitioners, but for them the
science and art of medicine never extended beyond
what their old teachers had taught. A Guy's man
they could just endure, for the sake, as one of them
said, of Bright, and Cooper, and Addison, but for
men of other schools they entertained a supreme
and really ludicrous contempt. 2

IN MEDICINE 71

Can we say, as English, French, German, or The curse of

American physicians, that our culture is always nationalism.

cosmopolitan, not national, that our attitude of

mind is always as frankly open and friendly to the

French as to the English, to the American as to

the German, and that we are free at ah1 times and

in all places from prejudice, at all times free from

a self-satisfied feeling of superiority, the one over

the other ? There has been of late years a closer

union of the profession of the different countries

through the International Congress and through

the international meetings of the special societies ;

but this is not enough, and the hostile attitude has

by no means disappeared. Ignorance is at the root.

When a man talks slightingly of the position and

work of his profession in any country, or when

a teacher tells you that he fails to find inspiration

in the work of his foreign colleagues, in the words

of the Arabian proverb — he is a fool, shun him.

Full knowledge which alone disperses the mists of

ignorance, can only be obtained by travel or by

a thorough acquaintance with the literature of the

different countries. Personal, first-hand intercourse

with men of different lands, when the mind is young

and plastic, is the best vaccination against disease.

The man who has sat at the feet of Virchow, or

has listened to Traube, or Helmholtz, or Cohnheim,

can never look with unfriendly eyes at German

medicine or German methods. Who ever met

with an English or American pupil of Louis or of

Charcot, who did not love French medicine, if not

for its own sake, at least for the reverence he bore

72 CATHOLICITY

his great master ? Let our young men, particularly
those who aspire to teaching positions, go abroad.
They can find at home laboratories and hospitals
as well equipped as any in the world, but they may
find abroad more than they knew they sought —
widened sympathies, heightened ideals, and some-
thing perhaps of a Weltcultur which will remain
through life as the best protection against the vice
of nationalism. 23

<#

If the life and work of such men as Bichat and
Laennec will not stir the blood of a young man and
make him feel proud of France and of Frenchmen,
he must be a dull and muddly-mettled rascal. In
reading the life of Hunter, of Jenner, who thinks of
the nationality which is merged and lost in our
interest in the man and in his work? In the
halcyon days of the Renaissance there was no
nationalism in medicine, but a fine catholic spirit
made great leaders like Vesalius, Eustachius, Sten-
sen, and others at home in every country in Europe.
While this is impossible to-day, a great teacher of
any country may have a world-wide audience in
our journal literature, which has done so much to
make medicine cosmopolitan. 23

Democracy Shun as most pernicious that frame of mind, too
in medicine. often, I fear, seen in physicians, which assumes an
air of superiority and limits as worthy of your com-
munion only those with satisfactory collegiate or
sartorial credentials. 26

IN MEDICINE 73

The passports to your fellowship should be
honesty of purpose and a devotion to the highest
interest of your profession, and these you will find
widely diffused, sometimes apparent only when you
get beneath the crust of a rough exterior. 24

$
By his commission the physician is sent to the Thecosmo-

sick, and knowing in his calling- neither Tew nor P°litan
irv M « /• i. i. i • character

Gentile, bond or free, perhaps he alone rises Ofthe

superior to those differences which separate and physician,
make us dwell apart, too often oblivious to the
common hopes and frailties which should bind us
together as a race. In his professional relations,
though divided by national lines, there remains the
feeling that he belongs to a guild which owes no
local allegiance, which has neither king nor country,
but whose work is in the world. The Aesculapian
temple has given place to the hospital, and the
priestly character of the physician has vanished
with the ages ; still, there is left with us a strong
feeling of brotherhood, a sense of unity, which the
limitations of language, race, and country have not
been able to efface. So it has seemed meet and 1

right to gather here this evening to do honour to
a man— not of this country, nor of our blood —
whose life has been spent in the highest interests of
humanity, whose special work has revolutionized
the science of medicine, whose genius has shed
lustre upon our craft. 8

S>

Another unpleasant manifestation of collegiate chau- {The « lock
vinism is the outcome, perhaps, of the very keen com-

74 CATHOLICITY

petition which at present exists in scientific circles.
Instead of a generous appreciation of the work done
in other places, there is a settled hostility and a
narrowness of judgement but little in keeping with
the true spirit of science. Worse still is the 4 lock
and key ' laboratory in which suspicion and distrust
reign, and every one is jealous and fearful lest the
other should know of or find out about his work.
Thank God! this base and bastard spirit is not
much seen ; but it is about, and I would earnestly
advise any young man who unwittingly finds him-
self in a laboratory pervaded with this atmosphere,
to get out ere the contagion sinks into his soul. 23

Science and It is well to acknowledge the debt which we every -
practice. ^av practjtioners owe to the great leaders and
workers in the scientific branches of our art. We
dwell too much in corners, and, consumed with the
petty cares of a bread-and-butter struggle, forget
that outside our routine lie Elysian fields into
which we may never have wandered, the tillage of
which is not done by our hands, but the fruits of
which we of the profession (and you of the public)
fully and freely enjoy. The lesson which should
sink deepest into our hearts is the answer which
a life such as Virchow's gives to those who to-day,
as in past generations, see only pills and potions
in the profession of medicine, and who, utilizing
the gains of science, fail to appreciate the dignity
and the worth of the methods by which they are
attained. As Pausanias pestered Empedocles, even

IN MEDICINE 75

to the end, for the details of the cure of Pantheia,
so there are with us still those who, 4 asking not
wisdom, but drugs to charm with,' are impatient at
the slow progress of science, forgetting that the
chaos from which order is now appearing has been
in great part dispelled by the work of one still
living — by the man whom to-night we delight to
honour. 8

HONESTY, TRUTH, ACCURACY, AND
THOROUGHNESS IN MEDICINE

THE ARTISTIC SENSE OF PERFECTION

The artistic sense of perfection in work is another
much-to-be-desired quality to be cultivated. No matter
how trifling the matter on hand, do it with a feeling that
it demands the best that is in you, and when done look it
over with a critical eye, not sparing a strict judgement of
yourself. This it is that makes anatomy a student's
touchstone. Take the man who does his 'part' to per-
fection, who has got out all there is in it, who labours over
the tags of connective tissue, and who demonstrated
Meckel's ganglion in his part— this is the fellow in after
years who is apt in emergencies, who saves a leg badly
smashed in a railway accident, or fights out to the finish,
never knowing when he is beaten, in a case of typhoid
fever. **

78 HONESTY, TRUTH, ACCURACY, AND

Nature and If we have now so far outgrown this idea as to
hesitate to suggest, in seasons of epidemic peril,
that ' it is for our sins we suffer ' — when we know
the drainage is bad ; if we no longer mock the
heart prostrate in the grief of loss with the words
1 whom the Lord loveth He chasteneth ' — when we
know the milk should have been sterilized — if,
I say, we have, in a measure, become emancipated
from such teachings, we have not yet risen to a true
conception of nature. l4

tf

Rarely has the credo of a zealous physician been
more beautifully expressed than in the following
words of Dr. Bassett : —

* I do not say that the study of nature, human
and comparative, as far as it relates to medicine, is
an easy task ; let any one undertake a foreign
language, and when he thinks he has mastered it,
let him go into its native country and attempt to
use it among the polite and well informed ; if he
succeed, let him go among the illiterate and rude,
where slang is current ; into the lunatic asylum,
where the vernacular is babbled in broken sentences
through the mouth of an idiot, and attempt to
understand this ; should he again succeed he may
safely say that he knows the language. Let him
then set down and calculate the cost, in labour,
time, and talent ; then square this amount and go
boldly into the study of physiology ; and when he
has exhausted his programme, he will find himself
humbly knocking at the door of the temple, and it
will be opened ; for diligence, like the vinegar of
Hannibal, will make a way through frozen Alps ; it
is the " Open Sesame " of our profession. When
he is satisfied with the beautiful portions of the

THOROUGHNESS IN MEDICINE 7*

interior, its vast and varied dimensions, the intricate
and astounding action of its machinery, obeying
laws of a singular stability, whose very conflict
produces harmony under the government of
secondary laws, if there be anything secondary in
nature! — when he is satisfied (and such are not
satisfied until informed), he will be led to his ulti-
mate object, to take his last lessons from the poor
and suffering, the fevered and phrenzied, from the
Jobs and Lazaruses, — into the pest-houses and
prisons, and here, in the magazines of misery and
contagion, these Babels of disease and sin, he must
not only take up his abode, but following the
example of his Divine Master, he must love to
dwell there ; — this is Pathology. When such an one
re-enters the world he is a physician ; his vast
labours have not only taught him how little he
knows, but that he knows his little well. Con-
scious of this virtue, he feels no necessity of
trumpeting his professional acquirements abroad,
but with becoming modesty and true dignity, which
constitutes genuine professional pride, he leaves
this to the good sense of his fellow citizens to
discover.' I2

You remember, in the Egyptian story, how Typhon Fragments
with his conspirators dealt with good Osiris; how oftruth-
they took the virgin Truth, hewed her lovely body
into a thousand pieces, and scattered them to the
four winds ; and, as Milton says, ' from that time
ever since, the sad friends of truth, such as durst
appear, imitating the careful search that Isis made
for the mangled body of Osiris, went up and down
gathering up limb by limb still as they could find
them. We have not yet found them all,' but each

jO HONESTY, TRUTH, ACCURACY, AND

Nature and '°^ us may Plc^ UP a fragment, perhaps two, and in
disease. moments when mortality weighs less heavily upon

the spirit, we can, as in a vision, see the form divine,
just as a great naturalist, an Owen or a Leidy, can
reconstruct an ideal creature from a fossil frag-
ment. 20

The To the physician particularly a scientific discipline

discipline of js an incalculable gift, which leavens his whole life,
science. . . , ' . f .

giving exactness to habits of thought and tempering

the mind with that judicious faculty of distrust which
can alone, amid the uncertainties of practice, make
him wise unto salvation. For perdition inevitable
awaits the mind of the practitioner who has never
had the full inoculation with the leaven, who has
never grasped clearly the relations of science to
his art, and who knows nothing and perhaps cares
less for the limitations of either. 2I

Humbug. It cannot be denied that in dealings with the public
just a little touch of humbug is immensely effective,
but it is not necessary.

In a large city there were three eminent con-
sultants of world- wide reputation ; one was said to
be a good physician but no humbug, the second
was no physician but a great humbug, the third
was a great physician and a great humbug. The
first achieved the greatest success, professional and
social, possibly not financial. 6

Truth hard Start out with the conviction that absolute truth
to reach. js ^^ tQ reacj1 -m matters relating to our fellow

THOROUGHNESS IN MEDICINE 8l

creatures, healthy or diseased, that slips in observa-
tion are inevitable even with the best trained
faculties, that errors in judgement must occur in
the practice of an art which consists largely in
balancing probabilities ; — start, I say, with this
attitude of mind, and mistakes will be acknow-
ledged and regretted ; but instead of a slow pro-
cess of self-deception, with ever-increasing inability
to recognize truth, you will draw from your errors
the very lessons which may enable you to avoid
their repetition. 22

$?

And, for the sake of what it brings, the grace of Humility,
humility is a precious gift. When to the sessions
of sweet silent thought you summon up the re-
membrance of your own imperfections, the faults of
your brothers will seem less grievous, and, in the
quaint language of Sir Thomas Browne, you will
1 allow one eye for what is laudable in them.' 22

& '

The wrangling and unseemly disputes which
have too often disgraced our profession arise, in a
great majority of cases, on the one hand, from this
morbid sensitiveness to the confession of error, and,
on the other, from a lack of brotherly consideration,
and a convenient forgetfulness of our own failings.22

*>

A man' cannot become a competent surgeon with- The sciences
out a full knowledge of human anatomy and essential,
physiology, and the physician without physiology
and chemistry flounders along in an aimless fashion,
never able to gain any accurate conception of

G

82 HONESTY, TRUTH, ACCURACY, AND

disease, practising a sort of popgun pharmacy,
hitting now the malady and again the patient, he
himself not knowing which. 25

The art of detachment, the virtue of method, and
the quality of thoroughness may make you students,
in the true sense of the word, successful prac-
titioners, or even great investigators, but your
characters may still lack that which can alone give
permanence to powers — the grace of humility. 22

As the divine Italian, at the very entrance to
Purgatory, was led by his gentle master to the
banks of the island and girt with a rush, indicating
thereby that he had cast off all pride and self-
conceit, and was prepared for his perilous ascent
to the realms above, so should you, now at the
outset of your journey, take the reed of humility in
your hands, in token that you appreciate the length
of the way, the difficulties to be overcome, and the
fallibility of the faculties upon which you depend. 22

In these days of aggressive self-assertion, when
the stress of competition is so keen and the desire
to make the most of oneself so universal, it may
seem a little old-fashioned to preach the necessity
of this virtue, but I insist for its own sake, and for
the sake of what it brings, that a due humility
should take the place of honour on the list. 22

Reverence

for truth the ror its own sake, since with it (humility) comes

humffit not on^ a reverence f°r truth, but also a proper

THOROUGHNESS IN MEDICINE 83

estimation of the difficulties encountered in our
search for it. 22

&

At the outset do not be worried about this big Truth.
subject — Truth. It is a very simple matter if each
one of you starts with the desire to get as much as
possible. No human being is constituted to know
the truth, the whole truth, and nothing but the
truth ; and even the best of men must be content
with fragments, with partial glimpses, never the
full fruition. In this unsatisfied quest the attitude
of mind, the desire, the thirst (a thirst that from
the soul must rise!), the fervent longing are the
be-all and the end-all.45

&

What is the student but a lover courting a fickle Truth :
mistress who ever eludes his grasp ? In this very what Jt is-
elusiveness is brought out his second great charac-
teristic— steadfastness of purpose. Unless from the
start the limitations incident to our frail human
faculties are frankly accepted, nothing but disap-
pointment awaits you. The truth is the best you
can get with your best endeavour, the best that the
best men accept — with this you may soon learn
to be satisfied, at the same time retaining a due
humility and an earnest* desire for an ever larger
portion. 45

$

Only by keeping the mind plastic and receptive Notrecog-
does the student escape perdition. It is not, as o^togthe
Charles Lamb remarks, that some people do not imindT
know what to do with truth when it is offered to blindness.'

G 2

84 HONESTY, TRUTH, ACCURACY, AND

them, but the tragic fate is to reach, after years
of patient search, a condition of mind-blindness,
in which the truth is not recognized, though it
stares you in the face. This can never happen to
a man who has followed step by step the growth
of a truth, and who knows the painful phases of
its evolution. It is one of the great tragedies
of life that every truth has to struggle to accep-
tance against honest but mind-blind students.
Harvey knew his contemporaries well, and for
twelve successive years demonstrated the circu-
lation of the blood before daring to publish the
facts on which the truth was based. Only stead-
fastness of purpose and humility enable the student
to shift his position to meet the new conditions in
which new truths are born. 4S

Professional More perhaps than any other professional man, the
doctor has a curious — shall I say morbid? — sensi-
tiveness to (what he regards) personal error. In
a way this is right ; but it is too often accompanied
by a cocksureness of opinion which, if encouraged,
leads him to so lively a conceit that the mere
suggestion of mistake under any circumstances is
regarded as a reflection on his honour, a reflection
equally resented whether of lay or professional
origin.22 '

Thorough- And thirdly, add to the virtue of method the
quality of thoroughness, an element of such im-
portance that I had thought of making it the only
subject of my remarks. 22

THOROUGHNESS IN MEDICINE 85

Let me tell you briefly what it means. A know-
ledge of the fundamental sciences upon which our
art is based — chemistry, anatomy, and physiology —
not a smattering, but a full and deep acquaintance,
not with all the facts — that is impossible — but with
the great principles based upon them. 22

*>

You cannot of course in the brief years of
pupilage so grasp the details of the various branches
that you can surely recognize and successfully treat
all cases. But here, if you mastered certain prin-
ciples, is at any rate one benefit of thoroughness —
you will avoid the sloughs of charlatanism. 22

&

You should, as students, become familiar with
the methods by which advances in knowledge are
made, and in the laboratory see clearly the paths
the great masters have trodden, though you your-
selves cannot walk therein. 22

&

The higher the standard of education in a pro- Charlatan-
fession the less marked will be the charlatanism, ism<
whereas no greater incentive to its- development
can be found than in sending out from our colleges
men who have not had mental training sufficient to
enable them to judge between the excellent and
the inferior, the sound and the unsound, the true
and the half true. 22

&

A rare and precious gift is the art of detachment, The art of
by which a man may so separate himself from a life- detachment

86 HONESTY, TRUTH, ACCURACY, AND

long- environment, as to take a panoramic view of
the conditions under which he has lived and moved •
it frees him from Plato's den long enough to see
the realities as they are, the shadows as they appear.
Could a physician attain to such an art, he would
find in the state of his profession a theme calling
as well for the exercise of the highest faculties of
description and imagination as for the deepest
philosophic insight. 23

t

Intellectual I began by speaking of the art of detachment as
detachment. tjiat rare an(j precjous quality demanded of one

who wished to take a philosophical view of the
profession as a whole. In another way and in
another sense this art may be still more precious.
There is possible to each one of us a higher type of
intellectual detachment, a sort of separation from
the vegetative life of the workaday world — always
too much with us — which may enable a man to gain
a true knowledge of himself and of his relations to
his fellows. Once attained, self-deception is im-
possible, and he may see himself even as he is seen
— not always as he would like to be seen — and his
own deeds and the deeds of others stand out in
their true light. In such an atmosphere pity for
himself is so commingled with sympathy and love
for others that there is no place left for criticism
or for a harsh judgement of his brother. But, as
Sir Thomas Browne — most liberal of men and
most distinguished of general practitioners — so
beautifully remarks : ' These are thoughts of things
which thoughts but tenderly touch/ and it may be

THOROUGHNESS IN MEDICINE 87

sufficient to remind this audience, made up of prac-
tical men, that the word of action is stronger than
the word of speech. 23

^?

In the first place, acquire early the art of detach- The art of
ment, by which I mean the faculty of isolating detachment-
yourselves from the pursuits and pleasures incident
to youth. 22 (See Work)
' *

Occasionally we do find an individual who takes
to toil as others to pleasure, but the majority of us
have to wrestle hard with the original Adam, and
find it no easy matter to l scorn delights and live
laborious days.'22 (See Work)

i

Of special importance is this gift (of isolating
yourselves from the pursuits and pleasures incident
to youth) to those of you who reside for the first
time in a large city, the many attractions of which
offer a serious obstacle to its acquisition. The
discipline necessary to secure this art brings in its
train habits of self-control, and forms a valuable
introduction to the stern realities of life.22 (See
Work)

^)

I need scarcely warn you against too close atten-
tion to your studies. I have yet to meet a medical
student, the heyday in whose blood had been
quite tamed in his college days ; but if you think
I have placed too much stress upon isolation in
putting the art of detachment first in order amongst
the desiderata, let me temper the hard saying by

88 HONESTY, TRUTH, ETC., IN MEDICINE

telling you how with 4 labours assiduous due plea-
sures to mix.' 22 (See

It cannot be denied that we have learned more
rapidly how to prevent than how to cure diseases,
but with a definite outline of our ignorance we no
longer live now in a fool's paradise, and fondly
imagine that in all cases we control the issues of
life and death with our pills and potions. 25

<t

It took the profession many generations to learn
that fevers ran their course, influenced very little, if
at all, by drugs, and the ;£6o which old Dover
complained was spent in drugs in a case of ordi-
nary fever about the middle of the eighteenth
century is now better expended on a trained nurse,
with infinitely less risk, and with infinitely greater
comfort to the patient.25

0

With the diminished reliance upon drugs, there
has been a return with profit to the older measures
of diet, exercise, baths, and frictions, the remedies
with which the Bithynian Asclepiades doctored the
Romans so successfully in the first century. 23

t

Though used less frequently, medicines are now
given with infinitely greater skill ; we know better
their indications and contra- indications; and we may
safely say (reversing the proportion of fifty years
ago) that for one damaged by dosing, one hundred
are saved. 25

ENCOURAGEMENT AND INFLUENCE
IN MEDICINE

MISSIONARY WORK

There are regions, in partibus infideHum, to which you
will go as missionaries, carrying the gospel of loyalty to
truth in the science and in the art of medicine, and your
lives of devotion may prove to many a stimulating
example. 20

90 ENCOURAGEMENT AND INFLUENCE

As willing to You cannot afford to stand aloof from your pro-
beTta1 ^t0 fessional colleagues in any place. Join their associa-
tions, mingle in their meetings, giving of the best
*of your talents, gathering here, scattering there ;
/but everywhere showing that you are at all times
faithful students, as willing to teach as to be
taught. 26

Linacre and his successors, Caius, Harvey, and
Glisson, brought the new learning from Italy, and,
moreover, gave to English medicine that smack of
culture, that tincture so peculiarly its own. From
Holland a succeeding generation drew rich stores
of knowledge, and the methods of teaching of the
great Boerhaave were quickly adopted by English
and Scotch students. From France came next the
new science of Bichat, the new art of Laennec, and
the new methods of Louis. To another group the
great teachers of Austria contributed accuracy in
clinical methods, a zest for the study of special
branches and a much- needed, at the time, thera-
peutic nihilism. The debt of the present genera-
tion to Germany can never be paid. Think of the
scores who have found inspiration in our common
master Virchow; and in the scientific study of
disease the Fatherland is still in the van. The
great republic of medicine knows and has known
no national boundaries, and post-graduate study
in other lands gives that broad mental outlook
and that freedom from the trammels of local
prejudice which have ever characterized the true
physician. 2

IN MEDICINE 91

Powerful as was the effect of Louis's writings on Louis: his
American medicine, it cannot compare with the Ji,^^
influence which he exerted through his pupils, who pupils.
1 caught his clear accents, learned his great language,
made him their model.' Of the great triumvirate
of the French school of the fourth decade, Louis
possessed a singular power of attracting hard-
working capable men, and this in spite of the fact
that his rivals and friends, Chomel and Andral,
possessed more brilliant gifts of a certain kind.
As a writer in the Lancet said (1872, II), l Year by
year fresh bands of students came to imbibe from
his lips the instruction which their predecessors
had abandoned with reluctance, till his academic
progeny knew no distinction of race or even colour,
but coalesced into a noble band of enthusiasts in
the cause of medicine, of science, and of humanity.'
In this academic progeny Louis's American pupils
take a very unusual position. Among the thousands
in the profession of this country who have during
this century sought light and learning in the older
lands, the group of young men who studied in Paris,
between 1830 and 1840, had no predecessors and
have had no successors. Partly because the time
was ripe, and they were active agents in bringing
the new art and science to the New World, partly
owing to inherent capabilities, &c., but not a little
because the brightest minds among them fell under
the influence of Louis — they more than any others ,
gave an impetus, which it still feels, to the scientific
study of medicine in the United States. ^

SILENCE AND SELF-CONTROL

AEQUANIMITAS

Let me recall to your minds an incident related of that
best of men and wisest of rulers, Antoninus Pius, who,
as he lay dying in his home at Lorium in Etruria, summed
up the philosophy of life in the watchword, Aequanimitas
As for him, about to pass flammantia moenia mundi (the
flaming ramparts of the world), so for you, fresh from
Clotho's spindle, a calm equanimity is the desirable
attitude.20

94

SILENCE AND

The

careless

tongue.

' Well, so have I, and you ought always to put the
most charitable construction on such remarks ;
the same people when I come back will prob-
ably say I have returned. Sometimes remarks of
this sort are made carelessly, as men trample upon
worms ; sometimes from wantonness, as boys pull
off the wings of flies and pierce them with pins ;
sometimes for spite, as we kill fleas ; sometimes
for experiment, as philosophers torture dogs ; but
seldom from wickedness, as pagans skin saints, and
as Christians skin one another.' I2 (Bassett.)

tf

Things medical and gruesome have a singular
attraction for many people, and in the easy days of
convalescence a facile-tongued nurse may be led on
to tell of ' moving incidents ' in ward or theatre,
and once untied, that unruly member is not apt
to cease wagging with the simple narration of
events.' l5

The discreet To talk of diseases is a sort of Arabian Nights'
entertainment to which no discreet nurse will lend
her talents. l5

Imperturba- In a true and perfect form, imperturbability is in-

The unruly
member.

bility.

dissolubly associated with wide experience and an
intimate knowledge of the varied aspects of disease.
With such advantages he is so equipped that no
eventuality can disturb the mental equilibrium of
the physician ; the possibilities are always manifest,
and the course of action clear. 20

t

Imperturbability means coolness and presence of
mind under all circumstances, calmness amid storm,

SELF-CONTROL 95

clearness of judgement in moments of grave peril,
immobility, impassiveness, or, to use an old and
expressive word, phlegm. It is the quality which
is most appreciated by the laity, though often mis-
understood by them ; and the physician who has
the misfortune to be without it, who betrays in-
decision and worry, and who shows that he is
flustered and flurried in ordinary emergencies,
loses rapidly the confidence of his patients. 20

&

From its very nature this precious quality (im- Impertur-
perturbability) is liable to be misinterpreted, and of^mis
the general accusation of hardness, so often brought taken for
against the profession, has here its foundation. 20 hardness.

&

Keen sensibility is doubtless a virtue of high Value of
order, when it does not interfere with steadiness of callous-
hand or coolness of nerve ; but for the practitioner
in his working-day world, a callousness which
thinks only of the good to be effected, and goes
ahead regardless of smaller considerations, is the
preferable quality. 20

$?

It is sad to think that, for some of you, there Failure.
is in store disappointment, perhaps failure. You
cannot hope, of course, to escape from the cares
and anxieties incident to professional life. Stand
up bravely, even against the worst. 20

The first essential is to have your nerves well in Vaso-

hand. Even under the most serious circumstances, motor
t . . ' contro

the physician or surgeon who allows ' his outward

96 SILENCE AND

action to demonstrate the native act and figure
of his heart in complement extern,' who shows
in his face the slightest alteration, expressive of
anxiety or fear, has not his medullary centres under
the highest control, and is liable to disaster at any
moment. I have spoken of this to you on many
occasions, and have urged you to educate your
nerve centres so that not the slightest dilator or
contractor influence shall pass to the vessels of your
face under any professional trial. 20

Value of an Far be it from me to urge you, ere Time has
inscrutable carve<j w[th his hours those fair brows, to quench
on all occasions the blushes of ingenuous shame,
but in dealing with your patients emergencies
demanding these should certainly not arise, and
at other times an inscrutable face may prove a
fortune. 20

The silent And in closing, may I say a few words to
>r ers. t^e vounger practitioners in the audience whose
activities will wax, not wane, with the growing years
of the century which opens so auspiciously for this
school, for this city, and for our country. You
enter a noble heritage, made so by no efforts of
your own, but by the generations of men who have
unselfishly sought to do the best they could for
suffering mankind. Much has been done, much
remains to do ; a way has been opened, and to do
the possibilities in the scientific development of
medicine there seems to be no limit. Except in its
application, as general practitioners, you will not

SELF-CONTROL 97

have much to do with this. Yours is a higher and
more sacred duty : think not to light a light before
men that they may see your good works ; contrari-
wise, you belong to the great army of quiet workers,
physicians and priests, sisters and nurses, all the
world over, the members of which strive not,
neither do they cry, nor are their voices heard in
the streets, but to them is given the ministry of
consolation in sorrow, need, and sickness. Like
the ideal wife of whom Plutarch speaks, the best
doctor is often the one of whom the public hears
the least; but nowadays, in the fierce light that
beats upon the hearth, it is increasingly difficult to
lead the secluded life in which our best work is
done. To you the 'silent workers of the ranks, in
villages and country districts, in the slums of our
large cities, in the mining camps and factory towns,
in the homes of the rich, and in the hovels of the
poor, to you is given the harder task of illustrating
with your lives the Hippocratic standards of learn-
ing, of sagacity, of humanity, and of probity. Of
learning, that you may apply in your practice the
best that is known in our art, and that with the
increase in your knowledge there may be an in-
crease in that priceless endowment of sagacity, so
that to all, everywhere, skilled succour may come
in the hour of need. Of a humanity, that will
show, in your daily life, tenderness and considera-
tion to the weak, infinite pity to the suffering, and
broad charity to all. Of a probity, that will make
you under all circumstances true to yourselves, true
to your high calling, and true to your fellow man. 24

H

PATIENT DEVOTION TO DUTY AND
HIGH IDEALS

THE CALL OF LIFE

Chief among the hard sayings of the Gospels is the
declaration, He that loveth father or mother or son or
daughter more than Me is not worthy of Me. Yet the
Spirit has made possible its acceptance, and that which is
responsible for Christianity as it is— or rather, perhaps, as
it was— is the same which in all ages has compelled men
to follow ideals, even at the sacrifice of the near and dear
ones at home. In varied tones, to all, at one time or
another, the call comes ; to one, to forsake all and follow
Him ; to another, to scorn delights and live the laborious
days of a student ; to the third, to renounce all in the life
Sannyasi. Many are the wand-bearers, few are the mystics,
as the old Greek has it, or, in the words which we know
better, * many are called, but few are chosen. ' The gifts were
diversified, but the same spirit animated the « flaming heart
of St. Theresa,' the patient soul of Palissy the potter, and
the mighty intellect of John Hunter. I2

H 2

TOO PATIENT DEVOTION TO

The busy, . . . What I mean by * better women ' is that the

hapfpy'lifed eyes °^ y°ur sou^s ^ave ^een °Pene(i> the range
of your sympathies has been widened, and your
characters have been moulded by the events in
which you have been participators during the past
two years. l4

Practically there should be for each of you a busy,
useful, and happy life ; more you cannot expect ;
a greater blessing the world cannot bestow. l4

Busy you will certainly be, as the demand is great,
both in private and public, for women with your
training-.

Useful your lives must be, as you will care for
those who cannot care for themselves, and who
need about them, in the day of tribulation, gentle
hands and tender hearts. l4

A debt to And happy lives shall be yours, because busy and

our times. useful ; having been initiated into the great secret

that happiness lies in absorption in some vocation

which satisfies the soul ; that we have here to add

what we can to, not to get what we can from, life. l4

Great men. « I am glad I know what great men are. I am glad
I know of what they are made, and how they made
themselves great, though this knowledge has broken
the last of my household gods ; yet it has taken
away the flaming sword that stood before the gates
of this Paradise, where may still be seen the track
of the serpent and of the devil himself, so I will keep
out of bad company.' I2 (Bassett.)

