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PRESENTED 


THE  UNIVERSITY  OF  TORONTO 


From  Kuysch's  cabinet.  Note  the  pathetic  pose  of  the  foetal  skeleton 
at  the  top.  He  is  playing  left-handed  with  an  injected  artery  as  a  bow  on  a 
sequestrum  as  a  violin.  Note  also  the  feather  borne  by  another  to  the  left; 
the  coils  of  intestine  (probably  his  own)  by  a  third  to  the  right,  who  also  holds 
in  his  other  hand  an  injection  of  the  pampiniform  plexus ;  the  vesical  vase  to 
the  extreme  left ;  the  touching  symbolism  of  the  recumbent  skeleton  and  its 
butterfly ;  and  the  rockery  of  calculi  interspersed  with  arterial  and  other  in- 
jections. Ruysch's  Thesaurus  Anatomicus,  III.  Amstel.  1703. 


ADDRESSES 

AND  OTHER  PAPERS 


BY 

WILLIAM  WILLIAMS  KEEN 

M.D.,  LL.D.,  F.R.C.S.  (HON.) 

Professor  of  Surgery,  Jefferson  Medical  College,  Philadelphia  ;    Membre 

Correspondant    Stranger   de    la   Soci6t6    de    Chirurgie    de    Paris; 

Membre  Honoraire  de  la  Soci6t6  Beige  de  Chirurgie ;      Ehren- 

mitglied  der  Deutschen  Gesellschaft  fiir  Chirurgie ;  Honorary 

Member  of  the  Clinical  Society  of  London,  etc. 


Illustrated 


PHILADELPHIA  AND  LONDON 

W.  B.  SAUNDERS  &  COMPANY 

1905 


Copyright,  1905,  by  W.  B.  Saunders  &  Company. 


PREFACE. 


These  occasional  addresses  and  other  papers  are  published 
in  the  hope  that  they  may  prove  useful  both  to  the  profes- 
sion and  to  the  public  and  hi  response  to  numerous  requests. 

I  trust  that  a  few  repetitions  will  be  forgiven  inasmuch 
as  the  audiences  were  different  and  the  facts  important.  Of 
course  the  statistics  and  allusions  to  current  events  must 
be  read  as  of  the  date  when  the  addresses  were  originally 
delivered  and  not  of  the  date  of  the  present  volume. 

I  have  to  thank  the  Editors  and  Publishers  of  the  various 
periodicals  and  books  in  which  some  of  the  papers  first  ap- 
peared for  permission  to  republish  them. 

WILLIAM  W.  KEEN. 

PHILADELPHIA,  May  8,  1905. 


CONTENTS. 


PAGE 

THE  EARLY  HISTORY  OF  PRACTICAL  ANATOMY  .............       1 


HISTORY  OF  THE  PHILADELPHIA  SCHOOL  OF  ANATOMY 
AND  ITS  RELATION  TO  MEDICAL  TEACHING  ...........     41 

'-"OuR  RECENT  DEBTS  TO  VIVISECTION.  •.  .................     68 

-  RECENT  PROGRESS  IN  SURGERY  ........................     89 

THE  NEW  ERA  IN  MEDICINE  AND  ITS  DEMANDS  UPON  THE 
PROFESSION  AND  THE  COLLEGE  ......................   Ill 

THE  REAL  REWARDS  OF  MEDICINE  ......................   137 

MEDICINE  AS  A  CAREER  FOR  EDUCATED  MEN  .............   146 

V-VlVISECTION  AND  BRAIN  SURGERY  .......................   166 

MEDICAL  EDUCATION  ...................................   194 

THE  ADVANTAGES  OF  AN  ACADEMIC  TRAINING  FOR  A  MED- 

ICAL CAREER  .....................................  203 

LITERARY  METHODS  IN  MEDICINE  .......................  213 

ADDRESS  AT  THE  UNVEILING  OF  THE  STATUE  OF  THE  LATE 

PROF.  SAMUEL  D.  GROSS,  M.D  ......................  231 

SEMICENTENNIAL  ADDRESS  IN  SURGERY  BEFORE  THE  AMER- 
ICAN MEDICAL  ASSOCIATION  ........................  243 

THE  DEBT  OF  THE  PUBLIC  TO  THE  MEDICAL  PROFESSION  ____  271 

THE  ENDOWMENT  OF  MEDICAL  COLLEGES  ................  295 

THE  IDEAL  PHYSICIAN  .................................  307 

ADDRESS  AT  THE  ROYAL  COLLEGE  OF  SURGEONS  OF  ENGLAND 
AT  THE  CONFERRING  OF  HONORARY  DEGREES  AT  THE 
CENTENARY  CELEBRATION  OF  THE  GRANTING  OF  ITS 
PRESENT  CHARTER  ................................  315 

THE  PROGRESS  OF  SURGERY  IN  THE  NINETEENTH  CENTURY.  318 


VI  CONTENTS. 

PAGE 

THE  MISSION  OF  A  MEDICAL  COLLEGE 359 

THE  DUTIES  AND  RESPONSIBILITIES  OF  TRUSTEES  OF  PUBLIC 

MEDICAL  INSTITUTIONS 369 

THE  QUALITIES  ESSENTIAL  TO  SUCCESS  IN  MEDICINE 390 

THE  CHEERFULNESS  OF  DEATH 397 

THE  NEED  FOR  INCREASED  ENDOWMENTS  FOR  MEDICAL 

INSTRUCTION 399 

AGE  AND  YOUTH  IN  MEDICINE 410 

SURGICAL  REMINISCENCES  OF  THE  CIVIL  WAR  ...  .  420 


THE  EARLY  HISTORY  OF  PRACTICAL 
ANATOMY.* 


IN  welcoming  you  here  this  evening,  gentlemen,  at  the 
beginning  of  the  winter  session, — and  welcome  you  I  do 
with  the  sincerest  pleasure, — it  has  occurred  to  me  that  in 
no  way  could  we  spend  a  pleasanter  hour  than  in  reviewing 
the  early  history  of  practical  anatomy.  We  shall  see  in  the 
difficulties  that  attended  its  beginning,  and  the  improve- 
ments that  have  been  gradually  introduced,  how  much  better 
off  we  are  than  were  our  predecessors,  and  how  zealously  we 
should  avail  ourselves  of  these  advantages. 

The  life  and  labors  of  Vesalius  have  been  so  often  and  so 
fully  discussed  that  you  have  readily  at  hand  the  means  of 
acquainting  yourselves  with  them.  I  shall  not,  therefore, 
enter  into  these  in  detail,  but  only  allude  to  them  when  nec- 
essary. But  Vesalius,  who  was  born  in  1514,  although  the 
real  father  of  anatomy,  was  by  no  means  the  first  who  prac- 
tised human  dissection.  If  we  wish  to  see  its  starting-point, 
we  must  go  back  to  ancient  times.  We  must  retrace  our 
steps  to  the  third  century  before  Christ,  and  transfer  ourselves 
from  the  amphitheatre  of  Padua  to  that  of  Alexandria,  to 

*  The  Introductory  Address  to  the  course  of  lectures  on  anatomy  at 
the  Philadelphia  School  of  Anatomy,  Tuesday,  October  6,  1874.  This 
was  originally  given  as  the  Introductory  to  the  course  of  1870,  and  was 
then  printed.  The  edition  was  soon  exhausted,  and  by  request  was  re- 
peated and  reprinted  in  1874  with  corrections  and  additions.  The 
address  is  reprinted  from  the  edition  of  1874  with  the  kind  permission 
of  J.  B.  Lippincott  Company. 

1  1 


2  ADDRESSES   AND    OTHER    PAPERS. 

discover  the  bold  innovators  who  first  forced  the  dead  human 
body  to  disclose  its  secrets  for  the  benefit  of  the  living. 

Two  centuries  earlier  still,  Democritus  and  Hippocrates 
had  taken  the  first  tentative  steps,  hi  the  examination  of  the 
bodies  of  the  inferior  animals,  but  they  ventured  no  further 
than  this. 

It  is  in  Alexandria,  three  hundred  years  before  Christ,  that 
we  meet  with  the  first  human  anatomists,  Herophilus  and 
Erasistratus;  and  they  are  said  to  have  been  such  zealous 
cultivators  of  the  new  science  that  they  not  only  dissected  the 
dead  human  body,  but  even  the  living,  in  order  to  search  for 
the  hidden  springs  of  life  itself.*  It  is  curious  to  note  how 
this  belief  that  anatomists  were  addicted  to  ante-mortem  dis- 
section has  not  been  peculiar  to  Egypt,  but  has  pervaded  all 
lands  and  all  times.  Vesalius  was  shipwrecked  and  died 
when  fleeing  for  his  life  on  a  similar  charge,  f  The  Edinburgh 
Act  of  1505,  giving  the  surgeons  the  body  of  one  criminal 
annually  "to  make  an  anatomic  of,"  was  guarded  by  the 
proviso,  "after  he  be  deid/'J  and  even  Staupa,  a  medical 
man,  hi  his  book  on  dissection,  published  so  late  as  1827, 
gravely  advises  the  student  to  assure  himself  that  the  body 
is  "really  dead."§  Even  poetry  has  lent  its  aid  to  perpet- 
uate the  legend  of  the  "Invisible  Girl,"  whose  ghost  was  be- 

*  Biographic  M6dicale  par  ordre  chronologique,  par  MM.  Bayle  et 
Thillaye,  Paris,  1855,  tome  i,  p.  40.  This  charge  of  Tertullian  is  reason- 
ably accounted  for  on  the  ground  that  such  rumors  would  naturally  attach 
themselves  to  the  first  dissectors  of  the  human  body.  It  is  stated  that 
Cocchi,  in  his  De  Usu  Art.  Anat.,  Florence,  1736,  has  vindicated  them 
from  the  charge.  Surgeons,  however,  not  infrequently  have  been  allowed 
to  test  operations  on  criminals,  who  were  pardoned  if  they  survived. 
Galen  thus  operated  in  cases  of  nerve  wounds,  and  Par6,  Colot,  and 
numerous  other  surgeons,  in  cases  of  lithotomy. 

t  Bayle  et  Thillaye,  op.  cit.,  tome  i,  p.  231. 

J  Prof.  Struthers's  Hist.  Edin.  Anatom.  School,  Edin.  Med.  Journ.,  Oct. 
1866,  p.  289,  note. 

§  Hyrtl,  Handbuch  der  Zergliederungskunst,  pp.  51,  52. 


AATD  R  JLAJL        VZ  <TA  L  1 1  ^.i* 


From  the  first  edition  of  Vesalius'  Anatomy  (1543). 


THE    EARLY   HISTORY   OF   PRACTICAL   ANATOMY.  3 

lieved  to  haunt  Sir  Charles  Bell's  anatomical  rooms,  where 
she  had  been  dissected  alive  on  the  night  preceding  that  ap- 
pointed for  her  marriage.* 

*  See  Gibson's  Rambles  in  Europe,  pp.  143-44.     The  poem  does  not 
follow  the  legend  as  to  the  dissection's  being  ante-mortem.     In  Hood's 


"  GIN    A    BODY    MEET    A    BODY/ 

Whims  and  Oddities  the  title  is  "  Mary's  Ghost."  Gibson  wrongly  entitles 
it  the  "Invisible  Girl."  I  have  given  the  original  text,  which  differs 
slightly  from  Gibson's,  and  I  add,  also,  Hood's  original  wood-cut. 


MARY'S  GHOST. 


L 


'Twas  in  the  middle  of  the  night 
To  sleep  young  William  tried; 

When  Mary's  ghost  came  stealing  in 
And  stood  at  his  bedside. 

2. 
Oh,  William,  dear  !  Oh,  William,  dear  ! 

My  rest  eternal  ceases ; 
Alas !  My  everlasting  peace 

Is  broken  into  pieces. 


3. 


I  thought  the  last  of  all  my  cares 
Would  end  with  my  last  minute, 

But  when  I  went  to  my  last  home, 
I  didn't  stay  long  in  it. 

4. 
The  body-snatchers,  they  have  come 

And  made  a  snatch  at  me ; 
It's  very  hard  them  kind  of  men 

Won't  let  a  body  be. 


ADDRESSES   AND    OTHER   PAPERS. 


But  the  example  of  Alexandria  in  the  cultivation  of  anat- 
omy aroused  no  imitators — no  rivals.  For  several  centu- 
ries Egypt  was  the  only  medical  centre  of  the  world.  Anat- 
omists of  every  country  resorted  thither,  and  in  the  second 
century  after  Christ  we  find  Galen  compelled  to  go  from  Per- 
gamus  to  Alexandria  in  order  to  see  a  skeleton.  Even  in 
Rome  itself,  and  as  court  physician  at  a  later  period,  Galen 
could  dissect  nothing  but  the  lower  animals.  The  burning 
of  the  dead  by  the  Romans  prohibited  totally  any  attempt 
at  anatomy,  and,  instead  of  sending  his  students  to  Egypt 
to  study  anatomy,  he  sent  them  to  Germany  to  dissect  the 
slain  among  the  national  enemies,  while  he  contented  him- 
self with  the  ape.* 

This  feeble  light  at  Rome  and  Alexandria,  however,  was 
soon  extinguished,  and  human  dissection  disappeared  from 
history  for  twelve  centuries.  The  twilight  of  the  well-named 


5. 

You  thought  that  I  was  buried  deep, 
Quite  decent-like  and  chary ; 

But  from  her  grave  in  Mary-bone, 
They've  come  and  bon'd  your  Mary. 

6. 
The  arm  that  used  to  take  your  arm 

Is  took  to  Dr.  Vyse ; 
And  both  my  legs  are  gone  to  walk 

The  hospital  at  Guy's. 

7. 
I  vow'd  that  you  should  have  my  hand, 

But  fate  gave  us  denial; 
You'll  find  it  there  at  Dr.  Bell's, 

In  spirits  and  a  phial. 

8. 
As  for  my  feet,  the  little  feet, 

You  used  to  call  so  pretty, 
There's  one,  I  know,  in  Bedford^Row, 

The  t'other  's  in  the  city. 


9. 
I  can't  tell  where  my  head  is  gone, 

But  Dr.  Carpue  can ; 
As  for  my  trunk,  it's  all  packed  up 

To  go  by  Pickford's  van. 

10. 
I  wish  you'd  go  to  Mr.  P. 

And  save  me  such  a  ride; 
I  don't  half  like  the  outside  place 

They've  took  for  my  inside. 

11. 
The  cock,  it  crows — I  must  be  gone ! 

My  William,  we  must  part ! 
But  I'll  be  your's  in  death,  altho' 

Sir  Astley  has  my  heart. 

12. 
Don't  go  to  weep  upon  my  grave, 

And  think  that  there  I  be ; 
They  have'nt  left  an  atom  there 

Of  my  anatomic. 


*  Hyrtl,  Lehrbuch  der  Anatomie  des  Menschen,  8te   Auflage,  Wien 
1863,  p.  230.     William  Hunter's  Introductory  Lectures,  p.  24. 


THE   EARLY   HISTORY   OF   PRACTICAL   ANATOMY.  5 

"  Dark  Ages"  had  set  in,  and  when,  in  A.D.  640,  the  vast  treas- 
ures of  the  Alexandrian  library  were  burned,  night  itself  came 
on.  So  long  and  so  deep  has  that  night  been  in  the  very 
natal  city  of  human  anatomy  that  it  is  but  six  years  since 
the  death  of  Clot  Bey,  the  first  public  lecturer  on  anatomy 
in  Alexandria  for  about  seventeen  hundred  years;  and  so 
strong  are  Mussulman  prejudice  and  hatred,  that,  although 
under  the  protection  of  the  Pasha  Mehemet  Ali,  when  he  first 
opened  the  thorax  of  a  body  a  student  rushed  upon  him  and 
stabbed  him  with  a  poniard.  The  blade  slid  over  the  ribs, 
and  Clot  Bey,  perceiving  that  he  was  not  seriously  hurt,  took 
a  piece  of  plaster  from  his  dressing-case,  and,  applying  it  to 
the  wound,  coolly  observed  to  the  class,  "  We  were  speaking, 
gentlemen,  of  the  disposition  of  the  ribs  and  sternum,  and 
I  now  have  the  opportunity  of  showing  how  a  blow  directed 
from  above  has  so  little  chance  of  penetrating  the  thorax," 
and  went  calmly  on  with  his  lecture.* 

The'  Mohammedans,  into  whose  hands  medicine  passed  at 
the  fall  of  Alexandria,  wholly  abandoned  dissection,  and,  as 
we  have  just  seen,  had  even  the  fiercest  prejudice  against  it, 
based  on  its  prohibition  by  the  Koran  and  the  seven  days' 
ceremonial  uncleanness  it  denounced  against  all  who  even 
touched  a  dead  body.  Galen's  anatomy  of  the  ape  reigned 
supreme  till  the  time  of  Vesalius,  in  1543.  Even  then  the 
substitution  of  the  lower  animals  for  man  was  neither  wholly 
nor  easily  overthrown.  In  Paris  we  find  Sylvius,  the  teacher, 
and  afterwards  the  fierce  opponent  of  Vesalius  as  an  inno- 
vator, lecturing  "from  small  fragments  of  dogs."f  The  ape 
was  preferred  by  many  on  account  of  its  outward  resemblance 
to  man,  but  swine  were  the  favorites,!  because,  being  om- 
nivorous animals,  they  still  more  closely  resembled  the  hu- 

*  Medical  Times  and  Ga*,  Sept.  9,  1868. 

t  Morley's  Life  of  Jerome  Cardan,  vol.  ii,  p.  100. 

J  Hyrtl,  Zerglied.,  p.  28.     Text  and  note. 


6  ADDRESSES   AND   OTHER   PAPERS. 

man  race,  "especially,"  says  Hyrtl,  with  one  of  his  usual  sly 
thrusts,  "certain  individuals  among  them."  Vesalius  him- 
self so  far  yielded  to  the  popular  fancy  that  some  of  his  des- 
criptions are  drawn  from  this  very  source,  and  the  frontis- 
piece of  his  anatomy,  in  the  first  edition  (1543)  and  later 
ones,  show  a  number  of  apes,  goats,  and  dogs.  In  1627  Spige- 
lius  similarly  honors  the  swine*;  and  even  so  lately  as  the 
middle  of  the  last  century  William  Hunter  tells  us  that  "  the 
operations  of  surgery  were  still  explained  to  very  little  pur- 
pose upon  a  dog."f 

But  with  the  rise  of  the  Italian  universities  came  the  first 
gleams  of  light.  Bologna,  the  oldest  of  them  all,  is  in  many 
respects  the  most  famous.  Founded  in  1088  as  a  school  of 
Roman  law,  the  fame  of  her  professors  was  such  that,  as  early 
as  1262,  no  less  than  ten  thousand  students  were  gathered 
there.  J  The  faculties  of  medicine  and  of  arts  were  founded 
before  the  fourteenth  century,  and  soon  added  to  her  fame. 
Here,  two  centuries  before  Vesalius  was  born,  the  first  dis- 
sections of  modern  times  were  made.  In  1315,  Mondini,  or 
Mundinus,  publicly  dissected  two  female  bodies,  §  and  estab- 
lished what  was  intended  to  be  an  annual  custom,  but  which, 
strange  to  say,  was  soon  neglected.  Bologna,  the  first  in  the 
new  era  of  medicine,  has  not  since  then  been  behind  her  rivals 
in  the  healing  art.  The  names  of  Carpi,  Vesalius,  Arantius, 
Malpighi,  Valsalva,  Varolius,  and  Galvani  alone  are  enough 
to  make  her  famous.  But  she  was  also  the  earliest  exponent 
of  one  of  the  great  questions  of  the  present  day  in  medical 
as  well  as  other  circles.  Her  female  professors  have  rivalled 

*  Hyrtl,  Zerglied,  p.  28.     Text  and  note. 

t  Introductory  Lectures,  p.  88. 

J  Encyc.  Britan.,  vol.  xxi,  p.  449.  In  the  fourteenth  century  there  were 
thirteen  thousand.  Paris  had  at  one  time  as  many  as  thirty  thousand. 

§  New  Am.  Cyc.,  first  ed.,  article  Anatomy,  i,  519.  Encyc.  Brit., 
eighth  ed.,  article  Anatomy.  Curiously  enough,  William  Hunter,  in 
his  Introductory  Lectures,  does  not  mention  Mondini,  but  traces  modern 
anatomy  back  only  to  Leonardo,  and  says  he  was  the  first  to  go  even  thus 
far  back. 


ANDRE  AE      VESALII 

BRVXFLLENSIS,     SCHOLAE 
incdicorum  Pjuumar  p; 
Humanicorpon 
Ubritpttm, 


Frontispiece  to  the  first  edition  of  Vesalius'  Anatomy  (1.543),  showing  ani- 
mals used  in  dissection,  as  well  as  the  human  body. 


The  Anatomical  Theater  in  Bologna  in  which  the  first  modem  dissections 
were  made  in  A.  D.  1315  by  Mundinus.  Among  the  other  professors  of  anatomy 
in  Bologna  who  presumably  lectured  in  this  room  were  Carpi,  Vesalius,  Aran- 
tius,  Malpighi,  Yalsalva  and  Varolius,  as  well  as  a  woman  professor  of  anatomy, 
Madonna  Manzolina.  Probably  Harvev  attended  lectures  here. 


The  ceiling  of  the  Anatomical  Theater  in  Bologna. 


THE   EARLY   HISTORY   OF   PRACTICAL   ANATOMY.      .          7 

their  male  associates  in  distinction.  In  medicine  she  has 
even  had  a  professor  of  anatomy,  Madonna  Manzolina,  and, 
in  1865,  I  saw  in  the  museum  preparations  made  by  her  that 
would  do  credit  to  our  own  times.*  In  1732  Laura  Bassi 
was  made  doctor  of  laws  and  lecturer  on  philosophy,  and  in 
1817  the  immediate  predecessor  of  that  astonishing  linguist, 
Mezzofanti,  in  the  Greek  chair,  was  Matilda  Tambroni.  In 
the  fourteenth  century  we  find  Novella  d' Andrea,  the  pro- 
fessor of  canon  lawf;  and  such  was  her  beauty  that  she  had 
a  curtain 

"  Drawn  before  her, 

Lest  if  her  charms  were  seen,  the  students 
Should  let  their  young  eyes  wander  o'er  her, 
And  quite  forget  their  jurisprudence." 

Yet  notwithstanding  the  fame  given  to  the  Bolognese  School 
and  the  impulse  given  to  anatomy  by  the  teaching  of  Mon- 
dini,  the  science  retrograded,  and  all  the  Italian  schools  de- 
clined. The  time  of  renovation  had  not  yet  arrived.  The 
school  of  Salernum,  which  had  been  the  most  famous  for 
several  centuries,  mourned  by  Petrarch,  even  passed  out  of 
existence.!  The  dark  ages  were  not  yet  over.  Boccaccio 
laments  that  when  visiting  the  library  of  the  celebrated  mon- 
astery of  Monte  Casino,  near  Naples,  he  found  the  doors 
gone,  grass  growing  in  the  windows,  and  the  precious  books 

*  Those  who  wish  to  pursue  the  subject  of  women  in  medicine  further 
will  find  much  of  interest  in  the  following :  Lipinski,  Histoire  des  f emmes 
me"dicales,  Paris,  1900;  Schelenz,  Frauen  im  Reiche  Aeskulap's,  Leip- 
zig, 1900;  and  Baudouin,  Femmes  mtfdecines  d'Autrefois,  Paris,  1901. 
(W.  W.  K.,  1905.) 

t  Encyc.   Brit.,  vol.  xxi,  p.  451. 

|  Frederick  II  (Charles  II?  1285-1309),  of  Naples,  prohibited  sur- 
geons from  practising  unless  they  understood  the  "  anatomy  of  the  human 
body,  without  which  one  cannot  perform  any  operation,  nor  direct  the 
cure  after  having  done  it."  Malgaigne's  edition  of  Park's  works,  Introd., 
p.  xxx.  Did  they  then  dissect?  I  can  find  no  record  of  it ;  yet  this  would 
suggest  it  strongly. 


8  ADDRESSES   AND    OTHER   PAPERS. 

and  manuscripts  yet  undestroyed  covered  with  dust  and 
mold.* 

From  Mondini  to  Vesalius  the  best  anatomist  of  his  age 
was  undoubtedly  Leonardo  da  Vinci,  the  great  artist.  Not 
only  did  he  dissect  the  horse  and  other  inf erior  animals,  but 
also  the  human  body.  From  these  dissections  he  made  his 
celebrated  sketch-book  of  drawings  in  red  chalk,  now  hi  the 
British  royal  collection  at  Windsor,  and  labelled  by  him  with 
reversed  letters,  so  that  they  have  to  be  read  by  a  looking- 
glass.  | 

But  now  came  the  revival  of  learning  early  in  the  sixteenth 
century.  That  wonderful  awakening  of  the  human  mind 
which  was  manifested  hi  the  discovery  of  America,  of  the  pas- 
sage to  the  East  Indies,  and  of  the  Copernican  system,  and  in 
the  invention  of  printing,  of  the  compass,  and  of  gunpowder, 
could  not  but  find  a  new  path  of  progress  in  medicine  as  well. 
Vesalius  took  the  lead  in  1537  as  a  teacher  of  genuine  anat- 
omy in  Padua,  and  in  1543  he  published  his  splendid  work 
which  soon  revolutionized  the  science.  A  host  of  anatomists 
followed  in  his  path.  Columbus,  Eustachius,  Fallopius,  Fa- 
bricius,  Gasser,  Ingrassius,  Arantius,  Vidius,  Varolius,  and 
others,  all  diligent  anatomists  of  the  sixteenth  century,  have 
left  their  mark  in  the  household  names  of  elementary  anat- 
omy. I  say  elementary  anatomy  advisedly,  for  the  first  dis- 
sections were  both  naturally  and  of  necessity  confined  to  the 
grosser,  ocular  parts  of  the  body.  The  bones,  muscles,  and 
viscera  were  almost  the  only  well-dissected  and  well-described 
parts,  and  if  we  except  Vidius  and  his  perplexing  "Vidian 
nerve,"  none  of  the  anatomists  just  mentioned  have  their 
names  associated  with  any  of  the  finer  parts.  For  such  mi- 

*  Malgaigne's  Par6,  Introd.,  p.  xlvii. 

fWm.  Hunter,  Introd.  Lect.,  pp.  37-39,  and  R.  Knox,  M.D.,  Great 
Artists  and  Great  Anatomists,  London,  1852,  Leonardo.  It  is  under- 
stood that  these  sketches  will  soon  be  published.  Many  autotype  re- 
productions of  other  sketches  by  Leonardo  have  been  published  by  Braun, 
of  Dornach,  and  they  amply  attest  his  wonderful  knowledge  of  anatomy. 


'.^>    vf*)r/^A     P^/»**«r   V 


Pjc- 
'  'r^     -S  S**\  ' 

**&  -T-'MV,'', -X'' 

' 


*"••.  "—"V-r- 


.     Three  of  Leonardo  Da  Vinci's  drawings  with  reversed  lettering. 
From  Richter's  da  Vinci,  by  permission  of  Messrs.  Sampson,  Low,  Marston  &  Co. 


THE   EARLY   HISTORY   OF   PRACTICAL   ANATOMY.  9 

nuter  investigation  gross  anatomy  had  first  to  clear  a  path. 
Bodies  also  were  too  few,  and  had  to  be  too  hastily  dissected; 
and  their  instruments  were  too  imperfect.  The  dissecting- 
forceps,  without  which  no  minute  dissection  could  be  carried 
on,  is  not  certainly  over  one  hundred  and  fifty  years  old,  and 
may  be  far  less.*  Not  to  speak  of  modern  pictures  represen- 
tative of  practical  anatomy,  Rembrandt's  famous  painting  hi 
the  Hague,  about  two  hundred  years  old,  represents  Van 
Tulp  demonstrating  the  muscles  with  our  ordinary  surgical 
dressing-forceps.  This  awkward  substitute,  together  with 
double  hooks  on  a  handle,!  and  the  fingers  were  then  the 
anatomist's  only  resources.  Moreover,  no  good  means  had 
as  yet  been  devised  for  preserving  bodies  for  more  prolonged 
and  delicate  dissections,  nor  for  injecting  the  vessels,  nor  for 
making  permanent  preparations,  whether  for  reference  or  for 
teaching;  and  models  were  undreamed  of.  Discouraged  by 
many  as  a  useless  innovation;  frowned  upon  by  others  as 
repugnant  to  our  better  feelings;  obstructed  by  the  law; 
treated  even  as  impious;  fostered  only  by  the  love  of  knowl- 
edge and  by  its  own  necessity,  the  science  found  few  cultiva- 
tors among  the  bulk  of  the  profession. 

Among  the  teachers  of  anatomy  it  was  not  infrequent,  but 
outside  the  lecture-room  no  dissecting-rooms  existed.  Stu- 
dents saw  the  demonstration,  and  that  was  all.  None  of 
them  dissected  for  themselves.  Nor  when  we  come  to  later 
times  do  we  find  the  case  rapidly  bettered.  The  first  Monro 
says  that  in  his  student  days,  early  in  the  last  [eighteenth] 
century,  his  Scotch  anatomy  was  limited  "  to  seeing  the  dis- 
section of  the  human  body  once  in  two  or  three  years."!  In 
William  Hunter's  time,  at  the  end  of  the  same  century,  prac- 
tical anatomy  was  unknown  to  the  mass  of  the  profession 

*  Hyrtl,  Zerglied.,  pp.  19  and  20. 

t  See  them  figured  in  Michael  Lyser's  Culter  Anatomicus,  Amstel., 
1653. 

I  Edin.  Journal,  Oct.,  1866,  Hist.  Edin.  Anat.  School. 


10  ADDRESSES   AND   OTHER   PAPERS. 

until  he  established  the  celebrated  Great  Windmill  Street 
School.  In  1866  we  find  Professor  Struthers,  of  Aberdeen, 
saying,  "Less  than  a  generation  ago  it  was  not  an  uncom- 
mon thing  to  find  medical  practitioners  who  had  never  dis- 
sected."* And  even  to-day,  after  considerable  personal  ex- 
perience as  a  teacher  of  anatomy,  I  have  grave  doubts  whether 
the  majority  of  our  students  dissect  the  human  body  more 
than  once. 

But,  in  spite  of  these  obstacles,  anatomy,  both  descriptive 
and  practical,  went  on  gaming  favor  with  both  its  teachers 
and  the  profession  at  large. 

Italy,  the  focus  of  the  arts  and  sciences  in  the  revival  of 
Greek  learning,  naturally  took  the  lead.  In  her  celebrated 
universities  professorships  of  anatomy  were  founded  early  in 
the  sixteenth  century,  and  her  schools  were  crowded  with 
hundreds,  and  even  thousands,  of  students  from  all  parts  of 
Europe,  who  returned  to  their  native  cities,  carrying  with 
them  patriotic  desires  for  the  advancement  of  science  in  their 
own  lands.f 

England  was  among  the  first  to  profit  by  the  shining  ex- 
ample. Soon  after  the  founding  of  the  Royal  College  of  Sur- 
geons in  1540,  through  the  influence  of  Dr.  Caius,  the  king's 
physician,  and  the  founder  of  Caius  College,  Cambridge,  Henry 
VIII  granted  to  the  Royal  College  of  Surgeons  the  privilege  of 
dissecting  four  felons  annually,  and  in  1564  Elizabeth  gave  the 
same  privilege  to  the  Royal  College  of  Physicians.!  In  1581 
the  latter  college  created  the  lectureship  on  anatomy,  and  in 
1583  built  in  Knight  Rider  Street  the  first  anatomical  theatre. 
Here,  in  1615,  Harvey  was  elected  lecturer,  or,  as  it  was  then 

*  Edin.  Journal,  Oct.)*  1866,  Hist.  Edin.  Anat.  School. 

t  From  1204,  when  the  University  of  Vicenza  (the  first  after  Bologna) 
was  founded,  to  1445,  eighteen  universities  were  founded  in  Italy  alone, 
and  thirteen  more  in  other  parts  of  Europe,  to  which  thirteen  others  were 
added  before  the  year  1500. 

J  The  Gold-headed  Cane,  pp.  91,  92. 


THE   EARLY   HISTORY   OF   PRACTICAL  ANATOMY.  11 

called,  reader,  in  anatomy,  and  here  he  gave  his  first  public 
demonstrations  of  the  circulation  of  the  blood  about  a  year 
later.* 

The  facilities  for  general  medical  dissection,  however,  were 
very  limited,  and,  as  if  to  discourage  it  still  further,  in  1745 
a  fine  of  £10  was  imposed  on  anyone  dissecting  outside  of 
Barber-Surgeons'  Hall.  But  such  a  state  of  affairs  could  not 
long  exist.  The  profession,  under  the  lead  of  William  Hun- 
ter, soon  broke  away  from  such  bonds,  and  for  over  half  a 
century  almost  every  distinguished  anatomist  had  dissecting- 
rooms  attached  to  his  private  dwelling,  where  he  and  his  pupils 
cultivated  the  science.  In  17701  William  Hunter  bought 
a  lot  in  Great  Windmill  Street,  London,  opposite  the  Hay- 
market,  and  built  on  it  a  dwelling-house,  an  anatomical  theatre, 
dissecting-rooms,  and  a  museum.  The  lecture-room  was 
.lighted  from  above,  and  the  seats  rose  as  hi  our  own  amphi- 
theatres. Here  he  lectured,  assisted  by  his  brother  John,  by 
Hewson,  and  by  Cruikshank,  till  his  death,  in  1783.  Here 
he  collected  his  splendid  museum,  now  in  Glasgow,  at  a  cost 
of  £100,000,1  and  his  brother  John  began  his  own  collection, 
which  cost  him  before  its  completion  £70 ,000,  §  and  now  forms 
the  chief  ornament  of  the  Museum  of  the  Royal  College  of 
Surgeons.  At  William  Hunter's  death  the  anatomical  school 
passed  into  the  hands  of  his  nephew,  Baillie,  and  then  suc- 
cessively to  Cruikshank,  Wilson,  Sir  Benjamin  Brodie,  Sir 
Charles  Bell,  and  Shaw,  and  finally  to  Mayo  and  Csesar  Haw- 
kins. On  Mayo's  removal,  in  1833,  to  University  College 
Hospital,  this  celebrated  school  came  to  an  end.  ||  But  it 

*  The  Gold-headed  Cane,  pp.  95-98. 

t  William  Hunter  began  his  first  course  of  Anatomical  Lectures,  how- 
ever, on  Feb.  1,  1746.  Tweedy's  Hunterian  Oration,  Lancet,  Feb.  18, 
1905.  (W.  W.  K.,  1905.) 

J  Brodie 's  works,  vol.  i,  p.  448. 

§«Life  of  John  Hunter,  p.  72. 

||  For  these  and  other  interesting  particulars  as  to  this  celebrated  school, 


12  ADDRESSES   AND    OTHER   PAPERS. 

had  left  its  mark.  Thousands  of  educated  anatomists  had 
gone  forth  from  its  walls  to  practice  all  over  Great  Britain 
and  in  this  country.  It  furnished  William  Hunter's  museum 
to  Glasgow  in  1807,  and  John  Hunter's  to  the  Royal  College 
of  Surgeons,  London,  while,  later  still,  those  of  Wilson  and 
Sir  Charles  Bell  went  to  ornament  the  museum  of  the  Royal 
College  of  Surgeons  of  Edinburgh,  and  that  of  Mayo  to  Uni- 
versity College,  London.  From  it  as  a  foster-mother,  too, 
along  with  the  institution  of  new  public  schools  connected 
with  the  hospitals,  many  other  private  schools  sprang  up, 
and  presented  the  finest  opportunities  for  the  diffusion  of 
anatomical  knowledge,  so  that  in  1825-26,  besides  the  hos- 
pitals, there  were  no  less  than  seven  such  private  schools  of 
anatomy  in  London.* 

Next  to  England  in  point  of  time,  Holland  was  the  fore- 
most in  cultivating  anatomy  in  its  modern  revival.  Ruysch, 
Swammerdam,  Albinus,  and  Boerhaave,  in  the  last  hah0  of 
the  seventeenth  century,  were  not  only  the  anatomical  lights 
of  their  own  country,  but  also  of  all  Europe,  and  especially 
of  Germany  through  Haller,  and  of  Scotland  through  the 
Monros. 

I  have  already  quoted  the  Edinburgh  Act  of  1505,  which 
allowed  of  the  annual  dissection  of  a  criminal,  and  also  the 
early  experience  of  the  first  Monro,  which  shows  how  rarely 
this  was  made  available.  The  first  Scotch  anatomical  theatre 
was  built,  and  the  first  public  demonstrations  given,  in  1697. 
But  it  was  not  till  1720  that  a  regular  professor  was  appointed. 
At  that  date  Monro  primus  was  elected  Professor,  at  the  ex- 
traordinary salary  of  £15  per  annum!  From  this  time  till 
1859,  when  Monro  the  third  died,  the  history  of  Edinburgh 

see  Letter  from  Sir  B.  Brodie  to  Dr.  Craigee,  in  Appendix  to  Thom- 
son's Life  of  Cullen;  Pichot's  Life  and  Labors  of  Sir  C.  Bell;  Wm.  Hunt- 
er's Introd.  Lects.,  Lect.  2d,  and  fol.  papers;  John  Hunter's  Life,  and  Life 
of  Hewson. 

*  Lancet,  1825,  pp.  26  et  seqq.,  gives  a  list  of  them  all. 


THE   EARLY   HISTORY   OF   PRACTICAL  ANATOMY.  13 

anatomy,  and  that  of  this  astonishing  family,  are  almost 
identical.  True,  John  Bell  and  Knox,  Charles  Bell,  Barclay, 
Innes,  and  others  lectured  in  private  schools;  but  the  Mon- 
ros  held  the  sceptre.  All  of  them  lived  to  old  age,  Alexander 
primus  dying  at  seventy,  Alexander  secundus  at  eighty-four, 
and  Alexander  tertius  at  eighty-six.  All  were  professors  early 
in  life;  at  twenty-three,  twenty-one,  and  twenty-five,  respec- 
tively. All  of  them  taught  for  long  periods:  thirty-eight, 
fifty-four,  and  forty-eight  years;  and  father,  son,  and  grand- 
son, they  held  the  anatomical  chair  in  Edinburgh  from  1720 
till  1846,  a  period  of  one  hundred  and  twenty-six  years!* 

In  view  of  the  fact  that  this,  our  own,  city  was  only  founded 
in  1682,  it  shows  unusual  vigor  and  enterprise  that  in  1751 
— less  than  seventy  years  after  it  was  a  wilderness — Dr.  Cad- 
walader,  a  pupil  of  Cheselden,  in  London,  gave  demonstra- 
tions hi  anatomy  in  Second  Street  above  Walnut.  Eleven 
years  later,  Dr.  Shippen,  Jr.,  a  pupil  of  the  Hunters,  became 
a  regular  lecturer,  and  the  founder  of  the  medical  department 
of  the  University  of  Pennsylvania.  The  following  is  his  an- 
nouncement in  the  "Pennsylvania  Gazette"  of  November 
25,  1762:  "Dr.  Shippen's  anatomical  lectures  will  begin  to- 
morrow evening  at  six  o'clock,  at  his  father's  house,  in  Fourth 
Street.  Tickets  for  the  course  to  be  had  of  the  doctor,  at 
five  pistoles  each,  and  any  gentlemen  who  incline  to  see  the 
subject  prepared  for  the  lectures,  and  learn  the  art  of  dis- 
secting, injections,  etc.,  are  to  pay  five  pistoles  more."  His 
Introductory  was  delivered  in  the  State  House,  and  his  class 
numbered  twelve.  Three  years  later  his  house  was  mobbed 
for  alleged  violation  of  the  church  burying-ground,  an  asser- 
tion which  the  doctor  denied  in  a  public  announcement,  and 
at  the  same  time  declared  that  he  had  only  dissected  the 
bodies  of  "suicides,  executed  felons,  and  now  and  then  one 
from  the  Potter's  Field."  f 

*  Edin.  Journal,  Oct.,  1866,  Hist.  Edin.  Anat.  School. 

t  Carson's  History  Med.  Dept.  Univ.  Penna.,  pp.  39,  40,  80-81,  and  Ap- 


14  ADDRESSES   AND   OTHER   PAPERS. 

Dr.  Shippen  was  not  alone  in  this  misfortune,  for  Monro 
was  mobbed  in  1725,  Macartney  in  Dublin  many  years  after, 
and  Sir  Astley  Cooper  and  others  have  barely  escaped  it,  be- 
sides all  the  fights  and  riots  in  which  students  and  resurrec- 
tionists have  been  involved.  These  troubles  point  to  a 
difficulty  which  from  the  dawn  of  practical  anatomy  has 
always  been  felt.  The  problem  how  to  obtain  a  sufficient 
knowledge  of  anatomy  and  yet  not  to  do  violence  to  the  feel- 
ings of  the  community  is  one  difficult  of  solution.  Had  all 
"anatomists  been  even  so  gallant  as  Riolan,  physician  to  Louis 
XIII,  who  dissected  females  only  on  couches  of  germander,, 
daphne,  clematis,  and  thyme,  and  entombed  them  in  their 
floral  beds,*  yet  the  difficulty  would  not  have  been  overcome. 
The  problem  was  only  solved  by  the  anatomy  acts  which 
were  passed  in  England  in  1832,  f  on  the  continent  at  various 
periods  some  years  before,  and  in  this  country  by  Massachu- 
setts in  1831J  and  New  York  soon  after.  §  But  these  acts 
were  only  obtained  after  the  community  had  been  driven  to 
it,  not  only  by  the  repeated  violations  of  the  public  peace 
and  public  feelings,  but  also  by  repeated  crimes. 

When  a  student  with  Sylvius  in  Paris,  Vesalius  had  to 
prowl  around  the  places  of  execution  and  spoil  the  gallows 
of  its  victims,  and  to  retain  his  booty  was  sometimes  obliged 

pendix,  p.  217.  For  many  other  interesting  facts  in  the  early  history  of 
anatomy  in  this  country,  see  Prof.  A.  B.  Crosby's  address  before  the  New 
Hampshire  Medical  Society  (1870). 

*  Riolan's  Enchiridium,  quoted  by  Hyrtl,  Zerglied.,  p.  31. 

t  For  this  act,  known  as  the  Warburton  Act,  see  the  Lancet,  1831-32, 
p.  713. 

J  For  copy,  see  Am.  Journ.  Med.  Sci.,  vol.  viii,  1831,  p.  264. 

§  The  Pennsylvania  Anatomy  Act  was  passed  in  1883.  It  is,  I  be- 
lieve, the  best  in  the  United  States.  Under  its  provisions  we  have 
now  an  ample  supply  of  cadavera,  while  its  provisions  carefully 
prevent  wounding  the  sensibilities  of  the  community.  For  the  full 
text  of  the  Act  see  Medical  News,  Aug.  11,  1883,  p.  167,  Pamphlet 
Laws  of  Penna.,  1883,  p.  119;  and  with  an  amendment  in  Purdon's 
Digest,  voL  i,  p.  106. 


THE   EARLY   HISTORY   OF   PRACTICAL   ANATOMY.  15 

to  hide  the  bodies  even  in  his  own  bed.*  The  more  enlight- 
ened, though  cautious  rulers  and  legislative  bodies,  soon  pro- 
vided a  partial  supply.  The  first  recognized  source,  and  un- 
til the  present  century  the  only  legal  one,  was  from  executed 
criminals — an  illustration  of  which  may  be  seen  in  Hogarth's 
"Reward  of  Cruelty."  But  Cortesius  tells  us  about  1600, 
that  so  jealously  guarded  was  this  privilege  (in  Messina)  that 
in  twenty-four  years  he  could  but  twice  dissect  a  subject, 
and  then  under  great  difficulties  and  in  great  haste.f  What 
a  contrast  to  the  five  thousand  now  annually  dissected  in 
Paris  alone  !t 

In  England  it  was  not  till  the  reign  of  George  II,  in  1726,  § 
that  all  criminals,  instead  of  a  few,  were  given  for  dissection. 
This  act  was  in  force  till  1832,  but  this  source  of  supply  was 
insufficient  even  when  executions  were  more  frequent  than 
now.  In  all  Great  Britain,  from  1805  to  1820,  there  were 
executed  eleven  hundred  and  fifty  criminals,  or  about  seventy- 
seven  annually;  and  at  the  same  time  there  were  over  one 
thousand  medical  students  in  London  and  nearly  as  many 
in  Edinburgh.  The  result  was  a  natural  one.  The  grave- 
yards were  rifled;  and,  as  the  demand  was  a  permanent  one, 
there  arose  a  set  of  the  lowest  possible  villains  who  provided 
a  permanent  supply — the  resurrectionists — a  race  of  men  now 
happily  almost  extinct. 

At  first  but  few  in  number,  they  soon  rapidly  increased, 
till  in  1828  there  were  in  London  over  one  hundred  regular 
resurrectionists,  ||  besides  many  occasional  volunteers;  and 
their  trade  was  so  extensive  that,  if  the  police  were  more 
than  usually  vigilant  in  Edinburgh  or  Dublin,  they  would 
supply  those  more  distant  schools.  Their  skill  was  such  that 

*  Morley's  Life  of  Jerome  Cardan,  vol.  ii,  p.  11. 

t  Hunter's  Introd.  Lect.,  pp.  41-42. 

J  Hosp.  and  Surgeons  of  Paris,  by  F.  C.  Stewart,  pp.  144,  145. 

§  9  George  II,  cap.  31,  Lancet,  1834-35,  vol.  i,  p.  356. 

||  Lancet,  1828-29,  p.  793. 


16  ADDRESSES   AND   OTHER   PAPERS. 

i 

no  obstacle  was  insuperable.  The  police  watched  the  grounds 
—they  were  either  bribed  or  made  drunk;  relatives  replaced 
them — but  a  half-hour's  unwary  slumber  on  the  part  of  the 
weary  watcher  was  enough  for  an  adept;  high  walls  were 
built — they  scaled  them;  spring-guns  were  set — they  sent 
women  as  mourners  to  the  funerals,  who  discovered  the  posi- 
tion of  the  pegs;  a  stone,  an  old  branch,  a  blade  of  grass  laid 
on  a  newly-made  grave  was  made  to  act  as  a  detective — but 
the  practised  eye  of  a  regular  would  detect  it  in  a  moment,  and 
replace  it  after  the  theft.  So  skillful  were  they  that  Sir 
Astley  Cooper,  in  his  evidence  before  the  Parliamentary  Com- 
mittee, declared  that  no  matter  what  the  social  position  of 
any  person  in  England,  he  could  obtain  his  body  if  he  de- 
sired it*;  and  such  villains  were  they  that,  for  a  respectable 
price,  they  would  unhestitatingly  make  a  subject  of  him,  their 
best  though  unwilling  patron.  The  laws  against  their  crimes, 
and  the  vigilance  of  the  police,  had  but  one  effect — not  to 
stop  the  trade,  but  only  to  increase  the  cost  of  subjects.! 
The  ordinary  charge  was  from  £7  to  £10  apiece,  but  often 
this  was  largely  increased.  In  1826  the  price  was  as  high 
as  £16  to  £22;  and  sometimes  when  the  police  were  unusually 
vigilant,  even  £30 — $150 — were  paid  for  a  single  subject  !t 
Their  avarice  was  unbounded.  Stimulated  by  the  jealousy 
and  rivalry  of  the  various  schools,  they  usually  demanded 
a  special  fee  at  the  beginning  and  the  end  of  every  session; 
and  so  necessary  were  they,  that  they  were  often  paid  as  high 
as  £50  to  £60  hi  these  special  fees.  In  case  anyone  was  im- 
prisoned, his  bail  was  paid,  and  often,  also,  an  allowance 

*  Life  of  Sir  A.  Cooper,  vol.  i,  p.  407. 

t  So  inadequate  was  the  supply,  that  a  serious  proposal  was  made  to 
import  the  subjects  from  France  to  Ireland.  Lancet,  1826-27,  p.  80. 

J  Lancet,  1826-27,  vol.  ii,  p.  80;  and  1828-29,  vol.  i,  pp.  434  and  563; 
1837-38,  vol.  i,  p.  589.  Life  of  Sir  A.  Cooper,  vol.  i,  pp.  361,  396,  397, 
403.  Some  of  the  resurrectionists  died  rich.  See  A.  Cooper's  Life,  vol. 
i,  pp.  416-418. 


THE    EARLY   HISTORY   OF   PRACTICAL   ANATOMY.  17 

of  ten  shillings  per  week  was  paid  him  while  he  was 
in  jail.  In  one  case  recorded  by  Bransby  Cooper,  this  was 
continued  at  least  during  two  years.*  But  when  any  sub- 
ject was  specially  desired  by  an  enthusiastic  anatomist,  then 
was  their  carnival  of  extortion.  In  1783,  when  O'Brien,  the 
Irish  giant  (whose  skeleton,  eight  feet  four  inches  high,  now 
adorns  the  Hunterian  Museum  of  the  Royal  College  of  Sur- 
geons), was  in  failing  health,  John  Hunter  sent  his  servant 
Howison  to  watch  the  disposition  of  the  remains.  This  fact 
unfortunately  coming  to  the  knowledge  of  the  patient,  in 
his  unbounded  horror  of  the  surgeon's  scalpel  he  ordered  that 
after  death  his  body  should  be  watched  day  and  night  till 
a  leaden  coffin  could  be  made,  in  which  he  should  be  taken 
to  sea  and  buried  there.  Soon  afterwards  he  died,  and  the 
watchers  were  set.  Howison,  having  discovered  the  tavern 
where  they  refreshed  themselves  when  off  duty,  soon  struck 
a  bargain  with  one  of  them,  that  if  his  companions  would 
agree  to  it,  the  body  should  be  stolen  at  night,  and  for  their 
consent  the  watchers  were  to  receive  £50.  The  others,  satis- 
fied with  all  but  the  price,  demanded  £100,  which  Hunter 
agreed  to  pay.  Finding  him  so  eager,  they  soon  made  other 
difficulties,  and  again  and  again  increased  the  price  until  they 
had  raised  it  to  £500!  Accordingly,  the  body  was  stolen  at 
night,  conveyed  in  Hunter's  own  carriage  to  his  dissecting- 
room,  and  immediately  prepared,  but  with  such  haste,  for 
fear  of  interruption,  that  the  bones  could  never  be  properly 
whitened.f 

•  O'Brien's  coffin  was  not  the  only  one  which  contained  what 
might  be  called  a  "foreign  body"  when  the  clergy  performed 
the  burial  service.  Such  thefts  became  a  regular  part  of  the 
trade,  and  if  a  night  intervened  between  the  finding  of  a  body 
and  the  holding  of  a  coroner's  inquest,  the  body  was  liable  to 

*  Sir  A.  Cooper's  Life,  pp.  360-362  and  369. 

t  Otley's  Life  of  John  Hunter,  pp.  106,  107,  in  Palmer's  Ed.  of  Hunt- 
er's Works,  London,  1835. 
2 


18  ADDRESSES   AND   OTHER   PAPERS. 

disappear,  and  the  resurrectionist  often  attended  the  inquest 
to  see  the  astonishment  of  the  jury.  Sometimes  they  picked 
up  cases  of  apoplexy  in  the  street,  carried  them  to  one  of  the 
hospitals  as  relatives  of  the  patient,  claimed  the  body  after 
death,  and  quickly  assuaged  their  grief  with  guineas  from 
the  anatomical  school  of  another  hospital.  Patrick,  one  of 
the  most  celebrated  of  the  gang,  for  some  months  carried 
on  successfully  the  ruse  of  claiming  relationship  with  dying 
men  and  women,  whose  names  he  ascertained,  in  the  various 
workhouses,  and  his  career  was  only  cut  short  by  the  jealousy 
of  a  rival  named  Murphy,  who  denounced  him  to  the  authori- 
ties. But  Murphy  himself  adopted  a  similar  plan  on  another 
occasion.  Observing  one  day,  while  walking,  a  neat  meeting- 
house with  a  paved  burial-ground,  in  which  was  a  trap-door, 
he  soon  returned  in  a  suit  of  solemn  black,  seeking  a  quiet 
sanctuary  for  the  remains  of  his  wife.  Descending  into  the 
vault  to  select  the  place  of  her  repose,  while  the  back  of  the 
sexton  was  turned  he  quietly  slipped  the  bolts  of  the  trap- 
door, and  that  very  night,  entering  the  vault  by  this  means, 
he  rifled  every  body  there  of  the  teeth,  which,  as  porcelain 
teeth  were  then  unknown,  he  sold  to  the  dentists  at  a  net 
gain  of  £60.  Once,  a  body  stolen  from  the  grave  was  sold 
to  Lizars,  in  Edinburgh,  and  paid  for;  was  re-stolen  from 
Lizars's  dissecting-room  the  same  night  and  sold  to  Knox; 
the  scoundrels  netting  £25  in  all,  and  without  the  possible 
fear  of  indictment,  least  of  all  for  their  second  theft! 

Sometimes  adventurous  students  carried  the  plunder  home 
in  hackney-coaches,  and  this  gave  rise  occasionally  to  amus- 
ing adventures.  On  one  occasion,  the  hackman,  aware  of 
the  illegal  nature  of  his  passenger's  baggage,  having  arrived 
opposite  the  Bow  Street  police  headquarters,  thrust  his  head 
in  at  the  window,  and  said  to  the  uneasy  occupant,  "The 
fare,  sir,  to  the  hospital  is  a  guinea,  you  know,  unless  you 
wish  to  be  put  down  here."  "Quite  right,  my  man,  drive 
on,"  was  the  unhesitating  reply. 


THE   EARLY   HISTORY   OF   PRACTICAL   ANATOMY.  19 

Along  with  the  debasing  qualities  necessarily  developed 
by  such  an  occupation,  came  also  some  of  the  more  enviable 
qualities  of  body  and  mind.  Thus,  on  one  occasion,  when 
a  party  of  medicals,  headed  by  a  noted  Edinburgh  surgeon, 
were  discovered  in  a  city  churchyard,  the  chief  actor  laid  hold 
of  two  large  adults,  just  disinterred,  and,  carrying  one  under 
each  arm,  escaped  into  the  garden  of  a  private  institution 
under  the  stimulating  fire  of  blunderbusses.  But  strategy 
and  adroitness,  combined  with  brute  force,  were  still  more 
frequently  called  into  play.  A  country  lad,  whose  disease 
was  peculiar  and  his  skeleton  much  desired,  had  been  buried 
in  an  exposed  cemetery,  in  a  fishing  village  on  the  Firth  of 
Forth,  and  watchers  were  set.  The  resurrectionists,  in  full 
force,  attempted  to  bribe  them,  to  outwit  them,  to  entrap 
them,  but  all  to  no  avail.  Weeks  passed  by,  and  the  excite- 
ment was  gradually  dying  out,  when,  one  evening,  at  dusk, 
two  well-dressed  gentlemen,  smoking  their  cigars,  drove  up 
in  a  dog-cart  to  the  little  inn  and  alighted.  The  whip-hand 
gentlemen  told  the  hostler  that  he  expected  a  livery  servant 
to  bring  a  parcel  for  him  which  was  to  be  placed  in  the  box. 
In  a  short  time  the  parcel  was  delivered,  and  presently  the 
two  gentlemen  returned  and  departed.  The  sharp-eyed 
stable-boy  could  not  help  remarking  that  the  livery  servant 
who  brought  the  parcel  "  was  deuced  like  the  off-side  gentle- 
man," and  fancied  he  saw  a  bit  of  scarlet  lining  under  his 
brown  overcoat.  "Haud  yer  tongue,  Sandie,"  said  his  su- 
perior :  "  ye're  aye  seeing  farlies."  While  the  gentlemen  were 
driving  away,  the  watchers  we.re  approaching  the  grave,  and, 
to  their  utmost  astonishment,  it  had  been  despoiled.  Listen, 
the  Edinburgh  surgeon,  and  Crouch,  the  London  resurrec- 
tionist, needed  but  thirty  minutes  for  such  work,  especially 
by  daylight.  All  the  detectives  were  put  upon  the  track, 
and  all  the  dissecting-rooms  searched,  but  in  vain.  Years 
afterwards,  skeleton  No.  3489,  with  the  donor's  name  at- 


20  ADDRESSES   AND   OTHER   PAPERS. 

tached,  was  added  to  the  noblest  anatomical  collection  in 
Britain.* 

The  bodies  were  generally  left  in  the  night  in  bags,  and 
this  gave  them  occasionally  a  chance  too  good  to  be  lost. 
They  bagged  drunken  men  on  the  street  and  delivered  them 
as  subjects,  sometimes  to  their  great  astonishment,  at  others 
with  their  connivance.  Mr.  Clift,  the  curator  of  the  Hun- 
terian  Museum,  was  once  thus  waked  up  while  a  student 
with  John  Hunter,  and  two  bags  delivered  and  paid  for  on 
the  spot.  The  men  had  gone  but  a  few  steps  when  Mr.  Clift 
perceived  the  swindle,  and,  though  in  his  night-clothes,  he  ran 
after  them,  collared  the  principal,  and  said  to  him,  "You've 
left  me  a  live  man."  "I  know  it,"  said  the  man,  shaking 
off  his  hold  and  escaping  with  the  money;  "  you  can  kill  him 
when  you  want  him."f 

But  such  a  degrading  occupation  necessarily  debased  the 
men  to  the  level  of  committing  any  crime.  The  increasing 
number  of  students  leading  to  a  growing  demand  for  subjects, 
and  the  increased  vigilance  of  the  police  adding  to  the  difficulty 
of  procuring  them,  the  fears  of  medical  men  that  murder  would 
be  resorted  to  were  soon  realized.  In  1827  the  University 
of  Edinburgh,  with  nine  hundred  students  in  its  class,  for  the 
first  time  made  dissection  compulsory,  and  thus  greatly  stimu- 
lated the  demand.  London,  Liverpool,  and  Dublin  all  in 
turn  supplied  the  want,  but  the  prices  obtained  soon  gave  rise 
to  the  horrible  crimes  of  Bishop,  J  in  London,  and  William 

*  These  details,  and  many  others  equally  interesting  and  amusing,  may 
be  found  in  the  account  of  the  Resurrectionists,  in  the  Life  of  Sir  Astley 
Cooper,  vol.  i,  pp.  334-448,  and  in  Lonsdale's  Life  of  Robert  Knox,  the 
Anatomist,  pp.  47-116.  The  comic  side  of  the  subject  may  be  seen  in 
Hood's  Jack  Hall  (Jackal),  in  his  Whims  and  Oddities. 

t  The  late  Prof.  S.  H.  Dickson  informed  me  that  he  had  this  not  un- 
common "Joe  Miller"  of  the  present  day  from  Mr.  Clift  personally. 

J  I  found  this  man's  crimes  alluded  to  several  times  in  the  Lancet, 
1832-33,  vol.  i,  pp.  244,  341,  568,  when  first  preparing  this  lecture;  but, 
notwithstanding  the  most  thorough  search,  I  was  unable  to  obtain  any  of 


THE   EARLY   HISTORY   OF   PRACTICAL   ANATOMY.  21 

Burke,  in  Edinburgh,  the  latter,  from  the  atrocity  of  his 
crimes,  being  made  eternally  infamous  by  giving  his  name 
to  the  crime  of  "Burking." 

His  trial,  twenty-four  hours  long,  one  "of  unexampled 
length,"  said  the  judge,  in  curious  contrast  to  our  more  tardy 
justice,  took  place  December  24,  1828.  After  his  conviction 
he  made  a  confession  of  all  his  many  crimes.  While  he  and 
his  mistress,  Helen  McDougall,  were  lodging  with  a  man  by 
the  name  of  Hare,  one  of  the  lodgers  died  owing  Hare  £4. 
They  took  the  body  to  Dr.  Knox,  and  sold  it  for  £7  10s. 
Finding  it  so  profitable,  the  three  then  proceeded  to  smother 
every  available  lodger  who  fell  into  their  hands,  and,  in  the 
year  that  elapsed  before  their  detection,  sixteen  persons  had 
thus  been  murdered.  Burke  was  executed  Jan.  28,  1829,  and, 
by  order  of  the  judge,  like  Anton  Probst  in  this  very  city,  was 
publicly  dissected.*  His  skeleton  is  in  the  Anatomical  Mu- 
seum of  the  University  of  Edinburgh,!  and  from  his  tanned 
skin  John  Arthur,  afterwards  janitor  to  Prof.  John  Goodsir, 
had  made  a  tobacco-pouch,  which  he  carried  for  many  years 
as  a  memento  of  the  period  when  he  first  became  connected 
with  the  dissecting-room. I 

Such  crimes  called  public  attention  to  the  imperative  ne- 
cessity of  a  proper  source  of  supply  for  dissecting  material. 

the  particulars,  save  that  he  and  a  man  named  Williams  murdered  an 
Italian  boy,  and  were  betrayed  by  Hill,  the  dissecting-room  porter  at 
King's  College.  Since  then,  Dr.  J.  F.  Clarke  has  published  his  Auto- 
biographical Recollections  of  the  Profession.  In  this  entertaining  book 
(pp.  100-104,  and  the  Medical  Times  and  Gazette,  March  11,  1871)  a  full 
account  of  the  facts  is  given.  A  curious  bit  of  history  is  added  in  the 
London  letter  of  the  Philadelphia  Medical  Times  of  May  17,  1873,  p. 
524,  showing  how  the  murderers  were  detected  by  the  sagacity  of  the 
late  Mr.  Partridge. 

*  Lancet,  1828-29:  his  trial,  pp.  424-431;  his  confession,  pp.  667,  668. 

t  Lonsdale's  Life  of  Knox,  p.  76,  note.  This  book  contains  a  very 
full  account  of  the  careers  of  Burke  and  Hare,  and  their  relations  with 
Knox. 

J  Goodsir's  Anatom.  Memoirs,  vol.    i,  p.  163,note. 


22  ADDRESSES  AND  OTHER  PAPERS. 

The  Warburton  anatomy  bill  accordingly  was  enacted  Au- 
gust 1,  1832,  giving  all  unclaimed  bodies,  under  proper  regu- 
lations, to  the  various  schools.  This  has  been  the  model  for 
all  subsequent  acts,  our  own  passed  but  six  years  ago  among 
them.  For  several  years  there  were  loud  complaints  as  to 
its  operation,  but  experience  gradually  removed  its  difficul- 
ties, and  now  it  supplies  all  the  schools  well,  and  at  moderate 
prices.  The  price  in  Edinburgh  at  present  is  $3  per  part.* 
Our  own  act  is  suffering  the  same  trial.  Obstinacy  and  kna- 
very are  combined  to  defeat  it,  but  I  do  not  doubt  that  in  the 
end  it  will  gain  the  victory,  and  afford  us  an  ample  supply 
worthy  of  a  great  medical  centre. f 

Not  only,  however,  do  we  have  an  immense  advantage  in 
these  days  over  the  so-called  good  old  times  in  the  facility 
of  obtaining  material,  but  also  our  means  of  pursuing  prac- 
tical anatomy  are  vastly  more  perfect  and  more  prolific. 

In  the  Museum  of  the  Royal  College  of  Physicians  the  cu- 
rious observer  will  notice  "six  tablets  or  boards  upon  which 
are  spread  the  different  nerves  and  blood-vessels,  carefully 
dissected,"  removed  from  the  body  and  dried.  "In  one  of 
them  the  semilunar  valves  of  the  aorta  are  distinctly  to  be 
seen."J  Such  are  the,  to  us,  wretched  preparations  with 
which  Harvey  illustrated  his  lectures  on  the  circulation,  and 
they  were  probably  used  before  his  royal  patron  when  he 
demonstrated  his  wonderful  discovery  to  Charles  I.  He 

*  Really  the  price  of  a  "part"  in  Edinburgh  is  but  6*.  ($1.50),  but  the 
body  is  divided  into  ten  parts — two  each  to  the  head,  the  thorax,  and  the 
abdomen,  and  one  to  each  of  the  four  extremities.  The  body  lies  on  its 
back  for  three  days  to  give  time  to  have  the  thorax  and  abdomen  opened 
and  examined,  and  the  perineum  dissected;  then  on  its  belly,  for  dissec- 
tion of  the  muscles  of  the  back  and  then  of  the  spinal  cord.  Each  man 
next  removes  his  own  extremity,  and  dissects  it  separately. 

t  See  foot  note  page  14. 

J  Harlan's  Gannal's  Hist,  of  Embalming,  p.  258,  and  the  Gold-headed 
Cane,  pp.  127,  128.  Similiar  preparations  are  in  the  College  of  Surgeons, 
purchased  in  Padua,  by  John  Evelyn,  made  by  Fabritius  Bartoletus,  then 
Veslengius's  assistant,  and  afterwards  physician  to  the  King  of  Poland. 


THE   EARLY   HISTORY   OF   PRACTICAL  ANATOMY.  23 

made  them  probably  at  Padua,  under  the  eye  of  Fabricius, 
the  re-discoverer  of  the  valves  in  the  veins.*  If  anyone 
compares  them  with  our  splendid  preparations  and  models, 
how  insignificant  they  seem!  But  they  were  among  the  first 
essays  in  a  new  art  whose  benefits  are  still  felt  by  all  medical 
students. 

Carpi,|  Etiennes,t  and  Eustachius,§  in  the  sixteenth  cen- 
tury, and  Malpighi,  ||  Glisson,^[  and  Willis,**  in  the  seventeenth 
had  used  air,  water,  milk,  ink,  and  other  colored  fluids,  with 
which  to  inject  and  trace  the  vessels.  In  Holland,  however, 
the  first  substantial  progress  was  made.  De  Graaf,  about 
1668,  improved  the  syringe,  and  injected  mercury  into  the 

*  Charles  Etiennes  (Carolus  Stephanus)  was  the  first  who  properly  un- 
derstood the  valves  in  the  veins.  He  speaks  of  them  (in  his  De  Dissec. 
part.  Corp.  Humani,  Paris,  1545,  quoted  in  Hyrtl's  Zerglied.,  p.  585,  note) 
as"apophyses  membranarum "  which  obviate  the  danger  from  regurgita- 
tion.  This  anticipates  by  two  years  Cananus,  who,  in  1547,  when  Fabri- 
cius was  but  ten  years  old,  demonstrated  the  valves  in  the  azygos  veins. 
Aiken's  Bibl.  Med.,  Harvey,  p.  312,  and  Bayle  et  Thillaye,  op.  cit.,  i, 
p.  234. 

f  Professor,  hi  Pavia  and  Bologna,  1502-27.  He  is  the  first  who  speaks 
of  injections,  when  treating  of  the  renal  vessels  "per  syringam  aqua 
callida  plenam."  Isagoga  brevis  in  Anat.  Corp.  Hum.,  Bonon.,  1522,  in 
Hyrtl,  Zerglied.,  p.  585. 

%  He  blew  air  into  the  veins  by  a  metal  tube.  Hyrtl,  Zerglied.,  p. 
585. 

§  Portal  (Hist,  de  1'Anatomie,  Paris,  1770,  tome  i,  p.  634)  says  that 
Eustachius  injected  "fluids  of  various  colors  and  densities." 

II  Malpighi  used  ink  and  other  fluids  assiduously,  and  by  them  made 
various  discoveries  in  the  kidney  and  elsewhere. 

Tf  Glisson  injected  the  liver  with  ink.  Hyrtl,  Zerglied.,  p.  586.  Portal, 
iii,  261. 

**  Willis  injected  the  brain  with  "aqua  crocata."  He  discovered  the 
"Circle  of  Willis"  by  this  means.  The  tubes  of  Bellini  in  the  kidneys 
were  discovered  in  a  similar  manner.  The  pains  anatomists  took  at  that 
time  were  so  great  that  a  preparation  by  Hildanus  (A.D.  1624)  is  said 
to  exist  in  Berne,  which  exhibits  the  entire  venous  system  dissected  out 
by  means  of  their  distension  by  air,  and  the  hundreds  of  ligatures  that 
it  would  require.  Hyrtl,  Zerglied.,  pp.  586,  587. 


24  ADDRESSES   AND   OTHER   PAPERS. 

spermatic  vessels.*  Swammerdam,  Ruysch,  and  Albinus, 
however,  really  created  and  diffused  the  knowledge  of  the 
art  of  injections.  Swammerdam  saw  that  in  order  to  fulfill 
its  purpose  the  material  used  ought  to  be  injected  as  a  fluid 
and  yet  solidify  in  the  vessels,  and  not  evaporate  as  water 
did.  He  first  used  suet;  in  1667  he  substituted  wax,  and 
in  1672  he  sent  to  the  Royal  Society  a  preparation  thus  in- 
jected.f  His  success  was  such  that  in  his  best  preparations 
he  filled  even  the  arteries  of  the  skin  of  the  face.  Two  years 
later  he  gave  up  anatomy  as  impious,  joined  the  party  of  a 
religious  fanatic,  and  died  in  1680. 

Before  relinquishing  his  profession  he  made  his  method 
public  in  Amsterdam,  Paris,  and  London,  and  gave  special 
instruction  to  his  friend  and  fellow-townsman  Ruysch,  who 
pushed  the  art  so  far  that  he  was  said  to  believe  that  the 
body  was  almost  wholly  made  up  of  vessels.  J  Leeuwenhoek, 
another  citizen  of  Leyden,  had  fortunately  just  at  this  time 
invented,  or  rather  made  really  available,  the  microscope,  § 
and  thus  Ruysch  was  enabled  not  only  to  inject  finer  ves- 
sels directly,  but  also  to  discover,  as  a  result  of  his  injections, 
networks  of  vessels  hitherto  unsuspected.  ||  His  first  trials 

*  Encyc.  Brit.,  vol.  ii,  p.  761.  Portal,  Hist,  de  1'Anat.,  tome  iii,  pp. 
220,  221,  261.  Strangely  enough,  Hyrtl  (Zerglied.,  p.  587),  who  is  usually 
so  exact,  attributes  the  first  mercurial  injections  to  Nuck,  whose  work 
(Adenogr.  Curios.,  Leydae,  1692)  was  published  twenty-four  years  later 
than  De  Graaf's  "De  Usu  Siphonis." 

t  Portal,  Hist,  de  PAnat.,  iii,  334. 

J  This  erroneous  belief  (totum  corpus  ex  vasculis)  was  really  held  by 
Ruysch  and  nearly  all  his  contemporaries.  "Antoine  Ferrein,"  says 
Sprengel  (Hist,  de  la  Med.,  tome  iv,  p.  338),  "was  the  only  one  who  ad- 
vocated the  parenchyma  of  the  organs  against  Ruysch  and  Malpighi." 
It  was  long  held  by  Boerhaave's  school  also. 

§  Magnifying  lenses  of  rock  crystal  were  found  in  the  palace  of  Nim- 
roud,  by  Layard.  The  compound  microscope  was  invented  by  Hans 
Zansz,  spectacle-maker,  at  Middleburg,  Holland,  in  1590.  Encyc.  Brit., 
8th  ed.,  art.  Microscope,  p.  801. 

||  He  discovered  the  vasa  vasorum,  the  bronchial  arteries,  the  vessels 


'    fTl 

if':  _A  /  "\  'H'.'u/.  lj)£S  am  A  7   mtmra/a  rvntm 

S  /  .          ~N      ,- 

f    ,';-i>.Vr'   ^//  flltmailC   c.n.rri<n>;,,i    CWrf  , 

.  /  A 

•  f,ifcr   .tn:(tiT'f    \rin      •itn    tcn'.v 


Portrait  of  Frederic  Ruvwcli. 


\?fsSONIO~\N~AKSBEB.GIOS  i~i°' 


Ruvsch's    Museum. 


THE   EARLY   HISTORY   OF   PRACTICAL   ANATOMY.  25 

were  made  on  the  bodies  of  infants,  but  finally,  when,  in  1666, 
Admiral  Berkeley  was  killed  and  his  body  captured  in  the 
memorable  four  days'  fight  between  the  English  and  the 
Dutch  fleets,  Ruysch  successfully  embalmed  his  body  by 
order  of  the  States  General,  and  sent  it  back  to  England  with 
an  almost  natural  appearance.*  Such  was  his  success,!  says 
M.  Fontenelle,  that  he  seemed  not  to  preserve  men  after 
death,  but  rather  to  prolong  their  life.  At  the  close  of  his 
long  career  they  remained  perfectly  preserved,  with  their 
original  softness,  flexibility,  and  color. 

In  his  museum,  which  was  called  the  eighth  wonder  of 
the  world,  the  dulce  and  the  utile  were  elegantly  combined. 
Flowers,  ornamental  shell-work,  and  rarities  worthy  a  royal 
cabinet  were  interspersed  with  skeletons,  injections,  and 
other  anatomical  pieces  (see  Frontispiece),  and  many  of  them, 
especially  the  fcetal  skeletons,  were  labelled  with  appropriate 
and  instructive  mottos.J  Thus,  one  who  did  not  attain  to 

of  the  middle  layer  of  the  choroid,  called  the  "  Tunica  Ruyschiana  "  (though 
this  was  first  accurately  described  by  Zinn,  in  1755),  the  finer  vessels  in  the 
serous  and  synovial  membranes,  the  pia  and  dura  maters,  the  corpora 
cavernosa,  and  many  parenchymata.  Hyrtl,  Zerglied.,  p.  594.  Sprengel, 
Hist,  de  la  MeU,  tome  iv,  pp.  144,  233,  277,  278. 

*Bayle-et  Thillaye,  op.  cit.,  vol.  i,  p.  528.  Portal,  Hist,  de  1'Anat., 
tome  iii,  p.  262.  So  natural  was  one  infant's  body  that  Peter  the  Great 
is  said  to  have  kissed  it. 

t  Hyrtl  (Zerglied.,  p.  597)  found  the  process  described  by  J.  Ch.  Rieger 
(Introd.  in  notitiam  rerum  natural,  et  artefact.,  etc.,  Hagae,  1743,  4to,  2 
vols.)  under  "Animal"  (vol.  i)  and  "Balsamus"  (vol.  ii,  pp.  54-57).  The 
latter  contains  a  copy  of  Ruysch 's  autograph  directions  as  to  his  mode  of 
injection  and  preservation.  The  following  are  extracts:  "Pro  materie 
ceracea  sumendum  sebivm,  et  quidem  tempore  hyemali  simplex — aestivo 
tempore  exiguum  frustum  cerce  albce  addendum.  Liquefactae  materiae 
additur  cinnabaris  factitiae  quantitas  sufficiens,  aut  quantum  vis,  idque 
movendo,  donee  bene  permixta  sit  cinnabaris.  Liquor  meus  est  spiritus,  e 
vino,  vel  frumento  confectus,  cui  si  addere  velimus  in  destillatione  manipu- 
lum  piperis  nigri,  eo  acrius  penetrat  per  carnosa  spartes." 