DUTY AND HIGH IDEALS IOI

Nowhere in ancient history, sacred or profane, do Women :
we find instances of the devoted heroism of women old and new*
such as dot the annals of the Catholic Church, or such
as can be paralleled in our own century. Tender
maternal affection, touching filial piety, were there;
but the spirit abroad was that of Deborah not of
Rizpah, of Jael not Dorcas. l4

fc

The saddest lament in Oliver Wendell Holmes's The voice-
poems is for the voiceless, — less'

4 for those who never sing,
But die with all their music in them.1

The extracts which I have read show Dr. Bassett
to have been a man of no ordinary gifts, but he was
among the voiceless of the profession. Nowadays,
environment, the opportunity for work, the skirts
of happy chance, carry men to the summit. To
those restless spirits who have had ambition without
opportunities, and ideals not realizable in the world
in which they move, the story of his life may be
a solace. I began by saying that I would tell you
of a man of whom you had never heard, of a humble
student in a little town in Alabama. What of the
men whom he revered, and for whom in 1836 he
left wife and children ? Are they better known to
us ? To-day scarcely one of those whom he men-
tions touches us with any firmness from the past.
Of a majority of them it may be said, they are as
though they had not been. Velpeau, Andral,
Broussais, the great teachers whom Bassett followed,
are shadowy forms (almost as indistinct as the pupil),

102 PATIENT DEVOTION TO

dragged out to the daylight by some laudator tem-
poris actz, who would learn philosophy in history.
To have striven, to have made an effort, to have
been true to certain ideals — these alone are worth
the struggle. Now and again in a generation, one
or two snatch something from dull oblivion ; but
for the rest of us, sixty years ? — we, too, are with
Bassett and his teachers — and

4 no one asks

Who or what we have been,
More than that he asks what waves,
In the moonlit solitudes mild
Of the midmost ocean, have swelled,
Foam'd for a moment, and gone.'12

tf
Visions of To a friend Bassett writes on the date of April 5: —

* This world has never occupied a large share of
my attention or love. I have asked but little of it,
and got but little of what I asked. It has for many
years been growing less and less in my view, like
a receding spirit in space ; but no better land has
appeared to my longing vision ; what lies beyond
me has become insignificant, before me it is a vast
interminable void, but not a cheerless one, as it is
full of pleasant dreams and visions and glorious
hopes. I have covered it with the landscape of
Claude, and peopled it with the martyrs of science,
the pioneers of truth, the hound-hunted and crucified
of this world, that have earned and then asked for
bread and received a serpent — all who have suffered
for the truth. How glorious it is to contemplate in
the future these time-buffeted at rest, with their
lacerated feelings soothed as mine have been this
day by the tender regard your wife has manifested
for my future well-being.' 12

DUTY AND HIGH IDEALS IO^

In the older States utility is no longer regarded as The utility
the test of fitness, and the value of the intellectual cry*
life has risen enormously in every department.
Germany must be our model in this respect. She
is great because she has a large group of men pur-
suing pure science with unflagging industry, with
self-denying zeal, and with high ideals. No second-
ary motives sway their minds, no cry reaches them
in the recessesof their laboratories, 'Of what practical
utility is your work ? * but, unhampered by social or
theological prejudices, they have been enabled to
cherish * the truth which has never been deceived —
that complete truth which carries with it the antidote
against the bane and danger which follow in the
train of half- knowledge.' 2I (Helmholtz.)

%

A conscientious pursuit of Plato's ideal perfection The three
may teach you the three great lessons of life. You
may learn to consume your own smoke. The
atmosphere is darkened by the murmurings and
whimperings of men and women over the non-
essentials, the trifles that are inevitably incident to
the hurly-burly of the day's routine. Things cannot
always go your way. Learn to accept in silence the
minor aggravations, cultivate the gift of taciturnity
and consume your own smoke with an extra draught
of hard work, so that those about you may not be
annoyed with the dust and soot of your complaints.
More than any other the practitioner of medicine
may illustrate the second great lesson, that we are
here not to get all we can out of life for ourselves,
but to try to make the lives of others happier. This

104 PATIENT DEVOTION TO

is the essence of that oft-repeated admonition of
Christ, 4 He that findeth his life shall lose it, and he
that loseth his life for My sake shall find it,' on
which hard saying if the children of this generation
would only lay hold, there would be less misery and
discontent in the world. It is not possible for any
one to have better opportunities to live this lesson
than you will enjoy. The practice of medicine is
an art, not a trade ; a calling, not a business ;
a calling in which your heart will be exercised
equally with your head. Often the best part of
your work will have nothing to do with potions
and powders, but with the exercise of an influence
of the strong upon the weak, of the righteous upon
the wicked, of the wise upon the foolish. To you,
as the trusted family counsellor, the father will come
with his anxieties, the mother with her hidden grief,
the daughter with her trials, and the son with his
follies. Fully one-third of the work you do will be
entered in other books than yours. Courage and
cheerfulness will not only carry you over the rough
places of life, but will enable you to bring comfort
and help to the weak-hearted and will console you
in the sad hours when, like Uncle Toby, you have
4 to whistle that you may not weep.'24

tf

The student Learn to love the freedom of the student life, only
too quickly to pass away ; the absence of the coarser
cares of after days, the joy in comradeship, the
delight in new work, the happiness in knowing that
you are making progress. Once only can you enjoy
these pleasures. The seclusion of a student life is

DUTY AND HIGH IDEALS 105

not always good for a man, particularly for those
of you who will in after years engage in general
practice, since you will miss that facility of inter-
course upon which often the doctor's success
depends. On the other hand sequestration is
essentiaTTor those of you with high ambitions pro-
portionate to your capacity. It was for such that
St. Chrysostom gave his famous counsel : l Depart
from the highways and transplant thyself into some
enclosed ground, for it is hard for a tree that stands
by the wayside to keep its fruit till it be ripe.' 24

&

Sitting in Lincoln Cathedral and gazing at one of Ideals, value
the loveliest of human works — for such the angel of-
choir has been said to be — there arose within me,
obliterating for the moment the thousand heraldries
and twilight saints and dim emblazonings, a strong
sense of reverence for the minds which had con-
ceived and the hands which had executed such
things of beauty. What manner of men were they
who, in those (to us) dark days, could build such
transcendent monuments ? What was the secret of
their art? By what spirit were they moved?
Absorbed in thought, I did not hear the beginning
of the music, and then, as a response to my reverie
and arousing me from it, rang out the clear voice
of the boy leading the antiphon, ' That Thy power,
Thy glory, and the mightiness of Thy kingdom might
be known unto men.' Here was the answer. 22

*

Always seek your own interests, make of a high
and sacred calling a sordid business, regard your

106 PATIENT DEVOTION TO

fellow creatures as so many tools of trade, and, if
your heart's desire is for riches, they may be yours ;
but you will have bartered away the birthright of
a noble heritage, traduced the physician's well-
deserved title of the Friend of Man, and falsified
the best traditions of an ancient and honourable

guild. 22

<?

And though this course does not necessarily
bring position or renown, consistently followed it
will at any rate give to your youth an exhilarating
zeal and a cheerfulness which will enable you to
surmount all obstacles — to your maturity a serene
judgement of men and things, and that broad
charity without which all else is nought — to your
old age that greatest of blessings, peace of mind ;
a realization, maybe, of the prayer of Socrates for
the beauty in the inward soul and for unity of the
outer and the inner man ; perhaps, of the promise
of St. Bernard, /#*: sine crimine.pax sine turbine^

pax sine rixa. 22

tf

And, if the fight is for principle and justice, even
when failure seems certain, where many have failed
before, cling to your ideal, and, like Childe Roland
before the dark tower, set the slug-horn to your
lips, blow the challenge, and calmly await the

conflict. 20

9

Not that we all live up to the highest ideals, far
from it — we are only men. But we have ideals,
which mean much, and they are realizable, which

DUTY AND HIGH IDEALS 107

Of course there are Gehazis among us who serve The
for shekels, whose ears hear only the lowing of the Gehazis-
oxen and the jingling of the guineas, but these are
exceptions. The rank and file labour earnestly for
your good, and self-sacrificing devotion to your
interests animates our best work. 25

&

No other profession can boast of the same unbroken Methods
continuity of methods and of ideals. We may and ideals-
indeed be justly proud of our apostolic succession.
Schools and systems have flourished and gone,
schools which for generations have swayed the
thought of our guild ; the philosophies of one age
have become the absurdities of the next, and the
foolishness of yesterday has become the wisdom of
to-morrow ; through long ages which were slowly
learning what we are hurrying to forget, amid all
the changes and chances of twenty-five centuries,
the profession has never lacked men who have lived
up to these Greek ideals. They were those of Galen
and Aretaeus, of men of the Alexandrian and
Byzantine schools, of the best of the Arabians, of
the men of the Renaissance, and they are ours
to-day. 23

^

A second distinctive feature is the remarkable
solidarity. Of no other profession is the word
* universal '/applicable in the same sense. The cele-
brated phrase used of the Catholic Church is in
truth much more appropriate when applied to
medicine. It is not the prevalence of disease or
the existence everywhere of special groups of men

I08 PATIENT DEVOTION TO

to treat it that betokens this solidarity, but it is the
identity throughout the civilized world of our
ambitions, our methods and our work. To wrest
from nature the secrets which have perplexed
philosophers in all ages, to track to their sources
the causes of disease, to correlate the vast stores of
knowledge, that they may be quickly available for
the prevention and cure of disease — these are our
ambitions. To carefully observe the phenomena of
life in all its phases, normal and perverted, to make
perfect that most difficult of all arts, the art of
observation, to call to aid the science of experi-
mentation, to cultivate the reasoning faculty, so as
to be able to know the true from the false — these
are our methods. To prevent disease, to relieve
suffering, and to heal the sick — this is our work.
The profession in truth is a sort of guild or brother-
hood, any member of which can take up his calling
in any part of the world and find brethren whose
language and methods and whose aims and ways
are identical with his own. 23

tf

Thirdly, its progressive character. Based on
science, medicine has followed and partaken of its
fortunes, so that in the great awakening which has
made the nineteenth memorable among centuries,
the profession received a quickening impulse more
powerful than at any period in its history. With
the sole exception of the mechanical sciences, no
other department of human knowledge has under-
gone so profound a change — a change so profound
that we who have grown up in it have but slight

DUTY AND HIGH IDEALS 109

appreciation of its momentous character. And not
only in what has been actually accomplished in un-
ravelling the causes of disease, in perfecting methods
of prevention, and in wholesale relief of suffering,
but also in the unloading of old formulae, and in
the substitution of the scientific spirit of free inquiry
for cast-iron dogmas, we see a promise of still
greater achievement and of a more glorious
future. 23

fc

And lastly, the profession of medicine is dis-
tinguished from all others by its singular beneficence.
It alone does the work of charity in a Jovian and
God-like way, dispensing with a free hand truly
Promethean gifts. There are those who listen to
me who have seen three of the most benign en-
dowments granted to the race since the great Titan
stole fire from heaven. Search the scriptures of
human achievement and you cannot find any way
to equal in beneficence the introduction of anaes-
thesia, sanitation, with all that it includes, and
asepsis — a short half-century's contribution towards
the practical solution of the problems of human
suffering, regarded as eternal and insoluble. We
form almost a monopoly or trust in this business.
Nobody else comes into active competition with us,
certainly not the other learned professions which
continue along the old lines. Every new year sees
some new conquest, so that we have ceased to
wonder. The work of half a dozen men, headed
by Laveran, has made waste places of the earth
habitable, and the wilderness to blossom like the

110 PATIENT DEVOTION TO

rose. The work of Walter Reed and his associates
will probably make yellow fever as scarce in the
Spanish Main as is typhus with us. There seems
to be no limit to the possibilities of scientific
medicine, and while philanthropists are turning- to
it as to the hope of humanity, philosophers see, as
in some far-off vision, a science from which may
come in the prophetic words of the Son of Sirach,
* Peace over all the earth.' 23

tf

Patience. It has been said that ' in patience ye shall win your
souls,' and what is this patience but an equanimity
which enables you to rise superior to the trials of

life?20

tf

Persistency Your very hopes may have passed out of sight, as

of lorfeliness ^ ^ t^iat was near anc* ^ear to t^ie Patriarch at
the Jabbok ford, and, like him, you may be left to
struggle in the night alone. Well for you, if you
wrestle on, for in persistency lies victory, and with
the morning may come the wished- for blessing. 20

&

Defeat. But not always ; there is a struggle with defeat

which some of you will have to bear, and it will be
well for you in that day to have cultivated a cheer-
ful equanimity. 20

Face dis- Even with disaster ahead and ruin imminent, it is
aster boldly. |3etter to face ^em wjth a smile, and with the head
erect, than to crouch at their approach. 20

$

Heroism The sick love-child of Israel's sweet singer, the
anddevo- plague.stricken hopes of the great Athenian states-

DUTY AND HIGH IDEALS III

man, Elpenor, bereft of his beloved Artemidora, and
* Tully's daughter mourned so tenderly,' are not of
any age or any race — they are here with us to-day,
with the Hamlets, the Ophelias, and the Lears.
Amid an eternal heritage of sorrow and suffering
our work is laid, and this eternal note of sadness
would be insupportable if the daily tragedies were
not relieved by the spectacle of the heroism and
devotion displayed by the actors. 45

fr

Quickly there arises the memory of the men who Devotion
have done so much for British medicine in that ° u y*
great empire (India). Far from their homes, far
from congenial surroundings, and far from the
stimulus of scientific influences, Annesley, Ballingall,
Twining, Morehead, Waring, Parkes, Cunningham,
Lewis, Vandyke Carter, and many others have
upheld the traditions of Harvey and Sydenham. 4

&

Nothing will sustain you more potently in your Recognize
humdrum routine, as perhaps it may be thought, j^fe^1
than the power to recognize the true poetry of life — humdrum
the poetry of the commonplace, of the ordinary routine.
man, of the plain, toil-worn woman, with their
loves and their joys, their sorrows and their griefs.
The comedy, too, of life will be spread before you,
and nobody laughs more often than the doctor at
the pranks Puck plays upon the Titanias and the
Bottoms among his patients. The humorous side
is really almost as frequently turned towards him
as the tragic. Lift up one hand to heaven and
thank your stars if they have given you the proper

IT2

DUTY AND HIGH IDEALS

Sense of
humour an
essential.

A nature
* sloping to-
wards the
southern
side.'

sense to enable you to appreciate the inconceivably
droll situations in which we catch our fellow crea-
tures. Unhappily, this is one of the free gifts of
the gods, unevenly distributed, not bestowed on all,
or on all in equal portions. In undue measure it is
not without risk, and in any case in the doctor it
is better appreciated by the eye than expressed on
the tongue. Hilarity and good humour, a breezy
cheerfulness, a nature ' sloping towards the southern
side,' as Lowell has it, help enormously both in the
study and in the practice of medicine. To many
of a sombre and sour disposition it is hard to
maintain good spirits amid the trials and tribula-
tions of the day, and yet it is an unpardonable
mistake to go about among patients with a long
face. 45

CHARITY AND FRATERNITY
IN MEDICINE

CHARITY

It may be that in the hurry and bustle of a busy life
I have given offence to some— who can avoid it? Un-
wittingly I may have shot an arrow o'er the house and
hurt a brother— if so, I am sorry, and I ask his pardon. So
far as I can read my heart I leave you in charity with all.
I have striven with none, not for the reason given by
Walter Savage Landor, because none was worth the strife,
but because I have had a deep conviction of the hatefulness !
of strife, of its uselessness, of its disastrous effects, and
a still deeper conviction of the blessings that come with
unity, peace, and concord. And I would give to each one
of you, my brothers — you who hear me now, and to you who
may elsewhere read my words— to you who do our greatest
work, labouring incessantly for small rewards in towns and
country places — to you the more favoured ones who have
special fields of work — to you teachers and professors and
scientific workers— to one and all, throughout the length
and breadth of the land— I give a single word as my parting
commandment :— 'IT IS NOT HIDDEN FROM THEE, NEITHER
IS IT FAR OFF. IT IS NOT IN HEAVEN, THAT THOU SHOULDEST
SAY, WHO SHALL GO UP FOR US TO HEAVEN, AND BRING
IT UNTO US, THAT WE MAY HEAR IT, AND DO IT ? NEITHER
IS IT BEYOND THE SEA, THAT THOU SHOULDEST SAY, WHO
SHALL GO OVER THE SEA FOR US, AND BRING IT UNTO US,
THAT WE MAY HEAR IT, AND DO IT ? BUT THE WORD IS
VERY NIGH UNTO THEE, IN THY MOUTH, AND IN THY HEART,
THAT THOU MAYEST DO IT '-CHARITY.^

I

114 CHARITY AND FRATERNITY

Quarrels of The quarrels of doctors make a pretty chapter in
doctors. the history of medicine. Each generation seems to
have had its own. The Coans and Cnidians, the
Arabians and Galenists, the humoralists and the
solidists, the Brunonians and the Broussaisians, the
homoeopaths and the regulars, have in different
centuries rent the robe of Aesculapius. But these
larger quarrels are becoming less and less intense,
and in the last century no new one of moment
sprang up ; and it is safe to predict that in the
present century, when science has fully leavened
the dough of homoeopathy, the great breach of our
day will be healed. l6

<t

So far as my observation goes, the fault lies with
the older men. The young fellow, if handled
aright and made to feel that he is welcomed, not
an intruder to be shunned, is only too ready to
hold out the hand of fellowship. The medical
society comes in here as professional cement. The
meeting in a friendly, social way, with a free and
open discussion of affairs, fosters a spirit that refuses
to recognize in differences of opinion on the non-
essentials of life a cause of personal animosity or ill-
feeling. An aptitude of mind habitually friendly,
more particularly to the young man, even though
you feel him to be the David to whom your
kingdom may fall; a little of the old-fashioned
courtesy which makes a man shrink from wounding
the feelings of a brother practitioner, in honour
preferring another; — with such a spirit abroad in
the society and among its older men, there is no

IN MEDICINE 115

room for envy, hatred, malice, or any uncharitable-
ness. l6

9

The practice of medicine calls equally for the exer-
cise of the heart and the head ; and when a man has
done his best, to have his motives misunderstood and
his conduct of a case harshly criticized, not only by
the family, but by a colleague who has been called in,
small wonder, when the opportunity arises, if the old
Adam prevails and he pays in kind. So far as my
observation goes, there are three chief causes for
the quarrels of doctors. The first is lack of proper Friendly
friendly intercourse, by which alone we can know intercourse
our colleagues. It is the duty of the older man to
look on the younger one who settles near him not
as a rival, but as a son. He will do to you just
what you did to the older practitioner, when, as
a young man, you started — get a good many of
your cases ; but if you have the sense to realize that
this is inevitable, unavoidable, and the way of the
world, and if you have the sense to talk over, in
a friendly way, the first delicate situation that
arises, the difficulties will disappear and recurrences
of a misunderstanding- may be made impossible.
The young men should be tender with the sensibili-
ties of their seniors, deferring to their judgement
and taking counsel with them. 4l

Whether a man will treat his professional brethren Training an

in a gentlemanly way or in a narrow illiberal spirit jpportant

& . :. factor,

is partly a matter of temperament, partly a matter

of training. If we had only to deal with one another

I 2

Il6 CHARITY AND FRATERNITY

the difficulties would be slight, but it must be con-
fessed that the practice of medicine among- our
fellow creatures is often a testy and choleric business.
When one has done his best, or when a mistake has
arisen through lack of special knowledge, but more
particularly when, as so often happens, our heart's
best sympathies have been engaged, to be mis-
understood by the patient and his friends, to have
evil motives imputed and to be maligned, is too
much for human endurance, and justifies a righteous
indignation. 23

tf

Charity. When a man reaches the climacteric, and has
long passed beyond the professional stage of his
reputation, we who are still lin the ring' must
exercise a good deal of charity, and discount largely
the on dits which indiscreet friends circulate. 6

$
Drugs— the It is too late in this day of scientific medicine to

most uncer- prattie of such antique nonsense as is indicated in

tain element F

in our art the 'pathies. We have long got past the stage

when any 'system ' can satisfy a rational practitioner,
long past the time when a difference of belief in the
action of drugs — the most uncertain element in our
art — should be allowed to separate men with the
same noble traditions, the same hopes, the same
aims and ambitions. It is not as if our homoeopathic
Homoeo brothers are asleep ; far from it, they are awake —
pathy. many of them at any rate — to the importance of the

scientific study of disease, and all of them must
realize the anomaly of their position. It is distress-
ing to think that so many good men live isolated,

IN MEDICINE 117

in a measure, from the great body of the profession.
The original grievous mistake was ours — to quarrel
with our brothers over infinitesimals was a most
unwise and stupid thing to do. That we quarrel
with them now is solely on account of the old
Shibbolethunder which they practise. Homoeopathy
is as inconsistent with the new medicine as is the
old-fashioned polypharmacy, to the destruction of
which it contributed so much. The rent in the
robe of Aesculapius, wider in this country than
elsewhere, could be repaired by mutual concessions Mutual con-
—on the one hand by the abandonment of special
designations, and on the other by an intelligent
toleration of therapeutic vagaries which in all ages
have beset the profession, but which have been
mere flies on the wheels of progress. 4l

&

If young graduates could be taken more fre- Attitude of

quently as assistants or partners, the work of |^ntialto~

the profession would be much lightened, and promotion of

it would promote amity and good fellowship, concord.

A man of whom you may have heard as

the incarnation of unprofessional conduct, and

who has been held up as an example of all that

was pernicious, may be, in reality, a very good

fellow, the victim of petty jealousies, the mark of

the arrows of a rival faction ; and you may be

surprised to find that he loves his wife, and is

devoted to his children, and that there are people

who respect and esteem him. After all, the attitude

of mind is the all-important factor in the promotion

of concord. When a man is praised, or when

Il8 CHARITY AND FRATERNITY

a young man has done a good bit of work in your
special branch, be thankful — it is for the common
good. Envy, that pain of the soul, as Plato calls
it, should never for a moment afflict a man of
generous instincts who has a sane outlook in
life. The men of rival schools should deliberately
cultivate the acquaintance of each other and en-
courage their students and the junior teachers to
Say a good fraternize. If you hear that a young fellow just

word for the starting has made mistakes or is a little * off colour,1
«off colour' s f , .

man. S° out °* your way to say a good word to him, or

for him. It is the only cure ; any other treatment
only aggravates the malady. 4l

Uncharita- The most widespread, the most pernicious of all
pemictous v*ces' ec!ual *n ^ts disastrous effects to impurity,
of all vices, much more disastrous often than intemperance,
because destructive of all mental and moral nobility,
as are the others of bodily health, is unchari-
tableness — the most prevalent of modern sins,
peculiarly apt to beset all of us, and the chief
A thought- enemy to concord in our ranks* Oftentimes it is
a thoughtless evil, a sort of tic or trick, an un-
conscious habit of mind and tongue which gradually
takes possession of us. No sooner is a man's
name mentioned than something slighting is said
of him, or a story is repeated which is to his
disadvantage, or the involuntary plight of a
brother is ridiculed, or even his character is tra-
duced. In chronic and malign offenders literally,
4 with every word a reputation dies.' The work

IN MEDICINE 119

of a school is disparaged, or the character of the
work in a laboratory is belittled ; or it may be
only the faint praise that damns, not the generous « The faint

meed from a full and thankful heart. We have Praise*;hat

damns,
lost our fine sense of the tragic element in this vice,

and of its debasing influence on the character. It^
is interesting that Christ and the Apostles lashed 7
it more unsparingly than any other. Who is
there among us who does not require every day
to take to heart that counsel of perfection : ' Judge
not according to the appearance, but judge righteous
judgement ' ? One of the apostles of our profession,
Sir Thomas Browne, has a great thought on the
question : —

'While thou so hotly disclaimest the devil,
be not guilty of diabolism. Fall not into one
name with that unclean spirit, nor act his nature
whom thou so much abhorrest — that is, to accuse,
calumniate, backbite, whisper, detract, or sinis-
trously interpret others. Degenerous depravi-
ties, and narrow-minded vices ! not only below
St. Paul's noble Christian, but Aristotle's true gentle-
man. Trust not with some that the Epistle of
St. James is apocryphal, and so read with less fear
that stabbing truth, that in company with this vice
thy religion is in vain. Moses broke the tables
without breaking of the law ; but where charity is
broke the law itself is shattered, which cannot be
whole without love, which is the fulfilling of it.
Look humbly upon thy virtues ; and though thou
art rich in some, yet think thyself poor and naked
without that crowning grace, which thinketh no
evil, which envieth not, which beareth, hopeth,
believeth, endureth all things. With these sure
graces, while busy tongues are crying out for a drop

120

CHARITY AND FRATERNITY

of cold water, mutes may be in happiness, and sing
the Trisagion in heaven.' 4l

The honest
heart.

I say advisedly an honest heart — the honest head
is prone to be cold and stern, given to judgement,
not mercy, and not always willing to entertain that
true charity which, while it thinketh no evil, is
anxious to put the best possible interpretation upon
the motives of a fellow worker. It will foster, too,
an attitude of generous, friendly rivalry untinged
by the green peril, jealousy, that is the best
preventive of the growth of a bastard scientific
spirit — loving seclusion and working in a lock-and-
key laboratory, as timorous of light as is a
thief.45

tf

The hardest lesson of all to learn is that the law of
the higher life is only fulfilled by love, i. e. charity.
Many a physician whose work is in a daily round
of beneficence will say hard things and think hard
things of a colleague. No sin will so easily beset
you as uncharitableness towards your brother
practitioner. So strong is the personal element in
the practice of medicine, and so many are the
wagging tongues in every parish, that evil-speaking,
lying, and slandering find a shining mark in the
lapses and mistakes which are inevitable in our
work. There is no reason for discord and disagree-
ment, and the only way to avoid trouble is to have
two plain rules. From the day you begin practice
never under any circumstances listen to a tale told

IN MEDICINE 121

to the detriment of a brother practitioner. And
when any dispute or trouble does arise, go frankly,
ere sunset, and talk the matter over, in which way
you may gain a brother and a friend. Very easy
to carry out, you may think ! Far from it ; there
is no harder battle to fight. Theoretically there
seems to be no difficulty, but when the concrete
wound is rankling, and after Mrs. Jones has rubbed
it in with cayenne pepper by declaring that Dr. J.
told her in confidence of your shocking bungling,
your attitude of mind is that you would rather see
him in purgatory than make advances towards
reconciliation. Wait until the day of your trial
comes and then remember my words. 24

It is the confounded tales of patients that so often Tittle-tattle.

set us by the ears, but if a man makes it a rule

never under any circumstances to believe a story

told by a patient to the detriment of a fellow

practitioner, even if he thinks it to be true, though

the measure he metes may not be measured to him

again, he will have the satisfaction of knowing that

he has closed the ears of his soul to ninety- nine

lies, and to have missed the hundredth truth will not

hurt him. l6

fc

Women, our greatest friends and our greatest
enemies, are the chief sinners ; and while one will
exhaust the resources of the language in describing
our mistakes and weaknesses, another will laud her
pet doctor so indiscriminately that all others come
under a sort of oblique condemnation. Feminae

122 CHARITY AND FRATERNITY

sunt medicorum tubae is an old and true saying-.
It is hard to say whether, as a whole, we do not
suffer just as much from the indiscriminate praise.
But against this evil we are helpless. Far other-
wise, when we do not let the heard word die ; not
to listen is best, though that is not always possible,
but silence is always possible, than which we have
no better weapon in our armoury against evil-
speaking, lying, and slandering. The bitterness is
when the tale is believed and a brother's good name
is involved. Then begins the worst form of ill-
treatment that the practitioner receives, and at his
own hands. He allows the demon of resentment
to take possession of his soul, when five minutes'
frank conversation might have gained a brother.
In a small or large community what more joyful
than to see the brethren dwelling together in unity ?
The bitterness, the rancour, the personal hostility
which many of us remember in our younger days
have been largely replaced by a better feeling, and
while the golden rule is not always, as it should be,
our code of ethics, we have certainly become more
charitable the one towards the other. 23

<#

And the third cause of uncharitableness is the
wagging tongues of others who are too often ready
to tell tales and make trouble between doctors.
There is only one safe rule, never listen to a patient
who begins with a story about the carelessness and
inefficiency of Dr. Blank. Shut him or her up
with a snap, knowing full well that the same tale
may be told of you a few months later. Fully half

IN MEDICINE 123

of the quarrels of doctors are fomented by the tittle-
tattle of patients, and the only safeguard is not to
listen. Sometimes it is impossible to check the
flow of imprecation and slander, and then apply
the other rule — perfectly safe, and one which may be
commended as a good practice — never believe what
a patient tells you to the detriment of a brother,
even though you may think it to be true. 4l

fc

In the hospital, we learn to scan gently our brother Charity of
man, judging not, asking no questions, but meting toe hosPital-
out to all alike a hospitality worthy of the Hotel
Dieu, and deeming ourselves honoured in being
allowed to act as its dispensers. l4

&

In the hospital, too, are daily before our eyes the
problems which have ever perplexed the human
mind ; problems not presented in the dead abstract
of books, but in the living concrete of some poor
fellow in his last round, fighting a brave fight, but
sadly weighed, and going to his account 4 un-
housel'd, disappointed, unanel'd, no reckoning
made.'14

&

Among the ancients, many had risen to the idea of The spirit
forgiveness of enemies, of patience under wrong- oflove*
doing, and even of the brotherhood of man ; but
the spirit of Love received its incarnation only with
the ever memorable reply to the ever memorable
question, Who is my neighbour? — a reply which
has changed the attitude of the world. l4

124

CHARITY AND FRATERNITY

Romola, the student, helping her blind father, and
full of the pride of learning, we admire ; Romola,
the devotee, carrying in her withered heart woman's
heaviest disappointment, we pity; Romola, the
nurse, doing noble deeds amid the pestilence, rescu-
ing those who were ready to perish, we love. l5

There is no higher mission in this life than nursing
God's poor. In so doing a woman may not reach
the ideals of her soul ; she may fall far short of the
ideals of her head, but she will go far to satiate the
longings of the heart from which no woman can
escape. lS

Dreams. To each one of us at some time, I suppose, has
come the blessed impulse to break away from all
such ties and follow cherished ideals. Too often it
is but a flash of youth, which darkens down with
the growing years. Though the dream may never
be realized, the impulse will not have been wholly
in vain if it enables us to look with sympathy upon
the more successful efforts of others. l5

Artofgiv- May I say a word on the art of giving? The
essence is contained in the well-known sentence : —
4 Let every man do according as he is disposed in
his heart, not grudgingly, or of necessity.' Sub-
scriptions to a cause which is for the benefit of the
entire profession should truly be given as a man
is disposed in his heart, not in his pocket, and
assuredly not of necessity, but as a duty, even
as a privilege, and as a pleasure. With the young
among you the days of travail and distress are not

IN MEDICINE 125

yet over, and to give would be wrong. It is
sufficient for such to have the wish ; the elder brothers
will bear your share ; only be sure to foster those
generous impulses, which are apt to be intense in
direct proportion to the emptiness of the purse. 10

&

Beyond a modest competency the sensible doctor
does not aspire, but in the profession of every state
there is a third group, composed of a few men, who,
dry-nursed by us, sometimes by the public, have
become prosperous, perhaps wealthy. Freely they
have received, freely they should give. It must be
acknowledged, however, that the admonition of
Sir Thomas Browne, 4 should your riches increase,
let your mind keep pace with them,' is not always
regarded by them. There has been a good deal in
the papers lately about the large fortunes left by
doctors; but it has not been a pleasant feature
to note, with scarcely an exception, either an entire
neglect or a very beggarly remembrance of the
profession in which these men had at any rate laid
the foundation of their large fortunes. I0

&

In conclusion, may I paraphrase those noble words
of Aristotle, in which he laid down the duty of
the citizen to the state, as also peculiarly appro-
priate in defining the obligations of the doctor
to his calling ? No physician has a right to consider
himself as belonging to himself; but all ought to
regard themselves as belonging to the profession, in-
asmuch as each is a part of the profession ; and care
for the part naturally looks to care for the whole. I0

MEDICAL EDUCATION

The Teacher
The Student
The University
The Hospital

THE SEARCHER FOR KNOWLEDGE

« He who knows not, and knows not that he knows not,
is a fool. Shun him.

He who knows not, and knows that he knows not, Is
simple. Teach him/ (Arabian proverb.)

128 MEDICAL EDUCATION

Education: What, after all, is education but a subtle, slowly-
what it is. 4 eg-ecte(i change, due to the action of the externals
— of the written record of the great minds of all
ages, of the beautiful and harmonious surroundings
of nature and of art, and of the lives, good or ill,
of our fellows ?— these alone educate us, these alone
mould the growing mind. 2I

The complex, varied influences of art, of science,
and of charity ; of art, the highest development of
which can come only with that sustaining love for
ideals which l burns bright or dim as each are
mirrors of the fire for which all thirst ' ; of science,
the cold logic of which keeps the mind independent
and free from the toils of self-deception and half-
knowledge ; of charity, in which we of the medical
profession, to walk worthily, must live and move
and have our being. 2I

Education. At the outset appreciate clearly the aims and
objects each one of you should have in view — a
knowledge of disease and its cure, and a knowledge
of yourself. The one, special education, will make
you a practitioner of medicine ; the other, an inner
education, that may make you a truly good man,
four-square and without a flaw. The one is ex-
trinsic and is largely accomplished by teacher and
tutor, by text and by tongue; the other is in-
trinsic and is the mental salvation to be wrought
out by each one for himself. The first may be
had without the second ; any one of you may
become an active practitioner, without ever having

MEDICAL EDUCATION 129

sense enough to realize that through life you have
been a fool ; or you may have the second without
the first, and without knowing much of the art,
you may have the endowments of head and heart
that make the little you do possess go very far in
the community. What I hope to infect you with
is a desire to have a due proportion of each. 24

&

Some will tell you that the profession is under- What the
rated, unhonoured, underpaid, its members social profession]
drudges — the very last profession they would re-
commend a young man to take up. Listen not to
these croakers; there are such in every calling,
and the secret of their discontent is not hard to
discover. The evils which they deprecate, and
ascribe — it is difficult to say to whom — in themselves
lie ; evils, the seeds of which were sown when they
were as you are now (students) ; sown in hours of
idleness, in inattention to studies, in consequent
failure to grasp those principles of their science
without which the practice of medicine does indeed
become a drudgery, for it degenerates into a busi-
ness. I would rather tell you of a profession
honoured above all others ; one which, while
calling forth the highest powers of the mind, brings
you into such warm personal contact with your
fellow men that the heart and sympathies of the
coldest nature must needs be enlarged thereby.
For, consider the practical outcome of all you
gather ; the active work for which your four years'
study is a preparation. Will not your whole
energies be spent in befriending the sick and

K

130 MEDICAL EDUCATION

suffering ? in helping those who cannot help them-
selves ? in rescuing valuable lives from the clutch
of grim death ? in cheering the loving nurses of the
sick, who often hang upon your words with a most
touching trust ? Aye ! and in lessening the sad sum
of human misery and pain by spreading, so far as
in you lies, the knowledge of those grand laws of
health transgressed so ignorantly and yet avenged
so fatally ? 3l

tf

Except it be a lover, no one is more interesting
as an object of study than a student. Shakespeare
might have made him a fourth in his immortal
group. The lunatic with his fixed idea, the poet
with his fine frenzy, the lover with his frantic
idolatry, and the student aflame with the desire for
knowledge are of * imagination all compact.' To
an absorbing passion, a whole-souled devotion,
must be joined an enduring energy, if the student
is to become a devotee of the grey-eyed goddess
to whose law his services are bound. Like the
quest of the Holy Grail, the quest of Minerva is
not for all. For the one, the pure life ; for the
other, what Milton calls 'a strong propensity of
nature/ Here again the student often resembles
the poet — he is born, not made. While the resultant
of two moulding forces, the accidental, external
conditions, and the hidden, germinal energies,
which produce in each one of us national, family,
and individual traits, the true student possesses in
some measure a divine spark which sets at naught
their laws. . . . There are three unmistakable signs

MEDICAL EDUCATION 131

by which you may recognize him ... an absorbing how you
desire to know the truth, an unswerving steadfast- ma7 ^D0vr
ness in its pursuit, and an open, honest heart, free
from suspicion, guile, and jealousy. 4S

*>

A word or two on method in study, though it is Method in
not an easy matter to discuss, for the very good study-
reason that there is no one method suitable to all
alike. Who will venture to settle upon so simple
a matter as the best time for work ? . . . The other The time for
day I asked Edward Martin, the well-known stady-
story-writer, what time he found best for work.
* Not in the evening, and never between meals ! '
was his answer, which may appeal to some of my
hearers. . . . Outside of the asylum there are also Two types
the two great types, the student-lark who loves to of student,
see the sun rise, who comes to breakfast with a
cheerful morning face and in hilarious spirits — two
hours of work and half an hour's exercise before
breakfast, never so * fit ' as at 6 a.m. ! We all know
the type. What a contrast to the student-owl with
his saturnine morning face, thoroughly unhappy,
cheated by the wretched breakfast-bell of the two
best hours of the day for sleep, no appetite, and
permeated with an unspeakable hostility to his
vis-a-vis, whose morning garrulity and good
humour are equally offensive. Only gradually,
as the day wears on and his temperature reaches
98-2°, does he become endurable to himself and to
others. But see him really awake at 10 p.m. !
While the plethoric lark is in hopeless coma over
his books, from which it is hard to rouse him suffi-

K 2

132

MEDICAL EDUCATION

ciently to get his boots off for bed, our lean owl-
friend, Saturn no longer in the ascendant, with
bright eyes and cheery face, is ready for four hours
of anything you wish — deep study, or

* Heart affluence in discoursive talk,'

and by 2 a.m. he will undertake to unsphere the
spirit of Plato. In neither a virtue, in neither a
fault; we must recognize these two types of
students, differently constituted owing possibly —
though I have but little evidence for the belief— to
thermal peculiarities. 4S

Concentra-
tion and
thorough.

Get accustomed to test all sorts of book problems
and statements for yourself, and take as little as
possible on trust. The Hunterian ' Do not think,
but try ' attitude of mind is the important one to
cultivate. The question came up one day, when
discussing the grooves left on the nails after fever,
how long it took for the nail to grow out, from
root to edge. A majority of the class had no
further interest ; a few looked it up in books ; two
men marked their nails at the root with nitrate of
silver, and a few months later had positive know-
ledge on the subject. They showed the proper
spirit.45 ^

Men will not take time to get to the heart of
a matter. After all, concentration is the price the
modern student pays for success. Thoroughness
is the most difficult habit to acquire, but it is the
pearl of great price, worth all the worry and trouble

MEDICAL EDUCATION 133

of the search. The dilettante lives an easy, butter- The
fly life, knowing nothing of the toil and labour
with which the treasures of knowledge are dug out
of the past, or wrung by patient research in the

laboratories. 45

*

I have always been much impressed by the advice Isolation,
of St. Chrysostom : * Depart from the highway and
transplant thyself in some enclosed ground, for it
is hard for a tree which stands by the wayside to
keep her fruit till it be ripe.1 4S

&

Concentration has its drawbacks. It is possible Concentra-
te become so absorbed in the problem of the tion: its

/- * n 11 ~ drawbacks,
'enclitic 6e, or the structure of the flagella of

the Trichomonas, or of the toes of the prehistoric
horse, that the student loses the sense of proportion
in his work, and even wastes a lifetime in researches
which are valueless because not in touch with cur-
rent knowledge. You remember poor Casaubon,
in Middlemarch) whose painful scholarship was
lost on this account. The best preventive to this Get de-
is to get denationalized early. The true student
is a citizen of the world, the allegiance of whose
soul, at any rate, is too precious to be restricted
to a single country. The great minds, the great
works, transcend all limitations of time, of lan-
guage, and of race, and the scholar can never feel
initiated into the company of the elect until he can
approach all of life's problems from the cosmo-
politan standpoint.45

134

MEDICAL EDUCATION

The self- A serious drawback in the student life is the self-
consciousness, bred of too close devotion to books.
A man gets shy, * dysopic,' as old Timothy Bright
calls it, and shuns the looks of men, and blushes
like a girl. The strength of a student of men is to
travel — to study men, their habits, character, mode
of life, their behaviour under varied conditions, their

Study men. vices, virtues, and peculiarities. Begin with a care-
ful observation of your fellow students and of your
teachers ; then, every patient you see is a lesson in
much more than the malady from which he suffers.
Mix as much as you possibly can with the outside
world, and learn its ways. The student societies,
the students' union, the gymnasium, and the out-
side social circle should be cultivated systemati-
cally, to enable you to conquer the diffidence
which goes with bookishness and which will prove
a very serious drawback in after-life. I cannot too
strongly impress upon the earnest and attentive
men among you the necessity of overcoming this
unfortunate failing in your student days. It is not
easy for every one to reach a happy medium, and
the distinction between a proper self-confidence

* Cheek.' and ' cheek,' particularly in junior students, is not
always to be made. The latter is met with
chiefly among the student pilgrims who, in travel-
ling down the Delectable Mountains, have gone
astray and have passed to the left hand, where
lieth the country of Conceit, the country in
which you remember the brisk lad Ignorance met
Christian.45

MEDICAL EDUCATION 135

Two letters from Louis to James Jackson, Sr., show The waiting
how important he thought a prolonged period of Years-
study was for a young man. He says : —

4 1 pointed out to him (James Jackson, Jr.) the
advantage it would be for science and for himself if
he would devote several years exclusively to the
observation of diseases. I now retain the same
opinion and am strengthened in it ; for the more
I become acquainted with, and the more I notice
him applying himself to observation, the more I am
persuaded that he is fitted to render real service to
science, to promote its progress. I find that he
would be well pleased to follow for a certain period
the vocation for which nature has fitted him; but
he has stated to me that there are many difficulties
which would prevent his devoting himself exclusively
to observation for several years. But can these
difficulties be insurmountable ? '

And again : — .

* Let us suppose that he should pass four more
years without engaging in the practice of medicine,
what a mass of positive knowledge will he have
acquired ! How many important results will he
have been able to pubh'sh to the world during that
period ! After that he must necessarily become one
of the bright lights of his country ; others will
resort to him for instruction, and he will be able to
impart it with distinguished honour to himself. If
all things be duly weighed, it will appear that he
will soon redeem the four years, which men of
superficial views will believe him to have lost.'

In another letter, the following year, just before
young Jackson's departure from Paris, he refers
again to this question, and urges Dr. Jackson to
allow his son to devote himself exclusively to

'Laws of
nature must
be dis-
covered, not
invented.'
(Louis.)

Thorough
regard for
truth and
elevation
of mind
essentials to
the accurate
observer of

136 MEDICAL EDUCATION

observation for several years in Boston. The extract
from this letter is worth quoting- : —

4 Think for a moment, sir, of the situation in which
we physicians are placed. We have no legislative
chambers to enact laws for us. We are our own
lawgivers ; or rather, we must discover the laws on
which our profession rests. We must discover
them and not invent them ; for the laws of nature
'are not to be invented. And who is to discover
these laws ? Who should be a diligent observer of
nature for this purpose, if not the son of a physician,
who has himself experienced the difficulties of the
observation of disease, who knows how few minds
are fitted for it, and how few have at once the talents
and inclination requisite for the task ? The inclina-
tion especially, for this requires that the observer
should possess a thorough regard for truth, and
a certain elevation of mind, or rather of character,
which we rarely meet with. All this is united in
your son. You ought — for in my opinion it is
a duty — you ought to consecrate him for a few
years to science. This, sir, is my conviction, and
I hope it will be yours also. I know very well that
every one will not be of the same opinion ; but
what matters it, if it be yours ? — if you look upon
a physician, as I do, as holding a sacred office,
which demands greater sacrifices than are to be
made in any other profession?'30

Louis and

Andral

compared.

In one of his (W. W. Gerhard) letters to his brother,
dated January 18, 1832, he says: —

* Dr. Louis is delivering an interesting clinic at
La Pitie ; he is a remarkable man, very different
from the physicians of England or America, and
remarkable even at Paris by the strict mathe-
matical accuracy with which he arrives at his

MEDICAL EDUCATION 137

results ; he is not a brilliant man, not of the same
grade of intellect as his colleague at La Pitie,
Andral.'

In another letter he gives an account of his
day's work: —

4 The morning from seven to ten is occupied A medical
with the visit and clinic at the hospital ; there are student's
several distinct clinics now in actual progress ; each Jay aV the
of them has its advantages. I shall vary my at- g^^^oi in the
tendance at the various hospitals, and select those thirties,
lecturers who are of real merit. At this moment
we are following Piorry at the Salpetriere, a very
distant hospital, two or three miles from our lodg-
ings; his patients are all old women, and not
interesting. My object in following his course is
to obtain some interesting information on the best
mode of investigating the diseases of the chest.
M. Piorry has devoted special attention to this
subject. From Salpetriere we hurry to La Pitie ;
we hear a surgical lecture, reach home to break-
fast, and then to the school of medicine. The
lectures at the school, with a private course of
anatomy during the hour of intermission, fill up
the remainder of the day until four. Fortunately
a private clinic at La Charite introduces me to a
set of very interesting cases, especially on pectoral
cases. Dr. Dagneau has a class who pay him ten
francs a month, and enjoy the privilege of examin-
ing the patients much more conveniently than is
practicable during the morning visit in the midst
of a crowd of students. We dine at 5.30, and The delights
then lectures again until eight o'clock. Imagine pf positive
the facilities, the delightful advantage of acquiring ^™atlon
positive information, and what is at least as im- gaming the
portant, of learning the mode of obtaining these methods of
positive results. We see and hear the men who acquiring
are so well known to us in America, learn to form these.

133

MEDICAL EDUCATION

teacher to
student.

a correct estimate of their relative worth — in short,
one of the most striking advantages of a medical
visit to Europe is to acquire the sort of liberal
professional feeling which is rarely secured by the
continued intercourse with the same men, and the
unpleasant medical politics which divide the pro-
fession in America.'30

Relation of A fraternal attitude is not easy to cultivate — the
chasm between the chair and the bench is difficult
to bridge. Two things have helped to put up
a cantilever across the gulf. The successful teacher
is no longer on a height, pumping knowledge at
high pressure into passive receptacles. The new
methods have changed all this. He is no longer
Sir Oracle^ perhaps unconsciously by his very
manner antagonizing minds to whose level he can-
not possibly descend, but he is a senior student
anxious to help his juniors. When a simple,
earnest spirit animates a college, there is no ap-
preciable interval between the teacher and the
taught — both are in the same class, the one a little
more advanced than the other. So animated, the
student feels that he has joined a family whose
honour is his honour, whose welfare is his own, and
whose interests should be his first consideration. 4S

Teachers

and

teaching.

The phenomenal strides in every branch of scientific
medicine have tended to overload it with detail.
To winnow the wheat from the chaff and to pre-
pare it in an easily digested shape for the tender
stomachs of the first- and second-year students
taxes the resources of the most capable teacher. l3

MEDICAL EDUCATION 139

The devotion to a subject, and the enthusiasm
and energy which enable a man to keep abreast
with its progress, are the very qualities which often
lead him into pedagogic excesses. To reach a
right judgement in these matters is not easy, and
after all it may be said of teaching as Izaak Walton
says of angling : * Men are to be born so, I mean
with inclinations to it.' l3

fe

Professors may be divided into four classes. There Four classes
is, first, the man who can think, but who has neither of teachers,
tongue nor technique. Though useless for the
ordinary student, he may be the leaven of a
faculty and the chief glory of his University.
A second variety is the phonographic professor,
who can talk, but who can neither think nor work.
Under the old regime he repeated year by year
the same lecture. A third is the man who has
technique, but who can neither talk nor think ; and
a fourth is the rare professor who can do all three,
think, talk, and work. l3

to

For the crass therapeutic credulity, so widespread Scepticism,
to-day, and upon which our manufacturing chemists value of-
wax fat, there is no more potent antidote than the
healthy scepticism bred of long study in the post-
mortem room. l6

fc

Routine, killing routine, saps the vitality of many Killing
teachers who start with high aims, and who, for routine-
years, strive with all their energies against the
degeneration which it is so prone to entaiL In

140

MEDICAL EDUCATION

the smaller schools isolation, the absence of con-
genial spirits working at the same subject, favours
stagnation, and after a few years the fires of early
enthusiasm no longer glow in the perfunctory
lectures. In many teachers the ever-increasing
demands of practice leave less and less time for
study, and a first-class man may lose touch with
his subject through no fault of his own, but
through an entanglement in outside affairs which
he cannot control, yet deeply regrets. To his
five natural senses the student-teacher must add
two more — the sense of responsibility and the
sense of proportion. Most of us start with a
highly developed sense of the importance of the
work, and with a desire to live up to the respon-
sibilities entrusted to us. Punctuality, the class
first, always and at all times ; the best that a man
has in him, nothing less; the best the profession
has on the subject, nothing less; fresh energies
and enthusiasm in dealing with dry details ; ani-
mated, unselfish devotion to all alike ; tender con-
sideration for his assistants — these are some of
the fruits of a keen sense of responsibility in
a good teacher. The sense of proportion is not
so easy to acquire, and much depends on the
training and on the natural disposition.45

The true The past is always with us, never to be escaped ;

a^s^hooi88 °f k al°ne *s en(iuring ; but, amidst the changes and
chances which succeed one another so rapidly in
this life, we are apt to live too much for the
present and too much in the future.20

Sense of
responsi-
bility and
proportion.

The class
always first.

MEDICAL EDUCATION 141

The great possession of any University is its
great names. It is not the ' pride, pomp, and cir-
cumstance ' of an institution which bring honour ;
not its wealth, nor the number of its schools ; not
the students who throng its halls, but the men
who have trodden in its service the thorny road
through toil, even through hate, to the serene
abode of Fame, climbing 'like stars to their
appointed height.'20

^

But it is a secondary matter, after all, whether Man the
a school is under State or University control, measure of
whether the endowments are great or small, the
equipments palatial or humble ; the fate of an in-
stitution rests not on these ; the inherent, vital ele-
ment, which transcends all material interests, which
may give to a school glory and renown in their
absence, and lacking which, all the * pride, pomp,
and circumstance ' are vain — this vitalizing element,
I say, lies in the men who work in its halls, and
in the ideals which they cherish and teach. 22

S>

There is no more potent antidote to the corroding Value of
influence of mammon than the presence in a com- scientific
munity of a body of men devoted to science, living
for investigation and caring nothing for the lust of
the eyes and the pride of life. 22

*?

We forget that the measure of the value of
a nation to the world is neither the bushel nor
the barrel, but mind\ and that wheat and pork,
though useful and necessary, are but dross in

I42

MEDICAL EDUCATION

comparison with those intellectual products which
alone are imperishable. 22

Education, The hardest conviction to get into the mind of

a life course. a beginner is that the education upon which he is

engaged is not a college course, not a medical

course, but a life course, ending only with death,

for which the work of a few years under teachers

is but a preparation. Whether you will falter and

fail in the race or whether you will be faithful to the

end depends on the training before the start, and

on your staying powers, points upon which I need

Student and not enlarge. You can all become good students,

genius. a few j^y become great students, and now and

again one of you will be found who does easily

and well what others cannot do at all, or very

badly, which is John Ferriar's excellent definition

of a genius. 4S

The art-- The best that is known and taught in the world —
nothing less can satisfy a teacher worthy of the
name, and upon us of the medical faculties lies
a bounden duty in this respect, since our art, co-
ordinate with human suffering, is cosmopolitan. 22

tf

The aim of a school should be to have these
departments in the charge of men who have, first,
enthusiasm, that deep love of a subject, that desire
to teach and extend it without which all instruction
becomes cold and lifeless ; secondly, a full and
personal knowledge of the branch taught \ not
a second-hand information derived from books, but

world-wide.

The good
teacher.

MEDICAL EDUCATION 143

the living experience derived from experimental
and practical work in the best laboratories. 22

*

Men are required who have a sense of obligation^
that feeling which impels a teacher to be also a
contributor, and to add to the stores from which
he so freely draws. 22

%>

The investigator, to be successful, must start
abreast of the knowledge of the day, and he differs
from the teacher, who living in the present, ex-
pounds only what is current, in that his thoughts
must be in the future, and his ways and work in
advance of the day in which he lives. a2

fc

The same obligation rests on him to know and
to teach the best that is known and taught in the
world: on the surgeon, the obligation to know
thoroughly the scientific principles on which his
art is based, to be a master in the technique of
his handicraft, ever studying, modifying, improv-
ing; on the physician, the obligation to study
the natural history of diseases, and the means for
their prevention, to know the true value of regimen,
diet, and drugs in their treatment, ever testing,
devising, thinking; — and upon both, to teach to
their students habits of reliance, and to be to them
examples of gentleness, forbearance, and courtesy
in dealing with their suffering brethren. 22

fc

There is a great need in the colleges of this country Thinkers,
of men who are thinkers as well as workers — men

144 MEDICAL EDUCATION

with ideas; men who have drunk deep of the
astral wine, and whose energies are not sapped
in the treadmill of the class-room.21

t

Thinking— The other function of a University is to think.

function. Teaching current knowledge in all departments;
teaching the steps by which the status praesens
has been reached, and teaching how to teach, form
the routine work of the various college faculties. 25

e

What I mean by the thinking function of a
University, is that duty which the professional
corps owes to enlarge the boundaries of human
knowledge. Work of this sort makes a University
great, and alone enables it to exercise a wide
influence on the minds of men. 2S

3

The very best instructor for students may have
no conception of the higher lines of work in his
branch, and contrariwise, how many brilliant in-
vestigators have been wretched teachers!25

tf

In a school which wishes to do thinking as well
as teaching, men must be selected who are not only
thoroughly au courant with the best work in their
department the world over, but who also have ideas,
with ambitibn and energy to put them into force —
men who can add, each one in his sphere, to the
store of the world's knowledge. Men of this stamp
alone confer greatness upon a University. They
should be sought for far and wide; an institution
which wraps itself in Strabo's cloak and does not

MEDICAL EDUCATION 145

look beyond the college gates in selecting professors
may get good teachers, but rarely good thinkers. 2S

*

Surrounded by a group of bright young minds,
well trained in advanced methods, not only is the
professor himself stimulated to do his best work,
but he has to keep far afield and to know what is
stirring in every part of his own domain. 2S

b

With a system of fellowships and research scholar-
ships a University may have a body of able young
men, who on the outposts of knowledge are ex-
ploring, surveying, defining, and correcting. Their
work is the outward and visible sign that a Univer-
sity is thinking. 25

Perfect happiness for student and teacher will come Examina-
with the abolition of examinations, which are stum- tions<
bling-blocks and rocks of offence in the pathway of
the true student. l3 .

How can we make the work of the student in the Teaching
third and fourth year as practical as it is in his theart-
first and second ? I take it for granted we all feel
it should be. The answer is: take him from the
lecture^room, and take him from the amphitheatre —
put him in the out-patient department, put him in
the wards. It is not the systematic lecture, not the
amphitheatre clinic, nor even the ward- class — all of
which have their value — in which the reformation
is needed, but in the whole relationship of the
senior student to the hospital. During the first two

L

146 MEDICAL EDUCATION

years, he is thoroughly at home in the laboratories,
domiciled, we may say, with his place in each one,
to which he can go and work quietly under a
tutor's direction and guidance. To parallel this
condition in the third and fourth years certain re-
forms are necessary. First, in the conception of
how the art of medicine and surgery can be taught.
My firm conviction is that we should start the third-
year student at once on his road of life. Ask any
physician of twenty years' standing how he has
become proficient in his art, and he will reply,
by constant contact with disease ; and he will add
that the medicine that he learned in the schools
was totally different from the medicine he learned
at the bedside. The graduate of a quarter of a
century ago went out with little practical know-
ledge, which increased only as his practice increased.
In what may be called the natural method of teach-
ing the student begins with the patient, using books
and lectures as tools, as means to an end. The
student starts, in fact, as a practitioner, as an ob-
server of disordered machines, with the structure and
orderly functions of which he is perfectly familiar.
Teach him how to observe, give him plenty of facts
to observe, and the lessons will come out of the
facts themselves. For the junior student in medicine
and surgery it is a safe rule to have no teaching
without a patient for a text, and the best teaching
is that taught by the patient himself. The whole
art of medicine is in observation, as the old motto
goes, but to educate the eye to see, the ear to hear,
and the finger to feel takes time, and to make a

MEDICAL EDUCATION 147

beginning, to start a man on the right path, is all
that we can do. We expect too much of the
student and we try to teach him too much. Give
him good methods and a proper point of view, and
all other things will be added as his experience
grows. 2? ,

The second, and the most important reform,
is in the hospital itself. In the interests of the
medical student, of the profession, and of the
public at large we must ask from the hospital
authorities much greater facilities than at present
enjoyed, at least by the students of a majority of
the medical schools of this country (United States).
The work of the third and fourth year should be
taken out of the medical school entirely and trans-
ferred to the hospital, which, as Abernethy remarks,
is the proper college for the medical student, in his
last years at least. 2? .

It is, I think, safe to say that in a hospital with
students in the wards the patients are more care-
fully looked after, their diseases are more fully
studied and fewer mistakes made. The larger
question of the extended usefulness of the hospital
in promoting the diffusion of medical and surgical
knowledge, I cannot here consider. 27

*

There is no scarcity of material ; on the contrary,
there is abundance. Think of the plethora of
patients in this city (New York), the large majority
of whom are never seen, not to say touched by a

L2

148

MEDICAL EDUCATION

medical art

medical student. Think of the hundreds of typhoid
fever patients, the daily course of whose disease is
never watched or studied by our pupils! Think
of how few of the hundreds of cases of pneumonia
which will enter the hospital during the next three
months, will be seen daily, hourly, in the wards by
the fourth -year men ! And yet it is for this they are
in the medical school, just as much as, more indeed
than they are in it to learn the physiology of the
liver or the anatomy of the hip -joint. 27

Study of the The great difficulty is in the third part of the
education of the student, viz. his art. In the old
days when a lad was apprenticed to a general
practitioner, he had good opportunities to pick up
the essentials of a rough and ready art, and the
system produced many self-reliant, resourceful
men. Then with the multiplication of the medical
schools and increasing rivalry between them came
the two years' course, which for half a century lay
like a blight on the medical profession, retarding
its progress, filling its ranks with half- educated men,
and pandering directly to all sorts of quackery,
humbuggery, and fraud. The awakening came
about thirty years ago, and now there are few
schools in this country without a four years' course,
and all are trying to get clear of the old shackles
and teach rational medicine in a rational way. But
there are extraordinary difficulties in teaching the
medical student his art. It is not hard, for ex-
ample, to teach him all about the disease pneumonia,
how it prevails in the winter and spring, how

some of the
difficulties.

MEDICAL EDUCATION 149

fatal it always has been, all about the germ, all
about the change which the disease causes in the
lungs and in the heart — he may become learned,
deeply learned, on the subject — but put him beside
a case, and he may not know which lung is in-
volved, as he does not know how to find out, and
if he did find out, he might be in doubt whether
to put an ice-bag or a poultice on the affected
side, whether to bleed or to give opium, whether
to give a dose of medicine every hour or none at
all, and he may not have the faintest notion whether
the signs look ominous or favourable. So also
with other aspects of the art of the general prac-
titioner. A student may know all about the bones In practice
of the wrist— in fact he may carry a set in his atoepretical
pocket and know every facet and knob and nodule alone is
on them ; he may have dissected a score of arms ; inadequate,
and yet when he is called to see Mrs. Jones, who
has fallen on the ice and broken her wrist, he may
not know a Colics' from a Pott's fracture, and as
for setting it secundum artem, he may not have
the faintest notion, never having seen a case. Or
he may be called to preside at one of those awful
domestic tragedies — the sudden emergency, some
terrible accident of birth or of childhood — that
require skill, technical skill, courage — the courage
of full knowledge ; and if he has not been in the
obstetrical wards, if he has not been trained prac-
tically, if he has not had the opportunities that are
the rights of every medical student, he may fail at
the critical moment ; a life, two lives, may be lost,
sacrificed to ignorance, often to helpless, involun-

Instruction
in the art
the greatest
work of the
Johns
Hopkins
Hospital.

Nickel-in-
the-slot
attitude of
mind.

MEDICAL EDUCATION

tary ignorance. By far the greatest work of the
Johns Hopkins Hospital has been the demonstra-
tion to the profession of the United States and to
the public of this country of how medical students
should be instructed in their art. I place it first
because it was the most needed lesson, I place it
first because it has done the most good as a stimu-
lating example, and I place it first because never
before in the history of this country have medical
students lived and worked in a hospital as part of
its machinery, as an essential part of the work of
the wards. In saying this Heaven forbid that I
should obliquely disparage the good and faithful
work of my colleagues elsewhere. But the amphi-
theatre clinic, the ward and dispensary classes, are
but bastard substitutes for a system which makes
the medical student himself help in the work of
the hospital as part of its human machinery. He
does not see the pneumonia case in the amphi-
theatre from the benches, but he follows it day
by day, hour by hour ; he has his time arranged
that he can follow it ; he sees and studies similar
cases, and the disease itself becomes his chief
teacher, and he knows its phases and variations as
depicted in the living; he learns under skilled
direction when to act and when to refrain ; he
learns insensibly principles of practice, and he
possibly escapes a nickel-in-the-slot attitude of
mind, which has been the curse of the physician
in the treatment of disease. And the same with
the other branches of his art ; he gets a first-hand
knowledge, which, if he has any sense, may make

MEDICAL EDUCATION 151

him wise unto the salvation of his fellows. And
all this has come about through the wise provision
that the hospital was to be part of the medical
school, and it has become for the senior students,
as it should be, their college. Moreover, they are
not in it upon sufferance and admitted through
side-doors, but they are welcomed as important
aids, without which the work could not be done
efficiently. The whole question of the practical Practical
education of the medical student is one in which education-
the public is vitally interested. Sane, intelligent
physicians and surgeons with culture, science, and
art, are worth much in a community, and they are
worth pay ing for in rich endowments of our medical
schools and hospitals. Personally there is nothing
in my life in which I take greater pride than in
my connexion with the organization of the medical
clinic of the Johns Hopkins Hospital, and with the
introduction of the old-fashioned methods of prac-
tical instruction. I desire no other epitaph than
the statement that I taught medical students in the The ward as is
wards, as I regard this as by far the most useful and aclass-room.
important work I have been called upon to do. 44

There are hundreds of earnest students, thousands
of patients, and scores of well-equipped young men
willing and anxious to do practical teaching. Too
often, as you know full well, 'the hungry sheep
look up and are not fed ' ; for the bread of the
wards they are given the stones of the lecture-room
and the amphitheatre. The dissociation of student

152 MEDICAL EDUCATION

and patient is a legacy of the pernicious system of
theoretical teaching from which we have escaped
in the first and second years. 27

Students in For the third- and fourth -year students, the hospital

hospital (see js t^Q conepre . for the juniors, the out-patient

'Teaching ,J ~

the Art' department and the clinics; for the seniors, the

also). wards. They should be in the hospital as part of

its equipment, as an essential part, without which
the work cannot be of the best. They should be
in it as the place in which alone they can learn the
elements of their art and the lesson which will be
of service to them when in practice for themselves. 27

Experience. Each case has its lesson — a lesson that may be,
but is not always, learnt, for clinical wisdom is not
the equivalent of experience. A man who may
have seen 500 cases of pneumonia may not have
the understanding of the disease which comes with
an intelligent study of a score of cases, so different
are knowledge and wisdom, which, as the poet
truly says, l far from being one, have oft-times no
connexion.' l6 ,

Judgement Listen to the appropriate remark of the father of
difficult. medicine, who twenty -five centuries ago had not
only grasped the fundamental conception of our art
as one based on observation, but had laboured also
through a long life to give to the profession which
he loved the saving health of science — listen, I say,
to the words of his famous aphorism : * Experience
is fallacious and judgement difficult ! ' l6

MEDICAL EDUCATION 153

The problems of disease are more complicated and Uncertain-
difficult than any others with which the trained tie^_ ?f.