%  Bayle  et  Thillaye,  op.  cit.,  vol.  i,  p.  529.  The  plates  in  Ruysch's 
Thesaurus  Anatomicus,  i-vi,  Amstel.,  1701,  illustrate  these  quaint,  but 
withal  artistic,  arrangements.  See  opposite  plate. 


26  ADDRESSES   AND    OTHER   PAPERS. 

even  uterine  maturity  holds  an  inflated  bladder  aloft,  and 
teaches  us  the  shortness  of  life  in  its  motto,  "Homo  Bulla," — 
"Man  but  a  bubble."  Another  holding  a  preparation  of  the 
lymphatics  showing  their  valves,  which  had  been  made 
twenty-five  years  before,  and  not  long  after  their  first  dis- 
covery by  Aselius,  in  1622,  reminds  you  they  are  "  as  difficult 
as  beautiful."  A  third,  a  uterus  containing  a  fetus,  hints 
at  a  questionable  paternity:  "Quo  minime  credis  gurgite 
piscis  erit," — "Fish  may  be  found  in  least  suspected  pools." 
A  still-born  child's  motto,  "Hsec  mihi  prima  dies,  hsec  mihi 
summa  fuit," — "This  my  first  day  was  my  last,"  reminds  one 
of  the  laconic  epitaph  in  a  similar  case — 

"  If  I  was  so  soon  to  be  done  for, 
What  was  I  ever  begun  for?" 

And  the  head  of  a  noted  woman  of  Leyden,  whose  finger 
points  to  the  syphilitic  perforations  of  her  skull,  has  the  warn- 
ing motto,  "In  similar  waters  similar  fish  are  found."*  The 
museum  was  the  admiration  of  all  distinguished  men  at  home 
and  abroad.  Generals,  ambassadors,  princes,  and  even  kings 
delighted  to  visit  it,  and  spend  whole  days  with  its  author,  f 
Peter  the  Great,  when  in  Holland,  in  1698,  thus  divided  his 
tune  with  Leeuwenhoek  and  Ruysch:  he  attended  the  lec- 
tures of  the  latter,  and  became  an  earnest  student  of  medi- 
cine. He  always  carried  a  small  surgical  case.  He  learned 
to  draw  teeth,  to  bleed,  and  to  dissect.  So  enthusiastic  a 
pupil  did  he  prove  that  he  always  occupied  the  front  seat, 
and  during  one  of  the  lectures  he  leaped  up  and  was  about 
to  seize  the  scalpel  the  master  held.|  The  Tsar's  surgical 

*  Ruysch,  Museum  Anatomicum.  An  Appendix  to  his  Opera  Om- 
nia  Anat.  Med.  Chirur.,  4to,  Amstel.,  1721,  pp.  110, 158, 156, 173,  174,  and 
163,  respectively.  (In  the  Library  of  the  College  of  Physicians  of  Phil- 
adelphia.) 

t  Portal,  Hist,  de  1'Anat.,  tome  iii,  p.  262. 
J  Life  of  Peter  the  Great,  London,  1832. 


THE   EARLY   HISTORY   OF   PRACTICAL   ANATOMY.  27 

operations,  however,  did  not  prove  so  successful,  for  a  Dutch 
merchant's  wife  whom  he  tapped  died  soon  after,  but  the 
Tsar,  by  way  of  consolation,  attended  the  funeral.  On  his 
return  to  Leyden,  in  1717,  he  purchased  Ruysch's  museum 
for  30,000  florins,  and  sent  it  to  St.  Petersburg.  Ruysch, 
though  seventy-nine  years  old,  immediately  went  to  work 
on  another.  When  his  son,  his  efficient  assistant,  died,  in 
1727,  he  pressed  his  two  daughters  into  the  work,  and  so 
diligent  had  he  been  that  after  his  death,  in  1731  (set.  ninety- 
three),  his  second  museum  was  sold  to  Stanislaus,  King  of 
Poland,  for  20,000  florins.* 

*  These  are  the  statements  generally  made  as  to  their  disposition  on 
the  authority  of  Burggraeve,  Precis  de  1'Hist.  de  1'Anat.,  Gand,  1840,  pp. 
295,  296.  Hyrtl  states  (Zerglied.,  p.  592,  note)  that  Heister  asserts  in  the 
Preface  to  Vater's  Museum  Anat.  propr.,  Helmst.,  1750,  that  the  second 
museum  was  bought  by  Fred.  Aug.  I,  Elector  of  Saxony,  from  Ruysch's 
heirs,  and  carried  to  Dresden.  Fred.  Aug.  II  sent  it  to  Wittenberg,  and 
Vater,  Ruysch's  pupil,  then  Professor  of  Anatomy  in  the  University,  made 
a  catalogue  of  it  (Regii  Mus.  Anat.  August.  Catal.  Univ.  Vittebergae,  1736) . 
Haller  (Bibl.  Anat.,  tome  ii,  p.  43)  says  of  this  collection:  "  Aliquse  partes 
corp.  hum.  ex  Ruyschii  thesauris  coemtae,  aliqua  undique  collecta." 

The  question  is  often  asked,  "  What  became  of  Ruysch's  preparations?" 
Conflicting-  statements  are  made,  some  stating  they  exist  at  the  present 
day  in  perfect  preservation.  (Bayle  et  Thillaye,  vol.  ii,  p.  85,  Parson's 
Anat.  Prep.,  Pref.,  p.  v.)  I  am  glad,  therefore,  to  be  able  to  give  so  val- 
uable an  opinion  as  that  of  Prof.  Hyrtl,  which,  being  founded  on  personal 
observation,  is  both  interesting  and  "decisive.  He  says  (Zerglied.,  pp. 
592,  593) : 

"Ruysch's  fame  outlasted  his  collections,  and  the  many  preparations 
which  he  expected  to  preserve,  'per  liquorem  suum  balsamicum  seternos 
in  annos,'  no  longer  exist.  In  the  Leyden  Anatomical  Museum  Prof. 
Halbertsma  showed  me  a  planta  pedis  which  it  is  thought  was  injected  by 
Ruysch.  In  the  Greifswald  Museum  I  saw  two  others  which,  it  is  asserted, 
are  Ruysch's  injections.  They  came  from  Vater's  private  collection  (Mus. 
Anat.  prop,  above).  The  preparations  sent  to  him  by  Ruysch  (with 
whom  he  was  in  uninterrupted  relations)  are  especially  noted  as  such. 
After  Vater's  death  the  collection  passed  into  the  hands  of  his  successor, 
Langguth,  and  at  the  dissolution  of  the  University  of  Wittenberg  was 
bought  by  an  apothecary  for  the  glass !  By  him  a  part  was  sold  to  Prof. 
Schultze,  in  Greifswald,  when  travelling  through  Wittenberg.  In  the 
Museum  at  Prague,  also,  I  found  three  small  preparations — an  injected 


28  ADDRESSES   AND   OTHER   PAPERS. 

What  in  Ruysch's  time  was  a  profound  secret  is  in  our 
day  a  common  art.  By  the  help  of  many  workers  in  the 
same  field*  our  means  of  injection  are  greatly  increased,  and 
our  results,  though  to  the  eye  they  do  not  reach  those  popu- 
larly ascribed  to  Ruysch,  yet  for  diffusing  the  knowledge  of 


finger,  a  piece  of  intestinal  mucous  membrane,  and  a  child's  hand — whose 
mode  of  preservation  so  exactly  corresponded  with  that  in  Ruysch's 
Thesaurus  Anatomicus  that  they  are  most  likely  the  work  of  this  master- 
hand,  and  were  probably  among  those  collected  by  Du  Toy,  Professor 
of  Anatomy  at  Prague  in  the  first  half  of  the  last  century,  in  his  scientific 
tour  in  the  Netherlands.  Even  in  the  Vienna  Museum,  according  to 
Schwediauer,  towards  the  end  of  the  last  century  some  of  Ruysch's  prep- 
arations were  to  be  found.  Those  at  Prague  I  have  examined,  and  found 
them  entirely  worthless."  On  page  595  he  speaks  of  them  as  "scarcely 
to  be  recognized  as  injections  of  the  vessels,"  and  of  the  "ruined  speci- 
mens in  Greifswald  and  Prague  .  .  .  which  through  long  continuance 
in  spirit  (liquor  balsamicus)  are  brittle,  and  by  the  development  of  the 
fatty  acids  are  discolored  and  reduced  to  a  grayish-brown  and  crumbling " 
pasty  mass  (Teig) — extravasation  everywhere." 

The  Russian  collection,  however,  Hyrtl  seems  not  to  have  examined, 
and  it  is  with  pleasure,  therefore,  that  I  can  state  both  on  the  authority  of 
a  letter  from  E.  Schuyler,  Esq.,  of  the  United  States  Legation  at  St.  Peters- 
burg (see  the  letter  in  the  Phila.  Med.  Times,  Feb.  1,  1872,  p.  173),  and 
another  private  letter  from  Prof.  Pelechin,  Assistant  Professor  of 
Surgery  in  the  Imperial  Medical  School  of  St.  Petersburg,  that  Ruysch's 
cabinet  forms  at  the  present  time  part  of  the  Anatomical  Museum  of  the 
Imperial  Academy  of  Sciences,  and  is  in  an  excellent  state  of  preservation, 
the  injections  being  perfect.  Unfortunately,  a  small  piece  of  a  fetal  in- 
testine sent  me  by  Prof.  Pelechin  for  microscopical  sections  was  destroyed 
by  the  carelessness  of  a  third  person.  It  was  perfectly  preserved,  and 
looked  very  like  a  successful  vascular  injection. 

*  Restricted  as  I  was  in  time,  I  was  unable  to  develop  many  points  as  I 
would  gladly  have  done  had  time  allowed.  The  principal  cultivators  of 
the  art  of  injections  since  Ruysch  are  as  foUows:  Alex.  Monro  primus 
added  the  stopcock  to  the  injecting  tubes,  and  used  double  injections,  viz. : 
glue  to  fill  the  finer  vessels,  followed  by  wax  for  the  coarser.  None  of  his 
preparations  remain  even  in  Edinburgh.  Hyrtl,  Zerglied.,  p.  599. 

Lieberkiihn  (Berlin,  1711-46)  was  the  first  whose  injections  really  stood 
the  test  of  the  microscope,  and  are  worthy  of  comparison  with  the  prepa- 
rations made  at  present.  Sixty-six  of  them  are  in  the  Vienna  Museum, 
each  in  the  focus  of  one  of  his  simple  microscopes  which  are  attached  to 
the  slides.  He  first  made  the  joint  between  the  syringe  and  the  arterial 


THE    EARLY    HISTORY   OF   PRACTICAL   ANATOMY.  29 

anatomy  among  the  profession,  and  for  anatomical  and  micro- 
scopical research,  they  are  vastly  better.  Injections  of  plas- 
ter of  Paris,*  wax,  paint,  glue,t  ether,  and  rubber  everyone 
can  now  make,  and  the  wonderfully  beautiful  results  of  Hyrtl, 
Gerlach,  Beale,  and  Thiersch  are  only  equalled  by  the  inge- 
nuity of  Chrzonszczewsky,  who  has  recently  effected  the  phys- 
iological injection  of  the  bile-ducts  by  coloring  the  bile  and 
then  tying  the  hepatic  duct.  Bidloo,  in  Amsterdam,  in  1685, 
and  Cowper  and  Nicholls,  of  Oxford, J  a  little  later,  added 
to  our  means  of  illustration  by  injecting  the  vessels  and  hoi- 
tube  air-tight  by  means  of  friction  instead  of  a  screw.  The  wings  by 
which  it  is  now  held  were  as  yet  unknown,  and  were  replaced  by  a  hook. 
He  used  wax,  resin,  turpentine,  and  cinnabar.  Hyrtl,  op.  cit.,  p.  602. 

In  the  present  century,  Shaw's  "cold  paint  injection"  (see  Parson's 
Anat.  Preps.,  pp.  2,  3,  and  Homer's  Pract.  Anat.,  Introd.,  pp.  xviii  and 
xix,  where  this  is  attributed  to  Allan  Ramsay)  has  been  largely  used. 
Bowman's  double  cold  injection  by  acetate  of  lead  followed  by  chromate 
of  potash,  both  in  solution,  Voigt's  solution  of  glue,  Gerlach's  of  carmine, 
Beale's  of  Prussian  blue,  etc.,  have  all  been  admirable.  No  one  has  done 
more  to  advance  the  art  than  Hyrtl  himself,  who  was  the  first  to  make 
preparation«*of  two,  three,  and  four  different  colored  injections,  and  has 
left  no  kingdom,  family,  or  genus  whose  anatomy  is  not  illustrated  by  his 
splendid  researches.  No  medical  man  should  visit  Philadelphia  without 
inspecting  the  splendid  collection  of  his  injected,  and  especially  his  cor- 
roded, preparations,  recently  purchased  (1874)  by  the  College  of  Physi- 
cians for  the  Mutter  Museum.  They  are  the  most  superb  specimens  of 
anatomical  preparations  I  have  ever  seen. 

*  First  used  by  Trew  (Commerc.  Liter.  Noricum,  1732,  p.  298),  and 
now  in  use  generally  in  this  country  and  in  Berlin,  while  wax  in  various 
forms  and  combinations  is  used  in  Edinburgh,  London,  Heidelberg,  Paris, 
Vienna,  etc. 

t  First  used  by  P.  S.  Rouhault,  Surgeon  to  the  King  of  Sardinia,  1718; 
Hyrtl,  Zerglied.,  pp.  589,  590.  . 

J  Win.  Hunter  (Tntrod.  Lect.,  p.  56),  and  following  him  most  other 
English  and  American  writers  (e.  g.,  The  Gold-headed  Cane,  p.  129;  Hor- 
ncr's  Anat.,  Introd.,  pp.  xiv-xv,  note),  give  the  sole  credit  of  this  beauti- 
ful invention  to  Professor  Nicholls.  Hyrtl,  however,  places  the  credit 
further  back  and  of  right  with  Bidloo  (Anat.  Corp.  Human.,  Amstel.,  1685), 
who  injected  melted  bismuth  into  the  lungs,  and  Cowper  (The  Anat.  of 
Human  Bodies,  Oxford,  1697),  who  used  Jead  (Hyrtl,  Zerglied.,  p.  604). 
Possibly  Nicholls  was  the  first  thus  to  prepare  the  vessels. 


30  ADDRESSES   AND   OTHER   PAPERS. 

low  viscera  with  wax  or  metal,  and  then  corroding  or  macera- 
ting the  animal  textures,  leaving  the  injection  as  their  per- 
fect representative.  Auzoux's  splendid  models  have  won  for 
him  the  cross  of  the  Legion  of  Honor.*  Suchet,  about  1850, 
revived  the  Egyptian  method  of  tanning,  but,  unfortunately 
and  wrongfully,  kept  the  process  a  profound  secret.  In  1867, 
at  the  Paris  Exposition,  in  noble  contrast  to  this  illiberal 
spirit,  Brunetti,  of  Padua,  explained  to  the  Paris  Medical 
Congress,  in  the  crowded  amphitheatre  of  the  Ecole  de  Me"de- 
cine,  his  method  of  tanning  by  which  he  had  made  the  aston- 
ishing preparations  which  he  then  exhibited.  For  durability, 
preservation  of  form  and  structure,  both  anatomical  and 
pathological,  even  to.  microscopical  exactness,  _they  are  unri- 
valled, and  he  was  rewarded  with  a  special  gold  medal,  as  well 
deserved  as  was  the  applause  his  liberal  spirit  elicited  from 
an  appreciative  audience.f 

Still  later  (1873),  Dr.  Marini,  of  Naples,  exhibited  at  the 
Vienna  Exposition  some  anatomical  preparations  made  by 
some  new  methods  (which  he  also  wrongfully  keeps  secret), 
which,  it  is  asserted  after  ten  years,  retain  all  their  original 
freshness  and  natural  appearance  even  to  the  fatty  tissues. 


*  Plastic  models  are  now  made  by  Auzoux  with  great  beauty  and  exact- 
ness, and  the  history  of  their  development  may  be  found  in  the  New  Amer 
Cyc.,  first  ed.,  vol.  i,  pp.  517, 518,  and  vol.  ii,  p.  409.  In  1823  in  the  reor- 
ganization of  the  universities  to  get  rid  of  the  materialism  of  the  French 
Revolution  the  old  prejudices  against  dissection  were  revived.  In  conse- 
quence of  the  difficulties  thus  thrown  in  the  way  of  dissection,  it  occurred 
to  Auzoux,  in  1825,  to  make  models  in  papier-mach6.  In  1830  the  inven- 
tion was  perfected,  and  Auzoux  now  employs  from  sixty  to  eighty  hands 
in  his  manufactory,  and  supplies  the  world  with  his  models  (of  which 
he  makes  about  two  hundred),  in  human,  comparative,  and  vegetable 
anatomy. 

f  See  Med.  News  and  Library,  Jan.,  1868.  I  have  in  my  possession  now 
two  specimens  of  tuberculosis  of  the  lungs  and  cirrhosis  of  the  liver, 
kindly  sent  me  by  Professor  Brunetti,  which  are  witnesses  to  the  excel- 
lence of  his  method.  The  color  is,  of  course,  destroyed  by  the  alcohol  and 
the  tanning. 


THE   EARLY   HISTORY   OF    PRACTICAL   ANATOMY.  31 

The  body  of  Thalberg  has  been  thus  preserved  for  the  adorn- 
ment of  his  widow's  drawing-room.* 

Dissections  having  for  their  object  such  permanent  prepa- 
rations cannot  be  made  in  haste.  They  require  considerable 
time.  So  too  dissections  for  a  series  of  lectures  on  various 
systems,  such  as  the  muscular,  the  vascular,  etc.,  require 
that  we  shall  be  able  to  preserve  the  body  unless  we  go  back 
to  the  short  courses  of  bygone  days.  Thus,  in  Edinburgh, 
in  1697,  in  the  first  course  of  public  lectures,  as  the  felon's 
body  by  law  had  to  be  buried  in  ten  days,  ten  lectures  were 
delivered  on  successive  days  by  as  many  different  lecturers, 
in  which  the  entire  subject  was  treated.  How  hurried  the 
course  was  we  may  judge,  seeing  that  on  one  day  the  brain, 
spinal  cord,  and  all  the  nerves  were  finished,  and  on  another, 
all  of  the  five  senses.!  But  when  we  go  back  to  Mondini  in 
1315,  we  find  him  the  embodiment  of  brevity,  for  he  com- 
pleted the  .anatomy,  physiology,  and  surgery  of  the  entire 
body  in  five  lectures. 

The  first  example  we  have  of  the  use  of  preservative  means 
is  in  the  now  familiar  Egyptian  mummies.  Believing  in  the 
immortality  of  the  soul,  and  that  they  could  retain  the  soul 
within  the  body  so  long  as  its  form  was  preserved  entire,  it 
was  very  natural  that  the  Egyptians  should  endeavor  to  do 
by  art  what  nature  showed  them  to  be  possible  in  the  desic- 
cated mummies  of  the  deserts  around  them.  Various  methods 


*  Med.  News  and  Library,  Nov.,' 1873,  p.  183;  Med.  Times  and  Gaz., 
Sept.  6,  1873. 

t  Edin.  Med.  Journal,  Oct.,  1866,  p.  294.  The  meagre  number  of  lec- 
tures on  important  branches  in  later  times  also  is  striking.  Thus,  Mr. 
Bronfield,  of  St.  George's  Hospital,  delivered  but  thirty-six  lectures  on 
anatomy  and  surgery,  Dr.  Nicholls,  William  Hunter's  teacher,  lectured  on 
anatomy,  physiology,  pathology,  and  midwifery  in  thirty-nine,  and  Mr. 
Nource,  at  St.  Bartholomew's,  embraced  "t6tam  rem  anatomicam"  in 
twenty-three  lectures.  (John  Hunter's  Life,  p.  4,  note.)  William  Hunter 
enlarged  the  number  of  lectures  on  anatomy  alone  to  eighty-six,  about 
the  present  length  of  such  a  course. 


32  ADDRESSES   AND   OTHER   PAPERS. 

were  adopted,  of  which  we  have  a  .short  description  in  the 
embalming  of  Jacob's  body  in  Genesis,*  and  at  a  greater 
length  in  Herodotus  and  Diodorus  Siculus.  Three  principal 
modes  existed,  differing  chiefly  in  expense.  The  cheapest 
was  available  to  even  the  poor,  the  second  cost  about  $450, 
and  the  third  about  $1250. t  In  the  last,  having  removed 
the  brain  and  its  membranes  through  the  nostrils,  by  break- 
ing through  the  ethmoid  bone  with  a  curved  piece  of  iron, 
they  made  an  incision  of  five  inches  in  the  loins,  removed  the 
thoracic  and  abdominal  viscera,  cleansed  them  with  palm 
wine  and  aromatics,  and,  after  a  prayer  by  the  priest  that 
all  the  sins  of  eating  and  of  drinking  might  be  forgiven,  cast 
them  into  the  river. J  The  abdomen  was  next  filled  with 
every  sort  of  spicery  except  frankincense,  and  the  body  placed 
for  forty  days  in  natrum,  an  impure  carbonate  of  soda.  The 
heart  embalmed  apart,  having  been  placed  between  the  thighs, 
the  whole  body  was  then  wrapped  in  cere-cloths  with  all  the 
exactness  of  our  modern  spiral  and  reverse  bandages,  and 
sealed  up  with  wax  or  bitumen,  §  and  in  some  cases  even  gold 
was  used.  ||  Bitumen  in  many  instances  was  used  in  the  body 
itself.  In  case  the  usual  means  were  wanting,  honey  was 
used  as  the  sole  preservative,  as  in  the  case  of  Alexander  the 
Great.^[  Some  seem  to  have  been  preserved  by  tanning,  and 
then  enveloped  in  wax.  In  fact,  the  very  name  of  mummy** 


*  Gen.  1 :  2,  3. 

t  Rawlinson's  Herod.,  vol.  ii,  pp.  119,  120,  and  notes. 
J  Pettigrew's  Hist,  of  Egyptian  Mummies,  London,  1834,  p.  58. 
§  Rawlinson's  Herodotus  Hist.,  ii,  §  136,  and  Diodorus  Siculus,  Bk.  I, 
vol.  i,  p.  102,  §  xcii. 

||  One  was  found  in  Siberia,  wrapped  in  forty  pounds  of  gold.  Petti- 
grew,  op.  cit.,  p.  65. 

^1  Statius,  lib.  iii,  Carm.  ii,  v.  117.  Pettigrew,  op.  cit.,  p.  86.  King 
Aristobulus's  body  was  similarly  preserved.  Josephus,  Antiq.,  lib.  xiv, 
cap.  vii. 

**  Rawlinson's  Herod.,  vol.  ii,  p.  122,  note. 


THE   EARLY   HISTORY   OF  PRACTICAL  ANATOMY.  33 

is  supposed  to  be  derived  from  the  Arabic  "mummia,"  from 


[mum,"  "wax."* 


The  mummies  have  been  put  to  some  curious  uses.     The 
Egyptians  gave  them  as  pledges  for  the  repayment  of  bor- 


*  William  Hunter,  at  the  close  of  each  session,  usually  devoted  one  lec- 
ture to  teaching  his  students  how  to  make  preparations,  and  described  also 
a  process  in  imitation  of  the  Eygptian  method,  which  he  had  put  in  use. 
In  the  case  of  the  wife  of  Martin  Van  Butchell  (whose  body  is  now  in  the 
Museum  of  the  Royal  College  of  Surgeons)  his  success  was  very  good,  and 
her  husband's  own  account  of  it  is  such  a  curious  document  that  I  give 
it  below.  Not  satisfied  with  preserving  this  treasure,  he  soon  solaced  him- 
self with  a  second  wife: 

"  14  Jan.,  1775.  At  2£  this  morning  my  wife  died.  At  8  this  morning 
the  statuary  took  off  her  face  in  plaster.  At  half -past  2  this  afternoon  Mr. 
Cruikshank  injected  at  the  crural  arteries,  5  pints  of  oil  of  turpentine  mixed 
with  Venice  turpentine  and  vermilion. 

"  15th.  At  9  this  morning  Dr.  Hunter  and  Mr.  C.  began  to  open  and 
embalm  the  body  of  my  wife.  Her  diseases  were  a  large  empyema  in  the 
left  lung  (which  would  not  receive  any  air)  accompanied  with  pleurisy 
and  pneumonia  and  much  adhesion ;  the  right  lung  was  beginning  also  to 
decay,  and  had  some  pus  in  it.  The  spleen  hard  and  much  contracted; 
the  liver  diseased  called  Rata  Malpighi.  The  stomach  very  sound.  The 
kidneys,  uterus,  bladder,  and  intestines  in  good  order.  Injected  at  the 
large  arteries,  oil  of  turpentine  mixed  with  camphored  spirits,  i.  e.  10  oz. 
camphor  to  a  quart  spirits,  so  as  to  make  the  whole  vascular  system  tur- 
gid; put  into  the  belly  part  6  Ibs.  rosin  powder,  3  Ibs.  camphor  powder, 
and  3  Ibs.  of  nitre  powder  mixed  with  rectified  spirits. 

"  17th.  I  opened  the  abdomen  and  put  in  the  remainder  of  powders 
and  added  4  Ibs.  rosin,  3  Ibs.  nitre,  and  1  Ib.  camphor.  .  .  . 

"  18th.  Dr.  H.  and  Mr.  C.  came  at  9  this  morning  and  put  my  wife  into 
the  box,  on  and  in  130  Ibs.  wt.  of  Paris  plaster,  at  18  pence  a  bag.  I  put 
between  the  thighs,  3  arquebusade  bottles,  one  full  of  camphored  spirits 
very  rich  of  the  gum,  one  containing  8  oz.  of  oil  of  rosemary,  and  in  the 
other  2  oz.  lavender. 

"  19th.  I  closed  up  the  joints  of  the  box  lid  and  glasses  with  Paris 
plaster  mixed  with  gum  water  and  spirits  of  wine. 

"25th.     Dr.  H.  came  with  Sir  Thomas  Wynn  and  lady. 

"Feb.  5.     Dr.  H.  came  with  2  ladies  at  10  this  evening. 

"7th.  Dr.  H.  came  with  Sir  Jno.  Pringle,  Dr.  Herberden,  Dr.  Watson, 
and  about  12  more  Fellows  of  the  Royal  Society. 

"llth.  Dr.  H.  came  with  Dr.  Solander,  Dr.  ,  Mr.  Banks,  and 

3 


34  ADDRESSES   AND   OTHER   PAPERS. 

rowed  money,*  the  "hypothecated  bonds"  of  the  Alexandrian 
"  Bourse."  But  in  the  middle  ages  they  were  still  more  curi- 
ously employed,  as  potent  remedies  in  falls,  bruises,  and  other 
external  injuries.  " Mummy,"  says  Sir  Francis  Bacon,  "hath 
great  force  in  staunching  of  blood,  which  may  be  ascribed  to 
the  mixture  of  balms  that  are  glutinous."  Francis  I  always 
carried  with  him  a  little  packet  of  powdered  mummy  and 
rhubarb  for  falls  and  other  accidents.f  So  great  was  the 
demand  that  as  the  real  article  was  difficult  to  obtain,  like 
Waterloo  bullets,  they  were  manufactured,  at  enormous  prof- 
its by  avaricious  Jews  in  Alexandria.  Ambroise  Pare,  who 
was  born  in  1509,  in  his  book  on  the  mummy, J  states  that 
having  learned  this  fact  from  his  friend  De  la  Fontaine,  who 
had  observed  it  in  Egypt,  and  also  having  never  seen  any 
good  effect  from  the  remedy,  he  did  all  in  his  power  to  dis- 
courage its  use  both  in  his  own  practice  and  also  in  all  his 
consultations.  He  gives  us  too,  in  his  book  on  embalming, 
a  method  he  himself  used  for  the  preservation  of  a  body, 
with  very  gratifying  success,  and  .as  it  is  the  earliest  of  the 

another  gentleman.  I  unlocked  the  glasses  to  clean  the  face  with  spirits 
of  wine  and  oil  of  lavender. 

"  12th.     Dr.  H.  came  to  look  at  the  neck  and  shoulders. 

"  13th.  I  put  4  oz.  camphored  spirits  into  the  box  at  the  sides  and 
neck,  and  6  Ibs.  of  plaster. 

"  16th.  I  put  4  oz.  oil  of  lavender,  4  oz.  oil  of  rosemary,  and  \  oz. 
oil  of  chamomile  flowers  (the  last  cost  4  shillings)  on  sides  of  the  face, 
and  3  oz.  of  very  dry  powder  of  chamomile  flowers,  on  the  breast,  neck, 
and  shoulders." 

The  body  resembles  a  Guanche  mummy  rather  than  an  Egyptian,  and 
is,  properly  speaking,  a  desiccated  rather  than  an  embalmed  body.  Petti- 
grew,  op.  cit.,  p.  258,  note. 

*  Pettigrew,  op.  cit.,  pp.  16  and  17. 

t  Pettigrew,  op.  cit.,  p.  9.  Even  to-day  they  are  used  by  the  Arabs 
mixed  with  honey  (p.  12). 

J  The  Workes  of  that  Famous  Chirurgion,  Ambroise  Pare",  London, 
1649,  p.  332.  Note  the  capital  pun  on  his  name  in  the  motto  under  his 
portrait  in  the  frontispiece.  "  Humanam  Ambrosii  vere  haec  pictura 
Paraei,  efngiem,  sed  opus  continet  ambrosiam." 


Portrait  of  Ambroise  Pare'-. 


THE   EARLY   HISTORY   OF   PRACTICAL  ANATOMY.  35 

more  modern  methods,  I  will  give  its  quaint  and  curious  de- 
tails and  results.* 

"The  body  which  is  to  be  embalmed  for  a  long  continuance 
must  first  of  all  be  emboweled,  keeping  the  heart  apart  that 
it  bee  embalmed  as  the  kinsfolkes  may  thinke  fit.  Also  the 
braine,  the  scull  being  divided  with  a  saw,  shall  be  taken 
out.  Then  shall  you  make  deepe  incisions  alongst  the  armes, 
thighes,  legges,  backe,  loynes,  and  buttockes,  especially  where 
the  greater  veines  and  arteries  runne,  first,  that  by  these 
meanes  the  blood  may  be  pressed  forth,  which  otherwise 
would  putrifie,  .  .  .  and  then  that  there  may  be  space 
to  put  in  the  aromaticke  powders.  The  whole  body  shall 
be  washed  over  with  a  sponge  dipped  in  aqua  vitse  and  strong 
vinegar,  wherein  shall  be  boiled  wormewood,  aloes,  coloquin- 
tida,  common 'salt  and  alum.  Then  these  incisions  and  all 
the  passages  and  open  places  of  the  body  and  the  three  bellys 
shall  be  stuffed  with  the  following  spices  grossely  powdered: 
ty. — Pulv.  rosar.,  chamomil.  melil.  balsam,  menthse,  aneth. 
saluise,  lauend.  rosism.  maioram.  thymi,  absinthii,  cyperi, 
calami  aromatici,  gentianae,  ireos  flor.  assse  odoratae,  caryo- 
phyll.  nucis  moschatse,  cinnamomi,  styracis,  calamitse,  be- 
nioini,  myrrhse,  aloes,  santal.  [with  exquisite  indefiniteness], 
quod  sufficit.  Let  the  incisions  be  sowed  up,  and  forthwith 
let  the  whole  body  be  anointed  with  turpentine  dissolved 
with  oyle  of  roses  and  chamomile.  Then  wrap  it  in  linen 
cloath  and  ceare  cloaths.  I  put  in  mind  hereby,  that  so  the 
embalming  may  become  more  durable,  to  steepe  the  bodys 
in  a  woodden  tubbe  filled  with  strong  vinegar  and  the  decoc- 
tion of  aromaticke  bitter  things,  as  aloes,  rue,  coloquintida 
and  wormwoode,  and  there  keep  them  for  twenty  days,  pour- 
ing in  thereunto  eleven  or  twelve  pints  of  aqua  vitS3."  Al- 
cohol is  the  real  means,  you  will  observe.  And  now  for  the 
result.  "I  have  at  home  the  body  of  one  that  was  hanged, 
which  I  begged  of  the  sheriff,  embalmed  after  this  manner, 

*Op.  cit.,  pp.  1130,  1132. 


36  ADDRESSES  AND   OTHER   PAPERS. 

which  remains  sound  for  more  than  twenty-five  yeeres,  so 
that  you  may  tell  all  the  muscles  of  the  right  side  (which  I 
have  cut  up  even  to  their  heads,  and  plucked  them  from  those 
that  are  next  them  for  distinction's  sake,  that  so  I  may  view 
them  with  my  eyes  and  handle  them  with  my  hands,  that 
by  renuing  my  memory  I  may  worke  more  certainely  and 
surely  when  as  I  have  any  more  curious  operations  to  be  per- 
formed). The  left  side  remains  whole,  and  the  lungs,  heart, 
diaphragma,  stomache,  spleene,  kidneyes,  beard,  haires,  yea, 
and  the  nailes,  which  being  pared  [he  adds  with  charming 
naivete],  I  have  often  observed  to  grow  again  to  their  former 
bignesse." 

A  century  later -than  Pare,  Ruysch,  as  we  have  seen,  was 
said  to  have  the  most  astonishing  means  for  the  preservation 
of  his  subjects.  But  we  must  make  large  allowances  for  the 
natural  exaggeration  of  the  extremely  happy  results  of  what 
was  then  a  new  art.  Nor  should  we  be  the  better  off  did  we 
possess  the  secret  of  his  contemporary  De  Bilsius,  a  noted 
charlatan  of  Rotterdam,  whose  boasted  method,  Haller  says, 
was  bought  by  the  States  of  Brabant  for  the  enormous  sum 
of  122,000  florins,  or  more  than  four  times  the  price  of 
Ruysch's  first  museum.  The  bodies  he  pretended  to  embalm 
for  the  University  of  Louvain  were  soon  destroyed,  and,  ap- 
parently in  proof  of  the  inefficacy  of  his  own  method,  so  foul 
was  the  air  of  the  rooms  in  which  he  prepared  his  subjects, 
that  it  was  said  to  have  been  the  cause  of  the  consumption 
to  which  he  fell  a  victim.* 

The  traveller  in  Europe  to-day  finds  a  number  of  specimens 
of  bodies  preserved  either  by  art  or  by  nature,  curious  alike 
to  the  antiquary  and  the  anatomist.  In  Milan  is  the  body 
of  St.  Carlo  Borromeo,  who  died  in  1584;  on  the  Rhine,  near 
Bonn,  in  an  old  monastery,  lie  over  a  score  of  monks  in  cas- 
sock and  cowl,  placed  in  its  vault  before  Columbus  had  dis- 
covered the  New  World;  and  again,  in  the  church  of  St. 

*  Bayle  et  Thillaye,  op.  cit.,  vol.  ii,  pp.  84,  85. 


THE    EARLY   HISTORY   OF   PRACTICAL   ANATOMY.  37 

Thomas,  at  Strasburg,  are  seen  the  bodies  of  the  Count  of 
Nassau  and  his  daughter  over  six  hundred  years  old.  The 
skin  is  yellow  and  shrivelled,  but  perfectly  preserved;  the 
small  clothes  of  the  father  have  been  replaced  by  imitations, 
but  the  clothes  of  the  daughter  are  intact.  The  lace  on  her 
blue  gown  is  perfect,  bunches  of  silver  flowers  adorn  her  hair, 
jewels  lie  on  her  breast,  and  even  diamond  rings  clasp  the 
shrivelled  fingers  as  in  mockery  of  death.  All  of  these  have 
been  probably  preserved  by  the  aluminous  soils  in  which  they 
were  placed.  Cold  has  done  the  same  work  for  the  ghastly 
remains  in  the  morgue  on  top  of  the  great  St.  Bernard,  while 
desiccation  has  shrivelled  both  features  and  limbs  into  con- 
tortions worthy  o'f  purgatory. 

The  largest  collection  of  bodies  preserved,  not  by  nature, 
but  by  art,  and  by  the  simplest  method,  namely,  that  of  desic- 
cation by  means  of  artificial  heat,  is  in  the  monastery  of  the 
Capuchins,  near  Palermo.  All  its  inmates  who  have  died 
for  the  last  two  hundred  and  fifty  years,  more  than  two  thou- 
sand in  number,  stand  upright  in  ghostly  companionship  in 
the  niches  of  its  subterranean  galleries.* 

None  of  these  means,  however,  would  do  for  dissection. 
For  practical  anatomy  the  introduction  of  alcoholf  without 
the  numerous  drugs  that  Pare  used,  was  the  first  efficient 
means  which  rendered  patient  and  prolonged  dissection  avail- 
able, and  Cuvier  points  to  its  use  as  an  indispensable  step  in 
the  progress  of  comparative  anatomy,  as  it  rendered  possible 

*  The  reader  who  is  curious  in  such  things  will  find  many  other  such 
instances  described  in  full  in  Pettigrew's  Hist.  Egypt.  Mummies,  and  in 
Harlan's  Gannal's  Hist,  of  Embalming,  8vo,  Philada.,  1840.  Among 
them  are  not  only  full  accounts  of  the  Egyptian  mummies,  but  also  of 
those  of  Peru,  Mexico,  the  Guanches,  etc.,  and  of  the  bodies  preserved 
at  Bordeaux,  Toulouse,  etc.  Dr.  A.  B.  Granville's  Essay  on  Egyptian 
Mummies,  Phil.  Trans.,  1825,  pp.  969  et  seqq.,  also  contains  some  interest- 
ing facts,  including  a  case  of  ovarian  disease  discovered  in  a  mummy. 

t  Abucasis  in  the  twelfth  century  first  showed  how  to  get  spirits  from 
wine.  Raymond  Lully  (thirteenth  century)  first  dehydrated  it  by  carb. 
potass.  Gmelin's  Handb.  Chem.,  vol.  viii,  p.  194. 


38  ADDRESSES   AND   OTHER   PAPERS. 

the  preservation  of  animals  while  being  transported  from 
distant  parts  of  the  world.  Since  then  chemistry  has  added 
largely  to  our  means  for  such  purposes,  such  as  chloride  of 
zinc,  arsenic,  salt  and  nitre,  hyposulphite  of  soda,  acetate  of 
aluminum,  and  other  means  for  special  purposes.  In  Berlin, 
Heidelberg,  Vienna,  etc.,  alcohol  is  used  where  a  prolonged 
dissection  is  necessary;  but  for  the  ordinary  dissections  of 
students  nothing  whatever  is  used.  The  greater  number  of 
unclaimed  bodies,  arising  from  overcrowding,  poverty,  and 
want,  so  amply  supplies  the  anatomical  schools  that  they 
dissect  without  any  antiseptic,  and  remove  the  subjects  the 
moment  decomposition  sets  in.  In  Vienna  no  part  is  allowed 
to  remain  on  the  tables  more  than  seven  days.  But  while 
such  an  arrangement  would  be  disastrous  here,  it  works  well 
there  by  reason  of  their  different  mode  of  study.  The  dis- 
secting-rooms are  only  open  from  twelve  noon  to  seven  P.M., 
and  from  October  to  April;  and  during  the  first  two  years 
the  student  does  little  beyond  dissection  and  the  study  of 
anatomy. 

In  this  country,  where  the  supply  of  material  never  equals 
the  demand,  especially  in  the  winter,  we  are  compelled  to 
preserve  them  for  months.  The  chloride  of  zinc  and  arsenic 
are  the  favorite  means.* 

By  such  a  hasty  review  as  I  have  now  given  of  the  imper- 
fect methods,  the  meagre  advantages,  and  the  restricted  op- 
portunities for  the  cultivation  of  practical  anatomy  by  former 
students  of  medicine,  we  can  appreciate  how  vastly  better 

*  For  some  researches  of  my  own  with  a  new  preservative — hydrate  of 
chloral — see  the  Philadelphia  Medical  Times,  March  21,  1874,  On  the 
Anatomical,  Pathological,  and  Surgical  Uses  of  Chloral.  My  subsequent 
experiments  have  fully  borne  out  the  conclusions  there  stated.  They  will 
be  given  at  length  in  a  subsequent  paper  (Amer.  Jour.  Med.  Sci.,  July, 
1875). 

In  the  N.  Y.  Med.  Record,  Jan.  9,  1897,  p.  48,  I  have  shown  that 
hyaline  and  granular  casts  and  epithelial  cells  were  preserved  in  the  urine 
by  chloral  for  nearly  twenty  years. — (W.  W.  K.,  1905.) 


THE   EARLY   HISTORY   OF   PRACTICAL  ANATOMY.  39 

off  we  of  to-day  are  from  every  point  of  view.  The  good 
old  times  are  the  myths  of  croakers  with  which  they  would 
repress  the  progressive  spirit  of  the  present.  Never  has  anat- 
omy made  so  rapid  and  so  substantial  progress  as  in  the 
present  century,  and  never  has  it  in  this  country  attained 
such  a  point  as  it  occupies  to-day.  Yet  we  lack  much.  Our 
very  wealth  of  opportunities  threatens  us  with  a  Capuan 
repose,  unless  the  stirring  examples  of  the  great  men  who 
have  preceded  us  stimulate  us  to  exertion.  Tertullian  says 
that  Herophilus,  in  Alexandria,  dissected  over  six  hundred 
bodies.*  Berengarius  of  Carpi,  the  contemporary  of  Vesa- 
lius,  dissected  over  one  hundred.f  Haller,  who  died  a  cen- 
tury ago,  says  that  with  his  own  hand  he  had  dissected  over 
four  hundred  in  seventeen  years J ;  and  that  almost  unequalled 
worker,  John  Hunter,  when  asked  at ,  the  trial  of  Captain 
Donellan,  in  1781,  whether  he  had  not  dissected  more  than 
any  other  man  in  Europe,  replied,  "In  the  last  thirty-three 
years  I  have  dissected  some  thousands  of  bodies. "§  It  seems 
an  exaggeration;  but  remember  his  habits.  For  thirty  years 
his  working-day  consisted  of  nineteen  to  twenty  hours.  He 
rose  at  four  or  five  o'clock,  and  always  dissected  till  his  break- 
fast hour,  at  nine,  and  after  his  labors  in  practice  and  the 
hospital-wards  were  over,  his  labors  in  the  dissecting-room 
recommenced,  and  he  never  left  it  till  midnight  or  even  later. 
When  any  of  you,  then,  visit  the  Hunterian  Museum,  in  Lon- 
don, remember  what  it  cost  him  in  money,  and,  what  is  more, 
the  unceasing  labor  of  a  long  life.  Such  diligence  has  some- 
times, alas!  cost  the  world  more  than  money  or  toil.  It  cost 
the  life  of  Bichat,  who  died  at  barely  thirty-one  from  con- 
stant confinement  in  his  dissecting-rooms.  "Bichat,"  wrote 
Corvisart  to  the  First  Consul,  "has  just  died  on  a  field  of 

*Encyc.  Brit.,  vol.  ii,  p.  751.     Wm.  Hunter,  Introd.  Lect.  p.  19. 

t  Bayle  et  Thillaye,  op.  cit.,  vol.  i,  p.  244. 

J  Encyc.  Brit.  8th  ed.,  vol.  ii,  p.  715.  §  Life,  vol.  i,  p.  134. 


40  ADDRESSES   AND   OTHER   PAPERS. 

battle  that  counts  more  than  one  victim.     No  man  in  so  short 
a  time  has  done  so  much  and  so  well."* 

Joining  diligent  work  to  the  unequalled  opportunities  that 
we  now  have,  the  laborers  in  the  vast  field  of  medicine,  in 
whatever  department  they  toil,  will  meet  with  a  reward  never 
before  equalled.  The  future  opens  to  the  active  worker  the 
brightest  prospects.  Happy  will  he  be  who  knows  how  to 
avail  himself  of  its  advantages! 

*  Bichat,  Sur  la  Vie  et  la  Mort,  p.  xiv. 


THE  PHILADELPHIA  SCHOOL  OF  ANATOMY  (1820-1875). 

The  middle  building  is  the  original  one ;  the  lower  one  to  the  right  was  added 
to  the  School  later.      That  to  the  left  was  a  carpenter  shop. 


THE   HISTORY   OF   THE 

PHILADELPHIA  SCHOOL  OF  ANATOMY 

AND  ITS  RELATIONS  TO  MEDICAL  TEACHING.* 


MEN  and  institutions  alike  are  to  be  judged  by  two 
standards:  first,  by  the  work  they  do  themselves, 
and,  secondly,  by  the  work  they  train  others  to  do,  and  thus 
prolong  indefinitely  their  influence.  Some  are  great  in  the 
one, — solitary  students,  whose  organizing  ability  and  personal 
influence  whether  by  mental  or  by  actual  contact  is  but  little 
developed.  Others  live  and  die,  leaving  but  little,  it  is  true, 
that  men  may  quote  or  name,  but  leaving  a  precious  harvest 
of  remoter  influences  on  even  a  distant  mental  posterity. 
Some  few  are  great  in  both.  Great  teachers  are  apt  rather  to 
excel  in  their  personal  magnetic  influence  on  others,  and  the 
world  owes  more  than  it  will  ever  know  to  their  continuing, 
but  untraced,  influences. 

Tested  by  either  of  these  rules,  the  "Philadelphia  School 
of  Anatomy"  has  accomplished  a  not  ignoble  work.  Within 
its  walls,  earnest,  intelligent,  laborious  men  of  science  have 
taught,  experimented,  and  investigated,  and  published  the 
results  of  their  work  in  many  a  book  and  pamphlet  and  scien- 
tific paper,  thus  fulfilling  the  first  test;  while  to  judge  it  by 
the  second,  it  is  only  necessary  to  point  to  the  thousands  of 
men  who  have  studied  and  dissected  here,  and  here  begun 
their  scientific  lives,  and  are  now  spread  all  over  the  country, 
and  in  fact  all  over  the  world,  doing  the  best  of  work  as  prac- 
titioners, teachers,  writers,  and  original  investigators. 

*  A  lecture  delivered,  March  1,  1875,  at  the  dissolution  of  the  school. 
Reprinted  with  the  kind  permission  of  J.  B.  Lippincott  Company. 

41 


42  ADDRESSES   AND    OTHER   PAPERS. 

Few  schools  of  this  sort  have  existed.  Many,  very  many, 
dissecting-rooms  and  private  anatomical  schools  have  been 
established  by  individuals,  to  continue  so  long  as  they  them- 
selves chose  to  teach,  and  then  to  disappear;  but  this  one 
has  not  been  the  creature  of  any  one  man.  It  has  outlived 
not  only  its  founder,  but  most  of  its  earlier  teachers.  It  has 
never  been  a  chartered  institution,  or  enjoyed  the  "jura, 
honores,  et  privilegia  ad  eum  gradum  pertinentia,"  but  it 
has  outlasted  more  than  one  such  in  this  city  alone.  In  this 
country  I  know  of  no  similar  school,  and  the  only  one  in 
Britain  which  outstripped  it  either  in  age,  in  celebrity,  or  in 
influence  was  the  Great  Windmill  Street  School.  Founded 
in  1770*  by  William  Hunter,  it  boasted  the  names  of  both 
the  Hunters,  of  Hewson,  Cruikshank,  Baillie,  Wilson,  Brodie, 
Sir  Charles  Bell,  Shaw,  Mayo,  and  Ca3sar  Hawkins,  and  came 
to  an  end  in  1833,  having  existed  for  sixty-three  years,  a 
period  only  exceeding  the  life  of  this  school  by  eight  years. 

The  PHILADELPHIA  SCHOOL  OF  ANATOMY  was  opened  in 
the  month  of  March,  1820  (nine  years  before  the  lately  des- 
troyed Medical  Hall  of  the  University  of  Pennsylvania  was 
built),  as  the  private  anatomical  school  of  Dr.  Jason  Valen- 
tine O'Brien  Lawrance,  under  the  name  of  the  "Philadelphia 
Anatomical  Rooms."  It  began  at  the  upper  end  of  Chant 
Street  (then  called  College  Avenue),  on  the  north  side,  in  the 
easternmost  of  the  two  buildings  since  used  by  the  school. 
About  this  date,  besides  the  anatomical  rooms  of  the  Univer- 
sity, there  were  several  private  dissecting-rooms  in  this  city, 
but  they  were  on  a  different  basis  from  this.  In  1818  Dr.  Jo- 
seph Parrish  opened  one  almost  in  the  rear  of  Christ  Church 
and  placed  Dr.  Richard  Harlan  in  charge  of  it.  In  1822  Dr. 
Thomas  T.  Hewson  opened  another  over  his  stable  in  Library 
Street,  next  to  the  present  Custom  House,  and  afterwards,  in 
1829,  in  Blackberry  Alley,  in  the  rear  of  his  house  on  Wal- 
nut Street  above  Ninth.  Dr.  George  McClellan  had  another 

*See  p.  11. 


PHILADELPHIA   SCHOOL  OF   ANATOMY.  43 

on  Sansom  Street  above  Sixth,  and  a  fourth  existed  on  the 
west  side  of  Eighth  Street  above  Jayne  (then  Lodge  Alley), 
but  under  whose  care  I  have  not  been  able  to  discover.  But, 
so  far  as  I  can  learn,  all  of  these  were,  mainly  at  least,  for  the 
office  students  of  their  proprietors,  and  they  were  all  ephem- 
eral. Lawrance,  however,  who  was  a  great  favorite  with 
the  students,  at  their  request  opened  his  school  for  all  who 
might  come,  and  so  founded  a  school  which  has  existed  for 
fifty-five  years,  and  has  educated  thousands  of  students  and 
scores  of  teachers  for  their  work. 

Lawrance  was  born  in  New  Orleans  in  1791,  and  graduated 
at  the  University  of  Pennsylvania  in  1815,  after  six  years  of 
study,  at  the  age  of  twenty-four.  He  returned  at  once  to 
his  native  city,  and  began  the  practice  of  medicine  with  his 
stepfather,  Dr.  Flood.  But  he  thirsted  for  the  scientific  ad- 
vantages he  had  found  in  this  city  during  his  student-life, 
and  at  the  end  of  three  years  he  sacrificed  all  his  unusually 
brilliant  prospects  at  home,  and  came  to  Philadelphia  in  1818, 
when  he  at  once  renewed  his  scientific  labors.  At  that  time 
the  University  (then  our  only  medical  school)  closed  its  doors 
in  April,  and  they  remained  unopened  till  November,  for  our 
present  admirable  summer  courses  were  begun  only  about 
ten  years  ago.  To  fill  out  this  long  hiatus  Lawrance  opened 
his  school  and  gave  a  course  on  Anatomy  and  Surgery,  which 
began  in  March,  had  a  recess  in  August,  and  ended  in  Novem- 
ber. He  gave  six  lectures  in  the  week,  and  his  personal  qual- 
ities, as  well  as  the  ease  and  perspicuity  of  his  style  as  a  lec- 
turer, made  his  school  a  decided  success.  In  the  fall  of  the 
same  year  he  became  the  assistant  to  Dr.  Gibson,  the  Pro- 
fessor of  Surgery  in  the  University,  and  in  1822  he  was  also 
made  the  assistant  to  Dr.  Horner,  then  Adjunct  Professor 
of  Anatomy.  These  positions,  together  with  that  of  Surgeon 
to  the  Philadelphia  Hospital,  would  have  assured  him  in  time 
a  remunerative  practice,  but,  like  many  another  who  has 
lived  "  the  scientific  life,"  he  had  to  struggle  on  with  but  a 


44  ADDRESSES   AND   OTHER   PAPERS. 

scanty  income  in  the  earlier  days  of  his  practice,  and  he  died, 
before  the  reward  had  come,  a  victim  to  his  zeal  and  devo- 
tion. While  attending  the  poor  in  the  Ridge  Road  District, 
during  an  epidemic  of  typhus  fever,  in  the  summer  of  1823, 
he,  who  had  lived  among  cadavera  unharmed,  was  attacked 
by  the  disease,  and  died  in  August  after  a  short  illness.* 

Like  most  of  his  followers  in  the  school,  not  satisfied  with 
teaching,  he  was  also  a  frequent  writer,  as  well  as  active  in 
original  investigations  and  experiments.  In  1821  the  "Acad- 
emy of  Medicine"  was  formed  "for  the  improvement  of  the 
science  of  medicine,"  and  he  entered  into  its  work  with  alac- 
rity. The  discovery  of  the  absorbent  vessels  had  led  to  the 
belief  that  they  were  the  only  channels  of  absorption  until 
Magendie  had  then  recently  reasserted  absorption  by  other 
channels,  especially  the  veins.  Dr.  Chapman,  then  Professor 
of  Practice  and  Physiology  in  the  University,  utterly  rejected 
these  views,  and  at  his  instance,  and  with  his  generous  pecu- 
niary assistance  in  the  summer  of  1822,  Dr.  Lawrance,  assisted 
by  Drs.  Harlan  and  Coates,  a  committee  of  the  Academy  of 
Medicine,  performed  upwards  of  ninety  experiments  on  living 
animals.  Not  satisfied  with  these,  in  the  succeeding  sum- 
mer, with  Dr.  Coates,  he  repeated  and  varied  them  in  a  second 
series  of  over  one  hundred  experiments,  and  he  had  begun  also 
a  third  series  to  determine  absorption  by  the  brain,  which  was 
only  cut  short  by  his  untimely  death.  The  results  were  pub- 
lished in  Dr.  Chapman's  journal,  "The  Philadelphia  Journal 
of  the  Medical  and  Physical  Sciences"  (iii,  273,  and  v,  108 
and  327),  and  they  not  only  verified,  but  extended,  Magen- 
die's  views. 

In  New  Orleans  he  had  recklessly  exposed  himself  to  yellow 
fever  in  making  necropsies  on  putrid  bodies.  He  investigated 
the  subject  still  further  in  the  epidemic  of  1820,  and  left  the 
most  complete  record  of  autopsies  in  this  disease  then  extant. 

*  Obituary  Notice,  by  Dr.  Coates,  Phila.  Jour.  Med.  and  Phys.  Sci., 
1823,  p.  171,  and  Eulogium  by  Professor  Jackson,  ibid.,  p.  376. 


PHILADELPHIA  SCHOOL  OF  ANATOMY.  45 

So  diligent  a  writer  was  he  that  he  left  behind  him  over  three 
thousand  pages  of  manuscript,  much  of  it  for  use  in  a  pro- 
jected work  on  Pathological  Anatomy,  a  subject  then  strangely 
neglected  in  America. 

At  Dr.  Lawrance's  death  the  school  passed  into  the  hands 
of  Dr.  John  D.  Godman.  He  was  born  in  1794*  in  Annapolis. 
He  began  life  as  a  printer,  but  at  the  age  of  fifteen  he  studied 
medicine  with  Dr.  Davidge,  Professor  of  Anatomy  in  the 
University  of  Maryland.  While  still  a  student  he  lectured 
for  his  preceptor  for  some  weeks  with  such  enthusiasm  and 
eloquence  as  to  gain  universal  applause.  Soon  after  his  grad- 
uation, in  1821,  he  was  appointed  Professor  of  Anatomy  in 
the  Medical  College  of  Ohio,  a  recently-established  institution, 
in  which  he  stayed  only  a  year.  Returning  to  Philadelphia, 
he  retired  from  practice  in  1823,  when  he  began  teaching  in 
the  anatomical  school.  The  very  first  winter  he  had  a  class 
of  seventy  students.  As  was  the  custom  for  many  years  after- 
wards, he  gave  three  courses  a  year,  viz. :  the  autumn  course, 
twice  a  week  from  September  to  November;  the  winter,  four 
times  a  week  from  November  to  March;  and  the  spring,  twice 
a  day  (with  a  view  to  graduation)  from  March  1  to  April  1, 
the  remainder  of  the  year  being  a  vacation  in  teaching,  but 
devoted  to  work.  The  fee  for  each  course  was  ten  dollars, 
the  same  as  at  present,  though  but  two  annual  courses  are 
now  delivered,  from  October  till  March  and  April  till  October, 
with  a  recess  in  July  and  August. 

Dr.  Godman's  style  as  a  lecturer  was  characterized  by  sim- 
plicity of  language,  directness  of  statement,  and  fertility  of 
illustration.  His  lecture-table  was  peculiar  in  its  construc- 
tion, being  arranged  with  ratchets  and  screws  so  that  the 
whole  subject,  or  any  part  of  it,  could  be  lifted  or  lowered 
at  will.  Another  peculiarity,  also,  in  which  he  prided  him- 
self, was  his  invariable  habit  of  dissecting  before  the  class 
while  he  lectured,  no  previous  dissection,  however  incom- 

*Dr.  Sewall  states  1798;   Dr.  S.  Austin  Allibone,  1794. 


46  ADDRESSES   AND    OTHER   PAPERS. 

plete,  having  been  made, — a  method  which  was  only  prac- 
ticable to  such  an  expert  dissector  as  he,  and  before  the  in- 
troduction of  the  chloride  of  zinc  which  hardens  the  tissues 
so  much,  but  which  would  again  be  possible  if  chloral  be  used. 
Dissecting  wounds  were  then  frequent.  During  his  first  win- 
ter several  of  his  class  suffered;  his  janitor,  from  a  scratch 
on  his  thumb  nearly  lost  his  life,  and  Dr.  Godman  himself 
was  poisoned  three  times,  once  so  severely  that  his  arm  was 
useless  for  some  weeks.  All  the  means  then  in  use,  salt  and 
saltpetre,  corrosive  sublimate,  pyroligneous  acid,  etc.,  were 
poor  preservatives,  for  he  speaks  of  repeatedly  "dissecting 
bodies  in  various  states  of  putrefaction,"  and  he  made  the 
great  improvement  of  using  whisky — an  impure  form  of  al- 
cohol— for  injection.  Since  that  time  chloride  of  zinc  (which 
was  introduced  in  this  city  in  1846  by  Prof.  Ellerslie  Wallace, 
then  Demonstrator  of  Anatomy  in  the  Jefferson  Medical  Col- 
lege), alcohol,  and  more  lately  chloral  (which  I  was  the  first 
to  use  eighteen  months  ago*),  have  banished  dissecting  wounds 
proper,  and  in  an  experience  as  student  and  teacher  of  fifteen 
years,  in  intimate  acquaintance  with  several  thousand  stu- 
dents, I  have  never  known  a  single  instance  of  such  a  wound. 
About  1824  he  established,  in  connection  with  the  school, 
a  reading-room  and  library,  supplied  with  text-books  and 
journals,  and  not  long  afterwards  he  desired  to  enlarge  the 
sphere  of  the  school  by  additional  associated  lecturers.  Ac- 
cordingly he  invited  Dr.  R.  E.  Griffiths  (afterwards  of  the 
University  of  Virginia)  to  lecture  on  Practice  and  Materia 
Medica,  and  Dr.  Isaac  Hays  on  Surgery  and  the  Eye,  he  him- 
self lecturing  on  Anatomy  and  Surgery, — a  scheme  which 
was,  however,  frustrated  by  his  removal.  Dr.  Hays  was  ap- 
pointed to  deliver  the  "Introductory,"  an  unfinished  pro- 
duction still  lying  in  the  drawer  of  the  accomplished  editor 
of  "The  American  Journal  of  the  Medical  Sciences."  In  1826 
his  widely-spread  fame  had  attracted  attention  to  him  so  prom- 

*  See  my  paper  in  the  Philadelphia  Medical  Times,  March  21,  1874. 


PHILADELPHIA   SCHOOL    OF  ANATOMY.  47 

inently  that  he  was  called  from  College  Avenue  to  the  chair 
of  Anatomy  in  Rutgers  Medical  College,  recently  established 
in  New  York  City.  It  was  no  slight  compliment  that  he 
should  be  thus  selected  as  a  member  of  the  faculty  in  a  school 
which  had  to  struggle  for  existence  in  the  midst  of  bitter 
rivalries  with  far  older  institutions.  Unfortunately,  his  health 
broke  down  in  the  midst  of  his  second  course,  and,  after  vainly 
traveling  in  search  of  health,  he  settled  in  Germantown,  where 
he  died  in  1830,  in  the  serene  hope  of  a  blissful  immortality. 
The'  closing  scenes  in  his  life  were  so  remarkable  for  Christian 
faith  that  his  Memoir,  by  Professor  Sewall,  has  been  published 
by  the  American  Tract  Society,  and  is  also  appended  to  New- 
man Hall's  narrative  of  the  death  of  Dr.  William  Gordon. 

Dr.  Godman's  early  education  had  been  very  defective; 
but  by  his  industry  he  mastered  Latin,  Greek,  French,  Ger- 
man, Danish,  Italian,  and  Spanish,  and,  as  Robert  Walsh 
remarks,  "he  finally  became  one  of  the  most  accomplished 
general  scholars  and  linguists,  acute  and  erudite  naturalists, 
ready,  pleasing,  and  instructive  lecturers  and  writers  of  his 
country  and  era."  He  was  ever  ready  with  his  pen,  as  well 
as  his  scalpel.  In  1825  he  became  one  of  the  editors  of  the 
"Philadelphia  Journal  of  the  Medical  and  Physical  Sciences." 
In  1827,  largely  through  his  influence,  the  profession  in  New 
York  agreed  to  support  this  journal  if  it  dropped  its  local 
name,  and  from  this  sprang  our  representative  quarterly, 
"The  American  Journal  of  the  Medical  Sciences."  Among 
the  extensive  works  he  planned,  while  in  College  Avenue, 
none  saw  the  light  save  the  "Natural  History  of  American 
Quadrupeds,"  in  three  volumes.  His  laborious  and  ardent 
pursuit  of  knowledge  is  well  shown  by  the  fact  that  in  inves- 
tigating the  habits  of  the  shrew  mole  he  walked  many  hun- 
dred miles.  He  edited  also  the  "  Journal  of  Foreign  Medical 
Science  and  Literature,"  and  Sir  Astley  Cooper  on  "Disloca- 
tions and  Fractures."  He  translated  from  the  Latin,  in  1824, 
Scarpa  on  the  "Bones."  He  published  two  books,  "Ana- 


48  ADDRESSES   AND    OTHER   PAPERS. 

tomical  Investigations,  comprehending  Descriptions  of  the 
Various  Fasciae  of  the  Human  Body,  the  Discovery  of  the 
Manner  in  which  the  Pericardium  is  formed  from  the  Super- 
ficial Fascia,  the  Capsular  Ligament  of  the  Shoulder-joint 
from  the  Brachial  Fascia,  and  the  Capsular  Ligament  of  the 
Hip-joint  from  the  Fascia  Lata,  etc."  (Philadelphia,  1824), 
and  "Contributions  to  Physiological  and  Pathological  Anat- 
omy" (Philadelphia,  1825),  and  papers  on  "The  Propriety  of 
Explaining  the  Actions  of  the  Animal  Economy  by  the  Assist- 
ance of  the  Physical  Sciences"  (Philadelphia  Journal,  etc., 
iii,  46),  "  On  the  Doctrine  of  Sympathy  as  Based  on  Anatomy  " 
(ibid.,  vi,  337),  "On  Arterial  and  Other  Irregularities"  (ibid., 
xii,  201)  and  other  papers  on  the  "Fascise"  (ibid.,  vi,  261,  and 
viii,  87).  Before  he  published  his  alleged  discoveries  as  to 
the  fascise,  he  invited  the  anatomists  and  surgeons  of  the 
city  to  a  demonstration  by  actual  dissection  before  them. 

When  Dr.  Godman  went  to  Rutgers  College,  in  1826,  he 
was  succeeded  by  Dr.  James  Webster.  He  retained  the  school 
for  four  years,  until,  in  1830,  he  was  called  to  the  chair  of 
Anatomy  in  the  Geneva  Medical  College.  Though  not  so 
polished  and  industrious  as  Godman,  he  was  a  good  teacher 
and  an  excellent  anatomist.  He  was  thoroughly  devoted  to 
the  interests  of  his  class,  and  at  one  time,  when  there  was 
greater  difficulty  than  usual  in  getting  subjects, — a  chronic 
ailment  of  dissecting-rooms, — he  sat  up  night  after  night, 
watching  that  neither  the  University  nor  any  private  room 
should  obtain  them  till  he  was  supplied,  and  he  gained  his 
point.  His  literary  labors  while  here  were  limited  to  editing 
the  "American  Medical  Recorder,"  from  1827  to  1829,  when 
it  also  merged  into  the  "American  Journal  of  the  Medical 
Sciences,"  and,  I  believe,  also  another  rather  pugilistic  jour- 
nal, which,  however,  was  short  lived. 

This  brings  us  down  to  living  persons;  and  my  account 
must  now  deal  rather  with  narrative  than  criticism.  After 


PHILADELPHIA  SCHOOL  OF  ANATOMY.  49 

Dr.  Webster  left,  the  rooms  were  vacant  for  a  year, — the 
only  hiatus  in  their  history. 

In  1831,  three  years  after  his  graduation  from  the  Univer- 
sity, Dr.  Joseph  Pancoast  reopened  the  rooms,  and  in  the  seven 
years  he  lectured  here  he  laid  the  foundation  for  his  subse- 
quent brilliant  career  both  as  anatomist  and  surgeon.  •  He 
gave  the  usual  three  annual  courses  which  Godman  had  es- 
tablished. No  other  lectures  were  given  in  the  building  dur- 
ing his  administration.  In  1838  he  was  elected  Professor  of 
Anatomy  in  the  Jefferson  Medical  College,  in  which  position 
his  fame  has  not  been  limited  even  by  the  wide  bounds  of 
the  Republic.  His  pen  also  was  not  idle  during  these  years. 
In  his  opening  year  he  translated  Lobstein  on  the  "Sym- 
pathetic Nerve,"  from  the  Latin;  later,  he  published  Manec 
on  the  "Sympathetic"  and  on  the  " Cerebro-Spinal  System 
in  Man,"  edited  "Quain's  Anatomical  Plates"  in  quarto,  and 
fitly  closed  his  career  in  the  Avenue  by  preparing  a  new  edi- 
tion of  Homer's  "Anatomy,"  in  two  volumes. 

On  the  promotion  of  Dr.  Pancoast  to  the  Jefferson,  in  1838, 
Dr.  Justus  Dunott  succeeded  him,  and  lectured  about  three 
years,  when  Dr.  Joshua  M.  Allen  became  his  associate.  Up 
to  1839  the  Philadelphia  Anatomical  Rooms  consisted  solely 
of  the  east  building,  the  other  being  a  store-house.  Now, 
the  two  buildings  become  sometimes  rival  schools,  but  for 
the  most  part  united  under  one  head.  In  1838  Dr.  James 
McCHntock  fitted  up  a  dissecting-room  at  the  southeast  cor- 
ner of  Eighth  and  Walnut  Streets,  and  called  it  the  "Phila- 
delphia School  of  Anatomy."  In  the  spring  of  1839,  his  next- 
door  neighbor,  the  late  Hon.  William  M.  Meredith,  vigorously 
remonstrated  with  him  on  account  of  the  stench  from  his 
rooms,  the  cause  being  a  lion's  carcass,  of  which  it  could  not 
be  said,  as  of  Samson's  lion,  "  Out  of  the  strong  cometh  forth 
sweetness."  Dr.  McCHntock  then  rented  and  fitted  up  the 
western  building,  threw  the  second  and  third  stories  together 
as  the  lecture-room,  in  which  we  are  now  assembled,  but  very 

4 


50  ADDRESSES   AND    OTHER    PAPERS. 

different  from  its  present  arrangement,  which  was  made  by 
Allen  at  &  later  date.  The  lecturer  stood  at  the  south,  or 
Chant  Street,  end,  and  under  the  rising  seats  slept  the  janitor 
and  his  family;  the  first  floor,  afterwards  the  Museum,  and 
now  the  dead-room,  serving  for  parlor,  dining-room,  and 
kitchen.  Moreover,  at  the  Chant  Street  end,  both  in  the 
second  and  third  stories,  was  a  small  room,  so  that  the  lec- 
ture-room was  much  smaller  than  it  is  at  present.  Dr.  Mc- 
Clintock  gathered  here  a  very  large  class  by  his  brilliant 
demonstrations,  until,  in  1841,  he  was  elected  Professor  of 
Anatomy  in  the  Vermont  Academy  of  Medicine  (afterwards 
Castleton  Medical  College),  and  also  in  the  Berkshire  Medical 
Institution,  Pittsfield,  Massachusetts.  Dunott  and  Allen 
(who  had  been  McClintock's  student  and  demonstrator)  then 
occupied  both  buildings,  under  the  name  of  the  Philadelphia 
School  of  Anatomy.  Soon  after  this  (precisely  when  I  have 
been  unable  to  discover),  Dr.  Allen  was  left  in  sole  charge, 
and  from  this  date  until  1852  he  conducted  a  most  success- 
ful school.  While  he  was  lacking  in  scholarship  and  cultiva- 
tion, he  insisted  strenuously  on  neat  dissection,  and  was  clear 
and  practical  as  a  teacher,  and  many  men  still  recall  his  in- 
struction with  great  vividness  and  pleasure.  While  here  he 
published  his  "Dissector's  Manual." 

One  incident  demands  notice  as  an  innovation  up  to  that 
time  unheard  of.  On  a  hot  July  day,  about  1843  or  1844,  one 
of  our  distinguished  physiologists  informs  me,  being  himself 
then  a  student  here,  he  entered  the  room  adjoining  the  lecture- 
room,  and  was  surprised  to  see  in  that  place  a  bonnet  and  pair 
of  gloves,  and  in  a  moment  to  hear  the  rustling  of  a  lady's  dress. 
Not  that  the  presence  of  females  was  so  rare  in  the  school,  but 
they  scarcely  needed  so  elaborate  a  toilet.  Peering  cautiously, 
as  he  then  well  might,  into  the  lecture-room,  he  saw  a  lady  at 
work  at  the  table  dissecting  a  negro  subject.  She  afterwards 
dissected  in  the  room  above  with  the  ordinary  medical  classes. 
"It  was  probably,"  says  her  sister,  "the  first  time  that  a 


PHILADELPHIA   SCHOOL   OF  ANATOMY.  51 

woman  had  dissected  as  a  medical  student."  She  had  read 
with  the  late  Prof.  S.  H.  Dickson,  of  the  Jefferson,  then  hi 
Charleston,  South  Carolina,  was  residing  in  the  family  of  Dr. 
William  Elder,  afterwards  studied  and  graduated  in  medicine 
at  Geneva,  and  is  now  practising  her  profession  successfully 
in  the  city  of  New  York.  Two  ladies  have  dissected  here 
(privately,  however)  under  my  own  supervision,  one,  Frau 
Hirschfeldt,  who  is  now  practising  dentistry  with  great 
success  in  Berlin;  the  other,  a  young  lady  who  desired  to 
perfect  herself  as  an  anatomical  artist,  and  who  made  many 
of  my  drawings.  In  the  last  two  winter  sessions,  also,  very 
many  ladies  were  members  of  my  classes  in  Artistic  Anatomy, 
and  were  greatly  interested  in  the  dissection  of  the  muscles. 

In  1842  Dr.  William  R.  Grant,  who  had  been  demonstrator 
of  Anatomy  at  the  Jefferson,  held  the  western  building  for  a 
year,  when,  on  his  becoming  Professor  of  Anatomy  and 
Physiology  in  the  Pennsylvania  College,  he  relinquished  it 
to  Dr.  McClintock,  and  from  1843  to  1847  the  two  buildings 
were  again  under  separate  control,  the  eastern  being  occupied 
by  Allen,  the  western  by  McClintock.  In  1844  Dr.  McClintock 
enlarged  the  school,  having  lectures  on  Practice  by  Dr.  James 
X.  McCloskey,  and  on  Materia  Medica  by  Dr.  Jackson  Van 
Stavern.  With  more  mature  plans,  in  the  spring  of  1847 
he  secured  the  charter  of  the  Philadelphia  Medical  College, 
and  during  that  summer  their  lectures  were  given  partly  in 
this  building,  partly  in  the  School  of  Pharmacy,  then  in  Filbert 
Street  above  Seventh.  Its  Faculty  consisted  of  Dr.  Mc- 
Clintock, on  Anatomy,  Physiology,  and  Surgery;  Jesse  R. 
Burden,  on  Materia  Medica;  Thomas  D.  Mitchell,  afterwards 
of  the  Jefferson,  on  Practice  and  Obstetrics;  and  William  H. 
Allen,  now  [1875]  President  of  Girard  College,  on  Chemistry. 
In  the  fall  of  1847  the  Philadelphia  College  removed  to  Fifth 
Street  below  Walnut,  and  both  the  buildings  again  came  under 
Dr.  Allen's  control  until  1852,  when  he  was  elected  Professor 
of  Anatomy  in  the  Pennsylvania  Medical  College. 


52  ADDRESSES   AND    OTHER   PAPERS. 

A  name  familiar  to  all  present  then  follows — Dr.  D.  Hayes 
Agnew.  He  assumed  the  responsibilities  of  the  school  in  1852, 
and  held  it  for  ten  years.  During  this  period,  beginning  with 
but  nine  students,  such  was  the  prosperity  of  the  school  that 
he  threw  the  small  room  in  the  .third  story  into  the  lecture- 
room,  to  accommodate  the  crowds  of  students  who  gathered 
almost  nightly  to  hear  his  lucid  demonstrations.  I  well  re- 
member many  a  dyspeptic  supper  hastily  swallowed  that  I 
might  be  early  in  attendance  and  so  secure  a  good  seat,  and 
much  of  my  own  success  is  due  to  his  example  and  training. 
Dr.  Agnew  also  altered  the  second  story  of  the  eastern  building 
for  his  Operative  Surgery  courses,  in  which  his  classes  were 
large.  While  teaching  here  he  published  his  "Dissector's 
Manual,"  his  lecture  on  the  career  of  Baron  Larrey,  a  valuable 
and  prolonged  series  of  papers  in  the  "Medical  and  Surgical 
Reporter,"  on  "Anatomy  in  its  Relations  to  Medicine  and 
Surgery,"  and  prepared  a  work  on  the  fasciae  of  the  human 
body,  which,  however,  he  never  published. 

Although  not  a  part  of  the  proper  history  of  the  Philadelphia 
School  of  Anatomy,  yet,  as  connected  with  the  teaching  done 
in  the  Avenue,  it  gives  me  pleasure  to  allude  to  the  successful 
school  established  on  the  opposite  side  of  the  street  by  Dr. 
William  S.  Forbes.  In  1856,  while  Dr.  Agnew  was  teaching, 
Dr.  Forbes  opened  his  school,  which  was  designed  largely  to 
give  facilities  for  dissection  to  the  students  of  the  dental 
colleges,  in  one  of  which  he  was  Professor  of  Anatomy.  He 
continued  to  teach  for  twelve  years,  a  period  longer  than  any 
other  teacher  in  the  Avenue. 