* . medicine.

mind has to grapple ; the conditions in any given
case may be unlike those in any other ; each case,
indeed, may have its own problem. Law, con-
stantly looking back, has its forms and procedures,
its precedents and practices. Once grasped, the
certainties of divinity make its study a delight and
a pastime ; but who can tell of the uncertainties of
medicine as an art? The science on which it is
based is accurate and definite enough ; the physics
of a man's circulation are the physics of the water-
works of the town in which he lives, but once out
of gear, you cannot apply the same rules for the
repair of the one as of the other, l6

fc

Variability is the law of life. As no two faces are Probability,
the same, so no two bodies are alike, and no two
individuals react alike and behave alike under the
abnormal conditions which we know as disease.
This is the fundamental difficulty in the education
of the physician, and one which he may never grasp,
or he takes it so tenderly that it hurts, instead of
boldly accepting the axiom of Bishop Butler, more
true of medicine than of any other profession :
* Probability is the guide of life.' Surrounded by
people who demand certainty, and not philosopher
enough to agree with Locke, that l probability
supplies the defect of our knowledge and guides
us when that fails, and is always conversant about
things of which we have no knowledge,1 the prac-
titioner too often gets into a habit of mind which

154

MEDICAL EDUCATION

resents the thought that opinion, not full knowledge,
must be his stay and prop. There is no discredit,
though there is at times much discomfort, in this
everlasting per hap s with which we have to preface
so much connected with the practice of our art.
It is, as I said, inherent in the subject. l6

Value of May not the loss of a professor bring stimulating
Sotversit1 & ^>ene^ts to a University ? ... It is strange of how
teaching slight value is the unit in a great system. A man
may have built up a department and have gained
a certain following, local or general; nay, more,
he may have had a special value for his mental and
moral qualities ; and his fission may leave a scar,
even an aching scar, but it is not for long. Those
of us accustomed to the process know that the
organism as a whole feels it about as much as a big
polyzoon when a colony breaks off, or a hive of bees
after a swarm — 'tis not indeed always a calamity,
oftentimes it is a relief. **

staff.

The

professor.

Change is the very marrow of his existence —
a new set of students every year, a new set of
assistants, a new set of associations every few years
to replace those called off to other fields ; — in any
active department there is no constancy, no stability
in the human surroundings. And in this there is
an element of sadness. A man comes into one's
life for a few years, and you become attached to
him, interested in his work and in his welfare, and
perhaps you grow to love him as a son, and then,
off he goes ! — it must be as bad as having a daughter

MEDICAL EDUCATION 155

married — leaving you with a bruised heart. After
teaching for thirty years, and coming into very
intimate contact with my assistants, my heart is all
cicatrices, covered with one big 4 milky patch.' 44

*

The question may be asked whether, as professors, In-breeding
we do not stay too long in one place. It passes
my persimmon to tell how some good men — even
lovable and righteous men in other respects —
have the hardihood to stay in the same position
for twenty-five years. To a man of active mind too
long attachment to one college is apt to breed self-
satisfaction, to narrow his outlook, to foster a local
spirit, and to promote senility. 44

&
A common type of collegiate chauvinism is mani- Collegiate

fest in the narrow spirit too often displayed in chauvinism
-„. r .' ~ i and dangers

filling appointments. The professoriate of the Ofin-breed-

profession, the most mobile column of its great ing.
army, should be recruited with the most zealous
regard to fitness, irrespective of local conditions
that are apt to influence the selection. In-breeding
is as hurtful to colleges as to cattle. The inter-
change of men, particularly of young men, is most
stimulating, and the complete emancipation of
the chairs which has taken place in most of our
Universities should extend to the medical schools.
Nothing, perhaps, has done more to place German
medicine in the forefront to-day than a peripatetic
professoriate, owing allegiance only to the pro-
fession at large, regardless of civic, sometimes,
indeed, of national limitations and restrictions.

156 MEDICAL EDUCATION

We acknowledge the principle in the case of the
scientific chairs, and with increasing frequency act
upon it, but an attempt to expand it to other
chairs may be the signal for the display of rank
parochialism. 23

tf

The There remains now to foster that indefinite some-

^ing which, for want of a better term, we call the
University spirit, a something which a rich institu-
tion may not have, and with which a poor one may
be saturated ; a something which is associated with
men and not with money, which cannot be pur-
chased in the market or grown to order, but which
comes insensibly with loyal devotion to duty and
to high ideals, and without which Nehushtan is
written on the portals of any school of medicine,
however famous. 25

BOOKS, LIBRARIES, AND MEDICAL
SOCIETIES

«RELIGIO MEDICI*

To the writings of one old physician I can urge your
closest attention. There have been, and, happily, there
are still in our ranks notable illustrations of the intimate
relations between medicine and literature, but in the group
of literary physicians Sir Thomas Browne stands pre-
eminent. The Religio Medici, one of the great English
classics, should be in the hands— in the heart too — of
every medical student. As I am on the confessional
to-day, I may tell you that no book has had so enduring
an influence on my life. I was introduced to it by my
first teacher, Rev. W. A. Johnson, Warden and Founder
of Trinity College School, and I can recall the delight
with which I first read its quaint and charming pages. It
was one of the strong influences which turned my thoughts
towards medicine as a profession, and my most treasured
copy— the second book I ever bought — has been a constant
companion for thirty-one years, comes viae vitaeque. l3

158 BOOKS, LIBRARIES, AND

The value of The organization of a library means effort, it means
library union, it means progress. It does good to men

who start it, who help with money, with time and
with the gifts of books. It does good to the young
men, with whom our hopes rest, and a library
gradually and insensibly moulds the profession of
a town to a better and higher status. 3

t

The Index I need not refer in this audience to the use of the
Catalogue. in(jex Catalogue in library work ; it is also of in-
calculable value to any one interested in books.
Let me give an everyday illustration. From the
library of my friend, the late Dr. Rush Huidekoper,
was sent to me a set of very choice old tomes, among
which was a handsome folio of the works of du
Laurens, a sixteenth - century physician. I had
never heard of him, but was very much interested
in , some of his medical dissertations. In a few
moments from the Index Catalogue the whole
bibliography of the man was before me, the dates
of his birth and death, the source of his biblio-
graphy, and where to look for his portrait. It is
impossible to over-estimate the boon which this
work is to book-lovers. 3

The reaper Too often the reaper is not the sower. Too often

tn^sower t^le ^ate °^ t^lose w^° kbour at some object for the
public good is to see their work pass into other
hands, and to have others get the credit for en-
terprises which they have initiated and made
possible. l9

MEDICAL SOCIETIES 159

It is hard for me to speak of the value of libraries Books,
in terms which would not seem exaggerated. Books value of-
have been my delight these thirty years, and from
them I have received incalculable benefits. l9

&

To study the phenomena of disease without books
is to sail an uncharted sea, while to study books
without patients is not to go to sea at all. l9

9 .

Only a maker of books can appreciate the labours
of others at their true value. Those of us who have
brought forth fat volumes should offer hecatombs
at the shrines of Minerva Medica. What exsuccous,
attenuated offspring they would have been but for
the pabulum furnished through the placental circu-
lation of a library ! How often can it be said of us
with truth, Das beste was er ist verdankt er

Andern!^

9

But when one considers the unending making of Sir William
books, who does not sigh for the happy days of ?^Te s
that thrice happy Sir William Browne, whose pocket library,
library sufficed for his life's needs ; drawing from
a Greek testament his divinity, from the aphorisms
of Hippocrates his medicine, and from an Elzevir
Horace his good sense and vivacity ? l9

9

There should be in connexion with every library Library
a corps of instructors in the art of reading, who instructors,
would, as a labour of love, teach the young how to
read. l9

160 BOOKS, LIBRARIES, AND

Books. It was a singularly judicious action on the part of

the men who controlled this institution (in the
thirties) to begin a collection of books. They

*fh) knew the true g^g^ °f a profession's standing, not
. \j? the number of its schools, not the length of the roll
of students, not the material wealth of the physicians;
these are as dross and slag, chaff and dust, in
estimating the true worth of a profession. Books
are tools, doctors are craftsmen, and so truly as one
can measure the development of any particular
handicraft by the variety and complexity of its
, tools, so we have no better means of judging the
intelligence of a profession than by its general
collection of books. A physician who does not use
books and journals, who does not need a library,
who does not read one or two of the best weeklies
and monthlies, soon sinks to the level of the cross-
counter prescriber, and not alone in practice, but in
those mercenary feelings and habits which charac-
terize a trade. I0

The true worker does not want textbooks ; he
looks to journal literature and monographs, and the
extraordinary development of all special depart-
ments makes the work of a library committee
very difficult unless it has a rich appropriation. I0

$

Four sorts An old writer says that there are four sorts of

of readers. readers : ' Sponges, which attract all without dis-

tinguishing ; Ho wre-glasses, which receive and powre

out as fast ; Bagges, which only retain the dregges

of the spices and let the wine escape ; and Sieves,

MEDICAL SOCIETIES l6l

which retaine the best onely.' A man wastes a great
many years before he reaches the ' sieve ' stage. l9

$

No class of men needs friction so much as physicians ; The Medical
no class gets less. The daily round of a busy Society-
practitioner tends to develop an egoism of a most
intense kind, to which there is no antidote. The
few set-backs are forgotten, the mistakes are often
buried, and ten years of successful work tend to'/
make a man touchy, dogmatic, intolerant of correc-
tion, and abominably self-centred. To this mental
attitude the Medical Society is the best corrective,
and a man misses a good part of his education who
does not get knocked about a bit by his colleagues
in discussions and criticisms. I0

&

The very marrow and fitness of books may not Books alone
suffice to save a man from becoming a poor, mean- l
spirited devil, without a spark of fine professional
feeling, and without a thought above the sordid
issues of the day. I0 ,

The promotion and dissemination of medical know- The
ledge throughout the State remains our important
function. Physicians as a rule have less apprecia- baneful in-
tion of the value of organization than the members
of other professions. In large cities weakness Medical
results from the breaking into cliques and coteries, Society,
the interests of which take precedence over others
of wider and more public character. Jealousies and
misunderstandings are not unknown, and there is
a baneful individualism — every man for himself —

M

162 BOOKS, LIBRARIES, ETC.

a centrifugalizing influence against which the Society
is and has been the only enduring protest. I0

tf

The self- The man who knows it all and gets nothing from
the Society reminds one of that little dried -up
miniature of humanity, the prematurely senile infant,
whose tabetic marasmus has added old age to in-
fancy. Why should he go to the Society and hear
Dr. Jones on the gastric relations of neurasthenia
when he can get it so much better out of the works
of Einhorn or Ewald ? He is weary of seeing
appendices, and there are no new pelvic viscera for
demonstration. It is a waste of time, he says, and
he feels better at home, and perhaps that is the best
place for a man who has reached this stage of
intellectual stagnation. l6

VALUE OF TRAVEL

TRAVEL

To walk the wards at Guy's or St. Bartholomew's, to
see the work at the St. Louis or the Salpetrfere, to put in
a few quiet months of study at one of the German
university towns, will store the young man's mind with
priceless treasures. I assume that he has a mind. I am
not heedless of Shakespeare's sharp taunt :—

'How much the fool that hath been sent to Rome
Exceeds the fool that hath been kept at home ! '

M 2

164 VALUE OF

Travel. If he (the physician) cannot go abroad, let him
spend part of his short vacations in seeing how
it fares with the brethren in his own country.
Even a New Yorker will learn something in the
Massachusetts General and the Boston City Hos-
pitals. A trip to Philadelphia would be most
helpful; there is much to stimulate the mind at
the old Pennsylvania Hospital and at the Univer-
sity, and he would be none the worse for a few
weeks spent still further south on the banks of the
Chesapeake. The all -important matter is to get
breadth of view as early as possible, and this is
difficult without travel.6

The future Meanwhile, to students who wish to have the best
West that the world offers, let me suggest that the lines

of intellectual progress are veering strongly to the
West, and I predict that in the twentieth century
the young English physicians will find their keenest
inspiration in the land of the setting sun. 2

Catholicity. If the work is to be effective, the student must keep
in touch with scholars in other countries. How often
has it happened that years of precious time have
been given to a problem already solved or shown to
be insoluble, because of the ignorance of what had
been done elsewhere! And it is not only book
knowledge and journal knowledge, but a knowledge
of men that is needed. The student will, if possible,
see the men in other lands. Travel not only
widens the vision and gives certainties in place
of vague surmises, but the personal contact with

TRAVEL 165

foreign workers enables him to appreciate better
the failings or successes in his own line of work,
perhaps to look with more charitable eyes on
the work of some brother whose limitations and
opportunities have been more restricted than his
own. 45 ^

There are two appalling diseases which only a Infantilism

feline restlessness of mind and body may * head in the

teacher,
off ' in young men in the academic career. There

is a remarkable bodily condition, known as in-
fantilism, in which adolescence does not come
at the appointed time, or is deferred until the
twentieth year or later, and is then incomplete,
so that the childish mind and the childish form and
features remain. The mental counterpart is even
more common among us. Intellectual infantilism
is a well-recognized disease, and just as imperfect
nutrition may cause failure of the marvellous
changes which accompany puberty in the body,
so the mind too long fed on the same diet in one
place may be rendered rickety or even infantile.
Worse than this may happen. A rare, but still Progeriain
more extraordinary, bodily state is that of progeria, the teacher-
in which, as though touched with the wand of some
malign fairy, the child does not remain infantile,
but skips adolescence, maturity, and manhood, and
passes at once to senility, looking at eleven or
twelve years like a miniature Tithonus ' marred
and wasted,' wrinkled and stunted, a little old man
among his toys. It takes great care on the part
of any one to live a mental life corresponding to

l66 VALUE OF

the ages or phases through which his body passes.
How few minds reach puberty, how few come to
adolescence, how few attain maturity ! It is really
tragic — this widespread prevalence of mental in-
fantilism, due to careless habits of intellectual feed-
ng. Progeria is an awful malady in a college.
Few faculties escape without an instance or two,
and there are certain diets which cause it just as
surely as there are waters in some of the Swiss
valleys that produce cretinism. I have known an
entire faculty attacked. The progeric himself is
a nice enough fellow to look at and to play with,
but he is sterile, with the mental horizon narrowed,
and quite incapable of assimilating the new thoughts
of his day and generation.

*

As in the case of many other diseases, it is more
readily prevented than cured, and, taken early,
change of air and diet may do much to antagonize
a tendency, inherited or acquired. Early stages
may be relieved by a prolonged stay at the
University Baths of Berlin or Leipzig, or if at
the proper time a young man is transferred from
an American or Anglican to a Gallic or Teutonic
diet. Through no fault of the men, but of the
system, due to the unfortunate idea on the part
of the denominations that in each one of the States
they should have their own educational institutions,
collegiate infantilism is far too prevalent, against
which the freer air and better diet of the fully
equipped State Universities are proving a rapid, as
they are the rational, antidote. 44

TRAVEL 167

I wish we could encourage on this continent The narrow
(America) among our best students the habit of sPirit-
wandering. I do not know that we are quite pre-
pared for it, as there is still great diversity in the
curricula, even among the leading schools, but it
is undoubtedly a great advantage to study under
different teachers, as the mental horizon is widened
and the sympathies enlarged. The practice would
do much to lessen that narrow ' I am of Paul and
I am of Apollos ' spirit which is hostile to the best
interests of the profession. 4S

&

It is more particularly upon the younger men that Advantages
I would urge the advantages of an early devotion °gri^tetic
to a peripatetic philosophy of life. Just so soon life for the
as you have your second teeth think of a change ; teacher,
get away from the nurse, cut the apron-strings of
your old teachers, seek new ties in a fresh environ-
ment, if possible, where you can have a certain
measure of freedom and independence. Only do
not wait for a fully-equipped billet almost as good
as that of your master. A small one, poorly ap-
pointed, with many students and few opportunities
for research, may be just what is needed to bring
out the genius — latent and perhaps unrecognized —
that will enable you in an unfavourable position to
do well what another could not do at all, even in
the most helpful surroundings. 44

*>

Nor would I limit this desire for change to the
teachers. The student of the technical school

l68 VALUE OF

should begin his Wander jahre early, not post-
poning them until he has taken his M.D. or Ph.D.
A residence of four years in the one school is apt
to breed prejudice and to promote mental astigma-
tism which the after years may never be able to

correct. 44 ,

9

Travel and Permanence of residence, good undoubtedly for the
pocket, is not always best for wide mental vision
in the physician. ,

You (army surgeons) are modern representatives
of a professional age long past, of a day when
physicians of distinction had no settled homes.
You are Cyprid larvae, unattached, free-swimming,
seeing much in many places ; not fixed as we
barnacles of civil life, head downward, degenerate
descendants of the old professional Cirripeds, who
laid under contribution not one but a score of
cities. 26 ,

Morgan, Rush, Shippen, Bard, Wistar, Hossack,

and others had received an education comprising

all that was best in the period, and had added the

. acquired culture which can come only from travel

and wide acquaintance with the world. 4

3

Morgan, the founder of the medical school of
the University of Pennsylvania, was away seven
years, and before returning had taken his seat as
a corresponding member of the French Academy
of Surgery, besides having been elected a Fellow
of the Royal Society. 4

TRAVEL 169

In a nomad life this common infirmity, to the
entertainment of which the twin sisters, Use and
Wont, lend their ever ready aid, will scarcely
touch you (the army surgeon), and for this mercy
give thanks ; and while you must, as men, entertain
many idols of the tribe, you may at least escape the
idol of the cave. Enjoying the privilege of wide
acquaintance with men of varied capabilities and
training, you can, as spectators of their many
crotchets and of their little weaknesses, avoid placing
an undue estimate on your own individual powers
and position. 26

^

If the licence to practise meant the completion of Foreign
his education, how sad it would be for the young travel,
practitioner, how distressing to his patients ! More
clearly than any other the physician should illus-
trate the truth of Plato's saying, that education is
a lifelong process. The training of the medical
school gives a man his direction, points him the way,
and furnishes him with a chart, fairly incomplete,
for the voyage, but nothing more. Post-graduate
study has always been a characteristic feature of our
profession. These three hundred years the schools
of Italy, Holland, France, Austria, and Germany
have in turn furnished instruction to the young
English practitioners who believed in the catholicity
of medicine, and who felt the sharp sting of the
remark which associates homely wits with home-
keeping youths. At first it was the grand tour,
and many of the masters spent years in foreign
study. In spite of our journals and international

170 VALUE OF TRAVEL

societies and increased facilities for travel, I am
not sure that, among the teachers in our art the
world over, medicine to-day is more cosmopolitan
than it was in the seventeenth and eighteenth
centuries. We now spend a few months or a year
in foreign study, whereas our great-grandfathers
thought nothing of two and three years. I have
seen the manuscript journal of Dr. John Morgan
(a Pennsylvania colonist), the founder of the first
medical school in America (University of Pennsyl-
vania), who after graduation at Edinburgh, spent
three years on the continent, and became thoroughly
familiar with Italian, Dutch, and French medicine,
reaching such distinction as a student that he took
his seat as a corresponding member of the Paris
Academy of Surgery, and was elected a Fellow of
the Royal Society. 2

THE PRACTITIONER OF MEDICINE

The Student Practitioner
The General Practitioner
The Specialist
The Consultant

PHYSICIANS— TWO SORTS

There are only two sorts of doctors : those who practise v
with their brains, and those who practise with their
tongues. a5

THE TRUE PHYSICIAN

The studious hard-working man who wishes to know
his profession thoroughly, who lives in the hospitals and
dispensaries, and who strives to obtain a wide and philo-
sophical conception of disease and its processes, often has
a hard struggle, and it may take years of waiting before
he becomes successful ; but such form the bulwarks of our
ranks, and outweigh scores of the voluble Cassios who
talk themselves into, and often out of, practice. 25

172 THE PRACTITIONER

The waiting Medicine is a most difficult art to acquire. All the
college can do is to teach the student principles,
based on facts in science, and give him good methods
of work. These simply start him in the right
direction ; they do not make him a good practi-
tioner— that is his own affair. To master the art
requires sustained effort, like the bird's flight which
depends upon the incessant action of the wings, but
this sustained effort is so hard that many give up
the struggle in despair. And yet it is only by per-
sistent intelligent study of disease upon a methodical
plan of examination that a man gradually learns to
correlate his daily lessons with the facts of his
previous experience and of that of his fellows, and
so acquires clinical wisdom. Nowadays it is really
not a hard matter for a well-trained man to keep
abreast of the best work of the day. He need not
be very scientific so long as he has a true apprecia-
tion of the dependence of his art on science, for, in
a way, it is true that a good doctor may have practice
and no theory, art and no science. To keep up
a familiarity with the use of instruments of precision
is an all- important help in his art, and I am pro-
foundly convinced that as much space should be
given to the clinical laboratory as to the dispensary.
One great difficulty is that while waiting for the
years to bring the inevitable yoke, a young fellow
gets stale and loses that practised familiarity with
technique which gives confidence. I wish the older
practitioners would remember how important it is
to encourage and utilize the young men who settle
near them. -In every large practice there are a dozen

OF MEDICINE 173

or more cases requiring skilled aid in diagnosis, and
this the general practitioner can have at hand. It
is his duty to avail himself of it, and failing to do so
he acts in a most illiberal and unjust way to himself
and to the profession at large. Not only may the
older man, if he has soft arteries in his grey cortex,
pick up many points from the young fellow, but
there is much clinical wisdom afloat in each parish
which is now wasted or dies with the old doctor,
because he and the young men have never been on
friendly terms. 23

From the vantage-ground of more than forty years Three

of hard work, Sir Andrew Clark told me that he Pf*0?8 °*

the physi-
had striven ten years for bread, ten years for bread cian's life.

and butter, and twenty years for cake and ale ; and
this is really a very good partition of the life of the
student of internal medicine, of some at least, since
all do not reach the last stage. 6

*>

During this period (first ten years after graduation) Time is
let him (the young physician) not lose the substance money-
of ultimate success in grasping at the shadow of
present opportunity. Time is now his money, and
he must not barter away too much of it in profitless
work — profitless so far as his education is concerned,
though it may mean ready cash. 6

fc

Five years, at least, of trial await the man after The waiting
parting from his teachers, and entering upon an
independent course — years upon which his future
depends and from which his horoscope may be cast

174 THE PRACTITIONER

with certainty. It is all the same whether he settles
in a country village, or goes on with hospital and
laboratory work ; whether he takes a prolonged trip
abroad ; or whether he settles down in practice, with
a father or a friend — these five waiting years fix his
fate so far as the student life is concerned. Without
any strong natural propensity to study, he may feel
such a relief after graduation that the effort to take
to books is beyond his mental strength, and a weekly
journal with an occasional textbook furnish pabulum
Dead enough, at least, to keep his mind hibernating. But

mentally in ten vears later he is dead mentally, past any possible
without hope of galvanizing into life as a student, fit to do
a routine practice, often a capable, resourceful man,
but without any deep convictions, and probably more
interested in stocks or in horses than in diagnosis
or therapeutics. But this is not always the fate of
the student who finishes his work on Commence-
ment Day. There are men full of zeal in practice,
who give good service to" their fellow creatures,
who have not the capacity or the energy to keep up
with the times. While they have lost interest in
science, they are loyal members of the profession,
and appreciate their responsibilities as such. That
fateful first lustrum ruins some of our most likely
material. Nothing is 'more trying to the soldier
than inaction, to mark time while the battle is
raging all about him; and waiting for practice
is a serious strain under which many yield. In the
cities it is not so hard to keep up : there is work
in the dispensaries and colleges, and the stimulus
of the medical societies ; but in smaller towns and

OF MEDICINE 175

in the country it takes a strong man to live through
the years of waiting without some deterioration. 45

It is a common error to think that the more a doctor Simply
sees the greater his experience and the more he in§notaU'
knows. No one ever drew a more skilful distinction
than Cowper in his oft-quoted lines, which I am
never tired of repeating in a medical audience : —

4 Knowledge and wisdom, far from being one,
Have oft-times no connexion. Knowledge dwells
In heads replete with thoughts of other men ;
Wisdom in minds attentive to their own.
Knowledge is proud that he has learned so much ;
Wisdom is humble that he knows no more.'45

What we call sense or wisdom is knowledge, ready Sense and
for use, made effective, and bears the same relation wisdom con-
to knowledge itself that bread does to wheat. The
full knowledge of the parts of a steam engine and
the theory of its action may be possessed by a man
who could not be trusted to pull the lever to its
throttle. It is only by collecting data and using
them that you can get sense. One of the most
delightful sayings of antiquity is the remark of
Heraclitus about his predecessors — that they had
much knowledge, but no sense.45

I wish I had time to speak of the value of note- Note-taking.

taking. You can do nothing as a student in practice

without it. Carry a small notebook which will fit

into your waistcoat pocket, and never ask a new

patient a question without notebook and pencil in

hand. After the examination of a pneumonia case

176 THE PRACTITIONER

two minutes will suffice to record the essentials in
Routine and the daily progress. Routine and system, when once
made a habit, facilitate work, and the busier you
are the more time you will have to make observa-
tions after examining" a patient. Jot a comment at
the end of the notes : * clear case,' ' case illustrating
obscurity of symptoms,' * error in diagnosis,' &c.
The making of observations may become the exer-
cise of a jackdaw-like trick, like the craze which so
many of us have to collect articles of all sorts. The
study of the cases, the relation they bear to each
other and to the cases in literature — here comes in
the difficulty. Begin early to make a threefold
category — clear cases, doubtful cases, mistakes.
And learn to play the game fair, no self-deception,
no shrinking from the truth ; mercy and considera-
tion for the other man, but none for yourself, upon
whom you have to keep an incessant watch. You
remember Lincoln's famous 'mot about the impossi-
bility of fooling- all of the people all of the time.
It does not hold good for the individual who can
fool himself to his heart's content all of the time. If
necessary, be cruel ; use the knife and the cautery
to cure the intumescence and moral necrosis which
you will feel in the posterior parietal region, in
Gall and Spurzheim's centre of self-esteem, where
you will find a sore spot after you have made
The only a mistake in diagnosis. It is only by getting- your

way to make cases grouped in this way that you can make any
real pro- . ,, . •

gress. real progress in your post-collegiate education ;

only in this way can you gain wisdom with ex-
perience. 45

OF MEDICINE 177

Of the three well-stocked rooms which it should The de-
be the ambition of every young doctor to have in his siderata of
house, the library, the laboratory, and the nursery — doctor,
books, balances, and bairns — as he may not achieve
all three, I would urge him to start at any rate with
the books and the balances. A good weekly and
a good monthly journal to begin with, and read
them. Then, for a systematic course of study,
supplement your college textbooks with the larger
systems — Allbutt or Nothnagel — a system of sur-
gery, and, as your practice increases, make a habit
of buying a few special monographs every year.
Read with two objects: first, to acquaint yourself
with the current knowledge on a subject and the
steps by which it has been reached ; and secondly,
and more important, read to understand and
analyse your cases. To this line of work we
should direct the attention of the student before
he leaves the medical school, pointing in specific
cases just where the best articles are to be found,
sending him to the Index Catalogue — that marvellous The Index
storehouse, every page of which is interesting and Catalogue.
the very titles instructive. Early learn to appreciate
the differences between the descriptions of disease
and the manifestations of that disease in an in-
dividual— the difference between the composite The work-
portrait and one of the component pictures. By "*& library,
exercise of a little judgement you can collect at
moderate cost a good working library. Try, in the History of
waiting years, to get a clear idea of the history of medicme-
medicine. Read Foster's Lectures on the History
of Physiology, Baas's History of Medicine. Get the

N "

I78

THE PRACTITIONER

Have an
avocation.

Value of
autopsies.