In  1862  Dr.  Agnew  relinquished  the  anatomical  department 
to  Dr.  James  E.  Garretson,  who  had  been  his  Demonstrator 
for  five  years.  Dr.  Agnew  retained  the  course  in  Operative 
Surgery  for  a  year,  when  he  became  Demonstrator  of  Anatomy 
and  afterwards  Professor  of  Surgery  in  the  University.  He 
was  succeeded  in  the  department  of  Operative  Surgery  from 
1864-67  by  Dr.  J.  M.  Boisnot.  After  two  years  of  successful 


PHILADELPHIA   SCHOOL  OF  ANATOMY.  53 

teaching  of  Anatomy  Dr.  Garretson  withdrew,  on  his  election 
to  the  chair  of  Surgery  in  the  Philadelphia  Dental  College. 
During  his  connection  with  the  school,  though  he  published 
nothing,  his  pen  was  not  idle,  for  he  has  since  given  us  his 
large  work  on  "Oral  Surgery,"  and  who  does  not  know  the 
genial  and  philosophic  "John  Darby"? 

In  the  summer  of  1865  Dr.  James  P.  Andrews,  now  of 
Lancaster  County,  assumed  the  duties  of  lecturer,  but  his 
health  failing,  he  was  succeeded  in  the  autumn  by  Dr.  R.  S. 
Sutton.  After  a  year's  teaching,  Dr.  Sutton  removed  to 
Pittsburg,  and  on  October  22,  1866,  I  gave  the  first 
lecture  of  my  life  to  a  class  of  seven  students,  of  whom  two 
were  "capita  mortua."  With  the  present  lecture,  after  nine 
years  of  unceasing  labor,  my  connection  with  the  school, 
and  the  school  itself,  ceases,  since  the  property  will  be  occupied 
by  the  new  post-office,  and  science  will  yield  to  at  least  one 
form  of  literature.* 

It  ill  becomes  one  to  speak  of  himself,  but  I  may  perhaps 
be  permitted  to  state  the  following  facts:  I  have  lectured 
here  longer  than  any  of  my  predecessors,  Allen  and  Agnew 
only  excepted;  I  have  given  nine  winter  and  five  summer 
courses  on  Descriptive  and  Surgical  Anatomy,  three  summer 
courses  on  Clinical  or  Surface  Anatomy,  two  courses  on  Ar- 
tistic Anatomy,  and  thirteen  courses  on  Operative  Surgery, 
besides  private  courses  to  numerous  individual  students  and 
graduates.  I  have  had  nearly  fifteen  hundred  students,  of 
whom  at  least  five  are  already  professors  in  medical  colleges, 
and  one  has  opened  the  first  dissecting-room  ever  established 
in  Japan.  They  have  come  from  the  District  of  Columbia, 
and  every  State  in  the  Union,  except  New  Mexico  and  Ne- 
braska, and  from  fourteen  foreign  countries,  as  follows: 
Canada,  Nova  Scotia,  Prince  Edward's  Island,  New  Bruns-. 
wick,  Cuba,  Porto  Rico,  Mexico,  Costa  Rica,  Nicaragua,  Den- 
mark, Norway,  Prussia,  Switzerland,  and  England. 

*  The  two  buildings  occupied  the  space  now  a  passageway  on  the 
western  side  of  the  present  post-office  building. — (W.  W.  K.,  1905.) 


54  ADDRESSES  AND   OTHER   PAPERS. 

From  1866  to  1870  I  occupied  only  the  western  building, 
Dr.  Richardson  having  the  lower  story  of  the  other  for  his 
Quiz  Class,  and  Dr.  H.  Lenox  Hodge,  from  1868  to  1870,  the 
upper  story  for  his  courses  in  Operative  Surgery,  but  in  order 
to  accommodate  my  increasing  classes  I  was  obliged,  in  1870, 
to  obtain  the  use  of  both  buildings,  and  later  still  further  to 
enlarge  the  lecture-room  by  placing  the  gallery  over  my 
head,  while  many,  even  then,  were  unable  to  obtain  seats. 
During  this  time,  also,  I  have  published  a  series  of  "Clinical 
Charts  of  the  Human  Body,"  a  sketch  of  the  "Early  History 
of  Practical  Anatomy,"  and  a  pamphlet  on  the  "Anatomical, 
Pathological,  and  Surgical  Uses  of  Chloral"  (which  I  deem 
my  most  important  contribution  to  practical  anatomy).*  I 
have  edited,  also,  Flower's  "Diagrams  of  the  Nerves,"  and 
Heath's  "Practical  Anatomy,"  and  have  published  anatomi- 
cal and  surgical  papers  on  "A  New  Diagnostic  Sign  of  Frac- 
ture of  the  Fibula,"  on  "The  Anatomy  of  the  Optic  Chiasm" 
(with  Dr.  William  Thomson),  on  "The  Ossification  of  the 
Atlas  Vertebra,"  on  "A  Case  of  Asymmetry  of  the  Skull," 
on  "A  Malformation  of  the  Brain,"  on  "The  Physiology  of 
the  Inferior  Laryngeal  Nerves  and  the  Intercostal  Muscles," 
as  observed  in  a  case  of  judicial  hanging,  and  numerous  other 
general  medical  articles,  besides  gathering  the  materials  for 
several  other  papers  and  perhaps  more  extended  publications. 

But  no  history  of  this  school  would  be  complete  did  it 
not  include  a  fitting  notice  of  the  teachers  who  have  been 
associated  with  it.  It  has  held  a  peculiar  relation  to  medical 
teaching  hi  this  city,  and  a  very  large  part  of  its  usefulness 
has  consisted  in  the  fact  that  it  has  afforded  a  field  in  which 
any  eager  aspirant  for  medical  honors  might  enter  without 

*  At  the  close  of  the  lecture  a  subject  injected  six  weeks  before  with 
one-quarter  of  a  pound  of  chloral  in  six  pints  of  water  was  shown,  and 
its  advantages  fully  illustrated.  [Other  methods  have  long  since  replaced 
the  use  of  chloral,  but  its  value  as  a  preservative  of  urine  is  well  estab- 
lished.—W.  W.  K.,  1905.] 


PHILADELPHIA   SCHOOL  OF  ANATOMY.  55 

much  risk  as  a  "free  lance."  Medical  teaching  on  other  sub- 
jects is  rarely  directly  remunerative.  The  expenses  of  rooms 
properly  cared  for,  and  of  the  means  of  illustration,  so  far 
outstrip  the  income,  especially  at  the  outset,  when  the  lec- 
turer is  unknown,  that  few  can  afford  the  pecuniary  risk 
of  failure,  and  those  few  scarcely  ever  care  to  try.  But  a 
successful  anatomist,  since  his  classes  are  large,  can  readily 
meet  the  expenses  of  such  a  school,  and  thus  afford  to  furnish 
accommodations  for  private  teachers  for  a  moderate  sum, 
often  merely  a  nominal  one.  It  has  always  been  my  own 
policy,  therefore,  to  encourage  all  such  private  teaching  by 
charging  a  sum  barely  sufficient  to  cover  my  expenses,  feeling 
that  thereby  I  gave  generous  aid  to  the  cause  of  medical 
teaching  and  to  the  teacher  himself,  and  yet  indirectly 
benefitted  myself  by  making  the  school  by  so  much  the  more 
a  medical  centre.  Moreover,  if  one  began  and  succeeded,  he 
made  a  reputation,  and  the  rewards  that  are  sure  to  follow 
faithful  and  successful  teaching  came  in  due  time;  while  if 
he  failed  here,  he  was  but  little  the  loser  whether  in  pocket 
or  in  fame.  But  if  one  tries  his  "  'prentice  hand"  as  an 
official  "Lecturer"  in  one  of  our  medical  schools  and  fails 
publicly,  it  damages  him  almost  beyond  recovery.  In  this 
way  the  Philadelphia  School  of  Anatomy  has  been  a  fertile 
foster-mother  of  youthful  teachers,  of  whom  many  are  now 
among  the  brightest  ornaments  of  our  profession. 

It  has  always  been  the  habit  in  the  medical  profession, 
as  in  the  legal,  for  the  student  to  enter  the  office  of  a  pre- 
ceptor, formerly  as  an  "articled  pupil,"  more  recently  as  an 
"office  student,"  and  by  the  payment  of  an  annual  sum — 
for  many  years  one  hundred  dollars — he  obtained  more  or 
less  instruction  according  to  his  preceptor's  ability,  zeal,  and 
conscientiousness.  The  more  distinguished  men  gathered 
many  such  pupils,  and  when  the  labor  of  personal  instruction 
became  too  onerous,  they  associated  others  with  them  in 
the  duties  of  office  instruction.  Gradually  the  habit  of 


56  ADDRESSES   AND   OTHER   PAPERS. 

lecturing  grew  up  among  them,  and  thus  arose  the  numerous 
associations  for  medical  instruction  by  lectures  and  by  a 
daily  "Quiz,"  which  have  been  so  prominent  and  have  done 
such  good  work  in  our  Philadelphia  medical  teaching. 

Dr.  Nathaniel  Chapman,  so  far  as  I  can  learn,  was  the 
first  in  this  city  thus  to  enlarge  the  facilities  for  his  office- 
students.  In  181,7  he  associated  with  himself  Dr.  Horner 
(on  Anatomy),  and  they  occupied  a  room  over  his  stable 
(a  rather  favorite  place,  it  would  seem,  for  anatomists), 
in  the  rear  of  his  house,  on  the  south  side  of  Walnut 
Street,  the  second  door  below  Eighth.  In  1819-20  Dr. 
Dewees  joined  them,  and  soon  after,  Drs.  Hodge,  Bell, 
Jackson,  J.  K.  Mitchell,  and  for  some  time  Dr.  T.  P. 
Harris.  This  afterwards  became  the  "Medical  Institute," 
obtained  a  charter,  and  erected  a  building  in  Locust  Street 
above  Eleventh,  afterwards  occupied,  from  1846  to  1848, 
by  the  "Franklin  Medical  College." 

In  1818  Dr.  Joseph  Parrish  began  a  similar  association  with 
Dr.  George  B.  Wood,  and  afterwards  also  with  Drs.  Richard 
Harlan  and  Shoemaker.  From  this,  in  1830,  arose  the  "Phil- 
adelphia Association  for  Medical  Instruction,"  consisting  of 
Drs.  Parrish,  Wood,  Samuel  George  Morton,  John  Rhea 
Barton,  and  Franklin  Bache,  who  were  joined  at  various 
times  by  Jacob  Randolph,  W.  W.  Gerhard,  Joseph  Pancoast, 
and  William  Rush.  For  six  years  the  association  continued 
its  labors;  but,  then,  as  some  grew  in  years  and  practice, 
and  others  were  absorbed  by  the  colleges,  it  was  dissolved. 
The  "School  of  Medicine"  was  a  third  similar  organization 
formed  about  the  same  time,  in  which  were  Drs.  William 
Gibson,  Jacob  Randolph,  B.  H.  Coates,  Rene  La  Roche, 
John  Hopkinson,  and  Charles  D.  Meigs.  Meigs  and  Bache 
held  a  peculiar  relation,  for  Bache,  of  the  "  Philadelphia  Asso- 
ciation," admitted  also  the  students  of  the  "School  of  Medi- 
cine" to  his  lectures  on  Chemistry,  and  Meigs,  of  the  rival 
school,  in  return,  admitted  the  students  of  both  to  his  lectures 


PHILADELPHIA  SCHOOL  OF  ANATOMY.  57 

on  Obstetrics.  Nearly  all  of  those  I  have  named  became 
professors  in  the  University  or  the  Jefferson,  and  of  them  all, 
alas,  only  George  B.  Wood,  Joseph  Pancoast,  and  B.  H. 
Coates  survive! 

In  1842,  while  Dr.  Joshua  M.  Allen  was  at  the  head  of 
the  Philadelphia  School  of  Anatomy,  the  second  "  Philadel- 
phia Association  for  Medical  Instruction,"  generally  known 
as  the  "Summer  Association,"  was  formed,  for  the  purpose 
of  giving  lectures  during  the  long  recess  in  the  colleges  from 
March  to  November.  It  consisted,  originally,  of  Drs.  John  F. 
Meigs,  on  Obstetrics;  Joshua  M.  Wallace  (the  brother  of  Prof. 
Ellerslie  Wallace),  on  Surgery;  Robert  Bridges,  on  Chemistry; 
Francis  Gurney  Smith,  Jr.,  on  Physiology;  and  Joshua  M. 
Allen,  on  Anatomy.  The  lectures  were  given  in  the  eastern 
building  till  about  1847,  when  they  changed  to  the  western 
one,  and  in  1854  to  Butler's  Avenue,*  in  the  rear  of  the 
Jefferson  Medical  College.  Here  they  continued  till  1860, 
when  they  disbanded.  In  1845,  when  Dr.  Meigs  began  to 
lecture  on  Diseases  of  Children,  Dr.  D.  H.  Tucker  followed 
on  Obstetrics,  and,  in  1850,  on  the  latter's  removal  to  the 
Richmond  Medical  College,  as  Professor  of  Obstetrics,  he 
was  followed  by  Dr.  William  V.  Keating.  At  Dr.  J.  M. 
Wallace's  death,  the  surgical  lectureship  was  filled  by 
the  appointment  of  Dr.  J.  H.  B.  McClellan  in  1851,  Dr. 
Addinell  Hewson  in  1853,  and  Dr.  John  H.  Brinton  in 
1860.  Dr.  Bridges,  though  elected  to  the  College  of  Phar- 
macy meantime,  retained  his  lectureship  on  Chemistry  from 
1842  to  1860, — the  only  constituent  member  of  the  Asso- 
ciation who  remained  to  its  close.  In  Anatomy,  when  Dr. 
Allen  became  Professor  of  Anatomy  in  the  Pennsylvania  Col- 
lege, in  1852,  Dr.  Ellerslie  Wallace,  then  also  Demonstrator  of 
Anatomy,  and  since  Professor  of  Obstetrics,  in  the  Jefferson, 
became  his  successor.  Dr.  F.  G.  Smith  continued  to  lecture 

*  This  little  street  is  now  covered  by  part  of  the  new  Hospital  of  the 
Jefferson  Medical  College.— (W.  W.  K.,  1905.) 


58  ADDRESSES   AND    OTHER   PAPERS. 

on  Physiology  till  1852,  when  he  was  elected  to  the  Professor- 
ship of  Physiology  in  the  Pennsylvania  College,  and  was  suc- 
ceeded by  Dr.  S.  Weir  Mitchell  who  served  until  1860.  The 
first  lecturer  on  Practice  was  Dr.  Alfred  Stille,  who  joined  the 
Association  in  1844,  and  resigned  in  1850,  on  account  of  ill 
health.  In  1854  he  became  Professor  of  Practice  in  Pennsyl- 
vania College,  and  now  fills  so  admirably  the  same  chair  in 
the  University.  He  was  succeeded  by  Dr.  John  F.  Meigs  from 
1850  to  1854,  and  he,  again,  in  1855,  by  Dr.  Moreton  Stille,  the 
brother  of  Alfred  Stille,  and  already  widely  known  as  the  joint 
author  of  "Wharton  and  Stille's  Medical  Jurisprudence."  A 
career  of  great  prominence  was  then  suddenly  cut  short  by  a  sad 
accident.  A  decomposing  subject  left  in  the  lecture-room  from 
Friday  till  Monday,  in  July,  so  poisoned  the  air  that  Stille  and 
several  of  the  class  were  made  faint  and  sick.  Stille  lectured 
as  long  as  he  could,  but  finally  was  compelled  to  yield, 
went  home,  and,  after  a  brief  illness,  died  from  pyaemia. 
The  next  year  the  place  was  filled  by  Dr.  J.  M.  Da  Costa,  now 
Professor  of  Practice  at  the  Jefferson.  Dr.  Francis  West — 
who  will  forget  his  fine  face  and  courtly  manners? — lectured 
on  Materia  Medica  from  1844  till  1859,  when  Dr.  James 
Darrach  succeeded  him.  On  Diseases  of  Children  Dr.  John 
F.  Meigs  was  the  only  lecturer  from  1840  to  1850,  and  on 
Medical  Jurisprudence,  Dr.  Edward  Hartshorne  from  1847  to 
1849. 

Besides  their  duties  in  the  association,  several  of  the  mem- 
bers also  gave  independent  courses.  Thus,  Dr.  Brinton  gave 
private  courses  on  Operative  Surgery,  and  lectured  on  general 
surgical  subjects  from  1853  to  1861,  and  laid  the  foundation 
for  his  later  reputation,  both  as  Clinical  Surgeon  to  the  Phila- 
delphia Hospital  and  Lecturer  on  Operative  Surgery  in  the 
Jefferson.  He  occupied  the  third  story  or  garret  of  the  eastern 
building,  a  room  which  was  destroyed  when  a  new  and  flat 
roof  was  put  on  the  building,  about  1864.  Many  a  night 
did  I  dissect  there  as  a  student  till  midnight,  with  no  com- 


PHILADELPHIA  SCHOOL  OF  ANATOMY.  59 

panions  save  the  cadavera  and  the  hungriest  of  rats.  They 
were  scarcely  afraid  of  the  living,  much  less  of  the  dead. 
When  Dr.  Mitchell  was  experimenting  here  on  his  snakes, 
wishing  sometimes  to  work  till  late  into  the  night,  and  his 
stock  of  candles  being  low,  he  would  only  light  a  frugal  stump 
when  an  observation  had  to  be  made  and  recorded.  In  the 
intervals  of  darkness  the  rats  would  swarm  all  over  the  room 
and  the  tables,  and  scarcely  scamper  away  when  wierdly 
lighted  up  by  the  great  bowl  of  his  meerschaum.  So  hungry 
were  they  that  on  one  occasion,  when  one  of  my  fellow  office 
students  fell  into  an  alcoholic  sleep  on  the  table,  mistaking 
him  for  a  cadaver  (for  Dr.  Brinton  always  used  alcohol  for 
preserving  his  subjects),  they  gnawed  through  his  boots,  and 
only  awakened  him  when  they  had  made  slight  progress  on 
his  toes. 

While  at  work  here  Dr.  Brinton  repeated  Suchet's  ex- 
periments on  tanning  muscles  after  injecting  gelatin,  dis- 
covered the  method  of  preserving  fresh  preparations  by 
applying  gutta-percha  dissolved  in  benzole,  dissected  over 
one  hundred  sterna  for  his  paper  on  "Dislocations  of  the 
Sternum,"  and  discovered  the  valve  in  the  right  spermatic 
vein,  one  of  the  few  discoveries  recorded  in  macroscopical 
human  anatomy  of  late  years. 

Dr.  Da  Costa  also  gave  private  courses  on  Physical 
Diagnosis  from  1854  to  1863.  Such  was  his  reputation 
when  I  attended  them,  a  year  before  their  close,  that  he 
was  compelled  to  refuse  many  anxious  applicants,  lest  the 
classes  should  become  unwieldy  for  that  method  of  personal 
instruction,  and  such  his  diligence  that  here  were  begun  the 
numerous  observations  for  his  unrivalled  later  work  on  "  Diag- 
nosis." Here,  also,  most  of  the  actual  laboratory  and  ex- 
perimental work  was  done  for  papers  on  "The  Pathology  of 
Acute  Pneumonia,"  "The  Effects  of  Respiration  on  the  Size 
and  the  Position  of  the  Heart,"  on  "Blowing  Sounds  in  the 
Pulmonary  Artery,"  on  "The  Morbid  Anatomy  and  Symp- 


60  ADDRESSES   AND   OTHER   PAPERS. 

toms  of  Cancer  of  the  Pancreas,"  and  on  "Serous  Apoplexy." 
At  the  same  time,  also,  he  translated  Kollicker's  "Microscopi- 
cal Anatomy"  from  the  German. 

The  front  room  on  the  lower  floor,  and  afterwards  that 
in  the  second  story,  were  occupied  by  Dr.  S.  Weir  Mitchell 
as  his  Physiological  Laboratory.  Besides  his  lectures  on 
Physiology  in  the  Association,  from  1853  to  1860,  he  gave, 
in  1856,  the  first  purely  experimental  course  on  Physiology 
in  the  city,  and  also  made  in  these  rooms  nearly  all  of  his 
extremely  important  physiological  experiments  and  dis- 
coveries. Here  (for  sentimental  philocanism  was  not  yet  a 
feminine  fashion)  dogs,  cats,  pigeons,  goats,  guinea-pigs, 
turtles,  rabbits,  ducks,  geese,  mice,  rats,  and  last,  but  not 
least,  sundry  snakes,  copper-heads,  moccasins,  and  rattlers, 
were  his  familiars  within,  while  gaping  crowds  of  swarming 
children  with  eyes  and  ears  intent  were  only  too  familiar 
without.  Beginning  in  1853,  his  first  important  paper  was 
the  joint  work  of  Dr.  William  A.  Hammond  and  himself  on 
"Corroval  and  Vao."  Then  followed  his  unexpected  and 
valuable  discovery  of  Saccharine  or  Diabetic  Cataract.  From 
1857  to  1861  he  was  engaged  more  or  less  continuously  on  his 
well-known  work  on  "Snakes  and  Snake-venom," — a  work 
which,  after  a  series  of  years,  the  English  observers  have  taken 
up  in  India  with  the  result  of  confirming  and  extending,  but 
hi  no  important  particular  of  reversing  his  own  conclusions. 
Among  them  the  most  brilliant  was  his  discovery  of  the 
corroding  action  of  the  venom  on  the  blood-vessels.  In  1860 
and  1861  I  was  his  assistant,  and  again  in  1867  and  1868  in 
renewed  experiments  on  the  same  subject. 

Many  are  the  amusing  stories  that  could  be  told  of  such 
somewhat  perilous  work;  of  the  rude  and  insecure  boxes  in 
which  they  were  received,  sometimes  a  section  from  the 
hollow  trunk  of  a  tree  battened  at  each  end,  with  scanty 
nails;  of  the  suddenly  discovered  escape  of  a  snake  or  two 
on  more  than  one  occasion, — a  discovery  none  the  less  dis- 


PHILADELPHIA    SCHOOL  OF  ANATOMY.  61 

quieting  from  the  fact  that  no  antidote  had  as  yet  been 
found;  or  of  the  janitor  who,  one  night,  when  locking  up, 
being  slightly  mystified  by  sundry  potations,  and  treading 
on  a  headless  snake  who  rattled  vigorously  and  struck 
him  with  his  stump,  ran  to  a  brick  pile  near  by,  and,  filling 
his  arms  with  the  bats,  let  fly  at  random  into  the  dark 
room  (he  had  more  than  St.  Patrick's  aversion  to  snakes), 
and  bottles,  crucibles,  costly  thermometers,  and  two  weeks 
of  carefully  prepared  results  were  in  the  morrow's  woeful 
count  of  cost.  Many  were  the  assistants  who  came,  and, 
not  liking  the  work,  quietly  disappeared;  one  of  them,  how- 
ever, rather  hurriedly,  for  he  sat  down  all  unconscious  upon 
a  lighted  cigar,  and  leaning  rudely  against  the  snake-box 
started  them  to  rattling  just  as  the  cigar  burned  through, 
when,  leaping  up  in  affright,  he  ran  away,  crying,  "I'm 
bitten!  I'm  bitten!"  and  was  seen  no  more.  On  another 
occasion,  just  as  the  snake  was  about  to  strike  him,  a  dog 
tore  himself  loose  and  went  flying  out  Chant  Street,  dragging 
a  long  chain  behind,  while  the  experimenters,  with  their 
long  black  gowns  flying  all  abroad,  rushed  after  him  in  the 
vain  hope  of  a  successful  chase.  It  so  happened  that  they 
were  just  raising  the  statue  of  Franklin  into  place  in  front  of 
the  Franklin  Market,  now  the  Mercantile  Library,  and  among 
the  lookers  on,  leaning  against  the  church,  was  one  of  Perm's 
most  placid  followers.  The  swaying  chain  coiled  itself  like 
another  snake  around  the  leg  of  the  unsuspecting  observer, 
and  arrested  the  dog's  rapid  flight  to  the  detriment  of  his 
friend's  centre  of  gravity.  But  the  sight  of  his  pursuers 
lending  vigor  to  his  struggles,  with  a  yelp  and  a  tug  he  rasped 
the  cuticle  off  his  groaning  victim  and  flew  up  Tenth  Street. 
Two  weeks  afterwards  the  physiologist  and  the  canine  en- 
countered each  other  on  the  street.  The  recognition  was 
mutual,  and,  as  the  dog  darted  away,  his  owner  remarked  to 
a  friend  alongside,  "He's  gone  on  werry  queer  since  he  got 
back!" 


62  ADDRESSES   AND   OTHER   PAPERS. 

The  speedy  disposition  of  so  many  uninjected  animals  in 
summer,  when  the  work  was.  mainly  done,  presented  many 
serious  obstacles,  until,  at  last,  during  the  regime  of  one 
ingenious  assistant  (who  generally  superintended  such  mat- 
ters), nothing  was  heard  of  them  either  in  the  way  of  trouble 
or  expense.  On  inquiry,  a  true  stroke  of  genius  was  dis- 
covered. The  baggage  trains  of  the  Pennsylvania  Railroad 
used  to  go  out  Market  Street  at  night,  and  he  simply  tied 
them  by  a  rope  to  the  tail  of  the  train.  Those  dogs  never 
needed  sepulture. 

It  can  now  be  easily  understood  how  not  so  much  even  as 
a  chip  has  ever  been  stolen  from  me  with  such  occupants 
in  the  building,  both  dead  and  alive,  although  the  inhabitants 
of  Chant  Street,  when  I  first  began  teaching,  consisted  largely, 
as  Bret  Harte  has  described  them,  of  "blazing  ruins,"  and 
though  the  door  has  often  gone  unlocked  and  the  cellar  was 
almost  always  accessible.  Even  a  former  office-boy  (of  Afri- 
can extraction)  could  never  be  induced  to  put  foot  inside  the 
building,  alleging  that  "he'd  heerd  of  their  layin'  for  colored 
boys  before  now ! " 

After  finishing  his  investigations  on  serpents,  Dr.  Mitchell 
experimented  largely  on  Woorara,  and  published  a  paper  on 
the  results.  In  1862-63  he  investigated  the  Chelonia,  and 
found  that  their  respiration  was  mammalian  and  not  ba- 
trachian  in  type,  and,  with  Dr.  George  R.  Morehouse,  he  dis- 
covered the  extraordinary  chiasm  in  their  inferior  laryngeal 
nerves,  the  only  nervous  chiasm  known,  save  the  optic.  In 
1867-68  he  investigated  especially  the  effects  of  extreme  cold 
on  the  nerves  and  nerve-centres,  and  in  1869  his  extended 
experiments  on  the  cerebellum  were  made,  when  he  preserved 
a  pigeon  without  any  cerebellum  for  the  before  unexampled 
period  of  nine  months. 

No  more  brilliant  corps  of  teachers,  perhaps,  has  ever  been 
gathered  in  this  city  than  this  old  "Summer  Association." 
Tucker  became  Professor  of  Obstetrics  first  in  Franklin  Col- 


PHILADELPHIA   SCHOOL  OF  ANATOMY.  63 

lege  and  then  in  Richmond;  Keating  went  to  the  Jefferson; 
Bridges  to  the  Franklin  College  and  the  College  of  Pharmacy; 
Allen,  as  Professor  of  Anatomy,  to  the  Pennsylvania  College; 
Ellerslie  Wallace,  first  as  Demonstrator  of  Anatomy,  and 
then  Professor  of  Obstetrics,  to  the  Jefferson ;  Francis  Gurney 
Smith,  to  the  chair  of  Physiology  in  the  Pennsylvania  College, 
and  then  to  the  University  of  Pennsylvania;  Alfred  Stille', 
to  that  of  Practice  in  Pennsylvania  College,  and  then  to  the 
University;  Da  Costa,  to  the  chair  of  Practice  in  the  Jefferson; 
Mitchell  here  formed  that  habit  of  exact  scientific  observation 
and  sagacious  deduction  which  has  given  him  a  reputation 
on  two  continents,  while  Meigs,  McClellan,  Hewson,  Brinton, 
Darrach,  and  Hartshorne  have  all  become  well-known  hospital 
teachers  and  practitioners. 

As  writers,  too,  during  this  period,  few  men  have  been 
busier.  Besides  the  books  and  papers  I  have  already  noted 
among  the  direct  results  of  their  labors  here,  I  mention  the 
following:  Dr.  Tucker  wrote  his  "Principles  and  Practice  of 
Midwifery."  Dr.  Alfred  Stille  published  a  part  of  his  lectures 
under  the  title  of  "Elements  of  General  Pathology,"  while 
the  lectures  on  Practice  most  carefully  and  "elaborately 
written  out  have  formed  the  foundation  of  all  those  upon  the 
same  subject  which  he  has  since  delivered."  He  also  pub- 
lished his  "Medical  Institutions  of  the  United  States"  and 
his  "Report  on  Medical  Literature,"  and  with  Dr.  Meigs 
translated  Andral's  "Pathological  Hsematology."  Dr.  John 
F.  Meigs  published  his  lectures  on  "Diseases  of  Children," 
the  well-thumbed  book  of  multitudes  of  practitioners,  now 
grown  to  be  a  most  portly  volume.  Dr.  F.  G.  Smith  trans- 
lated Barth  and  Roget's  "Manual  of  Auscultation  and  Per- 
cussion," and  edited  Carpenter's  various  physiological  works, 
Kirkes's  and  Paget's  "Physiology,"  and  Churchill  on  "Ob- 
stetrics." Dr.  Keating  edited  Ramsbotham's  "Obstetrics," 
and  Churchill  on  "Children";  Dr.  Bridges  edited  Fownes's 
"Chemistry";  Dr.  Hewson  edited  Mackenzie  on  the  "Eye," 


64  ADDRESSES  AND   OTHER   PAPERS. 

and  Wilde  on  the  "Ear,"  and  all  of  them  wrote  numerous 
papers,  reviews,  etc.,  and  also  practised  medicine!  Truly 
they  were  busy  men. 

In  1855,  during  Dr.  Agnew's  administration,  another 
association  was  started,  which,  like  the  one  just  named,  was 
called  after  an  older  one,  already  noticed,  the  "Pennsylvania 
Academy  of  Medicine."  It  consisted  of  Drs.  W.  W.  Gerhard, 
Henry  H.  Smith,  D.  Hayes  Agnew,  Bernard  Henry,  R.  A.  F. 
Penrose,  and  Mr.  Edward  Parrish,  the  son  of  Dr.  Joseph 
Parrish,  who  lectured  on  Practical  Pharmacy,  and  the  next 
year  they  were  joined  also  by  Dr.  Edward  Shippen.  For  two 
years  they  continued  as  an  association  of  lecturers,  then  Drs. 
Gerhard,  Agnew,  Penrose,  and  Mr.  Parrish  went  on  as  a  Quiz 
association  for  a  year,  when  they  disbanded.  Dr.  Agnew 
gave  his  usual  courses  in  the  School  of  Anatomy,  and  Dr. 
Penrose  continued  to  lecture  here  on  Obstetrics  until  called 
to  the  University  in  1863.  They  were  equally  fortunate 
in  promotion  with  the  members  of  the  other  association,  for 
four  of  the  seven  went  to  the  University  as  professors :  Gerhard 
on  Clinical  Medicine,  Henry  H.  Smith  and  Agnew  as  Profes- 
sors of  Surgery,  and  Penrose  on  Obstetrics.  Mr.  Parrish,  in 
an  Introductory  to  the  course  of  1857,  "  On  Summer  Medical 
Teaching  in  Philadelphia,"  has  given  the  only  brief  sketch 
of  the  Philadelphia  School  of  Anatomy  and  some  of  the  asso- 
ciations and  teachers  I  have  noticed,  that  has  ever  appeared. 

Besides  these  distinct  associations  for  lecturing,  numerous 
other  independent  experimenters  and  lecturers  have  availed 
themselves  of  the  facilities  it  afforded,  scanty  as  they  have 
often  been,  for  their  work.  Before  my  own  day  I  have  been 
able  to  learn  the  names  of  only  a  few;  but  these  are  of  interest. 
In  1849  Dr.  Brown-Se*quard  gave  his  first  lecture  in  America 
in  this  room  to  Dr.  Francis  Gurney  Smith's  class  in  physiology 
in  the  "Summer  Association."  It  was  on  the  Physiology  of 
the  Nervous  System;  and  during  the  lecture,  with  that  extra- 
ordinary manual  dexterity  for  which  he  is  noted,  he  cut  the 


PHILADELPHIA   SCHOOL   OF   ANATOMY.  65 

anterior  and  posterior  roots  of  the  spinal  nerves  in  some 
frogs,  and  demonstrated  the  cross-sensibility  of  the  spinal 
marrow  by  sections  of  its  lateral  halves  in  the  guinearpig. 
This  was  followed  by  a  course  to  the  physicians  of  the  city. 
His  next  course  was  given  in  the  Franklin  Institute.  About 
this  time,  also,  Dr.  John  Hastings  of  the  Navy  gave  some 
lectures  on  yellow  fever,  apropos  of  the  then  existing  epidemic, 
based  on  his  personal  observations  during  the  Mexican  war. 
In  1859,  Dr.  S.  W.  Gross,  while  one  of  Dr.  Agnew's  demon- 
strators, gave  courses  on  Operative  Surgery  and  Surgical 
Anatomy,  and  again  in  1866-67.  In  1860,  and  for  some  time 
afterwards,  Dr.  John  W.  Lodge  gave  courses  in  Experimental 
Physiology  in  the  summer,  and  on  Urinary  Pathology  in  the 
winter.  In  Obstetrics,  Dr.  J.  M.  Corse  also  lectured  here. 
In  1864-67  Dr.  J.  M.  Boisnot,  and  also,  in  1865-66,  Dr.  J. 
Bernard  Brinton,  each  gave  courses  in  Operative  Surgery. 

Since  I  have  had  charge  of  the  school,  Dr.  Isaac  Ott  has 
experimented  on  cocaine  and  other  poisons,  and  Dr.  H.  C. 
Wood,  Jr.,  on  the  physiological  action  of  the  alkaloids  of 
veratrum  viride,  until  my  landlord  complained  of  the  barking 
dogs  with  such  energy  that  I  was  fearful  of  summary  eject- 
ment. I  well  remember,  too,  among  other  odors,  the  per- 
sistent, and  it  seemed  almost  imperishable,  smell  from  a  seal 
which  Dr.  Harrison  Allen  dissected  here  some  years  ago. 
Besides  these,  the  following  regular  courses  of  lectures  have 
been  given  here:  on  Obstetrics,  Dr.  F.  H.  Getchell  and  W.  F. 
Jenks;  on  the  Microscope,  Dr.  James  Tyson;  on  Operative 
Surgery,  Dr.  Hodge  gave  independent  courses,  from  1868  to 
1870,  in  the  eastern  building;  on  Bandaging  and  Fractures, 
Drs.  J.  Ewing  Mears  and  0.  H.  Allis;  on  Physical  Diagnosis, 
Drs.  John  S.  Parry,  0.  P.  Rex,  Stanley  Smith,  and  Hamilton 
Osgood;  on  Venereal  Diseases,  Dr.  William  G.  Porter;  on 
Ophthalmology,  Drs.  George  C.  Harlan,  George  Strawbridge, 
and  W.  W.  McClure;  and  on  Laryngoscopy,  Dr.  J.  Solis 

Cohen.    For  a  number  of  years,  also,  the  Naval  Examining 
5 


66  ADDRESSES   AND   OTHER   PAPERS. 

Board  examined  all  their  candidates  for  admission  and  pro- 
motion here. 

Of  the  various  quiz  associations  I  have  been  able  to  learn 
but  little  beyond  my  personal  knowledge.  That  which  fol- 
lowed the  Academy  of  Medicine  I  have  already  named.  In 
1837  Dr.  E.  G.  Davis  quizzed  on  all  the  branches  himself, 
as  I  learn  from  an  old  circular,  as  also,  at  first,  was  Dr.  D.  D. 
Richardson's  habit.  Dr.  Richardson's  quiz  lasted  from  1860 
to  1871,  and  in  the  last  few  years  he  was  assisted  by  Drs. 
Boisnot,  Cohen,  and  Witmer.  He  had  as  many  as  eighty 
pupils.  From  1866-68, 1  quizzed  with  Drs.  Duer,  Dunglison, 
and  Maury;  1868-69,  with  Drs.  Warder,  McArthur,  Leaman, 
and  Hears;  and  from  1869  to  1872  with  Drs.  Hutchins,  Allis, 
Rex,  Getchell,  LerTman,  and  Loughlin.  This  winter  Drs. 
Wilson,  West,  Greene,  and  Osgood  occupied  this  room.  From 
1869  to  1871,  also,  the  eastern  building  was  occupied  by  the 
quiz  of  Drs.  Willard,  Curtin,  Cheston,  Jenks,  Wilson,  and 
Githens.  Of  these  numerous  medical  men  many  have  already 
attained  distinction;  the  rest  deserve  it,  and  with  years  no 
doubt  will  win  it. 

The  Janitors  deserve  a  passing  word.  They  have  been 
mostly  apostolic  in  name  (as  well  as  somewhat  over- 
obedient  to  the  apostolic  injunction  to  Timothy),  for  two 
Johns  and  two  Jameses  have  occupied  the  post  for  some 
forty  years  of  its  history.  One,  whom  most  of  the  older 
graduates  will  remember,  was  here  for  about  twenty-five 
years.  Crabbed  and  cross,  yet  a  favorite  withal,  versed  in  all 
subject-lore  beyond  his  fellows,  he  was  only  once  baffled. 
When  the  two  buildings  were  rivals  and  subjects  unusually 
scarce,  a  fresh  cadaver  was  stolen  from  this  building  at  night 
and  conveyed  across  the  roof  to  the  other.  Being  too  closely 
guarded  for  another  Stygian  journey  back,  and  the  offense 
not  being  indictable  at  law,  even  he  was  foiled.  He  alternated 
from  being  a  whisky-barrel  in  the  morning  to  a  barrel  of 
whisky  in  the  evening,  and  it  was  always  supposed  that  he 


PHILADELPHIA  SCHOOL  OF  ANATOMY.  67 

died  of  spontaneous  combustion,  like  old  Krooks  in  "Bleak 
House,"  till  I  learned  lately  that  he  stuck  to  his  colors  to  the 
last,  and  died  from  drinking  the  alcohol  from  specimens. 

Such,  in  brief,  is  the  history  of  this  now  somewhat  venerable 
school,  and  of  the  many  teachers  associated  with  it.*  I  can 
count  eighty-five  teachers  who  have  won  their  spurs  in  its 
lecture-rooms,  formed  here  their  habits  of  thought,  style  of 
lecturing,  methods  of  scientific  research,  and  gained  their 
early  fame  as  writers  and  teachers,  so  that  twenty-seven  have 
become  professors  in  sixteen  medical  colleges,  here  and  else- 
where, and  fifty-one  hospital  and  clinical  physicians,  surgeons, 
obstetricians,  etc.,  of  distinction.  Thirty-two  books  have 
been  written  or  edited,  eleven  pamphlets  and  not  less  than 
thirty  papers  of  value  have  been  published  by  its  various 
teachers.  Its  Assistant  Demonstrators  are  too  numerous  for 
me  even  to  mention.  Its  students  I  cannot  trace.  Most  of 
them  are  personally  unknown  to  me.  But  this  I  know,  that, 
spread  all  over  the  world,  doing  faithfully  their  daily  work, 
in  relieving  the  suffering,  soothing  the  dying,  helping  the 
poor,  assuaging  the  pestilence  that  walketh  in  darkness, 
improving  the  public  health,  advancing  the  domain  of  pure 
and  applied  science,  teaching  earnestly  its  results  to  thousands 
of  eager  students,  who,  in  turn,  will  swell  their  noble  ranks, 
promoting  in  general  the  moral  and  material  welfare  of  man- 
kind, some  in  lofty,  some  in  lowly  station,  they  will  confess 
that  here  they  first  developed  their  scientific  tastes  and 
aspirations;  here  they  were  taught  to  look  beyond  the  lower 
to  the  highest  and  noblest  aims  of  our  profession;  here  they 
first  caught  the  inspiration  that  has  made  them  what  they 
are;  and  that  they  will  think  kindly  of  the  dear  old  school 
and  its  faithful  teachers,  and  it  may  be  even  drop  a  tear  of 
regret  when  they  learn  that  the  Philadelphia  School  of  Anat-  . 
omy  is  only  a  thing  of  the  vanished  past. 

*  Mr.  F.  Gutekunst,  712  Arch  Street,  has  photographed  the  building 
for  any  who  may  desire  to  obtain  such  a  memento. 


OUR  RECENT  DEBTS   TO  VIVISECTION.* 


[After  a  few  introductory  remarks  appropriate  to  the  special  occasion  the 
address  continued  as  follows.] 

TO  one  of  these  medical  issues  of  the  day  I  purpose  to 
direct  your  attention  at  present — one  as  to  which 
intense  feeling,  especially  among  women,  has  been  aroused, 
— viz.,  the  question  of  experiments  upon  animals. 

Epithets  and  invective  have  been  freely  used,  but,  as  befits 
the  audience  and  the  occasion,  I  shall  endeavor  to  approach 
it  hi  a  perfectly  calm  and  fair  spirit,  seeking  to  lay  before  you 
only  one  aspect  of  a  many-sided  question, — viz.,  the  actual 
practical  benefits  it  has  conferred  upon  man  and  animals — 
a  fact  that  is  constantly  denied,  but  which  medical  evidence 
proves  to  be  incontestable. 

I  shall  not  consider  the  important  older  discoveries  it  has 
given  us,  but  only  those  since  1850,  almost  all  of  which  are 
within  my  own  personal  recollection.  Even  of  these  I  must 
omit  nearly  all  of  its  contributions  to  physiology  and  to  pa- 
thology, though  so  much  of  our  practice  is  based  upon  these, 
and  confine  myself  to  the  advances  it  has  enabled  us  to  make 
in  medical  and  surgical  practice.  I  shall  endeavor  to  state 
its  claims  with  moderation,  for  an  extravagant  claim  always 
produces  a  revulsion  against  the  claimant,  and  is  as  unwise 
as  it  is  unscientific. 

Again  it  must  be  borne  in  mind  that,  as  in  nearly  every 
other  advance  in  civilization  and  in  society,  so  in  medicine, 
causes  are  rarely  single,  put  generally  multiple  and  inter- 

*  The  address  to  the  graduates  at  the  Thirty-third  Commencement  of 
the  Woman's  Medical  College  of  Pennsylvania,  March  11,  1885. 

68 


OUR  RECENT   DEBTS  TO  VIVISECTION.  69 

woven.  While  vivisection  has  been  a  most  potent  factor  in 
medical  progress,  it  is  only  one  of  several  factors  the  disen- 
tanglement of  which  and  the  exact  balancing  of  how  much  is 
due  to  this  or  to  that  are  often  difficult  and  sometimes  impos- 
sible. Let  me  add  one  word  more.  All  that  I  may  say  is 
purely  upon  my  own  responsibility.  I  commit  the  opinion 
of  no  one  else  to  any  view  or  any  statement  of  fact. 

Medicine  in  the  future  must  either  grow  worse,  stand  still, 
or  grow  better. 

To  grow  worse,  we  must  forget  our  present  knowledge — 
happily,  an  inconceivable  idea. 

To  stand  still,  we  must  accept  our  present  knowledge  as  a 
finality,  complacently  pursuing  the  well-worn  paths ;  neither 
hoping  nor  trying  for  anything  better — happily,  again,  an 
impossibility. 

To  grow  better  we  must  try  new  methods,  give  new  drugs, 
perform  new  operations,  or  perform  old  ones  in  new  ways ; 
that  is  to  say,  we  must  make  experiments.  To  these  ex- 
periments there  must  be  a  beginning:  they  must  be  tried 
first  on  some  living  body,  for  it  is  often  forgotten  that  the 
dead  body  can  only  teach  manual  dexterity.  They  must  then 
be  tried  either  on  an  animal  or  on  you.  Which  shall  it  be? 
In  many  cases,  of  course,  which  involve  little  or  no  risk  to 
life  or  health,  it  is  perfectly  legitimate  to  test  probable  im- 
provements on  man  first,  although  one  of  the  gravest  and 
most  frequent  charges  made  against  us  doctors  is  that  we  are 
experimenting  upon  our  patients. 

But  in  many  cases  they  involve  great  risk  to  life  or  health. 
Here  they  cannot,  nay,  they  must  not,  be  tested  first  upon 
man.  Must  we,  then,  absolutely  forego  them,  no  matter  how 
much  of  promise  for  life  and  health  and  happiness  they  pos- 
sess? If  not,  the  only  alternative  we  have  is  to  try  them  on 
the  lower  animals,  and  we  would  be  most  unwise — nay,  more, 
we  would  be  cruel,  cruel  both  to  man  and  to  animals — if  we 


70  ADDRESSES  AND   OTHER   PAPERS. 

refused  to  pain  or  even  to  -slay  a  few  animals,  that  thousands, 
both  of  men  and  of  animals,  might  live. 

Who  would  think  it  right  to  put  a  few  drops  of  the  hydro- 
chlorate  of  cocaine  (a  year  ago  almost  an  unknown  drug) 
into  the  eye  of  a  man,  not  knowing  what  frightful  inflamma- 
tion or  even  loss  of  sight  might  follow?  Had  one  dared  to  do 
it,  and  had  the'  result  been  disastrous,  would  not  the  law  have 
held  him  guilty  and  punished  him  severely,  and  all  of  us  have 
said  Amen?  But  so  did  Christison  with  Calabar  bean,  and 
well-nigh  lost  his  own  life.  So  did  Toynbee  with  prussic  acid 
on  himself,  and  was  found  dead  hi  his  laboratory.*  Accord- 

*  I  add  the  following  striking  extract  from  a  speech  in  defense  of  vivi- 
section, on  April  4,  1883,  by  Sir  Lyon  Playfair,  deputy  Speaker  of  the 
House  of  Commons — no  mean  authority.  The  italics  are  my  own: 

"  For  myself,  although  formerly  a  professor  of  chemistry  in  the  greatest 
medical  school  of  this  country,  I  am  only  responsible  for  the  death  of  two 
rabbits  by  poison,  and  I  ask  the  attention  of  the  House  to  the  case  as  a 
strong  justification  for  experiments  on  animals,  and  yet  I  should  have  been 
treated  as  a  criminal  under  the  present  act  had  it  then  existed.  Sir  James 
Simpson,  who  introduced  chloroform — that  great  alleviator  of  animal 
suffering — was  then  alive  and  in  constant  quest  of  new  anaesthetics.  He 
came  to  my  laboratory  one  day  to  see  if  I  had  any  new  substances  likely 
to  suit  his  purpose.  I  showed  him  a  liquid  which  had  just  been  discovered 
by  one  of  my  assistants,  and  Sir  James  Simpson,  who  was  bold  to  rash- 
ness in  experimenting  on  himself,  desired  immediately  to  inhale  it  in  my 
private  room.  I  refused  to  give  him  any  of  the  liquid  unless  it  was  first 
tried  upon  rabbits.  Two  rabbits  were  accordingly  made  to  inhale  it ;  they 
quickly  passed  into  anaesthesia  and  apparently  as  quickly  recovered,  but 
from  an  after-action  of  the  poison  they  both  died  a  few  hours  afterwards. 
Now,  was  not  this  a  justifiable  experiment  upon  animals  ?  Was  not  the 
sacrifice  of  two  rabbits  worth  saving  the  life  of  the  most  distinguished  physician 
of  his  time  f  .  .  .  Would  that  an  experiment  of  a  like  kind  on  a  rabbit 
or  a  guinea-pig  had  been  used  by  John  Hunter,  who  probably  shortened 
his  own  noble  life  by  experimenting  on  himself!  .  .  . 

"  Let  me  give  one  other  instance.  ...  A  few  years  ago  two  young 
German  chemists  were  assistants  in  a  London  laboratory.  They  were  ex- 
perimenting upon  a  poison  which  I  will  not  even  name,  for  its  properties 
are  so  terrible.  It  is  postponed  in  its  action,  and  then  produces  idiocy 
or  death.  An  experiment  on  a  mouse  or  a  rabbit  would  have  taught  them 
the  danger  of  this  frightful  poison ;  but  in  ignorance  of  its  subtle  properties, 
they  became  its  unhappy  victims,  for  one  died  and  the  other  suffered  in- 


OUR  RECENT  DEBTS  TO  VIVISECTION.  71 

ingly,  Roller,  of  Vienna,  properly  and  wisely  tried  cocaine  first 
on  animals,*  and  then,  finding  its  beneficial  effects,  tried  it 
upon  man  with  like  results,  and  one  of  the  most  remarkable 
drugs  of  modern  times  was  thus  made  available.  We  are  only 
on  the  threshold  of  its  usefulness.  It  has  been  used  hi  the 
eye,  the  ear,  the  nose,  the  mouth,  the  larynx,  and  all  other 
mucous  membranes,  in  the  removal  of  tumors,  and  as  an  in- 
ternal medicine.  When  its  physiological  action  has  been 
still  more  thoroughly  and  systematically  investigated,  its 
poisonous  dose  ascertained,  when  we  know  how  it  works,  what 
its  effects  are  upon  the  blood-pressure,  the  heart,  the  nerves, 
the  blood-vessels — effects  that  can  not  be  accurately  studied 
upon  man — its  usefulness  may  be  increased  to  an  extent  as 
yet  but  little  dreamed  of.  Should  it  only  soothe  the  last 
painful  hours  of  our  great  hero,  General  Grant,  a  nation  will 
bless  it  and  the  experiments  which  gave  it  effect.  Moreover, 
had  the  experiments  of  Dr.  Isaac  Ott,  of  Easton,f  on  this  very 
drug,  borne  their  due  fruit,  America  would  have  had  the 
honor  and  the  human  race  the  benefits  of  cocaine  ten  years 
ago — ten  years  of  needless  suffering! 

This  is  but  one  illustration  of  the  value  of  experiments 
upon  animals  in  the  realm  of  new  drugs.  In  fact,  substitute 
for  cocaine  other  drugs,  or  new  operations,  or  new  methods 
of  medical  treatment,  and  the  argument  repeats  itself  for 
each.  Within  the  last  thirty  years  a  multitude  of  new  drugs 
have  thus  been  discovered,  and  their  effects  have  been  either 
first  tested  upon  animals,  or  their  properties  studied  exhaust- 
ively in  a  manner  impracticable  upon  man.  I  will  only  enu- 

tellectual  death.  Yet  the  promoters  of  this  bill  would  not  suffer  us  to 
make  any  experiments  on  the  lower  animals  so  as  to  protect  man  from 
such  catastrophes.  It  is  by  experiments  on  animals  that  medicine  has 
learned  the  benefits,  but  also  has  been  taught  to  avoid  the  dangers  of 
many  potent  drugs — as  chloroform,  chloral,  and  morphia." 

*  Archives  of  Ophthalmology,  Sept.  and  Dec.,  1884,  p.  402;  New  York, 
Putnam's. 

t  Ott,  Cocaine,  Veratrine,  and  Gelsemium,  Philadelphia,  1874. 


72  ADDRESSES    AND    OTHER   PAPERS. 

merate  some  of  them,  since  time  will  not  allow  me  to  enter 
upon  each  in  detail.  Thus  have  been  introduced  lily-of-the- 
valley  in  heart  disease,  yellow  jasmine,  hi  diseases  of  the 
heart  and  nervous  system,  paraldehyde  and  chloral  hydrate, 
so  valuable  for  sleep,  caffeine  for  headache,  eucalyptus  as  an 
antiseptic  and  in  medicine,  nitroglycerine  for  nervous  mala- 
dies, Calabar  bean  for  disease  of  the  eye  and  nervous  system, 
naphthaline  and  iodoform  in  surgery,  quebracho  as  an  an- 
tispasmodic,  antipyrine  and  kairine  hi  fever,  jaborandi  in 
dropsy,  salicylic  acid  in  rheumatism,  nitrite  of  amyl  in  epi- 
lepsy and  intermittent  fever,  jequirity  in  ophthalmic  surgery, 
piscidia  as  a  substitute  for  opium,  the  hypodermatic  method 
of  using  drugs,  and  so  on  through  a  long  list.  And,  as  to  the 
old  drugs,  it  may  be  truly  said  that  we  have  little  exact — 
that  is,  scientific — knowledge  of  any  one  except  through 
experiments  upon  animals.* 

Let  us  now  see  something  of  what  America  has  done  in 
advancing  practical  medicine  by  vivisection.  In  passing,  I 
may  say  that  the  assertion  that  America  has  contributed  but 
little,  so  far  from  being  an  argument  for  the  restriction  of 
vivisection,  is  a  strong  argument  for  its  further  cultivation, 
hi  order  that  greater  good  may  result  from  remarkable  dis- 
coveries here,  equal  to  those  that  I  shall  show  have  been 
made  in  Europe. 

*  For  three  hundred  years  digitalis,  for  instance,  has  been  given  as  a 
depressant  of  the  heart,  and,  when  a  student,  I  was  taught  to  avoid  it 
carefully  when  the  heart  was  weak.  But  the  accurate  experiments  of 
Bernard  and  others  have  shown  that  it  is,  on  the  contrary,  actually  a 
heart  tonic  and  stimulant.  So  long  as  I  live  I  shall  never  forget  the  intense 
joy  of  myself  and  the  agonized  parents,  when  one  bright  young  life  was 
brought  back  from  the  very  grave,  some  five  years  ago,  by  the  knowledge 
of  this  fact,  and  this  is  but  one  of  many  such  cases.  Thus  have  the  action 
and  dangers  of  our  common  ansesthetics  been  positively  and  accurately 
ascertained;  thus  the  action  of  ergot  on  the  blood-vessels,  explaining 
alike  its  danger  as  an  article  of  food  and  its  wonderful  use  in  certain  tumors 
of  the  uterus  and  diseases  of  the  nervous  centres;  thus,  too,  every  one 
who  gives  opium  in  its  various  forms  is  a  debtor  to  Bernard,  and  every 
one  who  gives  strychnine  a  disciple  of  Magendie. 


OUR   RECENT   DEBTS   TO   VIVISECTION.  •    73 

Wounds  of  the  abdomen,  especially  gunshot  wounds,  are 
among  the  most  fatal  injuries  known  to  surgery.  A  small, 
innocent-looking,  external  pistol  wound  may  cover  multiple 
and  almost  inevitably  fatal  perforations  of  the  abdominal 
viscera.  The  recoveries  from  3717  such  wounds  during 
the  late  Civil  War  only  numbered  444,  and  of  those  with  es- 
cape of  the  intestinal  contents  the  recoveries,  says  Otis,  may 
be  counted  on  one's  fingers.  The  prevailing  treatment  as 
laid  down  in  our  text-books  has  been  purely  conservative, 
treating  symptoms  as  they  arise.  The  brilliant  results 
achieved  hi  other  abdominal  operations  have  led  a  few  bold 
spirits,  such  as  our  own  Sims,  Gross,  Otis,  McGuire,  and 
others,  to  advocate  the  opening  of  the  abdomen  and  the  re- 
pair of  the  injuries  found. 

In  May  of  last  year,  Parkes,  of  Chicago,  reported  to  the 
American  Medical  Association*  a  serious  of  systematic  ex- 
periments on  thirty-seven  dogs,  that  were  etherized,  then 
shot,  the  abdomen  opened,  and  the  wounds  of  the  intestines, 
arteries,  mesentery,  etc.,  treated  by  appropriate  surgical 
methods.  The  results  confirmed  the  belief  awakened  by 
earlier  experiments  and  observations  that  surgery  could 
grapple  successfully  with  multiple  and  formidable  wounds, 
by  sewing  them  up  hi  various  ways,  or  even  by  removing  a 
piece  of  the  bowel  and  uniting  the  cut  ends.  Hard  upon  the 
heels  of  this  important  paper,  and  largely  as  its  result,  comes 
a  striking  improvement  in  practice.  And  remember  that 
this  is  only  the  first  fruit  of  a  rich  harvest  for  all  future  time, 
hi  all  countries,  in  peace  and  in  war. 

November  2d,  of  last  year,  a  man  was  brought  to  the  Cham- 
bers Street  Hospital,  in  New  York,  with  a  pistol-shot  wound 
hi  the  abdomen.  Under  careful  antiseptic  precautions,  and 
following  the  indications  of  Parkes,  the  abdomen  was  opened 

*  Medical  News,  May  17,  1884.  I  shall  refer  readers  frequently  to  this 
journal,  as  it  is  often  more  accessible  than  foreign  journals,  and  it  will 
refer  them  to  the  original  papers. 


74  ADDRESSES   AND   OTHER   PAPERS. 

by  Dr.  Bull,*  coil  after  coil  of  the  intestines  was  drawn  out, 
the  bullet  was  found  and  removed,  and  seven  wounds  of  the 
intestines  were  successively  discovered  and  properly  treated, 
and  the  patient  made  an  uninterrupted  recovery.  A  re- 
covery, after  so  many  wounds,  any  one  of  which  would  neces- 
sarily have  been  fatal  under  the  old  methods  of  treatment, 
shows  that  we  have  now  entered  upon  a  proper  and  success- 
ful method  of  treatment  for  such  frightful  accidents,  f 

This  is  but  one  of  the  remarkable  achievements  of  late 
years  in  abdominal  surgery.  The  spleen  has  been  removed, 
part  of  the  stomach  has  been  cut  out  for  cancer,  J  part  of  the 
bladder  §  has  been  dissected  away,  the  entire  gall-bladder 
has  been  removed,  and  several  inches  of  the  intestine  have 
been  cut  out,  ||  all  with  the  most  remarkable  success.  To  all 
of  these,  experiments  upon  animals  have  either  led  the  way 
or  have  taught  us  better  methods.  To  recite  each  in  detail 
would  occupy  too  much  time,  but  one  illustration  I  must  not 
omit,  for  the  improvement,  produced  by  it  and  other  ex- 
periments, affects  every  abdominal  operation.  When  I  was 
a  student,  the  peritoneum  was  avoided  by  knife  and  needle 
wherever  possible.  After  the  death  of  his  fourth  case  of 
ovariotomy,  Mr.  (now  Sir  Spencer)  Wells,  ^[  in  making  the 
post-mortem,  was  led  to  believe  that  the  then  received  treat- 
ment of  the  peritoneum  was  incorrect,  and  that  he  ought  to 
bring  its  surfaces  hi  contact  in  order  to  obtain  secure  union. 

*  Medical  News,  Feb.  14,  1885. 

t  Since  1885  hundreds  of  such  wounds  have  been  successfully  treated 
and  recovery  has  followed  after  as  many  as  nineteen  wounds  of  the  bowels. 
— (W.  W.  K.,  1905.) 

J  Since  1885  the  entire  stomach  has  been  repeatedly  removed. — (W. 
W.  K.,  1905.) 

§  Since  then  the  entire  bladder  has  been  repeatedly  removed. — (W. 
W.  K.,  1905.) 

||  Much  larger  portions  have  been  removed  since  then,  even  as  much 
as  eight  feet  eight  inches,  with  success. — (W.  W.  K.,  1905.) 
1  Wells,  Ovarian  and  Uterine  Tumors,  1882,  p.  197. 


OUR  RECENT   DEBTS   TO   VIVISECTION.  75 

Accordingly,  instead  of  testing  his  ideas  upon  women,  he 
experimented  upon  a  few  dogs,  and  found  that  his  suspicions 
were  correct.  Since  then  it  has  been  accepted  as  a  cardinal 
point  in  all  abdominal  operations.  Following  this  came 
improvements  in  the  ligatures  used,  in  the  method  of  treat- 
ing the  pedicle,  in  the  use  of  antiseptics,  etc.,  all  more  or  less 
the  result  of  experiments  upon  animals,  and  what  are  the 
results?  Taking  successive  hundreds  of  cases,  Sir  Spencer 
Wells's  percentage  of  mortality  has  decreased  steadily  from 
thirty-four  per  cent,  to  eleven  per  cent. 

Since  then,  others  have  reduced  the  percentage  of  deaths 
after  ovariotomy  to  three  in  the  hundred;  and  Martin,  of 
Berlin,  has  lost  but  1  patient  from  blood-poisoning  in  his 
last  130  cases. 

It  can  not  be  claimed,  of  course,  as  to  all  this  wonderful 
history  of  abdominal  surgery — and  remember  that  in  1862, 
when  I  was  a  medical  student,  I  heard  ovariotomists  de- 
nounced from  a  professor's  chair  as  murderers! — that  ex- 
periments upon  animals  have  done  the  whole  work.  No  one 
man,  no  one  series  of  experiments  has  sufficed,  and  experi- 
ment alone  would  not  have  done  it.  But  had  such  experi- 
ments not  been  made  on  animals,  as  to  the  peritoneum,  the 
pedicle,  the  sutures,  the  ligatures,  etc.,  we  should  be  far  be- 
hind where  we  now  are,  and  still  be  ignorantly  sacrificing 
human  life  and  causing  human  suffering. 

But  to  return  to  America.  The  first  condition  to  success- 
ful treatment  is  an  accurate  knowledge  of  what  any  disease 
is — its  cause  and  its  course;  then  we  may  guide  it,  and  in 
due  time,  it  may  be,  cure  it. 

Before  Dr.  H.  C.  Wood's*  accurate  experiments  on  the 
effects  of  heat  on  animals  the  nature  and  effects  of  sunstroke 
were  almost  matters  of  mere  conjecture.  Every  one  had 
his  own  theory,  and  the  treatment  was  equally  varied.  Even 
the  heat-effects  of  fever  itself — the  commonest  of  all  symp- 

*  Wood,  Thermic  Fever  or  Sunstroke,  Philadelphia,  1872. 


76  ADDRESSES   AND   OTHER   PAPERS. 

toms  of  disease — were  ill  understood.  Wood  exposed  animals 
to  temperatures  of  120°  to  130°  F.  and  studied  the  effects. 
These  experiments  have  often  been  alluded  to  as  "baking 
animals  alive."  You  will  note  that  the  heat  was  no  greater 
than  that  to  which  laborers  are  frequently  exposed  hi  our 
hot  summer-days,  when  working  in  the  sun  or  in  many  in- 
dustrial works.  -His  experiments  showed  that  the  effects  of 
sunstroke — or,  as  he  happily  termed  it,  thermic  or  heat  fever, 
a  scientific  name  now  widely  adopted — were  solely  due  to 
the  heat,  death  following  from  coagulation  of  the  muscular 
structure  of  the  heart,  or  by  its  effects  on  the  brain.  They 
explained  also  many  of  the  phenomena  of  ordinary  fever  as 
the  result  of  heat  alone.  They  have  established  the  rational 
and  now  generally  adopted  treatment  of  sunstroke  by  re- 
duction of  the  body-temperature;  and  the  same  method  is 
now  beginning  to  be  appreciated  and  employed  in  ordinary 
fever.* 

The  same  observer,  with  Dr.  Formad,  has  made  important 
experiments  on  the  nature  of  diphtheria,  and  when  we  learn, 
as  we  probably  soon  shall,  how  to  deal  with  the  microscopical 
forms  of  life  which  seem  to  be  its  cause,  it  will  not  be  too  much 
to  hope  that  we  may  be  able  to  cope  far  more  successfully  with 
a  disease  now  desolating  so  many  homes,  f 

In  India  alone  twenty  thousand  human  beings  die  annually 
from  snake-bite,!  and  as  yet  no  antidote  has  been  discovered. 
How  can  we  search  intelligently  for  an  antidote  until  we  know 

*  Eighteen  out  of  Wood's  experiments  were  on  the  general  effects  of 
heat,  as  above  alluded  to.  In  six  others  the  local  effects  of  heat  (135° 
to  190°  F.)  on  the  brain,  and  in  four  others  the  local  effects  (up  to  140° 
F.)  on  the  nerves  were  studied  and  gave  most  valuable  results,  entirely 
and  evidently  unattainable  on  man. 

t  The  remarkable  results  in  lessening  the  mortality  from  diphtheria 
by  the  use  of  the  antitoxine  discovered  since  this  address  was  published 
are  now  universally  known.  Thousands  of  human  lives,  especially  of 
children,  are  saved  annually  in  this  country  alone. — (W.  W.  K.,  1905.) 

%  Fayrer,  Thanatophidia  of  India,  p.  32. 


OUR  RECENT   DEBTS   TO   VIVISECTION.  77 

accurately  the  effects  of  the  poison?  This  can  not  be  studied 
on  man;  we  must  resort  to  animals,  or  else  let  the  holocaust 
go  on.  Accordingly,  Dr.  T.  Lauder  Brunton  began  such  a 
series  of  experiments  hi  London,  but  was  stopped  by  the 
stringent  antivivisection  laws  there  hi  force.  But  Drs.  Weir 
Mitchell  and  Reichert,*  in  this  city,  have  recently  under- 
taken experiments  on  cobra  and  rattlesnake  venom,  the  cobra- 
poison  being  furnished,  be  it  observed,  by  the  British  Govern- 
ment, whose  own  laws  have  prevented  investigations  for  the 
benefit  of  its  own  subjects!  The  results  are  as  yet  only  partly 
made  known,  but  they  have  been  brilliantly  successful  hi 
showing  that  there  are  two  poisons  in  such  venom,  each  of 
which  has  been  isolated  and  its  effects  studied.  The  first 
step  has  been  taken — the  poison  is  known.  Who  will  raise 
a  finger  to  stop  progress  toward  the  second — the  antidote?  f 
Can  the  sacrifice  of  a  few  scores  of  animals  each  year  in  such 
research  weigh  for  a  moment  against  the  continuous  annual 
sacrifice  of  twenty  thousand  human  beings?  J 

The  modern  history  of  anesthetics  is  also  of  interest.  To 
say  nothing  of  ether  and  chloroform,  whose  safer  use  Bert 
has  investigated  in  France,  nor  of  cocaine,  to  which  I  have 
already  alluded,  let  us  see  what  experiments  on  animals  have 

*  Medical  News,  April  28,  1883. 

t  Since  then  Calmette  and  Noguchi  have  both  discovered  an  anti- 
venene  or  antidote  to  the  venom  of  snakes. — (W.  W.  K.,  1905.) 

J  I  am  permitted  by  Rev.  R.  M.  Luther,  of  this  city,  to  state  the  follow- 
ing fact  in  illustration  of  the  practical  value  of  vivisection  in  snake-bite: 
When  a  missionary  in  Burmah,  he  and  his  brother-in-law,  Rev.  Mr.  Vin- 
ton  (two  missionary  vivisectionists!),  made  a  number  of  experiments  to 
discover  an  antidote  to  the  poison  of  the  "  brown  viper" — a  snake  but  little 
less  venomous  than  the  cobra.  They  found  a  substance  which  is  an  anti- 
dote in  about  sixty  per  cent,  of  the  cases  if  applied  at  once  Thah  Mway, 
one  of  their  native  preachers,  when  bitten  by  the  brown  viper,  had  some 
of  this  antidote  with  him,  and  by  its  use  his  life  was  saved  when  on  the 
verge  of  death.  This  one  life  saved,  it  is  estimated,  has  been  the  means 
of  leading  two  thousand  Karens  to  embrace  Christianity.  Was  not  this 
one  life  worth  all  the  dogs  used  in  the  experiments — to  make  no  mention 
of  the  many  other  lives  that  will  be  saved  in  all  the  future  ? 


78  ADDRESSES   AND   OTHER   PAPERS. 

shown  us  as  to  bromide  of  ethyl — an  anaesthetic  lately  revived 
in  surgery.  Its  revival  has  quickly  been  followed  by  its 
abandonment  on  account  of  the  frequent  sacrifice  of  human 
life — that  is  to  say,  experiments  on  human  beings  have  proved 
it  to  be  deadly.  Now,  Dr.  H.  C.  Wood,*  soon  after  its  re- 
introduction,  made  a  study  of  its  effects  on  animals,  and 
showed  its  physiological  dangers.  Had  his  warnings  been 
heeded,  not  a  few  human  lives  would  have  been  saved. 

The  ideal  anaesthetic,  that  will  abolish  pain  without  abolish- 
ing consciousness,  and  do  so  without  danger,  is  yet  to  be  found. 
Cocaine  is  ouY  nearest  approach  to  it.  Now,  in  all  fairness 
and  common  sense,  would  it  be  real  kindness  or  real  cruelty 
to  obstruct  the  search  for  such  an  anaesthetic — a  search  which 
will  surely  be  rewarded  by  success,  but  which,  if  not  carried 
on  by  experiments  on  animals,  must  be  tried  by  deadly  ex- 
periments upon  man,  or  else  be  entirely  given  up? 

In  1869  I  was  called  to  see  a  man  suffering  to  the  last  de- 
gree from  an  abscess  in  the  loin.  I  recognized  the  fact  that 
it  arose  from  the  kidney,  but  I  was  powerless.  All  that  I 
could  do  was  to  mitigate,  and  that,  alas!  but  little,  his  piti- 
less sufferings  till  death  came  to  his  relief,  after  nearly  a  year 
of  untold  agony.  I  have  never  forgotten  his  sufferings,  nor 
the  sharp  pain  I  felt  when  I  learned,  two  years  later,  how  I 
might  possibly  have  saved  his  life.  In  the  very  same  year 
(1869),  Simon,  of  Heidelberg,  f  had  a  woman  under  his  care 
suffering  from  urinary  fistulae  from  a  healthy  kidney — a  sur- 
gical accident  he  hi  vain  tried  to  heal.  That  she  could  live 
with  one  kidney  had  the  other  gradually  been  disabled  by 
disease  was  probable,  for  one  such  diseased  kidney  had 
been  already  removed  three  times  when  mistaken  for  ova- 
rian disease.  But  no  one  had  removed  a  healthy  kidney, 
and  then  studied  the  effects  on  the  remaining  kidney  and 
upon  the  heart;  no  one  had  tested  what  was  the  best  method 

*Philadelphia  Medical  Times,  April  24,  1880. 
t  Simon,  Chirurgie  der  Nieren,  1871,  preface. 


OUR   RECENT   DEBTS   TO   VIVISECTION.  79 

of  reaching  the  kidney,  whether  by  the  abdomen  or  the  loin, 
or  how  to  deal  with  its  capsule,  or  the  haemorrhage,  or  the 
surgical  after-effects.  Of  course,  Simon  could  have  tried  the 
experiment  on  his  patient,  blindly  trusting  to  Providence  for 
the  result.  But  he  chose  the  wiser  course.  He  studied  the 
previous  literature,  experimented  on  a  number  of  dogs  and 
watched  the  points  above  noted,  tried  various  methods  of 
operating  upon  the  dead  body,  and,  after  weighing  all  the 
pros  and  cons,  deliberately  cut  down  upon  the  kidney  of  his 
patient  after  a  carefully  formulated  plan,  not  by  the  abdomen, 
but  through  the  loin,  and  saved  her  life.  She  died  in  1877, 
after  eight  years  of  healthy  life,  free  from  her  loathsome  dis- 
order. 

Now,  what  have  been  the  results  of  these  experiments  upon 
a  few  dogs?  One  hundred  and  ninety-eight  times  the  kidney 
has  been  removed,  and  105  human  lives  have  been  saved; 
83  times  abscesses  in  the  kidney  have  been  opened,  and  66 
lives  saved;  17  times  stones  have  been  removed  from  the 
kidney  without  a  single  death — or,  in  all,  in  the  last  fifteen 
years,  298  operations,  and  188  human  lives  saved.  Besides 
this,  as  an  extension  of  the  operation  in  17  cases,  hi  which 
the  kidney,  having  no  such  attachments  as  ought  to  anchor 
it  hi  place,  was  floating  loosely  hi  the  abdomen  and  a  source 
of  severe  pain,  it  has  been  cut  down  upon  and  sewed  fast  in 
its  proper  place;  and  all  of  these  patients  but  one  recovered.* 

Looking  to  the  future,  when  not  hundreds,  but  thousands, 
of  human  beings  will  enjoy  the  benefits  of  these  operations, 
and  in  increasing  percentages  of  recoveries,  are  not  the  suf- 
ferings inflicted  on  these  few  dogs  amply  justified  as  in  the 
highest  sense  kind  and  humane  ?f 

*  In  the  20  years  since  this  address  was  delivered  these  figures  have 
been  multiplied  many  fold. — (W.  W.  K.,  1905.) 

t  Very  erroneous  views  prevail  as  to  the  sufferings  of  animals  from 
experiments  upon  them.  Many  persons  suppose  that  "vivisection" 
means  deliberate  "  cutting  up"  of  an  animal,  little  by  little,  till  not  enough 


80  ADDRESSES,  AND   OTHER   PAPERS. 

Not  long  since  Dr.  Ferrier,  of  London,  was  prosecuted  for 
the  alleged  performance  of  certain  experiments  on  the  brains 
of  the  lower  animals.  With  Fritsch,  Hitzig,  Goltz,  Yeo,  and 
others,  he  had  destroyed  or  galvanized  certain  limited  areas 
of  the  brain  (and  it  must  not  be  forgotten  that  the  brain  is 
wTholly  without  the  sense  of  pain),  and  so  determined  the 
exact  nervous  .centres  for  certain  limited  groups  of  muscles. 
As  a  result  of  their  labors,  the  brain  is  now  mapped  out  with 
reasonable  accuracy,  so  that,  given  certain  hitherto  ill-under- 
stood or  obscure  localized  symptoms,  we  can  now  say  that 
there  is  certainly  a  tumor,  an  abscess,  or  other  disease  in 
precisely  this  or  that  locality.  True,  we  can  doubtfully  infer 
somewhat  of  the  same  from  the  cruel  experiments  of  disease 
on  man.  But  nature's  experiments  are  rarely  ever  limited 
in  area  or  uncomplicated ;  they  are  never  systematic  and  ex- 
haustive ;  it  takes  years  to  collect  a  fair  number  of  her  clumsy 
experiments,  and  the  knowledge  is  diffused  through  many 
minds  instead  of  being  centered  in  one  that  will  systematize 
the  results. 

Said  Ferrier,  a  year  ago,  in  the  Marshall  Hall  Oration, 
"  There  are  already  signs  that  we  are  within  measurable  dis- 
tance of  the  successful  treatment  by  surgery  of  some  of  the 
most  distressing  and  otherwise  hopeless  forms  of  intracranial 
disease,  which  will  vie  with  the  splendid  achievements  of 
abdominal  surgery." 