4 Masters of Medicine ' Series, and subscribe to the
Library and Historical Journal.

Every day do some reading or work apart from
your profession. I fully realize, no one more so,
how absorbing is the profession of medicine, how
applicable to it is what Michelangelo says, * There
are sciences which demand the whole of a man,
without leaving the least portion of his spirit free
for other distractions ' ; but you will be a better man
and not a worse practitioner for an avocation. 45

In this dry-bread period he should see autopsies
daily, if possible. Successful knowledge of the
infinite variations of disease can only be obtained
by a prolonged study of morbid anatomy. While
of special value in training the physician in dia-
gnosis, it also enables him to correct his mistakes,
and, if he reads his lesson aright, it may serve to
keep him humble. 6

Publication. Too many 4 quiz ' classes or too much journal work
has ruined many a promising clinical physician.
While the Pythagorean silence of nearly seven
years, which the great Louis followed (and broke
to burst into a full-blown reputation), cannot be
enjoined, the young physician should be careful
what and how he writes. Let him take heed to
his education, and his education will take care of
itself, and in a development under the guidance
of seniors he will find plenty of material for papers
before medical societies and for publication in
scientific journals. 6

OF MEDICINE 179

Curiously enough, the student -practitioner may find Studious-
studiousness a stumbling-block in his career. A ^^bUngt
bookish man may never succeed ; deep-versed in block,
books, he may not be able to use his knowledge
to practical effect; or, more likely, his failure is
not because he has studied books much, but be-
cause he has not studied men more. He has Study men.
never got over that shyness, that diffidence, against
which I have warned you. I have known instances
in which this malady has been incurable ; in others
I have known a cure effected not by the public, but
by the man's professional brethren, who, appreciating
his worth, have insisted upon utilizing his mental
treasures. 45

&

It is very hard to carry student habits into a large The student
city practice; only zeal, a fiery passion, keeps the ^JJ:.1^6
flame alive, smothered as it is so apt to be by the difficulties,
dust and ashes of the daily routine. A man may and how he
be a good student who reads only the book of c^g^hem.
nature. Such a one I remember in the early
days of my residence in Montreal — a man whose John Bell,
devotion to patients and whose kindness and
skill quickly brought him an enormous practice.
Reading in his carriage and by lamplight at
Lucina's bedside, he was able to keep well in-
formed ; but he had an insatiable desire to know
the true inwardness of a disease, and it was in
this way I came into contact with him. Hard
pushed day and night, yet he was never too
busy to spend a couple of hours with me search-
ing for data which had not been forthcoming
N 2

i8o

THE PRACTITIONER

Quinquen-
nial brain-
dusting an
essential.

during life, or helping to unravel the mysteries of

a new disease. 45

$

The third essential for the practitioner as a student
is the quinquennial brain-dusting1, and this will
often seem to him the hardest task to carry out.
Every fifth year, back to the hospital, back to the
laboatory, for renovation, rehabilitation, rejuvena-
tion, reintegration, resuscitation, &c. Do not forget
to take the notebooks with you, or the sheets, in three
separate bundles, to work over. From the very
start begin to save for the trip. Deny yourself all
luxuries for it. ... Hearken not to the voice of old
4 Dr. Hayseed,' who tells you it will ruin your
prospects, and that he ' never heard of such a thing '
as a young man, not yet five years in practice,
taking three months' holiday. To him it seems
preposterous. Watch him wince when you say it
is a speculation in the only gold mine in which the
physician should invest — Grey Cortex! What about
the wife and babies, if you have them ? Leave them !
Heavy as are your responsibilities to those nearest
and dearest, they are outweighed by the heavier
responsibilities to yourself, to the profession, and
to the public. Like Isaphaena, the story of whose
husband — ardent, earnest soul, peace to his ashes ! —
I have told in the little sketch of An Alabama
Student, your wife will be glad to bear her share in
the sacrifice you make. 4S

theesS£ndf With £°°d health and £°°d habitS the end °f the
lustrum. second lustrum should find you thoroughly estab-

OF MEDICINE l8l

lished — all three rooms well furnished, a good
stable, a good garden, no mining stock, but a life
insurance, and, perhaps, a mortgage or two on
neighbouring farms. Year by year you have dealt
honestly with yourself; you have put faithfully the
notes of each case into their proper places, and you
will be gratified to find that, though the doubtful
cases and mistakes still make a rather formid-
able pile, it has grown relatively smaller. You
literally l own ' the country-side, as the expression
is. All the serious and dubious cases come to you,
and you have been so honest in the frank acknow-
ledgement of your own mistakes, and so charitable
in the contemplation of theirs, that neighbouring
doctors, old and young, are glad to seek your
advice. The work, which has been very heavy, is
now lightened by a good assistant, one of your own
students, who becomes in a year or so your partner.45

$

. . . The cultivated general practitioner. May this The highest
be the destiny of a large majority of you ! Have ^bltlon~~~
no higher ambition ! You cannot reach any cultivated

better position in a community ; the family doctor general

i i i - j 1 i re - practitioner,

is the man behind the gun, who does our effective

work. That his life is hard and exacting ; that he
is underpaid and overworked ; that he has but little
time for study and less for recreation — these are the
blows that may give finer temper to his steel, and
bring out the nobler elements in his character. 45

&

At the outset I would like to emphasize the fact Specialism,
that the student of internal medicine cannot be a

182

THE PRACTITIONER

Dangers of
adopting a
speciality
too early.

specialist. The manifestations of almost any one
of the important diseases in the course of a few
years will ' box the compass ' of the specialities. 6

tf

By all means, if possible, let him (the young1 physi-
cian) be a pluralist, and — as he values his future
life — -let him not get early entangled in the meshes
of specialism. 6

tf

There are three lines of work which he (the
young physician) may follow, all of the most in-
tense interest, all of the greatest value to him —
chemistry, physiology, and morbid anatomy. 6

tf
1 That which has been is that which shall be.'

Medicine may be said to have begun with special-
ists. The Ebers papyrus is largely taken up with
the consideration of local diseases, and centuries
later we find in Greece certain individuals treating
special ailments ; and Aristophanes satirizes a 'rectum
specialist ' in a way not unlike our comic journals
would ' poke fun ' at an oculist or" an aurist. The
tail of our emblematic snake has returned into its
mouth ; at no age has specialism been so rife. 43

tf

A serious danger is the attempt to manufacture
rapidly a highly complex structure from ill-seasoned
material. The speedy success which often comes
from the cultivation of a speciality is a strong in-
centive to young men to adopt early a particular
line of work. How frequently are we consulted

OF MEDICINE 183

by sucklings in our ranks as to the most likely
branch in which to succeed, or a student, with the
brazen assurance which only ignorance can give,
announces that he intends to be a gynaecologist or
an oculist. No more dangerous members of our
profession exist than those born into it, so to speak,
as specialists. Without any broad foundation in
physiology or pathology, and ignorant of the great
processes of disease, no amount of technical skill can
hide from the keen eyes of colleagues defects which
too often require the arts of the charlatan to screen
from the public. 43

$?

The restriction of the energies of trained students Specialism,
to narrow fields in science, while not without its
faults, has been the most important single factor
in the remarkable expansion of our knowledge.
Against the disadvantages in a loss of breadth and
harmony there is the compensatory benefit of a
greater accuracy in the application of knowledge
in specialism, as is well illustrated in the cultivation
of special branches of practice. 5

&

Dentistry, ophthalmology, and gynaecology are
branches which have been brought to a state of
comparative perfection, and very largely by the
labours of American physicians. 5

*

The advantages to the profession which followed Advantages
this differentiation have nowhere been more striking ?
than in this country, and the earnest workers in oph-
thalmology, gynaecology, dermatology, and other

184 THE PRACTITIONER

branches have contributed largely to inculcate the
idea of thoroughness, the necessity for which is apt
to be lost sight of in the hurry and bustle incident
to the growth of a nation. Better work is done all
along the line : a shallow diffuseness has given
place to the clearness and definiteness which comes
from accurate study in a limited field. The day
has gone by for Admirable Crichtons, and although
we have a few notable illustrations in our ranks of
men who have become distinguished authorities in
eye and skin diseases, and upon syphilis, without
sacrificing their interests in general surgery, such
are necessarily rare, and, unfortunately, from the
very circumstances of the case, likely to become
more uncommon. Then how comforting to the
general practitioner is the wise counsel of the
specialist. We take him a case that has puzzled
and annoyed us, the diagnosis of which is uncertain,
and we consult in vain the unwritten records of our
experience and the printed records of our books.
He labels it in a few minutes as a coleopterist would
a beetle, and we feel grateful for the accuracy of
his information, and happy in the possession of the
label. And if sometimes (standing like Aaron
between life and death) he illumines too brightly
the darkness of our ignorance, are we not as often
beholden to him for gentle dealing ? 43

t

The public It is almost unnecessary to remark that the

and special- public, in which we live and move, has not been

slow to recognize the advantage of a division of

labour in the field of medicine. The desire for

OF MEDICINE 185

expert knowledge is, however, now so general that
there is a grave danger lest the family doctor
should become, in some places, a relic of the past.
It must, indeed, be a comfort to thousands to feel
that in the serious emergencies of life expert skill
is now so freely available. 43

*

Perhaps, as specialists, no class in our profession has The gynae-
been more roundly abused for meddlesome work cologist
than the gynaecologists, and yet what shall not be
forgiven to the men who, as a direct outcome of
the very operative details which have received the
bitterest criticism, have learned to recognize tubal V
gestation, and are to-day saving lives which other-
wise would inevitably have been lost ? In one year
at the Philadelphia Pathological Society, Formad
has shown ten or twelve examples of ruptured
tubal pregnancy obtained in medico-legal work
(sudden deaths) in that city. The benefits which
the public reap from specialism may be gathered
from the fact that in a not much longer period of
time I have seen seven specimens of tubal gestation,
not removed by the pathologist, but by the gynae-
cologist, with the saving of five lives. The con-
servatism, which branded ovariotomists as butchers
and belly-rippers, is not yet dead among us, and
I say it frankly, to our shame, that it has not
always been professional encouragement, which has
supported the daring advances on special lines.
Humanity owes a great debt of gratitude to the
devoted men who have striven during the past half-
century for exactness in knowledge, and for its

i86

THE PRACTITIONER

The special-
ist; his
dangers,

and how he
may avoid
them.

Dangers of
specialism.

practical application in all departments, a debt too
great to pay, too great, one sometimes feels, even
to acknowledge. 43

tf

Next to the danger from small men is the serious
risk of the loss of perspective in prolonged and
concentrated effort in a narrow field. Against
this there is but one safeguard — the cultivation of
the sciences upon which the speciality is based.
The student-specialist may have a wide vision — no
student wider — if he gets away from the mechanical
side of the art, and keeps in touch with the physio-
logy and pathology upon which his art depends.
More than any of us, he needs the lessons of
the laboratory, and wide contact with men in
other departments may serve to correct the in-
evitable tendency to a narrow and perverted
vision, in which the life of the ant-hill is mistaken
for the world at large. 45

$

Specialism is not, however, without many dis-
advantages. A radical error at the outset is the
failure to recognize that the results of specialized
observation are at best only partial truths, which
require to be correlated with facts obtained by
wider study. The various organs, the diseases of
which are subdivided for treatment, are not isolated,
but complex parts of a complex whole, and every
day's experience brings home the truth of the
saying, ' When one member suffers all the members
suffer with it.' Plato must have discussed this very
question with his bright friends in the profession —

OF MEDICINE 187

Eryximachus, perhaps — or he never could have
put the following- words in the mouth of Socrates: —

*I dare say that you may have heard eminent
physicians say to a patient who comes to them
with bad eyes, that they cannot cure the eyes by
themselves, but that if his eyes are to be cured, his
head must be treated : and then again they say that
to think of curing the head alone and not the rest
of the body also, is the height of folly. And
arguing in this way they apply their methods to
the whole body, and try to treat and heal the whole
and the part together. Did you ever observe that
this is what they say ? ' *

A sentence which embodies the law and the gospel
for specialists. 43

&

In the cultivation of a speciality as an art there is The narrow

a tendency to develop a narrow and pedantic andpedan-
j , *\_ . tic special-

spirit ; and the man who, year in and year out, ists

examines eyes, palpates ovaries, or tunnels urethrae,
without regard to the wider influences upon which
his art rests, is apt, insensibly perhaps, but none
the less surely, to acquire the attitude of mind of
the old Scotch shoemaker, who, in response to the
Dominie's suggestions about the weightier matters
of life, asked, ' D'ye ken leather ? ' 43

Problems in physiology and pathology touch at Advantages
every point the commonest affections ; and exercised °f sttdy cf
in these, if only in the early years of professional

life, the man is chastened, so to speak, and can logy to the

specialist.

* Charmides : Jowett's translation.

i88

THE PRACTITIONER

never, even in the daily round of the most exacting
practice, degenerate into a money-making machine.
And let the younger of my hearers lay this to
heart: scan the lives of say twenty of the men
most prominent in special lines of medicine and
surgery to-day in this country, and you will find,
with scarcely an exception, the early years de-
voted to anatomical, physiological, or pathological
studies. They rose high because the foundations
were deep. The most distinguished oculists have
been men trained in physiology and pathology ; and
some, like Sir William Bowman, have had reputa-
tions so pre-eminent in several departments that
the identity of the physiologist has been lost in the
ophthalmologist. 43

$

Very little additional knowledge enables the general
practitioner to grapple with a large proportion of
the cases which in cities come under the care of the
specialist. The question resolves itself into one of
education. It is impossible in three sessions to
bring men beyond the superficial routine, but in
a more prolonged course — as I know from ex-
perience—the student can be taught practically,
in the wards and dispensaries, enough of the tech-
nique of the specialist to give, at least, a foundation
upon which to work. He should leave the schools
knowing the practical application of the micro-
scope, the ophthalmoscope, and the laryngoscope,
and in these and other lines he should have pro-
ceeded to the stage in which he recognizes the
limitations of his knowledge. Such a man, in

OF MEDICINE 189

general practice, should know a ' choked disc ' ;
the examination for tube-casts should be a familiar,
everyday task ; and he should be able to tell
whether a vocal chord was paralysed. A serious
obstacle to this happy consummation — which can
be reached in a well-ordered system of education —
is the absence, in the early years of practice, of
material upon which to freshen the memory and to
4 keep the hand in ' ; but the man who, as a student,
has reached a certain point always retains some
measure of the old facility. The post-graduate
schools have done much to enable men to revive,
and to acquire, technical skill, and have been of
great service in generalizing special knowledge.
In the practice of a good, all-round man, the num-
ber of cases demanding the help of a specialist is,
after all, not great. The ordinary run of nervous
disorders should be recognized ; adenoid vegetations
he would treat with the skill of a laryngologist ;
he would know enough not to tinker with a case
of glaucoma ; and though he might not diagnose
a pus -tube from tubal gestation, he would (in this
as in other details) have learned to know his limits
and be ready to seek further advice. 43

$

The organization of societies for the study of par- The special-
ticular diseases has been of late a very notable
feature in the professional life of this country.
Since the foundation of the Ophthalmological Society
more than a dozen associations have been formed,
and their union in a triennial congress has proved
a remarkable success. These societies stimulate

igo

THE PRACTITIONER

New school
of medicine.

work, promote good fellowship, and aid materially
in maintaining- the standard of professional scholar-
ship. They are nearly all exclusive bodies, limited
in membership, and demanding for admission evi-
dence of special fitness. This point is sometimes
urged against them ; but the members exercise no
arbitrary privilege in asking of candidates familiarity
with the subject, and evidence of ability to contri-
bute to the general store of knowledge. In some
of the specialities these societies have been particu-
larly useful in disciplining men who have traduced,
not the code, but the unwritten traditions of our
craft, acting as if they were venders of wares to be
haw^ked in the market-place. 43

if

In the fight which we have to wage incessantly
against ignorance and quackery among the masses,
and follies of all sorts among the classes, diagnosis,
not drugging, is our chief weapon of offence.
Lack of systematic personal training in the methods
of the recognition of disease leads to the mis-
application of remedies, to long courses of treat-
ment when treatment is useless, and so directly
to that lack of confidence in our methods which
is apt to place us in the eyes of the public on a level
with empirics and quacks. 23

<#

The nineteenth century has witnessed a revolution
in the treatment of disease, and a growth of a new
school of medicine. The old schools— regular and
homoeopathic — put their trust in drugs, to give
which was the alpha and omega of their practice.

OF MEDICINE 191

For every symptom there were a score or more of
medicines — vile, nauseous compounds in one case ;
bland, harmless dilutions in the other. The charac-
teristic of the new school is firm faith in a few
good, well-tried drugs, little or none in the great
mass of medicines still in general use. 5

&

Imperative drugging — the ordering of medicine
in any and every malady — is no longer regarded as
the chief function of the doctor. 5

&

The battle against polypharmacy, or the use
of a large number of drugs (of the action of which
we know little, yet we put them into bodies of the
action of which we know less), has not been brought
to a finish. 5

fc

One of the most striking characteristics of the
modern treatment of disease is the return to what
used to be called the natural methods — diet, exercise,
bathing, and massage. There probably never has
been a period in the history of the profession when
the value of diet in the prevention and the cure
of disease was more fully recognized. 5

&

All this change (from empiricism to science) has Facts,
come about by the observation of facts, by their
classification, and by the founding upon them
of general laws. 22

^

Emulating the persistence and care of Darwin,
we must collect facts with open-minded watchful-

THE PRACTITIONER

ness, unbiased by crotchets or notions ; fact on
fact, instance on instance, experiment on experi-
ment ; facts which fitly jointed together by some
master who grasps the idea of their relationship,
may establish a general principle. 22

The home
laboratory.

Man's im-
mutability,

and his
mutability.

A room fitted as a small laboratory, with the
necessary chemicals and a microscope, will prove
a better investment in the long run than a static
machine or a new-fangled air-pressure spray
apparatus. l6

tf

The history of the race is a grim record of passions
and ambitions, of weaknesses and vanities, a record,
too often, of barbaric inhumanity; and even to-
day, when philosophers would have us believe
man's thoughts had widened, he is ready as of old
to shut the gates of mercy, and to let loose the
dogs of war. l4

tf

Our study is man, as the subject of accidents or
diseases. Were he always, inside and outside, cast
in the same mould, instead of differing from his
fellow man as much in constitution and in his re-
action to stimulus as in feature, we should ere this
have reached some settled principles in our art. 22

And not only are the reactions themselves vari-
able, but we, the doctors, are so fallible, ever beset
with the common and fatal facility of reaching
conclusions from superficial observations, and con-

OF MEDICINE 193

stantly misled by the ease with which our minds
fall into the rut of one or two experiences. 22

&

I suppose, as a body, clergymen are better edu- The clergy
cated than any other, yet they are notorious andPhysic-
supporters of all the nostrums and humbuggery
with which the daily and religious papers abound ;
and I find that the further away they have wan-
dered from the decrees of the Council of Trent,
the more apt are they to be steeped in thaumaturgic
and Galenical superstition. 25

&

But know also, man has an inborn craving for Man— a
medicine. Heroic dosing for several generations ^^cm&"
has given his tissues a thirst for drugs. As I once animal,
before remarked, the desire to take medicine is one
feature which distinguishes man, the animal, from
his fellow creatures. It is really one of the most
serious difficulties with which we have to contend.
Even in minor ailments, which would yield to
dieting or to simple home remedies, the doctor's
visit is not thought to be complete without the
prescription. 25

^

And now that the pharmacists have cloaked even Pills and
the most nauseous remedies, the temptation is to P°tions-
use medicine on every occasion ; and I fear that
we may return to the state of polypharmacy, the
emancipation from which has been the sole gift
of Hahnemann and his followers to the race. As
the public becomes more enlightened, and as we
get more sense, dosing will be recognized as a very

o

THE PRACTITIONER

tioner's

the border-
land phar-
maceutical
houses.

minor function in the practice of medicine in com-
parison with the old measures of Asclepiades. *5

The practi- It may keep the practitioner out of the clutches of
the arch-enemy of his professional independence —
the pernicious literature of our camp-followers,
a literature increasing in bulk, in meretricious
attractiveness, and in impudent audacity. To
modern pharmacy we owe much, and to phar-
maceutical methods we shall owe much more in
the future, but the profession has no more insidious
foe than the large borderland pharmaceutical houses.
No longer an honoured messmate, pharmacy in
this form threatens to become a huge parasite,
eating the vitals of the body medical. We all
know too well the bastard literature which floods
the mail, every page of which illustrates the truth
of the axiom, the greater the ignorance the greater
the dogmatism. Much of it is advertisements of
nostrums foisted on the profession by men who
trade on the innocent credulity of the regular
physician, quite as much as any quack preys on
the gullible public. Even the most respectable
houses are not free from this sin of arrogance
and of ignorant dogmatism in their literature.
A still more dangerous enemy to the mental virility
of the general practitioner is the ' drummer * of
the drug- house. While many of them are good,
sensible fellows, there are others, voluble as Cassio,
impudent as Autolycus, and senseless as Caliban,
who will tell you glibly of the virtues of the extract
of the coccygeal gland in promoting pineal meta-

OF MEDICINE 195

bolism, and ready to express the most emphatic
opinions on questions about which the greatest
masters of our art are doubtful. No class of men
with which we have to deal illustrates more fully
the greatest of ignorance, which is the conceit that
a man knows what he does not know. 23

fc

I am often asked — Why have you not tried the Pseudo-

W treatment ? As well ask why do I not use

Bishop Berkeley's Tar-water. Any intelligent

physician who reads Dr. W 's articles in the

journals, or as they have been collected in his book,
must be impressed — first, with the crude, unscientific
character of his work, and of the ignorance every-
where displayed of the nature of typhoid fever ;
and, secondly, with the persistent vaunting of a

specific or cure-all. Dr. W is a devoted,

earnest man, who honestly believes in his plan — so
did Bishop Berkeley in his — but until the presenta-
tion has been made in a different way, I can no
more accept his statements than those of any other
misguided enthusiast who has been fortunate enough
to have his wares exploited in the profession by
a drug-house of repute. That any firm should
have lent their name to this * treatment,' that they
should have spread broadcast in the profession
its literature, may have been good business policy,
but displays a sad lack of judgement. On such
a question it is much easier to keep silence than to
speak one's mind frankly in what may appear an
ungracious, unkindly way ; but I am quite ready
to express this opinion in public, since I have had
O 2

196

THE PRACTITIONER

so often to do it in private, in response to scores of
letters from physicians in different parts of the
country. To one who appreciates what those
great masters, Nathan Smith, James Jackson,
W. W. Gerhard, Etisha Bartlett, and Austin Flint,
did in this country for the elucidation of typhoid

fever, the book itself issued by Dr. W is a

reflection on the memory of men whose works and
ways are alike our standard and our pride. *9

V

The danger Now, while nothing disturbs our mental placidity
of_thebusy more sadly than straitened means, and the lack
of those things after which the Gentiles seek,
I would warn you against the trials of the day soon
to come to some of you — the day of large and
successful practice. . . . Engrossed late and soon
in professional cares, getting and spending, you
may so lay waste your powers that you may find,
too late, with hearts given away, that there is
no place in your habit-stricken souls for those
gentler influences which make life worth living. 20

The busy
doctor.

Greater sympathy must be felt for the man who
has started all right and has worked hard at the
societies, but as the rolling years have brought
ever-increasing demands on his time, the evening
hours find him worn out, yet not able to rest, much
less to snatch a little diversion or instruction in the
company of his fellows whom he loves so well. Of
all men in the profession the forty-visit-a-day man
is the most to be pitied. Not always an automaton,

OF MEDICINE 197

he may sometimes by economy of words and extra-
ordinary energy do his work well, but too often he
is the one above all others who needs the refresh-
ment of mind and recreation that is to be had
in a well-conducted society. Too often he is lost
beyond all recall, and, like Ephraim joined to his
idols, we may leave him alone. Many good men
are ruined by success in practice, and need to pray
the prayer of the Litany against the evils of pros-
perity. It is only too true, as you know well, that
a most successful — as the term goes — doctor may
practise with a clinical slovenliness that makes it
impossible for that kind old friend, Dame Nature,
to cover his mistakes. A well-conducted society
may be of the greatest help in stimulating the
practitioner to keep up habits of scientific study.
It seems a shocking thing to say, but you all know
it to be a fact, that many, very many, men in large
practice never use a stethoscope, and as for a
microscope, they have long forgotten what
a leucocyte or a tube-cast looks like. This in
some cases may be fortunate, as imperfect or half-
knowledge may only lead to mistakes, but the
secret of this neglect of means of incalculable help
is the fact that he has not attained the full and
enduring knowledge which should have been given
to him in the medical school. It is astonishing
with how little outside aid a large practice may be
conducted, but it is not astonishing that in it cruel
and unpardonable mistakes are made. At whose
door so often lies the responsibility for death in
cases of empyema but at that of the busy doctor,

198 THE PRACTITIONER

who has not time to make routine examinations, or
who is l so driven ' that the urine of his scarlet
fever or puerperal patients is not examined until
the storm has broken ? l6

The general The peril is that should he (the physician) cease to
practitioner: ^ink for himself he becomes a mere automaton,
doing a penny-in-the-slot business which places
him on a level with the chemist's clerk who can
hand out specifics for every ill, from the ' pip *
to the pox.23

the best pro-
duct of our
profession.

Dangers of
prosperity.

Politics.

With an optimistic temperament and a good
digestion he is the very best product of our pro-
fession, and may do more to stop quackery and
humbuggery, inside and outside of the ranks, than
could a dozen prosecuting county attorneys. Nay
more ! such a doctor may be a daily benediction in
the community — a strong, sensible, whole-souled
man, living a life often of great self-denial, always of
tender sympathy, worried neither by the vagaries
of the well nor by the testy waywardness of the sick,
and to him, if to any, may come (even when he
knows it not) the true spiritual blessing — that ' bless-
ing which maketh rich and addeth no sorrow.1

The danger in such a man's life comes with
prosperity. He is safe in the hard-working day,
when he is climbing the hill, but once success is
reached, with it come the temptations to which
many succumb. Politics has been the ruin of many
country doctors. . . . He is popular ; he has a little

OF MEDICINE 199

money; and he, if anybody, can save the seat for the

party. When the committee leaves you, take the

offer under consideration, and if in the ten or twelve

years you have kept on intimate terms with those

friends of your student days, Montaigne and Plutarch,

you will know what answer to return. If you live Opening a

in a large town, resist the temptation to open •ana*°l*¥111

a sanatorium. It is not the work for a general

practitioner, and there are risks that you may

sacrifice your independence and much else besides.

And, thirdly, resist the temptation to move into a Moving to a

larger place. In a good agricultural district, or in larSer place.

a small town, if you handle your resources aright,

taking good care of your education, of your habits,

and of your money, and devoting part of your

energies to the support of the societies, &c., you

may reach a position in the community of which

any man may be proud. There are country

practitioners among my friends with whom I would

rather change places than with any in our ranks,

men whose stability of character and devotion

to duty make one proud of the profession.

As I have said before, have no higher ambition

than to become an all-round family doctor, whose

business in life is to know disease and to know how

to treat it. 45

Last year I was called to a town in Pennsylvania, The
and having to wait until late in the evening for the routinist-
return train, I insisted, as is my wont, that the
medical man should carry on his daily work and

200 THE PRACTITIONER

allow me to help if possible. An afternoon round
among people chiefly of the mechanic class, showed
me a shrewd, cheery man, who in twenty years had
gained the confidence and esteem of his patients.
Kindly, hopeful words, very sensible advice about
diet, and some half-dozen drugs seemed the essentials
in his practice. In the evening I saw him dispose
of a dozen patients at an outdoor dispensary rate ;
the examination was limited to the pulse, the tongue,
and sometimes the throat. The dispensing, which was
of the most primitive sort, was done at the table, on
which stood four or five tins and paper boxes con-
taining large quantities of calomel, soda, antip)^rin,
and Dover's powder. Other drugs, he said, were
rarely necessary. He never used a stethoscope ; he
had no microscope or instruments of precision other
than the thermometer. In reply to my questions he
said that he rarely had to make an examination.
' If the patient has fever I send him to bed, if there
is oedema I ask for the urine. Of course, I make
many mistakes, and I sometimes get caught, but
not oftener than the other fellows, and when I am
in serious doubt I ask for a consultation.' This
was a man of parts, a graduate from a good school,
but early in his career he had become very busy,
and gaining the confidence of the people, and having
much confidence in himself, he had unconsciously
got into a rut, out of which at forty only one thing
could lift him — a prolonged course of additional
study. This is by no means an exaggerated picture
of a routinist in general practice. We all have our
therapeutic ruts, and we all know consultants from

OF MEDICINE 2OI

whom patients find it very difficult to escape with-
out their favourite prescription, no matter what the
malady may be. Men of this stamp gain a certain
measure of experience, and if of a practical turn of
mind may become experts in mechanical procedures,
but to experience in the true sense of the word
they never attain. In reality they suffer from the
all-prevailing vice of intellectual idleness. It is so
much easier to do a penny-in-the-slot sort of practice,
in which each symptom is at once met with its
appropriate drug, than to make a careful examina-
tion and really to study the case systematically.
Much depends upon a man's mental constitution,
but much more on the sort of training he has had.
If, when a student, good methods are not acquired,
it is very hard to get into proper habits of work in

practice. 2

$?

The rationalist, on the other hand, always ap- The
preaches a patient as a mathematician does a rationalist,
problem. There is something to be found out ; in
each case, however trivial, there is something novel ;
and the problem of causation and the question of
relief, while not perhaps of equal importance, are
of equal interest. He may be just as busy as his care-
less brother, but he finds time to keep up a technical
dexterity in the use of instruments of precision,
and the stethoscope and the microscope are daily
helps in diagnosis. These men are the delight of
the consultant. To go into the country and find
the diagnosis is made a case of mitral stenosis,
a Friedrich's ataxia, a case of leukaemia, or one of

202

THE PRACTITIONER

Routine.

Experience
and the
general
practitioner.

The man
who does
not read.

myxoedema gives a man a thrill of pleasure such
as Comte says he always felt when a student gave
him an intelligent set of answers in an examination.
It is this class of practitioners for whom the post-
graduate courses are helpful and necessary. They
alone feel the need of keeping abreast of the times,
and men of this type will return every few years,
finding that a few months' course of study not only
improves and helps them personally, but is most
beneficial in their practice. 2

tf

In institutions the corroding effect of routine can
be withstood only by maintaining high ideals of
work ; but these become the sounding brass and
tinkling cymbals without corresponding sound
practice. l5

tf

For the general practitioner a well-used library
is one of the few correctives of the premature
senility which is so apt to overtake him. Self-
centred, self-taught, he leads a solitary life, and
unless his everyday experience is controlled by
careful reading, or by the attrition of a medical
society, it soon ceases to be of the slightest value,
and becomes a mere accretion of isolated facts,
without correlation. l9

t

It is astonishing with how little reading a doctor
can practise medicine, but it is not astonishing how
badly he may do it. Not three months ago a
physician living within an hour's ride of the Surgeon-
General's Library brought to me his little girl aged

OF MEDICINE 203

twelve. The diagnosis of infantile myxoedema
required only a half-glance. In placid contentment
he had been practising twenty years in ' Sleepy
Hollow,' and not even when his own flesh and blood
was touched did he rouse from an apathy deep as
Rip Van Winkle's sleep. In reply to questions :
No, he had never seen anything in the journals
about the thyroid gland ; he had seen no pictures
of cretinism or myxoedema ; in fact, his mind was
a blank on the whole subject. He had not been
a reader, he said, but he was a practical man with
very little time. l9

b

The physician, like the Christian, has three great Ignorance,
foes — ignorance, which is sin ; apathy, which is the aPathy' and
world ; and vice, which is the devil. There is a de- ignorance
lightful Arabian proverb, two lines of which run :
4 He who knows not, and knows not that he knows
not, is a fool. Shun him. He who knows not, and
knows that he knows not, is simple. Teach him.'
To a large extent these two classes represent the
people with whom we have to deal. Teaching
the simple and suffering the fools gladly, we
must fight the wilful ignorance of the one and the
helpless ignorance of the other, not with the sword
of righteous indignation, but with the skilful weapon
of the tongue. On this ignorance the charlatan
and the quack live, and it is by no means an easy
matter to decide how best to conduct a warfare
against these wily foes, the oldest and most for-
midable with whom we have to deal. As the in-
comparable Fuller remarks, 'Well did the poets

204

THE PRACTITIONER

Apathy our
most

dangerous
foe.

feign Aesculapius and Circe brother and sister . . .
for in all times (in the opinion of the multitude)
witches, old women, and impostors have had a
competition with doctors.' Education of the public
of a much more systematic and active kind is
needed. 4l

*

By far the most dangerous foe we have to fight is
apathy — indifference from whatever cause, not from
a lack of knowledge, but from carelessness, from
absorption in other pursuits, from a contempt bred
of self-satisfaction. Fully twenty-five per cent, of
the deaths in the community are due to this accursed
apathy, fostering a human inefficiency, and going
far to counterbalance the extraordinary achieve-
ments of the past century. Why should we take
pride in the wonderful railway system with which
enterprise and energy have traversed the land, when
the supreme law, the public health, is neglected?
What comfort in the thought of a people enjoying
great material prosperity when we know that the
primary elements of life (on which even the old
Romans were our masters) are denied to them?
What consolation does the ' little red school- house '
afford when we know that a Lethean apathy allows
toll to be taken of every class, from the little tots
to the youths and maidens ? Western civilization
has been born of knowledge, of knowledge won by
hard, honest sweat of body and brain, but in many of
the most important relations of life we have failed to
make that knowledge effective. And, strange irony
of life, the lesson of human efficiency is being

OF MEDICINE 205

taught us by one of the little nations of the earth,
which has so far bettered our instruction that we
must again turn eastward for wisdom. Perhaps in
a few years our civilization may be put on trial,
and it will not be without benefit if it arouses the
individual from apathy and makes him conscious
of the great truth that only by earnest individual
human effort can knowledge be made effective, and
if it arouses communities from an apathy which
permits mediaeval conditions to prevail without a
protest. 4l

Against our third great foe — vice in all its forms — we Vice,
have to wage an incessant warfare, which is not less
vigorous because of the quiet, silent kind. Better than
any one else the physician can say the word in season
to the immoral, to the intemperate, to the unchari-
table in word and deed. Personal impurity is the evil
against which we can do most good, particularly to
the young, by showing the possibility of the pure life
and the dangers of immorality. Had I time, and
were this the proper occasion, I would like to rouse
the profession to a sense of its responsibility toward
the social evil — the black plague which devastates the
land. I can but call your attention to an important
society, of which Dr. Prince Morrow of New York
is the organizer, which has for one of its objects the
education of the public on this important question.
I would urge you to join in a crusade quite
as important as that in which we are engaged
against tuberculosis. 4l

206

THE PRACTITIONER

Humility.
Confidence.