Note  the  fulfillment!  Last  fall,  within  a  year  of  the  fore- 
going prophecy,  a  man,  aged  twenty-five,  entered  the  London 

is  left  to  live.  So  far  is  this  from  the  truth,  that  Prof.  Gerald  Yeo,  from 
the  actual  reports  of  vivisectionists  in  England  (Fortnightly  Review, 
March,  1882),  estimates  that  of  100  such  experiments,  there  are: 

Absolutely  painless 75 

As  painful  as  vaccination 20 

As  painful  as  the  healing  of  a  wound 4 

As  painful  as  a  surgical  operation 1 

Total . .  100 


OUR  RECENT  DEBTS  TO  VIVISECTION.  81 

Hospital  for  Epilepsy  and  Paralysis.*  From  the  symptoms, 
which  I  need  not  detail,  Dr.  Hughes  Bennett,  basing  his  con- 
clusions on  Ferrier's  experiments,  diagnosticated  a  tumor  of 
small  size  on  the  surface  of  the  brain,  involving  the  center  of 
motion  for  the  muscles  of  the  hand.  On  November  15,  1884, 
at  his  instance,  Mr.  Godlee  trephined  the  skull  over  the  se- 
lected spot,  and  a  quarter  of  an  inch  below  the  surface  of  the 
brain  found  a  tumor  as  big  as  a  walnut,  and  removed  it.  For 
three  weeks  the  man  did  well,  but  died  on  the  twenty-eighth 
day  from  blood-poisoning,  such  as  might  follow  any  opera- 
tion, especially  a  new  one.  Macewen,  of  Glasgow,!  has 
similarly  trephined  a  woman,  the  victim  of  slow  paralysis  of 
body  and  mind,  and  opened  an  abscess  a  little  distance  below 
the  surface,  letting  out  two  teaspoonfuls  of  pus,  and  followed 
by  entire  mental  and  physical  recovery. 

By  these  experiments  and  operations  a  wide  door  is  open 
to  surgery  in  the  treatment  of  diseases  within  the  skull — 
diseases  heretofore  so  obscure  and  uncertain  that  we  have 
hardly  dared  to  attack  them.  The  question  is  not  whether 
death  or  recovery  followed  in  these  particular  cases.  The 
great,  the  startling,  the  encouraging  fact  is  that,  thanks  to 
these  experiments,  we  can  now,  with  well-nigh  absolute  cer- 
tainty, diagnosticate,  and  with  the  greatest  accuracy  locate 
such  diseases,  and  therefore  reach  them  by  operation,  and 
treat  them  successfully.  J  Would  that  I  had  been  born 
twenty-five  years  later,  that  I  might  enjoy  with  you  the  full 
luxury  of  such  magnificent  life-saving,  health-giving  dis- 
coveries ! 

It  is,  however,  by  the  experimental  study  of  the  effects  of 

*  Medical  News,  Jan.  17,  1885.  t  Ibid.,  Jan.  3,  1885. 

J  In  1899 — only  fourteen  years  after  this  address  was  delivered — 
Knapp  collected  491  operations  for  brain  tumors  in  which  the  result  was 
known.  In  64  operations  for  palliation — i.  e.,  relief  of  pain,  etc. — only 
4  died;  in  275  completed  operations  82  died  (30  per  cent.);  in  152  in- 
operable and  incompleted  cases,  86  died  (56  per  cent.). — (W.  W.  K.,  1905.) 
6 


82  ADDRESSES^  AND    OTHER    PAPERS. 

minute  organisms — microbes,  as  they  are  now  called — that 
some  of  the  latest  and  most  remarkable  results  have  been 
achieved.  The  labors  of  Koch,  Pasteur,  Klein,  Cheyne, 
Tommasi-Crudeli,  Wood,  Formad,  Sternberg,  and  others  are 
now  known  even  to  the  daily  press.  Let  us  see  what  they 
have  done. 

It  is  but  three  years  since  Koch  announced  that  consump- 
tion was  caused  by  the  "bacillus  tuberculosis."  Later  he 
had  studied  cholera  and  found  the  "  comma  bacillus,"  to  which 
he  ascribes  that  dreaded  disease.  In  spite  of  the  opposition  of 
prominent  scientists,  his  views  have  been  in  general  accepted, 
and  seem  to  be  reasonable. 

The  method  of  experiment  is  simple,  though  difficult.  The 
suspected  expectoration  or  discharge  is  placed  in  a  suitable 
soil,  and  after  cultivation  some  of  this  growth  is  placed  in 
another  culture-soil,  and  so  on  till  generation  after  gener- 
ation is  produced,  the  violence  of  the  poison  being  modified 
by  each  culture.  A  small  portion  of  any  one  of  these  cultures 
is  then  injected  under  the  skin  of  a  mouse  or  other  animal, 
and  in  time  it  dies  or  is  killed,  and  the  results  are  verified  by 
the  post-mortem. 

So  exact  is  the  knowledge  hi  tuberculosis  now  that  Koch 
can  predict  almost  to  an  hour  when  the  mouse  will  die  of 
consumption,  or  that  it  will  escape,  according  to  the  culture 
used. 

It  is  far  too  early  as  yet  to  say  that  these  studies  have  borne 
the  immense  practical  fruit  that  the  next  few  years  will  show ; 
but  they  have  already  enabled  us  to  recognize  by  the  micro- 
scope doubtful  cases  of  consumption  in  their  earlier  and  more 
remediable  stages,  and  have  made  certain  what  has  hitherto 
been  only  a  probability — that  consumption  is  distinctly  con- 
tagious. 

By  Gerlach's  experiments  on  animals  with  the  milk  from 
tuberculous  cows,  also,  it  has  been  shown  that  consumption 
may  be  contracted  from  such  milk.  How  important  this  con- 


OUR   RECENT   DEBTS   TO   VIVISECTION.  83 

elusion  is,  in  so  universal  an  article  of  food  to  young  and  old, 
I  need  not  do  aught  than  state. 

The  experiments  of  Wood  and  Formad  on  diphtheria  I  have 
already  alluded  to.  Those  of  Tommasi-Crudeli  also  have 
shown  that  probably  the  poison  of  malaria  is  due  to  like 
organisms,  while  a  large  number  of  other  diseases  are  being 
similarly  investigated. 

As  to  cholera,  the  classic  experiments  of  Thiersch,  in  1853,* 
are  well  known.  He  inoculated  56  mice  with  cholera  dis- 
charges. Of  these,  44  sickened  and  14  died  from  choleraic 
diseases.  In  the  same  year  two  water  companies  in  London 
experimented  on  500,000  human  beings,  one  of  them  in- 
oculating its  patrons  with  cholera  discharges  through  its  im- 
pure water-supply.  This  one  sickened  thousands  and  killed 
3476  human  beings,  most  of  whom  might  have  escaped  had 
the  lessons  of  Thiersch's  14  mice  been  heeded.  To  ask  the 
question,  which  was  the  more  cruel,  is  to  answer  it.f 

At  present  our  strenuous  efforts  are  all  in  one  direction— 
viz.,  to  study  these  microbes  by  the  microscope,  by  clinical 
observation,  and  by  experiments  on  animals,  in  order  to  find 
out  their  origin,  causes,  growth,  and  effects,  and  to  discover 
by  what  means  their  deadly  results  may  be  avoided,  or  by 
what  remedies,  without  harm  to  the  patient,  they  may  them- 

*John  Simon,  Proceedings  International  Medical  Congress,  London, 
1881. 

t  The  population  supplied  by  the  Southwark  and  Vauxhall  Company, 
in  the  epidemic  of  1848-49  died  at  the  rate  of  118  in  each  10,000,  and, 
in  that  of  1853-54,  at  the  rate  of  130  per  10,000.  Those  supplied  by  the 
Lambeth  Company  died  in  1848-49  at  the  rate  of  125  per  10,000,  but 
having  improved  its  water-supply  meantime,  the  death-rate,  in  1853-54, 
fell  to  37  per  10,000. 

If  Thiersch  lived  in  England  to-day,  he  would  have  to  take  out  a  license 
to  kill  his  fourteen  mice  in  the  interests  of  humanity — a  license  possibly 
refused,  or  only  to  be  obtained  after  the  most  vexatious  delays.  But 
any  housemaid  might  torture  and  kill  them  with  arsenic  or  phosphorus, 
or  Thiersch  might  give  them  to  a  favorite  terrier  without  the  slightest  in- 
terference, provided  only  it  be  not  for  a  scientific  or  a  humane  object  I 


84  ADDRESSES  AND   OTHER   PAPERS. 

selves  be  destroyed.  Evidently  these  studies  can  not  be  tried 
on  our  patients.  They  must  either  be  tried  on  animals  or  be 
abandoned. 

The  inoculation  experiments  of  modern  times  have  recently 
borne  rich  fruit  in  still  another  pestilential  disease — yellow 
fever — whose  ravages  hi  this  country  are  fresh  hi  our  minds. 
November  10, 1884,  M.  Bouley  reported  to  the  Paris  Academy 
of  Sciences*  that,  since  1880,  M.  Freire,  of  Rio  Janeiro,  had 
experimented  on  guinea-pigs  with  the  virus  of  yellow  fever/ 
and  believed  that  he  had  been  able  to  produce  such  attenua- 
tion of  the  virus  that  by  vaccination  he  could  secure  immunity 
from  this  dreadful  scourge.  Following  the  experiments,  he 
and  Rabourgeon  tested  the  results  on  themselves,  some  stu- 
dents of  medicine,  and  employes.  Later  the  Emperor  Dom 
Pedro  authorized  two  hundred  wharf-laborers  to  be  inoculated. 
All  these,  after  a  three  days'  mild  attack,  remained  free  from 
the  pestilence,  while  their  fellow-laborers,  similarly  exposed 
to  the  fever,  were  dying  on  every  hand.  If,  in  an  epidemic, 
this  still  prove  true,  as  there  seems  every  probability  it  will, 
from  the  five  hundred  lives  already  saved,  we  can  hardly  es- 
timate either  the  medical  or  the  commercial  advantages  to  this 
country  alone.  Is  this  cruelty?  Let  Norfolk,  and  Memphis, 
and  Pensacola,  and  New  Orleans  answer.f 

We  are  all  familiar  now  with  the  numerous  deaths  from 
eating  pork  infested  with  trichina.  While  I  was  in  Berlin, 
in  1865-66,  a  terrible  epidemic  of  the  then  new  disease  broke 
out  at  Hedersleben,  a  small  town  in  Prussian  Saxony.  I  well 
remember  with  what  zeal  Virchow  and  his  assistants  im- 

*  Medical  News,  Nov.  29,  1884.  f  Since  then  the 

brilliant  researches  of  Major  Reed,  Colonel  Gorgas,  and  other  American 
army  officers  in  Cuba  have  shown  that  the  mosquito  is  the  only  source 
of  propagation  of  yellow  fever.  The  cause  of  yellow  fever  is  still  un- 
known, but  mosquito  bars  have  replaced  these  inoculations  in  guarding 
against  the  fever,  as  our  knowledge  has  been  augmented,  and  Cuba  and 
the  United  States  have  been  freed  from  this  pestilence  and  its  ravages 
among  human  beings  and  its  commercial  disasters. — (W.  W.  K.,  1905.) 


OUR   RECENT   DEBTS   TO   VIVISECTION.  85 

mediately  investigated  the  disease,  inoculated  animals  with 
the  parasitic  worm,  studied  its  natural  history,  found  out 
that  heat  killed  it,  and  to-day,  as  a  result  of  these  and  other 
'  experiments,  we  all  know  how  to  avert  its  dangers  by  proper 
cooking,  or  to  avoid  it  altogether  by  the  microscope.  The 
value  of  these  experiments,  both  to  human  life  and  to  com- 
merce, you  know  even  from  the  daily  papers. 

You  will  find  it  difficult  to  make  the  non-medical  public 
understand — nay,  you  yourselves  as  yet  hardly  understand 
—the  enormous  advance  in  medicine  and  surgery  brought 
about  by  recent  researches  on  inflammation,  and  by  the  use 
of  antiseptics.  My  own  professional  life  only  covers  twenty- 
three  years,  yet  in  that  time  I  have  seen  our  knowledge  of 
inflammation  wholly  changed,  and  the  practice  of  surgery  so 
revolutionized  that  what  would  have  been  impossible  au- 
dacity in  1862  has  become  ordinary  practice  in  1885. 

It  would  seem  that  so  old  a  process  as  inflammation  would 
long  ago  have  been  known  through  and  through,  and  that 
nothing  new  could  be  adduced.  In  1851,  however,  Claude 
Bernard,  by  a  slight  operation,  divided  the  sympathetic 
nerve  in  a  rabbit's  neck  and  showed  its  influence  on  the 
calibre  of  the  blood-vessels.  In  1858  Virchow  published 
his  "Cellular  Pathology."  In  1867  Cohnheim  published 
his  studies  on  the  part  that  the  blood-cells  played  in 
inflammation  as  shown  hi  the  frog,  followed  by  further 
papers  by  Dr.  Norris,  of  this  city,  Strieker,  von  Reckling- 
hausen,  Waldeyer,  and  many  others.  Already  in  my 
lectures  I  have  pointed  out  to  you  in  detail  the  advances 
made  by  these  studies,  both  in  theory  and  practice.  They 
have  brought  about  an  entire  reinvestigation  of  disease,  and 
given  us  wholly  new  knowledge  as  to  abscesses,  ulceration, 
gangrene,  the  organization  of  clots  in  wounds,  and  after 
operations  and  ligature  of  blood-vessels  for  aneurism,  as  to 
thrombosis,  and  embolism,  and  paralysis,  and  apoplexy,  and 
a  score  of  other  diseases  through  the  diagnosis  and  treatment 


86  ADDRESSESg  AND   OTHER   PAPERS. 

of  which  now  runs  the  silver  thread  of  knowledge  instead  of 
ignorance. 

With  this  the  brilliant  results  of  the  antiseptic  system  have 
joined  to  give  us  a  new  surgery.  Sir  Joseph  Lister,  to  whom* 
we  chiefly  owe  this  knowledge,  has  done  more  to  save  human 
life  and  dimmish  human  suffering  than  any  other  man  of  the 
last  fifty  years.  Had  he  only  made  practicable  the  use  of 
animal  ligatures,  it  would  have  been  an  untold  boon,  the 
value  of  which  can  only  be  appreciated  by  doctors;  but  he 
has  done  far  more,  he  has  founded  a  new  system  of  surgery. 
We  may  reject  the  spray  and  carbolic  acid,  but  the  surgical 
world,  regardless  of  details,  with  few  exceptions  follows  the 
principles  upon  which  his  method  is  founded  and  humanity 
is  the  gamer,  by  the  nearly  total  abolition  of  inflammation, 
suppuration,  secondary  haemorrhage,  blood-poisoning,  gan- 
grene, and  erysipelas,  as  sequels  of  accidents  and  operations; 
by  the  relief  from  suffering  and  death,  by  operations 
formerly  impossible;  by  rendering  amputations  and  com- 
pound fractures  safe  and  simple  instead  of  deadly.  Reflect 
on  what  each  one  of  these  brief,  but  momentous,  statements 
means! 

But  we  have  by  no  means  reached  perfection.  Lister  him- 
self, no  tyro,  but  the  great  master,  is  still  searching  for  further 
improvements.  But  when  lately  he  desired  to  make  some 
experiments  on  animals,  still  further  to  perfect  our  practice, 
so  many  obstructions  were  thrown  in  his  way  in  England 
that  he  was  driven  to  Toulouse  to  pursue  his  humane  re- 
searches. 

I  had  intended  also  to  speak  of  many  other  practical  bene- 
fits to  man  directly,  but  can  only  mention  such  important 
matters  as  the  surgery  of  the  thyroid  gland,  the  seat  of  goitre; 
the  surgery  of  the  lungs,  part  of  which  have  been  removed; 
the  surgery  of  the  nerves,  removal  of  the  entire  larynx,  the 
remarkable  researches  of  late  years  as  to  the  periosteum  in 
the  reproduction  of  new  bone  after  removal  of  dead  or  diseased 


OUR  RECENT  DEBTS  TO  VIVISECTION.  87 

bone;  Bernard's  important  observations  as  to  diabetes; 
Brown-Se"quard's  experiments  on  epilepsy,  the  modern  ex- 
traordinary advance  in  nearly  all  the  diseases  of  the  nervous 
system,  and  a  number  of  other  discoveries,  as  to  all  of  which 
experiments  upon  animals  have  added  largely  to  our  knowl- 
edge, and  therefore  to  our  means  of  diminishing  suffering  and 
saving  human  life.  For  many  of  these,  as  well  as  for  the  most 
judicial  discussion  of  the  vivisection  question  I  have  yet  seen, 
I  must  refer  you  to  that  remarkable  book,  "Physiological 
Cruelty,"  written,  not  by  a  man,  but  by  a  woman* 

I  had  also  intended  to  refer  in  detail  to  the  splendid  re- 
sults of  vivisection  in  relieving  the  sufferings  of  animals,  and 
in  preventing  enormous  pecuniary  loss  to  man.  We  are  only 
beginning  to  see  that  vivisection  is  as  humane  to  animal  life 
and  suffering  as  it  is  to  human,  and  that  for  financial  reasons 
as  well  as  humane  motives  it  is  of  the  utmost  importance  to 
the  State  that  such  diseases  as  cattle  plague,  splenic  fever, 
chicken  cholera,  swine  plague,  and  others,  should  be  eradi- 
cated. Vivisection  has  shown  us  how  this  may  be  done,  and 
has  so  conferred  upon  animals,  too,  the  boon  of  life  and  health. 
For  all  this,  however,  I  must  refer  you  to  the  recent  admirable 
lecture  by  Prof.  Robert  Meade  Smith,  of  the  University  of 
Pennsylvania.! 

One  subject,  however,  is  so  recent  and  of  such  interest,  both 
to  man  and  animals,  that  I  must  not  pass  it  over — I  mean 
that  justly  dreaded  disease  hydrophobia.  Thanks  to  vivi- 
section, its  abolition  in  the  near  future  seems  no  longer  to  be 
a  matter  of  doubt. 

Within  the  last  three  years  Pasteur  has  announced  that, 
by  passing  the  virus  through  the  monkey,  he  has  been  able 
to  protect  dogs  from  hydrophobia  by  vaccination  with  this 
weakened  virus.  The  French  government  recently  appointed 


*  See  also  the  just  issued  Life  and  Labors  of  Pasteur. 
t  Therapeutic  Gazette,  Nov.,  1884. 


88  ADDRESSES   AND   OTHER   PAPERS. 

an  eminent  scientific  commission  to  report  on  the  alleged 
discovery.*  Pasteur  furnished  them  with  23  vaccinated 
dogs.  These  23,  and  19  others  unprotected,  were  all  in- 
oculated from  rabid  animals.  Of  the  19  unprotected,  14 
died.  Of  the  23  protected  dogs,  1  died  of  diarrhoea,  and  all 
the  others  escaped.  It  has  yet  to  be  tried  on  a  man  suffering 
from  hydrophobia,  but,  should  our  reasonable  hopes  be  real- 
ized, what  a  boon  it  will  be!f 

With  this  brief  summary  of  a  few  of  the  recent  practical 
benefits  from  vivisection,  I  must  close.  I  have  given  you 
only  ascertained  facts  for  your  future  use  in  the  communities 
in  which  you  may  settle.  They  may  assist  you  hi  forming 
public  sentiment  on  a  basis  of  fact,  of  reason,  and  of  common 
sense.  The  sentiment  of  our  own  profession,  so  constantly 
and  so  conspicuously  humane,  are  always  against  inflicting 
pain ;  but  if  in  yielding  to  sentiment  we  actually  increase  dis- 
ease, and  pain,  and  death,  both  among  animals  and  men,  our 
aversion  to  present  pain  is  both  unwise  and  actually  cruel. 

*  Medical  News,  August  30,  1884. 

t  In  the  last  twenty  years  "  Pasteur  Institutes "  for  the  treatment  of 
hydrophobia  and  some  similar  diseases  have  been  established  hi  nearly 
every  civilized  country  in  the  world.  Of  persons  bitten  by  animals  be- 
lieved to  be  rabid,  heretofore  about  sixteen  per  cent,  developed  hydro- 
phobia, and  every  one  died.  In  the  thousands  of  such  cases  treated  by 
Pasteur's  method  even  those  bitten  by  animals  known  to  be  rabid  the 
mortality  is  less  than  one  per  cent. — (W.  W.  K.,  1905.) 


RECENT  PROGRESS  IN  SURGERY.* 


IN  no  department  of  medicine  has  there  been  more  rapid 
and  in  many  respects  more  astonishing  progress  in 
recent  years  than  in  surgery.  This  progress  is  due  chiefly  to 
two  things — the  introduction  of  antiseptic  methods,  and  to 
what  we  have  learned  from  laboratory  work  and  experiments 
upon  animals. 

It  has  long  been  known  that  a  "simple"  fracture,  in  which 
the  skin  is  unbroken,  and  a  "compound"  fracture,  in  which 
the  skin  is  broken  and  the  air  has  easy  access  to  the  fractured 
bone,  were  vastly  different  in  their  dangers ;  but  why  the  com- 
munication with  the  air  was  so  dangerous  was  a  mystery. 
Of  late  years,  however,  the  germs  existing  in  the  atmosphere, 
and  on  every  material  coming  into  contact  with  the  wound, 
such  as  dirty  clothing,  ordinarily  clean  instruments,  the  skin 
of  the  patient,  the  hands  of  the  surgeon,  and  the  dressings, 
have  been  investigated  by  a  large  number  of  observers,  and 
it  has  been  abundantly  proved  that  infection  comes  not  from 
the  wound  itself,  but  from  the  exterior,  and  that  this  infec- 
tion from  without  is  the  cause  of  inflammation  and  of 
its  speedy  sequel,  the  formation  of  "pus"  (that  is,"matter"). 
Once  that  the  pus  begins  to  form,  fever,  abscesses,  blood- 
poisoning,  gangrene,  erysipelas,  one  or  all,  may  start  up  into 
ominous  and  fatal  activity.  Inflammation  and  suppuration 
(that  is,  the  formation  of  pus),  then,  are  the  causes  of  all  these 
evil  processes.  They  are  all  called  briefly  "septic"  (that  is, 

*  Reprinted  from  Harper's  Magazine,  October,  1889,  by  the  kind  con- 
sent of  Messrs.  Harper  &  Brothers. 

89 


90  ADDRESSES   AND   OTHER   PAPERS. 

"poisonous")  processes.  Hence  "antiseptic"  methods  are 
those  that  prevent  inflammation  and  suppuration. 

Now  we  see  why  a  compound  fracture,  or  any  other  "open" 
wound  (that  is,  one  in  which  the  protective  defense  of  the 
skin  is  destroyed),  is  so  much  more  dangerous  than  a  simple 
fracture,  or  a  subcutaneous  wound.  It  arises  from  the  fact 
that  these  septic  germs,  or  "microbes,"  have  easy  access  to 
the  tissues,  and,  once  there,  multiply  with  almost  incredible 
rapidity,  and  quickly  set  up  inflammation  and  suppuration 
and  their  consequences.  At  first  it  was  thought  that  the 
chief  danger  lay  in  atmospheric  germs,  but  later  investiga- 
tions have  proved  that  the  skin  of  the  patient,  and  especially 
the  hands  of  the  surgeon,  and  his  instruments  and  sponges, 
and  even  his  dressings,  are  far  more  frequent  sources  of  in- 
fection. 

Perhaps  I  cannot  better  illustrate  the  difference  between 
the  old,  or  "septic,"  and  the  new,  or  "antiseptic,"  surgery 
than  by  describing  two  amputations,  one  such  as  was  com- 
monly done,  for  instance,  during  the  Civil  War,  and  the  other 
such  as  is  done  now  by  every  good  surgeon.  In  fact,  it  is 
only  within  the  last  ten  or  fifteen  years  that  antiseptic  surgery 
has  become  generalized  in  the  profession. 

Let  us  suppose  an  amputation  above  the  elbow,  and  the 
operator  the  best  surgeon  of  the  Civil  War.  The  arm  was  not 
specially  prepared,  except  that  it  would  be  cleaned  of  its  coarse 
dirt  arising  from  the  accident,  but  that  would  be  all.  The 
instruments  were  taken  out  of  an  ordinary  case  and  placed 
on  a  table,  and  during  the  operation  were  frequently  placed 
upon  the  patient's  clothing,  soiled  often  by  the  accident  ne- 
cessitating the  operation,  as  well  as  by  more  or  less  wearing. 
If  the  instruments  or  sponges  fell  upon  the  floor,  they  would 
be  picked  up,  dipped  into  water,  and  then  used  with  innocent 
equanimity.  The  sponges,  washed  and  dried  from  the  last 
operation,  were  simply  thrown  into  a  basin  of  ordinary  water. 
The  hands  of  the  surgeon  were  as  clean  as  a  gentleman  would 


RECENT  PROGRESS  IN  SURGERY.  91 

always  keep  his  hands.  The  amputation  having  been  done, 
the  arteries  were  tied  with  silk  threads  (called  "ligatures"), 
one  end  of  each  being  left  long.  These  ends  were  left  hang- 
ing out  of  the  wound  at  any  convenient  place,  and  in  an  am- 
putation of  a  muscular  thigh  might  number  a  score  or  more. 
Hsemorrhage  having  been  checked,  the  two  flaps  were  sewed 
together  with  wire  or  silk  threads,  called  "sutures."  In 
threading  the  needle,  the  thread  would  often  be  shaped  into 
a  point  by  the  lips,  or,  after  being  wetted  with  septic  saliva, 
would  be  rolled  between  septic  fingers.  A  piece  of  lint,  or 
often  a  piece  of  soft,  old  linen  "rag,"  spread  with  some  grease, 
was  placed  upon  the  stump,  and  a  suitable  bandage  applied. 
The  next  day  the  dressings  were  removed,  and  the  wound  was 
redressed  hi  a  similar  manner.  At  the  end  of  twenty-four  or 
forty-eight  hours  a  fever  would  set  in,  called  in  our  text-books 
"surgical  fever,"  thus  assuming  that  a  surgical  operation 
always  resulted  in  such  a  fever ;  nor  was  the  assumption  erro- 
neous. This  would  continue  for  several  days,  the  temperature 
ranging  from  102°  to  104°  or  105°  F.  In  a  few  days,  when  sup- 
puration became  established  (and  this  was  always  expected 
by  the  surgeon),  the  fever  would  gradually  subside,  and 
later  the  suppuration  also  would  diminish.  At  the  end  of  a 
week  or  ten  days  the  surgeon  would  pull  gently  on  each  silk 
ligature,  to  see  if  it  had  rotted  loose  from  the  blood-vessel  and 
could  be  removed.  If  the  wound  became  unduly  inflamed, 
poultices  would  be  applied;  and  finally,  after  three  or  four 
weeks,  the  ligatures  would  all  have  been  removed,  and  the 
wound  would  soon  be  healed.  Very  rarely,  indeed,  would  a 
wound  heal  without  suppuration.  If  it  did,  it  always  excited 
remark,  and  would  be  recounted  as  a  surgical  triumph.  Often, 
on  the  other  hand,  grave  complications  arose  by  the  formation 
of  abscesses;  erysipelas  and  gangrene  were  fertile  sources  of 
danger,  and  very  often  of  death;  while  secondary  haemorrhage 
— that  is,  haemorrhage  following  premature  rotting  of  the  liga- 
tures on  the  blood-vessels — was  always  a  possible  and  fre- 


92  ADDRESSES   AND    OTHER   PAPERS. 

quently  an  actual  and  formidable  danger  to  life.  A  serious 
operation  from  which  the  patient  recovered  hi  less  than  a 
month  was  a  "remarkable  case." 

Contrast  this  with  a  similar  operation  performed  to-day 
by  any  ordinarily  well-instructed  surgeon.  The  day  before- 
hand, the  skin  in  a  wide  area  around  the  site  of  the  proposed 
operation  will  first  be  scrubbed  by  a  nail-brush  with  soap 
and  water,  then  with  ether,  then  with  some  antiseptic  solution, 
most  frequently  at  the  present  day  a  solution  of  corrosive 
sublimate,  one  part  to  one  thousand  of  water,  and  then  cov- 
ered with  an  antiseptic  dressing  until  the  operation  is 
begun.  The  object  of  this  is  to  free  the  skin  from  dirt  and 
fatty  matter,  making  it  surgically  clean  and  free  from  germs. 
The  instruments  will  have  been  boiled  in  a  covered  vessel  for 
fifteen  minutes,  or  disinfected  by  carbolic  acid  or  some 
equivalent  germicide,  and  are  then  placed  hi  a  tray  filled  with 
an  antiseptic  solution.  In  the  cleaning  of  them  after  the 
last  operation  all  rough  and  more  or  less  inaccessible  places 
where  germs  may  accumulate  (especially,  for  instance,  the 
joints)  will  have  been  scrupulously  disinfected.  If  during 
the  operation  an  instrument  is  laid  down,  it  is  never  placed 
on  the  clothing  of  the  patient,  but  either  is  replaced  in  the 
tray,  or  laid  upon  towels  or  sheets  which  have  been  disinfected 
and  spread  all  over  the  patient's  person  and  clothing  all 
around  the  field  of  operation. 

After  an  operation  the  sponges  are  thrown  away  if  they 
have  become  infected  from  pus;  but,  if  not,  they  are  very 
carefully  disinfected,  and  then  kept  permanently  in  a  car- 
bolic solution.  At  the  next  operation  they  are  placed  hi  a 
tray  containing  some  antiseptic,  or  at  least  water  which  has 
been  boiled,  for  heat  has  been  found  to  be  one  of  the  best 
antiseptics.  If  a  sponge  or  an  instrument  fall  on  the  floor, 
it  is  laid  aside,  or  before  being  used  again  is  thoroughly  dis- 
infected. The  hands  of  the  surgeon  will  next  receive  es- 
pecial care.  First  they  are  scrubbed  with  soap  and  water 


RECENT  PROGRESS  IN  SURGERY.  93 

and  a  nail-brush.  Then  the  nails  are  cleaned  anew,  for  the 
dirt  which  accumulates  under  them  is  found  to  be  one  of  the 
most  fruitful  sources  of  infection.  Then  the  hands  are  washed 
in  pure  alcohol,  and  last,  while  wet,  are  again  scrubbed 
with  the  antiseptic  solution,  the  nails  again  receiving  great 
care.  If  during  the  operation  the  hands  touch  anything 
not  itself  already  disinfected,  they  must  again  be  disinfected. 

These  precautions  being  complete,  the  operation  is  begun. 
The  blood-vessels  are  tied  with  catgut  or  silk  which  has  been 
disinfected,  and  both  ends  are  cut  short.  These  ligatures 
are  not  irritating  like  the  non-disinfected  silk  formerly  used. 
As  no  end  hangs  out,  they  are  never  pulled  upon,  but  are 
slowly  absorbed,  and  nothing  is  ever  heard  of  them  again. 
In  consequence  of  this  the  blood-vessels  are  never  afterward 
disturbed,  and  secondary  haemorrhage  is  now  one  of  the  rar- 
est complications  following  an  operation.  A  disinfected 
rubber  tube,  with  holes  in  it  for  draining  away  the  wound 
fluids,  which  ooze  from  the  raw  surfaces  for  some  time,  is 
then  inserted  between  the  flaps,  with  a  bundle  of  horse-hairs 
alongside  of  it.  The  flaps  are  now  united  by  sutures  of  cat- 
gut, disinfected  as  before,  or  sutures  of  wire  or  of  silk  simi- 
larly prepared.  A  large,  soft  dressing  of  many  layers  of  dry 
cheese-cloth  is  next  applied  by  a  bandage.  This  dressing 
has  been  thoroughly  impregnated  with  corrosive  sublimate  or 
some  other  antiseptic  solution.  The  finest  linen  or  lint,  clean 
as  the  driven  snow  to  the  ordinary  eye,  is  dirty  to  the  eye 
of  an  antiseptic  surgeon,  since  it  is  not  cleansed  from  the 
microscopical  germs  that  will  surely  cause  infection.  At  the 
end  of  twenty-four  hours  the  drainage  tube  is  removed,  the 
horse-hairs  being  sufficient  for  the  slight  later  drainage,  and 
another  similar  dressing  of  dry  antiseptic  cheese-cloth  is  ap- 
plied. The  horse-hairs  are  entirely  removed  after  four  or 
five  days. 

The  temperature  of  the  patient  scarcely  rises  above  the 
normal.  Apart  from  the  discomfort  of  the  ether-vomiting, 


94  ADDRESSES   AND   OTHER   PAPERS. 

from  shock,  and  from  loss  of  blood  (from  all  of  which  the 
patient  generally  recovers  in  twenty-four  hours  or  less),  he 
will  suffer  but  little  pain.  It  is  not  an  infrequent  thing  to 
see  a  patient  recover,  even  from  a  severe  operation,  with- 
out having  suffered  much  pain.  By  the  fifth  or  the  tenth  day, 
when  the  second  dressing  will  be  applied,  the  wound  is  well. 
No  complications  ought  to  occur,  saving  in  exceptional  cases. 
Secondary  haemorrhage  is  unknown.  Primary  union  of  the 
flaps  is  now  always  expected.  The  formation  of  pus  is  a  rare 
accident;  if  it  does  occur,  the  surgeon  asks  himself,  "What 
mistake  did  I  make?" 

Let  us  now  see  what  the  results  have  been  hi  amputations. 
In  Professor  Billroth's  clinic  in  Vienna,  in  the  seventeen 
years  from  1860  to  1877,  there  were  315  major  amputations 
done  (i.  e.,  excluding  fingers  and  toes)  in  the  most  approved 
methods  of  the  days  before  antiseptics  were  introduced. 
Of  these,  173,  or  54  per  cent.,  died.  From  1877  to  1880,  91 
such  amputations  were  done  by  the  same  surgeon  with  anti- 
septic precautions,  and  the  mortality  fell  to  18,  that  is,  19.7 
per  cent.  Of  the  91  cases,  56  were  uncomplicated  cases, 
of  whom  not  one  died.  The  general  rates  of  mortality  in 
amputations  in  different  hospitals  in  the  days  before  anti- 
septics were  employed  have  ranged  from  23  to  over  53  per 
cent.  Since  the  introduction  of  antiseptics  some  idea  of  the 
saving  of  life,  to  say  nothing  of  the  immense  decrease  of  pain 
and  suffering,  may  be  gathered  from  the  following  additional 
figures:  In  von  Brims'  clinic,  47  major  amputations  were 
done  antiseptically,  and  not  one  died.  Busch  reports  57 
similar  amputations,  with  a  mortality  of  3.5  per  cent. ;  Schede 
31  amputations  with  a  mortality  of  4.37  per  cent.;  Socin, 
48  amputations,  and  a  mortality  of  zero;  and  Volkmann, 
220  amputations,  with  a  mortality  of  but  3.5  per  cent.  I 
have  purposely  quoted  the  statistics  of  six  operators  so  as  to 
show  that  it  is  not  the  man,  but  the  method,  which  has 
yielded  such  splendid  results. 


RECENT  PROGRESS  IN  SURGERY.  95 

This  perfection  has  been  reached  by  an  immense  deal  of 
labor  on  the  part  of  many  observers,  first  and  foremost,  pri- 
mus inter  pares,  Sir  Joseph  Lister,  now  of  London.  The 
experiments  have  been  made  chiefly  in  two  directions.  First, 
on  animals,  to  discover  what  was  the  best  method  of  treating 
wounds,  and  especially  to  select  the  best  material  for  liga- 
tures and  sutures  by  which  to  tie  the  bleeding  vessels  and 
unite  the  flaps,  the  object  being  to  obtain  that  material  which 
would  not  carry  infection,  and  which,  at  an  early  date,  would 
be  entirely  absorbed.  These  experiments  upon  animals  have 
been  attended  with  but  little  pain,  and  hi  many  cases  practi- 
cally none,  for  they,  too,  have  been  done  antiseptically.  The 
results  shown  above  attest  the  immense  value  of  the  investi- 
gations. Yet  the  antivivisection  laws  in  England  are  so 
hostile  to  all  humane  progress  in  surgery  that  when,  a  few 
years  since,  Sir  Joseph  Lister  desired  to  carry  on  some  ex- 
periments with  a  view  to  still  greater  perfection,  he  was 
obliged  to  leave  London  and  go  to  France  in  order  to  perform 
them.  After  experimenting  in  animals  with  ligatures,  with 
sutures,  and  with  disinfectants  in  the  various  modes  of  the 
antiseptic  treatment  of  wounds,  then  followed  the  crucial 
test  in  man — a  test  only  justified  by  the  good  results  first 
obtained  in  animals.  These  trials  have  from  time  to  time 
been  followed  by  modifications  in  detail,  but  practically 
none  hi  principle. 

Secondly,  this  result  has  been  attained  by  a  painstaking 
study  of  the  entire  life-history  of  the  many  varieties  of  mi- 
crobes or  bacteria  now  known  to  exist ;  what  distinguishes  one 
from  another,  and  what  favors  and  what  hinders  the  devel- 
opment of  each.  Next  the  effects  of  their  intentional  in- 
oculation in  animals  were  observed;  and  then  the  results  of 
their  occurrence  in  man  in  various  diseases  and  accidents. 
In  fact,  this  study  of  bacteria  is  now  a  distinct  science,  known 
as  bacteriology,  and  has  among  its  students  some  of  the 
most  noted  names  in  medicine.  One  of  the  practical  results 


96  ADDRESSES   AND   OTHER   PAPERS. 

of  such  scientific  study  of  bacteriology  is  seen  in  the  recent 
immense  improvement  of  our  treatment  of  that  dangerous 
accident  already  alluded  to — compound  fractures.  The 
statistics  of  compound  fractures  from  a  half-dozen  of  the 
best  hospitals  of  America  and  Europe  for  varying  periods 
from  twelve  to  twenty  years  before  the  introduction  of  anti- 
septic methods  gave  a  mortality  varying  from  26  to  68  per 
cent.,  the  majority  of  deaths  being  from  serious  complica- 
tions due  to  blood-poisoning.  The  introduction  of  antiseptics 
caused  a  falling  off  of  the  death-rate  of  Billroth's  cases  in 
Vienna  to  one-tenth  of  what  it  formerly  was,  and  hi  the  other 
hospitals  in  similar  though  varying  proportions.  Still  more 
remarkable  are  the  results  recently  reported  by  Dennis  of 
New  York.  Of  446  compound  fractures  of  all  grades,  from 
the  most  severe  down,  of  which  385  belonged  to  the  class 
of  severe  fractures,  only  2  died,  the  mortality  being  less  than 
one-half  of  one  per  cent. — less  than  2  in  400  in  contrast  to 
the  rate  previous  to  the  introduction  of  modern  surgical 
methods  of  from  104  up  to  272  in  400!  At  present  his  list 
of  cases  extends  to  about  900  without  a  single  death  from 
blood-poisoning.  Nothing  can  add  force  to  such  a  statement. 

Besides  these  very  remarkable  results  in  the  almost  cer- 
tain and  painless  healing  of  severe  accidents  and  of  opera- 
tion wounds  within  the  last  few  years,  as  a  result  of  the  scien- 
tific studies  just  noted,  many  other  achievements  have  been 
made  possible  by  them  in  modern  surgery,  to  which  I  must 
now  allude. 

The  two  regions  of  the  body  in  which  the  most  marvelous 
advance  has  been  made  are  the  abdomen  and  the  head. 
Twenty-five  years  ago,  to  open  the  cavity  of  the  abdomen 
and  explore  the  peritoneum  (a  thin  membrane  which  lines 
the  entire  cavity  and  covers  all  its  contents)  was  a  step  from 
which  every  prudent  surgeon  shrunk.  If  it  were  opened 
by  accident,  there  was  nothing  left  for  us  but  to  do  the  best 
we  could,  and  usually  the  best  meant,  in  the  absence  of  anti- 


RECENT  PROGRESS  IN  SURGERY.  97 

septic  methods,  to  look  on  until  the  patient  died,  helpless  to 
do  aught  except  administer  a  few  anodynes  until  death  came 
to  his  relief. 

During  the  war  of  the  rebellion  there  were  64  cases  of 
wounds  of  the  stomach,  and  only  1  recovered.  Otis  estimated 
the  mortality  at  99  per  cent.  In  over  650  cases  of  wounds 
of  the  intestines  there  are  recorded  in  the  literature  of  the 
war  only  5  cases  of  recovery  from  wounds  of  the  small  intes- 
tine (and  there  is  some  doubt  as  to  whether  the  intestine  was 
wounded  in  these  5)  and  59  from  wounds  of  the  large  intestine. 
A  gun-shot  wound  in  the  abdomen  was  looked  upon  as  almost 
necessarily  fatal.  Surgeons  did  not  dare  to  open  the  abdo- 
men either  to  search  for  the  ball,  to  close  a  fatal  perforation 
of  the  bowels,  or  to  check  haemorrhage. 

America  can  rightly  boast  of  playing  the  chief  role  in  ef- 
fecting the  change  that  has  taken  place.  The  elder  Gross 
long  since  led  the  way  by  his  experiments  on  dogs,  but  we 
owe  our  present  boldness  and  success  chiefly  to  the  experi- 
ments of  Parkes,  Bull,  and  Senn, — all  Americans, — who 
have  first  shown  in  animals  that  it  was  safe  and  right,  with 
antiseptic  methods,  to  interfere  actively  for  the  health  and 
healing  of  our  patients.  While  it  is  true  that  a  small  rear- 
guard in  the  surgical  army  would  fold  their  hands  and  give 
opium  until  the  patient  died,  there  is  scarcely  a  man  abreast 
with  modern  ideas  who  in  such  a  case  would  not  open  the 
abdomen,  tie  bleeding  vessels,  sew  up  a  rupture  or  wound 
of  the  stomach  or  bowels,  remove  a  lacerated  kidney,  and 
in  general  repair  any  damage  done.  Of  course,  large  num- 
bers of  such  patients,  either  from  immediate  haemorrhage, 
or  from  the  severity  of  the  wound  inflicted,  must  always  die. 
But,  to  say  nothing  of  the  numerous  other  cases  in  which 
recovery  has  followed  operative  interference  in  such  wounds, 
even  though  multiple,  the  possibilities  of  modern  surgery 
are  well  shown  in  a  case  reported  by  Senn,  in  which  eleven 
perforations  of  the  bowel  were  sewed  up,  and  another  case 

7 


98  ADDRESSES    AND    OTHER    PAPERS. 

of  Hamilton's  in  which  there  was  so  extraordinary  a  number 
as  thirteen  wounds  of  the  intestines,  besides  wounds  of  the 
omentum  and  the  mesentery,  and  yet  both  of  these  patients 
made  uninterrupted  recoveries!  In  a  recent  table  by  Mor- 
ton of  19  cases  of  stab  wounds  (all,  of  course,  by  dirty 
knives,  and  one  even  by  a  ragged  splinter  of  dirty  wood) 
with  haemorrhage  and  protrusion  of  the  bowels,  12  recovered 
and  but  7  died,  and  even  of  110  gunshot  wounds  of  the  intes- 
tines in  which  the  abdomen  was  opened,  36  lives  were 
saved. 

If  this  be  the  admirable  showing  in  wounds  attended  by 
infection  from  dirty  knives,  from  the  dirt  on  the  clothing, 
and  from  the  ground  on  which  wounded  persons  would  fall, 
it  is  no  wonder  that,  with  clean  hands  and  instruments,  sur- 
geons have  dared  not  only  to  open  the  abdominal  cavity 
to  verify  a  probable  diagnosis,  or  to  perform  an  operation, 
but  to  go  still  farther  and  to  open  the  abdomen  to  make  a 
diagnosis.  It  is  often  impossible  to  make  an  absolute  diag- 
nosis from  external  examination  alone,  not  only  on  account 
of  the  inherent  difficulty  from  the  close  grouping  of  so  many 
organs  within  the  abdominal  cavity,  but  even  in  cases  ap- 
parently not  obscure  we  may  be  in  error.  At  the  present 
day  it  is  not  only  considered  justifiable  and  not  unreason- 
ably dangerous  to  open  the  abdomen  for  the  removal  of 
tumors  that  are  clearly  fit  for  operation,  but  in  a  very  large 
number  of  doubtful  cases  it  is  the  duty  of  the  surgeon  to 
make  a  small  opening  directly  into  the  abdominal  cavity, 
and  to  insert  two  fingers  in  order  to  determine  by  touch 
what  the  nature  of  the  tumor  or  other  disorder  is,  and,  hav- 
ing determined  its  nature,  to  proceed  to  its  removal,  if  the 
facts  warrant  it;  if  not,  the  abdominal  wound  is  closed,  and 
the  patient  almost  always  recovers  from  the  incision.  So 
slight  is  the  danger  from  such  "  exploratory  operations,"  as 
they  are  rightly  called,  that  it  is  not  to  be  weighed  for  a 
moment  against  the  advantages  derived  from  positive  knowl- 
edge. 


RECENT  PROGRESS  IN  SURGERY.  99 

The  most  remarkable  statistics  recently  published  are 
those  of  Mr.  Tait,  and  a  mere  statement  of  his  percentages 
will  go  far  to  convince  the  non-medical  public  of  the  correct- 
ness of  the  above  statements,  startling  as  they  appear  to  one 
unfamiliar  with  modern  surgical  progress.  Mr.  Tait  has 
completed  a  second  series  of  1000  cases  in  which  he  opened 
the  abdomen  for  the  removal  of  tumors,  for  abscesses,  for 
exploration,  etc.  In  his  first  1000  cases  only  92  patients 
died  (9.2  per  cent.),  and  in  the  second  1000  only  53  died 
(5.3  per  cent.).  In  ovariotomy  alone  the  percentage  fell  from 
8.1  hi  the  first  1000  to  3.3  in  the  second.  Only  a  quarter 
of  a  century  ago  the  mortality  of  ovariotomy  was  but  little, 
if  at  all,  under  50  per  cent.  I  have  heard  the  first  obstetri- 
cian of  his  day,  when  I  was  a  student,  say  that  any  man  who 
dared  to  open  the  abdomen  to  remove  an  ovarian  tumor 
should  be  indicted  for  murder!  Sir  Spencer  Wells,  even 
with  the  far  larger  mortality  of  his  earlier  days,  added  20,- 
000  years  to  human  life  as  the  net  result  of  1000  ovariotomies ! 
He  has  lived  to  see  even  his  great  success  far  surpassed  by 
the  best  surgeons;  and  all  over  the  civilized  world,  even  the 
average  surgeon  is  followed  by  benedictions  for  recovery 
in  ninety  out  of  every  hundred  of  such  operations. 

Surgeons  have  even  successfully  removed  tumors  that 
after  removal  weighed  more  than  all  the  rest  of  the  patient's 
body.  But  we  go  further  than  the  mere  removal  of  ab- 
dominal tumors.  In  a  considerable  number  of  cases  of 
cancer  of  the  stomach  the  diseased  part  of  the  stomach 
itself  has  been  removed,  and  the  patient  has  made  a  good 
recovery.  Of  course,  however,  the  disease  often  returns, 
and  is  eventually  fatal.  In  cases  of  cancer  and  obstruc- 
tion of  the  bowels,  or  of  extensive  wounds,  even  three  or 
four  feet  of  the  bowel  have  been  completely  removed, 
the  ends  sewed  together,  and  the  patients  have  recovered. 
In  other  cases,  instead  of  removing  the  diseased  parts,  open- 
ings have  been  made  in  the  bowel,  one  above  and  one  below 


100  ADDRESSES   AND    OTHER   PAPERS. 

the  disease,  the  two  openings  being  then  placed  opposite 
each  other  and  united  by  their  margins,  and  the  continuity 
of  the  bowel  has  been  thus  successfully  re-established,  the 
intestinal  contents  following  the  "short-cut"  thus  provided. 
This  very  new  operation  has  only  been  done  in  man  in  a  very 
small  number  of  cases,  but  the  mortality  in  dogs  is  only  7.69 
per  cent.,  and  as  our  procedure  will  improve  by  experience, 
it  will  probably  be  even  less  in  the  human  subject. 

When  the  spleen  is  enlarged,  it  also  has  been  successfully 
removed  in  90  cases,  followed  by  51  recoveries.  Occasion- 
ally the  spleen,  instead  of  being  fixed  in  its  place,  is  loose 
or  "floating"  in  the  abdominal  cavity.  In  10  cases  these 
have  been  removed,  with  8  recoveries. 

Another  remarkable  achievement  of  abdominal  surgery 
is  in  operations  on  the  gall-bladder.  Occasionally  a  number 
of  gall-stones*  are  formed  in  the  gall-bladder  or  its  duct  and 
produce  dangerous  and  often  fatal  disease.  In  78  cases 
now  recorded  the  gall-bladder  has  been  opened,  the  gall- 
stones removed,  and  64  of  the  patients  have  recovered. 
Not  satisfied  even  with  this,  in  22  cases  the  entire 
gall-bladder  itself  has  been  removed  to  prevent  any  re- 
currence of  the  disease,  and  19  of  the  patients  have  demon- 
strated the  fact  that  they  could  get  along  quite  as  well 
without  such  an  apparently  useless  appendage  as  with  it; 
in  fact,  in  their  cases  at  least,  a  good  deal  better.  In 
100  operations,  therefore,  on  the  gall-bladder  the  mortality 
has  only  been  17  per  cent.  Mr.  Tait  himself  has  performed 
54  such  operations,  and  has  lost  but  2  patients,  a  mortality 
of  less  than  4  per  cent.  Considerable  portions  of  the  liver 
have  also  been  removed  with  success,  one  of  the  operations 
being  necessitated  as  a  direct  result  of  the  use  of  corsets, 
in  the  opinion  of  the  operator. 

*  These  stones  arise  from  the  bile,  and  are  often  as  large  as  marbles. 
Sometimes  only  one  exists,  but  sometimes  there  are  even  hundreds  of 
them. 


RECENT  PROGRESS  IN  SURGERY.  101 

Operations  on  the  kidney  are  among  the  most  remarkable 
triumphs  of  abdominal  surgery.  In  1869  Simon,  of  Heidel- 
berg, had  a  patient  suffering  from  various  troubles  with  the 
duct  of  the  kidney.  After  many  experiments  on  dogs  to  de- 
termine whether  it  was  possible  for  them  to  live  with  one 
kidney,  after  the  sudden  removal  of  its  fellow,  he  ventured 
to  remove  this  otherwise  healthy  organ,  and  the  patient 
lived  for  eight  years  in  perfect  health.  Since  then  very  many 
such  operations  have  been  done,  and  the  latest  results  are 
as  follows:  In  375  cases  of  entire  removal  of  one  kidney  in 
consequence  of  its  being  hopelessly  diseased,  197  lives  were 
saved.  In  95  cases  of  abscesses  and  other  diseases,  in  which 
the  kidney  was  cut  down  upon  in  the  loin  or  abdomen,  and 
the  kidney  opened  and  drained,  76  lives  were  saved.  In  102 
cases  in  which  stones  were  removed  from  the  kidney,  76 
lives  were  saved,  and  in  25  cases  in  which  the  kidney  (as 
in  the  case  of  the  spleen  above  referred  to)  was  "floating" 
around  loose  in  the  abdomen,  and  a  source  of  discomfort  and 
pain,  it  had  been  cut  down  upon,  sewed  fast  in  its  proper 
place,  and  all  but  one  got  well,  and  even  this  one  death  was 
from  injudicious  surgery.  A  total  of  597  operations  on  the 
kidney  shows,  therefore,  recovery  and  in  general  complete 
restoration  to  health  in  373.  Had  the  patients  been  let 
alone  (as  they  would  have  been  prior  to  Simon 's  experiments 
in  1869),  almost  every  one  would  have  died,  and  that  too  after 
weeks,  or  years  it  might  be,  of  horrible  pain  and  loathsome 
disease. 

But  the  most  extraordinary  achievement  of  modern  sur- 
gery remains  to  be  told.  In  the  "  Lancet"  for  December  20, 
1884,  Dr.  Bennett  and  Mr.  Godlee  published  an  article  which 
startled  the  surgical  world.  Dr.  Bennett  had  diagnosticated 
not  only  the  existence,  but  the  exact  locality  of  a  tumor  in 
the  brain,  of  which  not  the  least  visible  evidence  existed  on 
the  exterior  of  the  skull,  and  asked  Mr.  Godlee  to  attempt 
its  removal.  The  head  was  opened  and  the  brain  exposed. 


102  ADDRESSES   AND   OTHER   PAPERS. 

No  tumor  was  seen,  but  so  certain  were  they  of  the  diagnosis 
that  Mr.  Godlee  boldly  cut  open  the  healthy  brain  and  dis- 
covered a  tumor  the  size  of  a  walnut  and  removed  it.  After 
doing  well  for  three  weeks,  inflammation  set  in,  and  the 
patient  died  on  the  twenty-sixth  day.  But,  like  the  failure 
of  the  first  Atlantic  cable,  it  pointed  the  way  to  success,  and 
now  there  have  been  20  tumors  removed  from  the  brain,  of 
which  17  have  been  removed  from  the  cerebrum  with  13  re- 
coveries, and  3  from  the  more  dangerous  region  of  the 
cerebellum,  all  of  which  proved  fatal.  Until  this  recent  in- 
novation every  case  of  tumor  of  the  brain  was  absolutely  hope- 
less. The  size  of  the  tumors  successfully  removed  has  added 
to  the  astonishment  with  which  surgeons  view  the  fact  of 
their  ability  to  remove  them  at  all.  Tumors  measuring  as 
much  as  three  and  four  inches  in  diameter  and  weighing  from 
a  quarter  to  over  a  third  of  a  pound  have  been  removed  and 
the  patients  have  recovered. 

Another  disease  formerly  almost  invariably  fatal  is  ab- 
scess of  the  brain.  In  the  majority  of  cases  this  comes  as 
a  result  of  long-standing  disease  of  the  ear,  which  after  a 
while,  involves  the  bone  and  finally  the  brain.  So  long  ago 
as  1879  Dr.  Macewen,  of  Glasgow,  diagnosticated  an  abscess 
in  the  brain,  and  wished  to  operate  upon  it.  The  parents 
declined  the  operation,  and  the  patient  died.  After  death 
Macewen  operated  precisely  as  he  would  have  done  during 
life,  found  the  abscess  and  evacuated  the  pus,  thus  showing 
how  he  could  probably  have  saved  the  child 's  life.  Since  then 
the  cases  treated  in  such  a  manner  amount  to  scores,  and 
more  than  half  of  them  have  recovered  without  a  bad  symp- 
tom. 

In  injuries  of  the  skull  involving  the  brain,  the  larger  ar- 
teries are  sometimes  wounded,  and  the  blood  that  is  poured 
out  between  the  skull  and  the  brain  produces  such  pressure 
as  to  be  speedily  fatal.  In  some  cases,  even  without  any 
wound,  the  larger  arteries  are  ruptured  by  a  blow  or  fall,  and 


RECENT  PROGRESS  IN  SURGERY.          103 

a  similar  result  follows  the  haemorrhage.  Nowadays,  in 
both  of  these  injuries,  any  well-instructed  surgeon  will  open 
the  head,  secure  the  bleeding  vessel,  and  turn  out  the  clot 
with  a  good  chance  of  recovery  in  a  large  number  of  cases. 
Even  gunshot  wounds  of  the  brain  are  no  longer  necessarily 
fatal.  Among  a  number  of  other  successful  cases  one  has 
been  recently  reported  in  which  the  ball  went  all  the  way 
from  the  forehead  to  the  back  of  the  head,  and  after  striking 
the  bone  rebounded  into  the  brain.  The  back  of  the  skull 
was  opened,  the  ball  removed,  and  a  rubber  drainage  tube 
of  the  calibre  of  a  leadpencil  passed  in  the  track  of  the  ball 
completely  through  the  head,  and  the  patient  recovered. 
So  little  danger  now  attaches  to  opening  the  skull,  with  anti- 
septic precautions  similar  to  those  already  described,  that 
the  latest  writer  on  trephining  (Seydel)  estimates  that  tre- 
phining per  se  is  fatal  only  in  1.6  per  cent,  of  the  cases.  Mr. 
Horsley  has  recently  published  a  most  remarkable  paper, 
including  10  operations  on  the  brain,  in  which,  without 
anything  on  the  exterior  to  indicate  its  situation,  the  site  of 
the  disease  was  correctly  located  in  all,  and  9  of  them 
recovered  after  operation. 

Almost  equally  astonishing  are  the  results  of  brain  surgery 
in  certain  cases  of  epilepsy;  for  the  surgical  treatment  of 
the  cases  justifying  such  interference  has  been  attended  with 
the  most  brilliant  results.  In  these  cases  the  spasm  begins 
in  a  particular  part  of  the  body ;  for  example,  the  hand  or  the 
thumb,  or  it  is  limited  to  one  arm,  or  to  one  side  of  the  body. 
Some  of  them  have  been  operated  upon  without  any  benefit, 
but  a  large  number  of  other  cases  have  been  operated  on 
and  either  benefited  or,  in  not  a  few  cases,  have  been  com- 
pletely restored  to  health.  That  the  words  "brilliant  re- 
sults" are  not  inappropriate  will  certainly  be  granted  when 
we  look  at  Mr.  Horsley's  table  of  cases.  One  patient  had 
2870  epileptic  convulsions  in  thirteen  days,  and  completely 
recovered,  not  only  from  the  operation,  but  also  from  his 


104  ADDRESSES   AND   OTHER   PAPERS. 

terrible  malady,  after  the  removal  of  a  diseased  portion  of 
the  brain,  the  result  of  an  old  depressed  fracture  of  the  skull. 
Besides  this,  a  few  cases  of  headache  so  inveterate  as  to 
make  ordinary  occupations  impossible  and  life  itself  a  burden 
have  been  cured  by  trephining  the  skull.  Even  insanity  itself 
has  been  cured  by  such  an  operation  in  cases  in  which  it 
has  followed  injuries  to  the  head.  What  the  ultimate  re- 
sult of  these  recently  inaugurated  operations  will  be  it  is  im- 
possible to  tell  as  yet,  but  thus  far  they  have  been  so  beneficent 
and  so  wonderful  as  to  arouse  not  only  our  greatest  astonish- 
ment, but  also  our  most  sanguine  hopes. 

The  question  will  naturally  arise  how  is  it  that  the  neu- 
rologists can  determine  so  exactly  the  location  of  such  tum- 
ors, abscesses,  haemorrhages,  scars,  and  other  alterations 
of  tissue  giving  rise  to  epilepsy  and  other  disorders  mentioned, 
without  the  slightest  indication  on  the  exterior  of  the  skull 
to  point  to  the  diseased  spot.  That  this  is  of  supreme  im- 
portance in  the  brain  will  be  evident  upon  a  moment's  re- 
flection. In  other  parts  of  the  body,  even  if  we  make  an  error 
of  an  inch  or  two,  it  is  of  comparatively  little  importance, 
as  the  incision  can  be  easily  prolonged,  and  heals  readily. 
But  in  the  skull,  from  the  very  nature  of  the  bony  envelope, 
an  error  of  an  inch  or  two  means  almost  certain  failure  to 
find  the  disease,  and  means,  therefore,  possibly  the  death 
of  the  patient. 

It  is  impossible  within  the  limit  of  this  paper  to  state  in 
detail  the  method,  but  the  following  brief  sketch  may  give 
some  idea  of  it.  Whatever  can  be  advanced  against  vivi- 
section, there  is  this  to  be  said  in  its  favor,  that  without  it 
the  exact  localization  of  cerebral  tumors  and  other  such 
lesions,  which  is  one  of  the  chief  glories  of  the  present  day, 
would  be  impossible.  We  owe  our  knowledge  of  the  loca- 
tion of  cerebral  functions  to  many  observers,  chief  of  whom  are 
Ferrier  and  Horsley,  of  England,  and  Fritsch,  Hitzig,  and 
Goltz,  of  Germany.  Horsley 's  method  will  suffice  as  a  type. 


RECENT  PROGRESS  IN  SURGERY.  105 

The  brain  of  a  monkey  having  been  exposed  at  the  part 
to  be  investigated,  the  poles  of  a  battery  are  applied  over 
squares  one-twelfth  of  an  inch  in  diameter,  and  all  the  vari- 
ous movements  which  occur  (if  any)  are  minutely  studied. 
One  square  having  been  studied,  the  next  is  stimulated,  and 
the  results  are  again  noted,  and  so  on  from  square  to  square. 
These  movements  are  then  tabulated.  For  example,  all 
those  adjacent  squares  which,  when  stimulated,  produce 
movements  of  the  thumb  are  called  the  region  for  repre- 
sentation of  the  thumb,  or,  shortly,  "the  thumb  centre"; 
and  to  all  those  squares  which  produce  movements  of  the 
hand,  the  elbow,  the  shoulder,  or  the  face,  etc.,  are  given 
corresponding  names.  In  this  way  the  brain  has  been 
mapped  out,  region  by  region,  and  the  same  minute,  patient 
study  given  to  each. 

These  animals,  I  should  add,  are  etherized  so  that  they  do 
not  suffer  the  least  pain.  I  may  also  say  in  passing  that  such 
operations,  with  few  exceptions,  even  without  ether,  are 
not  painful.  The  brain  itself  can  be  handled,  compressed 
cut,  or  torn  without  the  least  pain.  A  number  of  cases  have 
already  been  reported  in  which  a  considerable  portion  of  the 
human  brain  has  been  removed  by  operation  and  the  patients 
have  been  out  on  the  street  within  a  week,  without  pain, 
fever,  or  a  single  dose  of  medicine. 

Studying  in  this  way  the  brain  of  the  lower  animals,  we 
now  have  a  very  fair  knowledge  of  the  localization  of  many  of 
its  functions.  With  the  functions  of  the  front  part  we  are 
as  yet  not  familiar.  The  part  which  lies,  roughly  speaking, 
behind  and  in  front  of  one  of  the  chief  fissures  of  the 
brain  (the  fissure  of  Rolando),  which  runs  downward  and 
forward  above  the  ear,  is  known  as  the  motor  region. ' '  In 
this  region  the  different  centres  have  been  mapped  out  in  the 
monkey's  brain,  and  have  been  verified  in  the  brain  of  man 
many  times.  Most  of  that  part  of  the  brain  above  and 
behind  the  ear  has  no  special  functions  that  we  know  of  at 


106  ADDRESSES   AND   OTHER   PAPERS. 

present,  except  one  region,  which  is  the  centre  for  sight. 
Injury  to  this  produces  blindness  of  the  half  of  each  retina 
on  the  same  side  as  the  injury  to  the  brain.  But  it  is  extremely 
difficult  to  obtain  in  the  lower  animals  any  evidence  of  the 
special  senses  other  than  that  of  touch,  the  abolition  of  which 
produces  loss  of  feeling,  of  which  we  can  get  exact  evidence. 
Motion  and  sensation,  therefore,  are  the  two  things  that  can 
be  most  readily  determined. 

Having  now  ascertained  in  animals  the  location  of  the 
particular  centres,  the  next  step  is  to  apply  this  knowledge  to 
the  human  brain  in  judging  of  the  processes  of  disease.  But 
it  will  be  easily  seen  that  the  experiments  that  disease  per- 
forms in  a  human  brain  are  clumsy,  spread  over  a  wide  area, 
and  therefore  often  difficult  of  interpretation.  Instances 
affecting  a  single  little  area  of  brain  surface  one-twelfth  of 
an  inch  in  diameter  are  almost  unknown,  and  a  tumor  has  been 
removed  of  such  size  that  it  produced  direct  pressure  upon 
more  than  twelve  hundred  such  squares,  and  indirectly  pro- 
duced pressure  upon  many  distant  parts  of  the  brain.  This 
is,  of  course,  very  clumsy  experimentation.  The  familiar 
game  of  "shouting  proverbs  "  will  well  illustrate  the  difficulty 
of  interpreting  the  answers  of  disease  to  our  question,  "Where 
is  it  located?"  Imagine  1200  persons,  each  assigned  a  single 
word  of  a  proverb  of  1200  words.  At  a  given  signal  each 
shouts  his  own  word.  What  a  Babel  of  sound !  How  utterly 
impossible  of  disentanglement  and  proper  arrangement ! 
This  is  the  answer  of  disease  as  represented  by  such  a  tumor. 
Take  each  of  the  1200  persons  in  the  proper  order  and  question 
him  separately  and  repeatedly,  write  down  the  answers  ac- 
curately and  in  their  proper  sequence,  and  behold  the  prov- 
erb! This  is  the  answer  of  scientific  investigation  as  seen 
in  vivisection. 

Instead  of  there  being  a  tumor,  a  blood-vessel  will  some- 
times break  in  the  brain,  and  produce  a  clot,  affecting  similarly 


RECENT  PROGRESS  IN  SURGERY.  107 

a  large  area;  or  softening  of  the  brain  will  in  the  same  way 
invade  an  equal  or  a  greater  number  of  centres.  It  is  there- 
fore extremely  rare  that  we  can  find  a  small  area,  such  as 
that  for  speech,  or  for  the  hand,  or  for  the  arm,  or  for  the 
face,  or  for  the  leg,  or  for  sight,  that  is  involved  entirely  by 
itself.  But  such  cases  do  occasionally  occur,  and  they  are 
extremely  valuable  in  fortifying  the  conclusions  derived  from 
the  exact  experiments  of  the  laboratory.  While  some  of  the 
cases  have  introduced  confusion  and  uncertainty  from  the 
character  of  nature's  experiments,  it  can  be  broadly  asserted 
that  generally  they  have  absolutely  confirmed  them.  The 
results  obtained  by  the  surgery  of  the  brain  have  more  than 
confirmed  them;  for,  as  indicated  already,  the  brain  has 
been  opened,  and  that  portion  which,  according  to  experi- 
ment, is  believed  to  be  the  centre  for  the  wrist,  or  for  the 
shoulder,  etc.,  has  been  cut  out,  and  paralysis  of  the  cor- 
responding part  (a  paralysis  which,  however,  is  only  tem- 
porary) has  proved  positively  the  exactness  of  the  inference 
from  animals. 

We  are  still  a  little  uncertain  as  to  the  exact  functions  of 
large  portions  of  the  brain,  but  we  have  made  a  reasonable 
beginning;  we  have  found  firm  ground  to  stand  upon,  and  the 
results  already  obtained  in  the  relief  of  human  suffering  and 
the  cure  of  disease  are  such  as  readily  encourage  the  hope 
that  in  the  near  future  we  shall  be  able  to  do  vastly  more. 
The  opponents  of  vivisection  have  stoutly  contended  that 
it  has  shown  no  useful  results.  Let  us  wholly  ignore  the 
researches  of  Sir  Charles  Bell,  of  Harvey  or  Hunter,  or  other 
experimenters  of  the  past.  Here  is  a  field  in  which  the  last 
ten  years  have  opened  wholly  new  ground  for  modern  sur- 
gery, in  which  already  the  operations  of  the  last  four  years 
have  been  marvellously  successful,  and  have  startled  even 
surgeons  themselves.  Had  vivisection  done  nothing  else 
than  this,  it  would  be  amply  justified,  and  to  obstruct  re- 


108  ADDRESSES   AND    OTHER   PAPERS. 

searches  so  rich  in  beneficent  results  would  be  a  disaster  to 
humanity.* 

But  not  only  has  the  brain  been  opened  and  compelled  to 
give  up  its  secrets,  and  to  yield  itself  to  the  successful  as- 
saults of  the  surgeon,  but  the  spine  has  also  of  late  been  the 
field  of  some  remarkable  work.  About  a  year  ago  Mr.  Hors- 
ley  reported  a  remarkable  case,  hi  which  a  tumor  by  pressure 
on  the  spinal  cord  had  been  the  source  of  most  frightful  pain 
for  a  long  tune,  and  of  paralysis  of  all  the  lower  half  of  the 
body.  Once  that  an  accurate  diagnosis,  not  only  of  its  ex- 
istence, but  of  its  actual  locality,  was  made,  he  made  an 
incision  in  the  back,  exposing  the  backbone,  cut  away  the 
bone  down  to  the  membrane,  and  even  to  the  spinal  marrow 
itself,  and  removed  the  tumor.  When  last  reported  the 
patient  was  able  to  walk  three  miles,  and  even  to  dance. 
Since  then  there  have  been  numerous  successful  operations 
upon  the  spine  in  this  country,  hi  England,  and  in  France, 
and  the  near  future  will  doubtless  show  even  better  results. 
Already  severe  fractures  of  the  spine  have  been  operated 
upon  by  removal  of  the  fragments  sticking  into  the  spinal 
marrow,  and  recovery  has  followed  instead  of  a  lingering 
and  certain  death. 

We  are  only  just  beginning  to  interfere  surgically  with 
the  lungs;  to  open  abscesses  in  them,  and  to  remove  por- 

*  The  facts  stated  in  this  paper,  it  seems  to  me,  are  a  striking  vindi- 
cation of  the  value  and  necessity  of  vivisection.  Personally  I  have  never 
done  any  such  experiments,  save  a  few  some  twenty  years  ago.  Indis- 
criminate experimentation  by  untrained  students  I  would  heartily  dis- 
courage, as  they  would  lead  to  no  good  results.  But  as  a  matter  of  fact 
such  indiscriminate  experiments  by  students  do  not  exist.  They  have 
neither  the  time,  the  money,  nor  the  facilities  for  it.  Only  competently 
trained  men  who  will  make  a  serious  and  systematic  investigation  of 
definite  problems,  and  educe  the  knowledge  that  will  widen  our  scientific 
horizon  and  enlarge  our  resources  in  the  healing  art,  should  engage  hi  it, 
and  as  a  fact  I  believe  only  such  do  engage  in  it.  Moreover,  they  ought 
to,  and,  so  far  as  my  knowledge  extends,  they  do  inflict  no  needless  pain. 


RECENT  PROGRESS  IN  SURGERY.  109 

tions  successfully;  and  several  ribs  have  been  removed  in 
cases  of  chronic  pleurisy  and  deformed  chests. 

Formerly  one  of  the  most  dangerous  operations  known 
was  the  removal  of  goitres.  Haemorrhage,  inflammation, 
and  blood-poisoning  destroyed  a  very  large  number  of  such 
cases,  and  when  Kocher,  of  Berne,  in  1882,  reported  58  opera- 
tions, with  a  mortality  of  only  14.3  per  cent.,  it  was  deemed 
a  triumph.  But  improved  methods  of  operation  reduced 
the  mortality  until,  in  1884,  he  reported  43  more  operations, 
with  a  mortality  of  only  6.9  per  cent.,  and  in  1889  he  has 
just  reported  250  additional  operations,  and  all  but  6  pa- 
tients recovered — a  mortality  of  but  2.4  per  cent.,  or,  if  we 
exclude  the  25  cases  of  cancer,  which  gave  4  of  the  deaths, 
we  have  225  cases  and  only  2  deaths,  a  mortality  of  but 
0.8  per  cent. 

We  see  few  cases  of  severe  knock-knee  and  bowlegs  in  this 
country,  but  among  the  ill-fed  lower  classes  of  Europe  they 
are  common.  Formerly  almost  nothing  could  be  done; 
but  a  few  years  ago  surgeons  began  to  operate  upon  them 
in  this  way :  A  small  cut  is  made  through  the  skin  and  mus- 
cles down  to  the  bone,  and  by  a  saw  or  a  chisel  the  bone  is 
divided.  The  limb  is  then  straightened,  and  the  case  treated 
precisely  as  if  it  were  an  ordinary  fracture.  It  heals  without 
fever  or  serious  pain,  and  the  patient  is  well.  With  modern 
methods  this  is  not  a  dangerous  operation,  as  will  be  seen 
by  the  remarkable  paper  read  by  Macewen,  of  Glasgow,  at 
the  International  Medical  Congress  of  1884,  in  Copenhagen, 
when  he  reported  1800  operations  on  1267  limbs  hi  704  pa- 
tients, and  only  5  died,  in  spite  of  the  fact,  too,  that  most  of 
them,  from  deformity  in  several  limbs,  had  to  have  multiple 
operations.  Even  these  deaths  were  not  due  to  the  operation, 
but  followed  from  pneumonia,  typhoid  fever,  consumption, 
and  diphtheria. 

We  have  learned,  too,  that  portions  of  the  body  can  be 
entirely  severed,  and,  if  suitably  preserved,  can  be  replaced, 


110  ADDRESSES   AND   OTHER   PAPERS. 

and  they  will  adhere  and  grow  as  if  nothing  had  happened. 
When  a  wound  is  slow  in  healing,  we  now  take  bits  of  skin, 
either  from  the  patient's  own  body  or  provided  by  generous 
friends,  or  even  from  frogs,  and  "graft"  them  on  the  surface 
of  the  wound.  They  usually  adhere,  and  as  they  enlarge 
at  their  margins,  they  abridge  by  one-half  the  time  required 
for  "healing.  Even  a  large  disk  of  bone,  one  or  two  niches 
in  diameter,  when  removed  from  the  skull,  can  be  so 
treated.  It  is  placed  in  a  cup  filled  with  a  warm,  antiseptic 
solution.  This  cup  is  placed  hi  a  basin  of  warm  water,  and 
it  is  the  duty  of  one  assistant  to  see  that  the  thermometer 
in  this  basin  shall  always  mark  100°  to  105°  F.  The  bone 
may  be  separated  from  the  skull  so  long  as  one  or  two  hours, 
but,  if  properly  cared  for,  can  be  replaced,  and  will  grow  fast 
and  fulfill  its  accustomed,  but  interrupted,  duty  of  protect- 
ing the  brain. 

The  remarkable  progress  of  surgery  which  I  have  so  im- 
perfectly sketched  above  has  been,  as  I  have  shown,  the  re- 
sult chiefly  of  experimental  laboratory  work.  To  Mr.  Car- 
negie, of  New  York,  is  due  the  credit  of  establishing  the  first 
bacteriological  laboratory  in  this  country,  and  from  studies 
in  this  laboratory  arose  the  brilliant  and  beneficent  results 
hi  the  treatment  of  compound  fractures  which  I  have  quoted. 
If  one  laboratory  can  give  such  beneficent  results  in  one  single 
surgical  accident,  what  will  not  many  do,  each  vying  with 
all  the  rest  hi  investigating  different  important  surgical  and 
medical  questions  as  yet  unsolved?  Could  wealthy  private 
citizens  erect  more  useful  monuments  of  enduring  fame? 
In  Europe  the  government  establishes  and  supports  such 
laboratories.  In  America  we  must  look  to  private  munifi- 
cence, and  never  yet  has  humanity  made  such  an  appeal  to 
my  countrymen  in  vain. 