Just pride
and hope.

To each one of you the practice of medicine will
be very much as you make it — to one a worry,
a care, a perpetual annoyance ; to another, a daily
joy and a life of as much happiness and usefulness
as can well fall to the lot of man, because it is
a life of self-sacrifice and of countless opportu-
nities to comfort and help the weak-hearted,
and to raise up those that fall. In the student
spirit you can best fulfil the high mission of our
noble calling — in his humility, conscious of weak-
ness, while seeking strength; in his confidence,
knowing the power while recognizing the limita-
tions of his art ; in his pride in the glorious heritage
from which the greatest gifts to man have been
derived ; and in his sure and certain hope that
the future holds for us still richer blessings than
the past. 45

Mental in- Jn no single relation of life does the general
practitioner show a more illiberal spirit than in the
treatment of himself. I do not refer so much to
careless habits of living, to lack of routine, or to
failure to pay due attention to the business side
of the profession — sins which so easily beset him —
but I would speak of his failure to realize, first, the
need of a lifelong progressive personal training;
and secondly, the danger lest in the stress of practice
he sacrifice the most precious of all possessions, his
mental independence. 23

Self- Self-satisfaction, a frame of mind widely diffused,

satisfaction. js manifest often in greatest intensity where it should

OF MEDICINE 207

be least encouraged, and in individuals and com-
munities is sometimes so active on such slender
grounds that the condition is comparable to the
delusions of grandeur in the insane. 26

&

There are men who have never had the preliminary Experience,
education which would enable them to grasp the
fundamentals of the science on which medicine is
based. Others have had poor teachers, and have never
received that bent of mind which is the all -important
factor in education ; others again fall early into the
error of thinking that they know it all, and bene-
fiting neither by their mistakes nor by their successes,
miss the very essence of all experience, and die
bigger fools, if possible, than when they started. 25

$

Experience, in the true sense of the term, does
not come to all . with years, or with increasing
opportunities. Growth in the acquisition of facts
is not necessarily associated with development.
Many grow through life as the crystal, by simple
accretion, and at fifty possess, to vary the figure,
the unicellular mental blastoderm with which they

started. 26

v

Chauvinism in the unit, in the general practitioner, Chauvinism
is of much more interest and importance. It is *** the
amusing to read and hear of the passing of the Practltloner-
family physician. There never was a time in our
history in which he was so much in evidence, in
which he was so prosperous, in which his prospects
were so good or his power in the community so

208

THE PRACTITIONER

potent. The public has even begun to get senti-
mental over him. He still does the work ; the
consultants and the specialists do the talking and
the writing, and take the fees. By the work, I mean
the great mass of routine practice which brings the
doctor into every household in the land and makes
him, not alone the adviser, but the valued friend.
He is the standard by which we are measured.
What he is, we are ; and the estimate of the pro-
fession in the eyes of the public is their estimate of
him. A well-trained, sensible doctor is one of the
most valuable assets of a community, worth to-day,
as in Homer's time, many another man. To make
him efficient is our highest ambition as teachers, to
save him from evil should be our constant care as
a guild. 23

The general The circumstances of life mould him (the family
practitioner, physician) into a masterful, self-confident, self-
centred man, whose worst faults often partake of
his best qualities. 23

The isola- Few men live lives of more devoted self-sacrifice
nofprac- than the family physician, but he may become so
completely absorbed in work that leisure is un-
known ; he has scarce time to eat or sleep, and, as
Dr. Drummond remarks in one of his poems, ' He.
is the only man, I know me, don't get no holiday.'
There is danger in this treadmill life lest he lose
more than health and time and rest — his intellectual
independence. More than most men he feels the
tragedy of isolation — that inner isolation so well

OF MEDICINE 209

expressed in Matthew Arnold's line, 'We mortal
millions live alone.' 23

Even in populous districts the practice of medicine The lonely
is a lonely road which winds uphill all the way, road<
and a man may easily go astray and never reach
the Delectable Mountains unless he early finds those
shepherd guides of whom Bunyan tells, Knowledge,
Experience, Watchful, and Sincere. 23

At times, and in degrees differing with our tempera-
ments, there come upon us bouts of depression,
when we feel that the battle has been lost, and that
to fight longer is not worth the effort, periods when,
amid the weariness, the fever, and the fret of daily
practice, things have gone against us; we have
been misunderstood by patients, our motives have
been wrongly interpreted, and smitten perhaps in
the house of our friends, the worries of heart, to
which we doctors are so subject, make us feel
bitterly the uncertainties of medicine as a profession,
and at times make us despair of its future. In
a voice that one may trust, Bartlett concludes his
inquiry with these memorable words, which I quote,
in the hope that they may soothe the heartache of
any pessimistic brother : —

'There is no process which can reckon up the Words to
amount of good which the science and art of soothe the
medicine have conferred upon the human race; heartache-
there is no moral calculus that can grasp and
comprehend the sum of their beneficent operations.

p

210 THE PRACTITIONER

Ever since the first dawn of civilization and learning,
through

"The dark backward, and abysm of time,"

they have been the true and constant friends of the
suffering sons and daughters of men. Through
their ministers and disciples, they have cheered the
desponding ; they have lightened the load of human
sorrow; they have dispelled or diminished the gloom
of the sick-chamber ; they have plucked from the
pillow of pain its thorns, and made the hard couch
soft with the poppies of delicious rest ; they have
let in the light of joy upon dark and desolate
dwellings ; they have rekindled the lamp of hope
in the bosom of despair ; they have called back the
radiance of the lustreless eye and the bloom of
the fading cheek ; they have sent new vigour through
the failing limbs ; and, finally, when exhausted in
all their other resources, and baffled in their skill —
handmaids of philosophy and religion — they have
blunted the arrows of death, and rendered less
rugged and precipitous the inevitable pathway to
the tomb. In the circle of human duties, I do not
know of any, short of heroic and perilous daring,
or religious martyrdom and self-sacrifice, higher
and nobler than those of the physician. His daily
round of labour is crowded with beneficence, and
his nightly sleep is broken, that others may have
better rest. His whole life is a blessed ministry of
consolation and hope.' 4z

Fate. Alike in that you are men, and white, you are

unlike in your features, very unlike in your minds
and in your mental training, and your teachers will
mourn the singular inequalities in your capacities.
And so it is sad to think will be your careers ; for

OF MEDICINE 21 1

one success, for another failure ; one will tread the
primrose path to the great bonfire, another the
straight and narrow way to renown ; some of
the best of you will be stricken early on the road,
and will join that noble band of youthful martyrs
who loved not their lives to the death ; others,
perhaps the most brilliant among you, like my old
friend and comrade, Dick Zimmerman (how he
would have rejoiced to see this day !), the fates will
overtake and whirl to destruction just as success
seems assured. When the iniquity of oblivion has
blindly scattered her poppy over us, some of you
will be the trusted counsellors of this community,
and the heads of departments of this faculty ; while
for the large majority of you, let us hope, is
reserved the happiest and most useful lot given to
man — to become vigorous, whole-souled, intelligent,
general practitioners. 24

In a play of Oscar Wilde's one of the characters Success
remarks, ' There are only two great tragedies in life,
not getting what you want— and getting it ! ' and
I have known consultants whose treadmill life
illustrated the bitterness of this mot^ and whose
great success at sixty did not bring the success they
had anticipated at forty. The mournful echo of the
words of the preacher rings in their ears, words
which I not long ago heard quoted with deep feel-
ing by a distinguished physician : * Better is an
handful with quietness, than both the hands full
with travail and vexation of spirit.'6

P2

212

THE PRACTITIONER

Poll the successful consulting physicians of this
country to-day, and you will find that they have
evolved either from general practice or from
laboratory and clinical work; and many of the
most prominent have risen from the ranks of
general practitioners. 6

tf

This is, of course, a very full programme, but in
ten years a bright man, with what Sydenham calls
4 the ancient and serious diligence of Hippocrates,'
will pick up a very fair education, and will be fit to
pass from the dispensary to the wards. 6

$

Ten years' hard work tells with colleagues and
friends in the profession, and with enlarged clinical
faculties the physician enters upon the second, or
bread-and-butter period. This, to most men, is the
great trial, since the risks are greater, and many
now drop out of the race, wearied at the length
of the way, and drift into specialism or general
practice. 6

tf

The physician develops more slowly than the
surgeon, and success comes later. There are
surgeons at forty years in full practice and at the
very top of the wave, a time at which the physician
is only preparing to reap the harvest of years of
patient toil. The surgeon must have hands, and
better, young hands. 6

tf

At the end of twenty years, when about forty-five,
our Lydgate should have a first-class reputation in

OF MEDICINE 213

the profession, and a large circle of friends and brain is his

students. He will probably have precious little ^P1^1-

capital in the bank, but a very large accumulation

of interest-bearing funds in his brain-pan. He has

gathered a stock of special knowledge which his

friends in the profession appreciate, and they begin

to seek his counsel in doubtful cases, and gradually

learn to lean upon him in times of trial. He may

awake some day, perhaps quite suddenly, to find

that twenty years of quiet work, done for the love

of it, has a very solid value. 6

&
In looking over my notes I find certain cases in Thecon-

which the visit has been of vital moment to the sultant and
„ . , . ,. . , . . theconsu'ta-

patient, usually in making a diagnosis, upon which tion .

successful treatment directly depended, as in

myxoedema or pernicious anaemia. In a very

much larger number there has been some important

suggestion to make, either in prognosis or in the

management of the case ; while in others the chief

value of the consultation has been in a reasonable

talk with the patient about his condition, with

assurance that there was nothing serious, and

general advice as to mode of life and diet. Coleridge

somewhere remarks that when a man is vaguely ill

the talk of a doctor about the nature of his malady

tones him down and consoles. It is very true, and

to tone down and console are important functions his function.

of professional advisers.

There is a group of cases in which the physician
seeks counsel on account of some special obscurity
in the disease, an obscurity which may not be

214

THE PRACTITIONER

lightened by the consultant after the most careful
scrutiny. Not to receive the positive information
they seek is often a great disappointment to both
doctor and patient, but we must remember that
there are — changing slightly Sir Thomas Browne's
phraseology — cases indissoluble in physic, and
a diagnosis is not possible in every instance.
Frankly to confess ignorance is often wiser than to
beat about the bush with a hypothetical diagnosis.
A consultant's life is not without unpleasant
features, chief among which is the passing of judge-
ment on the unhappy incurables — on the cancerous,
ataxies, and paralytics, who wander from one city
to another. Few are able to receive the balm of
truth, but now and again one meets with a cheery,
brave fellow, who insists upon a plain, unvarnished
statement of his prospects. Still more distressing
are the instances of hopeless illness in which, usually
for the friends' sake, the entire * faculty ' is sum-
moned. Is there anything more doleful than the
procession of four or five doctors into a sick man's
room ? Who does not appreciate Matthew Arnold's
wish —

4 Nor bring to see me cease to live

Some doctor full of phrase and fame,
To shake his sapient head, and give
The ill he cannot cure a name ' ?

How often under such circumstances has the
bitterness of the last line recurred to me ! Oliver
Wendell Holmes, in the Memorial History of
Boston, speaking of two of the leading physicians
of the early part of the century, says, 1 1 used often

OF MEDICINE 215

to hear him (Dr. Danforth) spoken of as being-
called in " consultation," as the extreme unction of
the healing art is called. If " old Dr. Danfurt " or
" old Dr. Jeffers " were seen entering a sick man's
door it was very likely to mean nothing more nor
less than a nunc dimittis! Tis not pleasant to
think that pallida mors so often treads upon
our heels.

There is nothing new under the sun, and the
common practice of friends who, wishing to leave
nothing undone, call in a batch of consultants is
by no means modern. In the delightful lectures
on Latin Poetry, delivered in 1893 at the Johns
Hopkins University, Professor Tyrrell, of Dublin,
quoted a long passage from the Satyricon of
Petronius. The friends were discussing poor v

Chrysanthus, who had just * slipped his wind.'
Seleucus says, 4 And it is not as if he hadn't tried
the fasting cure. For five days neither bit nor sup
passed his lips, and yet he's gone. Too many
doctors did for him, or else it was to be. A doctor 's
really no use except to feel you did the right thing.'
The last sentence might have come from George
Eliot or George Meredith.

The value of careful note -taking is recognized by Note-taking
most consultants. I know, however, several men in ^d
large practice who have discarded it as altogether quired,
too onerous, and as taking up much more time than
it is worth. The material which an active consultant
may collect in a long life is enormous. The late
Austin Flint's notes cover 16,922 folio pages, all
written with his own hand. The late Palmer Howard

2l6 THE PRACTITIONER

constantly lamented that the leisure never came in
which he could work over the clinical records
which he had so faithfully kept for so many
years.

A case cannot be satisfactorily examined in less
than half an hour, unless the notes have been taken
previously by an assistant, a plan which consultants
in very large practice might adopt more widely.
A sick man likes to have plenty of time spent over
him, and he gets no satisfaction in a hurried ten or
twelve minutes' examination. If one never saw a
patient the second time, notes might be superfluous,
but can anything be more embarrassing in a return
visit than to have forgotten name, face, malady,
everything ? At such a moment well- indexed notes
are worth their weight in gold. Last year I had
a notable illustration of the value of memoranda,
however slight. Dr. Bray, of Chatham, brought
a patient, whom from certain peculiarities I remem-
bered at once, though nearly twelve years had
elapsed since I had seen him. In 1883 he had, at
Dr. Bray's suggestion, consulted me in Montreal.
Fortunately I was able to lay my hands at once on
the notes of the case. The point of interest in 1883
was whether the impotence was an early tabetic
symptom, an opinion favoured by Dr. Jewell, of
Chicago, and by a New York specialist whose name
I do not remember. In the twelve years the patient's
condition had remained unchanged, and many of
the symptoms which he thought were of recent
origin had been present at his first visit. Neither
the patient nor Dr. Bray had any recollection of

OF MEDICINE 217

a previous consultation with me, of the truth of
which only my notes convinced them.

The histories may be taken very conveniently on
the cards of the Boston Library Bureau, and filed
away alphabetically. I have had much comfort
since the adoption of this plan. It is a great saving
of time and labour to dictate the condition of the
patient to a secretary, who can (if the arrangement
of the consulting- rooms is not convenient) be
secluded behind a screen. She can afterwards add
the notes to the card on which the history has been
taken.

For several years I have adopted the plan of
dictating at odd times abstracts of the histories of
special cases and filing them in order ready for
publication. In this way, when noting carefully
during the session of 1892-3 all the cases of
abdominal tumour which came before me for dia-
gnosis, I had, in October, 1893, when I began the
series of lectures which have been published, all
the cases type-written and ready. It has always Value of
been a regret to me that I had not learned steno-
graphy, which Sir William Gowers has found so
serviceable, and the use of which in medical work
he has advocated so warmly. 47

&
The environment of a large city is not essential to The con-

the growth of a good clinical physician. Even in sultant in

it -r i t. • • i_- 1. smaller

small towns a man can, if he has it in him, become towns.

well versed in methods of work, and with the assist-
ance of an occasional visit to some medical centre
he can become an expert diagnostician and reach

2l8 THE PRACTITIONER OF MEDICINE

a position of dignity and worth in the community
in which he lives. 6

I wish to plead particularly for the wasted
opportunities in the smaller hospitals of our large
cities, and in those of more moderate size. There
are in this State a score or more of hospitals with
from thirty to fifty medical beds, offering splendid
material for good men on which to build reputa-

CUPID AND MARRIAGE

« A young man married is a man that 's marred.'

(Shakespeare.)

'Nought beneath the sky

More sweet, more worthy is than firm consent
Of man and wife in household government.'

(Odyssey, Chapman's translation.)

220 CUPID AND

So truly as a young- man married is a young man
marred is a woman unmarried, in a certain sense,
a woman undone. l5

tf

Hopeless To the worries of uncertain health and greatly
passion. embarrassed affairs there were added, in the summer
of 1 8 10, the pangs, one can hardly say of disprized,
but certainly of hopeless love. Writing to his
friend Reynolds, March 3, 1818, in comparing life
to a large mansion of many apartments, Keats says
pathetically that he could only describe two ; the
first, the Infant or Thoughtless Chamber, in which
we remain as long as we do not think ; and the
second, the Chamber of Maiden-Thought, in which
we first become intoxicated with the light and
atmosphere, until it gradually darkens and we see
not well the exit and we feel the 4 burden of the
mystery.' For his friends he hopes the third
Chamber of Life may be filled with the wine of
love and the bread of friendship. Poor fellow!
Within a year the younger Aphrodite, in the shape
of Fanny Brawne, beckoned to him from the door
of the third chamber. Through her came no
peace to his soul, and the Muses' inspiration was
displaced by a passion which rocked him as the
' winds rock the ravens on high ' — by Plato's fourth
variety of madness, which brought him sorrow and
'leaden-eyed Despair.' l8

tf

Emotions on How shall he (the young physician) live mean-
while ? On crumbs — on pickings obtained from
men in the cakes-and-ale stage (who always can

MARRIAGE 221

put paying work into the hands of the young men),
and on fees from some classes, journal work, private
instruction, and from work in the schools. Any
sort of medical practice should be taken, but with
caution— too much of it early may prove a good
man's ruin. He cannot expect to do more than just
eke out a living. He must put his emotions on
ice ; there must be no * Amaryllis in the shade,' and
he must beware the tangles of ' Neaera's hair.' 6

&

Another potent cause of worry is an idolatry by The two
which many of you will be sore let and hindered. S°ddesses-
The mistress of your studies should be the heavenly
Aphrodite, the motherless daughter of Uranus.
Give her your whole heart, and she will be your
protectress and friend. A jealous creature, brook-
ing no second, if she finds you trifling and coquet-
ting with her rival, the younger, earthly Aphrodite,
daughter of Zeus and Dione, she will whistle you
off and let you down the wind to be a prey, perhaps
to the examiners, certainly to the worm Regret. In
plainer language, put your affections in cold storage
for a few years, and you will take them out ripened,
perhaps a little mellow, but certainly less subject to
those frequent changes which perplex so many
young men. Only a grand passion, an all-absorb-
ing devotion to the elder goddess, can save the
man with a congenital tendency to philandering,
the flighty Lydgate who sports with Celia and
Dorothea, and upon whom the judgement ulti-
mately falls in a basil-plant of a wife like
Rosamond. 24

WORK

THE MASTER-WORD

It seems a bounden duty on such an occasion to be honest
and frank, so I propose to tell you the secret of life as
I have seen the game played, and as I have tried to play
it myself. You remember in one of the Jungle Stories that
when Mowgli wished to be avenged on the villagers he
could only get the help of Hathi and his sons by sending
them the master-word. This I propose to give you in the
hope, yes, in the full assurance, that some of you at least
will lay hold upon it to your profit. Though a little one,
the master- word looms large in meaning. It is the « Open
Sesame ' to every portal, the great equalizer in the world,
the true philosopher's stone which transmutes all the base
metal of humanity into gold. The stupid man among you
it will make bright, the bright man brilliant, and the
brilliant student steady. With the magic word in your heart
all things are possible, and without it all study is vanity
and vexation. The miracles of life are with it ; the blind
see by touch, the deaf hear with eyes, the dumb speak with
fingers. To the youth it brings hope, to the middle-aged
confidence, to the aged repose. True balm of hurt minds,
in its presence the heart of the sorrowful is lightened and
consoled. It is directly responsible for all advances in
medicine during the past twenty-five centuries. Laying
hold upon it Hippocrates made observation and science the
warp and woof of our art. Galen so read its meaning that
fifteen centuries stopped thinking, and slept until awakened
by the De Fabrica of Vesalius, which is the very incarnation
of the master- word. With its inspiration Harvey gave an
impulse to a larger circulation than he wot of, an impulse
which we feel to-day. Hunter sounded all its heights and
depths, and stands out in our history as one of the great
exemplars of its virtue. With it Virchow smote the rock,
and the waters of progress gushed out ; while in the hands
of Pasteur it proved a very talisman to open to us a new
heaven in medicine and a new earth in surgery. Not only
has it been the touchstone of progress, but it is the measure
of success in everyday life. Not a man before you but is
beholden to it for his position here, while he who addresses
you has the honour directly in consequence of having had
it graven on his heart when he was as you are to-day.
And the master-word is WORK. 2<

A relish for
work.

224 WORK

I was much interested the other day in reading
a letter of John Locke to the Earl of Peterborough,
who had consulted him about the education of his
son. Locke insisted that the main point in educa-
tion is to get ' a relish of knowledge. This is
putting life into a pupil.' Get early this relish,
this clear, keen enjoyance in work, with which
languor disappears and all shadows of annoyance
flee away. l3

Haste. Fevered haste is not encouraged in military circles,

and if you can adapt your intellectual progress
to army rules, making each step in your mental
promotion the lawful successor of some other, you
will acquire little by little those staying powers
without which no man is of much value in the

ranks. 26

<?

Ohne Hast, Success during the first ten years means endurance
ohne Rast. ancj perseverance • an things come to him who has
learned to labour and to wait, who bides his time
ohne Hast, aber ohne Rast, whose talent develops
in der Stille, in the quiet fruitful years of unselfish
work. 6

Live for the As to the method of w^ork, I have a single bit
daY- of advice, which I give with the earnest conviction

of its paramount influence in any success which
may have attended my efforts in life — Take no
thought for the morrow. Live neither in the
past nor in the future, but let each day's work

WORK 225

absorb your entire energies, and satisfy your widest
ambition. l3

The student who is worrying about his future,
anxious over the examinations, doubting his fitness
for the profession, is certain not to do so well as
the man who cares for nothing but the matter in
hand, and who knows not whither he is going. l3

Throw away, in the first place, all ambition beyond The day's
that of doing the day's work well. 26 work*

The travellers on the road to success live in the
present, heedless of taking thought for the morrow,
having been able at some time, and in some form or
other, to receive into their heart of hearts this
maxim of the Sage of Chelsea: Your business
is 4 not to see what lies dimly at a distance, but to
do what lies clearly at hand.' 26

Another aspect of the life of the army surgeon, Isolation,
isolation in some degree from professional col-
leagues, will influence you in different ways —
hurtfully in the more dependent natures, helpfully
in those who have learned that * not from without
us, only from within, comes, or can ever come,
upon us light'— and to such the early years of
separation from medical societies and gatherings
will prove a useful seed-time for habits of study,
and for the cultivation of the self-reliance that
forms so important an element in the outfit of
the practitioner.26

226 WORK

In the history of the profession there are grounds
for the statement that isolation promoted originality.
Some of the most brilliant work has been done by
men in extremely limited spheres of action, and
during the past hundred years it is surprising how
many of the notable achievements have been made
by physicians dwelling far from educational cen-
tres. Jenner worked out his discovery in a village ;
McDowell, Long, and Sims were country doctors ;
Koch was a district physician. 26

tf

Industry He (Bassett) was very much impressed by the inces-
essentialat sant industry of the French physicians. He says: —

4 When I look at some of the medical men
by whom I am surrounded, it makes me blush for
shame ; old men daily may be seen mixing their
white locks with boys, and pursuing their profession
with the ardour of youth. There is not a solitary
great man in France that is idle, for if he were, that
moment he would be outstripped ; it is a race, and
there are none so far ahead that they are not pressed
by others ; many are distanced, it is true, but there
are none allowed to walk over the course. Witness
Broussais, lecturing and labouring daily to sustain
himself, after having elevated himself to the pin-
nacle; Lisfranc, an old bachelor with thousands,
who after having made his daily visit and lepon
for ten months for duty, during the vacation of two
months he from choice gives a course of operations ;
and old Rollier may be seen daily supporting him-
self from bedpost to bedpost as jolly as if he were
not far over sixty. Velpeau from a poor boy
without money, time, education, or friends has
by industry made himself one of the first surgeons
in Europe.' I2

WORK 227

A few words in addition about this dry-bread Out-patient
decade. He should stick closely to the dispen-
saries. A first-class reputation may be built up in
them. Byrom BramwelTs Atlas of Medicine
largely represents his work while an assistant phy-
sician to the Royal Infirmary, Edinburgh. Many
of the best-known men in London serve ten,
fifteen, or even twenty years in the out-patient
departments before getting wards. Lauder Brun-
ton only obtained his full physicianship at St.
Bartholomew's after a service of more than twenty
years in the out-patient department.6

$

Faithfulness in the day of small things will insensi- The small
bly widen your powers, correct your faculties ; and, fidd-
in moments of despondency, comfort may be de-
rived from a knowledge that some of the best work
of the profession has come from men whose clinical
field was limited but well tilled. 26

&

The important thing is to make the lesson of
each case tell on your education. The value of ex-
perience is not in seeing much, but in seeing
wisely. *

^>

How can you take the greatest possible advantage System,
with the least possible strain ? By cultivating
system. I say cultivating advisedly, since some
of you will find the acquisition of systematic habits
very hard. There are minds congenitally sys-
tematic ; others have a lifelong fight against an
inherited tendency to diffuseness and carelessness

Q2

228 WORK

in work. A few brilliant fellows have to dispense
with it altogether, but they are a burden to their
brethren and a sore trial to their intimates. I have
heard it remarked that order is the badge of an
ordinary mind. So it may be, but as practitioners
of medicine we have to be thankful to get into that
useful class. Let me entreat those of you who are
here for the first time to lay to heart what I say on
this matter. Forget all else, but take away this
counsel of a man who has had to fight a hard battle,
and not always a successful one, for the little order
he has had in his life ; take away with you a pro-
found conviction of the value of system in your
work. I appeal to the freshmen especially, because
you to-day make a beginning, and your future
career depends very much upon the habits you will
form during this session. To follow the routine
of the classes is easy enough, but to take routine
into every part of your daily life is a hard task.
Some of you will start out joyfully as did Christian
and Hopeful, and for many days will journey safely
towards the Delectable Mountains, dreaming of
them, and not thinking of disaster until you find
yourselves in the strong captivity of Doubt and
under the grinding tyranny of Despair. You have
been over- confident. Begin again more cautiously.
No student escapes wholly from these perils and
trials ; be not disheartened, accept them. Let each
hour of the day have its allotted duty, and cultivate
that power of concentration which grows with its
exercise, so that the attention neither flags nor
wavers, but settles with a bull-dog tenacity on

WORK 229

the subject before you. Constant repetition makes
a good habit fit easily in your mind, and by the
end of the session you may have gained that most
precious of knowledge — the power to work. Do
not under- estimate the difficulty you will have
in wringing from your reluctant selves the stern
determination to exact the uttermost minute on
your schedule. Do not get too interested in one
study at the expense of another, but so map out
your day that due allowance is given to each.
Only in this way can the average student get the
best that he can out of his capacities. And it is
worth all the pains and trouble he can possibly
take for the ultimate gain, if he can reach his
doctorate with system so ingrained that it has
become an integral part of his being. 24

*
Ask of any active business man or a leader in

a profession the secret which enables him to accom-
plish much work, and he will reply in one word,
system ; or as I shall term it, the virtue of method,
the harness without which only the horses of genius

travel. 22

9

There are two aspects of this subject ; the first
relates to the orderly arrangement of your work,
which is to some extent enforced by the roster
of demonstrations and lectures, but this you will do
well to supplement in private study by a schedule
in which each hour finds its allotted duty. 22

9
Thus faithfully followed day by day, system may

become at last engrained in the most shiftless

230 WORK

nature, and at the end of a semester a youth of
moderate ability may find himself far in advance
of the student who works spasmodically, and trusts
to cramming. 22

tf

The incessant and irregular demands upon a
busy doctor make it (system) very difficult to
retain, but the public in this matter can be educated,
and the men who practise with system, allotting
a definite time of the day to certain work, accom-
plish much more and have at any rate a little
leisure; while those who are unmethodical never
catch up with the day's duties and worry themselves,
their confreres, and their patients. 22

tf

The secret of successful working lies in the
systematic arrangement of what you have to do,
and in the methodical performance of it. With
all of you this is possible, for few disturbing ele-
ments exist in the student's life to interrupt the
allotted duty which each hour of the day should
possess. Make out, each one for himself, a time-
table, with the hours of lecture, study, and re-
creation, and follow closely and conscientiously the
programme there indicated. I know of no better
way to accomplish a large amount of work, and
it saves the mental worry and anxiety which will
surely haunt you if your tasks are done in an
irregular and desultory way, With too many,
unfortunately, working habits ar.e not cultivated
until the constraining dread of an approaching
examination is felt, when the hopeless attempt

WORK 231

is made to cram the work of two years into a six
months' session with results only too evident to
your examiners. 3l

$

With Laurence Sterne, we can afford to pity Routine;
such, since they know not that the barrenness of itsvalue-
which they complain is within themselves, a result
of a lack of appreciation of the meaning and method
of work. 26

$

Let nothing slip by you ; the ordinary humdrum
cases of the morning routine have been accurately
described and pictured, but study each one sepa-
rately as though it were new — so it is, so far as
your special experience goes ; and if the spirit
of the student is in you the lesson will be there. 26

&

Look at the cases not from the standpoint of
textbooks and monographs, but as so many stepping-
stones in the progress of your individual develop-
ment in the art. This will save you from the
pitiable mental attitude of the men who travel from
Dan to Beer-sheba, and at every step cry out upon
its desolation, its dreariness, and its monotony. 26

&

Has work no dangers connected with it? What Dangers of
of this bogie of overwork of which we hear so work-
much ? There are dangers, but they may readily
be avoided with a little care. I can only mention
two, one physical, one mental The very best
students are often not the strongest. Ill- health, the

232 WORK

bridle of Theages, as Plato called it in the case of
one of his friends whose mind had thriven at the
expense of his body, may have been the diverting
influence towards books or the profession. Among
the good men who have studied with me there
stands out in my remembrance many a young
Lycidas, ' dead ere his prime,' sacrificed to careless-
ness in habits of living and neglect of ordinary
sanitary laws. Medical students are much exposed
to infection of all sorts, to combat which the body
must be kept in first-class condition. Grossteste,
the great Bishop of Lincoln, remarked that there
were three things necessary for temporal salvation
— food, sleep, and a cheerful disposition. Add to
these suitable exercise and you have the means by
which good health may be maintained. Not that
health is to be a matter of perpetual solicitation,
but habits which favour the corpus sanum foster
the mens Sana, in which the joy of living and the
joy of working are blended in one harmony. Let
me read you a quotation from old Burton, the great
authority on morbi eruditorum : —

4 There are many reasons why students dote more
often than others. The first is their negligence ;
other men look to their tools ; a painter will wash
his pencils ; a smith will look to his hammer, anvil,
forge; a husbandman will mend his plough -irons,
and grind his hatchet if it be dull ; a falconer or
huntsman will have an especial care of his hawks,
hounds, horses, dogs, &c. ; a musician will string
and unstring his lute, &c. ; only scholars neglect
that instrument, their brain and spirits (I mean),
which they daily use. 24

WORK 233

Much study is not only believed to be a weariness Worry,
of the flesh, but also an active cause of ill -health of
mind, in all grades and phases. I deny that work,
legitimate work, has anything to do with this. It
is that foul fiend Worry who is responsible for the
majority of the cases. The more carefully one
looks into the cause of the nervous breakdown in
students, the less important is work per se as
a factor. There are a few cases of genuine
overwork, but they are not common. Of the
causes of worry in the student life there are three
of prime importance to which I may briefly
refer.