THE  NEW  ERA  IN  MEDICINE  AND  ITS  DE- 
MANDS UPON  THE  PROFESSION  AND 
THE  COLLEGE.* 


ON  the  8th  of  October,  thirty  years  ago,  I  entered  the 
lower  lecture-room  of  the  College  building  for  the 
first  time  as  a  medical  student,  and  listened  to  the  Intro- 
ductory Lecture.  It  was  given  by  that  phenomenal  encyclo- 
paedia of  knowledge,  Robley  Dunglison,  for  so  many  years 
the  Dean  and  Professor  of  Physiology  in  this  School.  Time 
has  gradually  obliterated  its  then  deep  impressions,  and  now 
three  memories  alone  remain  to  me.  The  first  is  the  place 
where  I  sat;  the  second  the  precept,  which  has  so  often  since 
then  recurred  to  my  mind  in  solving  the  medical  problems 
which  have  presented  themselves  to  me,  that  I  must  not 
confound  the  post  hoc  and  the  propter  hoc,  the  sequence  with 
the  consequence;  and  the  third  was  the  gracious  welcome 
which  that  fluent  master  of  English  gave  to  us,  the  incoming 
class. 

It  is  my  pleasant  duty  to-night  to  repeat,  after  a  lapse 
of  so  many  years,  at  least  the  same  cordial  welcome  then 
extended  to  me — a  welcome  to  you  all,  from  North  and  from 
South,  from  the  Atlantic  and  the  Pacific,  and  even  from 
far-distant  foreign  shores.  Nor  is  this  welcome  a  merely 
formal  one;  it  is  heartfelt  and  true.  Not  only  for  myself, 
but  on  behalf  of  my  colleagues  of  the  Faculty,  do  I  welcome 
you,  as  kindly  and  as  earnestly  as  I  possibly  can,  to  the 

*  Introductory  Address  at  the  opening  of  the  Sixty-sixth  Annual  Ses- 
sion of  the  Jefferson  Medical  College.  Reprinted  from  the  Times  and 
Register,  October  18,  1890. 

Ill 


112  ADDRESSES   AND   OTHER   PAPERS. 

arduous  study  upon  which  some  of  you  are  about  to  enter; 
a  welcome,  quite  as  cordial,  I  also  extend  to  those  who  have 
already  trodden  the  thorny  path  of  the  first  or  second  year 
of  study,  and  who  have  now  a  better  capacity  to  appreciate 
what  they  learn,  and  a  better  appreciation  of  the  earnest 
efforts  that  will  be  made  by  every  teacher  of  the  school  from 
the  oldest  of  the  Faculty  to  the  latest  acquisition  among  the 
assistants  in  the  laboratories. 

The  welcome  thus  extended  is  saddened,  however,  by 
mournful  memories.  It  is  with  feelings  of  deep  respect  and 
admiration  that  I  refer,  as  is  proper,  to  the  teacher  whose 
honored  place  I  occupy,  whose  premature  and  unexpected 
death  robbed  the  Jefferson  College  of  one  of  its  brightest 
ornaments;  a  man  illustrious  by  his  name,  and  not  less 
honored  for  his  own  eminently  useful  scientific  achievements. 
The  warmth  of  admiration  and  affection  which  the  older 
students  among  you  bestowed  upon  the  late  Samuel  W. 
Gross  was  not  ill  bestowed,  but  was  well  deserved.  Pro- 
fessionally he  knew  but  one  thing — Surgery.  Even  from  his 
very  entrance  on  his  profession,  this  was  his  chosen  depart- 
ment, and  to  it  he  devoted  laborious  days  and  studious  nights. 
As  a  teacher  he  was  incisive,  progressive,  well  read,  versatile, 
and  accomplished.  He  was  no  uncertain  and  hesitating 
teacher,  but  gave  you,  in  his  own  clear-cut  and  positive  way, 
the  best  results  of  the  foremost  minds  of  the  profession,  both 
of  this  country  and  of  Europe.  Many  of  you  can  testify  to 
his  devotion  to  his  subject,  his  students,  and  his  Alma  Mater. 
He  sympathized  with  your  joys,  and  helped  you  over  the 
rough  places  with  the  utmost  gladness.  Few  schools  have 
had  two  such  ornaments  in  one  family  as  the  elder  and  the 
younger  Gross;  and  in  the  midst  of  all  the  pleasure  and  hilar- 
ity of  the  opening  of  the  session,  it  is  meet  and  proper  that 
we  should  pause  a  moment  to  lay  a  flower  on  the  bier  of  each. 

A  moment  ago  I  referred  to  the  time  when  I  myself  began 
the  study,  of  medicine.  You  can  scarcely  appreciate  what 


DEMANDS  OF  THE  NEW    ERA    IN   MEDICINE.  113 

the  study  of  medicine  then  meant,  as  compared  with  what 
it  means  to-day.  About  the  time  that  I  began,  the  custom 
had  just  ceased  for  each  member  of  the  Faculty  to  deliver 
an  Introductory  Lecture  to  his  course  each  year.  The  session 
began  on  the  second  Monday  in  October,  and  the  entire  first 
week  was  given  up  by  the  Faculty  to  the  daily  Introductories, 
and  by  the  students  to  more  or  less  of  revelry,  as  might 
become  both  their  consciences  and  their  purses.  In  the 
next  week  we  settled  down  to  greater  or  less  regularity  of 
life.  The  session  continued  until  the  end  of  February,  and 
not  a  few  men  of  the  first  year,  like  Charles  Lamb,  made  up 
for  coming  late  by  going  early.  Examination  over,  the  iron 
gate  that  used  to  guard  the  Tenth  Street  entrance  to  the 
College  swung  heavily  to,  and  was  not  opened  again  until 
the  next  October. 

There  were  no  laboratories.  Apart  from  the  seven  classical 
branches  there  was  absolutely  no  official  instruction.  No 
man  was  required  to  study  physical  diagnosis,  or  minor 
surgery,  or  chemistry,  or  the  microscope,  either  in  histology 
or  morbid  anatomy;  and  perhaps  not  a  score  of  men  in  any 
graduating  class  had  ever  seen  a  muscular-fibre  cell,  or  striped 
muscular  tissue,  or  a  nerve-cell,  or  a  nerve-tubule.  The 
fortunate  few  who,  in  the  offices  of  private  preceptors,  had 
a  chance  to  give  a  wondering  look  from  time  to  time  through 
a  microscope;  to  examine  the  urine  for  tube-casts,  or  for 
any  crystalline  element,  were  equally  small  in  number.  Nor 
were  there  more  who  were  ever  taught  to  test  the  urine  for 
albumin.  The  only  histological  reagents  were  acetic  acid  for 
clearing  up  a  specimen,  and  carmine  to  color  it,  and  the  hand- 
held razor  was  the  only  microtome.  There  was  no  laboratory 
of  physiology,  no  teaching  of  pathological  anatomy,  no  in- 
struction in  pharmacy.  Nor  could  any  man  properly  write 
his  first  prescription,  unless  he  had  been  privately  taught 
by  his  quiz  master  or  his  preceptor.  The  only  clinical  instruc- 
tion was  in  medicine  and  surgery,  neither  obstetrics,  gynaecol- 

8 


114  ADDRESSES   AND   OTHER   PAPERS. 

ogy,  nor  any  of  the  specialties  being  recognized.  Indeed,  a 
specialist  was  looked  at  askance  as  a  very  questionable  sort 
of  doctor. 

The  seven  months  intervening  between  February  and 
October  were  presumably  spent  with  one's  preceptor  at  home. 
How  much  each  student  would  learn  in  that  time  I  leave 
you  to  judge  as  leniently  as  possible.  During  the  spring  and 
fall,  however,  there  were  open  a  few  private  lectures  from 
voluntary  associations  of  teachers,  some  of  whom,  now  occu- 
pying honored  places,  I  see  about  me.  But  these  advantages 
were  limited  almost  exclusively  to  the  students  who  lived 
in  the  city.  The  examinations  were  easy,  and  for  the  disabled 
students  an  "omnibus"  was  prepared  to  carry  them  to,  if 
not  through,  the  perils  of  the  "  Green  room." 

Contrast  this  with  the  opportunities  that  you  have  to-day. 
Every  student  has  now  the  opportunity  to  become  versed 
in  bandaging,  the  application  of  fracture  dressings,  and  the 
performance  of  all  the  ordinary  surgical  operations  on  the 
cadaver.  All  of  you  will  have  had  some  practice  and  careful 
clinical  instruction  in  physical  diagnosis.  All  of  you  will 
have  attended  lectures  on  pathology  and  have  made  a  more 
or  less  careful  personal  study  of  both  normal  and  diseased 
structures  with  the  microscope.  All  of  you  will  have  passed 
through  the  laboratories  of  physiology,  of  materia  medica, 
of  experimental  therapeutics,  of  pharmacy,  of  chemistry, 
and  have  studied  especially  the  chemistry  of  the  urine  and 
other  secretions  and  excretions  of  the  body.  All  of  you  will 
have  had  careful  instruction  in  practical  obstetrics,  in  ob- 
stetrical examinations,  and  in  gynaecological  operations.  All 
of  you  will  also  have  had  instruction  in  diseases  of  the  eye, 
the  ear,  the  throat,  the  nose,  in  electricity,  toxicology,  ortho- 
paedics, diseases  of  the  skin,  diseases  of  children,  and  insanity, 
not  one  of  which  was  officially  taught  in  this  or  in  any  other 
medical  college  when  I  was  a  student. 

This  immense  change  smacks  almost  of  revolution.    But 


DEMANDS    OF  THE   NEW   ERA   IN   MEDICINE.  115 

there  is  need  of  a  new  and  fresh  overturning.  The  last  few 
years  have  seen  such  rapid  movement  and  progress  in  every 
department  of  medicine  that  we  stand  practically  in  a  "New 
Era  in  Medicine,"  and  the  new  era  makes  new  demands  both 
upon  medical  colleges  and  the  medical  profession  to  which, 
if  we  be  blind,  we  shall  be  derelict  in  our  duty,  both  to  our- 
selves and  the  public. 

Let  us  for  a  moment  take  a  bird's  eye  view  of  these  changes. 
First  of  all,  a  wholly  new  department  of  medical  science- 
Bacteriology — has  been  created.  Rejected  at  first  by  most, 
and  only  doubtfully  and  hesitatingly  believed  in  by  many, 
except  some  prophets  of  the  dawn  endowed  with  finer  vision 
than  the  rest,  it  has  achieved  within  the  last  ten  years  a 
positive  and  now  practically  unquestioned  place  in  medical 
science.  Its  revelation  of  the  causes  of  many  diseases  and 
its  explanation  of  their  phenomena  are  as  startling  as  they 
are  well  substantiated.  That  suppuration  and  erysipelas, 
tetanus  and  leprosy,  consumption  and  cholera  are  parasitic 
diseases  due  to  the  invasion  of  the  body  by  various  forms 
of  micro-organisms  is  a  discovery  of  the  first  importance,  and 
much  too  near  for  us  to  appreciate  as  yet  its  far-reaching 
influence.  Bacteriology  has  but  begun  its  infant  career.  It 
must  speedily  grow  into  one  of  the  most  weighty  of  the 
scientific  departments  of  medicine,  and  bids  fair  to  revolu- 
tionize our  practice  as  much  as  it  has  our  theories. 

The  old  Materia  Medica  and  Therapeutics  have  been  re- 
written within  the  last  few  years  in  the  Pharmacology  of 
the  present  day.  The  actual  daily  use  of  medicine  has  been 
marvelously  changed  of  late  by  experiments  made  to  discover 
the  real  physiological  and  therapeutical  action  of  remedies; 
their  effects  upon  the  heart,  the  arteries,  the  brain,  the 
respiration,  the  kidneys;  their  medicinal  and  their  toxic 
doses  and  effects;  and  from  these  facts  to  deduce  a  right  and 
rational  use  of  drugs.  Besides  this  the  extraordinary  num- 
ber of  new  drugs  and  the  numberless  new  methods  of  their 


116  ADDRESSES   AND   OTHER   PAPERS. 

administration,  the  present  scientific  use  of  massage  and  of 
electricity  in  its  various  forms,  the  increasing  use  of  Swedish 
movements,  of  heat,  of  cold,  of  mechanical  means  for  soothing 
and  stimulating  nerves  and  muscles,  and  for  spinal  extension 
are  all  additions  of  the  last  few  years. 

.Allied  to  this  there  is  virtually  a  "  New  Chemistry,"  not  only 
in  the  sense  in  which  the  term  is  used  by  Professor  Cook. 
Organic  chemistry,  by  its  analytical  methods,  has  given 
us  many  of  the  new  drugs  already  alluded  to,  and  by  its 
synthetical  combinations  has  even  produced  them  in  the 
laboratory  instead  of  waiting  for  Nature's  slow  distillation 
or  long  growth;  and,  by  its  substitution  compounds,  has 
given  us  different  series  of  remedies  of  immense  value,  all 
built  upon  a  single  base.* 

Chemistry  and  pharmacology,  with  physiological  physics, 
embryology,  and  experimental  physiology,  have  developed 
a  new  Physiology. 

Even  Anatomy,  a  field  of  stubble  scarce  worth  a  gleaner's 
searching  eye  as  was  supposed  by  many,  has  rewarded  the 
industrious  toiler  by  rich  and  full  sheaves.  Even  in  gross 
anatomy,  to  name  no  other,  the  mapping  of  the  convolutions 
of  the  brain,  and  determining  their  functions,  by  Ferrier, 
Horsley,  and  others;  the  study  of  surface  anatomy  in  its 
relations  to  the  interior,  by  Holden;  the  careful  study  of  the 
intestinal  canal  by  Treves,  have  been  of  immense  service: 
while  embryology  and  histology  and  comparative  anatomy 
have  reformed  a  large  part  of  the  science. 

These  scientific  departments  are  the  foundation  upon  which 
are  built  surgery,  medicine,  obstetrics,  and  gyna3cology,  the 
practical  departments  of  the  healing  art.  These,  too,  like 
Samson  of  old,  have  burst  the  withs  and  ropes  of  the  past 

*  If  any  one  doubt  the  existence  of  a  new-visaged  and  promising 
chemistry  and  pharmacology,  let  him  only  read  the  recent  lectures  of 
Dr.  Lauder  Brunton,  in  the  British  Medical  Journal,  On  the  Relation 
between  Chemical  Composition  and  Physiological  Action. 


DEMANDS   OF   THE   NEW    ERA    IX    MEDICINE.  117 

and  risen  up  in  renewed  strength,  and  have  gone  forth  con- 
quering and  to  conquer. 

In  Surgery  and  Gynaecology  the  effects  of  experiments 
upon  animals,  of  bacteriological  studies,  and  of  the  antiseptic 
method,  have  been  almost  past  belief.  The  mortality  of 
amputations  has  been  reduced  from  twenty-five  to  fifty  per 
cent,  down  to  from  four  per  cent,  to  zero,  and  compound 
fractures,  instead  of  yielding  a  holocaust  of  fifty  to  sixty  per 
cent.,  are  now,  if  rightly  treated,  scarcely  more  dangerous 
than  simple  fractures.  The  abdomen,  instead  of  being  for- 
bidden ground  like  the  lost  Eden,  with  the  peritoneum  for 
its  "  flaming  sword  which  turned  every  way  to  keep  the  way 
of  the  tree  of  life,"  might  almost  be  called  a  playground  in 
which  surgeons  disport  themselves  to  their  heart's  content, 
inventing  new  operations  as  children  invent  new  games;  not 
an  organ  contained  in  its  once  sacred  interior,  or  in  that  of 
the  pelvis,  is  free  from  attack,  and,  for  the  most  part,  happily, 
with  as  great  relief  to  the  patient  as  pride  to  the  surgeon. 
The  brain,  till  five  years  ago  the  most  dreaded  organ  in  the 
body,  is  now  not  only  freely  exposed  without  serious  danger, 
but  portions  of  it  excised,  abscesses  opened,  the  ventricles 
irrigated,  and  tumors  removed.  Bones  are  sawn  or  wired, 
joints  are  opened,  the  chest  is  invaded,  and  the  lungs  are 
resected.  These  and  other  operations  successfully  done  are 
witnesses  to  the  new  era  in  general  surgery  and  in  gynaecology, 
while  in  each  special  branch  of  surgery  the  same  could  be 
shown  to  be  true  had  I  only  the  time. 

In  Medicine  and  Obstetrics  the  same  progress  is  noted  in 
newer  and  better  treatment  of  many  of  the  ordinary  diseases 
and  the  usual  obstetrical  conditions.  The  diminution  of  the 
mortality  rates  is  simply  extraordinary;  and  often  the  new 
methods  of  treatment  are  as  simple  and  grateful  as  they  are 
successful.  To  name  but  one  department  of  each:  Our 
acquaintance  with  diseases  of  the  nervous  system  has  grown 
so  rapidly  that  a  text-book  of  thirty  years  ago  is  apt  to 


118  ADDRESSES   AND   OTHER   PAPERS. 

elbow  Galen  and  Avicenna  for  sympathy  in  its  neglect,  while 
the  mortality  of  the  puerperal  state  has  been  reduced  almost 
to  a  vanishing  point  by  the  introduction  of  antiseptics. 

Of  the  many  specialties  in  medicine  I  cannot  take  time 
to  speak,  save  to  note  the  fact  that  they  all  have  been  created 
or  remodeled  within  the  last  twenty  years. 

In  view  of  these  facts,  am  I  not  justified  in  calling  this 
"The  New  Era  in  Medicine"  ? 

It  will  be  the  duty,  the  privilege,  and  the  joy  of  the  teachers 
in  this  flourishing  and  progressive  school  of  medicine  to  give 
to  you  the  details  of  this  fascinating  medical  romance  in 
the  course  we  are  now  entering  upon,  and  I  envy  you  the 
privilege  of  engaging  in  this  study  thirty  years  later  than  I. 
I  have  not  used  the  word  "faculty,"  but  "teacher";  first, 
because  I  wish  to  recognize  and  I  wish  you  to  recognize 
the  worth  and  zeal  of  the  junior  teachers  associated  with  us, 
both  in  the  college  and  the  hospital ;  younger  men  who  freely 
give  of  their  time  to  aid  you,  and  largely  for  the  pure 
love  of  science.  The  best  and  highest  reward  that  ever 
comes  to  them,  as  to  us,  or  to  any  mortal,  is  the  inward  glow 
of  satisfaction  from  good  work  done  in  scientific  research, 
through  which  results  an  enlargement  of  the  domain  of  truth. 
"I  labor  less,"  said  Fresnel,  "to  catch  the  suffrages  of  the 
public  than  to  obtain  that  inward  approval  which  has  always 
been  the  sweetest  reward  of  my  efforts.  Without  doubt,  in 
moments  of  disgust  and  discouragement,  I  have  often  needed 
the  spur  of  vanity  or  emolument  to  excite  me  to  my  re- 
searches. But  all  the  compliments  I  have  ever  received  from 
Arago,  de  la  Place,  or  Biot  never  gave  me  such  large  pleasure 
as  the  discovery  of  a  theoretic  truth  or  the  confirmation  of 
a  calculation  by  experiment." 

The  word  "teacher"  also  designates  us  all  as  members  of 
one  of  the  noblest  guilds  in  the  world.  For  twenty-four 
years  I  have  also  myself  gloried  in  the  name  and  work  of 
a  teacher,  and  desire  no  better  title.  It  is  said  that  when 


DEMANDS    OF   THE    NEW    ERA    IN    MEDICINE.  119 

Agassiz's  will  was  opened  it  ignored  all  his  other  proud  titles 
and  began  majestically :  "I,  Louis  Agassiz,  teacher  ..." 

The  new  era  in  medicine  so  inadequately  described  now 
confronts  the  profession,  and  especially  you,  gentlemen,  who 
are  to  practice  it,  and  whose  lives  will  be  spent,  remember, 
among  the  glories  of  the  twentieth  century,  with  the  now 
undreamed  of  progress  of  that  happy  time.  It  confronts 
you  as  a  mighty  master,  with  uplifted  hand,  pointing  you 
upwards  and  onwards;  onwards  to  the  laborious,  but  great 
and  splendid,  work  awaiting  your  touch,  and  upwards  to 
the  prizes  for  the  foremost  and  worthiest.  But  it  makes  also 
its  demands — its  inexorable  demands — upon  you.  Satisfy 
them  you  must,  or  fail. 

Let  us  look  for  a  few  minutes  at  what  these  demands  upon 
the  profession  are. 

A  physician's  life  consists  of  three  periods :  his  preliminary 
education,  his  medical  college  course,  and  his  active  life  as 
a  practitioner.  These  may  be  called  the  Pre-collegiate,  the 
Collegiate,  and  the  Post-collegiate  periods,  and  I  purpose 
speaking  in  a  plain  and  practical  way  of  each. 

1.  The  Pre-collegiate  period,  or  that  of  preliminary  training. 

The  ideal  medical  college  would  perhaps  insist  that  this 
be  nothing  short  of  a  complete  liberal  education,  such  as  is 
given  in  our  American  colleges  and  universities.  It  is  an 
encouraging  feature  of  the  times  that  the  proportion  of  such 
college  graduates  now  in  our  medical  schools  is  steadily  on 
the  increase,  and  that  one  of  our  numerous  medical  societies 
is  composed  wholly  of  those  who  have  received  not  only  the 
degree  in  medicine,  but  that  in  arts  as  well.  Native  talent 
and  hard  work  will  always  tell,  but  such  talent  when  trained 
and  set  at  work  will  accomplish  vastly  more.  But  this  is  a 
world  of  imperfections  and  limitations  in  which  the  Utopia 
of  the  ideal-best  must  give  place  to  the  cold,  matter-of-fact 
attainable-best.  Desirable  as  it  might  be  that  all  of  the  pro- 
fession should  have  such  a  complete  preliminary  training, 


120  ADDRESSES   AND   OTHER   PAPERS. 

we  all  acknowledge  it  to  be  impossible,  at  least  at  present. 
But  such  a  preliminary  education  as  would  at  least  fit  a  man 
to  enter  the  freshman  class  at  our  ordinary  colleges  before 
many  years  pass  must  be,  in  my  opinion,  a  prerequisite  to 
the  study  of  so  wide,  so  progressive,  so  logical,  and  so  exacting 
a  science  as  medicine.  If  necessary  to  fit  a  man  to  study  the 
ordinary  college  branches,  it  would  seem  a  fortiori  to  be 
necessary  for  such  technical  study.  Even  this  we  cannot 
expect  at  once.  But  it  must  be  the  goal  toward  which  we 
must  strive.  I  congratulate  you  and  the  Jefferson  College 
most  heartily  on  the  inauguration  this  year  of  an  entrance 
examination — a  real,  though  a  moderate  one — a  beginning 
that  is  but  a  herald,  I  hope,  of  more  exacting  examinations 
in  the  future,  as  thus  we  grow  up  to  our  privileges  and  op- 
portunities. Moreover  I  must  not  forget  that  I  am  addressing 
those  who  have  concluded  this  first  period,  and  who  have 
already  entered,  or  are  about  to  enter,  upon  the  second. 
Those  of  you  who  have  had  a  complete  preliminary  training 
I  congratulate,  and  at  the  same  time  I  remind  you  that  more 
is  to  be  expected  and  exacted  from  you  than  from  others. 
Should  you  pride  yourselves  upon  the  privilege  and  relax 
your  efforts  in  the  least  degree,  remember  that  the  tortoise 
once  beat  the  hare,  and  can  do  it  again. 

To  those  of  you  that  have  not  had  such  a  preliminary 
training,  the  question  arises:  What  shall  you  do?  Recognize 
honestly  the  defect  and  go  to  work  manfully  to  make  up  for 
it  just  as  far  and  as  fast  as  you  can.  You  can  do  but  little 
of  this,  perhaps,  during  your  college  course.  In  the  winter 
you  will  have  no  time,  and  I  feel  chary  of  your  using  your 
summer  holidays  for  much  hard  work.  But  if  not  now,  then 
so  soon  as  you  graduate,  when  your  conspicuous  patients — 
conspicuous  by  reason  of  their  rarity — leave  you  plenty  of 
unasked-for  leisure,  then  you  must  begin  with  zeal  to  com- 
plete such  a  desirable  education.  But  more  of  this  hereafter. 

2.  The  collegiate  period,  or  that  spent  in  a  medical  college. 


DEMANDS   OF   THE    NEW    ERA   IX    MEDICINE.  121 

I  will  not  spend  time  in  a  repetition  of  the  trite  maxims 
inculcating  due  diligence,  hard  work,  regular  attendance, 
close  attention,  and  all  that.  You  were  once  boys  who 
needed  mental  and  possibly  even  corporal  flagellation.  But 
you  are  past  that  period,  and  are  now  young  men.  Not  that 
you  have  outgrown  the  need  for  these  virtues,  but  that  we 
take  it  for  granted  that  you  have  them  and  will  use  them. 
We  have  no  rules  and  no  roll  call  for  these  very  reasons. 
You  are  placed  upon  your  honor  to  do  your  very  "level  best." 
"Education,"  it  has  been  wittily  said,  "is  the  only  thing  in 
which  we  try  to  get  the  least  for  our  money."  It  is  for  you 
to  prove  the  falsity  of  the  saying. 

In  the  brief  time  you  will  spend  here  we  can  tell  you  but 
little  of  the  immense  array  of  facts  in  medicine.  You  will 
learn  much  it  is  true;  but  compared  with  what  you  do  not 
know,  what  you  will  know  when  you  graduate  will  be  as 
nothing.  The  chief  services  of  a  medical  college  are  twofold : 
First,  it  will  give  you  the  great  principles  that  underlie  each 
department,  with  the  main  facts  that  prove  them.  But 
secondly,  and  if  possible  even  more  important,  it  will  gives 
you  an  impetus  in  the  right  direction.  The  use  of  a  cannon 
is  to  compel  the  ball  to  follow  its  proper  path.  The  gun  is 
but  a  few  feet  long,  but  the  impetus  and  guidance  it  gives 
in  those  few  feet  are  unalterable.  The  huge  missile  follows 
its  determined  course  to  its  goal.  If  the  gun  is  aimed  low  its 
path  will  be  low  and  its  goal  will  be  near;  but  if  the  aim  be 
high  it  will  cover  miles  in  its  course  and  triumphantly  strike 
its  distant  target.  Enter  then  here  into  the  enthusiasm  of 
the  place  and  the  time.  Catch  the  scientific  spirit  pervading 
the  very  atmosphere  of  the  place.  Let  it  permeate  every 
fibre  of  your  mental  structure.  Let  it  be  your  meat  and 
drink,  your  very  life.  This  short  period  is  to  give  you  the 
"bent,"  "the  set,"  the  "curve"  of  your  whole  later  profes- 
sional life.  See  to  it  that  you  use  it  well. 

Remember,  however,  that  while  we  can  "teach,"  it  is 


122  ADDRESSES   AND   OTHER   PAPERS. 

you  that  must  "learn."  We  can  but  spread  the  rich  feast. 
It  is  you  who  must  eat  and  assimilate  it.  We  give  "instruc- 
tion"; you  must  transfer  it  into  an  "education,"  and  make 
it  an  abiding  possession.  "Pray,  Mr.  Opie,"  said  a  visitor 
to  the  artist,  "what  do  you  mix  your  colors  with?"  "With 
brains,  sir,"  was  the  brief,  but  pregnant,  answer. 

But  while  inculcating  all  this  diligence  and  enthusiasm  let 
me  caution  you  to  see  to  it  that  your  health  does  not  suffer: 
not  perhaps  from  too  much  work,  but  rather  from  unwise 
methods  of  work.  The  daily  bath  and  a  proper  amount  of 
exercise  will  go  far  to  counteract  the  bad  air  of  the  lecture- 
and  dissecting-rooms.  Get  to  bed  early;  then  you  know 
you  can  get  up  early,  which  you  all  so  much  long  for.  Study 
none  on  Sunday.  Being  medical  students  does  not  release 
you  from  the  moral  and  religious  duties  and  pleasures  of  the 
Sabbath — the  day  of  rest — here  any  more  than  at  home; 
and  a  complete  change  in  the  current  of  your  thoughts  is  no 
less  refreshing  than  it  is  physiological.  One  of  the  worst 
evils  of  our  present  system  of  education  is  cramming  for 
examination.  A  reasonable  review  of  bygone  lectures  is  wise 
and  useful,  but  cramming  is  quite  another  thing.  It  means 
that  you  have  been  lazy  and  derelict  during  the  winter,  and 
to  make  up  for  lost  time  you  ram  and  cram  your  heads  full 
of  a  mass  of  unassimilated  facts  to  dole  them  out  parrot-like 
to  the  too  inquisitive  professor.  I  cannot  better  present  its 
evils  than  by  quoting  from  that  wise  old  Grecian,  Epictetus, 
for  it  seems  to  be  a  very  hoary  vice:  "It  is,"  says  he,  "as 
if  sheep,  after  they  have  been  feeding,  should  present  their 
shepherds  with  the  very  grass  itself  which  they  had  cropped 
and  swallowed  to  show  how  much  they  had  eaten,  instead 
of  concocting  it  into  wool  and  milk."  Next  April,  remember, 
we  don't  want  the  "grass,"  but  the  "wool  and  milk." 

You  will  learn  the  use  of  many  new  and  valuable  instru- 
ments: The  microscope,  otoscope,  ophthalmoscope,  laryngo- 
scope, and  all  other  "scopes";  the  many  specula,  aural,  oral, 


DEMANDS   OF   THE   NEW   ERA   IN   MEDICINE.  123 

nasal,  vaginal,  rectal;  many  beautiful  and  useful  refinements 
in  chemical  reactions  and  in  pathological  appearances,  all 
useful  as  means  of  diagnosis.  You  must  master  them  all. 
They  are  the  tools  of  your  profession.  If  you  miss  learning 
their  use  now  you  may  never  again  have  the  chance.  In  the 
remote  West,  in  a  small  country  village  in  the  East,  or  else- 
where, you  will  sometimes  sorely  need  them,  when  you  will 
have  no  willing  professor  or  quiz  master  to  whom  you  may 
appeal.  They  will  help  you  in  a  multitude  of  cases,  and 
often  are  simply  indispensable. 

But  I  want  to  urge  you  to  do  one  thing  more :  to  combine 
with  all  of  our  nineteenth-century  inventions  eighteenth- 
century  shrewdness  of  observation  and  acute  cultivation  of 
the  normal,  unassisted  senses,  in  order  to  make  up  the  more 
perfect  doctors  of  the  twentieth  century.  If  you  have  not 
read  "Spare  Hours,"  by  the  lovable  and  accomplished  Dr. 
John  Brown,  of  Edinburgh,  the  author  of  "Rab  and  His 
Friends,"  that  most  charming  medical  story,  you  have  a 
treat  before  you.  Some  pages  are  more  succulent  than 
others,  but  there  is  not  a  sterile  patch  among  them.  In  the 
third  series  you  will  find  most  of  the  medical  papers,  and 
they  are  bracing  reading  for  a  doctor.  I  know  nowhere  a 
stronger  plea  for  this  very  education  of  the  senses  which  I 
wish  to  urge  upon  you.  As  there  were  heroes  before  Aga- 
memnon, so  eyes  and  ears  existed  before  oxygen  was  known 
or  Laennec  lived,  and  our  forefathers  had  sharp  eyes,  shrewdly 
hearing  ears,  and  delicate  fingers  that  had  to  take  the  place 
of  the  specula  and  the  scopes  of  our  day.  "Every  fellow," 
says  the  blind  but  knowing  master  of  wood-craft,  in  Dr.  .S. 
Weir  Mitchell's  last  story,  "every  fellow  ought  to  be  blind 
ten  years,  and  deaf  ten  more,  and  then  get  his  eyes  and  ears. 
He'd  know  a  heap,  I  tell  you  he  would." 

Medicine  is  not  a  deductive  science.  We  do  not  start 
from  a  priori  principles  and  reason  to  conclusions.  It  is 
intensely  inductive.  We  collect  our  facts,  the  more  the 


124  ADDRESSES   AXD   OTHER   PAPERS. 

better,  as  increasing  numbers  dimmish  the  ever-possible 
chances  of  error;  we  collate  them  in  orderly  sequence,  and 
gradually  rise  from  facts  to  principles.  Hence  if  our  facts 
are  badly  observed,  our  principles  are  sure  to  be  erroneous. 

I  am  persuaded  that  the  chief  source  of  errors  in  diagnosis 
is  not  want  of  knowledge,  but  careless  or  insufficient  exam- 
ination into  the  facts  of  the  disease.  I  have  seen  a  diagnosis 
of  rheumatism  of  the  knee-joint  in  a  case  in  which  lifting 
the  knee  two  inches  from  the  bed  instantly  showed  the 
crepitus  from  a  spontaneous  fracture  following  long-existing 
osteomyelitis.  I  have  been  called  to  a  case  of  haemorrhoids 
which  a  glance  and  a  touch  resolved  into  an  ischio-rectal 
abscess;  and  I  have  seen  days  of  uncertainty  and  groping 
for  a  diagnosis  cut  short  by  a  few  taps  over  the  back  of  the 
lungs  that  revealed  an  unsuspected  pneumonia.  Had  the 
leg  been  once  lifted,  the  perineum  inspected  and  touched, 
the  posterior  chest  examined — two  minutes  only,  but  two 
minutes  of  exactness — no  such  errors  would  have  occurred. 

The  eye  must  be  taught  to  take  in  much  for  which  no 
speculum  is  needful.  The  physiognomy  of  the  patient,  the 
modes  of  expression,  whether  facial  or  vocal,  spontaneously 
assumed  postures  of  the  body,  tremulous  or  steady  move- 
ments, the  color,  the  breathing  both  as  to  frequency  and 
character;  the  outlines  of  the  body,  normal  or  abnormal; 
the  exact  relations  of  parts;  all  these,  and  a  hundred  more, 
all  stand  with  their  cup  of  information  filled  to  the  brim  for 
him  who  will  drink.  The  ear  may  be  aided  by  the  stetho- 
scope, but  it  must  not  be  trammeled  by  it.  It  must  be 
trained  to  abnormal  alertness,  and  hear  every  sound,  from 
the  normal  loud  gurgling  of  the  intestines  to  the  faintest 
suggestion  of  it  while  using  taxis  in  a  hernia;  from  the  loud 
tubular  breathing  of  a  widespread  pneumonia,  to  the  judi- 
cious discrimination  of  the  relative  respiratory  murmur  in 
the  apices.  The  touch,  though  it  can  scarcely  be  educated 
up  to  the  standard  of  Laura  Bridgman,  can  give  you  the 


DEMANDS   OF   THE   NEW    ERA    IN    MEDICINE.  125 

needful  facts  as  to  hardness,  softness,  elasticity,  resistance, 
contour,  crepitus,  and  the  like,  if  you  will  but  use  it.  No 
instrument  can  replace  it.  Let  your  fingers  therefore  itch 
till  you  have  touched  and  felt  every  case  that  by  hook  or 
crook  you  can  lay  your  hands  on.  Smell  and  taste  are 
not  seldom  called  into  play,  arid  here  at  least  we  can  use  no 
artificial  helps.  Yet  they  are  sorely  neglected  with  all  the 
other  senses.  The  epicure  in  Juvenal's  day  could  distinguish 
between  an  oyster  from  the  Lucrine  Lake  or  from  Britain. 
We  could  do  as  much  were  we  to  cultivate  our  natural  powers 
as  well.  Cultivate  these  senses  largely  by  a  study  of  your 
own  body.  Hand  inexpertus  loquor.  The  hours  I  have  spent 
in  such  study  have  been  among  the  most  remunerative, 
not  only  in  the  facts  learned,  but  in  the  exact  methods 
acquired,  and  the  fine  filing  of  the  senses  to  a  cultivated 
acuteness. 

In  all  this  I  would  not  decry  the  use  of  the  modern  instru- 
ments of  precision.  Their  introduction  marks  the  beginning 
of  modern  science,  when  the  balance,  the  yardstick,  and 
the  pendulum  took  the  place  of  vague  guessing  at  weight, 
length,  and  time.  But,  back  of  all  our  medical  instruments, 
without  which  they  are  almost  worthless,  are  our  natural 
senses.  Fifty  instruments,  though  they  can  aid  the  five 
senses,  can  never  replace  them.  In  mountaineering,  the 
Alpenstock  is  invaluable  as  an  aid;  but  it  can  never  take 
the  place  of  a  stout  pair  of  legs. 

This  careful  development  of  the  senses  should  foster  a 
spirit  of  exactness  in  all  your  work;  in  the  use  of  instruments 
of  precision  as  well  as  of  the  senses  themselves.  Science,  is 
always  hostile  to  the  word  "about" — "about  three  inches 
long,"  "about  one  hundred  and  one  degrees,"  "about  ten 
days."  When  it  is  so  easy  to  use  the  measure,  the  ther- 
mometer, the  calendar,  why  say  "about"?  In  the  history 
of  a  case  as  derived  from  the  patient,  it  may  do  very  well; 
but  in  your  own  later  notes  it  should  never  appear.  One 


126  ADDRESSES   AND   OTHER   PAPERS. 

of  the  surprising  and  characteristic  differences  between  most 
of  the  laity — even  very  intelligent  men  and  women — and 
ourselves  is  their  inaccurate  observation  or  non-observation 
of  plain  facts.  This  is  due  solely  to  the  want  of  training  of 
their  natural  senses,  and  is  the  best  argument  I  can  give  you 
for  the  schooling  of  the  senses. 

I'  am  well  aware  that  during  your  collegiate  course  you 
will  have  only  moderate  opportunities  to  use  Nature's  gifts — 
in  my  day  we  had  none  at  all — and  that  most  that  I  have 
said  will  apply  rather  to  your  post-collegiate  course.  But 
the  accurate  scientific  habit  or  the  shiftless  unscientific  habit 
will  be  begun  and  largely  formed  here,  and  it  is  generally 
true  that  what  your  habits  are  when  you  graduate,  such  they 
will  be  until  Time  shall  administer  his  last  anodyne  and  you 
pass  into  your  long  sleep. 

Given  the  facts,  accurately  observed  and  carefully  noted, 
what  then?  Then  comes  the  highest  art  of  the  physician: 
the  reasoning  process  by  which  is  evolved  his  diagnosis,  upon 
which  depends  his  treatment.  He  must  take  one  plus  one 
and  make  them  into  two,  a  tertium  quid  wholly  distinct  from 
either  of  its  constituent  factors.  And  in  medicine  the  two 
ones  often  lie  far  apart.  They  must  be  correlated  not  only 
in  any  individual  case,  but  in  cases  years  asunder,  by  a 
mental  stereoscopic  vision,  the  possession  of  the  few,  the 
envy  of  the  many. 

This  logical  faculty  is  partly  inborn,  it  is  true,  and  varies 
in  natural  strength  as  much  as  the  natural  acuity  of  vision; 
but  it  is  also  amenable  in  an  immense  degree  to  cultivation. 
The  wider  your  knowledge,  the  better  your  reasoning  will  be. 
You  must  at  first  laboriously  toil  over  the  process,  as  does 
the  tyro  in  Euclid  over  every  equation  in  each  successive 
problem,  over  and  over  again.  But  when  these  steps  have 
become  as  A,  B,  C  to  him,  then  he  begins  to  leap,  and  finally, 
when  a  master  geometer,  his  "therefore"  clears  a  whole  book 
at  a  bound.  So  with  you,  the  halting  method  of  your  early 


DEMANDS   OF   THE    NEW    ERA    IN    MEDICINE.  127 

days,  if  carefully  purified  from  its  faults  and  strengthened 
by  constant  and  watchful  repetition,  will  at  length  give  way 
to  quick  perception;  the  correlated  facts  soon  become  as 
familiar  to  you  as  his  old  friends,  X,  Y,  and  Z,  are  to  the 
geometer,  and  with  a  mental  "therefore"  you,  as  quickly 
and  as  accurately,  leap  to  your  diagnosis,  and  thence  to  your 
treatment.  Painstaking  and  habitual  induction  slowly  give 
place  to  intuition.  To  the  laity  it  often  seems  so  easy  and 
takes  so  little  time  that  it  is  hardly  worth  paying  much  for. 
They  should  learn  that  it  is  like  the  ease  of  the  accomplished 
athlete,  the  swordsman,  the  equestrian.  As  in  a  plant,  the 
long  roots  are  hidden;  only  the  brilliant  flower  is  seen. 

Of  treatment,  the  last  and  most  important  point  of  all— 
the  "final  cause"  of  there  being  any  doctors  at  all — you  will 
hear  and  see  so  much  that  I  will  only  quote  Broussais:  "The 
real  physician  is  the  one  who  cures;  the  observation  that 
does  not  teach  the  art  of  healing  is  not  that  of  a  physician; 
it  is  that  of  a  'naturalist.'  '  And  I  add  my  commentary: 
"  The  observation  of  the  naturalist  must  precede,  as  it  ought 
to  lead  up  to,  the  art  of  the  physician." 

You  will  be  much  tempted  to  devote  yourself  to  one  or 
two  favorite  branches,  to  which  you  perhaps  think  you  will 
devote  yourself  later  as  specialists,  and  to  neglect  others. 
No  greater  mistake  could  be  made.  Few  men  follow  their 
early  selection  of  a  career.  Circumstances  compel  a  change. 
This  collegiate  part  of  your  course  stands  in  the  same  relation 
to  your  later  professional  life  that  a  common  school  education 
does  to  your  general  education. 

Everyone  must  know  the  three  R's  whatever  he  may  be, 
"farmer,  lawyer,  doctor,  chief."  So  every  doctor  must  know 
chemistry,  though  he  become  a  surgeon;  the  eye,  though  he 
practice  medicine;  the  microscope,  though  he  become  an 
obstetrician;  obstetrics,  though  he  turn  out  a  pathologist. 
Each  is  a  strand  in  the  stout  medical  rope,  and  without  it 
the  rest  would  be  weak  and  worthless.  You  must  "know 


128  ADDRESSES   AND   OTHER   PAPERS. 

something  about  everything,  and  everything  about  some- 
thing." Every  department  of  medicine  must  pay  tribute  to 
the  one  you  finally  select.  As  Iphicrates,  the  Athenian  gen- 
eral said,  when  asked  why  he  was  so  proud:  "Are  you  a 
soldier,  a  captain,  an  engineer,  a  spy,  a  pioneer,  a  sapper, 
a  miner?"  "No,"  said  Iphicrates,  "I  am  none  of  these,  but 
I  command  them  all." 

3.  The  Post-collegiate  period,  or  that  of  actual  practice. 

"Commencement"  is  not  inaptly  named,  for  it  is  the 
beginning  of  the  work  of  life.  I  was  not  idle  as  a  student, 
but  I  am  sure  that  I  have  labored  twice  as  hard  since  I  have 
had  my  coveted  sheepskin  as  I  ever  did  to  get  it.  "In 
nature,"  says  Emerson,  "nothing  is  ever  given  away.  Every- 
thing is  bought."  For  some  things  we  pay  dollars,  for  others, 
time;  for  others,  hard  labor.  Time  and  hard  labor  are  the 
sure  and  only  currency  of  the  realm  of  medicine.  These  alone 
bring  success.  And  by  "success"  I  do  not  mean  wealth, 
or  influence,  or  fame,  the  presidency  of  this  medical  society 
or  a  professorship  in  that  medical  college.  Success  is  a  rela- 
tive term ;  related  to  our  sphere  in  life  and  our  opportunities. 
There  is  a  dignity  in  mediocrity,  as  well  as  of  greatness.  The 
humble  country  doctor — like  the  Gideon  Gray  of  Scott's 
romance — if  he  has  kept  abreast  of  the  times  by  after-study, 
and  has  made  the  most  of  himself  and  his  opportunities,  has 
achieved  true  success.  Let  me  now  enumerate  some  of  the 
means  needful  to  this  end;  especially  needful  in  view  of  the 
demands  of  the  new  era. 

A  doctor  who  takes  no  medical  journal  is  like  the  business 
man  who  takes  no  newspaper.  Years  after  graduation  he 
stands  just  where  he  did  when  dubbed  an  M.D.,  barring  a 
certain  amount  of  rule-of-thumb  experience  he  may  have 
obtained.  He  is  like  a  mariner  who  would  stick  to  Fulton's 
antiquated  steamboat  instead  of  an  Atlantic  liner.  The 
medical  newspaper  stands  in  the  same  relation  to  medical 
books  that  the  daily  newspaper  does  to  works  on  history; 


DEMANDS   OF  THE   NEW   ERA   IN   MEDICINE.  129 

the  one  gives  us  the  current  events  and  thoughts  and  dis- 
coveries of  the  time,  sometimes  true,  sometimes  false;  the. 
other  consists  of  the  sedimentary  deposits,  gradually  harden- 
ing into  the  rock  of  well-ascertained  facts.  To  keep  up  with 
the  rapid  progress  of  medical  science  you  must,  therefore, 
first  of  all  take  as  many  medical  journals,  and  also  buy  as 
many  books  as  you  can  afford.  Make  a  note  of  every  paper 
of  importance  in  an  index  rerum,  or  better  by  a  card  cata- 
logue, such  as  is  used  in  all  our  libraries.  Skimp  your  table 
and  your  wardrobe  that  your  mind  may  be  fed  and  clothed. 
This  is  your  capital  in  trade. 

Carry  with  you  into  practice  the  habits  of  accuracy,  the 
healthy  use  of  your  senses  that  you  will  begin  here.  Accept 
all  the  helps  modern  science  has  given  and  the  many  others 
yet  to  be  added  to  them.  Study  each  case,  especially  your 
early  ones,  till  you  know  them  as  you  know  the  topography 
of  your  own  at  that  time  too  unfrequented  office.  One  case 
thoroughly  studied  will  do  more  to  enlarge  your  knowledge 
and  teach  you  methods  than  a  score  observed  in  a  careless, 
slovenly  manner.  Make  notes  of  every  case  you  have,  full 
notes  for  the  important  ones,  slight  for  the  trivial  ones. 
What  would  I  not  give  had  some  one  offered  me  and  had  I 
heeded  just  this  one  bit  of  advice!  Patients  soon  come  to 
the  man  who  is  interested  in  each  case,  studies  it  thoroughly, 
and,  therefore,  as  a  rule,  cures  it  surely  and  quickly. 

Now,  too,  will  come  the  time  when  you  can  remedy  any 
defects  of  early  education.  If  you  do  not  know  German 
and  French,  you  should  begin  to  acquire  at  least  a  reading 
knowledge  of  both,  within  a  week  after  you  have  your  diploma, 
possibly  even  before  you  get  an  office.  You  have  conquered 
a  new  realm  when  you  have  acquired  a  new  language.  No 
medical  man  at  the  present  day  can,  by  any  possibility,  afford 
to  be  ignorant  of  at  least  these  two.  If  he  is,  he  simply  must 
go  to  the  rear.  With  these  I  must  enter  a  plea  for  the  sturdy, 
sonorous  Latin,  and  if  possible  some  Greek.  Never  forget 


130  ADDRESSES   AND   OTHER   PAPERS. 

that  ours  is  happily  one  of  the  "Learned  Professions,"  and 
if  we  would  be  worthy  of  the  name,  some  little  classical,  as 
well  as  scientific,  learning  should  shed  a  halo  around  it.  Not 
only  are  they  needful  for  your  very  first  prescription,  and  for 
the  intelligent  appreciation  of  most  modern  scientific  terms, 
but  they  lead  to  the  highest  and  noblest  literature.  If  you 
have  once  tasted  of  the  honey  of  Hymettus  you  will  hardly 
be  satisfied  with  the  miserable  stuff  found  hi  many  of  the 
current  and  much-be-thumbed  books  of  the  day.  A  litera- 
ture that  has  dominated  the  world  for  over  twenty  centuries 
has  a  right  to  claim  some  of  your  time. 

Do  not  shelter  yourselves  behind  the  incessant  work  and 
endless  drives  of  a  "country  doctor."  I  fear  that  many  of 
our  country  doctors  waste  enough  time  in  gossip  and  profitless 
discussions  of  the  crops  and  politics,  and  what  not  besides, 
to  make  them  excellent  Latin  scholars  at  least.  Even  the 
long  drives  alone,  if  rightly  used,  would  suffice  to  add  one 
or  two  languages  to  their  literary  furnishing.  One  of  the 
most  remarkable  medical  pictures  of  the  time  is  that  given 
by  Dr.  John  Brown,  of  Dr.  Adams,  of  Banchory,  a  "  country 
doctor"  in  a  secluded  Scotch  village,  with  constant  hard 
work  on  horseback,  amid  bleak  hills  and  valleys  for  twenty 
miles  around.  Without  ever  neglecting  his  work  he  became 
one  of  the  most  accomplished  linguists  of  his  day,  and  at 
breakfast  was  fond  of  amusing  himself  by  translating  an  ode 
of  Horace  into  Greek  verse. 

A  happy  distinction  has  been  made  between  the  "Litera- 
ture of  Knowledge"  and  the  "Literature  of  Power."  Our 
science  brings  us  so  constantly  into  contact  with  the  first 
that  we  are  apt  to  neglect  the  second.  Much  of  the  literature 
of  power  you  will  find  in  Homer  and  Demosthenes,  in  Horace 
and  Cicero,  in  Moli£re  and  Goethe;  but  for  a  wide  acquain- 
tance with  it  you  must  naturally  look  to  our  mother-tongue — 
and,  happily,  you  do  not  look  in  vain.  Chaucer  and  Shake- 
speare, Milton  and  Macaulay,  Tennyson  and  Thackeray,  Whit- 


DEMANDS   OF   THE   NEW    ERA    IN   MEDICINE.  131 

tier  and  Longfellow,  Webster  and  Irving,  and  the  genial 
Oliver  Wendell  Holmes — one  whom  our  own  guild  ever 
delights  to  honor — these  will  conduct  you  into  the  higher 
realms  of  thought,  where  you  may  soar  undisturbed  by  care. 
"Some  books/'  says  Bacon,  "are  to  be  tasted,  others  to  be 
swallowed,  some  few  to  be  chewed  and  digested."  Read  the 
books  that  are  to  be  eaten  and  assimilated. 

I  urge  this  literary  culture  partly  because  it  will  afford 
endless  delight  and  broaden  and  inform  the  mind.  In  later 
life,  when  you  have  lost  some  of  the  fine  enthusiasm  of  youth; 
when  the  years  come  that  bring  the  philosophic  mind,  famil- 
iarity with  such  a  literature  will  be  a  never-failing  resource, 
for  it  never  loses  its  charm.  But  I  especially  urge  it  because 
the  new  era  in  science  demands  that  you  be  ready  to  report 
your  cases,  relate  your  discoveries,  and  discuss  them  before 
an  intelligent  public.  To  do  this  so  that  you  will  command 
a  hearing,  a  good  English  style  is  indispensable.  Few  scien- 
tific men  speak  or  write  effectively.  They  are  apt  to  be 
illogical  in  then-  methods,  wanting  in  force  in  their  arguments, 
discursive  and  inelegant  in  their  style.  If  you  will  make  the 
literature  of  power  your  companion,  and  then  will  write  and 
then  prune  mercilessly,  you  will  soon  acquire  such  a  command 
of  English  as  will  serve  you  many  a  good  turn.  The  secret 
of  Huxley's  and  of  Tyndall's  influence  lies  as  much  in  their 
forceful  and  elegant  English  as  in  their  scientific  acquisitions. 

Besides  all  these  scientific  and  literary  demands,  I  cannot 
pass  by  those  personal  qualities  that  the  age  requires  of  every 
gentleman.  Cultivate,  therefore,  neatness  of  apparel,  a 
courtesy  that  is  so  apparent  that  it  is  extended  to  the  hum- 
blest patient  in  as  large  measure  as  to  the  rich  and  influential. 
Appreciate  that  yours  is  not  a  trade  in  which  to  make  the 
most  money  in  the  least  time,  but  a  generous  profession,  by 
which,  it  is  true,  you  make  a  living,  but  also  do  far  more. 
You  give  what  money  cannot  pay  for,  and  for  which  you 
will  often  never  even  ask  for  any  sordid  quid  pro  quo.  Devo- 


132  ADDRESSES   AND   OTHER   PAPERS. 

tion  to  duty  to  the  neglect  of  self,  sympathy  and  succor  in 
the  hours  of  sorrow,  cheerfulness  that  vanquishes  despair, 
and  skill  that  baffles  even  death  itself,  these  are  not  to  be 
paid  for  by  money,  but  by  speaking  eyes,  grateful  hearts, 
and  well-cemented,  lifelong  friendship  and  devotion. 

Above  all,  cultivate  that  good  old  virtue,  "  common  sense." 
It  lies  back  of  all  your  science.  It  is  the  bed  rock  on  which 
all  success  is  based. 

Of  your  moral  and  religious  duties  I  may  add  only  a  word. 
Medicine  has  to  do  with  much  more  than  the  mere  healing 
of  human  infirmities  and  disease.  Its  investigations  carry 
you  far  beyond  the  animal  kingdom,  away  down  to  the  lowest 
vegetable  organisms,  which  bacteriology  has  shown  to  be 
such  important  factors  in  disease;  its  practice  has  to  do  with 
the  health  and  highest  happiness  of  vast  communities,  as 
well  as  the  welfare  of  each  individual,  with  all  his  various 
ties  and  relations,  in  our  complex  social  life;  and  its  specula- 
tions carry  you  far  above  and  beyond  the  hour  of  death. 
We  assist  at  the  beginning  of  the  earthly  life  in  its  frail 
cradle;  we  see  its  very  close  when  we  watch  the  last  respira- 
tion and  feel  the  last  pulse-beat.  That  this  is  not  the  "be-all 
and  the  end-all"  of  a  human  soul,  both  Holy  Writ  and  our 
own  inner  conviction  imperiously  assert.  If  we  could  but 
discern  it,  we  have  really  assisted  at  the  beginning  of  a 
second  and  the  greater  life — the  Eternal  Life.  Mindful,  then, 
of  our  high  calling,  we  should  be  thoughtful  and  religious 
men,  ever  asking  for  the  Divine  help  in  our  daily  round  of 
duties. 

When  I  began  writing  I  had  intended  to  speak  at  length 
also  of  the  demand  of  the  new  era  in  medicine  upon  our 
medical  colleges.  Time,  however,  will  only  allow  of  a  brief, 
but  most  important  allusion  to  it.  To  this  demand  the 
colleges  are  slowly  responding.  But  the  change  should  be 
more  general,  more  rapid,  and  more  radical. 

It  is  one  of  the  most  healthful  signs  of  the  times  that  it 


DEMANDS    OF   THE    NEW    ERA    IN    MEDICINE.  133 

is  in  the  larger  and  more  advanced  schools,  the  very  ones 
that  are  best  equipped  as  to  men,  money,  buildings,  and 
laboratories,  that  there  exists  the  greatest  unrest  and  dis- 
satisfaction with  present  achievements,  and  the  chief  reach- 
ing forward  to  better  and  larger  things.  Among  these 
stands  the  Jefferson  Medical  College.  While  conservative, 
she  is  progressive;  " Nulla  vestigia  retrorsum"  is  her  motto. 
That  she  is  alive  to  the  need  of  progress  and  has  met  it  in 
the  past,  the  contrast  I  have  described  between  my  own 
student  life  and  yours  gives  ample  proof.  That  the  new 
era  in  medicine  demands  still  more  she  recognizes,  and,  as 
you  will  have  seen  by  the  announcement,  she  again  meets 
the  demand.  To  your  joy  no  less  than  to  mine,  for  the 
student-mind  is  ever  alert  to  notice  signs  of  progress,  this 
year  we  inaugurate  a  full  and  required  three  years'  graded 
course.  Time  was  when  the  comparatively  narrow  field  could 
be  reaped  in  two  combined  hearty  attacks.  Even  then  it 
was  hard  work;  but  now  it  has  become  simply  impossible. 
The  profession  and  this  college  alike  recognize  it,  and  ac- 
cordingly we  provide  for  it.  If,  with  increasing  branches  of 
science,  and  increased  demand  for  a  deeper  as  well  as  a  wider 
knowledge,  a  reasonable  experience  shall,  as  I  believe  it  will, 
conclusively  show  that  more  is  needed,  I  am  persuaded  that 
the  Jefferson  College  will  recognize  that  need,  and  provide 
for  it  in  due  time.* 

In  connection  with  this  progressive  step,  I  am  glad  to  be 
able  to  announce  to  you  that,  during  my  late  visit  abroad, 
I  had  an  interview  with  Mr.  Hallett,  the  courteous  and  in- 
telligent Secretary  of  the  Conjoint  Board  of  Examination 
of  the  Royal  College  of  Physicians  of  London  and  the  Royal 
College  of  Surgeons  of  England,  and  that  these  two  colleges 
have  accorded  to  the  diploma  of  the  Jefferson  Medical  College 

*  The  three  years'  graded  course  was  quickly  followed  by  the  estab- 
lishment of  the  four  years'  graded  course. — (W.  W.  K.,  1905.) 


134  ADDRESSES   AND   OTHER   PAPERS. 

precisely  the  same  rights  and  privileges  that  are  accorded 
to  the  diploma  of  the  universities  of  Paris,  Berlin,  Bologna, 
and  all  the  best  foreign  schools. 

As  an  earnest  of  the  progressive  disposition  of  this  college, 
I  have  also  the  honor  of  making  to  you  another  announce- 
ment. Within  a  short  time,  the  wise  forethought  of  the 
Board  of  Trustees  has  been  well  shown  in  the  purchase  of  a 
lot  eighty-two  feet  in  front  on  Walnut  street,  south  of  the 
hospital,  upon  which  a  new  and  commodious  college  building 
will  be  erected,  an  ornament  to  the  city,  and  a  more  active 
center  of  scientific  life.  Nor  will  the  old  and  battered  college 
building  be  given  up  to  baser  uses.  Hallowed  by  the  memo- 
ries of  McClellan,  Dickson,  Mutter,  Bache,  Pancoast,  Dungli- 
son,  Gross,  and  scores  and  hundreds,  yea,  even  thousands, 
of  earnest  teachers  and  pupils,  and  remodelled,  it  will  take 
a  new  lease  of  useful  life  by  gathering  under  its  hospitable 
roof  the  many  well  equipped  laboratories  of  the  college,  all 
of  them  the.  product  of  the  last  twenty-five  years.  This  is 
happy  news,  especially  to  the  workers  in  the  ill-equipped, 
insufficient  quarters  of  the  past,  which  yet  have  been  the 
scenes  of  persistent,  patient,  and  most  useful  scientific  work. 

But  to  erect  a  new  college  building  and  alter  another,  and 
equip  the  laboratories,  will  take  money,  and  a  deal  of  money. 
For  this  we  must  appeal  largely  to  the  generous  sympathies 
of  a  community  long  noted  for  its  intelligent  benevolence. 
Yet  it  is  an  odd  fact,  to  which  I  call  especial  attention,  that, 
while  to  academies,  colleges,  seminaries,  and  other  institu- 
tions of  learning,  millions  have  been  given,  and  to  hospitals 
scores  of  millions,  yet,  to  fit  the  men  who  are  to  serve  these 
very  hospitals,  to  educate  the  doctors  who  are  to  have  the 
health  and  lives  of  the  whole  community  in  their  care,  nothing 
has  ever  been  given  until  of  late.  At  last  we  are  awakening 
to  the  fact  that  good  doctors  are  as  important  as  good  teachers 
and  preachers,  and  that  physical  health  is  no  less  important 


DEMANDS   OF  THE   NEW   ERA   IN   MEDICINE.  135 

than  mental  development.  To  erect  suitable  buildings  for 
an  important  medical  school,  and  to  equip  and  endow  its 
laboratories  and  museum,  is  as  much  a  work  of  philanthropy, 
and  brings  back  ultimately  to  the  community  as  large  a 
return  as  similar  gifts  to  academic  institutions  or  to  hospitals. 
We  have  already  hospitals  and  dispensaries,  and  asylums 
and  homes  in  excess  of  the  needs  of  the  community.  What 
is  needed  now  is  the  strengthening  and  development  of  the 
medical  schools  which  educate  the  men  who  make  the  hospitals 
useful;  the  endowment  of  laboratories  hi  which  original 
research  will  continue  for  all  time;  researches  which  will 
repay  for  their  outlay  a  thousandfold;  and  the  establishment 
of  scholarships  and  fellowships,  to  enable  young  men  whose 
devotion  to  a  scientific  career  is  hindered  and  often  blighted 
for  want  of  reasonable  pecuniary  help.  For  these  innovations 
and  encouragements  we  now  ask  money,  and  the  indications 
are  that  the  community  is  alive  to  the  need  for  them.  The 
recent  endowment  of  the  Chair  of  Surgery  in  the  University 
of  Pennsylvania,  the  erection  of  the  new  buildings  at  Harvard, 
the  establishment  of  the  Carnegie,  the  Loomis,  and  the  Hoag- 
land  laboratories,  and  especially  the  magnificent  gifts  of  the 
Vanderbilt  family  in  New  York,  and  of  Johns  Hopkins  at 
Baltimore — all  these  are  encouraging  signs. 

The  Jefferson  now  boldly  proclaims  its  work,  and  asks  for 
similar  help.  The  new  era  in  medicine  compels  us  to  enlarge 
our  facilities,  and  this  wider  and  better  instruction  will  benefit 
the  public  at  large.  To  them  we  appeal  confidently,  knowing 
that  they  will  not  disregard  an  appeal  founded  alike  in  justice, 
mercy,  and  charity. 

And  the  reasons  urging  on  this  college  to  these  large  and 
wise  advances  apply  equally  to  the  other  medical  schools,  and 
to  the  profession  at  large.  The  demands  of  the  new  era  in 
medicine  will  only  be  complied  with  when  the  medical  col- 
leges give  all  the  necessary  facilities  in  equipment  and  in 


136  ADDRESSES   AND    OTHER    PAPERS. 

time,  to  study  thoroughly  every  branch  of  medicine,  and  the 
student  conies  to  the  college  with  a  suitable  preliminary 
education,  avails  himself  during  his  college  course  of  the 
ample  means  provided  there,  and  after  graduation  grows  into 
the  cultured  and  experienced  doctor  by  the  means  and  methods 
I  have  pointed  out. 


THE  REAL  REWARDS  OF  MEDICINE.* 


GENTLEMEN  OF  THE  GRADUATING  CLASS  : 

THE  revolving  cycle  of  the  passing  years  makes  it  to-day 
my  pleasing  duty  to  say  a  parting  word  of  advice,  of  cau- 
tion, and  of  cheer  to  you.  And  first  let  me  say  the  word  of 
cheer;  not  only  because  it  is  the  pleasantest  to  be  spoken,  but 
because  in  your  earlier  years  of  practice  you  will  need  it  far 
more  than  any  other  word  I  could  speak  to  you.  I  am  sure 
that  the  public  do  not  understand,  nor  do  they  appreciate,  not 
only  the  many  years  of  study  before  a  young  doctor  can  even 
begin  to  be  self-supporting,  but  the  many  years  of  discourage- 
ment, with  an  empty  purse  and  accumulating  bills,  which 
beset  his  early  professional  life.  Should  he  desire  to  enter 
upon  the  profession  thoroughly  equipped,  it  means,  first,  the 
years  of  preparation  in  the  common  schools,  from  seven  to 
eighteen;  then  four  years  in  college;  then  four  years  of 
study  in  the  Medical  School;  then  at  least  a  year  in  a  Hos- 
pital, and,  if  possible,  a  year  or  two  abroad.  In  other 
words,  twenty-one  years  of  study  are  practically  what  is  re- 
quired completely  to  fit  a  man  even  to  begin  to  earn  his 
living  by  the  practice  of  medicine  in  any  of  its  branches. 
And  in  his  earlier  years  the  doctor  is  paid  in  many  cases 
far  less  than  the  pittance  which  is  bestowed  even  on 
the  humble  day  laborer.  I  remember  very  well  one  of  the 
brightest  young  men  in  the  profession,  who  had  all  the  ad- 
vantages I  have  just  described,  and  who,  some  time  after 

*  The  Valedictory  Address  delivered  at  the  Commencement  of  the 
Jefferson  Medical  College,  May  2,  1893.  Reprinted  from  the  College  and 
Clinical  Record,  May,  1893. 

137 


138  ADDRESSES   AND   OTHER   PAPERS. 

having  "hung  out  his  shingle,"  came  to  me  greatly  discouraged 
and  said,  "I  think  I  shall  have  to  give  up  the  practice  of 
medicine."  "Why  so,  Doctor?"  said  I  in  surprise,  knowing 
his  ability  and  future  promise.  "Because,"  said  he,  "I  do 
not  think  I  can  earn  enough  to  support  myself  and  my  wife" 
(for  he  was  already  married),  "and  I  do  not  wish  to  be 
dependent  all  my  life  on  my  father."  "  How  much  have  you 
earned  by  your  practice  since  your  graduation?"  I  asked. 
He  replied,  "It  is  now  seven  months  since  I  opened  my 
office,  and  I  have  received  exactly  $2.50."  In  other  words, 
in  210  days  he  had  received  a  little  more  than  one  cent  a 
day!  And  in  my  own  personal  experience,  when  I  had  been 
in  practice  for  five  years,  in  the  month  of  June,  I  paid  and 
received,  all  told,  seven  visits,  of  which  three  were  charity 
visits,  two  patients  ran  away  and  paid  me  nothing,  and  two 
paid  me  $1.00  each. 

Many  years  ago  I  was  returning  in  the  street  cars,  at  six 
o'clock  in  the  morning,  from  St.  Mary's  Hospital,  where  I 
had  spent  the  entire  night  in  attending  to  the  victims  of  a 
terrible  fire  in  a  mill,  and,  seeing  my  case  of  instruments,  a 
laborer,  evidently  an  intelligent  man,  just  starting  for  his 
summer  day's  work,  accosted  me  and  wanted  to  know  where 
I  had  been.  Upon  my  telling  him  what  I  had  been  doing, 
he  said  to  me:  "I  suppose  you'll  get  a  right  good  salary  for 
working  all  night  and  doing  a  lot  of  operations";  and  he 
was  completely  dumbfounded  when  he  learned  that  not  only 
had  I  gone  to  the  hospital  at  my  own  expense,  but  had  served 
the  institution  for  years  without  charge,  and  that  every 
hospital  surgeon,  hospital  physician,  and  hospital  resident 
in  the  city  gave  his  labor  and  the  best  work  of  his  life  for 
years  entirely  free  of  charge  to  the  patients  under  his  care. 

Yet  time  brings  its  rewards,  and  you  will  find  if  you  do 
good  work  that  your  friends  and  neighbors  will  after  a  tune 
surely  recognize  your  merit.  If  you  have  genius  you  may 
gain  a  fortune;  but  even  mediocrity  is  sure  of  a  competence 


THE  REAL  REWARDS   OF  MEDICINE.  139 

if  you  are  faithful  and  honest  in  your  work.  No  man  need 
ever  despair  of  making  at  least  a  decent  living  by  the  practice 
of  medicine. 

But  pecuniary  rewards  are  not  the  best  that  you  will  get, 
if  you  cultivate  everything  that  ennobles  the  profession  and 
discourage  all  that  tends  to  make  it  merely  a  trade  by  which 
to  make  money.  What,  then,  are  the  real  rewards  which 
the  profession  of  medicine  holds  out  to  you?  They  may  be 
sketched  somewhat  in  the  following  manner. 

First,  you  will  enjoy  a  sense  of  daily  duty  faithfully  per- 
formed. This  fills  a  noble  heart  with  a  glow  far  beyond 
the  satisfaction  of  an  expanding  balance  in  bank  or  a 
growing  hoard  of  stocks  and  bonds. 

"Count  that  day  lost  whose  low  descending  sun 
Views  from  thy  hand  no  noble  action  done. " 

If  you  do,  you  may  be  sure  that  no  day  will  be  lost,  but  that 
each  will  be  counted  among  your  gains.  Duty  is  often  irk- 
some drudgery;  but  put  your  heart  into  it  and  the  lowest  drud- 
gery becomes  the  highest  service  and  will  not  fail  of  its 
reward.  As  quaint  old  George  Herbert  says : 

"A  servant  with  this  clause 
Makes  drudgery  divine; 
Who  sweeps  a  room  as  for  Thy  laws 
Makes  that  and  the  action  fine." 

Life,  for  the  most  part,  is  a  matter  of  trivial  details.  The 
growth  of  character,  like  all  other  growth  in  nature,  is  the 
result  of  the  steady,  multiplied  activity  of  many  small  parts. 
The  giant  oak  which  resists  the  stoutest  storm  does  so  because 
in  the  many  days  of  soft  rain  and  bright  sunshine  its  roots 
were  slowly  spreading  far  and  wide  in  the  fertile  soil  by  the 
growth  of  cell  upon  cell  and  fibre  after  fibre,  its  strength 
being  tested  and  confirmed  by  summer  breezes  and  occa- 


140  ADDRESSES   AND   OTHER   PAPERS. 

sional  wintry  winds,  and  at  last  when  the  storm  conies  in 
its  fury  the  mighty  tree  has  so  faithfully  done  its  duty  in 
its  minute,  but  constant,  growth,  that  it  stands  unmoved 
and  unassailable.  So  the  small  daily  duties  of  life,  if  faith- 
fully performed,  will  gradually  develop  your  character  and 
fix  your  principles  so  firmly  that  the  storm  of  temptation, 
however  violent,  cannot  bend  or  swerve  you  from  the  path 
of  duty. 

This  daily  duty  may  lead  you  into  danger,  which  you  must 
face  with  the  coolness  and  courage  of  the  soldier  on  the  field 
of  battle.  True,  for  the  soldier  of  science  and  of  duty  there 
is  no  blare  of  trumpets,  no  beating  of  drums,  no  shouts  of 
the  combatants,  no  public  honors,  no  laurel  wreath,  for  the 
young  physician  is  in  the  lowly  home  of  poverty,  battling 
with  the  angel  of  death,  exposed  to  the  poison  of  diphtheria, 
of  yellow  fever,  of  cholera,  or  of  typhus,  and  may  himself 
fall  in  the  encounter,  a  victim  to  his  brave  sense  of  duty  to 
his  patient;  and  the  surgeon  in  the  hospital  exposes  himself 
daily  to  the  dangers  of  blood-poisoning,  dangers  which  I 
have  seen  in  more  than  one  case  cut  short  a  life  of  promise 
and  hide  it  in  the  grave.  But  he  lives  in  grateful  hearts, 
unknown  though  he  may  be  to  the  pages  of  history,  or  even 
beyond  a  small  circle  of  equally  obscure  friends.  But  their 
prayers  and  cries  are  heard  of  the  good  God,  and  the  Recording 
Angel  will  enter  every  such  unselfish  deed  in  God's  Book  of 
Remembrances. 

"  They  have  no  place  in  storied  page, 

No  rest  in  marble  shrine; 
They  are  past  and  gone  with  a  vanished  age, 

They  died  and  'made  no  sign.' 
But  work  that  shall  find  its  wages  yet, 
And  deeds  that  their  God  did  not  forget, 

Done  for  their  love  divine — 
These  were  the  mourners,  and  these  shall  be 
The  crowns  of  their  immortality. 


THE   REAL   REWARDS   OF   MEDICINE.  141 

"O!  seek  them  not  where  sleep  the  dead, 

Ye  shall  not  find  their  trace: 
No  graven  stone  is  at  their  head, 

No  green  grass  hides  their  face; 
But  sad  and  unseen  is  their  silent  grave — 
It  may  be  the  sand  or  the  deep  sea  wave, 

Or  a  lonely  desert  place; 

For  they  need  no  prayers  and  no  mourning  bell — 
They  were  tombed  in  true  hearts  that  knew  them  well." 

No  other  calling  has  ever  had  such  a  multitude  of  brave, 
unselfish,  unknown,  silent  martyrs,  who  have  freely  risked 
all  that  is  dearest  and  best,  even  to  life  itself,  as  our  own 
Profession.  Their  lives  have  not  been  lost,  for,  as  Ruskin 
has  well  said,  "Every  noble  life  leaves  the  fibre  of  it  inter- 
woven forever  in  the  work  of  the  world." 

Not  only  will  you  have  this  sense  of  daily  duty  well 
done,  but  if  you  use  your  time  well  there  will  be  a  daily 
personal  growth  in  knowledge.  To  this  end,  study  after 
you  have  graduated,  as  you  have  never  done  in  your  so-called 
"student  life."  Make  even  your  failures  a  fertile  soil  for  a 
larger  growth  and  better  achievement,  for 

"  The  tree 

Sucks  kindlier  nurture  from  a  soil  enriched 
By  its  own  fallen  leaves ;  and  man  is  made, 
In  heart  and  spirit,  from  deciduous  hopes 
And  things  that  seem  to  perish." 

You  will  have  earned  each  day  a  certain  modicum  of  money, 
but  you  will  also  have  added  to  the  store  of  knowledge  in 
your  mind,  to  be  of  use  to  your  future  patients;  so  that  your 
gains  cannot  be  measured  merely  in  dollars  and  cents,  but 
in  wider  knowledge,  in  pregnant  ideas,  in  mental  growth,  in 
better  judgment,  in  a  better  balanced  mind,  and  in  masterful 
ability  to  cope  with  dangers  by  reason  of  such  larger  knowl- 
edge. 

More  than  this;  you  promote  the  general  welfare  and  add 


142  ADDRESSES   AND   OTHER   PAPERS. 

to  the  prosperity  of  the  community  in  which  you  live,  by 
directly  diminishing  the  loss  of  time  and  money  to  the  wage- 
earners  of  the  community.  You  restore  the  sick  mother  to 
the  charge  of  her  household,  the  disabled  father  to  his  family 
— nay,  in  not  a  few  cases  you  save  life  itself.  And  how 
much  a  single  life  may  mean  to  a  man's  wife,  his  children, 
his  business,  his  church,  his  community,  his  nation!  Even 
if  you  cannot  save  We,  you  lessen  suffering  and  bring  cheer 
into  the  sick-room,  and  you  smooth  the  pillow  of  death  itself. 

In  Preventive  Medicine  you  can  do  still  more,  and  on  a 
far  larger  scale,  by  educating  the  community  as  to  personal 
and  municipal  health,  by  pointing  out  the  evils  of  dirt,  of 
filthy  streets,  of  foul  sewers,  of  impure  water,  of  tuberculous 
meat  and  milk,  of  crowded  tenements,  of  unwise  clothing, 
of  want  of  exercise,  of  want  of  the  daily  bath,  of  errors  of 
food  and  drink,  of  vile  habits,  and  a  host  of  other  enemies 
to  human  health  and  happiness.  This,  believe  me,  is  to  be 
the  greatest  function,  the  most  splendid  achievement  of  the 
coming  years. 

And,  lastly,  hi  this  brief  sketch  which  I  am  giving  you, 
you  should  do  one  thing  more.  Remember  that  science  looks 
to  you  for  enlargement  of  its  boundaries,  by  conquests  in  the 
domain  of  ignorance.  I  envy  you  your  position  on  the 
threshold  of  the  glorious  twentieth  century.  The  passing 
century  has  seen  great  victories,  but  the  next  one  will  see 
far  more.  Our  profession  is  not  complete,  "  totus,  teres,  atque 
rotundiis,"  but  I  believe  it  has,  as  it  were,  just  begun  its 
beneficent  career.  The  discovery  of  Anaesthetics  and  of 
Antisepsis,  and  the  creation  of  the  science  of  Bacteriology 
have  been  the  three  great  triumphs  in  medicine  of  the  nine- 
teenth century.  You  enter  upon  this  great  heritage,  freely 
bequeathed  to  you  by  your  predecessors,  you  begin  where 
they  left  off.  With  such  advantages  you  should  make  still 
greater  advances,  and  I  believe  that  you  are  on  the  eve  of 
still  more  blessed  and  portentous  discoveries.  The  cause  and 


THE  REAL  REWARDS   OF  MEDICINE.  143 

the  cure  of  the  great  destroyers  of  human  happiness  and 
human  life  are  to  be  discovered  by  you.  You  may  vanquish 
cholera,  consumption,  typhus,  yellow  fever,  scarlet  fever, 
and  other  demons  of  disease,  and  there  may  be  even  in  your 
own  class — why  not? — an  unsuspected  peer  of  Harvey,  of 
Jenner,  of  Lister,  of  Pasteur.  By  carrying  on  to  its  utmost 
limits  the  good  work  already  begun  in  the  Jefferson  Medical 
College,  by  earnestness  in  study,  by  exactness  in  observation, 
by  gathering  your  facts,  shrewdly  comparing  and  correlating 
them,  by  wise  experiments  to  ascertain  the  correctness  of 
your  conclusions,  and  then  by  publishing  them  for  the  in- 
formation and  enlightenment  of  the  profession,  you  will  fill 
out  the  duty  you  owe  to  the  Community,  the  College,  and 
the  Profession.  The  Alumni  of  the  Jefferson  Medical  College, 
whose  ranks  you  join  to-day,  have  reason  to  be  proud  of 
the  contributions  to  science  made  by  the  dear  old  College. 
Its  large  and  constantly  enlarging  body  of  Instructors  have 
always  been  hi  the  forefront  in  the  intellectual  arena  of 
Medicine.  It  was  not  less  a  matter  of  pride  than  of  delighted 
surprise  to  me,  not  long  since,  when,  apart  from  all  the 
splendid  work  of  its  Alumni  scattered  all  over  the  world, 
a  partial  compilation  of  the  books  and  papers  published  in 
two  years  only  by  the  teachers  connected  with  the  Jefferson 
showed  that  they  had  published  267  contributions  to  knowledge — 
almost  one  paper  every  two  working  days.  See  that  you 
keep  up — nay,  more,  that  you  extend — this  scientific  spirit, 
so  fruitful  of  blessings  to  humanity. 

We  are  about  entering  on  a  new  era  in  the  history  of  the 
College.  Its  educational  and  charitable  work  have  both  been 
hampered  for  the  past  twenty  years,  to  a  degree  only  appre- 
ciated by  those  engaged  in  the  daily  work  of  teaching  in  the 
College  and  in  caring  for  the  immense  number  of  patients  hi 
the  dispensary  service  of  the  Hospital.  Here,  again,  the 
community  is  hi  utter  ignorance  of  the  enormous  amount  of 
charitable  work  done  in  the  hospital.  At  the  end  of  my 


144  ADDRESSES   AND   OTHER   PAPERS. 

recent  term  of  service  of  only  eight  weeks  in  the  clinic,  I  re- 
ported to  the  Trustees  that  in  addition  to  all  the  work  in 
the  surgical  wards,  in  which  there  were  nearly  50  patients 
requiring  daily  care,  there  had  been  5005  visits  in  these  48 
working  days,  and  exactly  200  operations  done,  many  of 
them  of  the  most  serious  character,  and  without  a  single 
death. 

This,  mark  you,  is  only  the  record  of  eight  weeks  of  the 
entire  year  and  in  one  department  alone.  If  to  these  figures 
you  add  all  the  cases  in  the  clinics  for  Medicine,  Obstetrics, 
Gynaecology,  Diseases  of  the  Eye,  of  the  Throat,  of  the  Ear, 
of  the  Nervous  System,  of  Children,  of  Orthopaedic  Surgery, 
of  the  Skin,  etc.,  the  sum-total  is  simply  enormous.  And  all 
this  is  done  in  a  Hospital  built  before  these  numerous  clinics 
were  even  thought  of,  and  in  quarters  lamentably  deficient 
in  space,  air,  and  light. 

Besides  this  charitable  and  scientific  work,  you  know  even 
better  than  I  can  tell  you  the  absolute  need  for  enlargement 
of  the  facilities  in  the  various  laboratories  and  lecture-rooms, 
requisite  for  teaching  over  600  earnest  young  men  every  year. 
The  simple  fact  is  that  we  have  outgrown — immensely  out- 
grown— the  facilities  which  our  buildings  afford.  The  four 
years'  graded  course,  now  voluntary,  must  soon  be  com- 
pulsory, and  we  will  be  worse  off  than  ever.  Hence  the  bold 
plan  for  the  new  buildings  in  a  new  and  splendid  location. 
The  Trustees  and  Faculty  are  cordially  united  in  their  efforts 
for  a  "New  Jefferson,"  and  we  appeal  to  the  public  of  the 
State  and  of  the  City  for  aid. 

Colleges,  theological  and  technical  schools,  and  hospitals 
have  been  endowed  with  millions,  but  who  except  Johns 
Hopkins  has  ever  endowed  a  medical  school?  Yet  here  are 
educated  the  doctors  who  make  or  mar  human  lives  in  these 
very  hospitals  and  in  the  entire  community.  As  alumni  of 
this  now  ancient  and  honorable  school,  you  can  assist  in 
shaping  public  sentiment  in  this  direction.  We  appeal  to 


THE   REAL   REWARDS   OF   MEDICINE.  145 

this  charitable  community  to  aid  us  in  the  great  work  of 
training  their  medical  attendants  to  the  very  highest  point 
of  scientific  and  practical  skill  by  gifts  which  will  be  repaid 
to  them  a  hundredfold  in  their  own  lives  and  health  and  that 
of  those  dearest  to  them. 

I  welcome  you,  then,  finally,  into  the  goodly  company  of 
earnest  workers  and  soldiers  of  knowledge  in  the  campaign 
against  ignorance  and  disease.  Be  an  honor  to  the  College, 
true  to  yourselves,  and  faithful  to  your  fellow-men  and  to 
God  throughout  your  lives,  and  His  gracious  benediction, 
"Well  done,  good  and  faithful  servant,"  will  be  your  final 
and  blessed  reward. 


10 


MEDICINE  AS  A  CAREER  FOR  EDUCATED 

MEN.* 


"  T)  EAUTIFUL  for  situation,  the  joy  of  the  whole  earth," 
JLD  was  the  description  of  ancient  Jerusalem  by  its  en- 
thusiastic admirer.  And  surely  anyone  looking  on  Pardee 
Hall  would  be  justified  in  applying  this  encomium  to  Lafayette 
College.  It  is  a  genuine  pleasure  to  me  to  join  with  you  in 
your  annual  festival  when  your  tribes  come  up  to  their  intel- 
lectual Jerusalem,  "singing  their  songs  of  degrees"  as  of  old. 
And  although  the  son  of  another  academic  mother,  I  rejoice 
with  you  in  the  prosperity  and  glories  of  your  noble  college. 
I  see  around  me  old  men,  graduates  of  the  forties,  with 
silvered  heads,  their  paths  in  life  chosen,  their  duties  fulfilled, 
their  lives  culminating  in  honored,  cultivated  leisure  and 
wide  influence,  whose  achievements  are  recorded  in  the  his- 
tory of  the  world  of  art,  science,  literature,  language,  business, 
and  religion.  I  see,  again,  men  in  middle  life,  graduates  of 
the  sixties  and  seventies,  alert  for  every  opening  for  the  best 
work  in  the  world's  great  enterprises.  They  are  in  the 
forefront  of  the  fight  against  ignorance,  vice,  and  irreligion. 

But  it  is  rather  to  the  young  men,  and  especially  to  you, 
gentlemen  of  the  graduating  class, — who  are  now  taking  leave 
of  these  classic  shades  where  you  have  spent  the  four  most 
blissful  and  fruitful  years  of  a  man's  life,  to  which  he  ever 
reverts  as  the  halcyon  days  of  youth — to  you  that  I  espe- 

*  The  Commencement  Address  at  Lafayette  College,  June  13,  1893, 
and  (with  slight  changes)  the  Phi  Beta  Kappa  Address,  Brown  Univer- 
sity, June  20,  1893. 

146 


MEDICINE   AS   A    CAREER   FOR   EDUCATED   MEN.         ,  147 

cially  address  myself.  The  joys,  the  trials,  the  studies,  the 
achievements  of  your  college  life  are  now,  or  soon  will  be, 
over.  The  world  stands  open  before  you.  "What  shall  I 
do?"  is  the  question  of  questions  to  you.  The  decision  of 
this  question  may  make  or  mar  you. 

If  you  decide  rightly  you  will  achieve  success,  honor,  happi- 
ness, and  the  final  consolation  of  a  life  well  and  nobly  spent. 
If  wrongly,  your  decision  may  wreck,  even  hopelessly,  a  young 
life  full  of  brilliant  promise.  You  and  your  fellows  in  the 
many  colleges  of  the  land  who  will  graduate  in  this  leafy 
June  have  on  your  side  youth,  with  all  its  potencies.  You 
have  a  just  and  laudable  ambition.  You  are  ready  to  work 
your  finger-nails  off.  You  have  trained  intellects.  You  are 
members  of  the  true  aristocracy  of  learning,  men  of  marshalled 
forces,  the  hope  of  the  nation,  the  future  natural  leaders  of 
thought  in  public  and  in  private  life.  What  shall  you  do? 
"Surely,"  says  Carlyle  in  his  Biography  of  John  Stirling,  "the 
young  heroic  soul  entering  on  life  so  opulent,  full  of  sunny 
hope,  of  noble  valor,  and  divine  intention,  is  tragical  as  well 
as  beautiful  to  us." 

It  is  of  equal  importance  to  the  community  as  well  as  to 
you  that  you  elect  wisely  what  path  you  will  follow  in  this 
busy  world.  Some  of  you  will  enter  commercial  life,  lured 
possibly  by  hopes  of  material  reward.  Some  may  be  devoted 
to  art,  with  its  aesthetic  enjoyments.  Some  will  find  in  litera- 
ture the  contentment  and  fame  that  come  to  the  successful 
author.  Some  will  devote  your  lives  to  the  highest  human 
function  and  service  to  your  fellow-men,  in  winning  them  to 
Christ-like  lives  and  heavenly  aspirations.  Some  will  seek 
the  noble  profession  of  the  law  and  will  become  leaders  of 
the  bar  and  wear  the  ermine  on  the  bench.  Not  a  few,  I 
hope,  will  devote  yourselves  to  a  scientific  career,  with,  it 
is  true,  its  ceaseless  toil,  but  also  its  fascinating  investigations, 
its  splendid  discoveries,  its  beneficent  inventions. 

It  is  my  desire  to  lay  before  you  some  of  the  rewards,  the 


148  ADDRESSES  AND  OTHER  PAPERS. 

possibilities,  the  attractions  of  such  a  scientific  life,  and  to 
win  you  to  its  pursuit,  since  it  has  attractions — wonderful 
attractions — from  many  sides  and  for  every  type  of  man, 
excepting  always  the  lazy.  I  have  selected  as  my  topic, 
therefore,  "Medicine  as  a  Career  for  Educated  Men." 

I  .am  met  at  the  outset  by  the  query,  "  Are  there  not  already 
too  many  doctors?"  Yes;  far  too  many  poor  doctors,  but 
far  too  few  good  ones.  Webster's  oft-quoted  remark  that 
"there  is  plenty  of  room  at  the  top"  is  as  true  of  medicine  as 
of  any  other  profession.  In  any  profession  there  is  always 
a  reserved  seat  in  the  front  row  for  a  March,  a  Faraday,  a 
Schliemann,  a  John  Hunter,  a  Lister,  a  Virchow,  a  Pasteur, 
a  Gross.  And  although  no  one  of  you  may  become  the  peer 
of  those  I  have  named — and  yet  why  should  you  not? — still 
there  is  always  room  right  next  to  them  for  the  trained 
intellects  who  will  make  their  profession  an  integral  part  of 
their  lives  and  devote  themselves  earnestly  and  truly  to  its 
pursuit.  Never  has  there  been  in  medicine  such  a  demand 
for  men  of  the  highest  type,  the  deepest  insight,  the  pro- 
foundest  spirit  of  investigation.  Never  have  there  been  so 
many  questions  of  grave  import  to  the  human  race  awaiting 
solution.  The  mighty  problems  of  life  and  disease  and  death 
crowd  upon  us  and  await  the  touch  of  a  master-hand  to  make 
the  obscure  clear,  to  avert  the  dire  results  of  accident,  to 
stay  the  hand  of  the  Angel  of  Death  and  say  in  dominant 
tones :  "  Thus  far,  and  no  farther." 

Medicine  is  looking  to  just  such  well-equipped,  thoroughly 
trained  men  as  you  for  its  champions  in  this  daily  fight  with 
death.  And  if  you  wish  to  rise  above  the  dull  level  of  medi- 
ocrity it  will  be  to  you  college  men  that  the  renown  which  is 
the  proper  object  of  a  laudable  ambition  will  surely  come. 
President  Thwing,  in  the  June  "Forum"  states  that  Appleton's 
" Encyclopaedia  of  American  Biography"  contains  the  names 
of  912  doctors,  of  whom  473  were  college-bred  men.  The 
"Medical  Record,"  commenting  upon  this  fact,  estimates 


MEDICINE   AS   A   CAREER   FOR   EDUCATED   MEN.  149 

that  300,000  men  have  started  out  in  medicine  in  this  country 
during  the  present  century.  If  so,  the  chance  of  the  ordinary 
doctor's  becoming  famous  is  about  one  in  300.  But  if  he 
be  a  college-bred  man  it  is  about  one  in  six.  The  profession, 
as  I  have  said,  is  filled  to  repletion  with  poor  men  and  un- 
trained men.  What  we  want  is  the  men  fresh  from  the 
laboratories  of  the  best  colleges,  men  whose  minds  are  trained 
in  logical  methods,  who  are  versed  in  the  "humanities,"  who 
possess  refinement  and  culture,  who,  having  eyes  and  ears, 
have  learned  to  use  them  to  the  best  advantage.  In  that 
delightful  book,  "The  Gold-headed  Cane,"  Radcliffe— he  of 
the  library — visits  Mead  in  his  library  and  says :  "  As  I  have 
grown  older,  every  year  of  my  life  has  convinced  me  more 
and  more  of  the  value  of  the  education  of  the  scholar  and 
the  gentleman  to  the  thoroughbred  physician.  Perhaps  your 
friend  there  (pointing  to  a  volume  of  Celsus)  expresses  my 
meaning  better  than  I  can  myself  when  he  says  that  this 
discipline  of  the  mind,  '  quamvis  non  facial  medicum,  aptiorem 
tamen  medicince  reddit.'  ' 

The  signs  of  the  times  point  to  a  closer  affiliation  of  colleges 
and  medical  schools,  which  will  be  equally  advantageous  to 
both.  Five  years  ago  nearly  all  the  medical  schools  in  this 
country  were  two-year  schools.  Now  nearly  all  have  the 
three-year  courses  and  a  few  four,  and  the  new  Pennsylvania 
law  requires  four  years  of  study,  of  which  three  shall  be  hi 
a  medical  school.  This  movement  in  the  direction  of  a  more 
thorough  education  means  that  the  medical  schools  desire  to 
offer  a  curriculum  worthy  to  attract  the  best  educated  men. 
Moreover,  the  medical  schools  are  endeavoring  to  adjust 
their  courses  so  that  they  will  be  the  natural  continuation  of 
the  college  courses.  Without  sacrificing  the  symmetry  and 
completeness  of  the  college  curriculum  or  abridging  the 
studies  for  the  medical  degree,  their  aim  is  so  to  adjust  the 
two  that  they  shall  be  linked  together  as  one  complete  whole. 
Thus  many  of  the  medical  schools  are  considering  what  means 


150  ADDRESSES   AND    OTHER   PAPERS. 

can  be  adopted  to  draw  into  affiliation  with  them  the  col- 
leges and  college  men  in  preference  to  others.  The  larger 
development  of  the  Jefferson  Medical  College,  of  the  medical 
departments  of  Harvard  University,  of  the  University  of 
Michigan,  of  the  University  of  Pennsylvania,  and  of  Johns 
Hopkins,  are  evidences  of  the  same  wish  to  win  the  college 
men  to  a  medical  career.  The  union  of  the  College  of  Physi- 
cians and  Surgeons  with  Columbia  College  as  its  medical 
department,  and  the  projected  absorption  of  one  or  more  of 
the  Chicago  medical  schools  into  the  University  of  Chicago 
show  the  same  tendency.  Moreover,  the  colleges  are  looking 
equally  toward  the  medical  schools,  as  I  have  pointed  out, 
by  the  establishment  of  courses  which  will  naturally  lead  up 
to  medicine.  In  Brown  University  the  same  movement  is 
actively  taking  shape  through  the  Brown  University  Medical 
Association,  and  in  several  universities  with  medical  depart- 
ments similar  steps  have  already  been  taken.  It  is  a  move- 
ment full  of  promise. 

If  any  of  you  look  forward  to  medicine  as  a  career  you 
should  view  it  from  three  different  standpoints. 

First,  on  its  economic  side.  This  is  a  matter  of  no  little 
importance,  for  every  man  in  this  world  must  earn  his  living 
and  also  naturally  looks  forward  to  the  support,  not  only 
of  himself,  but  of  his  wife  and  children  in  the  future.  No 
one  should  expect  in  medicine  to  make  a  fortune.  A  few 
doctors  do  so,  but  they  are  the  exception.  But  every  man 
who  enters  medicine,  if  he  will  be  faithful  and  honest  in  his 
work,  and  a  fortiori  the  more  intellectual  college  man,  can 
be  sure  of  a  competence, — nay,  more,  can  be  sure  that  he 
will  enjoy  not  only  the  reasonable  reward  of  toil,  but  be  able 
to  lay  up  sufficient  for  his  own  old  age  and  for  his  family. 

Secondly,  a  much  more  elevating  and  attractive  side  is 
the  philanthropic  or  humanitarian.  The  medicine  of  the 
future  will  be  chiefly  in  the  direction  of  that  most  philan- 
thropic object,  the  prevention  rather  than  the  cure  of  disease. 


MEDICINE  AS   A   CAREER   FOR   EDUCATED  MEN.  151 

Hygiene  or  Preventive  Medicine  has  only  arisen  within  the 
last  forty  years.  It  has  already  done  much,  but  it  promises 
far  more.  If  it  is  necessary  to  show  that  the  knowledge  of 
hygiene  is  still  limited,  look  at  the  recent  reports  on  the 
sources  of  the  water-supply  of  New  York.  Nay,  you  need 
only  go  into  the  slums  of  your  own  city;  or  if  you  live  in 
the  more  God-blessed  country  you  may  find  a  startling 
ignorance  of  the  laws  of  health  in  almost  every  farm  house. 
Nay,  more,  you  need  only  cross-question  a  half  dozen  of  your 
intimate  friends  as  to  their  modes  of  life  to  discover  that 
the  laws  of  hygiene  are  "more  honored  in  the  breach  than 
in  the  observance." 

That  there  is  ample  room  for  missionary  work  in  the  matter 
of  personal  cleanliness  alone  will  be  evident  from  two  recent 
incidents  in  my  clinics  at  St.  Agnes'  and  the  Orthopaedic 
Hospitals.  At  the  former,  as  I  uncovered  the  feet  of  a  woman 
to  examine  them  in  consequence  of  an  accident,  I  was  startled 
at  their  condition  and  asked  her  when  she  had  had  a  bath. 
"And  phwat's  that?"  was  the  innocent  reply.  At  the  latter, 
last  winter,  after  examining  the  spine  of  a  young  lady  of 
sixteen,  the  daughter  of  a  respectable  farmer,  I  said  to  the 
parents  with  a  bluntness  born  of  indignant  surprise,  "It 
must  be  a  long  time  since  your  daughter  has  had  a  bath?" 
"Why,  yes,"  said  her  father,  "I  don't  believe  she  has  been 
in  a  tub  in  a  year."  To  which  his  indignant  wife  replied, 
"Why  of  course  she  has,  John.  Don't  you  remember  that 
bath  she  took  last  summer?"  They  probably  agree  with  a 
witty  medical  friend  who  seriously  avers  that  "everybody 
ought  to  take  a  bath  once  a  year  whether  he  needs  it  or  not." 

A  recent  census  of  a  portion  of  the  Chicago  slum  district 
also  has  disclosed  the  fact  that  in  a  population  of  16,000  there 
were  but  four  bath-tubs,  and  two  of  these  were  disconnected 
from  the  water-supply!  The  entire  community  suffers  from 
such  indecency,  uncleanness,  and  necessary  ill  health  of  a  part. 

What  a  fruitful  field  there  is  in  hygiene  both  for  scientific 


152  ADDRESSES   AND   OTHER   PAPERS. 

and  benevolent  teaching  as  to  plumbing,  drainage,  ventila- 
tion, clothing,  food,  drink,  city  architecture,  city  streets 
and  sewage,  city  water-supply,  city  parks  and  play 
grounds,  and  the  eradication  of  all  the  evil  influences 
which  confront  us,  both  in  country,  and  especially  in  city 
life!  Many  diseases  are  now  recognized  as  preventable  if 
the  community  were  only  alive  to  the  necessity  and  the 
possibility  of  their  prevention.  "For  every  case  of  typhoid 
fever,"  it  has  been  said  " somebody  ought  to  be  hung" — 
a  rough  and  epigrammatic  way  of  stating  what  is  undoubt- 
edly true,  that  in  a  perfectly  regulated  community  there 
would  be  no  typhoid  fever. 

But  besides  such  public  benevolent  service,  there  is  a  per- 
sonal philanthropic  side  of  medical  life,  to  which  I  gladly 
advert.  Picture  to  yourself  the  daily  life  of  the  doctor.  It 
has  undoubtedly  its  trials,  many  and  great.  The  humdrum 
recital  of  ancient  aches  and  pains  sometimes  becomes  irksome 
by  repetition.  The  doctor  has  patients  upon  whom  he  has 
bestowed  unremitting  care  and  his  very  best  mental  and 
physical  powers,  who  have  proved  ungrateful  and  have  even 
become  his  foes.  He  does  an  immense  amount  of  unrequited 
service.  His  nights  are  disturbed,  his  days  are  not  his  own, 
of  his  family  and  friends  he  sees  but  little.  But  then,  what 
calling  does  not  have  its  trials?  In  what  life  is  there  not 
friction,  which,  as  in  mechanics,  should  be  allowed  for,  and 
not  permitted  to  become  a  source  of  irritation  and  annoyance? 
But  ir  spite  of  all  these  trials,  the  doctor's  life  is  so  rich 
in  its  personal  rewards,  in  its  humane  service,  that  it  ought 
to  be  to  him  a  daily  joy. 

There  is  to  him  a  daily  personal  growth  in  knowledge. 
Every  sick-room  is  a  school-room,  and  every  case  a  lesson, 
from  which  he  comes  a  larger  man.  There  is  a  daily  personal 
growth  in  character,  so  that  he  should  lie  down  each  night 
a  better  man.  There  is  a  daily  personal  growth  in  his  power 
to  do  good,  which  should  be  at  once  a  reward  of  past  work, 


MEDICINE   AS   A   CAREER   FOR    EDUCATED   MEN.  153 

and  a  stimulus  to  better.  There  is  a  daily  personal  growth 
in  the  friendships  and  esteems  of  life,  which  constitute  one 
of  the  most  delightful  rewards  of  the  doctor.  What  greater 
joy  can  there  be  in  life  than  to  go  about  among  one's  fellow- 
men  carrying  with  him,  as  the  doctor  does,  an  atmosphere 
of  comfort,  of  hope,  of  courage,  of  health? 

There  come  to  him,  constantly,  cases  in  which  disease 
challenges  him  to  combat.  It  says  to  him,  as  it  were,  "Catch 
me  if  you  can,  in  all  my  devious  wanderings  and  unexpected 
disguises";  and  there  is  a  mental  exhilaration  in  following 
every  turn  in  the  trail  and  running  to  earth  the  fleeing  goblin 
that  is  captivating  to  every  inquiring  mind. 

Look  for  a  moment  at  the  methods  of  the  careful,  intelligent 
doctor,  as  he  investigates  such  a  case.  First,  he  inquires  with 
care  into  the  family  history  for  lurking  influences  of  evil 
heredity.  Next,  into  the  personal  history,  not  only  the 
physical  history  of  the  patient  from  his  birth,  but  also  the 
influences  of  his  environment,  his  habits,  his  hours  of  rest, 
his  methods  of  labor,  his  physical  and  mental  virtues  and 
vices.  Then  follows  the  history  of  his  present  illness,  in- 
cluding all  his  symptoms,  the  examination  of  his  secretions 
and  excretions,  the  shrewd  judgment  which  eliminates  the 
unessential  and  often  the  inaccurate  or  imaginative  statements 
from  those  which  are  real  and  essential.  Then,  too,  he  must 
not  forget  the  influence  of  mental  states ;  of  worry ;  of  family 
trouble;* of  personal  trials.  Next  he  passes  to  the  physical 
examination  of  his  patient,  when  his  eye  must  be  as  keen 
as  that  of  an  eagle,  his  touch  deft  and  delicate  in  estimating 
size,  consistency,  elasticity,  and  other  physical  conditions. 
He  must  then  co-ordinate  all  the  so  far  disjointed  facts  with 
a  mental  acumen  and  logical  method  which,  at  first  laborious, 
becomes  afterward  comparatively  easy  if  he  has  been  faithful 
and  thorough  in  his  earlier  investigations.  By  these  means 
he  reaches  a  diagnosis  and  settles  definitely  upon  the  medical 
or  surgical  treatment.  Each  case  is  then  a  study  in  physics, 


154  ADDRESSES   AND    OTHER   PAPERS. 

anatomy,  physiology,  pathology,  psychology,  chemistry, 
therapeutics.  In  the  vast  majority  of  cases  he  is  rewarded 
by  seeing  returning  health. 

Sir  Spencer  Wells,  as  the  net  result  of  his  first  1000  ovari- 
otomies, added  20,000  years  to  human  life,  and  so  far  has 
modern  surgery  surpassed  this  result  that  every  thousand 
similar  operations  to-day  add  not  less  than  30,000  years  to 
human  life!  Think  what  one  of  these  lives  means,  as  the 
pale  cheek  regains  its  color,  the  feeble  pulse  its  force,  strength 
succeeds  weakness,  each  day  records  a  gain,  and  finally 
health  is  re-established.  The  tender  father  returns  to  his 
usual  pursuits;  the  adored  mother  once  more  becomes  the 
center  of  loving  care  of  her  family;  the  beloved  child  is 
restored  to  the  family  circle  with  ruddy  health,  rescued  from 
the  valley  of  the  shadow  of  death  itself.  The  hushed  voices, 
the  soft  tread  of  the  sick-room  have  given  place  to  the 
laughter  of  health,  the  mists  of  sorrow  are  driven  away,  the 
anxious  alarms  of  disease  have  vanished.  What,  think  you, 
can  equal  the  joy  of  the  physician,  as  he  views  this  happy 
transformation?  Who  is  a  dearer,  more  cherished,  more 
welcome  friend  than  he?  Who  finds  a  warmer  place  by  the 
fireside  and  in  the  very  hearts  of  his  patients?  No  one  can 
adequately  appreciate  his  profound  joy,  his  daily  delight, 
his  deep  gratitude  to  the  "Giver  of  every  good  and  perfect 
gift."  Oh,  my  friends,  it  is  a  blessed  profession,  a  divine 
calling,  with  a  heavenly  recompense  on  earth ! 

But  sometimes  death  must  come.  Even  here,  however, 
the  kind  and  sympathetic  physician  finds  his  place.  Who 
can  so  tenderly  guide  the  poor  sufferer  to  his  long  rest,  so 
gently  assauge  the  pain  of  the  dying?  Who  so  endears  him- 
self to  broken  hearts  in  the  hour  of  their  bitter  extremity 
as  the  strong,  yet  tender,  Christian  physician?  Often  even 
death  makes  for  us  our  dearest,  most  loving  friends,  who 
would  pass  through  fire  and  water  for  us. 

Even  its  dangers  are  an  attraction  akin  to  those  which 


MEDICINE   AS   A   CAREER   FOR   EDUCATED   MEN.  155 

draw  the  hardy  mountaineer  toward  the  dizzy  heights  of 
the  Matterhorn.  And  when  to  these  dangers  is  added,  in 
times  of  pestilence,  the  clarion  call  of  duty  to  his  fellow-man, 
where  has  there  been  a  recreant  doctor?  Point  out  the 
renegade  if  you  can!  The  gallant  Six  Hundred  who  rode 
into  the  Valley  of  Death  were  no  braver  than  the  unsung 
heroes  of  Norfolk  or  of  Hamburg.  I  glory  in  my  profession 
that  in  such  hours  of  peril  it  has  known  no  cowards;  the 
meanest  soldier  in  its  ranks  has  been  a  brave,  unselfish, 
devoted  hero,  and  oftentimes  a  faithful,  gentle  martyr  dying 
at  his  post  of  duty. 

But  besides  the  economic  and  the  philanthropic  side, 
medicine  has,  thirdly,  its  splendid  scientific  aspect  which  fuses 
with  both  of  the  others,  and  yet  may  be  regarded  separately 
from  them.  Let  me  point  out  some  of  the  best  achievements 
and  present  problems  of  medicine.  The  present  century  has 
seen  vast  strides  in  every  department  of  medicine.  I  will 
not  weary  you  by  mentioning  the  improvements  made 
in  many  minor  details  which  would  be  more  suited  to  a 
technical  audience,  but  it  is  proper  that  I  should  allude 
to  three  brilliant  discoveries  which  stand  out  prominently 
as  of  the  first  magnitude. 

First,  the  discovery  of  anaesthetics.  The  beneficent  results 
from  this  discovery  are  so  well  known  that  I  need  only  call 
attention  to  them  and  also  note  in  passing  that  the  three 
principal  anaesthetics — ether,  chloroform,  and  nitrous  oxide — 
are  American  either  by  discovery  or  by  introduction  into 
general  use. 

The  second  great  achievement  is  the  antiseptic  method  by 
one  of  our  cousins  across  the  sea,  the  justly  immortal  Sir 
Joseph  Lister.  While  anaesthetics  have  been  an  immense 
boon,  especially  in  the  domain  of  surgery,  antiseptics  have 
saved  countless  lives  and  untold  suffering.  The  method  is 
so  recent  that  I  have  seen  both  its  birth  and  its  development. 
In  our  late  war  and  for  ten  years  after  its  close  every  wound 


156  ADDRESSES   AND    OTHER   PAPERS. 

and  every  operation  was  followed  as  a  matter  of  course  by 
fever  and  more  or  less  suppuration,  or  the  formation  of 
"matter,"  which  in  a  multitude  of  cases  resulted  in  blood- 
poisoning,  erysipelas,  hospital  gangrene,  lockjaw,  and  a 
hundred  other  kindred  evils  from  this  Pandora's  box.  Now, 
however,  we  are  enabled  to  perform  any  one  of  the  ordinary 
operations — such  as  amputations,  ligations  of  the  great 
blood-vessels,  the  extirpation  of  tumors,  and  the  like — with 
almost  absolute  safety,  and  this  surgical  safety  has  embol- 
dened us  to  perform  many  operations  undreamed  of  even  by 
an  Astley  Cooper,  a  Nelaton,  or  a  Pancoast.  The  great 
cavities  of  the  body — the  head,  the  abdomen,  the  pelvis,  and 
even  the  chest — are  invaded  with  a  sense  of  security  and  an 
almost  absolute  certainty  of  recovery  which  would  have 
astounded  our  fathers.  Amputations  which  were  formerly 
attended  with  a  mortality  of  nearly  fifty  per  cent,  are  now 
so  free  from  danger  that  we  always  expect  our  patients  to 
recover,  and  are  chagrined  if  they  do  not.  Compound  frac- 
tures, which  twenty  years  ago  often  had  a  mortality  of  over 
sixty  per  cent.,  now  scarcely  occasion  any  anxiety,  and 
ovariotomy,  formerly  a  most  dangerous  operation,  the  rise 
of  which  I  can  well  remember,  has  now  a  mortality  of  only 
ten,  five,  and  even  three  per  cent. 

The  third  great  discovery  of  the  century  is  the  new  science 
of  Bacteriology,  a  child  as  yet  in  its  teens.  It  arose  when 
many  of  my  younger  auditors  were  discarding  their  knicker- 
bockers for  trousers.  That  minute  organisms  or  germs  were 
the  cause  of  very  many  diseases  had  long  been  suspected, 
but  until  twelve  years  ago  we  were  not  at  all  certain  that 
the  process  of  inflammation  and  the  formation  of  matter 
or  pus,  or  that  many  well-known  diseases  were  the  result  of 
such  germs.  Now  we  know  not  only  that  they  are  the  cause 
of  all  inflammation,  but  scientific  investigation  has  shown 
us  that  all  suppuration,  pneumonia,  lockjaw,  diphtheria, 
erysipelas,  leprosy,  tuberculosis,  and  a  host  of  other  diseases 


MEDICINE   AS   A   CAREER   FOR   EDUCATED   MEN.  157 

are  due  to  these  minute  vegetable  germs.  You  can  easily 
understand  that  only  the  first  elementary  facts  have  been 
ascertained  and  by  no  means  all  of  these.  Here  is  a  whole 
new  science  awaiting  patient  investigation  and  brilliant  dis- 
covery. Who  that  has  ambition  and  enthusiasm  is  not 
aroused  by  such  a  prospect? 

How  is  it  that  these  minute  germs  produce  their  malign 
influences?  We  know  that  they  secrete  or  in  some  way 
produce  certain  deleterious  poisons  in  the  human  body,  but 
how  these  or  the  bacteria  act  we  do  not  know.  When  we 
learn  just  how  they  act,  in  all  probability  we  shall  be  able 
soon  to  discover  the  means  of  counteracting  their  harmful 
effects.  The  problem  how  to  destroy  the  bacteria  without 
destroying  the  patient  is  one  which  we  have  not  yet  solved. 
We  know  that  they  produce  infection.  We  know  fairly  well 
how  to  prevent  their  entrance  into  the  body  in  surgical  cases 
by  the  careful  antiseptic  cleansing  of  the  person  of  the  patient, 
of  the  instruments,  sponges,  dressings,  hands,  everything 
which  comes  in  contact  with  the  wound.  But  in  many 
instances  cases  are  brought  to  us  already  infected.  A  man 
who  has  met  with  any  accident  has  an  infected  wound,  and 
if  any  time  has  elapsed  his  system  has  become  infected.  We 
are  as  yet  groping  for  methods  by  which  we  can  surely  over- 
come such  a  previously  established  infection.  Here,  you 
see,  is  another  field  for  scientific  activity  and  the  most 
beneficent  results. 

We  are  learning  how  to  prevent  typhoid  fever,  tuberculosis, 
and  other  medical  diseases,  but  have  not  even  yet  begun  to 
learn  how  to  prevent  the  entrance  into  the  system  of  the 
bacteria  of  pneumonia,  influenza,  and  other  similar  diseases. 

Again,  there  are  certain  half -discovered  facts  which  already 
give  us  glimpses  of  unsuspected  triumphs.  Within  the  last 
few  years  it  has  been  found  by  experiments  on  animals  that 
the  germs  of  certain  diseases  when  inoculated,  for  instance 
in  a  rabbit,  from  that  to  a  second,  a  third,  and  so  on,  become 


158  ADDRESSES   AND   OTHER   PAPERS. 

intensified  in  their  action;  whereas  if  similarly  inoculated  in 
one  monkey  after  another  they  become  diluted  and  weakened 
in  their  action.  How  or  why  does  the  virus  or  germ  become 
stronger  by  transmission  through  a  series  of  rabbits,  and 
weaker  in  its  transmission  through  monkeys?  How  can  we 
utilize  this  for  the  benefit  of  humanity?  Here  is  another 
problem  awaiting  its  Newton  or  its  Morse. 

Again,  we  know  that  there  are  animals  in  which  we  cannot 
produce  certain  diseases.  For  instance,  the  attempt  has  been 
made  scores  of  tunes  to  inoculate  cancer  into  the  lower 
animals,  without  success.  They  do  not  suffer  from  measles 
or  scarlet  fever,  whooping-cough  or  mumps.  There  are  also 
diseases  peculiar  to  certain  animals  which  man  does  not  take. 
We  know  very  well  that  there  are  some  human  diseases  from 
which  certain  persons  are  exempt.  For  instance,  people  have 
grown  up  from  childhood,  been  exposed  to  scarlet  fever,  or 
measles,  or  small-pox,  and  yet  have  not  taken  it.  These 
animals  or  people  have  what  we  call  a  "natural  immunity" 
to  these  diseases.  Thus  far  preventive  medicine  has  only 
attacked  one  disease  in  the  way  of  producing  an  artificial 
or  "acquired  immunity."  This  is  vaccination  by  which  im- 
munity against  small-pox  is  produced;  or,  in  other  words, 
a  vaccinated  person  can  be  exposed  repeatedly  even  in 
epidemics  of  small-pox  without  contracting  the  disease. 
With  such  a  striking  example  before  us  for  over  a  century, 
how  strange  it  is  that  it  did  not  suggest  experiments  in  the 
same  direction  in  other  diseases. 

But  at  last  this  hint  has  been  taken  and  it  promises  much 
in  the  future.  For  instance,  it  has  been  discovered  that  if 
we  inoculate  an  animal  with  the  germ  of  lockjaw,  the  most 
virulent  of  all  bacteria,  and  then  take  the  watery  part  of  the 
animal's  blood — the  blood-serum — and  inoculate  another 
animal  with  it,  the  second  animal  may  then  be  inoculated 
with  the  germ  of  lockjaw  without  becoming  the  victim  of 
the  disease;  in  other  words,  in  the  second  animal  there  has 


MEDICINE   AS   A   CAREER   FOR   EDUCATED   MEN.  159 

been  produced  an  acquired  "immunity"  against  the  disease, 
Even  if  the  lockjaw  had  already  attacked  the  second  animal, 
this  blood-serum,  it  was  found,  would  vanquish  the  disease. 
Here  we  come  to  one  of  the  most  striking  recent  results  of 
scientific  investigation.  Once  that  it  had  been  tried  suffi- 
ciently often  to  determine  that  this  mode  of  conferring 
immunity  or  of  arresting  the  disease  was  not  deleterious  to 
the  animal,  it  was  deemed  right  that  the  same  attempt  should 
be  made  in  man  to  cure  this  dreadful  disease,  and  within  the 
last  three  or  four  years  there  have  been  recorded  nearly  a 
score  of  cases  in  which  patients  suffering  from  violent  attacks 
of  lockjaw  have  been  cured  by  inoculation  with  the  blood- 
serum  from  such  an  animal.  This  immunity  or  cure  is  sup- 
posed to  come  from  some  antidote,  or,  as  it  is  called,  "anti- 
toxin," produced  in  the  first  inoculated  animal  and  intro- 
duced into  the  body  of  the  second  animal  or  of  man  with 
the  blood-serum.  Think  you  that  it  will  be  no  great  service 
to  humanity,  no  great  scientific  feat,  which  will  fill  one's 
mind  with  a  wondering,  never-ending  satisfaction,  and  crown 
his  life  with  fame,  when  this  problem  is  fully  solved?  What 
extraordinary  results  it  may  lead  to  we  can  as  yet  only  guess 
at,  but  its  possibilities  seem  magnificent.  At  this  very 
moment  Dr.  Haffkine  is  in  India  inoculating  people  with 
the  antitoxin  of  cholera  and  bids  fair  to  succeed  in  his  efforts 
to  limit  or  prevent  this  fearful  plague. 

You  have  all  heard,  of  course,  of  Koch's  tuberculin.  This 
consists  of  a  modification  of  the  ptomaines  or  poisons  pro- 
duced by  the  little  bacillus  or  germ  which  causes  tuberculosis 
or  consumption.  You  know  how  the  discovery  was  prema- 
turely announced  and  heralded  by  the  newspapers  and  then 
fell  into  disuse,  and  has  been  the  object  both  of  obloquy  and 
ridicule.  As  a  matter  of  fact,  it  is  still  being  used  in  other 
modified  forms  by  physicians  and  surgeons,  and  it  is  not 
too  much  to  say  that  we  have  gone  a  long  way  towards 
finding  the  means  by  which  we  shall  probably  cure  con- 


160  ADDRESSES   AND   OTHER   PAPERS. 

sumption  and  all  the  other  baleful  effects  which  follow  from 
tuberculosis.  And  when  I  tell  you  that  there  is  not  an  organ 
in  the  body  which  is  not  affected  by  tuberculosis,  and  that 
it  is  the  cause  of  far  more  suffering  and  more  deaths  than 
any  other  disease,  you  will  appreciate  the  immense  boon  its 
cure  will  be. 

And  please  note  that  these  instances  which  I  have  given 
of  lockjaw,  of  cholera  and  of  consumption  are  but  types  of  a 
series  of  investigations  in  the  antitoxins  or  natural  antidotes. 
This  opens  the  door  to  a  wholly  new  class  of  remedies  fur- 
nished by  our  very  foes,  on  which  a  large  number  of  experi- 
ments are  being  constantly  made. 

The  fearful  ravages  of  cancer  are  familiar  to  all.  Its  cause 
is  unknown,  its  cure  compassed  only  by  its  early  extirpation, 
and  even  then,  I  must  regretfully  confess,  but  rarely.  But 
within  the  last  year  research  has  seemed  to  show  that  we  are 
on  the  verge  of  the  discovery  of  its  cause,  and  if  so,  time  will 
give  us  its  cure.*  Who  of  you  would  not  rather  make  such 
a  discovery  than  be  the  father  of  the  Atlantic  cable  or  the 
successful  general  of  a  great  war?  Who  would  be  so  blessed 
by  future  millions  of  mankind  as  the  discoverer  of  such  a 
boon  to  the  whole  race? 

Within  the  last  two  years  also  another  class  of  remedies  has 
been  introduced,  especially  in  connection  with  a  disease  with 
which  you  are  probably  not  familiar,  known  as  myxoedema. 
You  all  doubtless  are  aware  what  goitre  is.  Until  lately  it 
was  scarcely  deemed  amenable  to  operation,  but  modern 
surgical  methods  have  so  improved  that  several  hundreds  of 
cases  have  been  reported  in  which  the  goitre  has  been  re- 
moved, and  the  patients  have  nearly  all  recovered. t  But 

*  Up  to  this  time  the  cause  of  cancer  has  not  been  discovered,  but 
its  cure  is  no  longer  "rare";  about  50  per  cent,  of  the  cases  are  perma- 
nently cured  by  early  and  complete  operations. — (W.  W.  K.,  1905.) 

t  In  the  twelve  years  since  this  address  was  delivered  many  thousands 
of  successful  operations  have  been  done.  In  2000  cases  the  mortality  re- 
ported by  Koch er  is  less  than  1  per  cent. — (W.  W.  K.,  1905.) 


MEDICINE   AS   A    CAREER   FOR    EDUCATED   MEN.  161 

after  these  operations  a  curious  and  unexpected  result  was 
found.  Goitre  consists  in  the  enlargement  of  a  certain  gland 
in  the  neck  called  the  thyroid  gland.  If  the  whole  of  this 
gland  either  in  health  or  disease  is  removed,  a  considerable 
proportion  of  such  patients  undergo  a  sort  of  elephantine 
growth  all  over  the  body.  The  features  become  thick  and 
clumsy,  the  fingers  and  toes  swell  to  twice  their  ordinary 
size.  The  mental  condition  also  degenerates  into  a  form  of 
cretinism.  This  misfortune  attending  the  complete  removal 
of  the  gland  led,  first,  to  a  modification  of  the  operation, — 
viz.,  the  partial  instead  of  the  total  removal  of  the  gland; 
even  a  little  of  the  gland  if  left,  it  was  found,  would  prevent 
such  a  bad  result.  But  it  has  done  more  than  this.  Victor 
Horsley,  in  England,  suggested  that  in  cases  in  which,  as  some- 
times occurs,  this  disease,  myxoedema,  arose  spontaneously, 
the  thyroid  gland  itself  might  be  used  as  its  best  remedy. 

Accordingly  first  it  was  used  surgically.  The  thyroid 
gland  was  removed  from  a  sheep  and  transplanted  under  the 
skin  or  into  the  abdominal  cavity  of  the  patient.  It  grew 
there,  and  so  long  as  it  remained  the  patient  was  bettered; 
but  experience  showed  that  the  gland  soon  disappeared  and 
the  betterment  vanished  with  it.  Then  an  extract  was  pre- 
pared from  the  gland  and  used  hypodermically.  This  gave 
still  better  results,  but  it  was  suggested  again  that  if  the 
patient  were  simply  fed  on  the  gland  itself  (it  is  one  of  the 
sweetbreads  of  the  body)  cure  might  follow;  and  within  the 
past  year  a  large  number  of  cases  have  been  reported  which 
have  been  cured  by  this  wholly  new  method  of  treatment. 
See,  then,  here  another  fruitful  field  of  research  in  the  ad- 
ministration of  various  remedies  derived  from  particular 
glands  or  other  structures  in  the  animal  body.  Already  such 
an  extract  from  the  brain  has  been  used  in  epilepsy,  but  it 
is  too  early  as  yet  to  say  whether  the  result  will  prove  to  be 
good  or  not.  Within  a  month,  Vaughn,  of  Ann  Arbor,  has 

also  called  attention  to  the  fact  that  the  extract  of  the 
11 


162  ADDRESSES   AND   OTHER   PAPERS. 

thyroid  and  other  glands  is  fatal  to  bacteria.  This  new  dis- 
covery may  lead  to  the  most  beneficial  results. 

But  what  we  do  not  know  in  bacteriology  is  far,  far  greater 
than  what  we  do  know.  The  bacteria  of  scarlet  fever,  of 
measles,  of  small-pox,  of  whooping  cough,  of  typhus  fever, 
of  hydrophobia,  and  of  many  other  diseases  are  as  yet  un- 
known and  awaiting  your  touch,  your  investigation.  If  you 
miss  your  chance,  others  will  seize  it. 

If  I  were  to  ask  any  one  of  you  whether  Anatomy,  Physiol- 
ogy, and  Chemistry  are  comparatively  complete  sciences,  I 
suppose  you  would  answer  unhesitatingly,  yes.  On  the  con- 
trary, they  are  most  incomplete.  We  know  to  a  fair  extent 
the  gross  anatomy  of  the  human  body,  although  even  here  there 
is  an  immense  deal  to  be  learned;  but  the  minute  anatomy 
is  not  well  known,  and  there  is  scarcely  an  organ  in  the  body 
whose  physiology  has  been  half  studied.  Even  so  common 
a  substance  as  the  white  of  an  egg  has  defied  the  chemists, 
and  the  analysis  of  ninety-five  per  cent,  of  the  solids  of  the 
body  is  imperfect.  Yet  this  is  fundamental  Physiological 
Chemistry. 

When  I  first  taught  anatomy,  the  great  divisions  of  the 
brain  into  two  hemispheres,  the  cerebrum,  the  cerebellum, 
etc.,  were,  of  course,  known,  but  the  various  convolutions  of 
the  brain  surface  were  deemed  to  be  simply  fortuitous  by 
the  anatomist,  the  physiologist,  the  physician,  or  the  surgeon, 
and  that  one  convolution  had  no  more  value  than  another. 
Investigations  in  the  last  twenty  years  have  definitely  mapped 
out  the  brain,  showing  that  the  convolutions  and  fissures 
are  not  arranged  hap-hazard,  but  on  a  definite  plan.  A 
portion  of  the  brain  at  the  back  of  the  head  and  a  little  at 
the  side  of  the  head  are  fairly  well  known,  well  enough, 
indeed,  for  the  successful  performance  of  extraordinary 
operations  in  diseases  and  injuries  of  the  brain.  But  all  the 
rest  of  the  brain  is  as  yet  almost  a  terra  incognita — an  Africa 
standing  expectant  for  its  Stanley.  Here  again  is  another 


MEDICINE   AS   A   CAREER   FOR   EDUCATED   MEN.  163 

problem  seeking  solution,  a  problem  which  is  enough  to 
arouse  the  scientific  ambition  of  any  enthusiastic  mind. 

Again,  it  is  only  within  the  last  five  years  that  an  accurate 
knowledge  of  the  relation  of  diseases  of  the  ear  to  diseases  of 
the  brain  has  been  recognized,  and  their  scientific  surgical 
treatment  begun.  The  splendid  results  already  achieved  give 
promise  that  within  a  few  years  we  shall  know  not  only  how 
to  cure  brain  disease  the  result  of  disease  of  the  ear,  but — 
what  is  far  better — how  to  prevent  it. 

The  anatomy  of  the  nerves  has  been  known  for  many  years 
in  its  gross  outlines,  but  the  problems  which  present  them- 
selves here  are  many  and  varied.  Cut  a  certain  nerve,  the 
ulnar,  which  supplies  the  inner  part  of  the  hand,  and  the 
results  are  not  the  same  in  all  patients.  You  may  abolish 
touch  and  yet  pain  will  remain.  You  may  even  cut  out  one 
to  three  inches  of  the  sensitive  nerve  of  the  face,  as  I  have 
seen  within  the  last  few  weeks  in  several  cases,  and  it  will 
be  reproduced,  and  with  this  the  frightful  pain  of  tic  dou- 
loureux, for  which  the  nerve  was  removed,  will  return.  On 
the  other  hand,  by  a  wound  or  in  an  operation  from  one  to 
three  inches  of  a  nerve  may  be  removed,  and  you  want  the 
nerve  to  be  reproduced  and  so  re-establish  sensation  in  the 
skin  supplied  by  it  and  motion  in  the  muscles  to  which  it 
goes,  and  the  nerve  steadily  refuses  to  reproduce  itself.  Why 
in  the  one  case  it  will  and  why  in  the  other  case  it  will  not 
reproduce  itself  we  do  not  know.  In  fact,  what  we  do  not 
know  about  nerves  alone  would  make  a  good-sized  book. 

Thirty  years  ago  when  we  looked  at  an  eye  all  we  knew 
was  what  we  could  see  on  the  outside.  The  trouble  was  that, 
although  there  was  such  an  inviting  window  in  front  of  it  by 
which  we  could  look  in,  nothing  could  be  seen  inside  of  the 
eye  because  the  interior  was  totally  dark.  But  it  occurred  to 
Helmholtz  that  if  by  a  little  bit  of  looking-glass  he  reflected 
light  into  the  eye  and  then  scratched  a  little  hole  in  the  quick- 
silver, he  could  look  through  the  hole  into  the  illuminated 


164  ADDRESSES   AND   OTHER   PAPERS. 

interior  of  the  eye  and  see  all  there  was  inside  of  it.  From 
this  simple  idea  has  arisen  the  ophthalmoscope,  by  which  the 
whole  medicine  and  surgery  of  the  eye  have  been  revolu- 
tionized, and  great  light  has  been  also  thrown  on  the  diseases 
of  the  brain. 

Again,  when  the  mouth  was  opened,  we  could  see  certain 
parts,  but  the  whole  interior  of  the  larynx  and  windpipe  was 
beyond  our  sight,  and  therefore  beyond  our  knowledge.  But 
soon  after  the  ophthalmoscope  was  discovered  Czermak  and 
Tiirck  found  that  if  a  little  mirror  were  held  in  the  back 
of  the  throat  at  an  angle  of  about  45  degrees  and  a  ray 
of  light  were  thrown  upon  it  from  a  small  perforated  bit  of 
looking-glass,  the  ulterior  of  the  throat,  like  the  interior  of 
the  eye,  would  be  illuminated,  and  we  could  look  through 
the  little  hole  in  the  looking-glass  and  see  the  reflected  image 
of  the  vocal  chords  and  the  whole  of  the  larynx  in  the  mirror. 

Similar  inventions  await  the  ingenious  investigator  of  the 
future  for  the  examination  of  other  cavities  and  organs  of  the 
body,  and  the  day  is  not  far  distant  when  we  shall  be  able,  I 
hope,  to  see  and  therefore  to  know  the  interior  of  the  stomach 
as  well  as  we  do  the  exterior  of  the  body.  That  this  will 
illuminate  our  own  minds  as  well  as  the  stomachs  of  our 
patients  is  certain. 

And  so  I  might  go  on  in  one  department  of  medicine  after 
another,  presenting  to  you  similar  problems,  some  of  them  so 
technical  that  they  would  not  be  suited  to  a  non-professional 
audience,  and  in  each  show  you  the  vast  need  there  is  for 
bright  minds.  Has  the  last  word  been  said  in  surgery,  in 
medicine,  hi  the  diseases  of  any  of  the  special  organs  of  the 
body?  Nay,  verily  we  are  but  at  the  alphabet  of  investiga- 
tion and  of  cure.  Great  as  has  been  the  progress  in  the  last 
fifty  years,  greater  I  venture  to  say  than  in  all  previous  time, 
I  believe  that  the  next  fifty  years  will  far  eclipse  the  dis- 
coveries of  the  past  fifty.  Who  could  have  predicted  the 
rise  of  Bacteriology  a  score  of  years  ago?  And  who  will 


MEDICINE   AS   A   CAREER   FOR   EDUCATED    MEN.  165 

venture  to  say  that  in  the  next  twenty  years  another  science 
equally  far-reaching,  equally  beneficent,  equally  brilliant 
in  its  achievements,  may  not  arise?  Even  the  present  is  a 
splendid  time, 

"  An  age  on  ages  telling 
To  be  living  is  sublime." 

But  the  twentieth  century  in  which  you  will  live  will  be  the 
most  glorious  time  of  all  the  ages.  But  you  may  take  part 
in  this  grand  march  of  progress,  not  only  in  the  rank  and 
file,  but  as  a  leader  if  you  will  but  study  and  write.  Or  it 
may  be,  if  you  have  the  gift  of  imparting  knowledge,  you 
may  be  one  of  the  teachers  of  medical  science,  an  enviable 
post  of  honor  and  responsibility,  but  also  of  unequalled 
enjoyment. 

Have  I  not  put  before  you  enough  to  arouse  the  ambition, 
the  energy,  the  benevolence,  the  enthusiasm,  of  any  young 
man  about  to  choose  his  career?  Can  there  be  in  any  other 
department  of  human  knowledge  so  fine  a  field  for  research, 
for  discovery,  for  fame,  and,  what  is  far  better,  for  serving 
the  human  race?  If,  in  consequence  of  what  I  have  said  to 
you,  some  of  you  will  select  Medicine  as  your  chosen  pursuit, 
rest  assured  that  if  you  will  faithfully  perform  your  duty,  at 
the  close  of  life  you  will  have  the  pleasure  of  surveying  a 
career  which  has  been  advantageous  to  yourselves,  has  been 
a  means  of  doing  good  to  your  fellow-men,  and  I  verily  believe 
has  approximated  as  near  as  possible  to  the  Divine  Life  as 
is  given  to  any  man  to  do. 


VIVISECTION  AND  BRAIN-SURGERY.* 


TO  "Harper's  Magazine''  for  October,  1889,  I  contributed 
a  paper  in  which  I  demonstrated  the  fact,  and  to  some 
extent  the  causes,  of  the  recent  marvellous  progress  of  sur- 
gery. In  this,  as  in  an  earlier  publication,  I  attributed  it  to 
a  large  extent  to  vivisection.  Both  publicly  and  privately 
my  statements  have  been  called  in  question. 

The  seven  years  which  have  elapsed  since  my  first  pub- 
lication on  this  subject  have  demonstrated,  far  more  than  I 
even  hoped  or  expected,  the  truth  of  what  I  then  stated,  and 
it  would  seem  right  that  some  of  these  demonstrated  facts 
should  be  laid  before  the  public.  Moreover,  the  recent  re- 
vival of  the  discussion  of  the  subject  before  the  Church  Con- 
gress at  Folkestone,  England,  f  and  at  the  recent  meeting  of 
the  Humane  Society  in  Philadelphia  in  October,  1892,  makes 
it  especially  timely. 

I  shall  omit  many  topics  which  would  be  suitable,  such 
as  the  wonderful  results  of  Pasteur's  treatment  of  hydro- 
phobia, the  discoveries  of  bacteriology,  the  wholly  new  class  of 
remedies  which  medicine  owes  to  vivisection,  such  as  the 
antidotes  to  lockjaw  and  several  other  diseases,  derived 
from  the  blood  of  animals  inoculated  with  the  virus  of  these 
diseases — remedies  to  which  we  already  owe  astonishing 
cures.  In  the  present  paper  I  propose  to  limit  myself  to 
brain  surgery  alone,  and  to  give  a  glimpse  of  what  has  been 
done  up  to  the  present  time.  I  shall  show  especially  that 

*  Reprinted  from  Harper's  Magazine  for  June,  1893,  by  the  kind  per- 
mission of  Messrs.  Harper  &  Brothers. 

t  Church  Times,  October  14,  1892,  p.  1021. 

166 


VIVISECTION  AND   BRAIN   SURGERY.  167 

without  the  exact  knowledge  of  the  functions  of  the  brain, 
derived  almost  wholly  from  experimentation  upon  animals, 
it  would  be  simply  impossible  to  do  what  has  been  accom- 
plished. I  shall  not  restrict  myself  to  general  assertions 
which  may  easily  be  denied,  but  I  shall  relate  actual  cases, 
with  their  definite  results,  and  the  authority  for  each  case. 

In  order  to  understand  modern  progress  in  cerebral  sur- 
gery it  is  necessary  first  to  understand  what  has  been  achieved 
by  experimentation  upon  the  brain.  When  I  was  a  student 
of  medicine,  thirty  years  ago,  the  brain  was  regarded  as  a 
single  organ,  and  its  various  functions  were  not  thought  to 
have  any  especial  localized  centres  of  action.*  When  the 
brain  acted  it  was  thought  that  the  whole  of  it  acted,  just 
as  the  liver  or  the  stomach  acts,  as  a  whole.  Now  we  know 
that,  instead  of  the  brain  being  a  unit,  it  is  really  a  very  com- 
plex organ.  Just  as  in  the  abdomen,  besides  the  other  or- 
gans in  its  interior,  we  have  the  stomach,  the  liver,  the  pan- 
creas, and  the  bowel,  each  of  which  has  its  part  hi  digestion, 
so  correspondingly  in  the  brain,  besides  the  portions  con- 
cerned hi  sight,  smell,  thought,  etc.,  we  have  four  adjacent 
portions  which  are  concerned  hi  motion.  One  produces 
motion  of  the  face;  another  motion  of  the  arm;  a  third, 
motion  of  the  leg;  and  the  fourth,  motion  of  the  trunk. 

How,  it  may  be  asked,  have  these  facts  been  determined? 
Has  it  not  been  by  observing  the  effects  of  injuries  and  dis- 
eases in  man?  To  a  small  extent,  yes.  But  very,  very 
rarely  does  disease  or  injury  involve  only  one  of  these  very 
limited  regions  of  the  brain;  and  the  moment  two  or  more 
of  them  are  involved  our  inferences  become  confused  and 
misleading.  As  a  matter  of  fact  which  cannot  be  gainsaid, 
nine-tenths  of  our  knowledge  has  been  derived  from  exact 
experiment  upon  animals,  and  hi  this  way:  A  monkey  is 

*  The  "  bumps "  or  localized  centres  of  phrenology  were  always  dis- 
credited by  the  medical  profession,  and  experiments  upon  animals  and 
observation  in  man  have  entirely  overthrown  them. 


168  ADDRESSES    AND    OTHER   PAPERS. 

etherized,  a  certain  area  of  its  brain  is  exposed,  and  an  elec- 
trical current  is  applied.  This  stimulation  of  most  portions 
of  the  brain  is  followed  by  no  motion  in  any  part  of  the  body. 
These  parts  of  the  brain,  therefore,  have  nothing  to  do  with 
motion,  but  are  the  centres  for  general  sensation  (touch)  or 
for  certain  special  senses,  as  sight,  hearing,  etc.,  or  for  mental 
processes.  But  in  one  definite  region  of  the  brain,  called  the 
"motor  area,"  the  moment  the  brain  is  stimulated  by  the 
electrical  current  motion  is  produced.  Moreover,  it  was 
soon  found  that  stimulating  different  parts  of  this  motor 
area  produced  motion  in  different  parts  of  the  body,  and  that 
this  was  not  haphazard,  but  that  stimulation  of  one  part  of 
it  always  produced  motion  in  the  arm,  and  hi  another  part 
motion  hi  the  leg,  etc.  Thus  have  been  mapped  out  the 
various  portions  of  the  motor  area,  as  will  be  presently 
described  in  detail. 

It  is  evident  that  by  experiment  upon  animals  the  motor 
area  can  be  more  easily  and  more  exactly  determined  than 
can  those  regions  which  are  the  seat  of  the  faculties  of  smell, 
taste,  sight,  and  hearing,  the  presence  or  absence  of  these 
senses  in  animals  being  difficult  to  determine  with  absolute 
accuracy.  Still  more  is  this  true  of  the  parts  of  the  brain 
which  have  to  do  with  mental  processes.  Yet  disease  and 
injury  hi  man,  if  they  alone  could  answer  the  questions 
what  part  of  the  brain  has  to  do  with  motion,  what  part 
with  sight,  what  part  with  the  intellect,  ought  to  have  an- 
swered them  long  ago.  No  better  evidence  could  be  given 
of  the  superiority  of  experiment  upon  animals  over  observa- 
tion of  accident  and  disease  hi  man  in  determining  facts  of 
this  character  than  this,  that  those  centres  are  best  and  most 
accurately  known  which  can  be  determined  by  vivisection, 
and  that  those  in  which  vivisection  can  aid  us  but  little  are 
still  only  vaguely  located.  Thus  the  motor  area  is  positively 
and  definitely  located;  that  for  sight  approximately  well; 
those  for  hearing,  smell,  and  taste  and  general  sensation 


VIVISECTION    AND    BRAIN   SURGERY. 

(touch)  are  still  uncertain,  though  guessed  at.  As  to  those 
for  mental  processes,  except  perhaps  one  which  will  be  alluded 
to  later,  we  are  almost  wholly  in  the  dark.  Moreover,  dis- 
ease and  accident  have  made  their  cruel  and  rude  experi- 
ments ever  since  the  world  began.  But  as  a  matter  of  fact 
the  last  fifteen  years  of  experimentation  have  taught  us 
more  than  the  previous  fifteen  hundred  years  of  careful  ob- 
servation and  of  postmortem  examination. 

Let  me  now  briefly  explain  this  "  localization  of  function ' ' 
in  the  brain,  and  then  show  its  value  and  certitude  by  cases 


Fig.  1. — Side  view  of  the  surface  of  a  monkey's  brain,  showing  the 
location  of  the  various  fissures  and  of  the  motor  centres.  (Horsley 
and  Schafer.) 

which  arouse  our  interest  not  only  by  their  illustrating  the 
practical  applications  of  science,  but  by  the  cheering  and 
humane  results  in  the  relief  of  human  suffering  and  the  sav- 
ing of  human  life. 

Fig.  1  represents  the  motor  area  as  ascertained  by  many 
experiments  such  as  I  have  described  upon  the  brains  of 
monkeys.  On  its  surface  will  be  observed  certain  broad 
black  lines  labelled,  from  in  front  backward,  "Precentral 
sulcus,  Fissure  of  Rolando,  Intraparietal  fissure,  External 
parieto-occipital  fissure,  Fissure  of  Sylvius,  Parallel  fissure," 
and  others  without  names.  In  the  middle,  running  down- 


170  ADDRESSES   AND   OTHER   PAPERS. 

ward  and  forward  toward  the  left  hand  of  the  figure,  notice 
especially  the  fissure  of  Rolando.  This  and  the  fissure  of  Syl- 
vius are  the  most  important  fissures  of  the  entire  brain.  The 
fissure  of  Rolando  is,  so  to  speak,  the  "axis"  of  the  motor 
area  of  the  brain.  At  its  upper  end  will  be  observed  the 
centre  for  the  leg,  with  certain  minor  divisions  marked  in 
smaller  letters.  In  its  middle  lies  the  arm  centre;  and  it 
should  be  remarked  that  the  part  where  the  word  "retrac- 
tion" is  is  the  shoulder  centre,  a  little  lower  down  is  the  elbow 
centre,  and  where  "wrist  and  fingers"  occurs  is  the  hand  centre. 
At  the  lower  end  of  the  fissure  of  Rolando  lies  the  centre  for 
the  face,  and  at  other  points  will  be  observed  the  centres  for 
the  trunk  and  head.  By  the  word  "centre"  is  meant  that, 
for  example,  if  you  expose  the  part  of  the  brain  marked 
"arm,"  and  apply  the  poles  of  an  electric  battery  to  that 
portion  of  the  surface  of  the  brain,  you  will  produce  muscular 
movement  in  the  arm.  If  at  the  upper  end,  you  will  move 
the  shoulder;  at  the  middle,  the  elbow;  lower  down,  you 
will  move  the  hand,  etc.  This  diagram  shows  the  fissures 
and  centres  as  ascertained  in  the  brain  of  the  monkey,  but 
it  must  be  remembered  that  they  have  an  exact  parallel  in 
the  human  brain.  The  same  fissure  of  Rolando  exists  there, 
the  same  fissure  of  Sylvius,  the  same  intraparietal  fissure,  etc., 
as  is  seen  in  Figs.  3,  6,  and  8,  and  the  same  centres  for  the 
arm,  leg,  trunk,  and  head.  When  I  state  that  these  exist 
in  the  human  brain  I  am  not  stating  what  is  theoretical,  but 
that  which,  in  common  with  scores  of  surgeons,  I  have  veri- 
fied in  many  cases  in  which  I  have  exposed  the  human  brain, 
applied  the  battery  exactly  at  the  places  shown  in  this  dia- 
gram of  the  monkey's  brain  (with  such  modifications  as 
would  follow  the  slightly  altered  relations  of  the  same  parts 
hi  the  human  brain  as  compared  with  the  monkey's),  and 
have  obtained  in  man  exactly  the  same  resulting  motions 
as  have  been  thus  experimentally  determined  in  the  monkey. 
Naturally  the  first  question  that  will  occur  will  be,  "This 


VIVISECTION   AND   BRAIN   SURGERY. 


171 


diagram  shows  the  fissures  and  centres  on  the  brain,  but 
how  are  you  going  to  tell  from  the  outside  of  the  head,  with- 
out opening  the  skull,  where  they  lie?"  This  has  been  de- 
termined by  careful  study  of  the  human  brain  and  skull, 
and  then-  relations  to  each  other.  I  will  give  only  one  illus- 
tration, and  that  by  far  the  most  important,  namely,  how  we 
locate  the  fissure  of  Rolando,  and  therefore  practically  the 
whole  motor  area.  Measure  any  head  in  the  middle  line, 
from  a  point  between  the  eyebrows  to  that  bony  prominence 
which  any  one  of  my  readers  can  feel  at  the  back  of  the  head 
just  above  the  border  of  the  hair.  These  points  are  called 
respectively  the  "glabella"  and  the  "inion."  Divide  this 
distance  into  two  equal  parts,  and  thus  obtain  the  mid-point 
between  them.  The  fissure  of  Rolando  starts  half  an  inch 
behind  this  mid-point  between  the  glabella  and  the  inion, 
and  runs  downward  and  forward  at 
an  angle  of  67  degrees.  There  have 
been  constructed  various  simple  and 
other  complex  apparatuses  for  the 
purpose  of  determining  just  this 
angle  of  67  degrees,  but  it  was  re- 
served for  Mr.  Chiene,  of  Edinburgh, 
before  the  Congress  of  American 
Physicians  and  Surgeons  in  Wash- 
ington, in  September,  1891,  to  point 
out  the  simplest  possible  method  of 
determining  this  angle,  which  any  one 
of  my  readers  can  use.  If  a  square 

of  paper  be  folded  diagonally,  it  is  obvious  that  the  right 
angle  of  90  degrees  at  two  of  the  corners  is  divided  into  two 
halves,  or  two  angles  of  45  degrees  each.  If  the  paper  be  then 
again  folded  so  as  to  divide  one  of  these  angles  of  45  degrees 
into  two  angles  of  22.5  degrees  each,  it  is  evident  that  one  angle 
of  45  degrees  and  another  of  22.5  degrees  make  an  angle  of 
67.5  degrees,  which  varies  only  half  a  degree  from  that  of  the 


Fig.  2.— Prof.  Chi- 
ene's  method  of  finding 
the  angle  of  the  fissure 
of  Rolando. 


172  ADDRESSES   AND   OTHER   PAPERS. 

fissure  of  Rolando  (Fig.  2).  If  the  middle  line  of  the  head  be 
marked  with  an  aniline  pencil  on  the  shaven  scalp,  if  its  mid- 
point be  then  fixed,  and  if  the  strip  of  paper  just  described  be 
so  placed  that  its  edge  indicating  the  angle  of  67.5  degrees 
runs  downward  and  forward  from  a  point  half  an  inch  back 
of  the  mid-point,  the  edge  will  correspond  to  the  line  of  the 
fissure  of  Rolando,  and  can  be  marked  by  the  aniline  pencil 
on  the  scalp.  If  this  line  be  measured  for  a  distance  of  three 
and  three-eighths  inches  from  the  middle  line  of  the  head, 
the  length  of  the  fissure  of  Rolando  is  also  shown. 

It  is  not  necessary  for  me  to  go  further  into  details.  I 
purpose  now,  after  having  thus  explained  the  "localization  of 
function"  in  the  brain,  and  the  means  of  locating  the  motor 
area  from  the  exterior,  to  show  not  only  that,  as  a  matter  of 
fact,  it  has  been  verified  in  actual  surgical  experience,  but  also 
that  it  is  so  accurate  that  from  the  exterior  of  the  head, 
without  any  scar  or  other  evidence  of  injury  (or  even  in  the 
presence  of  an  otherwise  misleading  scar),  without  any  frac- 
ture of  the  skull,  without  any  lump,  prominence,  or  other 
means  to  guide  us,  cerebral  localization  is  a  reality,  and  as 
reliable  as  the  needle  of  the  compass  itself  to  guide  us  exactly 
to  the  correct  spot,  so  that  we  can  open  the  head  and  expose 
the  brain  with  an  accuracy  which  is  truly  marvellous.  If  the 
last  fifteen  years  of  experimentation  have  done  so  much, 
what  may  we  not  expect  in  the  next  fifteen?  Does  not  hu- 
manity as  well  as  science  protest  against  any  hindrance  to 
the  further  prosecution  of  work  which  has  accomplished 
such  results?  Is  this  the  work  of  "inhuman  devils,"  as 
Canon  Wilberforce  has  been  pleased  to  term  those  engaged 
in  it,  or  is  it  the  work  of  humane  men  of  science  anxious  to 
mitigate  human  suffering  and  prolong  human  life? 

Now  let  us  see  what  results  practical  surgery  has  given  us 
by  the  application  of  the  doctrines  of  cerebral  localization  of 
function  to  special  cases  otherwise  beyond  our  power  ex- 
actly to  diagnosticate  and  to  relieve.  In  each  case  I  give 


VIVISECTION   AND   BRAIN   SURGERY.  173 

the  published  authority,  or,  if  the  case  has  not  yet  been  pub- 
lished, the  records  are  accessible  in  the  hospitals  named. 
The  cases  are  not  of  the  time  of  John  Hunter  or  of  Sir  Charles 
Bell,  but  of  the  last  few  years,  and  can  be  investigated  and 
verified  now. 

The  first  case  shows  that  it  is  possible  not  only  to  diagnos- 
ticate in  general  the  fact  that  an  abscess  exists  hi  the  brain, 
but  to  locate  it  exactly,  and  to  open  it  with  the  same  precision 
as  in  opening  an  abscess  on  the  hand.  What  is  more  to  the 
point,  in  about  one-half  of  such  cases  we  can  now  cure  the 
patients,  who  before  vivisection  had  taught  us  modern  cere- 
bral localization  would  all  have  gone  to  their  graves. 

Case  I.  Abscess  in  the  Brain. — In  the  "British  Medical 
Journal"  of  April  21,  1888,  Mr.  Darner  Harrisson  records 
the  following  case :  A  boy,  aged  fifteen,  had  received  a  blow 
on  the  right  side  of  his  head  from  a  pan*  of  tongs  eight  days 
before  his  admission  to  the  hospital.  Three  days  after  the 
accident  a  convulsion  suddenly  set  in,  involving  the  right  side 
of  the  body,  beginning  in  the  arm  and  spreading  to  the  leg 
and  face,  and  followed  rapidly  in  four  days  by  eight  other 
convulsions  and  paralysis  of  the  entire  right  side  of  the  body. 
Most  of  my  readers  would  unhesitatingly  attribute  the  con- 
vulsions and  the  paralysis  to  this  blow  from  the  tongs.  But 
it  must  be  remembered  that  the  right  side  of  the  brain  supplies 
the  left  side  of  the  body,  and  vice  versa.  Hence  Mr.  Harrisson 
suspected  that  the  paralysis  of  the  right  side  of  the  body  in- 
dicated trouble  in  the  left  half  of  the  brain.  Examining  his 
head,  he  found  on  the  left  side  a  small  scar  at  the  junction 
of  the  arm  and  leg  centres.  Inquiry  elicited  the  fact  that, 
ten  years  before,  he  had  received  a  severe  blow  there,  which, 
however,  had  not  been  followed  by  any  serious  symptoms. 
Could  this  old  injury,  after  so  long  a  time  as  ten  years, 
possibly  be  the  cause  of  his  present  serious  trouble?  Further 
inquiry  brought  out  the  fact  that  for  about  a  year  before  his 
admission  the  boy  had  had  repeated  twitching  of  his  right 


174  ADDRESSES   AND   OTHER   PAPERS. 

arm.  So  convinced  was  Mr.  Harrisson  that  modern  cere- 
bral localization  was  right  that  he  opened  the  boy's  skull, 
not  where  most  people  would  suppose  would  be  natural, — 
namely,  on  the  right  side  of  the  head,  where  he  had  received 
the  blow  from  the  pair  of  tongs  eight  days  before, — but  on 
the  left  side,  at  the  site  of  the  blow  ten  years  before,  and  at 
a  definite  point, — namely,  over  the  fissure  of  Rolando, — at 
the  place  corresponding  to  the  motor  centre  for  the  arm  as 
established  by  experiments  on  animals.  Although  the  first 
injury  was  received  so  long  before,  yet  the  paralysis  showed 
that  it  was  the  left  side  of  the  brain  that  was  involved,  and 
the  twitching  of  the  arm  showed  that  this  was  the  particular 
part  of  the  left  side  of  the  brain  where  the  injury  probably 
existed.  Mr.  Harrisson  punctured  what  seemed  on  the  sur- 
face to  be  a  normal  brain,  and  opened  an  abscess,  and  this 
boy,  otherwise  absolutely  doomed  to  death,  made  an  unin- 
terrupted recovery.  This  is  only  one  instance  out  of  prob- 
ably more  than  one  hundred  and  fifty  cases  of  abscess  in  the 
brain  which  have  been  reported  within  the  last  seven  or 

eight  years  which  have  been  diag- 
nosticated with  the  same  accuracy 
and  by  the  same  means. 