An anticipatory attitude of mind, a perpetual
forecasting, disturbs the even tenor of his way and
leads to disaster. Years ago a sentence in one of
Carlyle's essays made a lasting impression on me :
* Our duty is not to see what lies dimly at a distance,
but to do what lies clearly at hand.' I have long
maintained that the best motto for a student is,
4 Take no thought for the morrow.' Let the day's
work suffice ; live for it, regardless of what the future
has in store, believing that to-morrow should take
thought for the things of itself. There is no such
safeguard against the morbid apprehensions about
the future, the dread of examinations and the doubt
of ultimate success. Nor is there any risk that such
an attitude may breed carelessness. On the contrary,
the absorption in the duty of the hour is in itself
the best guarantee of ultimate success. ' He that
observeth the wind shall not sow ; and he that
regardeth the clouds shall not reap,' which means

234

WORK

that you cannot work profitably with your mind
set upon the future. 24

tf

Banish the future ; live only for the hour and its
allotted work. Think not of the amount to be
accomplished, the difficulties to be overcome, or
the end to be attained, but set earnestly at the little
task at your elbow, letting that be sufficient for
the day ; for surely our plain duty is, ' Not to see
what lies dimly at a distance, but to do what lies
clearly at hand ' (Carlyle). 3l

tf

In the worry and strain of modern life, arterial
degeneration is not only very common, but occurs
often at a relatively early age. For this the high
pressure at which men live, and the habit of
working the machine to its maximum capacity, are
responsible, rather than excesses in eating and
drinking, or than any special prevalence of syphilis.
Angio-sclerosis, creeping on slowly but surely,
' with no pace perceived,' ' is the Nemesis through
which Nature exacts retributive justice for the trans-
gression of her laws — coming to one as an apoplexy,
to another as an early Bright 's disease, to a third
as an aneurism, and to a fourth as angina pectoris ;
too often slitting lthe thin -spun life' in the fifth
decade at the very time when success seems assured.
Nowhere do we see such an element of tragic
sadness as in many of these cases. A man who
has early risen and late taken rest, who has eaten
the bread of carefulness, striving for success in
commercial, professional, or political life, after

WORK 235

twenty-five or thirty years of incessant toil reaches
the point where he can say, perhaps with just
satisfaction, 'Soul, thou hast much goods laid up
for many years, take thine ease,' all-unconscious
that the fell sergeant has already issued the warrant.
How true to life is Hawthorne in The House of the
Seven Gables \ To Judge Pyncheon, who had ex-
perienced a mere dimness of sight and a throbbing
at the heart — nothing more — and in whose grasp
was the meed for which he had * fought, and toiled,
and climbed, and crept ' ; — to him, as he sat in the
old oaken chair of his grandfathers, thinking of
the crowning success of his life, so near at hand, the
avenger came through the arteries. 28

&

While medicine is to be your vocation or calling, Need of an
see to it that you have also an avocation — some avocation»
intellectual pastime which may serve to keep you
in touch with the world of art, of science, or of
letters. Begin at once the cultivation of some
interest other than the purely professional. The \
difficulty is in a selection, and the choice will be ^
different according to your tastes and training. No
matter what it is, have an outside hobby. For the
hard-working medical student it is easier perhaps
to keep up an interest in literature. Let each
subject in your year's work have a corresponding
outside author. When tired of anatomy refresh
your minds with Oliver Wendell Holmes after
a worrying subject in physiology, turn to the great
idealists, to Shelley or to Keats, for consolation ;
when chemistry distresses your soul, seek peace in

WORK

the great pacifier, Shakespeare ; ten minutes with
Montaigne will lighten the burden. I?

But do not get too deeply absorbed to the exclusion
of all outside interests. Success in life depends as
much upon the man as upon the physician. Mix
with your fellow students, mingle with their sports
and their pleasures. You are to be members of
a polite as well as of a liberal profession, and the
more you see of life outside the narrow circle of
your work the better equipped will you be for the
struggle. I often wish that the citizens in our large
educational centres would take a little more interest
in the social life of the students, many of whom
catch but few glimpses of home life during their

course.

i3

By nature man is the incarnation of idleness, which
quality alone, amid the ruined remnants of Edenic
characters, remains in all its primitive intensity. *2

For better or worse, there are few occupations of
a more satisfying character than the practice of
medicine, if a man can but once get orientirt and
bring to it the philosophy of honest work, the
philosophy that insists that we are here, not to get
all we can out of life about us, but to see how much
we can add to it. The discontent and grumblings
which one hears have their source in the man more
often than in his environment. l6

WORK 237

Occasionally a man of superlative merit is neglected, Failure,
but it is because he lacks that most essential gift,
the knowledge how to use his gifts. The failure in
99 per cent, of the cases is in the man himself; he
has not started right, the poor chap has not had ^/
the choice of his parents, or his education has
been faulty, or he has fallen away to the worship
of strange gods, Baal or Ashtoreth, or worse still,
Bacchus. But after all, the killing vice of the
young doctor is laziness. He may have worked
hard at college, but the years of probation have
been his ruin. Without specific subjects upon
which to work, he gets the newspaper or the novel
habit, and fritters his energies upon useless literature.
There is no greater test of a man's strength than
to make him mark time in the 4 stand and wait'
years. Habits of systematic reading are rare, and
are becoming more rare, and five or ten years from
his licence, as practice begins to grow, may find
the young doctor knowing less than he did when
started, and without fixed educational purpose in
life.16

MAN'S YEARS OF USEFULNESS AND
HOW HE MAY PROLONG THEM

«H y a beaucoup de vieillards a quarante ans et une
infinite de jeunes a soixante. ' (Laurens.)

240 MAN'S YEARS OF USEFULNESS AND

Conserva- Conservatism and old fogeyism are totally different
fogeyism ^ ^ings ; the motto of the one is, ' Prove all things,
and hold fast that which is good,' and of the other,
'Prove nothing, but hold fast that which is old.'
Do not suppose that you have here a monopoly of
the article;, which is a human, not a national,

/malady, for we see a very virulent type in America.
In its illusiveness, and in the disastrous consequences
which have often followed its hunting, old fogeyism
is a sort of Snark in the medical profession. Before
this Boojum, in the form of an entrenched variety,
many /good men and true have softly and silently
vanished away like the ' beamish ' nephew of the
bellman, sacrificed to intellectual staleness in high
places. One of the best correctives is the plan
followed at Harvard, which asks every teacher to
take the Sabbatical year, ensuring in this way rest
of the mind, if not refreshment. To maintain mental
freshness and plasticity requires incessant vigilance ;
too often, like the dial's hand, it steals from its
figure with no pace perceived — except by one's
friends, and they never refer to it. A deep and
an enduring interest in the manifold problems of
medicine, and a human interest in the affairs of our
brotherhood ; if these do not suffice nothing will. 2

The fossil- After all, no men among us need refreshment and
ized teacher, renovating more frequently than those who occupy
positions in our schools of learning. Upon none does
intellectual staleness more readily steal ' with velvet
step, unheeded, softly,' but none the less relentlessly.
Dogmatic to a greater or less degree all successful

HOW HE MAY PROLONG THEM 241

teaching must be, but year by year, unless watchful,
this very dogmatism may react upon the teacher,
who finds it so much easier to say to-day what he
said last year. After a decade he may find it less
trouble to draw on home supplies than to go into
the open market for wares, perhaps not a whit
better, but just a wee bit fresher. After twenty
years the new, even when true, startles, too often
repels ; after thirty — well, he may be out of the race,
still on the track perhaps, even running hard, but
quite unconscious that the colts have long passed
the winning-post. These unrefreshed, unregenerate
teachers are often powerful instruments of harm,
and time and again have spread the blight of blind
conservatism in the profession. Safely enthroned
in assured positions, men of strong and ardent
convictions, with faithful friends and still more
faithful students, they too often come within the
scathing condemnation of the blind leaders of the
blind, of those who would neither themselves enter
into the possession of new knowledge nor suffer
those who would to enter. The profession has
suffered so sorely from this blight of old fogeyism
that I may refer to the most glaring instance in
our history. In the scientific annals of this great
metropolis there is no occasion more memorable
than April 16, 1616, when Harvey began his re-
volutionary teaching. Why the long, the more
than Horatian delay, in publishing his great dis-
covery ? He knew his day and generation, and
even after twelve years of demonstration, which
should have disarmed all opposition, we know how

R

242 MAN'S YEARS OF USEFULNESS AND

coldly the discovery was received, particularly in
certain quarters. Harvey, indeed, is reported to
have said that he did not think any above forty
years of age had accepted the new truth. Many of
us have lived through and taken part in two other
great struggles. The din of battle over the germ
theory of disease still rings in our ears. Koch's
brilliant demonstration of the tuberculosis bacillus
had a hard uphill fight to recognition. The vested
interests of many minds were naturally against it,
and it was only the watchers among us, men like
Austin Flint, who were awake when the dawn
appeared. It is notorious that the great principles
of antiseptic surgery have grown slowly to accept-
ance, and nowhere more slowly than in the country
in which they were announced, the country which
has the great honour to claim Lord Lister as a
citizen. Old fogeyism of the most malignant type
stood in the way, and in some places, strange to
stay, still stands. 2

La crise de As Locke says : * Truth scarce ever yet carried
it by vote anywhere at its first appearance,' and
these well-known examples illustrate a law in
human knowledge that a truth has to grow to
acceptance with the generation in which it is an-
nounced. Progress is an outcome of a never-
ending struggle of the third and fourth decades
against the fifth, sixth, and seventh. Men above
forty are rarely pioneers, rarely the creators in
science or in literature. The work of the world
has been done by men who had not reached la

,

HOW HE MAY PROLONG THEM 243

crise de guarante ans. And in our profession
wipe out, with but few exceptions, the contributions
of men above this age and we remain essentially as
we are. Once across this line we teachers and
consultants are in constant need of post-graduate
study as an antidote against premature senility.
Daily contact with the bright young minds of our
associates and assistants, the mental friction of
medical societies, and travel are important aids.
Would you know the signs by which in man or
institution you may recognize old fogeyism ? There
are three: first, a state of blissful happiness and
contentment with things as they are ; secondly,
a supreme conviction that the condition of other
people and other institutions is one of pitiable
inferiority ; and thirdly, a fear of change, which
not alone perplexes but appals. 2

*

The teacher's life should have three periods: Three
study until twenty-five, investigation until forty, {^"teacher's
profession until sixty, at which age I would have life,
him retired on a double allowance. **

fc

Insensibly, in the fifth and sixth decades, there Presenility.
begins to creep over most of us a change, noted
physically among other ways in the silvering of
the hair and the lessening of elasticity, which
impels a man to open rather than to vault a five-
barred gate. 22

$>

Harvey complained in his day (1578-1657) that
few men above this critical age (forty) seemed able

R 2

244 MAN'S YEARS OF USEFULNESS AND

to accept the doctrine of the circulation of the
blood, and in our own time it is interesting to note
how the theory of the bacterial origin of certain
diseases has had, as other truths, to grow to accept-
ance with the generation in which it was announced.
The only safeguard in the teacher against this
lamentable condition is to live in, and with, the
third decade, in company with the younger, more
receptive and progressive minds. 22

When a man nor wax nor honey can bring home,
he should, in the interests of an institution, be dis-
solved from the hive to give more labourers room ;
though it is not every teacher who will echo the
sentiment —

4 Let me not live . . .
After my flame lacks oil, to be the snuff
Of younger spirits whose apprehensive senses
All but new things disdain.'

As we travel farther from the East, our salvation
lies in keeping our faces toward the rising sun,
and in letting the fates drag us, like Cacus his
oxen, backward into the cave of oblivion. 22

$

Walk with One thing may save him (from becoming useless in
the young. j^s advancing years). It was the wish of Walter
Savage Landor always to walk with Epicurus on
the right hand and Epictetus on the left ; and
I would urge the clinical physician, as he travels
farther from the East, to look well to his com-
panions—to see that they are not of his own age

HOW HE MAY PROLONG THEM 245

and generation. He must walk with the 'boys,'
else he is lost, irrevocably lost ; not all at once, but
by easy grades, and every one perceives his ruin
before he, ' good, easy man,' is aware of it. I would
not have him a basil plant, to feed on the brains of
the bright young men who follow the great wheel
uphill, but to keep his mind receptive, plastic, and
impressionable he must travel with the men who
are doing the work of the world, the men between
the ages of twenty-five and forty. 6

fc

After years of hard work, at the very time when The calm,
a man's energies begin to flag, and when he feels
the need of more leisure, the conditions and sur-
roundings that have made him what he is and that
have moulded his character and abilities into some-
thing useful in the community — these very circum-
stances ensure an ever-increasing demand upon
them ; and when the call of the East comes, which
in one form or another is heard by all of us, and
which grows louder as we grow older, the call may
come like the summons to Elijah, and not alone the
ploughing of the day, but the work of a life, friends,
relatives, even father and mother, are left, to take
up new work in a new field. Or, happier far, if
the call comes, as it did to Puran Das in Kipling's
story, not to new labours, but to a life * private,
unactive, calm, contemplative.' 44

RELIGION, DEATH, AND IMMORTALITY

« Life is a pure flame, and we live by an invisible sun
within us.'

' There is nothing strictly immortal, but immortality.
Whatever hath no beginning, may be confident of no end *
(all others have a dependent being and are within the reach
of destruction) ; « which is the peculiar of that necessary
Essence that cannot destroy itself; and the highest strain
of omnipotency, to be so powerfully constituted as not to
suffer even from the power of itself.' (Sir Thomas Browne,
tfydriotapbia-Urn Burial.)

248

RELIGION, DEATH

Science and And thirdly, every one of you will have to face
the ordeal of every student in this generation who
sooner or later tries to mix the waters of science
with the oil of faith. You can have a good deal of
both if you only keep them separate. The worry
comes from the attempt at mixture. As general
practitioners you will need all the faith you can
carry, and while it may not always be of the con-
ventional pattern, when expressed in your lives
rather than on your lips, the variety is not a bad
one from the standpoint of St. James; and may
help to counteract the common scandal alluded
to in the celebrated diary of that gossipy old
pastor-doctor, the Rev. John Ward : ( One told the
Bishop of Gloucester that he imagined physicians
of all other men the most competent judges of
affairs of religion, and his reason was because they
were wholly unconcerned with it.' 24

The pathos
of early
death.

Sudden
death.

All lovers of poetry cherish Keats's memory for the
splendour of the verse with which he has enriched
our literature. There is also that deep pathos
in a life cut off in the promise of such rich fruit.
He is numbered among 4 the inheritors of un-
fulfilled renown,' with Catullus and Marlowe, with
Chatterton and Shelley, whom we mourn as doubly
dead in that they died so young. l8

tf

' With what strife and pains we come into the
world we know not, but it is commonly no easy
matter to get out of it,' Sir Thomas Browne says ;
and, having regard to the uncertainties of the last

AND IMMORTALITY 249

stage of all, the average man will be of Caesar's
opinion, who, when questioned at his last dinner-
party as to the most preferable mode of death,
replied, ' That which is the most sudden.' Against
this, one in a string of grievous calamities, we pray
in the Litany, though De Quincey insists that the
meaning here is 4 unprepared.' In this sense sudden
death is rare in angina pectoris, since the end comes
but seldom in the first paroxysm. Terrible as are
some of these incidental conditions accompanying
coronary artery lesions, there is a sort of kindly
compensation, as in no other local disease do we so
often see the ideal death — death, like birth, * a sleep
and a forgetting/ *8

$

Angina Pectoris Vera, Heredity. The best-known Matthew
instance is that of the Arnold family. William
Arnold, collector of customs of Cowes, died sud-
denly of spasm of the heart in 1801. His son, the
celebrated Thomas Arnold, of Rugby, . . . died in
his first attack. Matthew Arnold, his distinguished
son, was a victim of the disease for several years,
and died suddenly in an attack on Sunday, April 15,
1 888, having been spared, as he hopes in his little
poem called A Wish, —

'the whispering, crowded room,
The friends who come, and gape, and go;
The ceremonious air of gloom —

All, which makes death a hideous show ! ' 28

^

Than the physician, no one has a better oppor- Thephysi-

cian ciiiu tn£
tunity to study the attitude of mind of his fellow problem.

25°

RELIGION, DEATH

men on the problem. Others, perhaps, get nearer
to John, taking no thought for the morrow, as
he disports himself in the pride of life ; but who
gets so near to the real John as known to his
Maker, to John in sickness and in sorrow, and sore
perplexed as to the future ? The physician's work
lies on the confines of the shadow-land, and it might
be expected that, if to any, to him would come
glimpses that might make us less forlorn when
in the bitterness of loss we cry : —

1 Ah, Christ ! that it were possible
For one short hour to see
The souls we loved, that they might tell us
What and where they be ! ' 3z

' Clean for-
gotten, like
the dead
man out of
mind.'

Communion
of Saints
and

the busy
life.

habitually talk of the departed, not as though
they had passed from death unto life and were
in a state of conscious joy and felicity, or other-
wise, but we count them out of our circle with
set deliberation, and fix between them and us
a gulf as deep as that which separated Dives from
Lazarus. That sweet and gracious feeling of an
ever-present immortality, so keenly appreciated in
the religion of Numa, has no meaning for us. The
dead are no longer immanent, and we have lost
that sense of continuity which the Romans ex-
pressed so touchingly in their private festivals
of the Ambarvalia, in which the dead were invoked
and remembered. Even that golden cord of Catholic
doctrine, the Communion of the Saints, so comfort-
ing to the faithful in all ages, is worn to a thread in
our working- day world. Over our fathers immor-

AND IMMORTALITY 251

tality brooded like the day ; we have consciously
thrust it out of lives so full and busy that we have
no time to make an enduring covenant with our
dead.32

$

As a rule, man dies as he had lived, uninfluenced How man
practically by the thought of a future life. Bunyan dies*
could not understand the quiet, easy death of
Mr. Badman, and took it as an incontestable sign
of his damnation. The ideal death of Cornelius,
so beautifully described by Erasmus, is rarely seen.
In our modern life the educated man dies usually
as did Mr. Denner in Margaret Deland's story —
wondering, but uncertain, generally unconscious
and unconcerned. I have careful records of about
five hundred death-beds, studied particularly with
reference to the modes of death and the sensations
of the dying. The latter alone concern us here.
Ninety suffered bodily pain and distress of one sort
or another, eleven showed mental apprehension,
two positive terror, one expressed spiritual exalta-
tion, one bitter remorse. The great majority gave
no sign one way or the other ; like their birth,
their death was ' a sleep and a forgetting.' The
Preacher was right : in this matter man hath no
pre-eminence over the beast — * as the one dieth,
so dieth the other.' 32

fc

The search of science for the spirits has been Science and
neither long nor earnest ; nor is it a matter of sur-
prise that it has not been undertaken earlier by
men whose training had fitted them for the work.

252

RELIGION, DEATH

It is no clear, vasty deep, but a muddy, Acheronian
pool in which our modern spirits dwell, with Circe
as the presiding deity and the Witch of En -dor
as her high priestess. Commingling with the
solemn incantations of the devotees who throng
the banks, one can hear the mocking laughter of
Puck and of Ariel, as they play among the sedges
and sing the monotonous refrain, * What fools these
mortals be ! ' Sadly besmirched, and more fitted
for a sojourn in Ancyra than in Athens, has been
the condition of those who have returned from the
quest, and we cannot wonder that scientific men
have hesitated to stir the pool and risk a touch
from Circe's wand. All the more honour to those
who have with honest effort striven to pierce the
veil and explore the mysteries which lie behind it. 32

tf

The immor- Science has put on an immortality of the flesh, and
tality of the jn a remarkable triumph of research has learned to
recognize in every living being at once immortal
age beside immortal youth. The patiently worked -
out story of the morphological continuity of the
germ-plasm is one of the fairy tales of science.
You who listen to me to-day feel organized units
in a generation with clear-cut features of its own,
a chosen section of the finely woven fringe of life
built on the coral reef of past generations, — and,
perhaps, if any, you citizens of no mean city have
a right to feel of some importance. The revela-
tions of modern embryology are a terrible blow to
this pride of descent. The individual is nothing
more than the transient offshoot of a germ-plasm,

AND IMMORTALITY 253

which has an unbroken continuity from generation
to generation, from age to age. This marvellous
embryonic substance is eternally productive, eter-
nally forming new individuals to grow up and
to perish, while it remains in the progeny always
youthful, always increasing, always the same.
4 Thousands upon thousands of generations which
have arisen in the course of ages were its products,
but it lives on in the youngest generations with the
power of giving origin to coming millions. The
individual organism is transient, but its embryonic
substance, which produces the mortal tissues,
preserves itself, imperishable, everlasting, and
constant.' 32

*

Though his philosophy finds nothing to support it, Value of a

at least from the standpoint of Terence the scientific pelief in

immortality.
student should be ready to acknowledge the value

of a belief in a hereafter as an asset in human life.
In the presence of so many mysteries which have
been unveiled, in the presence of so many yet
unsolved, he cannot be dogmatic and deny the
possibility of a future state ; and however distress-
ing such a negative attitude of mind to the Teresian,
like Pyrrho, he will ask to be left, reserving his
judgement, but still inquiring. He will recognize
that amid the turbid ebb and flow of human misery,
a belief in the resurrection of the dead and the life
of the world to come is the rock of safety to which
many of the noblest of his fellows have clung ; he
will gratefully accept the incalculable comfort of
such a belief to those sorrowing for precious friends

254 RELIGION, DEATH, AND IMMORTALITY

hid in death's dateless night ; he will acknowledge
with gratitude and reverence the service to humanity
of the great souls who have departed this life in
a sure and certain hope — but this is all. Whether
across death's threshold we step from life to life, or
whether we go whence we shall not return, even to
the land of darkness, as darkness itself, he cannot
tell.32

$

On the question before us wide and far your hearts
will range from those early days when matins and
evensong, evensong and matins, sang the larger
hope of humanity into your young souls. In certain
of you the changes and chances of the years ahead
will reduce this to a vague sense of eternal con-
tinuity, with which, as Walter Pater says, none of
us wholly part. In a very few it will be begotten
again to the lively hope of the Teresians ; while
a majority will retain the sabbatical interest of the
Laodicean, as little able to appreciate the fervid
enthusiasm of the one as the cold philosophy of
the other. Some of you will wander through all
phases, to come at last, I trust, to the opinion of
Cicero, who had rather be mistaken with Plato
than be in the right with those who deny altogether
the life after death ; and this is my own confessio

32

VARIA

VARIA

Parting.

256

Of course upon a few the sense of personal loss
falls heavily; the faculty of getting attached to
those with whom we work is strongly developed
in most of us, and some will realize the bitterness
of the lines : —

1 Alas ! that all we loved of him should be
But for our grief as if it had not been.' 44

Common sense in matters medical is rare, and is
usually in inverse ratio to the degree of education. z5

When schemes are laid in advance, it is surprising
how often the circumstances fit in with them. 6

$

In the life of every successful physician there comes
the temptation to toy with the Delilah of the press,
daily and otherwise. There are times when she
may be courted with satisfaction, but beware!
sooner or later she is sure to play the harlot, and
has left many a man shorn of his strength, viz. the
confidence of his professional brethren. 6

Equanimity. One of the first essentials in securing a good-
natured equanimity is not to expect too much of
the people amongst whom you dwell. 20

Two views From two points alone have we a wide and
satisfactory view of life — one, as amid the glorious
tint of the early morn, ere the dew of youth has
been brushed off, we stand at the foot of the hill,
eager for the journey ; the other, wider, perhaps

Common
sense.

The future.

Delilah of
the press.

in life.

VARIA 257

less satisfactory, as we gaze from the summit at
the lengthening shadows cast by the setting sun. »

You remember in the ascent of the Mountain of
Purgatory, Dante, after a difficult climb, reached
a high terrace encircling the hill, and sitting down
turned to the east, remarking to his conductor, ' All
men are delighted to look back.' So on this
occasion, from the terrace of a quarter of a century,
I am delighted to look back, and to be able to tell
you of the prospect. l3

fc

The gospel of * living ' as against that of * doing,' The gospel
which Milton preached in the celebrated sonnet On of Kvin£'
his Blindness, found in Keats a warm advocate.
1 Let us not, therefore,' he says, ' go hurrying about
and collecting honey, bee-like buzzing here and
there for a knowledge of what is not to be arrived
at, but let us open our leaves like a flower, and be
passive and receptive, budding patiently under the
eye of Apollo, and taking truths from every noble
insect that favours us with a visit.' Fatal to en-
courage in an active man of affairs, this dreamy
state, this passive existence, favours in * bards of
passion and of mirth' the development of a fruitful
mental attitude. l8

&

The dreamer spins from his c own inwards his own The
airy citadel'; and as the spider needs but few dreamer-
points of leaves and twigs from which to begin his
airy circuit, so Keats says, ' man should be content
with as few points to tip with the fine web of his
soul, and weave a tapestry empyrean, full of symbols

S

Mind the
measure of
man.

The credu-
lous public.

VARIA

for his spiritual eye, of softness for his spiritual
touch, of space for his wanderings, of distinctness
for his luxury.' l8

Who has not known lives of the greatest freshness
and nobility hampered at every turn and bound in
chains the most commonplace and sordid, lives
which illustrate the liberty and freedom enjoyed by
minds innocent and quiet, in spite of stone walls
and iron bars ? On the other hand, scan the history
of progress in the profession, and men the most
liberal and narrow, reeking of the most pernicious
type of chauvinism, have been among the teachers
and practitioners in the large cities and great
medical centres ; so true is it, that the mind is its
own place and in itself can make a man independent
of his environment. 23

1 Knowledge comes, but wisdom lingers,' and in
matters medical the ordinary citizen of to-day has
not one whit more sense than the old Romans,
whom Lucian scourged for a credulity which made
them fall easy victims to the quacks of the time,
such as the notorious Alexander, whose exploits
make one wish that his advent had been delayed
some eighteen centuries. 20

Curious, odd compounds are these fellow creatures,
at whose mercy you will be ; full of fads and
eccentricities, of whims and fancies ; but the more
closely we study their little foibles of one sort and
another in the inner life which we see, the more

VARIA 259

surely is the conviction borne in upon us of the
likeness of their weaknesses to our own. 20

fc

Deal gently then with this deliciously credulous
old human nature in which we work, and restrain
your indignation, when you find your pet parson has
triturates of the hundredth potentiality in his waist-
coat pocket, or you discover accidentally a case of
Warner's Safe -Cure in the bedroom of your best
patient. It must needs be that offences of this
kind come ; expect them, and do not be vexed. 20

fc

Hence the need of an infinite patience and of an
over-tender charity towards these fellow creatures ;
have they not to exercise the same toward us ? 20

&

Sometimes from our desolation only does a better Inexorable
life begin. Surely the blood penalty has been paid Nature :
in full for the gross neglect of sanitary laws. The
wantonness of the sacrifice is so terrible, so in-
human. Nature is inexorable, and red in tooth
and claw with ravin, knows nothing of our humani-
tarian care of the individual. But her sacrifice is
never wantons Careful of the type, careless of the
single life, sacrifice is a law of being, a condition of
existence. In one of his delightful lectures on the cares for the
Foundations of Zoology, Professor Brooks tells us species
that of the countless millions of the king of fish physician
which yearly enter the Columbia River seeking the cares for the
breeding-grounds, in the stern impulse of pro- mdlvlduaL
pagation, none return. 4 The whole race is wiped
out, utterly exterminated, as soon as it arrives at
S 2

260

VARIA

Lives offered
on the altars
of Ignorance
and Neglect.

ADelian
sacrifice.

maturity and physical perfection in order that the
perpetuation of the species may be assured.' Our
ways, thank God, are not Nature's. Indulge as we
may in speculations on the improvement of the
race, in practice we care nothing for the species,
only for the individual. Reversing Nature's method,
we are careless of the type, careful only of the
single life. Year by year unwilling witnesses of an
appalling sacrifice, as fruitless as it is astounding,
year by year we physicians sit at the bedsides of
thousands upon thousands, chiefly of youths and
maids, whose lives are offered up on the altars of
Ignorance and Neglect. Walking always in its
shadow, compassed always by its sorrows, we learn
to look on death with mingled feelings. There
is the death that comes with friendly care to the
aged, to the chronic invalid, or to the sufferer with
some incurable malady* Very different, indeed, is
it with typhoid fever. A keen sense of personal
defeat in a closely contested battle^ the heart-
searching dread lest something had been left un-
done, the pitifulness of the loss, so needless- — and
as a rule ' in the morn and liquid dew of youth ' —
the poignant grief of parents and friends worn out
by the strain of anxious days and still more anxious
nights— these make us feel a death from typhoid
fever to be a Delian sacrifice. 39

Limitations We recognize to-day the limitations of the art;

of the art we know better the diseases curable by medicine,
and those which yield to exercise and fresh
air ; we have learned to realize the intricacy of the

VARIA 26l

processes of disease, and have refused to deceive
ourselves with half-knowledge, preferring" to wait
for the day instead of groping blindly in the dark
or losing our way in the twilight. The list of
diseases which we can positively cure is an ever-
increasing one ; the number of diseases the course
of which we can modify favourably is a growing
one ; the number of incurable diseases (which is
large, and which will probably always be large) is
diminishing. 4l

$?