Case  //.—In  the  "British  Medi- 
cal Journal"  for  August  11,  1888, 
Dr.  Macewen,  of  Glasgow,  relates 
the  case  of  a  patient  who,  among 
Fig.  3. — Side  view  of  the     other  symptoms  of  abscess  of  the 

human  brain.  The  shaded  brain>  had  partial  paralysis  of  the 
area  shows  the  location  of  the  •  i,  -i  f  .-,  f  j  •  i, 

abscess   producing    pressure       nSht    Slde    °f  the    face    and    right 

on  the  lower  part  of  the  motor  arm,  and  paralysis  of  the  nerve 
area.  (See  Fig.  1.)  supplying  the  left  eyeball.  For 

reasons  stated  in  the  paper  he  con- 
cluded, with  great  acuteness  of  reasoning,  that  the  abscess 
could  not  be  in  the  motor  area  for  the  face  and  arm  on  the 
left  side  of  the  brain,  but  in  the  projecting  part  of  the  brain 


VIVISECTION  AND   BRAIN   SURGERY.  175 

just  below  these  centres,  but  producing  pressure  upon  them 
(Fig.  3).  He  confidently  operated  at  this  precise  spot,  and 
opened  an  abscess  in  the  inside  of  the  brain  in  the  exact  posi- 
tion described,  and  gave  exit  to  six  tdblespoonfuls  of  pus, 
when  the  symptoms  vanished,  and  in  three  weeks  the  patient 
was  well! 

Case  III.  Brain  Tumors. — Nothing  could  be  easier  than 
to  locate  a  tumor  of  the  brain  which  showed  itself  externally. 
In  a  case  in  which  the  tumor  is  as  large  as  that  shown  in  Fig. 
4  (which  is  the  natural  size  of  a  tumor  removed  from  a  man 
who  is  still  living,  six  years  after  the  operation*)  it  might  be 


Fig.  4. — Natural  size  of  a  tumor  removed  from  the  brain. 
The  patient  is  living  after  six  years.* 

thought  easy  to  locate  it,  though,  as  a  matter  of  fact,  it  is 
very  difficult,  owing  to  the  large  area  of  brain  involved.  But 
when  I  say  that  the  existence  of  a  tumor  about  the  size  of  the 
end  of  the  forefinger  can  be  diagnosticated,  and  that  before 
touching  the  head  it  should  be  said  (and  I  was  present 
when  the  statement  was  made)  that  it  was  a  small  tumor, 
that  it  did  not  lie  on  the  surface  of  the  brain,  but  a  little 
underneath  it,  and  that  it  lay  partly  under  the  centre  for  the 
face  and  partly  under  that  for  the  arm  hi  the  left  side  of  the 

*  This  patient  is  still  living,  eighteen  years  after  the  operation. — ( W.  W. 
K.,  1905.) 


176  ADDRESSES   AND   OTHER   PAPERS. 

brain,  and  that  the  man  was  operated  on,  and  the  tumor 
found  exactly  where  it  was  believed  to  be,  with  perfect  re- 
covery of  the  patient,  it  is  something  which  ten  years  ago 
would  have  been  deemed  the  art  of  a  magician  rather  than 
the  cold  precision  of  science. 

In  the  "American  Journal  of  the  Medical  Sciences"  for 
July,  1888,  this  case  is  detailed  by  Drs.  Seguin  and  Weir,  as 
follows:  A  gentleman,  thirty-nine  years  of  age,  had  been 
perfectly  healthy  until  August,  1882,  when  he  had  malarial 
fever,  accompanied  with  a  good  deal  of  pain.  One  day,  as 
he  arose  to  go  to  the  window,  his  wife  noticed  a  spasm  of  the 
right  cheek  and  neck,  which  did  not  involve  the  arm,  nor 
was  consciousness  lost.  In  1886,  two  or  three  similar  at- 
tacks having  occurred  in  the  interval,  he  fell,  unconscious, 
and  bit  his  tongue.  These  attacks  were  all  accompanied 
with  twitching  of  the  right  arm  and  hand  and  right  side  of 
the  face.  His  memory  became  impaired  and  his  speech 
thick.  No  injury  had  ever  been  received  on  his  head,  nor 
was  anything  abnormal  observed  even^when  his  head  was 
shaved.  Gradually  his  right  hand  and  arm  became  weak, 
and,  as  a  result,  his  handwriting  became  bad.  This  weak- 
ness of  the  right  arm  slowly  increased,  and  along  with  it  a 
weakness  of  the  right  leg,  and  as  a  consequence  of  the  in- 
creasing paralysis  of  his  face,  drooling  at  the  right  side  of 
the  mouth  set  in. 

Dr.  Weir  examined  him  at  Dr.  Seguin 's  request,  and  both 
of  them  reached  a  diagnosis,  chiefly  based  upon  the  facts 
already  given,  that  the  man  had  a  small  tumor  situated  as 
above  described,  and  on  November  17,' 1887,  the  skull  was 
opened  at  the  junction  of  the  arm  and  face  centres.  This 
operation  I  had  the  pleasure  of  witnessing  personally.  Noth- 
ing abnormal  was  seen  on  the  surface  of  the  brain.  Yet 
so  confident  was  Dr.  Weir  of  the  correctness  of  the  diagnosis 
that  he  boldly  cut  into  the  brain  substance,  and  from  its  in- 
terior removed  a  tumor  of  the  size  indicated  by  means  of  a 


VIVISECTION   AND   BRAIN   SURGERY. 


177 


small  surgical  spoon.  The  man  made  a  perfect  recovery. 
When  examined  microscopically,  the  tumor  was  found  to  be 
of  a  malignant  character.  It  returned  in  about  four  years, 
and  finally  destroyed  his  life.  Fig.  5  shows  the  tumor  rep- 
resented as  a  little  ball  in  the  substance  of  the  brain. 

In  one  sense,  as  a  surgical  feat,  the  removal  of  a  tumor  as 
large  as  that  shown  in  Fig.  4  is  a  much  more  difficult  and  ex- 
traordinary operation  (and  one  nearly  twice  as  large,  weigh- 
ing over  half  a  pound,  has  lately  been  successfully  removed 
by  Bramann!);  but  as  a 
matter  of  diagnosis  and  of 
surgical  skill,  locating  and  re- 
moving so  small  a  tumor  from 
the  brain  so  successfully,  and 
without  the  slightest  indica- 
tion on  the  exterior  to  guide 
one,  is  a  much  more  brilliant 
and  remarkable  operation. 

In  the  address  which  I  pub- 
lished in  1885 1  alluded  to  the 
first  and  then  the  only  case 
known  of  removal  of  a  brain 
tumor,  and  said:  "By  these 
experiments  and  operations  a 
wide  door  is  opened  to  surgery 
in  the  treatment  of  diseases 

within  the  skull,  diseases  heretofore  so  obscure  and  uncertain 
that  we  have  hardly  dared  to  attack  them.  The  ques- 
tion is  not  whether  death  or  recovery  followed  in  this  par- 
ticular case.  The  great,  the  startling,  the  encouraging  fact 
is  that  with  this  experience  we  can  now,  with  well-nigh  ab- 
solute certainty,  diagnosticate  the  existence  of,  and  with  the 
greatest  accuracy  locate,  such  diseases,  and  therefore  reach 
them  by  operation,  and  treat  them  successfully."  That  my 
prophesy  has  been  verified,  let  me  quote  the  statistics  gath- 
12 


Fig.  5. — A  cross  section  of  the 
brain  (only  a  part  of  the  left  side  is 
shown).  The  round  shaded  spot 
represents  the  brain  tumor.  (Seguin 
and  Weir.) 


178  ADDRESSES   AND    OTHER   PAPERS. 

ered  by  Dr.  Knapp,  of  Boston,  in  1891.  He  collected  46 
cases  of  operations  for  tumors  of  the  brain,  operated  on  in 
the  last  six  years,  of  which  30  recovered (!),  15  died,  and 
the  result  was  unknown  in  1.  It  must  be  remembered 
that  these  30  which  recovered  would  every  one  of  them 
have  died  had  not  vivisection  given  us  the  means  of  accurately 
locating  the  disease.  That  we  have  not  yet  reached  the 
accuracy  which  is  to  be  desired  is  shown  by  the  fact  that  in 
15  other  cases  no  tumor  was  found  at  the  point  of  opera- 
tion, and,  of  these,  13  died.  Most  of  these  tumors  lay 
not  in  the  motor  region  of  the  brain,  but  in  other  parts  of  it, 
in  which  our  means  of  diagnosis  are  as  yet  very  imperfect  for 
the  very  reason  that  vivisection  has  thrown  but  little  light 
on  the  function  of  these  regions.  There  were  also  4  cases 
of  tumors  which  were  found,  but  were  so  large  as  to  be 
irremovable,  and,  of  these,  3  died.  To  these  statistics  I 
can  add  3  other  cases.  In  1  of  these  the  tumor  was  not 
rightly  located  (it  was  not  in  the  motor  region),  and  there- 
fore was  not  found  at  the  operation,  and  the  patient  died. 
In  the  other  2  cases  the  tumor  was  found,  but  was  irre- 
movable. One  patient  died,  and  the  other  recovered  from 
the  operation,  but  died  from  the  disease  four  months  after- 
wards. He  had,  however,  been  relieved  from  the  atrocious 
headaches  which  rendered  life  a  burden,  and  his  delusional 
insanity  had  almost  wholly  disappeared — results  which  fully 
justified  the  operation  by  the  comfort  of  his  few  remaining 
days.  (Another  remarkable  case,  in  which  a  growth  of  the 
under  surface  of  the  bone  pressing  on  the  arm  centre  was 
exactly  located  and  successfully  removed,  is  related  by  Dr.  A. 
B.  Shaw,  of  St.  Louis,  in  the  "American  Journal  of  the  Medi- 
cal Sciences,"  December,  1892,  p.  691.*) 

Case  IV.  Hcemorrhage  Inside  the  Skull. — Let  me  next 
give  a  case  of  a  different  character,  but  equally  accurate  and 
astonishing.  An  artery  about  as  thick  as  the  lead  in  an  or- 

*  For  later  statistics  as  to  brain  tumors,  see  foot  note  on  p.  81. 


VIVISECTION   AND   BRAIN   SURGERY.  179 

dinary  lead-pencil  runs  in  the  membranes  of  the  brain  on  the 
inside  of  the  skull,  in  the  region  called  "the  temple,"  and 
grooves  the  bones  quite  deeply.  In  some  cases  hi  which  a 
heavy  blow  is  received  on  the  surface  of  the  skull,  without 
fracture,  or  it  may  be  even  without  leaving  any  mark  what- 
ever on  the  skull,  this  artery  is  ruptured,  and  a  large  amount 
of  blood  is  poured  out  on  the  surface  of  the  brain.  Formerly  it 
was  not  only  almost  impossible  to  make  a  diagnosis  of  such  an 
injury,  but,  even  if  the  rupture  of  the  artery  was  suspected, 
before  antiseptic  surgery  (itself  the  child  of  vivisection)  arose, 
such  patients  were  only  treated  with  a  little  opium,  rest,  and 
regulated  diet.  Most  of  them  died,  but  occasionally  one  got 
well.  Of  147  cases  collected  by  Wiesmann  which  were  not 
operated  on,  131,  or  over  89  per  cent.,  died.  The  symptoms 
of  such  an  injury  are  fairly  clear,  but,  until  the  doctrines  of 
cerebral  localization  were  accepted,  were  often  misleading. 
The  patient  is  stunned  by  the  blow,  but  usually  recovers  con- 
sciousness, only  to  relapse  again  into  unconsciousness  when 
the  amount  of  blood  poured  out  is  sufficient  to  compress  the 
brain,  this  compression  of  the  brain  producing  also  paralysis. 
Generally  the  artery  on  the  same  side  of  the  head  as  the  blow 
is  ruptured,  and  the  paralysis  will  be  on  the  opposite  side  of 
the  body.  But  sometimes,  instead  of  the  artery's  being  rup- 
tured on  the  same  side  as  the  blow,  it  will  be  ruptured  on  the 
opposite  side;  or,  again,  if  the  blow  be  in  the  middle  line,  as 
in  a  case  recently  under  my  care,  it  may  be  difficult  to  tell 
which  side  has  been  involved.  Moreover,  as  the  artery  splits 
into  two  branches,  one  of  which  runs  in  the  direction  of  the 
motor  region  and  the  other  back  of  it,  it  may  be  difficult  to 
know  where  to  open  the  skull  in  order  to  reach  it.  Now  it  is 
very  evident  that  if  we  make  an  incision  into  the  forearm  to 
reach  an  abscess  or  a  tumor,  and  it  is  found  that  the  trouble 
lies  one  or  two  inches  further  up  or  down,  the  incision  can  be 
easily  prolonged  in  the  right  direction,  and  will  heal  readily. 
But  in  the  skull  our  diagnosis  must  be  correctly  located  within 


180  ADDRESSES   AND    OTHER   PAPERS. 

a  very  small  limit  of  error,  for  it  is  evident  that  we  cannot 
enlarge  the  opening  in  the  bone  at  will  to  almost  any  extent, 
as  we  can  in  the  flesh.  Wiesmann  has  also  collected  110 
cases  which  were  thus  operated  on,  of  whom  36  died,  or  only 
33  per  cent. !  What  a  contrast  to  the  89  per  cent,  of  deaths 
when  no  operation  was  performed!  In  the  majority  of  these 
36  who  died  the  clot  was  not  found,  and  was  therefore  not 
removed,  because  in  the  earlier  days  we  lacked  the  boldness 
and  therefore  the  exactness  of  modern  times. 

Let  me  now  give  the  case  furnished  me  by  Dr.  Dench,  by 
permission  of  Dr.  Bull,  of  New  York  ("Buck's  Reference 
Hand-book  of  the  Medical  Sciences,"  vol.  viii,  p.  227).  A 
young  man  had  been  shot  in  the  head,  the  ball  entering  above 
the  ear,  two  and  a  half  inches  to  the  left  of  the  middle  line  of 
the  head.  When  first  seen  his  right  arm  was  paralyzed,  and 
shortly  afterward  the  paralysis  had  extended  to  the  right  leg 
and  face.  A  diagnosis  was  made  of  haemorrhage  from  one  of 
the  arteries  of  the  brain,  by  reason  of  the  fact  that  the  paral- 
ysis had  extended  so  rapidly  from  the  arm  centre  to  the  leg  and 
face  centres,  for  no  other  cause  excepting  haemorrhage  could 
be  so  rapidly  progressive.  The  wound  was  exposed,  and  a 
considerable  clot  gushed  out,  when  motion  immediately  re- 
turned in  the  leg.  The  bone  was  then  trephined,  not  at  the 
bullet  opening,  but  a  quarter  of  an  inch  below  and  in  front 
of  the  wound,  when  this  bleeding  menuigeal  artery  was  ex- 
posed and  tied.  It  was  found  that  a  large  branch  of  an  ar- 
tery in  the  brain  itself  had  also  been  severed.  This  was  tied, 
and  in  two  months  the  man  was  well,  no  fever  following,  and 
no  "matter"  having  formed.  He  could  speak  perfectly  well, 
and  could  use  his  arm,  but  not  his  hand.  The  ball  was  never 
found. 

Case  V. — It  may  be  objected  that  in  the  preceding  case 
there  was  a  wound  to  point  out  exactly  the  situation  of 
the  injury.  Let  me  therefore  give  a  somewhat  similar 
case  in  which  no  such  guide  existed:  M.  Michaux  ("Medi- 


VIVISECTION   AND    BRAIN    SURGERY.  181 

cal  News,"  May  2,  1891,  p.  504,  from  "Revue  de  Chi- 
rurgie,"  1891,  vol.  xi,  p.  376)  reports  a  case  of  trephining, 
for  serious  meningeal  haemorrhage,  probably  of  spontane- 
ous origin,  followed  by  cure.  A  man  was  brought  to 
the  hospital  in  a  state  of  complete  apoplexy,  with  pa- 
ralysis of  the  left  face  and  right  arm.  There  was  no  sign 
of  fracture  or  other  injury.  During  the  next  few  days  the 
paralysis  extended  to  the  right  leg.  Epileptic  convulsions 
set  in,  at  first  limited  to  the  paralyzed  regions,  then  becoming 
general.  Occurring  at  intervals  in  the  beginning,  they  be- 
came continuous  at  the  end  of  three  or  four  days.  The  pa- 
tient was  addicted  to  absinthe,  and  his  head  had  troubled 
him  for  several  months.  The  trephine  was  applied  over  the 
fissure  of  Rolando  on  the  left  side,  over  the  " motor  area" 
for  the  arm  and  leg,  and  an  opening  six  centimetres  long  was 
made,  through  which  the  membranes  of  the  brain  were  in- 
cised. This  was  followed  immediately  by  the  escape  of  four 
tablespoonfuls  of  large,  blackish  clots.  After  the  operation 
the  patient  improved  rapidly,  and  in  a  month  most  of  the 
symptoms  had  disappeared. 

Drs.  Bremer  and  Carson,  of  St.  Louis  ("American  Journal 
of  the  Medical  Sciences,"  February,  1892,  p.  134),  and  Drs. 
Homans  and  Walton,  of  Boston  ("Boston  Medical  and  Sur- 
gical Journal,"  February  12,  1891),  have  published  cases  hi 
which,  also  without  external  signs,  such  clots  have  been  ac- 
curately located  and  removed  with  success.  In  the  latter 
case  there  was  evidence  of  an  injury,  but  the  clot  was  on  the 
opposite  side  of  the  head. 

Case  VI.  Mental  Disorders. — I  shall  now  add  a  case  in- 
volving the  centres  for  mental  processes,  hi  the  establishment 
of  which  vivisection  has  done  but  little,  for  reasons  already 
explained,  but  a  case  of  great  interest  and  value. 

If  the  reader  will  look  at  Fig.  1,  and  will  find  the  fissure  of 
Sylvius  and  follow  it  to  its  upper  end,  he  will  see  that  this 
end  terminates  hi  a  A-shaped  convolution  between  the  in- 


182 


ADDRESSES   AND   OTHER   PAPERS. 


traparietal  and  the  external  parieto-occipital  fissures.  In 
this  portion  of  the  brain  have  been  located  certain  menta[ 
processes,  including  the  ability  to  recognize  objects  and  their 
uses.  The  location  of  this  convolution  of  the  brain  can  be 
made  with  almost  the  same  accuracy  as  that  of  the  fissure 
of  Rolando. 

The  following  case  of  Macewen,  of  Glasgow  ("British 
Medical  Journal,"  August  11,  1888,  p.  306),  will  illustrate 
the  accuracy  of  this  localization.  A  year  before  Dr.  Mac- 
ewen saw  him  the  patient  had  received  an  injury  which 
had  resulted  in  melancholia.  Though  formerly  a  happy 
husband  and  father,  he  now  repeatedly  contemplated  the 

murder  of  his  wife  and  children. 
There  were  no  phenomena  con- 
nected with  motion  in  any  part  of 
the  body  by  which  the  injury  could 
be  located ;  but  it  was  discovered 
by  that  careful,  close  investigation 
for  which  this  surgeon  is  so  well 
known  that,  immediately  after  the 
accident,  for  two  weeks  he  had 
suffered  from  what  is  called  "psy- 
chical blindness,"  or  "mind-blind- 
ness"; that  is  to  say,  his  physical 

sight  was  not  at  all  affected,  but  his  mind  was  not  able  to  in- 
terpret what  he  saw.  I  presume  he  was  a  stanch  Scotch 
Presbyterian.  He  knew  that,  as  was  customary,  his  New 
Testament  was  lying  by  his  side,  but  when  he  looked  at  it  he 
was  utterly  unable  to  recognize  it.  While,  however,  his  men- 
tal sight  was  thus  affected,  his  sense  of  touch  was  perfect, 
and  when  he  passed  his  hand  over  the  smooth  leather  cover 
of  his  well-known  book  and  felt  the  deep-indented  letters  on 
the  back  he  recognized  it  as  his  familiar  friend ;  but  when  he 
opened  it,  the  printed  words  were  unknown  symbols  to  him. 
This  gave  to  Macewen  the  key  to  the  injury.  He  located  on 


Fig.  6. — Side  view  of  the 
human  brain.  The  shaded 
area  shows  where  the  bone 
pressed  on  the  A -shaped  an- 
gular gyrus.  (Macewen.) 


VIVISECTION   AND   BRAIN   SURGERY.  183 

the  outside  of  the  skull  this  A-shaped  convolution  (Fig.  6, 
shaded  area),  known  as  the  "angular  gyms,"  and  found,  on 
removing  a  button  of  bone,  that  a  portion  of  the  inner  layer 
of  the  bone  had  become  detached  and  was  pressing  on  the 
brain,  one  corner  of  it  being  embedded  in  the  brain  substance. 
The  button  of  bone  was  removed  from  the  brain,  and,  after 
removing  the  splinter,  was  replaced  in  its  proper  position. 
The  man  got  well,  and,  although  still  excitable,  lost  entirely 
his  homicidal  tendencies  and  returned  to  work. 

Case  VII.  Epilepsy. — If  I  were  to  gather  together  the 
operations  which  have  been  done  for  epilepsy  since  we  have 
been  able  to  locate  the  centres,  especially  for  motion,  I  should 
perhaps  have  to  record  150  cases  or  more.  The  great  major- 
ity of  these  patients  have  recovered  from  the  operation,  or, 
in  surgical  parlance,  have  made  an  "operative  recovery," 
but  in  a  very  large  proportion  the  disease  has  returned,  gen- 
erally, however,  with  a  lessened  intensity.  In  a  small  pro- 
portion recovery  has  taken  place  from  the  disease  itself. 
But  it  is  evident  that  as  cerebral  surgery  covers  practically 
only  the  last  eight  or  ten  years,  it  is  much  too  early  to  for- 
mulate definitely  a  statement  of  what  the  results  may  be 
when  a  longer  time  has  elapsed. 

In  the  "American  Journal  of  the  Medical  Sciences"  for 
December,  1891,  Dr.  Charles  K.  Mills,  of  Philadelphia,  has  re- 
ported the  case  of  a  young  lady  twenty-seven  years  of  age, 
who  suffered  for  some  time  from  numbness  and  a  sense  of 
weight  in  the  left  hand,  arm,  and  foot.  After  about  five 
years  these  attacks  developed  into  distinct  epileptic  fits,  and 
had  become  extremely  frequent  at  the  time  when  Dr.  Mills 
first  saw  her,  in  November,  1890.  The  attacks  occurred 
both  in  the  daytime  and  at  night,  and  were  as  frequent  as  ten 
to  fifteen  in  the  twenty-four  hours.  Dr.  Mills  himself  often 
saw  them.  The  left  arm  was  first  raised,  the  motion  be- 
ginning in  the  shoulder  and  including  also  the  elbow.  From 
this  the  attack  extended  over  the  entire  body.  On  the  out- 


184 


ADDRESSES   AND   OTHER   PAPERS. 


side  of  the  head,  after  it  had  been  shaved,  absolutely  nothing 
was  found  which  could  be  a  guide  to  the  site  of  the  trouble. 
The  diagnosis  was  some  source  of  irritation  the  character  of 
which  was  unknown,  but  which  was  located  on  or  in  the  cen- 
tre for  the  left  shoulder.  Accordingly  the  fissure  of  Rolando 
was  mapped  out  on  the  shaven  head,  and  a  button  of  bone 
an  inch  and  a  half  in  diameter  was  removed,  the  centre  of 
which  was  an  inch  and  three-quarters  to  the  right  of  the 
middle  line.  Fig.  7  shows  the  button  of  bone,  the  inner  sur- 
face being  uppermost.  The  bone  was  very  thick,  from  five 

to  seven-sixteenths  of  an  inch, 
and  was  also  very  dense.  As 
soon  as  the  bone  was  removed, 
a  small  tumor  resembling  in 
shape  a  minute  bunch  of  grapes 
was  found,  the  apex  of  the  tumor 
being  within  one-sixteenth  of  an 
inch  of  the  point  where  it  was  be- 
lieved to  exist.  By  its  pressure  it 
had  produced  several  pits  on  the 
inner  surface  of  the  bone,  and 
these  holes,  as  well  as  the  groove 
for  a  large  blood-vessel  which 
supplied  the  tumor  with  blood, 
are  well  shown  in  the  middle  of 
the  button.  The  tumor,  with 

the  membrane  of  the  brain  to  which  it  was  attached,  was 
removed,  and  the  battery  was  then  applied  to  the  brain 
immediately  underneath  it.  Fig.  8  shows  the  fissure  of 
Rolando  as  a  line  running  downward  and  forward  across 
the  circle.  The  circle  represents  the  button  of  bone  re- 
moved, and  the  numbers  1  to  4  represent  the  points  at 
which  the  poles  of  the  battery  were  applied  to  the  brain.  On 
stimulating  the  brain  at  the  point  marked  1,  movements 
of  the  arm  at  the  shoulder  and  elbow  were  reproduced;  and 


Fig.  7.— The  button  of 
bone  removed  in  Case  VII. 
The  pits  in  the  bone  were  pro- 
duced by  the  tumor.  They  were 
almost  precisely  in  the  centre  of 
the  button,  and  thus  show  how 
exactly  the  tumor  was  located. 
(Mills.) 


VIVISECTION   AND   BRAIN   SURGERY.  185 

again  at  point  2  precisely  the  movements  of  her  attacks  fol- 
lowed. This  point  was  the  portion  of  the  brain  pressed  upon 
by  the  tumor.  Along  with  the  movements  of  the  shoulder 
at  point  1  the  elbow  was  involved,  and  at  point  2  it  was  found 
that  the  hip  and  knee  were  both  flexed,  and  the  entire  leg 
carried  away  from  its  fellow,  the  toes  and  foot  being  extended. 
It  was  very  evident,  then,  that  point  1  corresponded  to  the 
shoulder  and  elbow  centres,  and  point  2  corresponded  to  the 
upper  edge  of  the  shoulder  centre  and  also  to  the  edge  of  the 
leg  centre.  Excitation  at  point  3  was  followed  by  more  de- 


Fig.  8. — The  brain  in  Case  VII.  The  circle  shows  where  the  button 
of  bone  was  removed,  and  the  growth  found  almost  exactly  at  the  centre 
of  the  button.  (Mills.) 

cided  movements  of  the  lower  arm,  and  at  point  4  the  leg 
alone  moved,  the  shoulder  not  being  involved. 

Could  any  better  illustration  be  found  of  the  accuracy  of 
localization?  The  leg  centre  here,  when  compared  with  the 
leg  centre  in  Fig.  1  of  the  monkey's  brain,  is  found  exactly 
where  it  ought  to  be,  the  arm  centre  directly  below  it,  with 
the  shoulder,  elbow,  wrist,  and  hand  movements  precisely 
in  the  same  relative  positions  as  in  the  monkey's  brain.  Un- 
fortunately the  lady  has  not  been  cured.  But  the  fits  have 
been  greatly  moderated,  so  that  when  the  case  was  reported, 


186  ADDRESSES    AND    OTHER   PAPERS. 

nearly  a  year  after  the  operation,  she  had  usually  only  about 
three  attacks  in  the  twenty-four  hours  instead  of  ten  or  fif- 
teen, and  the  attacks  had  never  attained  the  same  severity 
as  before  the  operation.  Moreover,  after  the  operation,  In 
about  half  the  attacks  she  did  not  lose  consciousness,  and  so 
was  far  less  exposed  to  the  danger  of  falling  down  stairs,  into 
the  fire,  and  other  similar  perils  to  which  epilepsy  with  un- 
consciousness exposes  a  patient. 

Case  VIII. — Another  case,  which  is  fortunately  more  favor- 
able in  its  result,  is  published  in  the  "Medical  News"  of  April 
12,  1890.  A  little  boy,  six  and  a  half  years  old,  at  the  age  of 
fourteen  months  fell  about  ten  or  twelve  feet  from  a  hay-mow 
upon  a  plank  flooring.  He  was  unconscious  for  some  tune. 
No  decisive  evidence  of  injury  could  be  found  either  on  his 
head  or  other  parts  of  his  body,  but  from  his  prolonged  un- 
consciousness it  was  presumed  that  he  had  struck  his  head. 
Soon  after  this  accident  his  disposition  changed  materially 
for  the  worse.  He  became  irritable,  obstinate,  and  ill  tem- 
pered, and  very  frequently  kicked,  bit,  and  scratched,  and 
offered  other  violence  to  his  playmates.  His  room  had  to  be 
padded,  his  clothes  had  to  be  sewed  on  him  every  morning, 
and  he  would  kill  any  small  animals,  such  as  cats  or  chickens, 
that  came  hi  his  way.  When  two  and  a  half  years  old  his 
first  epileptic  fit  occurred.  He  had  from  three  to  six  attacks 
a  day,  with  some  intervals  of  comparative  freedom.  His 
father,  an  intelligent  clergyman,  estimated  that  in  the  four 
years  since  his  epilepsy  began  he  had  had  over  five  thousand 
fits!  Of  these,  about  eighty  per  cent,  began  hi  the  right 
hand.  The  attacks  were  observed  with  great  care  in  the 
Jefferson  Medical  College  Hospital  by  a  special  nurse,  and 
the  statement  of  his  father  that  they  usually  began  hi  the 
right  hand  was  verified.  When  the  attacks  began  the  child 
had  a  vocabulary  of  about  forty  words,  but  gradually  these 
were  reduced,  word  by  word,  until  his  speech  consisted  only 
of  three  words  and  a  little  jargon,  the  words  being  "papa," 


VIVISECTION   AND   BRAIN   SURGERY.  187 

"mamma,"  and,  characteristically  "no,"  rather  than  "yes." 
Examination  of  the  head  revealed  nothing  that  could  locate 
any  injury;  but  as  the  attacks  began  so  constantly  in  the 
right  hand,  it  was  resolved  to  remove  the  centre  for  this  part 
of  the  body,  in  the  hope  that  if  the  fits  were  prevented  at 
their  initial  spot  they  would  not  begin  elsewhere.  The  fis- 
sure of  Rolando  was  first  located,  then  the  position  of  the 
hand  centre  was  marked,  and  a  disk  of  bone  an  inch  and  a 
half  in  diameter  was  removed.  The  membranes  of  the  brain 
were  then  opened,  and  the  brain  itself  exposed.  Nothing 
abnormal  was  perceptible  either  by  eye  or  by  touch.  The 
battery  was  applied  to  the  portion  of  the  brain  exposed,  pro- 
ducing movements  of  the  hand,  showing  that  the  centre  had 
been  correctly  mapped  from  the  outside  of  the  skull.  Ex- 
citation of  the  brain  further  upwards  produced  elbow  move- 
ments (elbow  centre).  These  centres  were  therefore  exactly 
where  they  ought  to  lie,  as  shown  hi  the  monkey's  brain  (Fig. 
1).  The  portion  of  the  brain  that  moved  the  hand  was  then 
removed,  and  when  the  battery  was  applied  to  the  parts 
around  it,  it  was  found  that  all  the  centre  for  the  hand  and 
wrist  had  been  removed. 

The  boy  made  a  speedy  recovery  from  the  operation.  Three 
years  have  now  elapsed  since  the  operation.  Most  of  the 
tune  he  has  been  and  still  is  in  Misses  Bancroft  and  Cox's 
School  for  Feeble-minded  Children,  at  Haddonfield,  New 
Jersey.  He  has  had  there  very  painstaking  care,  and  to 
this  is  to  be  attributed  very  much  of  his  mental  improvement. 
During  the  last  six  months  of  1892  he  has  had  only  one  at- 
tack for  about  every  sixty  before  the  operation.  This  im- 
provement can  be  attributed  only  to  the  good  effects  of  the 
operation. 

Case  IX. — The  third  and  last  case  to  which  I  shall  refer 
has  not  been  published,  but  can  be  found  hi  the  records  of  the 
Orthopedic  Hospital  and  Infirmary  for  Nervous  Diseases  in 
Philadelphia,  Record  Book  S.  9,  p.  123.  A  young  girl  of  about 


188 


ADDRESSES   AND    OTHER   PAPERS. 


FISSURp  OF 

RPIAKDO 


twenty-one  was  admitted  to  the  infirmary  in  October,  1891. 
She  said  that  her  attacks  of  epilepsy,  from  which  she  had 
suffered  for  two  years  and  a  half,  always  began  in  the  right 
thumb.  This  fact  having  been  verified,  it  was  decided  to 
remove  the  centre  for  the  thumb,  for  the  same  reason  as  hi 
the  last  case, — i.  e.,  to  stop  the  very  beginning  of  the  fit.  It 
was  especial!}7  desired  to  remove  only  the  centre  for  the 
thumb,  and  not  that  for  the  hand,  in  order  not  to  interfere 
more  than  was  necessary  with  the  usefulness  of  her  hand, 
upon  which  she  depended  for  her  support,  as  she  was  a  mill 

girl.  This  was  an  unusual  and 
minute  attempt  at  localization, 
and  a  very  severe  test  of  the  ac- 
curacy of  the  mapping  of  the  brain 
by  vivisection.  On  October  6, 
1891,  the  fissure  of  Rolando  was 
first  located,  and  a  disk  of  bone  an 
inch  and  a  half  in  diameter  was 
removed,  the  centre  of  it  being 
two  and  five-eighths  inches  to  the 
left  of  the  middle  line.  Both  the 
bone  and  the  brain,  when  exposed, 
seemed  to  be  normal.  The  fissure 
of  Rolando  was  seen  crossing  the 
middle  of  the  opening,  downwards 
and  forwards  (Fig.  9).  By  the  bat- 
tery the  brain  was  stimulated  at  certain  definite  points  until 
the  thumb  centre  was  recognized,  and  also  the  face  centre, 
which  lay  somewhat  below  it,  and  the  wrist  centre,  which  lay 
— as  shown  by  experiments  on  the  monkey's  brain — a  little 
above  it.  Each  of  these  centres  was  recognized  by  the  move- 
ment of  the  part  supplied  by  it  (thumb,  face,  wrist)  when  the 
centre  was  touched  by  the  poles  of  the  battery.  Stimulation 
of  the  thumb  centre  produced  a  typical  epileptic  fit,  such  as 
she  had  suffered  since  her  admission,  beginning  in  the  thumb, 


Fig.  9. — The  circle  rep- 
resents the  opening  in  the 
skull  disclosing  the  thumb 
centre  almost  at  its  middle. 
The  shaded  area  represents 
the  part  of  the  brain  which 
was  removed. 


VIVISECTION   AND   BRAIN    SURGERY.  189 

as  she  had  asserted.  The  portion  of  brain  corresponding  to 
the  thumb  centre,  a  piece  about  half  an  inch  in  diameter,  was 
removed,  and  by  the  battery  it  was  determined  that  the  por- 
tion removed  was  the  whole  of  the  thumb  centre.  She  re- 
covered promptly  and  without  disturbance  from  the  opera- 
tion. 

It  was  necessary  in  this  case  to  be  unusually  accurate,  and 
not  to  remove  any  portion  of  the  brain  other  than  the  centre 
for  the  thumb,  and  for  three  reasons:  First,  if  too  much 
were  removed  upwards  and  backwards,  the  wrist  and  fingers 
would  be  paralyzed;  second,  if  too  much  were  removed  for- 
wards, the  muscles  of  the  face  would  be  involved ;  third,  a 
little  further  down  lies  the  centre  for  speech,  and  had  this 
part  of  the  brain  been  injured,  this  important  faculty  would 
have  been  destroyed,  thus  producing  serious  and  unneces- 
sary trouble. 

Note  now  the  accuracy  of  experimental  cerebral  localiza- 
tion. As  soon  as  the  patient  had  recovered  from  the  ether 
and  was  hi  a  suitable  condition,  her  ability  to  move  the  face 
and  hand  was  tested.  All  the  muscles  of  the  face  were  en- 
tirely intact,  and  could  be  moved  with  absolute  ease.  Her 
speech  also  was  unaffected.  She  had  absolute  and  perfect 
control  of  all  the  muscles  of  the  shoulder,  elbow,  wrist,  and 
hand,  with  the  single  exception  of  the  muscles  of  the  thumb, 
every  one  of  which  was  paralyzed.  In  order  to  understand 
how  curious  this  paralysis  is  hi  relation  to  the  thumb  centre 
hi  the  brain,  the  reader  must  observe  that  only  a  small  piece 
of  the  brain,  half  an  inch  square,  was  removed,  whereas  the 
muscles  of  the  thumb  lie  as  follows:  some  of  them  in  the 
ball  of  the  thumb  on  the  hand,  one  between  the  thumb  and 
forefinger,  one  on  the  front  of  the  forearm  reaching  almost 
to  the  elbow  (the  great  flexor  of  the  last  joint  of  the  thumb), 
and  three  of  them  on  the  back  of  the  forearm,  extending  half- 
way from  the  wrist  to  the  elbow;  and  yet  the  removal  of  so 
small  a  portion  of  the  brain  paralyzed  these  muscles  of  both 


190  ADDRESSES   AND   OTHER   PAPERS. 

widely  different  situation  and  widely  differing  functions 
(flexion,  extension,  abduction,  adduction,  and  circumduc- 
tion). 

By  June,  1892,  she  had  entirely  recovered  the  strength  of 
her  thumb,  as  shown  by  the  dynamometer,  both  sides  then 
registering  the  same  number  of  degrees. 

This  history  illustrates  one  of  the  most  curious  problems 
of  cerebral  surgery.  The  removal  of  any  portion  of  the  motor 
region  of  the  brain  is,  of  course,  followed  by  palsy  of  the 
part  of  the  body  supplied  by  that  brain  centre ;  but  though  I 
have  frequently  removed  portions  of  the  brain,  I  have  never 
yet  seen  this  paralysis  permanent.  I  have  seen  a  right  hand 
wholly  paralyzed  after  such  an  operation,  and  in  three  months 
it  had  regained  its  strength  and  dexterity  sufficiently  to  en- 
able its  owner  to  play  baseball.  But  while  this  is  true  of  the 
careful  removal  of  small  parts  of  the  brain  by  operation,  the 
wide-spread  in  juries  which  result  from  accident  are  not  sel- 
dom followed  by  extensive  palsies  which  remain  throughout 
life.  In  the  case  just  related  not  only  has  strength  re- 
turned equally,  but  such  delicate  movements  as  are  involved 
in  the  use  of  a  needle  have  been  preserved,  or  rather  restored. 
Usually,  however,  weakness,  to  a  greater  or  less  extent,  will 
remain  in  the  part  of  the  body  controlled  by  the  portion  of 
brain  removed.  Whether  there  is  actual  reproduction  of 
brain  tissue  or  not  is  as  yet  uncertain,  because  after  such 
operations  there  have  been  almost  no  deaths  at  a  period  suf- 
ficiently remote  to  enable  us  by  post-mortem  examination  to 
determine  whether  such  a  reproduction  has  occurred  or  not. 
It  is  possible  that  the  similar  centre  on  the  opposite  side  of 
the  head  is  capable  of  doing  double  duty;  for  although  nor- 
mally the  right  side  of  the  brain  controls  and  moves  the  left 
side  of  the  body,  and  vice  versa,  yet  apparently  there  is  a 
latent  power  which  when  necessary  is  called  into  play,  and 
enables  the  right  side  of  the  brain  to  innervate  and  control 
the  same  side  of  the  body  as  well  as  the  opposite  side,  just  as, 


VIVISECTION   AND   BRAIN   SURGERY.  191 

for  instance,  the  left  hand,  which  is  unused  to  writing,  can 
acquire  the  faculty  of  writing  if  the  right  hand  loses  it. 

There  has  also  been  performed  a  very  remarkable  opera- 
tion on  animals  which  may  hereafter  produce  important  re- 
sults. Several  experimenters  have  opened  the  heads  of  two 
dogs  (both  under  an  anesthetic,  and  both  as  carefully  and 
as  tenderly  cared  for  as  any  human  being  could  be,  the  opera- 
tions being  attended  with  but  little  pain,*  as  they  were  done 
with  the  most  careful  antiseptic  precautions),  have  taken  a 
bit  of  the  brain  from  the  head  of  each  dog  and  transferred  it 
to  that  of  the  other  dog.  The  pieces  so  transferred  have 
grown  hi  place,  and  have  caused  at  least  no  mischief.  Whether 
it  will  ever  be  possible  to  transfer  brain  tissue  from  the  lower 
animals  to  man,  and  whether  if  so  transferred  it  will  properly 
perform  its  function,  are  problems  as  yet  unsolved.  It  would 
be,  I  think,  unwise  to  test  its  effects  in  man  except  as  applied 
only  to  the  motor  regions  at  first,  for  we  have  every  reason 
to  believe  that  the  motor  cells  in  an  animal's  brain  subserve 
precisely  the  same  function  as  the  motor  cells  in  the  human 
brain.  Moreover,  nothing  of  this  kind  would  ever  be  done 
excepting  perhaps  in  case  of  an  accident  where  a  considerable 
portion  of  the  human  brain  was  destroyed,  when  possibly 
this  loss  could  be  made  good  from  an  animal's  brain.  It  is 
unnecessary,  however,  to  discuss  this  question  at  present,  for 
all  the  facts  hi  the  case,  the  needful  precautions  to  be  taken, 
and  all  the  possible  results,  must  first  be  determined  in  much 
greater  detail  and  by  much  larger  experimentation  on  animals 
than  has  yet  been  done  before  it  will  ever  be  considered  in 
man.  But  it  is  not  at  all  impossible  that  in  this  way  we  may. 
see  hereafter  one  of  the  most  brilliant  achievements  of  mod- 
ern cerebral  surgery. 

*  Most  operations  on  the  brain  are  followed  by  very  little  pain,  and 
sometimes  it  may  truthfully  be  said  by  none.  It  is  not  an  uncommon 
result  for  the  patient  to  take  no  medicine,  or  at  most  a  single  small  dose 
of  an  anodyne  on  the  first  day,  be  out  of  bed  in  three  to  five  days,  and 
entirely  weli  in  a  week  or  ten  days. 


192  ADDRESSES   AND    OTHER   PAPERS. 

But  we  must  return  again  to  our  last  patient,  for  her  sub- 
sequent history  as  to  her  epilepsy  is  quite  as  interesting  as, 
and  to  her  no  doubt  even  more  important  than,  the  con- 
dition of  her  thumb.  On  December  17,  1891,  seven  weeks 
after  the  operation,  she  had  one  slight  attack.  January  13 
and  30,  1892,  there  were  two ;  then  she  had  none  until  March 
12th;  another  very  slight  one  came  on  May  19th;  and  the 
last  to  date  were  two  on  July  8th  (a  slight  one)  and  10th, 
making  in  all  seven  attacks  in  eight  months.  The  intervals, 
therefore,  were  growing  longer,  and  the  attacks,  as  a  rule,  were 
less  severe,  while  before  the  operation  the  attacks  were  grow- 
ing more  severe  and  far  more  frequent,  for  at  the  tune  she 
entered  the  infirmary  they  were  tending  to  become  daily.* 

The  antivivisectionists  constantly  parade  the  few  physi- 
cians who  are  in  accord  with  then-  views,  and  by  frequent 
reappearances  make  an  apparent  army  upon  the  stage.  As 
a  matter  of  fact,  Mr.  Lawson  Tait  is  the  only  one  who  has  an 
international  reputation ;  the  rest  are  but  little  known.  Even 
Mr.  Tait  recently  changed  his  views,  and  in  a  speech  in  favor 
of  the  objects  of  the  British  Institute  of  Preventive  Medicine, 
which  are  largely  attained  through  vivisection,  has  declared 
that  "bacteriological  experiments  on  animals  had  proved 
of  great  value."  What  the  real  opinion  of  the  medical  pro- 
fession of  Great  Britain  is  as  to  the  value  of  vivisection  is  seen 
by  the  following  resolution,  which  was  passed  in  August,  1892, 
at  the  Nottingham  meeting  of  the  British  Medical  Associa- 
tion, and  passed  unanimousty.  The  weight  of  such  an  au- 
thority can  be  best  measured  when  I  state  that  it  is  the 
largest  and  most  important  association  of  physicians  in  the 
world,  and  numbers  over  15,000  members,  including  most 
of  the  distinguished  men  of  the  profession  in  Great 
Britain. 

*  Since  this  was  written  her  attacks  have  become  somewhat  more  fre- 
quent, but  are  still  far  less  frequent  and  severe  than  before  the  operation. 


VIVISECTION  AND   BRAIN   SURGERY.  193 

"Resolved,  That  this  general  meeting  of  the  British  Medical  Associa- 
tion records  its  opinion  that  the  results  of  experiments  on  living  animals 
have  been  of  inestimable  service  to  man  and  to  the  lower  animals,  and 
that  the  continuance  and  extension  of  such  investigations  is  essential  to 
the  progress  of  knowledge,  the  relief  of  suffering,  and  the  saving  of  life." 

I  have  thought  it  worth  while  not  to  content  myself  with 
broad  assertions  that  experimentation  on  animals  has  en- 
abled us  to  locate  with  absolute  accuracy  the  various  motor 
functions  and  to  some  extent  the  other  functions  of  the 
brain ;  but  to  any  doubting  Thomas  I  would  simply  say :  See 
any  brain  operation  of  this  character,  and  you  cannot  fail  to 
be  convinced  of  its  humanity  and  propriety. 


13 


MEDICAL  EDUCATION.* 


MR.  PRESIDENT  AND  GENTLEMEN  OF  THE  HARVARD  MEDICAL 
ALUMNI  ASSOCIATION  : 

I  ONLY  wish  that,  in  accordance  with  your  President's 
introduction,  I  could  rise  to  a  height  of  a  great  argument ; 
but  I  must  be  satisfied  as  nature  built  me.  I  am  very  glad, 
I  assure  you,  to  bring  to  you  the  greeting  of  your  Philadelphia 
brethren.  The  marble  doorsteps  of  Chestnut  Street,  so  cele- 
brated by  Dickens,  greet  the  gilded  dome  on  Beacon  Hill, 
where  the  descendants  of  the  Pilgrims  and  the  Puritans  "  live 
and  move  and  have  their  beans."  It  is  well  known  that  all 
of  the  streets  grow  grass  in  profusion;  and  Philadelphia  some- 
times, by  a  sepulchral  description,  is  said  to  be  a  well  "laid 
out"  city.  But  I  assure  you  that,  when  we  get  together 
such  lively  corpses  as  Mitchell  and  Wood  and  Pepper  and 
Hare  and  Goodell  and  Wilson  and  Montgomery,  we  have  a 
very  good  time. 

Your  President  was  kind  enough,  in  his  note  asking  me 
to  be  present  on  this  happy  occasion,  to  propose  that  I  should 
speak  on  the  subject  of  Medical  Education.  It  is  possibly  a 
well-worn  theme,  especially  before  you,  who  have  such 
elaborate  reports,  and  I  am  glad  to  say  such  encouraging 
reports,  from  year  to  year  of  the  progress  of  this  great  School; 
but  there  are  still  some  points  of  value,  it  seems  to  me,  which 
we  can  consider  here.  I  remember  very  well  indeed,  in  the 
days  of  the  elder  Gross,  hearing  ad  nauseam  of  medical  educa- 

*  An  address  delivered  at  the  Dinner  of  the  Harvard  Medical  Alumni 
Association,  June  26,  1894.  Reprinted  from  the  Bulletin  of  the  Harvard 
Medical  Alumni  Association,  June,  1894. 

194 


MEDICAL   EDUCATION.  195 

tion  and  the  progress  that  we  ought  to  make, — bushels  of 
talk  and  thimblefuls  of  action;  but,  after  all,  when  you 
consider  it,  these  discussions,  though  they  led  at  that  time 
to  very  meagre  action,  were  not  without  their  results,  and 
great  results,  too.  They  were  slowly  leavening  the  whole 
lump  of  the  profession.  They  gradually  made  the  profession 
the  support  of  all  the  progress  that  we  have  seen;  and  I  am 
sure  that  the  medical  schools,  even,  I  believe,  Harvard 
University  itself,  would  never  have  taken  the  remarkable 
steps  in  advance  which  the  last  few  years  have  witnessed, 
had  it  not  been  for  that  very  constant  talk,  that  very  constant 
working  of  the  leaven  throughout  the  profession.  I  trust 
the  profession.  I  trust  them  profoundly.  They  have  ever 
been  better  in  that  respect  than  the  schools  till  of  late. 

There  has  been  certainly  a  remarkable  wave  of  progress 
passing  over  this  country  in  the  matter  of  medical  education 
in  the  last  few  years.  It  has  been  demonstrated,  first  of  all, 
by  the  creation  of  State  Boards  of  Health,  and  especially  by 
the  noble  Illinois  State  Board  of  Health,  a  body  which  has 
done  more  for  medical  education  than  any  other,  I  believe, 
in  this  country,  because  it  fixed  an  advanced  standard. 
These  boards  now  have  been  established  in  almost  all  the 
States;  and  they  have  been  followed  by  a  still  more  notable 
advance, — namely,  the  establishment  of  State  Boards  of 
Medical  Examiners,  wholly  independent,  as  they  ought  to  be, 
of  the  medical  schools  themselves.  Again,  another  very 
remarkable  indication  is  that  our  universities  and  colleges 
all  over  the  land  are  establishing  distinct  courses  leading  up 
to  those  of  the  various  professional  schools,  medicine  among 
them.  And  what  does  this  mean  but  that  the  medical  schools 
want  better  men,  and  that  the  colleges  are  going  to  furnish 
them?  In  addition  to  this,  another  important  indication  in 
the  same  direction,  which  Dr.  Langmaid  has  just  alluded  to 
is  the  establishment  for  the  first  time  of  a  section  of  Medical 
Pedagogics  in  connection  with  the  Pan-American  Medical 


196  ADDRESSES   AND   OTHER   PAPERS. 

Congress.  I  hailed  with  great  delight  another  similar  indica- 
tion in  the  programme  of  the  American  Surgical  Association 
last  month  in  Washington,  on  seeing  that  one  of  the  leading 
papers  by  the  distinguished  gentleman  who  will  address  you 
later,  our  friend  Dr.  Billings,  of  Washington,  D.  C.,  was  entitled 
"Methods  of  Teaching  Surgery."  It  developed  what  to  my 
mind  was  one  of  the  most  fruitful,  and  to  me  personally  one 
of  the  most  useful,  debates  that  was  ever  held  in  that  body. 

Dr.  Billings  considered  in  that  address  three  points, — who 
were  to  be  taught,  what  was  to  be  taught,  and  how  it  was 
to  be  taught.  The  very  scope  of  his  paper,  perhaps,  pre- 
vented consideration  of  what  is,  I  think,  of  as  much  importance 
as  the  methods  of  teaching;  namely,  the  men  who  teach.  I 
would  like  much  to  see  delivered  before  all  of  the  boards  of 
trustees  of  our  medical  schools  in  this  country  (and  I  think 
the  faculties  might  benefit  quite  as  much)  a  course  of  lectures 
on  "  How  to  Conduct  a  Medical  School,  and  Who  Ought  to  be 
Made  Professors  in  it."  Trustees  should  not  select  men  be- 
cause they  are  their  friends,  nor  because  they  are  their  family 
physicians,  nor  because  they  are  related  to  them  in  any  way; 
but  there  should  be  one  sole  requisite  for  the  position  of  a 
teacher — that  he  should  be  the  best  and  most  capable  man 
to  teach. 

Moreover,  I  should  be  very  sorry  indeed  to  see  the  day  when 
the  practitioner  and  the  professor  are  to  be  divorced.  I  do 
not  know  anything  that  is  more  enlivening,  that  renders  a 
man's  lectures  more  juicy,  more  meaty,  than  to  have  the 
varied  experiences,  the  successes,  the  failures,  the  perplexi- 
ties, and  the  responsibilities  of  an  active  practice.  These 
very  men  on  the  benches  before  him  are  the  men  who  are  to 
follow  him  and  his  colleagues  in  the  actual  practice  of  the 
profession;  and  what  they  want  is,  not  only  science,  but  the 
applications  of  science  to  everyday  practice.  I  care  not  what 
the  department  is,  be  it  chemistry,  be  it  anatomy,  be  it 
pathological  anatomy,  be  it  any  of  even  the  purely  scientific 


MEDICAL   EDUCATION.  197 

departments  (except  possibly  physiology),  if  a  man  wants 
to  teach  it  in  a  live  way,  in  a  way  that  will  make  the  knowledge 
stick,  in  a  way  that  will  make  it  interesting  and  attractive 
instead  of  a  dry  statement  of  facts,  he  must  make  the  appli- 
cation of  almost  every  fact  in  his  scientific  teaching  to  prac- 
tice, he  must  show  their  practical  bearings  by  cases  drawn 
from  his  own  practice.  Along  with  that,  however,  I  believe 
that  the  time  will  come  when  the  men  who  are  professors 
in  our  schools  and  at  the  same  time  practitioners  will  largely 
change  their  methods  of  practice.  A  man  who  is  engrossed 
in  a  very  large  private  practice  often  finds  it  difficult  to  give 
that  amount  of  time  which  the  newer  education  and  the 
newer  methods  of  instruction  of  classes  in  small  sections 
require;  and  I  believe  that  in  the  future  the  professors  in 
our  medical  schools  will  be  more  and  more  restricted  in  their 
practice  until,  eventually,  they  will  practise  in  the  hospital, 
give  their  lectures,  and  do  little  or  no  outside  practice.  This 
will  require,  of  course,  very  much  larger  salaries  than  now 
can  be  given,  where  the  income  of  the  school  is  derived  from 
fees;  and,  in  order  to  do  this,  it  is  requisite  to  have  large 
endowments  of  the  medical  schools. 

You  all  know  the  great  need,  the  crying  need,  of  our 
medical  schools  at  the  present  day  is  larger  and  more  thorough 
laboratory  facilities;  and  that  means  immense  sums  of  money. 
I  do  not  know  anything  more  striking  than  the  figures  given 
by  Professor  Welch  in  a  recent  address,  in  which,  collecting 
all  the  statistics  from  the  medical  schools  for  1893,  he  showed 
that  independently  of  buildings,  I  believe,  the  permanent 
investments  yielding  revenues  to  medical  schools  in  this . 
country  were  but  little  over  $600,000,  and  the  endowments 
yielding  revenues  to  theological  schools  were  $17,600,000.  I 
believe  thoroughly  in  taking  care  of  the  souls  of  the  com- 
munity; but  I  put  it  to  you,  and  through  you  to  the  com- 
munity, gentlemen,  whether  there  is  not  a  vast  disproportion 
in  the  discharge  of  a  duty  that  the  public  owes  to  medical 


198  ADDRESSES   AND    OTHER   PAPERS. 

education  in  a  country  where  we  cannot  depend  upon  State 
aid,  when  they  have  only  given  a  paltry  $600,000  to  us 
as  contrasted  with  the  millions  for  theological  instruction. 
Observe  that  these  figures  apply  only  to  medical  schools, 
and  not  to  hospitals;  for  to  them  the  community  has  been 
wonderfully  and  praiseworthily  generous.  But,  strange  to 
say,  though  they  have  given  many  millions  for  hospitals, 
their  gifts  to  create  a  profession,  to  educate  the  men  who 
are  to  take  the  care  not  only  of  the  patients  in  these  hospitals, 
but  of  their  own  wives  and  children,  have  been  but  little  over 
a  half  million.  It  is  a  wonderful  lack  of  perception — percep- 
tion of  the  fitness  of  things;  nay,  perception  of  the  necessity 
of  things — that  the  community  does  not  see  that  it  is  quite 
as  much  their  duty  to  create  the  facilities  to  make  better 
doctors  as  to  help  the  invalid  and  injured  poor. 

I  think  another  of  the  most  important  things  in  connection 
with  such  professors  in  the  medical  schools,  and  one  that 
ought  to  be  a  duty,  is  that  of  visiting  other  great  medical 
centres  than  their  own,  and  seeing  other  men,  surgeons  and 
physicians,  bacteriologists  and  pathologists,  chemists  and 
clinicians,  do  their  work.  I  do  not  know  anything  that  is 
more  inspiring  to  me,  or  anything  that  I  learn  more  from 
than  a  day  in  Baltimore,  a  day  in  New  York,  a  day  in  Boston, 
from  time  to  time,  when  I  see  other  men  at  work,  and  I  gain 
many  an  idea,  many  a  good  point,  many  a  wrinkle  that  serves 
me  when  I  am  caught  in  some  case  of  great  perplexity.  It 
ought  to  be  a  duty,  as  well  as  a  pleasure,  to  every  teacher  to 
go  and  see  other  men  teach ;  and  he  will  learn  one  of  two 
things,  either  how  to  teach  better  or,  in  some  cases,  how  not 
to  teach. 

There  are  a  number  of  points  that  I  had  noted  that  I  should 
like  to  consider  at  present,  but  I  find  that  the  time  is  slipping 
by,  and  I  must  confine  myself  only  to  one  or  two.  Allusion 
was  made  in  Dr.  Billings's  address,  as  I  said,  to  the  students 
who  are  to  be  taught.  I  think  it  is  a  matter  of  great  impor- 


MEDICAL   EDUCATION.  199 

tance,  in  considering  the  requirements  for  admission  (a  sub- 
ject which  has  also  been  alluded  to  both  in  the  report  of  your 
Executive  Committee  and  of  the  President),  that  the  good 
work  at  the  threshold  of  medicine  should  be  carried  further. 
I  am  glad  to  congratulate  you,  gentlemen,  on  the  fact  that 
it  is  being  so  nobly  carried  on  by  Harvard  University.  I  do 
not  know  a  better  indication  for  the  future  of  the  medical 
profession  in  this  country  than  the  very  fact  that  was  alluded 
to  by  Dr.  Langmaid  a  moment  ago — of  the  increased  require- 
ments for  admission  to  be  exacted  in  1896  in  this  ancient 
and  honorable  School.  Now,  it  is  perfectly  true,  as  has  been 
urged  and  as  was  urged  anew  in  Washington,  that  we  must 
remember  that  medical  education  is  for  the  average  medical 
student,  that  it  is  for  the  medical  students  who  are  going 
to  the  country  crossroads  as  well  as  the '.  men  who  are 
going  to  settle  on  Beacon  Street,  or,  rather,  perhaps  I  ought 
to  say  on  Boylston  Street.  We  must  remember,  however, 
that  Harvard  College  can  afford,  gentlemen,  to  take  an  ad- 
vanced stand.  She  can  afford  to  do  so,  because  she  is  Harvard 
College,  because  she  can  set  the  pace  in  this  matter.  You 
need  not  fear  that  there  will  not  be  all  over  the  country  other 
schools  that  will  educate  the  crossroads  doctor, — plenty  of 
them.  They  will  spring  up — nay,  they  have  sprung  up — 
almost  in  every  hamlet,  and  a  good  many  of  them  have  died; 
and  the  more  that  die,  the  better.  As  a  matter  of  fact,  there 
will  always  be  enough  of  those  who  will  educate  men  for  the 
lower  strata;  but  there  ought  to  be  some  colleges — and 
Harvard  University  should  be  one  of  those  colleges,  and  I  am 
glad  to  say  that  it  is  one — that  will  educate  the  very  best 
doctors.  I  believe  it  will  be  only  a  short  time  when  you  will 
fling  your  banner  to  the  breeze,  and  say  that  A.B.  or  its 
equivalent  shall  be  the  absolute  requirement  for  admission 
to  the  Harvard  Medical  School. 

I  am  not  one  of  those  who  would,  at  the  present  time  at 
least,  unduly  lengthen  our  course.    I  alluded  a  moment  ago 


200  ADDRESSES   AND   OTHER   PAPERS. 

to  the  wave  of  medical  improvement  that  had  swept  over 
our  methods  of  education.  One  of  the  best  evidences  of  this 
is  the  large  number  of  colleges  within  the  very  last  few  years 
— nay,  within  the  last  two  years — that  are  urging  and  insist- 
ing upon  a  four  years'  medical  course.  It  was  but  last  week, 
in  reading  the  medical  journals,  that  I  found,  away  off  in 
distant  Oregon,  that  the  State  Board  of  Medical  Examiners 
had  issued  notice  that  after  1898  no  person  would  be  admitted 
to  practice  in  the  State  of  Oregon  who  had  not  had  four  years 
of  medical  study.  We  must  look  to  it  that  in  the  East  we  are 
not  outdone  by  the  West.  Not  only  our  medical  colleges,  but 
our  State  Boards,  must  exact  such  a  large  and  wise  require- 
ment as  that,  or  we  will  be  overrun  with  the  horde  of  doctors 
that  cannot  find  a  place  in  the  West. 

Among  the  methods  of  study  I  can  only  allude  to  two. 
One  is  that  we  have  not  in  this  country  at  all  such  service 
as  there  is  abroad  by  the  Chefs  de  Clinique.  It  may  possibly 
exist;  but  I  am  not  personally  aware  of  such  instruction  to 
practitioners  as  draws  not  only  students  from  all  parts  of 
our  own  country,  but — as  I  hope  will  not  be  far  hence — from 
Europe  as  well.  Only  the  other  day  I  was  reading  a  report 
by  Dr.  Laurent,  of  Brussels,  on  the  medical  .schools  of  this 
country.  He  remarked  in  the  very  beginning  of  it  that  some 
people  thought  there  was  not  very  much  to  be  learned  from 
this  country;  but  he  added  very  significantly,  "On  marche 
la-bas  a  pas  de  geant."  I  believe  that  these  giant  strides 
will  soon  carry  us  to  a  position  such  that  men  from  abroad 
will  be  able  to  come  here  and  get  in  our  own  schools  ex- 
actly the  teaching  that  many  of  us  have  had  in  Paris  or 
Vienna  or  Berlin  from  the  Chefs  de  Clinique,  or  from  men  who 
occupy  similar  positions  here.  Its  use  in  training  the  chefs 
themselves  as  clinical  teachers  would  by  no  means  be  its  least 
useful  function. 

Second,  a  great  deal  has  been  said  of  late  in  reference  to 
the  value  of  recitation  as  opposed  to  didactic  instruction. 


MEDICAL   EDUCATION.  201 

Now,  I  believe  thoroughly  in  recitations,  I  am  glad  to  see 
that  Harvard  has  established  them.  I  believe  they  ought 
to  be  official;  that  is  to  say,  compulsory.  Every  man  of  the 
class  should  go  before  the  examiner  from  day  to  day,  and  not 
merely  before  the  professor  for  an  examination  at  the  end 
of  his  term;  and  he  should  be  marked  by  this  official  quiz- 
master, and  his  standing  be  determined  by  his  recitations  as 
well  as  by  his  final  examination.  But,  gentlemen,  I  do  not 
believe  that  the  time  will  ever  come  when  the  living  voice, 
and  the  personality  of  the  speaker,  will  be  discontinued  and 
forgotten.  I  shall  never  forget,  for  instance,  one  story  that 
was  told  by  dear  old  Charles  D.  Meigs,  whom  you  remem- 
ber, perhaps,  as  being  rather  worsted  in  the  fight  with  Dr. 
Holmes  over  the  contagiousness  of  puerperal  fever.  It  was 
an  illustration  to  emphasize  the  point  which  he  wished  to 
inculcate  in  his  obstetrical  lectures,  that  the  child  should  be 
put  to  the  breast  very  early.  He  gave  a  description,  which 
I  will  not  attempt  to  rival, — for  it  is  one  of  the  most  beautiful 
pieces  of  poetry  in  prose  that  I  ever  heard, — of  the  birth  of 
Cam.  He  pictured  the  beautiful  bower  to  which  Eve  retired 
and  the  pains  that  she  suddenly  felt,  which — for  it  was  a 
novel  experience  to  her — she  thought  must  be  due  to  some 
grapes  that  she  had  eaten  the  day  before  that  had  disagreed 
with  her.  Finally,  she  fainted  away  for  a  moment.  Then, 
on  waking,  she  found  her  slippery  little  Cain,  and,  lifting  him 
up  in  surprise  in  her  arms,  he  fell  into  nature's  cradle,  and 
immediately  took  the  breast.  It  was  a  very  simple  little 
story,  but  it  was  beautifully  told;  and  to  this  day,  more  than 
thirty  years  since,  it  is  as  fresh  to  me  in  its  grace  and  in  its 
lesson  as  it  was  then.  And,  again,  I  shall  never  forget  the 
power  of  Samuel  D.  Gross.  When,  in  lecturing  on  diseases 
of  joints,  he  began  with  the  question  of  treatment,  looking 
round  the  amphitheatre  very  quietly,  he  said,  "The  first 
requisite  in  the  treatment  of  inflammation  of  a  joint  is  rest," 
then  after  a  pause,  "rest";  and  then,  rising  to  his  full  height 


202  ADDRESSES   AND    OTHER   PAPERS. 

and  folding  his  arms,  he  bent  majestically  forward,  and  re- 
peated, "In  the  name  of  God,  REST."  Now  you  might  read 
that  ten  times  in  a  book,  and  forget  it  the  next  minute;  but 
once  hear  it  from  the  lips  of  Gross,  with  his  tall  form,  fine 
figure,  and  handsome,  earnest  face,  and  I  would  defy  you 
ever  to  forget  it. 


THE  ADVANTAGES  OF  AN  ACADEMIC  TRAIN- 
ING FOR  A  MEDICAL  CAREER.* 


r  I  ^HE  time  is  rapidly  approaching  when  all  over  the  coun- 
JL  try  our  colleges  will  send  forth  several  thousand  young 
men  to  begin  their  active  work  in  life.  The  necessity  for  a 
wise  decision  as  to  what  shall  be  each  man's  career  needs 
no  comment. 

The  Editor  of  the  "  Brown  University  Magazine"  has  asked 
me  to  present  to  its  readers  some  of  the  advantages  which 
attend  an  academic  training  before  entering  upon  a  medical 
career.  Before  doing  so,  however,  I  must  add  a  word  of  com- 
mendation of  the  excellent  work  of  the  Brown  University 
Medical  Association,  which  has  done  so  much  to  foster  the 
medical  idea  among  the  students  of  the  University,  and  to 
suggest  changes  and  improvements  in  the  college  curriculum 
which  adapt  it  to  the  requirements  of  future  students. 

As  a  teacher  of  surgery  for  now  just  thirty  years,  I  feel 
that  I  may  speak  with  some  confidence  as  to  these  advantages, 
and  it  is  with  no  little  pleasure  that  in  my  own  case  I  have 
always  recognized  the  fact  that  whatever  success  may  have 
attended  either  my  writing,  my  practice,  or  my  teaching 
has  been  due  chiefly  to  the  training  I  received  in  my  dear 
Alma  Mater.  The  logical  acumen  of  Chace,  the  inspiration 
from  Lincoln,  the  rhetorical  grace  and  fine  criticism  of  Dunn, 
the  historical  generalizations  of  Gammell,  and  the  extraor- 
dinary knowledge  of  Sears  all  had  a  most  influential  part  hi 
forming  my  mind  and  shaping  my  subsequent  life.  I  can 

*  Reprinted  from  the  Brown  University  Magazine  for  April,  1896. 

203 


204  ADDRESSES   AXD   OTHER   PAPERS. 

never  be  grateful  enough  to  them  and  their  colleagues  in  the 
then  Faculty,  and  I  feel  it  is  but  a  very  small  repayment  on 
account  of  a  large  debt  when  I  can  do  anything  for  Brown 
University. 

That  college  men  take  precedence  of  others  who  have 
missed  such  invaluable  training  is  shown  by  the  statistics 
some  time  since  quoted  by  the  "Medical  Record."  Of  912 
physicians  deemed  worthy  of  notice  in  Appleton's  "  American 
Cyclopaedia  of  Biography,"  473  are  college-trained  men.  The 
"Record"  estimated  that  during  the  present  century  about 
300,000  men  have  entered  the  medical  profession.  Of  these, 
therefore,  nearly  1000,  that  is  about  1  in  300,  had  gamed 
more  or  less  prominence.  But  on  the  basis  of  there  being 
about  500  of  these  latter  who  were  college  men,  the  chances  of 
distinction  and  influence  for  a  college-bred  man  hi  medicine 
were  increased  from  1  in  300  to  1  in  60,  or  five  times  as 
great  as  if  he  had  not  had  such  intellectual  training. 

Never  has  there  been  a  time  when  the  demand  for  the  best 
and  ripest  intellect  in  medicine  was  more  pronounced  than 
at  present.  The  medical  horizon  is  broadening  most  rapidly. 
The  complexity  of  the  problems  constantly  presented  by 
disease  and  by  the  conditions  of  modern  social  life  and  the 
multiplicity  of  the  means  of  investigating  them;  the  logical 
methods  necessary  for  the  solution  of  these  problems;  the 
laboratory  facilities  which  are  required  to  that  end;  the 
relation  of  medicine  to  public  health  in  matters  of  sanitation 
both  for  the  individual  and  for  the  public,  in  peace  and  in 
war,  in  city  and  in  country,  all  attest  the  marvelous  activity 
of  the  medical  mind. 

To  anyone  about  to  enter  upon  such  a  life,  the  question 
will  naturally  occur:  what  are  the  requirements  for  such  a 
professional  career? 

They  may  be  stated,  I  think,  under  four  headings:  first, 
that  a  man  shall  have  a  strong  body  and  an  active  mind; 
secondly,  that  he  shall  have  the  ability  to  acquire  knowl- 


ACADEMIC  TRAINING   IN  MEDICINE.  205 

edge;  thirdly,  that  he  shall  have  the  ability  to  use  this 
knowledge;  and,  fourthly,  that  he  shall  have  the  ability  to 
impart  this  knowledge. 

As  to  the  first,  it  has  been  a  great  pleasure  to  me  in  the 
years  since  I  graduated  to  see  what  enormous  strides  have 
been  made  in  the  development  of  vigorous  bodies  hi  our 
college  men.  Saving  for  a  few  who  took  to  rowing  and  for 
some  sporadic  games  of  ball,  which  would  now  be  laughed 
to  scorn,  there  were  no  athletics  in  my  day.  A  few  men 
went  to  a  gymnasium  in  the  city,  but  the  great  bulk  of  stu- 
dents at  that  time  if  they  kept  their  health  were  fortunate. 
If  they  lost  it,  they  were  not  blamed,  though,  as  we  all  now 
know,  it  was  largely  their  own  fault.  But  I  am  thankful 
that  at  the  present  day  the  most  important  class  of  the 
future  citizens  of  the  republic,  from  the  intellectual  point  of 
view,  are  also  bound  to  be  the  strongest  and  best  from  the 
physical  point  of  view,  and  that  the  men  who  are  going  to 
influence  our  public  affairs  in  the  senate,  at  the  bar,  in  the 
pulpit,  in  engineering,  in  commerce,  and  at  the  bedside  are 
to  be  men  of  a  wholly  different  physique  from  those  of  thirty 
years  ago.  Moreover,  the  athletic  field  does  far  more  for 
men  than  merely  give  them  a  strong  body.  It  develops 
mental  and  moral  characteristics  of  the  highest  order  and 
the  greatest  importance  in  the  later  struggle  for  existence. 
But  to  the  students  of  a  college  whose  President  has  more 
than  once  declared  himself  convinced  of  the  importance  and 
value  of  athletics,  both  to  scholarship  and  health,  as  President 
Andrews  has  done,  it  is  not  necessary  for  me  further  to  enter 
upon  this  subject. 

The  strain  of  a  medical  life  is  very  severe.  The  loss  of 
sleep  during  many  continuous  hours  of  service  (and  the 
severer  and  more  responsible  the  case,  the  greater  the  like- 
lihood of  such  long  hours  of  endurance);  the  responsibility 
which  attaches  to  him  who  holds  a  human  life  in  his  hand; 
the  acute  nervous  strain  of  difficult  surgical  operations;  the 


206  ADDRESSES   AND    OTHER   PAPERS. 

need  of  constant  study  and  the  necessity  for  the  relinquish- 
ment  of  most  of  the  recreations  of  life,  all  require  that  the 
physician  should  be,  above  all,  a  strong  man  both  physically 
and  mentally,  or  he  will  be  in  one  respect  or  another  unequal 
to  the  task  set  before  him. 

II.  Let  us  turn,  however,  now  to  the  more  immediate  pro- 
fessional requirements,  for  it  may  be  well  said  that  strength 
of  body  and  alertness  of  mind  are  prerequisites  for  every 
calling.  In  many  years  of  teaching  I  have  seen  large  numbers 
of  students,  and  I  have  been  struck  with  the  great  differences 
in  their  ability  to  acquire  knowledge ;  not  only  that  personal 
difference,  which  one  may  say  is  inherited  in  nearly  all  men, 
but  in  their  mode  of  handling  intellectual  tools;  in  their  abil- 
ity to  grasp  and  master  ideas;  in  their  quick  comprehension 
of  logical  sequences;  in  their  correlation  of  ideas,  which  is 
but  another  way  of  saying  that  there  is  a  difference  in  seeing 
the  bearing  and  value  of  any  one  fact,  physical  sign,  or  medi- 
cal symptom,  a  faculty  which  one  man  will  possess  in  largest 
measure  and  another  in  least,  if,  indeed,  he  possesses  it  at  all. 
This  very  difference  in  the  ability  of  the  trained  mind  to  ac- 
quire more  knowledge  in  less  time  than  the  untrained  mind 
has  led  the  Jefferson  Medical  College  and  several  other  of  the 
leading  colleges  to  admit  students  with  a  University  degree, 
and  who  have  pursued  certain  studies  covering  largely  those  of 
the  first  year  in  medicine  as  well  as  the  last  year  hi  a  college 
course,  to  advanced  standing  in  the  second  year,  thus  requir- 
ing them  only  to  devote  three  years  to  their  technical  training, 
instead  of  four  years,  or,  including  the  college  course,  seven 
years  instead  of  eight. 