One of the most remarkable and beneficial reforms Insanity,
of the nineteenth century has been in the attitude
of the profession and the public to the subject of
insanity, and the gradual formation of a body of
men in the profession who labour to find out the
cause and the means of relief of this most distressing
of all human maladies. The reform movement in-
augurated by Tuke in England, by Rush in the
United States, by Pinel and Esquirol in France,
and by Jacobi and Hasse in Germany, has spread to
all civilized countries, and has led not only to the
amelioration and improvement in the care of the
insane, but to a scientific study of the subject which
has already been productive of much good. In
this country, while the treatment of the insane is
careful and humanitarian, the unfortunate affiliation
of insanity with politics is still in many States a
serious hindrance to progress.5

Doctor and

There are individuals — doctors and nurses, for ex- nurse-
ample — whose very existence is a constant reminder J

262 VARIA

of our frailties; and considering the notoriously
irritating character of such people, I often wonder
that the world deals so gently with them.

The presence of the parson suggests dim possi-
bilities, not the grim realities conjured up by the
names of the persons just mentioned ; the lawyer
never worries us in this way, and we can imagine in
the future a social condition in which neither divinity
nor law shall have a place, when all shall be friends
and each one a priest, when the meek shall possess
the earth ; but we cannot pic lure a time when birth,
and life, and death shall be separated from that
* grizzly troop ' which we dread so much, and which
is ever associated in our minds with * physician and
nurse.' l4

And a third factor, most important of all, illustrates
the old maxim, that more people are killed by
over- eating and drinking than by the sword.
Sensible people have begun to realize that alcoholic
excesses lead inevitably to impaired health. 5

A man may take four or five drinks of whisky
a day, or even more, and think perhaps he transacts
his business better with that amount of stimulant ;
but it only too frequently happens that early in the
fifth decade, just as business or political success
is assured, Bacchus hands in heavy bills for payment,
in the form of serious disease of the arteries or
of the liver, or there is a general break-down. 5

VARIA 263

While temperance in the matter of alcoholic
drinks is becoming characteristic of Americans,
intemperance in the quantity of food taken is
almost the rule* Adults eat far too much ; the
physicians are beginning to recognize that early
degenerations, particularly of the arteries and of
the kidneys, leading to Bright's disease, which
were formally attributed to alcohol, are due in large
part to too much food. 5

(1) Unanimity of opinion has not been reached Alcohol.
on the question of alcohol as a food ; the balance

of evidence is in favour of the view that it does
so act.

(2) A healthy man does not require alcoholic
stimulants of any kind.

(3) So far as actual damage to the machine,
a moderate quantity of beer or spirits, taken at
luncheon or dinner, seems to have no special in*
fluence one way or another.

(4) The danger lies in excess, but this is not
easy to define. A man who drinks between meals
drinks too much. A man who takes three or four
glasses of spirits daily is certainly drinking to
excess. He may feel no ill effects at the time,
but continued for years the practice may damage
seriously his constitution. To get the necessary
satisfaction he must inevitably increase the daily
amount, and such a man is always confronted by
the terrible danger of permanent enslavement.

Shakespeare gets to the root of the alcohol

264 VARIA

question in his well-known statement — * Good wine
is a good, familiar creature if it be well used.'46

Naturally studious, fond of poetry, history, bio-
graphy, and literature in general, and not for long
tied and bound in the chains of general practice,
Bartlett had ample opportunities to cultivate his
mind. He says in one of his letters to Green
(dated Pittsfield, Nov. i, 1835): — 4I pass a good
deal of my time here quite alone, so that I find
myself whiling away the hours in meditation much
oftener than when engaged in the more varied and
active affairs of business at home. I think that
I always leave Pittsfield with the better and purer
part of my being somewhat strengthened.' Burton
concludes' his immortal treatise with the advice,

* Be not solitary, be not idle,' but the true student,
in some part of his life at least, should know the

* fruitful hours of still increase.' For many years
Bartlett enjoyed a leisure known to-day to few
professors of medicine, the fruits of which are
manifest in his writings. Among his contem-
poraries in the profession there were brilliant
writers — Samuel Henry Dickson, Jacob Bigelow,
J. K. Mitchell — but in a style so uniformly high
and polished, yet withal so plain, not one of them
approached Bartlett. Compare, for example,
Samuel Jackson's Principles of Medicine, written
in 1832, with the first edition of the Fevers (1842) —
the one pompous, involved, obscure ; the other
clear, direct, simple. For style in his medical

VARIA 265

writings Bartlett may be called the Watson or
the Trousseau of America.42

$
We have the very highest authority for the state- Poetry—

ment that * the lunatic, the lover, and the poet, are

P . . . . , madness,

of imagination all compact. In a more compre-
hensive division, with a keener discernment, Plato
recognizes a madness which is not an evil, but
a divine gift, and the source of the chiefest blessings
granted to men. Of this divine madness poetry
occupies one of the fourfold partitions. Here is
his definition : —

4 The third kind is the madness of those who
are possessed by the Muses ; which, taking hold
of a delicate and virgin soul, and there inspiring
frenzy, awakens lyrical and all other numbers;
with these adorning the myriad actions of ancient
heroes for the instruction of posterity. But he
who, having no touch of the Muses' madness in his
soul, comes to the door and thinks that he will get
into the temple by the help of art — he, I say, and
his .poetry are not admitted ; the sane man dis-
appears and is nowhere when he enters into rivalry
with the madman/ l8

Here, in a few words, we hive expressed the very The poet's
pith and marrow of the nature of poetry, and a
clearer distinction than is drawn by many modern
writers of the relation of the art to the spirit, of the
form to the thought. By the help of art, without
the Muses' madness, no man enters the temple.
The poet is a ' light and winged and holy thing,'

266 VARIA

whose inspiration, genius, faculty, whatever we
may choose to call it, is allied to madness — he is
possessed or inspired. Oliver Wendell Holmes
has expressed this very charmingly in more modern
terms, speaking of his own condition when com-
posing the Chambered Nautilus : l In writing the
poem I was filled with a better feeling, the highest
state of mental exaltation and the most crystalline
clairvoyance that had ever been granted to me —
I mean that lucid vision of one's thought and all
forms of expression which will be at once precise
and musical, which is the poet's special gift, how-
ever large or small in amount or value.' To the
base mechanical of the working-day world, this
lucid vision, this crystalline clairvoyance and men-
tal exaltation is indeed a madness working in the
brain, a state which he cannot understand, a Holy
of Holies into which he cannot enter. l8

Verse-writ- It is remarkable how many physicians write poetry,

°r W^at P^368 ^ suck * have keen t0^ °f a
period in the history of the Royal College of

Physicians of London when every elect (censor), as
they were called, had written verses. Some begin
young, as did Bartlett ; others become attuned in
the deep autumnal tone of advancing years, when,
as Plato tells us in the Phaedo, even Socrates felt
a divine impulsion to make verses before quitting
the prison-house. Those of us who have read the
epic of the late distinguished Professor George B.
Wood, of the University of Pennsylvania, entitled,

VARIA 267

First and Last, published when he was sixty-four,
will devoutly hope that professors of medicine,
when afflicted with this form of madness, will
follow his example and publish their poems anony-
mously and in another country. Jacob Bigelow,
too, when nearly seventy, * darkened sanctities with
song' with his American Rejected Addresses.**
(Eolopoesis)

&

All the while Keats was * budding patiently,' feeling His master-
his powers expand, and with the 4 viewless winged P3881011'
Poesy ' taking ever larger flights. An absorption
in ideals, a yearning passion for the beautiful, was,
he says, his master-passion. Matthew Arnold re-
marks it was with him 4 an intellectual and spiritual
passion.1 It is 'connected and made one,' as
Keats declares that in his case it was, 'with the
ambition of the intellect.' ' It is,' as again he
says, * the mighty abstract idea of Beauty in all
things.' l8

$

Listen to one or two striking passages from his Beauty is
letters : — 4 This morning Poetry has conquered, — truttL
I have relapsed into those abstractions which are
my only life.' ' I feel more and more every day, as
my imagination strengthens, that I do not live in
this world alone, but in a thousand worlds. No
sooner am I alone than shapes of epic greatness are
stationed around me, and serve my spirit the office
which is equivalent to a king's body-guard. Then
" Tragedy with scepter'd pall comes sweeping by." '

268 VARIA

1 What the imagination seizes as beauty must be
truth/ the expression in prose of his ever memor-
able lines : —

* Beauty is truth, truth beauty, — that is all
Ye know on earth, and all ye need to know.' l8

The critic The truth is no event in Keats's life so warmly
and the poet. commends him to us, or shows more clearly the
robustness of his mind, than his attitude in this
much discussed episode (Endymion). In the first
place, he had a clear, for so young a man an
extraordinarily clear, perception of the limitation of
his own powers and the value of his work. The
preface to Endymion^ one of the most remarkable
ever written, contains his own lucid judgement.
He felt that his foundations were ' too sandy,' that
the poem was immature, feverish attempt, in which
he has moved, as he says, from the leading-strings
to the go-cart. Did any critic ever sketch with
firmer hand the mental condition of a young man
in transition?

* The imagination of a boy is healthy, and the
mature imagination of a man is healthy ; but the
space of life between, in which the soul is in a fer-
ment, the character undecided, the way of life
uncertain, the ambition thick-sighted ; thence pro-
ceeds mawkishness, and all the thousand bitters
which those men I speak of must necessarily taste
in going over the following pages.' l8

A long But as I speak, from out the memory of the past

groupWy there rises before me a shadowy group, a long line

VARIA 269

of students whom I have taught and loved, and
who have died prematurely — mentally, morally, or
bodily. To the successful we are all willing and
anxious to bring the tribute of praise, but none
so poor to give recognition to the failures. From
one cause or another, perhaps because, when not
absorbed in the present, my thoughts are chiefly
in the past, I have cherished the memory of many
young men whom I have loved and lost. lo victis /
let us sometimes sing of the vanquished ! Let us Those who

sometimes think of those who have fallen in the J^y® ^f?

in the battle
battle of life, who have striven and failed, who have Of life.

failed even without the strife. How many have
I lost from the student band by mental death,
and from so many causes — some stillborn from
college, others dead within the first year of infantile
marasmus, while mental rickets, teething, tabes, and
fits have carried off many of the most promising
minds. From improper feeding within the first five The mental
fateful years scurvy and rickets head the mental mor- deattL
tality bills of students. To the teacher-nurse it is a
sore disappointment to find at the end of ten years
so few minds with the full stature, of which the
early days gave promise. Still, so widespread
is mental death that we scarcely comment upon
it in our friends. The real tragedy is the moral The moral
death which, in different forms, overtakes so many death<
good fellows, who fall away from the pure, honour-
able, and righteous service of Minerva into the
idolatry of Bacchus, of Venus, or of Circe. Against
the background of the past these tragedies stand
out, lurid and dark, and as the names and faces

270 VARIA

of my old boys recur (some of them my special
pride), I shudder to think of the blighted hopes
and wrecked lives, and I force my memory back
to those happy days when they were as you are
now, joyous and free from care, and I think of
them on the benches, in the laboratories, and in
the wards — and there I leave them. 45

tf
Inheritors Less painful to dwell upon, though associated with

a more Poi§'nant gr'1Q^ is the fate of those whom
physical death has snatched away in the bud or
blossom of the student life. These are among the
tender memories of the teacher's life, of which he
does not often care to speak, feeling with Long-
fellow that the surest pledge of their remembrance
is l the silent homage of thoughts unspoken/ As
I look back it seems now as if the best of us had
died, that the brightest and the keenest had been
taken, and the more commonplace among us had
been spared. An old mother, a devoted sister,
a loving brother, in some cases a broken-hearted
wife, still pay the tribute of tears for the untimely
ending of their high hopes, and in loving remem-
brance I would mingle mine with theirs. What
a loss to our profession have been the deaths of
such true disciples as Zimmerman, of Toronto ; of
Jack Cline and of R. L. MacDonnell, of Montreal ;
of Fred Packard and of Kirkbride, of Philadelphia ;
of Livingood, of Lazear, of Oppenheimer, and of
Oechsner, in Baltimore — cut off with their leaves
still in the green, to the inconsolable grief of their
friends !

INDEX

Agnostic, visions of an, 102.
Alcohol, 263.

Ambition, the highest, 181.
American medicine, 22.

— peripatetic teacher, the early,
48.

Andral and Louis compared, 136.
Anglo-Saxon, the practical, 65,

66.
Apathy, the physician's most

dangerous foe, 204.
Arnold, Matthew, the death he

wished for, 249.
Art of detachment, the, 85, 87.

— of giving, 124.
Authority, vice of, 14.
Autopsies, value of, 178.
Avocation, advisability of having,

178.

Battle of life, those who have

fallen in the, 269.
Beaumont, William, 53 ; the man

and his opportunity, 4.
Beauty is truth, 267.
Bell, John, 1 79.
Bichat, 55.

Biology and the humanities, 58.
Books, 1 60; value of, 159; by

themselves not enough, 161.
Borderland pharmaceutical

houses — the practitioner's foes,

194.

Bovell, James, 45.
Brain-dusting, quinquennial, an

essential, 180.
Breeding and pasture, 58.
Broussais, 21.
Browne, Sir William, his pocket

library, 159.

Callousness, value of, 95.

Catholicity, 164.

Charcot, J. M., a cosmopolitan,

16 ; his attractive personality,

17 ; a teacher without attempt
at display or effort, 17; ^his
method a clinical lecture with-
out volubility, 17.

Charity, 116, 120; of the hos-
pital, 123 ; the art of giving,
124.

Charlatanism, 85.

Chauvinism, 70 ; collegiate, and
dangers of in-breeding, 155 ; in
the practitioner, 207.

Cheek, 134.

Clergy, the, and physic, 193.

Clinical experiments, 28.

Collegiate chauvinism, and
dangers of in-breeding, 155.

Common sense, 256.

Concentration, and thorough-
ness, 132; its drawbacks,

133-

Conservatism and old fogeyism,
240.

Consultant, the, 212 ; the second
period, 212 ; his brain is his
capital, 212 ; and the con-
sultation, 213; his function,
213 ; the unpleasant features,
214; note-taking and time
required, 215; value of steno-
graphy, 217; his opportuni-
ties in smaller towns, 217.

Credo of a physician, 78.

Critic and the poet, the, 268.

Cut bono ? 67.

Culture, 59.

Curse of nationalism, 71.

272

INDEX

Darwin, Charles, and J. Leidy,
parallel between, 47 ; ' stretch-
ing the pia mater J 48.

Death, pathos of early, 248 ;
sudden, 248; Matthew Ar-
nold's wish, 249 ; the physi-
cian and the problem, 249 ;
' clean forgotten, like the dead
man out of mind,' 250 ; com-
munion of saints and the busy
life, 250 ; how man dies, 251 ;
parting, 256; a long shadowy
group, 268 ; those who have
fallen in the battle of life, 269 ;
the mental, 269; the moral,
269.

Debt to our times, 100.

Defeat, no.

Delian sacrifice, a, 260.

Delilah of the press, 256.

Democracy, tyranny of, 24; in
medicine, 72.

Detachment, art of, 85, 87 ; in-
tellectual, 86.

Devotion, and heroism, no; to
duty, in.

Diagnosis, not drugging, 190.

Dilettante, the, 133.

Disaster, should be faced boldly,
no.

Discipline of science, 80.

Disease, nature and, 78.

Doctor and nurse, always with
us, 261.

Doctors, quarrels of, 1 14 ; friend-
ly intercourse needed, 115;
training an important factor,
115; mutual concessions
necessary, 117; attitude of
mind the all-essential to pro-
motion of concord, 117; say
a good word for the ' off
colour ' man, 1 18 ; tittle-tattle,
121 ; the wagging tongues,
122.

Dover, Thomas, a good fighter
and a good hater, 37 ; dis-
coverer of Robinson Crusoe,
38 ; ' Dover's Powder,' 38.

Dreamer, the, 257.

Dreams, 124.

Drugs, the most uncertain ele-
ment in our art, 116.
Duty, devotion to, in.

Education, medical, what it is,
128 ; its aims and objects,
128 ; a life course, 142 ; prac-
tical, 151. See also Medical
art.

Equanimity, 256.

Eryximachus, 24.

Evolution, 24.

Examinations, stumbling-blocks
and rocks of offence, 145.

Experience, 152, 207 ; and the
general practioner, 202.

Experiments in the laboratory,
27 ; clinical, 28.

Failure, 95.

Faith, science and, 248.

Fate, the practitioner's, 210.

Fevers, differentiation of, 23.

Foreign travel, 169.

France, honours her great men,

J7-

French school in the 'thirties/
a medical student's day at,

137-
Future, the, schemes for, 256.

Gehazis, the, 107.

General practitioner, the, 198;
the best product of our pro-
fession, 198; experience and
the, 203 ; qualities of the, 208.
See also Practitioner.

Goldsmith, Oliver, compared
with O. W. Holmes, 39.

Gospel of living, the, 257.

Great men, 100.

Greeks, back to the, 26.

Gynaecologist, the, 185.

Harvey, 31.

Heart, incorruptible treasures of

the, 59; the honest, 120.
Heroism and devotion, no.
Historical study, value of, 12.

INDEX

273

Holmes, Oliver Wendell, 38 ;
his 'one-hoss shay,' 38; the
American Goldsmith, com-
pared with the English Gold-
smith, 39 ; compared with
Charles Lamb, 39; studied
puerperal fever, 39 ; his great
contribution to science, 40 ;
an historic paragraph quoted,
41 ; his conclusion that puer-
peral fever is not a misfortune
but a crime, 41 ; essay on
Puerperal Feverand iheCkam-
bered Nautilus, 42.

Homoeopathy, 116.

Honest heart, the, 120.

Hospital, charity of the, 123;
students in, 152. See also
Medical art, teaching the.

Howard, Palmer, an ideal stu-
dent-teacher, 44 ; alert to new
problems, 45.

Humanities, biology and the, 58.

Humbug, 80.

Humility, 81, 82 ; reverence for
truth the fruit of, 82.

Humour, sense of, an essential,
112.

Hunter, John, 31.

Hutchinson, Jonathan, 3.

Ideals, value of, 105 ; and me-
thods, 107.

Ignorance, one of the physician's
great foes, 203 ; and Neglect,
lives offered on the altar of,
260.

Immortality, of the flesh, 252 ;
value of a belief in, 253 ; con-
fessio fidei, 254.

Immutability, man's, 192.

Imperturbability, 94 ; often mis-
taken for hardness, 95.

In-breeding, in the University,
155 ; dangers of, and col-
legiate chauvinism, 155.

Incorruptible treasures of the
heart, 59.

Independence, practitioner's
mental, 206.

Index Catalogue, the, 158, 177.
Infantilism in the teacher, 165.
' Inheritors of unfulfilled re-
nown,' 270.
Insanity, 261.

Inscrutable face, value of an, 96.
Intellectual detachment, 86.
Intemperance, 262.
Isolation, 133.

Johns Hopkins Hospital, in-
struction in the medical art its
greatest work, 150.

Keats, John, his master passion,

267.

Killing routine, 139.
Knowledge, sense and wisdom

contrasted with, 175.

Laboratory, experiments in the,
27; 'the lock and key,' 73;
the home, 192.

La crise de quarante ans, 242.

Laennec, 28.

Lamb, Charles, compared with
O. W. Holmes, 39.

Laws of nature must be dis-
covered, not invented, 136.

Leaven of life, the, 61.

Leidy, Joseph, his patient spirit,
kindly disposition, and sus-
tained zeal, 47 ; his ' ataraxia,'
47 ; parallel between him and
Darwin, 47 ; ' stretching the
pia mater J 48.

Lessons of life, the three great, 103.

Library, value of the local, 158 ;
Index Catalogue, 158, 177;
instructors, 159 ; the work-
ing, 177.

Life, leaven of, 61 ; the busy,
useful, and happy, 100 ;
poetry of, should be recog-
nized in the humdrum routine,
in ; the danger of the busy,
196; the strenuous, nemesis
in, 234 ; philosophy of, 236 f
the calm, contemplative, 245 ;
two views in, 256.

274

INDEX

Linacre, 4, 22.

* Lock and key ' laboratory, the,

73-

Locke, John, character of, 2;
his influence, 2.

Loneliness, persistency in the
midst of, no.

Lonely road, the, 209.

Louis, 31 ; practised in Odessa
for four years, 32 ; returned to
hospitals for six years for
clinical study, 32 ; his minute-
ness of inquiry and accuracy
of description, 33 ; his method
spoken of with contempt, 33 ;
but later applauded and imi-
tated, 34; introduced the
Numerical Method, 34; by
which is obtained facts upon
which the edifice of medicine
must rest, 34 ; his channels of
influence, 35 ; his teaching and
influence, 35 ; his American
pupils in Paris between 1830
and 1840, 39; his influence
through his pupils, 91 ; com-
pared with Andral, 136.

Love, the spirit of, 123.

MacDonnell, Richard Lea, 44.

Man, the measure of the school,
141 ; the self-satisfied, 162 ;
immutability of, 192 ; muta-
bility of, 192 ; a medicine-
taking animal, 193 ; mind the
measure of, 258.

Marriage, 220 ; hopeless passion,
220 ; emotions on ice, 220;
the two goddesses, 221.

Masters in medicine, 90

Medical art, the, is world-wide,
142 ; teaching the, 145 ; study
of the, 148; some of the diffi-
culties of, 148 ; in practice a
theoretical training alone is
inadequate, 149 ; instruction
in, the greatest work of the
Johns Hopkins Hospital, 150;
necessity of practical experi-
ence, 152 ; difficulty of judg-

ing cases, 152 ; probability
the guide of life, 153 ; limita-
tions of, 260.

Medical education. See Educa-
tion.

Medical Society, the, 161 ; is the
safeguard against baneful in-
dividualism, 161.

Medicine, American, 22 ; back
to the Greeks, 26; in America,
reform in, 28 ; in America at
opening of nineteenth century,
30; democracy in, 72; masters
in, 90 ; uncertainties of, 153 ;
history of, 177 ; new school
of, 190.

Methods and ideals, 107.

Microscope, invention of, 29.

Mind, nickel-in-the-slot attitude
of, 1 50; the measure of man,258.

Mind-training, 132.

Missionary work, 89 ; as willing
to teach as to be taught, 90.

Mitchell, Weir, 14.

Morton, Richard, 20.

Mutability, man's, 192.

Narrow spirit, the, 167.

Nationalism, the curse of, 71.

Nature, and disease, 78 ; a,
' sloping towards the southern
side,' 112; laws of, must be
discovered, not invented, 1 36 ;
inexorable, 259 ; cares for the
species while the physician
cares for the individual, 259.

Nature-physicians, the, 20.

Nautilus, the Chambered, O. W.
Holmes's, 42.

New school, the, 67.

New student, the, 49.

Nineteenth century, 53 ; its gift
to mankind, 13; medicine in
America at opening of, 30.

Nurse, the, 124 ; the discreet, 94 ;
Romola the, 1 24 ; and doctor,
always with us, 261.

Out-patient department, work in,
227.

INDEX

275

Pain, 67.

Past, the, 24.

Patience, no.

Pepper, William, a strong soul,
7 ; a leader, 8 ; a child of
fortune, 8 ; a modern Greek,
9 ; a cultured Hellene, 18 ; an
organizer, 19 ; undiminished
activity to the last, 19.

Perfection, artistic sense of, 77.

Peripatetic life, advantages of,
for the teacher, 167.

— teacher, the early American,
48.

Persistency in the midst of loneli-
ness, no.

Physic, the clergy and, 193.

Physician, the, qualities of, 64 ;
the high mission of, 66 ; cos-
mopolitan character of, 73 ;
credo of a, 78 ; the true, 171 ;
three periods of his life,
173; and the problem of death,
249. See also Practitioner.

Physicians, two sorts of, 171 ;
verse-writing, 266.

Pills and potions, 88, 193.

Pioneer spirit, the, 52.

Pluralist, the, 182.

Poet, the critic and the, 268.

Poet's gift, the, 265.

Poetry, a divine madness, 265.

— of life, should be recognized
in the humdrum routine, in.

Potions, pills and, 88, 193.

Practical education, 151.

Practice, and science, 74 ; isola-
tion of, 208.

Practitioner, the, dead mentally
in ten years without study,
174; simply seeing not all,
175; value of note-taking,
175 ; habits of routine and
system, 176; must play the
game fair, 1 76 ; only way to
make real progress, 176; the
desiderata of every young
doctor> 177 ; his working
library, 177; should have an
avocation, 1 78 ; should be

careful in his publication, 178 ;
his studiousness may be a
stumbling-block, 1 79 ; student
habits in a large city, 1 79 ;
his difficulties, and how he
may overcome them, 179;
quinquennial brain-dusting es-
sential, 1 80 ; end of the second
lustrum, 1 80 ; the highest am-
bition— the cultivated general
practitioner, 181 ; observation
of facts, 191 ; the home labora-
tory, 192 ; his foes— the bor-
derland pharmaceutical houses,
194 ; danger of the busy life,
196 ; the busy doctor, 196 ; the
general practitioner, 198 ; the
general practitioner the best
product of our profession, 198;
dangers of prosperity, 198 ;
politics, 198 ; opening a sana-
torium, 1 99 ; moving to a
larger place, 199 ; the rou-
tinist, 199 ; the rationalist,
20 1 ; corroding effect of rou-
tine, 202 ; experience and the
general practitioner, 202 ; the
man who does not read, 202 ;
his three great foes — ignor-
ance, apathy, and vice, 203;
the spirit of humility, con-
fidence, just pride, and hope,
206 ; his mental independence,
206 ; self-satisfaction, 206 ;
experience, 207 ; chauvinism
in the, 207 ; qualities of the,
208; isolation of practice, 208;
the lonely road, 209; words
to soothe the heartache, 209 ;
his fate, 210; success, 211.
See also General Practitioner
and Physician.

Presenility, 243.

Press, Delilah of the, 256.

Probability, 153.

Profession, the, what it is, 129.

Professional sensitiveness, 84.

Professor, the, 154.

Progeria in the teacher, 165.

Pseudo-science, 195.

276

INDEX

Public, the credulous, 258.

Publication, 178.

Puerperal fever, 'studied by
O. W. Holmes, 39 ; Holmes's
conclusion that its existence is
not a misfortune but a crime,
41 ; essay on, by Holmes, 42.

Rationalist, the, 201.
Readers, four sorts of, 160.
Reaper, the, often not the sower,

158.
Reform in medicine in America,

28.
Registration, interprovincial and

international, 25.
Responsibility and proportion,

sense of, 140.
Romola the nurse, 124.
Routine, and system, habit of,

176 ; the only way to make

real progress, 176; corroding

effect of, 202 ; value of, 231.
Routinist, the, 199.

Scepticism, value of, 139.

School, true greatness of a, 140 ;
man the measure of the, 141.

Science, the last and chief bless-
ing, 13; and practice, 74;
discipline of, 80; and faith,
248 ; and the spirits, 251.

Sciences, the, essential, 8r.

Scientific men, value of, 141.

Self-satisfied man, the, 162.

Sense of humour, an essential, 112.

Sensitiveness, professional, 84.

Silent workers, the, 96.

Specialism, 181, 183; advantages
of, 183; the public and, 184;
dangers of, 186.

Specialist, the, 182 ; dangers of
adopting a speciality too early,
182 ; his dangers, 186 ; how
he may avoid them, 186 ; nar-
row and pedantic specialists,
187; advantages of study of
physiology and pathology to,
187 ; education and the, 188 ;
societies and the, 189.

Spirit of love, the, 123.

Stenography, value of, 217.

Student, the, 130; how you may
know him, 131; two types of,
131 ; habits of concentration
and thoroughness, 132 ; the
dilettante, 133; his isolation,
133; drawbacks of concentra-
tion, 133; should get dena-
tionalized early, 133; the self-
conscious, 134; should study
men, 134; distinction between
self-confidence and ' cheek,'
134; the waiting years, 135;
thorough regard for truth and
elevation of mind essentials to
the accurate observer of dis-
ease, 1 36 ; a day at the French
school in the « thirties,' 137 ;
the delights of acquiring posi-
tive information and method
of obtaining, 137; relation of
teacher to, 138 ; his sense of
responsibility and proportion,
140 ; his education a life
course, 142 ; the genius, 142 ;
examinations, 145 ; the nickel-
in-the-slot attitude of mind,
150 ; the ward as a class-room,
151 ; work in the hospital,
152. See also Medical art,
teaching the.

Student life, the, 104.

Studiousness, may be a stumbling-
block, 179.

Study, method of, 131 ; the time
for, 131.

Study men, 134, 179.

Style in writing, 264.

Success, 211.

Sydenham, 4, 31; scepticism
of, 4.

Teacher, relation of, to student,
138 ; the good, 142 ; in-
fantilism in the, 165 ; progeria
in the, 165 ; advantages of
the peripatetic life for the, 167;
the fossilized, 240.

Teachers, and teaching, 138 ;

INDEX

277

four classes of, 139 ; killing
routine saps vitality of, 1 39.

Teacher's life, three periods in
the, 243.

Thinkers, 143.

Thinking, a University function,
144.

Thoroughness, 84.

Three great lessons of life, the,
103.

Time is money, 1 73.

Times, duty to better our, 51 ;
our debt to, 100.

Tittle-tattle, xai.

Tongue, the careless, 94 ; un-
ruly member, the, 94.

Training, an important factor,
115.

Travel, 164; and change, 168;
foreign, 169.

Truth, fragments of, 79 ; hard
to reach, 80 ; reverence for,
the fruit of humility, 82 ;
what it is, 83 ; not recognizing
it is mind-blindness, 83 ; and
elevation of mind, thorough
regard for essentials to the
accurate observer of disease,
136.

Uncertainties of medicine, 153.

Uncharitableness, the most per-
nicious of all vices, 118; a
thoughtless evil at times, 118 ;
' the faint praise that damns,'
119.

University, function of to think,
144.

— in-breeding in the, 155.

— spirit, the, 156.

— teaching staff, value of
changes in, 154.

Unruly member, the, 94.
Utility cry, the, 103.

Vaso-motor control, 95.
Verse-writing physicians, 266.
Vice, of authority, 14 ; one of

the physician's great foes, 205.
Virchow, Prof., visit to, 6 ;

the citizen, 7 ; the sanitarian,

54-

Visions of an Agnostic, 102.
Voiceless, the, 101.
Volte-face often necessary, 52.

Wagging tongues, the, 122.
Waiting years, the, 135, 172,

m-

Walk with the young, 244.

Wanderjahre, need of the, 70.

Ward, the, as a class-room, 151.

West, the, the future with, 164.

Wisdom, 66; sense and, con-
trasted with knowledge, 175.

Women, old and new, 101.

Work, the master word, 223 ;
get a relish for, 224 ; haste
not to be encouraged, 224;
ohne Hast, ohne Rast, 224;
live for the day, 224; the
day's work, 225 ; influence of
isolation, 225; industry es-
sential at all ages, 226 ; the
out-patient department, 227;
the small field, 227; system to
be cultivated, 227 ; value of
routine, 231 ; dangers of over-
work, 231 ; nemesis in the
strenuous life, 234; need of
an avocation, 235 ; the man,
not the doctor, 236 ; idleness,
236 ; failure, 237.

Workers, the silent, 96.

Working library, the, 177.

Worry, 233.

Writing, style in, 264.

Young doctor, the desiderata of
every, 177.

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