A  man  who  goes  through  Brown,  Princeton,  Harvard,  Yale, 
etc.,  is  furnished  with  a  knowledge  of  chemistry,  biology, 
physiology,  anatomy,  and  other  branches  such  that  he  has 
not  only  acquired  a  large  part  of  the  knowledge  of  the  first 
year  in  the  medical  school,  but,  above  all,  has  learned  how 
to  learn.  In  a  given  time  he  will  acquire  double  the  knowl- 


ACADEMIC   TRAINING   IN  MEDICINE.  207 

edge  that  the  man  fresh  from  the  counter  or  the  plough  or 
even  the  High  School  can  obtain.  More  than  this,  there  is 
developed  by  such  a  college  training  a  subtle  ability  to  dis- 
tinguish that  which  is  essential  from  that  which  is  incidental 
or  accidental,  which  enables  a  college  man  quickly  to  get  a 
broad,  fundamental  knowledge  that  the  non-trained  man  can 
never  get.  This  is  not  saying,  of  course,  that  there  are  no 
exceptions;  but,  as  we  all  know,  exceptions,  by  the  very  fact 
of  their  being  such,  prove  the  rule. 

Even  in  one  single  small  thing,  which,  however,  counts  for 
more  than  would  appear  upon  the  surface,  the  very  knowl- 
edge of  Greek  and  Latin,  from  which  the  vast  bulk  of  our 
medical  terms  are  coined,  facilitates  the  gaining  of  knowledge, 
and,  more  than  that,  gives  a  man  an  insight  into  the  real 
meaning  of  terms,  which  the  man  who  simply  takes  them 
memoriter  knows  nothing  about.  But,  happily,  academic 
studies  are  not  limited  now  as  formerly  to  the  narrow  range 
of  Latin,  Greek,  mathematics,  history,  logic,  rhetoric,  and 
their  allies,  but  have  widened  their  scope,  and  embrace  very 
many  of  the  scientific  branches  of  the  day.  Whatever  ad- 
vantage may  have  been  considered  to  arise  from  the  study  of 
Greek  and  Latin  as  means  of  training  the  mind  and  its  logical 
powers,  there  is  no  question  that  science  develops  power  of 
acute  observation  which  no  mere  literary  course  can  give; 
that  upon  these  facts  so  observed  is  built  a  series  of  logical 
propositions  as  technical,  as  difficult,  as  acute  as  any  that 
may  be  found  in  philosophy  or  literature.  The  men,  there- 
fore, who  come  from  our  colleges  to  the  study  of  medicine  have 
had  to  a  very  large  extent  their  powers  of  observation  and 
of  logical  deduction  developed  far  more  than  the  untrained 
minds  of  the  ordinary  country  or  even  city  young  man.  I 
know  of  no  one  who  needs  a  training  in  strict  logical  methods 
more  than  the  doctor. 

Anyone  who  follows  carefully  the  experiments,  reasoning, 
and  conclusions  of  Bernard  in  his  physiological  discoveries; 


208  ADDRESSES  AND   OTHER   PAPERS. 

of  Pasteur  in  his  brilliant  researches  on  the  diseases  of  the 
silkworm,  on  fermentation,  on  spontaneous  generation,  or 
on  hydrophobia;  or  of  Lister  in  his  search,  first  for  efficient 
and  then  for  better  antiseptic  methods,  can  reach  no  other 
conclusion  than  that  logic  can  handle  facts  as  well  as  ideas, 
and  that  mental  training  is  both  acquired  and  developed  in 
the  highest  degree  by  such  scientific  researches.  The  prob- 
lems of  bacteriology,  and  recently  the  questions  reaching 
even  to  the  very  constitution  of  matter  and  force  involved 
in  Roentgen's  discovery  of  the  z-rays,  demand  the  highest 
order  of  mental  equipment. 

It  must  be  observed  again  that  the  advantages  of  academic 
training,  while  I  am  endeavoring  to  state  them  especially  from 
the  view  of  the  prospective  medical  student,  endure  far  beyond 
that  period  of  life.  He  who  has  studied  the  humanities  under 
inspiring  teachers  has  had  developed  in  his  mind  a  love  of 
letters  and  appreciation  of  the  highest  and  best  and  noblest 
in  literature,  ancient  and  modern,  in  English,  in  foreign 
tongues,  in  prose  or  in  verse,  which  will  be  a  never-ending 
well-spring  of  joy  in  him.  If  he  becomes  a  successful  and 
busy  practitioner  in  any  branch  of  medicine  he  will  have  far 
too  little  time  to  give  to  those  studies  which  polish  the  mind 
and  adorn  the  character.  But  it  will  be  to  him  a  joy  that 
he  has  had  at  least  a  taste,  which  has  but  whetted  his  appetite 
for  more,  and  will  lead  him  to  steal  many  a  delightful  hour, 
even  from  sleep,  for  such  enjoyment.  He  will  be  none  the 
worse  a  doctor  if  he  can  read  an  ode  of  Horace,  or  a  page  of 
Homer,  nor  will  he  handle  the  scalpel  any  less  deftly  if  he 
knows  Shakespeare  by  heart  or  owns  a  well-thumbed  Goethe. 

III.  Having  acquired  a  certain  amount  of  learning  as  to 
the  fundamentals  of  medicine,  the  doctor  starts  out  on  his 
career.  However  great  or  small  his  scientific  acquirements, 
they  must  all  be  turned  to  the  final  cause  of  his  being  a 
doctor:  namely,  to  the  cure  of  his  patients.  How  does  a 
doctor  approach  this  problem,  which  awaits  his  solution  with 


ACADEMIC  TRAINING    IN    MEDICINE.  209 

every  patient  whom  he  sees?  There  are  four  stages.  First, 
the  facts  as  to  the  history  of  his  patient.  This  history  is  both 
personal  and  family.  He  not  only  wants  to  know  when  this 
present  illness  or  tumor  began,  and  the  symptoms  which  have 
attended  its  development,  but  what  was  its  cause — a  cause 
which  may  be  hidden  in  the  present  habits,  earlier  surround- 
ings, or  former  diseases  of  his  patients.  More  than  this,  so 
strong  is  the  influence  of  one  generation  upon  another  that 
a  large  number  of  diseases  are  dependent  upon  tendencies  in- 
herited from  ancestors ;  not  from  only  one,  but  it  may  be  even 
more  than  one,  prior  generation.  And  it  is  strange  how  very 
inaccurate  large  numbers,  even  of  intelligent  persons,  are; 
their  remembrance  of  facts  so  uncertain;  their  observation 
of  physical  conditions  so  vague  and  indefinite.  It  often  re- 
quires all  the  skill  in  cross-examination  that  is  expected  of 
an  acute  attorney  to  get  at  the  real  facts  of  the  case. 

When  these  are  set  in  order,  then  comes,  secondly,  the  phys- 
ical examination.  Here  nature  is  often  treacherous  and  jug- 
gles with  us,  even  on  the  edge  of  the  grave.  Touch,  sight,  and 
hearing  must  all  be  called  into  co-ordinate  energy,  and  all  be 
guided  by  a  clear,  logical  mind,  or  again  we  shall  not  get  the 
right  facts  as  to  the  physical  condition  of  the  patient.  The 
physical  signs  being  ascertained,  what  are  the  deductions  to 
be  drawn  from  them?  Here  comes  constantly  the  value  of 
academic  training.  Many  a  fact,  which  seems  at  first  glance 
to  be  important,  simply  because  it  is  upon  the  surface  and  is 
first  observed,  is  pushed  aside  at  once  by  the  logical  mind  of 
the  college-trained  man.  He  has  learned  by  long  experience 
how  to  see  through  the  superficial  to  the  deep,  through  the 
accidental  to  the  essential;  or,  it  may  be,  often  through  the 
mimicry  of  disease  to  the  true  disorder.  Having,  therefore, 
deduced  certain  logical  conclusions  as  to  the  malady,  or  in- 
jury, or  surgical  condition,  he  is  finally  prompt  in  the  selec- 
tion of  the  remedy,  whether  it  be  drug  or  diet  or  the  knife, 
and  his  decision  of  character  impresses  his  patients  with  a 

14 


210  ADDRESSES   AND   OTHER    PAPERS. 

confidence  in  his  skill,  which  a  friendly  and  a  kindly  demeanor 
enhances.  This  assures  him  success  in  his  profession. 

IV.  No  man  in  any  calling  of  life  can  live  alone;  nor  can 
the  doctor.  Even  with  his  very  first  patient  he  must 
use  tact  as  well  as  skill  clearly  to  set  forth  the  nature 
of  the  trouble,  and  the  need  for  the  regimen  or  operation 
he  advises,  or  to  satisfy  a  timid  patient  with  such  thoughtful 
and  guarded  statement  of  the  truth  as  will  not  needlessly 
alarm,  and  yet  will  invite  and  insure  obedience.  To  state 
this  accurately,  truthfully,  and  convincingly,  and  yet  not  too 
bluntly,  is  one  of  the  largest  elements  in  the  character  of 
a  successful  practitioner.  But  not  only  is  this  required  in 
relation  to  his  individual  patients.  He  must  impart  his 
knowledge  to  the  profession;  and  the  place  that  a  man  takes 
among  his  fellows,  both  of  his  own  calling  and  in  the  entire 
community,  depends  not  a  little  on  his  ability  to  set  forth 
his  ideas  clearly,  logically,  forcibly.  The  training  of  tongue 
and  pen  that  a  man  gets  in  Brown  University  is  simply 
invaluable  in  training  him  to  formulate  such  statements  of 
truth.  The  man  who  in  medical  societies  shows  that  his 
judgment  is  good,  that  he  is  familiar  with  the  literature  of 
the  subject,  that  he  knows  what  is  going  on,  that  he  is  pro- 
gressive and  keeps  up  with  the  times,  and  then  can  state 
his  views  in  a  forceful,  convincing  way,  becomes  a  man  of 
power;  a  man  whose  judgment  is  sought  for,  whose  advice 
is  asked  by  his  brother-practitioners.  And  it  does  not  take 
long  for  the  public  to  find  out  what  doctor  is  most  trusted 
by  other  doctors.  He  is  the  man  they  want  for  themselves. 

Such  papers  find  their  way  usually  into  our  medical 
journals,  which  stand  in  the  same  relation  to  the  more 
elaborate  and  systematic,  but  less  fresh,  books  which  are 
issued  from  the  medical  press  that  the  newspapers  do  to 
serious  works  of  history.  A  man's  reputation  is  built  up 
largely  on  the  papers  which  he  writes  and  presents  at  such 
societies  and  are  published  in  the  medical  journals;  and  all 


ACADEMIC   TRAINING   IN  MEDICINE.  211 

that  I  have  said  above  applies  to  such  published  papers,  and 
still  further,  of  course,  to  formal  statements  of  knowledge  in 
books.  The  wretched,  slovenly  style  that  one  often  sees  both 
in  journal  articles  and  books  is  not  surprising  when  we  con- 
sider how  relatively  few  men  there  are  who  cultivate  the 
rhetorical  graces  of  style.  As  Dr.  Billings  some  time  ago 
pointed  out,  even  the  very  title  of  a  paper  is  often  badly 
chosen.  If  I  am  searching,  for  instance,  for  all  the  published 
cases  of  gunshot  wound  of  the  kidney  for  the  purpose  of 
analyzing  them  and  determining  the  value  both  of  the  symp- 
toms and  the  physical  signs  and  of  the  methods  of  treatment, 
in  going  over  the  "Index  Medicus"  to  collect  the  recorded 
cases  am  I  likely  to  look  at  a  paper  which  may  relate  a  most 
interesting  and  important  case  of  gunshot  wound  of  the  kidney 
which  hides  it  under  the  vague  title  of  "Two  Interesting 
Surgical  Operations"?  The  title  of  a  paper  or  of  a  book  is 
like  the  name  of  a  man.  It  should  be  distinctive,  so  that  one 
may  always  refer  to  it  and  know  precisely  what  it  is  about. 

But  not  a  few  doctors  become  prominent  teachers.  The 
number  of  men  who  teach  in  any  one  of  our  medical  schools  is 
relatively  small,  yet  the  aggregate  number  of  teachers  in  the 
profession  is  very  large.  While  the  art  of  teaching  is,  to 
some  extent,  innate,  no  man  will  make  a  thoroughly  good 
and  successful  teacher  unless  he  has  had  more  or  less  of  such 
a  college  training.  The  ability  to  set  forth  his  ideas  in  logi- 
cal order,  in  natural  sequence,  passing  from  the  known  to  the 
unknown,  from  facts  to  deductions,  and  with  at  least  a  reason- 
able degree  of  rhetorical  grace  is  a  gift  which  is  susceptible 
of  the  greatest  possible  development  by  training.  Even 
great  geniuses  who  have  lacked  such  training,  such  as  John 
Hunter,  have  always  been  hampered  to  their  very  graves  by 
their  inability  to  express  themselves  in  graceful  and  yet 
forceful  English. 

I  might  go  further,  did  time  permit,  but  I  will  only  allude 
to  one  final  advantage,  as  it  seems  to  me,  of  a  college  train- 


212  ADDRESSES   AND   OTHER   PAPERS. 

ing,  and  that  is  on  the  moral  and  spiritual  side.  Whatever 
may  be  a  man's  relation  to  any  individual  religious  belief,  it 
is  scarcely  possible  for  him  to  go  through  the  four  years  of  a 
college  course  without  rising  to  a  higher  moral  plane,  with- 
out having  developed  within  him  the  spiritual  side  of  his 
nature  by  his  contact  with  earnest  men  of  various  faiths.  I 
would  trust  a  college  man  more  quickly  than  I  would  any 
other  man  morally  and  spiritually,  as  well  as  intellectually, 
for  I  believe,  though  there  are  vices  and  evil  influences  in 
every  college,  yet,  on  the  whole,  the  influence  of  a  college  We 
makes  for  righteousness  as  well  as  for  knowledge.  When  we 
reflect  that  the  physician's  influence  begins,  even  before 
birth  and  only  ends  with  the  grave  itself;  when  we 
consider  his  intimate  and  personal  sacred  relations  with  all 
the  members  of  a  family;  that  he  is  the  repository  of  facts 
which  he  must  no  more  disclose  than  the  listening  walls  of 
his  consulting  room;  when  we  consider  the  confidence  that 
is  bestowed  upon  him,  how  intimately  his  advice  affects  the 
whole  future,  not  only  physical,  but  intellectual  and  moral, 
of  so  many  of  his  patients,  surely  there  is  need  for  such 
a  man  to  live,  not  only  on  the  highest  intellectual  level,  but 
on  the  highest  moral  plane.  If  he  does  not,  he  is  unworthy 
of  the  noble  profession  which  he  ought  to  adorn. 


LITERARY  METHODS  IN  MEDICINE.* 


GENTLEMEN  : 

MY  subject  this  evening  is  "  Literary  Methods  in  Medi- 
cine," and  I  have  selected  it  for  this  reason:  I  well  re- 
member how  I  floundered  around  in  my  early  medical  career, 
and  the  many  mistakes  I  made,  until  I  finally  evolved  from 
my  own  experience,  together  with  suggestions  from  friends 
with  whom  I  talked  on  the  matter,  a  method  of  my  own. 
This  method  I  shall  describe  to  you,  and,  as  it  has  been  very 
satisfactory  to  myself,  I  think  it  may  be  of  use  to  you.  If 
you  will  look  in  the  "Medical  News"  for  August  12,  1893, 
you  will  see  a  similar  very  admirable  paper  by  Dr.  Bayard 
Holmes,  of  Chicago,  who,  so  far  as  I  know,  has  done  the  best 
work  in  this  country  with  a  view  of  urging  students  of  medi- 
cine and  doctors  to  follow  out  a  reasonable,  feasible,  and 
practical  method  of  making  their  knowledge  available,  first 
to  themselves,  and  secondly  to  others. 

I  purpose  to  speak  to  you  on  two  topics, — first,  "case- 
taking,"  and,  second,  the  writing  of  papers,  or  "case-using." 
I  would  be  very  glad  if  you  would  make  notes  as  we  go  along, 
as  I  think  they  will  be  useful  to  you  hereafter. 

I.  Case-taking. — Some  of  you  will  become  residents  in  the 
Jefferson  and  other  hospitals.  You  will  want  to  write  up  the 
history  also  of  your  private  cases,  and,  therefore,  you  must 
know  how  to  do  it. 

First,  record  the  name  of  the  person.  If  the  patient  is  a 
child,  always  record  the  father's  name,  or,  if  the  father  be 

*  A  lecture  delivered  before  the  W.  W.  Keen  Surgical  Society  of  the 
Jefferson  Medical  College.  Reprinted  from  International  Clinics,  vol.  i, 
seventh  series,  April,  1897,  by  permission  of  J.  B.  Lippincott  Co. 

213 


214  ADDRESSES   AND   OTHER   PAPERS. 

not  living,  the  mother's.  You  will  very  possibly,  years  later, 
want  to  find  out  the  after-history  of  the  patient.  A  child 
may  thus  be  reached  through  the  parents.  If  you  are  dealing 
with  a  married  woman,  record  her  husband's  name,  as,  if 
his  name  is  in  the  directory,  you  will  be  able  to  reach  him, 
and  through  him  the  wife.  Always  record,  also,  the  name  of 
the  family  physician  and  his  address,  so  that  you  may  obtain 
later  information  from  him.  Next,  note  the  residence,  then 
the  age,  and  then  the  occupation.  The  occupation  has  very 
often  a  great  deal  to  do  with  disease.  A  recent  case  in  the 
Jefferson  Hospital,  in  which  the  cause  of  necrosis  of  a  large 
part  of  the  pubic  bone  was  at  the  first  glance  inexplicable, 
is  a  good  illustration.  When  I  learned  that  the  man  worked 
in  an  iron  foundry,  and  used  an  iron  tool  with  a  long  handle, 
which  he  pushed  forward  by  the  pressure  of  his  body,  the 
cause  became  clear.  This  pressure  was,  of  course,  the  cause 
of  the  necrosis. 

I  remember  a  good  story  told  of  a  doctor  who  insisted  that 
his  patient  did  not  take  enough  exercise,  in  spite  of  the  man's 
protests  that  he  did.  Suddenly  he  asked  the  man's  occupa- 
tion. "Postman,  sir,"  was  the  unexpected  and  embarrassing 
though  convincing  reply. 

Next,  note  the  height,  and  then  the  weight,  so  as  to  deter- 
mine whether  the  person's  weight  is  out  of  proportion  to  the 
height,  and  whether  he  is  fat  or  thin.  Get  both  the  best 
weight  and  the-  present  weight.  If  a  year  ago  a  man  weighed 
one  hundred  and  forty  pounds  and  to-day  one  hundred 
pounds,  there  is  some  serious  trouble,  possibly  cancer  of  some 
of  the  digestive  organs  or  other  part  of  the  body.  The  loss 
of  weight  will  often  put  you  on  the  track  of  the  disorder. 
Inquire  into  and  record  the  patient's  habits  as  to  eating  and 
drinking,  and  especially  over-indulgence  in  either,  particu- 
larly as  to  alcohol,  and  often  into  his  sexual  habits  and  illicit 
indulgence. 

Having  recorded  these  preliminary  observations,  you  must 


LITERARY   METHODS   IN   MEDICINE.  215 

get  the  family  history,  to  see  whether  heredity  has  had  any- 
thing to  do  with  the  case.  Inquire  into  the  age  and  health 
of  the  patient's  father  and  mother  if  living,  or,  if  they  are 
dead,  how  old  they  were  and  the  cause  of  death;  also  the 
age  and  cause  of  death  of  the  grandparents,  as  well  as  of  the 
uncles  and  aunts  on  both  sides.  Ask  especially  as  to  tuber- 
culosis and  cancer.  In  this  way  you  may  determine  the 
question  of  heredity. 

Having  thus  obtained  the  family  history,  we  next  come 
to  the  personal  history.  You  will  first  inquire  what  prior 
illness  or  accident  the  patient  has  had.  You  will  very 
often  find  that  this  is  a  difficult  task.  You  must  have 
the  shrewdness  of  a  lawyer  in  cross-questioning  your  pa- 
tient in  order  to  determine  the  facts  of  the  personal  his- 
tory. As  an  illustration  of  this  I  may  mention  the  case  of 
a  little  girl  who  was  brought  to  my  clinic  at  the  Orthopedic 
Hospital  a  few  weeks  ago,  to  be  treated  for  curvature  of  the 
spine.  That  was  all  I  was  told  of  her  history.  I  asked  for 
more  data,  and  only  to-day  her  mother  remembered  that  a 
year  ago  she  was  subject  to  very  severe  attacks  of  pain, 
especially  in  the  right  iliac  fossa,  and  that  she  had  had  at 
that  time,  and  at  intervals  of  from  four  to  six  weeks  since, 
a  discharge  of  pus  from  the  vagina.  A  discharge  of  pus  from 
the  vagina  in  a  girl  of  seven  was  a  fact  of  prime  importance 
which  the  mother  had  entirely  neglected  to  tell  me  about. 

If  in  the  previous  history  there  is  noted  an  accident,  you 
will  want  to  inquire  particularly  into  the  details  of  that 
accident.  As  an  example  of  this,  a  man  may  tell  you  that  he 
had  a  fall  and  injured  his  head.  If  you  record  only  this,  you 
have  made  a  most  imperfect  record.  You  must  know 
whether  the  man  was  struck  severely  enough  to  tear  his 
scalp  or  fracture  his  skull;  whether  he  was  unconscious;  if 
unconscious,  when  he  came  to  himself,  and  whether  he  was 
able  to  get  up  and  walk  home,  as  well  as  what  later  symptoms 
were  observed.  All  these  details,  you  will  observe,  are  very 


216  ADDRESSES   AND   OTHER   PAPERS. 

important  for  you  to  obtain  in  connection  with  the  prior 
history  before  the  present  illness  began.  When  you  have 
to  do  with  a  woman,  you  will  wish  to  know  her  personal 
history  in  relation  to  her  sexual  organs;  when  menstruation 
began  and  its  character :  when  married;  how  many  children ; 
how  many  miscarriages;  whether  her  labors  were  normal  or 
instrumental;  whether  or  not  she  nursed  her  children; 
whether  or  not  she  has  had  any  trouble  with  her  breasts 
or  the  pelvic  organs.  These  facts  may  have  a  very  important 
bearing  on  the  history  of  your  patient.  In  both  sexes,  but 
especially  in  men,  you  must  inquire  as  to  syphilis,  acquired 
or  hereditary.  Here  your  ingenuity  and  tact  will  often  be 
taxed  to  the  utmost  to  get  at  the  truth.  If  the  facts  observed 
are  in  favor  of  a  syphilitic  history,  you  must  disregard  denials, 
but  you  will  record  both  the  denial  and  the  facts.  In  married 
women  you  must  often  avoid  the  direct  question,  and  reach 
the  facts  indirectly  by  inquiring  as  to  the  loss  of  hair,  sore 
throat,  sore  eyes,  blotches  on  the  skin,  etc.  In  all  cases 
observe  the  teeth  for  evidence  of  inherited  syphilis. 

Then  you  come  to  the  history  of  the  present  illness, — first, 
when  it  began,  and,  second,  how  it  began;  what  took  place 
at  the  beginning  of  the  illness,  and  whether  any  new  features 
have  developed  since;  whether  the  conditions  first  existing 
became  worse  or  better,  and  as  to  there  having  been  relapses. 
Next  you  wish  to  ascertain  and  describe  the  present  condition. 
Frequently  you  will  find  this  written  as  "S.  P.,"  meaning 
status  prcesens,  or  the  present  condition  of  the  patient.  You 
will  want  to  state  whether  the  patient  is  apparently  in  good 
or  ih1  health;  whether  there  is  any  evidence  of  long-con- 
tinued illness;  note  anything  that  strikes  you  particularly 
as  to  the  general  appearance  of  your  patient.  Then  begin  to 
describe  the  present  symptoms.  You  will  first  state  whether 
any  pain  exists  anywhere;  any  tenderness,  any  swelling, 
or  other  evidence  of  a  tumor.  When  you  have  described 
the  present  general  condition  and  symptoms,  you  will  wish 


LITERARY   METHODS   IN   MEDICINE.  217 

to  ascertain  the  local  conditions  and  the  physical  examination, 
as,  for  instance,  of  a  tumor  of  the  breast;  in  which  quadrant 
of  the  breast  it  exists;  if  the  nipple  is  retracted;  and  let  me 
say  here  that  if  it  is  not  retracted,  do  not  let  this  fact  pass 
without  comment.  It  is  important  to  state  negatives  as 
well  as  positives,  not  only  as  to  this,  but  many  other  condi- 
tions. State  if  there  is  any  discharge  from  the  nipple 
when  you  squeeze  the  breast.  If  there  is  a  lump,  you 
must  describe  the  size.  Do  not  say  it  is  as  big  as  an  apple 
or  the  size  of  a  cherry.  You  may  say  it  is  the  shape  of  a 
cherry  if  you  choose,  but  you  would  better  say  it  is  globu- 
lar. State  the  diameter,  whether  it  be  one  inch  or  two 
inches,  or  better  still  use  the  Metric  System.  You  feel  the 
tumor,  and  state  whether  it  is  hard,  elastic,  lobulated,  and 
whether  it  is  ulcerated.  In  that  way  you  give  to  the  reader 
of  your  paper  some  idea  of  what  you  find.  If  it  is  possible, 
always  give  the  circumference  as  well  as  the  diameter.  In 
the  case  of  a  goitre  or  other  tumor,  give  not  only  the  trans- 
verse and  the  vertical  measurements,  but  also  the  circumfer- 
ence from  one  side  to  the  other,  and  that  the  girth  of  the 
neck  was  so  many  inches.  If  possible,  use  French  centime- 
tres, as  this  is  much  better  than  English  inches. 

You  will  wish  to  preserve  any  photographs,  drawings, 
or  sketches  that  you  may  have  secured  in  connection  with 
the  case.  These  various  charts  that  I  show  you  are  very 
good  for  this  purpose.  These  are  "clinical  charts"  I  devised 
many  years  ago,  and  can  be  had  from  P.  Blakiston's  Son 
&  Co.  in  pads.  These  are  stencil  charts  in  use  at  the  Ortho- 
paedic Hospital.  In  the  case  of  tumors,  draw  an  outline 
of  them,  and  state  such  things  as  that  the  right  side  was 
dull  or  tympanitic,  etc. 

I  cannot  too  strongly  urge  that  you  should  make  a  care- 
ful, thorough  physical  examination  in  every  case.  Some 
time  ago  I  quickly  discovered  that  a  gentleman  had  a  can- 
cer of  the  rectum.  He  had  suffered  with  tenesmus,  pain, 


218  ADDRESSES   AND    OTHER   PAPERS. 

difficult  defecation,  and  blood  in  the  stools.  You  will 
scarcely  believe  me,  that  though  for  two  years  the  man 
had  suffered  in  this  way,  his  physician  had  never  once 
passed  his  finger  into  the  rectum!  If  he  had  done  so  he 
would  have  instantly  ascertained  that  the  man  had  a  can- 
cer. Another  example  was  that  of  a  gentleman  who  com- 
plained very  much  of  similar  symptoms  and  of  the  small 
diameter  of  the  stools,  they  being  no  larger  than  the  little 
finger.  No  examination  of  the  abdomen  had  been  made. 
On  examination  of  the  left  iliac  fossa  I  found  a  lump  there 
two  inches  in  diameter,  which  proved  to  be  a  cancer  of  the 
colon,  and  accounted  for  the  condition  present. 

Now  that  you  have  the  history,  what  will  you  do  with 
it?  Let  me  tell  you  my  own  method.  Different  surgeons 
and  physicians  pursue  many  different  methods,  more  or 
less  good.  My  own  method  is  one  that  has  been  evolved 
from  a  good  deal  of  experience,  and  has  served  not  only  my- 
self, but  many  of  my  friends.  Either  write  out  your  cases 
on  sheets  of  paper, — and  I  think  the  best  kind  is  the  legal 
cap, — or,  if  you  have  the  luxury,  dictate  them  to  a  stenog- 
rapher. File  them  alphabetically.  I  have  in  these  two  files 
my  cases  from  January  1,  1895,  to  January  1,  1896.  Com- 
monly I  use  two  of  these  in  a  year,  the  first  containing  the 
names  from  A  to  L,  the  second  from  M  to  Z;  They  are  called 
the  "  Shannon  binding  cases,"  and  may  be  obtained  of 
any  stationer.  The  notes  of  each  case  can  be  removed 
from  the  file  in  a  moment  without  disturbing  the  others. 
With  the  notes  I  file  photographs,  sketches,  or  diagrams 
of  the  case.  Unmounted  photographs  are  better  for  filing 
than  the  mounted.  When  an  operation  is  done,  write  up 
its  description  at  once,  so  as  not  to  forget  the  details. 
From  time  to  time  you  will  add  the  later  notes  to  com- 
plete the  history.  When  the  history  is  finished  I  file 
also  the  temperature  chart  and  any  other  additional 
records. 


LITERARY   METHODS   IN   MEDICINE.  219 

When  you  have  taken  these,  it  may  be,  elaborate  notes 
and  filed  them,  you  want  to  make  this  mass  of  notes  avail- 
able. You  must,  therefore,  index  them.  First  index  every 
case  by  name,  and  secondly  by  disease  or  operation  or  compli- 
cation. A  double  catalogue  is  therefore  indispensable.  The 
Library  Bureau  supplies  every  necessary  appliance  for  large 
and  small  libraries,  including  cards  of  a  uniform  size,  but 
varying  thicknesses  (I  always  use  a  medium  weight).  Neat 
cases,  holding  two,  four,  six,  or  more  drawers,  in  which 
the  cards  fit  exactly,  with  taller  cards  on  which  the  alpha- 
betical divisions  are  written  projecting  a  little  above  the 
other  cards,  are  placed  at  convenient  spaces,  to  enable  one 
readily  to  find  the  desired  card.  By  all  means  get  these 
inexpensive  cards  at  once.  The  case  holding  the  cards 
you  can  get  later,  when  your  patients  are  more  numerous 
and  your  purses  better  filled.  Simple  envelope  boxes  will 
answer  very  well  for  the  first  few  years.  Here  are  two 
drawers  from  my  own  card  catalogue  of  my  cases.  In 
the  first  are  the  names  of  all  the  patients  whose  histories 
I  have  from  A  to  L.  In  another  those  from  M  to  Z. 

They  are  indexed  under  A,  B,  C,  etc.,  and  are  then  sub- 
divided by  the  first  vowel  in  the  name.  Bates  would  be 
under  Ba,  Bloodgood  under  Bo,  and  so  on.  If  I  wish,  for 
example,  to  find  the  history  of  Harry  Fell,  I  turn  to  "Fell, 
Harry,"  and  find  his  case  recorded  as  "  right-sided  neurec- 
tomy  of  posterior  cervical  nerves,  1894";  then  I  go  to  my 
case  files  for  1894,  turn  to  F,  and  quickly  find  his  complete 
history.  To-day  a  patient  came  into  my  office  and  reported 
his  later  history  after  a  neurectomy  of  the  second  and  the 
third  divisions  of  the  fifth  nerve,  and  I  at  once  looked  up 
the  notes  and  added  this  information  to  the  history  in  order 
to  bring  it  up  to  date. 

But  you  not  only  want  your  cases  indexed  by  names, 
but  by  diseases,  operations,  or  complication.  I  have,  there- 
fore, another  set  of  drawers  with  cards  on  which  are  indexed 


220  ADDRESSES   AND   OTHER   PAPERS. 

all  my  cases,  classified  by  the  disease  or  the  operation,  or 
the  complication,  in  the  one  drawer  from  A  to  L  and  the 
other  from  M  to  Z,  and  subclassified  by  the  first  vowel  of 
each  disease  or  operation.  In  indexing  the  cases  on  this  set 
of  cards  I  will  often  index  the  same  case  under  two  or  three 
or  sometimes  even  more  headings.  Thus  an  aneurism  of  the 
popliteal,  for  which  I  ligated  the  femoral,  would  be  indexed 
under  "Artery,  popliteal,  ligation  of  femoral  artery  for  aneu- 
rism of,  John  F.  Smith,  1895,"— i.  e.,  in  the  file  for  1895; 
"Artery,  femoral,  ligation  of,  for  popliteal  aneurism,  John  F. 
Smith,  1895";  and  "Aneurism,  popliteal,  ligation  of  femoral 
artery,  John  F.  Smith,  1895."  If  I  removed  some  enlarged 
tuberculous  glands  of  the  neck,  and  was  obliged  in  the  course 
of  the  operation  to  ligate  the  jugular  vein,  I  would  index  it 
under  "Neck,  tuberculous  glands  of,  extirpation  of,  with  liga- 
tion of  jugular,  Peter  Jones,  1891,"  and  also  under  "Vein, 
jugular,  ligation  of,  during  removal  of  tuberculous  glands, 
Peter  Jones,  1891."  If  the  thoracic  duct  was  injured  during 
the  operation,  I  would  add  another  reference  under  "Tho- 
racic duct,  injury  of,  during  extirpation  of  tuberculous  glands, 
Peter  Jones,  1891."  In  a  moment,  by  turning  to  my  files 
for  1895  or  1891,  I  could  find  the  histories  of  Smith,  John  F., 
or  Jones,  Peter. 

If  I  want  to  write  a  paper  supplementing  that  of  Samuel  W. 
Gross  on  ligation  of  large  veins,  I  can  quickly  find  all  the 
data  I  possess  under  "vein,"  whether  it  be  the  "jugular," 
"axillary"  "femoral,"  or  any  other.  Each  of  these  large 
veins  would  have  its  own  card. 

Of  course,  this  method  means  a  good  deal  of  labor  and 
takes  a  great  deal  of  time.  It  pays,  however,  and  you  al- 
ways have  your  knowledge  available.  You  can  put  your 
hands  right  on  it,  and  is  far  better  than  to  trust  to  a  faulty 
memory.  Inevitably  you  will  forget  a  great  many  cases. 
Even  if  you  remember  them,  you  will  forget  the  salient 
points  you  would  have  noted  at  the  time. 


LITERARY  METHODS   IN   MEDICINE.  221 

Suppose  you  do  not  follow  such  a  system,  what  will  you 
have  to  do?  With  far  greater  labor  and  far  less  perfect 
results,  you  must  hunt  through  the  indexes  of  various  journals 
and  books  for  what  you  want.  Only  those  who  have  under- 
taken such  labor  know  what  patience,  diligence,  and  pains 
are  required  to  attain  what  you  wish,  and  then  most  imper- 
fectly. 

Let  me  beg  of  you  to  begin  this  or  some  other  system 
at  once.  The  moment  you  graduate  begin  taking  notes 
of  your  cases.  From  lack  of  such  a  system  a  large  num- 
ber of  cases  that  occurred  in  my  earlier  experience  have  been 
wholly  lost.  I  did  not  write  the  details  down  at  the  time. 

First,  therefore,  take  your  notes  carefully;  second,  file 
them  away;  third,  index  them  by  name;  and  fourth,  in- 
dex them  by  disease,  operation,  or  complication  in  the  way 
I  have  mentioned. 

Now,  how  will  you  use  them?  This  brings  us  to  the 
second  point. 

II.  Case-using. — You  can  refer  to  your  own  cases  very 
readily.  But  you  will  want  to  know  in  writing  any  particular 
paper,  what  other  surgeons  have  said  about  the  subject,  for 
there  have  been  wise  men  before  you.  You  must  know  what 
experience  they  have  had,  what  disasters  they  have  met 
with,  and  how  they  have  overcome  them,  for  this  will  act 
as  a  warning  and  also  as  an  encouragement  to  you.  You 
will  find  many  brilliant  ideas  new  to  you  that  were  known 
fifty  years  ago.  Unless  you  look  up  what  has  been  written 
by  your  predecessors  in  books  and  medical  journals  you 
will  often  be  brought  to  shame  and  grief. 

What  facilities,  then,  are  there  in  the  way  of  books? 
The  large  medical  libraries  of  the  country  are  practically 
found  in  only  five  cities.  First  and  foremost,  not  only  in 
this  country,  but  in  the  world,  is  the  library  of  the  Sur- 
geon-General of  the  Army  in  Washington.  Begun  during  the 
war,  it  has  now  grown  to  be  by  far  the  most  important 


222  ADDRESSES   AND   OTHER   PAPERS. 

medical  library  in  the  world,  and  it  is  made  splendidly  avail- 
able to  the  entire  profession.  At  any  time  that  I  wish  a 
book  not  in  this  city  I  can  get  it  from  Washington  by  a 
very  simple  process.  I  go  to  the  librarian  of  the  College 
of  Physicians  and  give  him  a  list  of  the  books  I  need.  He 
writes  to  Washington  for  them,  and  they  are  sent  not  to  me, 
but  to  the  library  of  the  College.  I  can  go  there  and 
spend  all  the  time  that  I  want  in  reading  them  over.  The 
surgeon-general's  library  is  free  to  the  entire  profession 
throughout  the  country.  All  I  have  to  do  is  to  pay  the 
expressage  both  ways;  there  is  no  fee  for  the  use  of  the 
books.  This  liberal  and  most  laudable  arrangement  was 
inaugurated  by  Dr.  John  S.  Billings.  Secondly,  we  have 
here  in  this  city  at  the  College  of  Physicians  the  next  most 
important  library.  It  is  a  magnificent  library,  larger  than 
any  other  medical  library  in  the  country  excepting  that 
of  the  Surgeon-General's  Office.  In  the  Pennsylvania 
Hospital  in  this  city  we  have  also  a  very  valuable  library 
as  far  as  it  goes,  although  it  is  not  as  large  as  that  of  the 
College  of  Physicians. 

If  you  are  in  or  near  New  York,  you  can  use  two  large 
libraries  there, — that  of  the  New  York  Hospital,  and,  still 
more  important,  the  library  of  the  Academy  of  Medicine.* 

In  Boston  you  can  use  the  library  of  the  Boston  Medical 
Library  Association,  which  is  one  of  the  most  valuable  in  this 
country.  In  Chicago  you  can  consult  the  books  of  the  New- 
berry  Library.  There  are  in  a  great  many  of  the  minor  medi- 
cal centres  small  local  libraries,  as,  for  instance,  in  Cleveland, 
where  there  has  recently  been  started  by  a  number  of  energetic 
doctors  the  beginning  of  a  very  excellent  library.f  I  hope 
one  of  the  first  things  you  will  do  will  be  to  join  with  your 
brother-physicians  in  starting  a  good  local  library.  All  of 

*  Since  this  address  was  written  (1897)  the  New  York  Hospital  Library 
has  been  given  to  the  Academy  of  Medicine. — (W.  W.  K.,  1905.) 
t  Many  other  local  medical  libraries  have  been  started  since  1897 


LITERARY  METHODS   IN   MEDICINE.  223 

these  libraries  have  card  catalogues  such  as  those  I  have 
described. 

Supposing  now  that  you  have  not  access  to  any  large  public 
library;  what  will  you  do?  First,  you  will  want  to  buy  the 
best  books  for  your  own  library.  Even  if  you  are  not  in- 
terested in  any  special  department,  but  are  general  practi- 
tioners, as  I  presume  most  of  you  will  be,  there  are  books  in 
many  special  departments  which  you  will  always  want  to 
buy  for  your  library  in  addition  to  such  as  treat  of  medicine, 
surgery,  gynaecology,  etc.,  in  general.  Some  of  you  who  can 
afford  it  will  do  this  readily,  others  less  quickly.  Every  one 
of  you  will,  I  hope,  found  somewhat  of  a  library.  The  man 
who  has  ten  books  is  only  one-half  as  good  as  he  who  has 
twenty, — and  has  read  them. 

Next,  with  regard  to  medical  journals.  If  you  read  Ban- 
croft's history  of  the  United  States,  and  after  that  McMaster's, 
you  would  have  some  knowledge  of  the  history  of  the  country, 
but  you  observe  that  your  history  would  date  back  to  when 
the  book  was  written.  So  in  text-books.  The  author  cannot 
issue  a  new  edition  every  year.  They  must  come  out  at 
certain  intervals  of  two  to  five  years  or  more.  Meantime, 
what  are  you  going  to  do?  There  is  constant  progress  going 
on,  and  you  must  keep  up  with  it.  You  keep  up  with 
civic  affairs  by  reading  the  newspapers,  and  the  newspaper 
is  to  history  what  the  medical  journal  is  to  medical  books. 
I  have  brought  quite  a  number  of  journals  in  order  to  say  a 
word  to  you  in  reference  to  them.  First,  take  your  local 
journal.  Never  mind  where  you  are,  always  take  the  journal 
in  your  own  neighborhood.  Very  likely  this  will  be  a  small 
journal,  and  will  not  give  you  all  the  information  you  need, 
so  you  must  take  some  others.  Let  me  point  out  to  you  a  few 
of  the  various  journals  which  I  take.  Of  course,  I  speak  only 
of  surgery,  and  no  other  department.  We  will  take  the 
American  journals  first.  Here  is  the  "Annals  of  Surgery," 
of  which  two  volumes  are  issued  annually.  In  this  you  get 
original  papers  and  a  very  admirable  review  of  the  surgical 


224  ADDRESSES   AND   OTHER   PAPERS. 

work  of  the  world.  I  get  as  much  out  of  this  as  any  other 
surgical  journal  I  see.  I  have  here  the  oldest  medical  journal 
in  the  world,  the  "American  Journal  of  the  Medical  Sciences," 
published  monthly  in  this  city.  This  is  volume  cxii,  which 
terminated  on  December  31.  Like  the  "Annals  of  Surgery," 
this  consists  of  original  papers,  reviews  of  books,  and  finally  a 
resume  of  the  more  important  recent  medical  papers.  Here 
is  another  journal  published  in  New  York,  the  "Medical 
News,"  of  which  I  have  here  a  single  weekly  number  and  a 
bound  volume.  In  this  there  are  original  papers,  proceedings 
of  medical  societies,  selections  from  other  journals,  etc.  This 
is  a  copy  of  the  "New  York  Medical  Record,"  a  weekly,  and 
this  is  one  of  the  bound  volumes  for  six  months  of  the  year. 
This  is  the  "New  York  Medical  Journal."  These  are  two 
excellent  journals,  both  of  the  same  type  as  the  "Medical 
News."  A  number  of  other  excellent  American  journals,  such 
as  the  "Boston  Medical  and  Surgical  Journal,"  the  "Inter- 
national Medical  Magazine,"  the  "Journal  of  the  American 
Medical  Association,"  the  "Medical  and  Surgical  Reporter," 
etc.,  I  see  regularly  in  a  small  "journal  club."  Here  are  two 
English  periodicals.  This  is  the  old  one  that  so  many  of  you 
are  familiar  with, — at  least  by  its  name,  now  a  happy  mis- 
nomer,— the  "Lancet."  This  is  the  "British  Medical  Jour- 
nal," and  these  two  are  the  best  journals  published  in  Great 
Britian,  not  only  for  surgery,  but  for  medicine,  obstetrics, 
gynaecology,  the  ear,  the  eye,  and,  in  fact,  every  department 
of  medicine.  They  are  universal  journals  in  that  respect. 

I  will  now  show  you  some  of  the  Continental  journals,  and 
this  leads  me  to  urge  you  all,  if  possible,  by  all  means  to  learn 
at  least  one  other  language  than  your  mother-tongue.  When 
you  have  acquired  another  language  you  have  doubled  your- 
self. If  you  have  an  opportunity  of  studying  only  one,  study 
German.  This  is  the  hardest  language,  perhaps,  but  it  is 
certainly  by  far  the  most  desirable  at  the  present  time  for 
papers  and  books  on  the  practice  of  medicine  and  surgery. 


LITERARY   METHODS   IX    MEDICINE.  225 

Add  French  to  German  if  at  all  possible,  for  there  is  much  that 
is  valuable  in  that  language.  Let  me  show  you  a  few  of  the 
foreign  journals  which  I  take  myself.  Here  are  single  num- 
bers of  the  "Deutsche  Zeitschrift  fur  Chirurgie"  and  the 
"Beitrage  zur  klinischen  Chirurgie,"  and  here  are  bound 
volumes  of  each.  This  is  another  one,  founded  by  the  great 
Langenbeck,  the  "  Archiv  fur  klinischen  Chirurgie,"  and  here 
is  one  of  the  volumes.  This  is  a  smaller  weekly  journal,  the 
"  Centralblatt  fiir  Chirurgie,"  which  has  often  one  important 
paper  at  the  beginning,  while  all  the  rest  consists  of  free  ab- 
stracts of  the  important  surgical  papers  of  the  world.  If  you 
take  only  one  German  journal,  this  is  the  one  I  would  advise 
you  to  take.  It  makes  one  large  volume  for  each  year.  In 
the  " Deutsche  medicinische  Wochenschrift,"  the  "Berliner 
klinische  Wochenschrift,"  the  "Wiener  medicinische  Wochen- 
schrift," and  the  "Wiener  Klinik"  you  will  find  many  im- 
portant contributions  to  medicine,  surgery,  obstetrics,  etc. 

In  French  literature  you  will  find  less  of  importance,  al- 
though there  is  a  good  deal.  I  take  these  two  journals,  the 
"Revue  de  Chirurgie"  and  the  "Archives  provinciales  de 
Chirurgie." 

When  you  first  enter  in  practice  you  most  probably  will  not 
be  able  to  subscribe  to  so  many  journals,  but  you  can  read  a 
number  of  them  at  small  expense  by  forming  a  "Journal 
Club  "  of  from  half  a  dozen  to  a  dozen  neighboring  doctors  who 
will  pay,  say  five  or  six  dollars  a  year  each.  With  this  money 
you  subscribe  to  as  many  journals  as  your  money  will  buy 
and  pass  them  from  week  to  week  around  the  club.  The 
journals  are  sold  to  the  highest  bidder,  to  whom  they  are . 
delivered  after  having  been  seen  by  all  the  club,  and  this  will 
add  to  the  receipts  of  the  club. 

Not  only  are  these  and  many  other  journals  of  value,  but 

you  will  find  "year-books"  in  which  are  gathered  all  the  more 

important  papers  of  each  year.     I  think  the  best  one  in  this 

country  is  the  "American  Year-book  of  Medicine  and  Sur- 

15 


226  ADDRESSES    AND   OTHER    PAPERS. 

gery."  It  is  a  large  book,  with  a  good  many  illustrations. 
This  is  the  volume  for  last  year.  It  consists  of  articles, 
criticisms,  and  suggestions.  One  who  reads  this  carefully  will 
keep  well  up  in  all  departments  of  medicine.  Every  year 
there  is  published  by  Dr.  Sajous  of  this  city  the  "Annual  of 
the  Universal  Medical  Sciences."  It  consists  of  five  volumes 
each  year,  and  I  have  brought  one  volume  as  a  specimen. 
"International  Clinics"  consists  of  four  volumes  a  year  of 
valuable  clinical  lectures  in  many  departments,  from  which 
you  will  gain  much. 

I  have  spoken  to  you  of  books,  of  journals,  and  of  year- 
books, but  you  cannot  be  expected  to  remember  all  of  the 
articles  you  read.  How  are  you  going  to  make  them  useful? 
Just  in  the  same  way  you  make  your  cases  useful.  Have  a 
second  card  catalogue  for  all  such  articles  and  books.  I  have 
brought  one  drawer  of  my  own  card  catalogue  along  to  show 
you  how  it  is  done.  I  saw,  for  example,  the  other  day  in  the 
"  Boston  Medical  and  Surgical  Journal,"  by  Higgins,  a  case  of 
Kraske's  operation  for  imperf orate  rectum.  In  the  "  Medical 
News"  I  soon  came  across  a  second  by  Elliot,  and  the  case 
I  myself  operated  on  the  other  day  is  the  third  case.  Im- 
mediately that  I  read  the  first  two  I  catalogued  them  under 
"Rectum,  imperf  orate,  Kraske's  operation  for,"  giving  the 
author,  the  journal,  the  volume,  year,  and  page.  I  also  cata- 
logued them  under  "  Kraske's  operation  for  imperf  orate  rec- 
tum." When,  then,  I  had  such  a  case  myself,  in  a  moment  I 
could  refer  to  all  the  prior  cases  I  had  seen  recorded,  and  thus 
learn  the  advantages,  the  disasters,  and  the  results  of  prior 
cases,  and  embody  them  in  any  paper  I  may  wish  to  write,  and 
in  my  daily  work  can  avail  myself  of  the  experience,  both 
favorable  and  unfavorable,  of  my  predecessors,  and  if  possible 
improve  upon  their  methods.  Sometimes  I  do  not  have  time 
to  read  the  articles  at  the  moment,  but  I  catalogue  them. 
If  I  have  occasion  thereafter  to  refer  to  the  topic,  I  can 
find  the  paper  and  can  immediately  get  access  to  it  and  read 


LITERARY   METHODS   IN   MEDICINE.  227 

it.  In  this  catalogue  I  follow  the  same  plan  that  I  do  with 
my  cases.  If  during  a  reported  operation  on  the  neck  the 
internal  jugular  was  divided,  I  would  catalogue  that  under 
"Vein,  jugular,"  and  also  under  "Neck,  glands  of."  In  that 
way  I  not  only  catalogue  the  important  papers,  but  also  the 
details.  Murphy's  button  is  a  new  appliance.  When  I  treat 
a  case  of  gastro-enterostomy  or  ileo-colostomy  or  intestinal 
anastomosis  in  which  Murphy's  button  has  been  used,  I  would 
catalogue  that  under  the  disease  and  also  under  "Murphy's 
button."  If  successful,  it  is  so  recorded.  If  an  accident 
happens  and  the  button  is  retained,  or  sloughing  follows,  I 
refer  to  it  in  my  catalogue.  If  I  read  John  Hunter's  "Life" 
and  find  a  statement  I  want  to  refer  to,  I  catalogue  it  with 
volume  and  page  under  one,  two,  or  three  headings.  In 
this  catalogue  of  papers,  and  also  in  my  cases,  I  make  cross- 
references,  as,  for  example,  cancer  of  the  rectum  is  so  closely 
allied  to  cancer  of  the  sigmoid  that  I  would  refer  under 
"Rectum,  cancer  of,"  to  "Sigmoid,  cancer  of,"  and  vice  versa. 
In  this  way  I  can  find  all  cases  that  are  allied. 

I  should  refer  also  to  certain  encyclopaedias,  as,  for  example, 
Ashhurst's  "International  Encyclopaedia  of  Surgery,"  in 
six  volumes  ;  Buck's  "Reference  Hand-book  of  the  Medical 
Sciences,"  in  eight  large  volumes,  and  other  similar  works,  of 
each  of  which  I  show  you  one  volume.  Specialties  also  have 
their  encyclopaedias,  such  as  those  on  the  eye,  the  ear,  chil- 
dren's diseases,  etc.  You  can  always  consult  these  with  profit. 
In  addition  to  these  there  are  the  "Transactions"  of  many 
societies,  as,  for  example,  of  the  American  Surgical  Associa- 
tion and  the  American  Orthopaedic  Association,  and  so  on  with 
many  other  associations.  You  should  make  all  of  these 
available  by  cataloguing  their  valuable  papers  in  the  way  I 
have  mentioned.  For  instance,  "Artery,  popliteal,  perfora- 
tion of,  by  a  splinter  of  bone  in  fracture,"  is  catalogued  under 
"  Artery,  popliteal,  perforation  of,"  etc.,  and  also  under  "  Frac- 
ture of  femur,  perforation  of  popliteal  by  a  splinter  of  bone," 


228  ADDRESSES   AND    OTHER   PAPERS. 

etc.  You  thus  have  not  only  the  fracture  of  the  femur  and 
its  result,  but  also  the  perforation  of  the  artery  and  its  cause 
noted.  Let  me  read  another,  "Artery,  renal,  aneurism  of, 
nephrectomy,  recovery."  Under  aneurism  I  would  have 
"Aneurism  of  renal  artery,  treatment  of,  by  nephrectomy," 
and  so  on.  Here  is  another  under  C,  "Cauda  equina,  lesions 
of.""  Then  follow  a  number  of  papers  on  that  subject  as  dis- 
tinguished from  the  lesions  of  the  spinal  cord.  These  quota- 
tions from  my  own  catalogue  are  sufficient  to  show  you 
the  method. 

Each  man  knows  his  own  needs,  his  own  tastes,  his  own 
practice  best.  Two  such  catalogues,  one  for  his  own  cases 
and  one  for  journal  articles,  books,  etc.,  all  bearing  on  the 
branch  of  practice  he  has  selected  or  on  all,  if  he  is  a  general 
practitioner,  will  well  equip  him  both  as  a  practitioner  and  as 
a  writer. 

But  these  catalogues  cover  only  a  small  portion  of  the 
literature  of  the  world.  If  you  wish  to  consult  this,  you  must 
do  so  by  larger  catalogues  than  a  personal  one. 

I  have  here  one  volume  of  the  "Index  Catalogue"  of  the 
magnificent  library  that  I  have  spoken  of,  that  of  the  Surgeon- 
General  of  the  United  States  Army, — an  entirely  unique 
literary  production  of  which  we  as  Americans  may  well  be 
proud.  How  many  medical  journals  do  you  suppose  there  are 
in  the  world?  Dr.  Robert  Fletcher  has  recently  said  there  are 
nearly  eleven  hundred,  and  every  article  in  all  these  journals 
as  well  as  all  medical  books  published  in  all  languages  are 
found  in  this  splendid  catalogue.  It  is  in  sixteen  large  quarto 
volumes  and  covers  every  subject  that  can  possibly  be  con- 
nected with  medicine.  The  literature  of  some  subjects  will 
cover  over  one  hundred  pages.  In  such  extensive  subjects  it 
is  subdivided  into  works  and  articles  bearing  on  the  anatomy, 
pathology,  etiology,  symptoms,  complications,  treatment,  etc., 
and  if  very  extensive  in  its  bibliography  it  is  again  subdivided 
very  minutely. 


LITERARY    METHODS    IN   MEDICINE.  229 

We  have  also  another  important  current  index  called  the 
"Index  Medicus,"  edited  by  Dr.  Billings  and  Dr.  Fletcher, 
of  which  I  show  you  vol.  xix.  This  monthly  publication 
contains  the  titles  of  all  the  medical  papers  and  books  in  the 
world  for  the  year.  The  value  of  such  an  index  is  simply 
incalculable. 

Now,  suppose  you  are  going  to  write  a  paper,  and  you  have 
the  material  from  the  notes  of  your  own  cases  (from  your  first 
card  catalogue),  and  have  read  all  you  need  in  the  books 
and  journal  articles  (from  your  second  card  catalogue),  and 
have  supplemented  these  by  reading  the  articles  or  books  of 
importance  which  you  have  found  recorded  in  the  "  Index 
Catalogue"  or  the  "Index  Medicus,"  how  will  you  go  about 
writing  your  paper  ? 

First  comes  the  title  of  the  paper  or  case,  and  I  would  advise 
you  to  take  pains  to  select  a  good  title.  Never  use  such  a  title 
as  "  Two  Interesting  Surgical  Cases,"  or  "  An  Unusual  Surgical 
Case,"  etc.  These  papers  will  go  in  the  "Index  Medicus" 
under  precisely  the  title  you  give,  and  the  titles  mentioned 
give  no  clue  to  the  nature  of  the  cases  you  report.  Suppose  I 
am  hunting  up  cases  of  operation  for  perforation  of  the  in- 
testine hi  typhoid  fever,  how  can  I  know  that  the  papers  just 
named  refer  to  just  the  cases  I  am  seeking  for?  The  fact  is 
that  papers  with  such  indefinite  titles  are  probably  never 
consulted.  State  what  you  are  writing  about  clearly  and 
tersely ;  if  it  be  a  case,  give  it  a  good  descriptive  name ;  and 
if  there  were  any  unusual  complications  deserving  attention 
or  any  novel  procedure  employed,  state  it  in  the  title. 

When  you  want  to  write  your  paper  and  have  your  title  and 
material,  after  any  introductory  or  historical  remarks,  you 
will  first  consider  the  etiology ;  next  the  pathology  (often  these 
two  are  intertwined) ;  third,  the  symptoms ;  fourth,  the  phy- 
sical signs;  fifth,  the  diagnosis;  sixth,  the  differential  diag- 
nosis; seventh,  the  prognosis;  and,  eighth,  the  treatment. 
This  plan  gives  a  logical  method  to  your  paper.  It  is  often 


230  ADDRESSES   AND    OTHER    PAPERS. 

well,  also,  at  the  end  of  a  paper  to  make  a  summary  of  your 
conclusions,  so  that  there  may  be  crystallized  from  .your  paper 
the  principal  conclusions  that  you  have  been  led  to.  Always 
try  to  express  yourself  clearly.  Never  try  to  use  fine  lan- 
guage ;  write  plainly  and  simply  so  that  anybody  may  under- 
stand it.  When  I  see  a  paper  written  by  a  man  whose 
former  papers  have  been  marked  by  clearness  and  good  sense, 
I  always  read  it.  You  soon  learn  to  "  size  up  "  the  writers  of 
papers  and  books. 

It  has  been  a  great  pleasure  to  me,  gentlemen,  to  meet  you 
this  evening.  I  hope  I  have  opened  your  eyes  to  the  vast 
fields  of  medical  bibliography  in  which  you  may  roam  at  will; 
have  shown  you  the  means,  the  methods,  and  the  great  labor 
which  your  teachers  and  the  writers  of  the  books  you  study 
and  often  admire  are  compelled  to  undertake  and  find  delight 
in;  have  exhibited  to  you  the  methods  by  which  you  can 
make  your  own  work  and  your  own  reading  valuable,  because 
it  is  properly  recorded  and  then  made  available  by  proper  in- 
dexing; and,  above  all,  have  stimulated  you  to  do  the  best 
work  in  your  power  and  to  add  to  your  at  first  scanty  knowl- 
edge, to  the  end  that  you  may  grow  better,  wiser,  and  abler 
men  and  make  that  larger  knowledge  available  for  the  relief 
of  human  suffering  and  the  prolongation  of  human  life. 


— 


I 


Bronze  statue  of  Samuel  D.  Gross  in  the  Smithsonian  Park,  Washington,  D.  C. 
The  building  in  the  background  is  the  Army  Medical  Museum 


ADDRESS  AT  THE  UNVEILING 

OF    THE    STATUE    OF   THE  LATE 

PROFESSOR   SAMUEL    D.  GROSS,  M.D., 

WASHINGTON,  D.  C,  MAY  5,  1897.* 


FELLOWS  OF  THE  AMERICAN  SURGICAL  ASSOCIATION,  MEM- 
BERS OF  THE  ALUMNI  ASSOCIATION  OF  THE  JEFFERSON 
MEDICAL  COLLEGE,  AND  FRIENDS  : 

/^  0  with  me,  your  spokesman,  to-day  to  the  Woodlands 
VJT  Cemetery,— that  "God's  Acre"  or  "Court  of  Peace," 
as  the  Germans  so  poetically  call  it, — which  holds  the  dust 
of  so  many  of  the  best  dead  of  Philadelphia.  Upon  an  urn 
there  treasured  you  will  read  the  following: 

IN  MEMORIAM. 

Within  this  urn  lie  the  ashes  of 

SAMUEL  D.  GROSS, 

A  Master  in  Surgery. 

His  life,  which  neared  the  extreme  limits  of  the  Psalmist,  was  one  un- 
broken process  of  laborious  years. 

He  filled  chairs  in  four  Medical  Colleges,  in  as  many  States  of  the  Union, 
and  added  lustre  to  them  all. 

He  recast  Surgical  Science,  as  taught  in  North  America,  formulated 

*  Reprinted  from  the  Transactions  of  the  American  Surgical  Associa- 
tion, 1897. 

The  statue,  in  bronze,  was  erected  by  the  American  Surgical  Associa- 
tion, the  Alumni  Association  of  the  Jefferson  Medical  College  and  other 
friends  of  Professor  Gross. 

231 


232  ADDRESSES   AND   OTHER   PAPERS. 

anew  its  principles,  enlarged  its  domain,  added  to  its  art,  and  imparted 
fresh  impetus  to  its  study. 

He  composed  many  Books  and  among  them 

A  SYSTEM  OF  SURGERY, 
which  is  read  in  different  tongues,  wherever  the  Healing  Art  is  practised. 

With  a  great  intellect,  carefully  trained  and  balanced,  he  aimed  with 
undivided  zeal  at  the  noble  end  of  lessening  human  suffering  and  length- 
ening human  life,  and  so  rose  to  the  highest  position  yet  attained  in  science 
by  any  of  his  countrymen. 

Resolute  in  truth,  he  had  no  fear;  he  was  both  tolerant  and  charitable. 

Living  in  enlightened  fellowship  with  all  laborers  in  the  world  of  Science, 
he  was  greatly  honored  by  the  learned  in  foreign  lands,  and  deeply  loved 
at  home. 


Behind  the  Veil  of  This  Life  There  is  a  Mystery  Which  He 

Penetrated  on  the 
SIXTH  DAY  OF  MAY,  1884. 


HIS  MEMORY 

Shall  exhort  and  his  Example  shall  encourage  and  persuade  those  who 
come  after  him  to  emulate  deeds  which,  great  in  themselves,  were  all 
crowned  by  the  milk-white  flower  of 

A  STAINLESS  LIFE. 

Who  and  what  was  the  man  of  whom  this  was  said? 

Samuel  David  Gross  was  born  near  Easton,  Pennsylvania, 
July  8,  1805,  and  died  in  Philadelphia  May  6,  1884,  having 
nearly  completed  his  seventy-ninth  year. 

His  early  years,  under  the  wise  training  of  a  good  mother, 
to  whose  memory  he  rightly  pays  just  tribute,  were  spent 
amid  the  rustic  labors  and  healthful  pleasures  of  a  Pennsyl- 
vania farm.  This  gave  him  a  strong  and  vigorous  body,  with- 
out which  he  never  could  have  performed  a  tithe  of  the  labor 
which  pre-eminently  distinguished  his  long  life.  Before  he 
was  six  years  old  he  determined  to  be  a  surgeon,  and  early 
in  his  professional  studies  to  be  a  teacher.  Yet  when  he  was 
fifteen  he  knew  scarcely  any  English.  Brought  up  among 


THE    S.   D.   GROSS   MEMORIAL   ADDRESS.  233 

the  sturdy,  honest,  laborious  Pennsylvania  Dutch,  he  could 
speak  that  curious  English-German.  But  his  English,  of 
which  he  became  so  fluent  a  master,  and  even  pure  German, 
which  he  began  to  study  at  the  same  time,  were  learned 
almost  as  foreign  tongues  and  as  a  result  of  his  appreciation 
at  that  early  age  of  his  need  for  a  better  and  wider  education. 
Even  a  still  more  striking  evidence  of  the  early  development 
of  the  innate  strength  of  his  character  and  indomitable  will 
is  a  story  told  in  his  autobiography.  While  a  boy  he  became 
expert  in  playing  cards ;  but  finding  that  he  was  becoming  so 
much  fascinated  by  them  that  he  replayed  his  games  in  his 
dreams,  he  resolved — fancy  this  in  a  boy  not  yet  fourteen! — 
to  abstain  from  the  game  for  twenty  years— a  vow  he  relig- 
iously fulfilled. 

At  seventeen  he  began  the  study  of  medicine  as  the  private 
pupil  of  a  country  practitioner,  but  after  learning  some 
osteology  With  the  aid  of  that  tuppenny  little  compend,  Fyfe's 
"Anatomy,"  and  a  skeleton,  he  gave  up  in  despair,  for  again 
he  found  his  intellectual  tools  unequal  to  his  work.  The 
little  Latin  he  had  was  insufficient,  and  to  understand  the 
technicalities  of  medicine,  Greek  was  a  sine  qua  non.  "This," 
he  says,  "was  the  turning-point  of  my  life.  ...  I  had 
made  a  great  discovery — a  knowledge  of  my  ignorance,  and 
with  it  came  a  solemn  determination  to  remedy  it."  Accord- 
ingly he  stopped  at  once  in  his  medical  career  and  went  to  an 
academy  at  Wilkes-Barre.  He  studied  especially  Latin  and 
Greek,  the  latter  by  the  use  of  Schrevelius's  lexicon,  in  which 
all  the  definitions  were  in  Latin,  and  Ross's  grammar,  con- 
structed on  the  same  principle.  But  to  a  master  will  like 
his  such  obstacles  were  not  insuperable.  To  Greek  and  Latin, 
English  and  German,  later  years  added  also  a  knowledge  of 
French  and  Italian. 

At  nineteen  he  began  the  study  of  medicine  again — a  study 
in  which  for  sixty  years  his  labors  never  for  a  moment  ceased 
or  even  relaxed. 


234  ADDRESSES   AND   OTHER   PAPERS. 

In  1828,  at  the  age  of  twenty-three,  he  took  his  degree  in 
the  third  class  which  was  graduated  from  the  Jefferson  Medi- 
cal College.  He  opened  an  office  first  in  Philadelphia,  but 
soon  removed  to  Easton.  Nothing  is  more  characteristic  of 
the  man  than  that,  while  waiting  for  practice,  he  spent  hours 
daily-  in  dissecting  in  a  building  he  erected  at  the  back  of 
his  garden,  and  provided  himself  with  a  subject  by  driving 
in  a  buggy  all  the  way  from  Easton  to  Philadelphia  and  back 
with  this  gruesome  companion;  wrote  a  work  on  descriptive 
anatomy,  which,  however,  he  never  published,  and  in  eighteen 
months  after  graduation  had  translated  and  published  Bayle 
and  Hollard's  "General  Anatomy";  Hatin's  "Obstetrics"; 
Hildebrand  on  "Typhus,"  and  Ta vernier's  "Operative  Sur- 
gery"— works  aggregating  over  eleven  hundred  pages.  His 
motto  was  indeed  " Nulla  dies  sine  linea."  His  "stimulus" 
he  himself  says  "was  his  ambition  and  his  poverty." 

In  1833,  five  years  after  his  graduation,  he  entered  upon 
his  career  as  a  teacher — a  career  which  continued  for  forty- 
nine  years,  until  within  two  years  of  his  death.  This  took 
him  first  to  Cincinnati  as  Demonstrator  of  Anatomy  in  the 
Medical  College  of  Ohio.  Those  of  my  audience  who  left 
Cincinnati  yesterday  will  be  amused  to  learn  that  by  stage, 
canal,  and  primitive  steamboat,  it  took  him  thirteen  days 
to  reach  the  Queen  City;  and  all  of  you  will  admire  the  pluck 
and  courage  of  the  young  man  when  I  add  that  his  total 
worldly  goods  on  reaching  there  were  one  hundred  dollars 
in  his  purse,  a  wife  and  two  children  in  his  family,  but  also 
in  his  breast  a  heart  ready  to  grapple  with  any  difficulties 
and  a  determination  to  conquer  them  all. 

In  1835  he  became  Professor  of  Pathological  Anatomy  in 
the  Cincinnati  Medical  College,  where  he  was  a  colleague  of 
Daniel  Drake,  Willard  Parker,  and  James  B.  Rogers,  one  of 
the  famous  four  brothers,  with  a  second  of  whom — Robert 
E. — he  was  later  a  colleague  in  the  Jefferson. 

His  book  on  "Bones  and  Joints"  had  appeared  in  1830, 


THE   S.    D.    GROSS   MEMORIAL   ADDRESS.  ,    235 

and  next,  as  a  result  of  four  years'  study  and  teaching,  his 
"Elements  of  Pathological  Anatomy"  was  published  in  1839- 
It  is  strange  to  think  that  in  a  then  small  Western  town 
in  America  a  young  teacher  in  a  new  medical  school  should 
have  published  the  first  book  in  the  English  language  on 
pathological  anatomy.  No  wonder,  then,  that  it  brought 
him  fame  and  practice;  that  its  second  edition  made  him 
a  member  of  the  Imperial-Royal  Society  in  Vienna;  and  that, 
thirty  years  afterward,  Virchow,  at  a  dinner  he  gave  to  its 
then  distinguished  author,  should  show  it  as  one  of  the  prizes 
of  his  library. 

In  1840  he  went  to  the  University  of  Louisville  as  Professor 
of  Surgery,  and,  excepting  one  year  when  he  was  Professor 
of  Surgery  in  the  University  of  the  City  of  New  York,  he 
remained  there  for  sixteen  years,  happy  in  his  family,  his  stu- 
dents, his  flowers,  and  his  generous  hospitality.  He  and  his 
colleagues — Drake  and  Austin  Flint — soon  made  it  the  most 
important  medical  centre  in  the  West,  and  he  was  in  surgery 
the  reigning  sovereign.  While  there  he  published,  in  1851, 
his  work  on  the  "Urinary  Organs,"  and  in  1854  another 
pioneer  work,  that  on  "Foreign  Bodies  in  the  Air-passages." 
His  fame  had  become  so  great  that  he  was  invited  to  the 
University  of  Virginia,  the  University  of  Louisiana,  the  Uni- 
versity of  Pennsylvania,  and  other  schools.  But  he  was 
steadfast  to  Louisville  until  his  beloved  Alma  Mater  called 
him  to  the  chair  just  vacated  by  Mutter.  From  1856,  when 
in  his  Introductory  he  said,  "whatever  of  life  and  of  health 
and  of  strength  remain  to  me  I  hereby,  in  the  presence  of 
Almighty  God  and  of  this  large  assemblage,  dedicate  to  the 
cause  of  my  Alma  Mater,  to  the  interest  of  medical  science, 
and  to  the  good  of  my  fellow-creatures,"  until  he  resigned 
his  chair  in  1882 — nay,  until  his  death  in  1884 — this  was 
absolutely  true.  Even  when  the  shadows  of  death  were 
thickening  he  corrected  the  proof-sheets  of  two  papers  on 
"Wounds  of  the  Intestines"  and  "Lacerations  Consequent 


236  ADDRESSES   AND   OTHER    PAPERS. 

upon  Parturition,"  his  last  labors  in  the  service  of  science 
and  humanity. 

Three  years  after  he  entered  upon  his  duties  at  the  Jefferson 
he  published  his  splendid  "System  of  Surgery" — a  work 
which,  though  in  many  respects  its  pathology  and  its  practice 
are  now  obsolete,  is  a  mine  of  information,  a  monument  of 
untiring  labor,  a  text-book  worthy  of  its  author,  and  one 
which  has  been  the  companion  and  guide  of  many  generations 
of  students.  It  was  translated  into  several  foreign  tongues 
and  passed  through  six  editions,  the  last  appearing  only 
seventeen  months  before  his  death.  That  even  when  verging 
upon  fourscore  he  should  have  been  willing  to  throw  aside 
all  his  strong  prejudices  and  accept  the  then  struggling  prin- 
ciples and  practice  of  Listerism  shows  the  progressive  charac- 
ter of  his  mind  and  his  remarkable  willingness  to  welcome 
new  truths. 

From  his  removal  to  Philadelphia  until  his  death,  twenty- 
eight  years  later,  his  life  can  be  summed  up  in  a  few  sentences : 
daily  labor  in  his  profession,  editorial  labor  without  cessation 
for  some  years  in  managing  the  "North  American  Medico- 
Chirurgical  Review, "  the  successor  of  the  Louisville  "  Medical 
Review,"  of  which  he  had  also  been  the  editor;  article  after 
article  in  journals;  address  after  address;  twenty-six  annual 
courses  of  lectures  on  surgery  to  thousands  of  students;  labors 
without  ceasing  until  he  wrapped  the  drapery  of  his  couch 
around  him  and  calmly  passed  away. 

In  reviewing  his  life  we  may  fittingly  consider  it  from  the 
standpoint  of  the  surgeon,  the  author,  the  teacher,  and  the 
man. 

As  a  surgeon  he  was  painstaking,  thorough,  and  careful 
in  his  investigation  of  a  case,  skillful  as  an  operator,  and, 
having  so  vast  an  experience  and  equally  extensive  acquaint- 
ance with  the  wide  literature  of  his  profession,  he  was  scarcely 
ever  perplexed  by  the  most  difficult  case  and  rarely  at  a  loss 
as  to  the  proper  course  to  pursue  in  the  most  unexpected 
emergencies. 


THE   S.    D.    GROSS   MEMORIAL   ADDRESS.  237 

He  was  a  practitioner  of  the  old  school,  who  always  mingled 
medicine  with  surgery,  and  attributed  much  of  his  success 
in  the  latter  to  his  experience  in  the  former.  In  theory  he 
sometimes  clung  to  beliefs,  which,  in  practice,  he  abandoned. 
In  one  of  his  later  papers,  "A  Lost  Art,"  and  in  his  lectures, 
he  still  advocated  bloodletting;  but  in  the  nearly  twenty 
years  hi  which  as  a  student,  an  assistant  in  his  clinic,  and  a 
quiz-master  I  saw  much  of  his  practice  I  only  remember  two 
cases  in  which  he  actually  bled  his  patients. 

His  influence  on  the  profession  was  marked  and  wholesome. 
For  many  years  he  was  almost  always  at  the  annual  meetings 
of  the  American  Medical  Association  and  the  American 
Surgical  Association,  was  looked  up  to  in  both  as  the  Nestor 
of  the  profession,  and  his  papers  and  his  wise  words  of  counsel 
moulded  both  the  thought  and  the  action  of  his  brethren  to  a 
notable  degree.  He  founded  two  medical  journals,  was  the 
founder  of  the  Pathological  Society  of  Philadelphia  and  of 
the  Philadelphia  Academy  of  Surgery,  the  founder  and  first 
president  of  the  American  Surgical  Association,  and  the  first 
president  of  the  Alumni  Association  of  the  Jefferson  Medical 
College.  It  is  peculiarly  fitting,  therefore,  that  these  last 
two  associations  should  unite  to-day  in  erecting  and  unveiling 
the  bronze  statue  of  one  who  did  so  much  for  them  and  whom 
they  rightly  delight  to  honor.  All  who  knew  his  tall,  manly 
figure  and  his  fine  face  will  agree  that  it  is  a  speaking  likeness, 
both  hi  pose  and  feature.  Could  I  only  get  a  glimpse  of  the 
right  hand  which  holds  his  familiar  scalpel  I  would  recognize 
the  man.  Ex  pede  Herculem !  Ex  manu  Gross  ! 

As  an  author,  his  chief  characteristics  were  untiring  indus- 
try, comprehensiveness,  methodical  treatment  of  his  subject, 
and  a  singular  felicity  of  style,  especially  for  one  who  acquired 
English  so  late  and  with  difficulty.  In  fact,  through  life  his 
speech,  by  a  slight,  though  not  unpleasant,  accent,  always 
betrayed  his  German  descent. 

He  "blazed"  more  than  one  new  "trail"  in  the  forests  of 


238  ADDRESSES   AND    OTHER   PAPERS. 

surgical  ignorance.  In  the  early  part,  and  even  in  the  middle 
of  this  century,  it  was  rare  for  Americans  to  write  medical 
books.  The  most  they  did  was  either  to  translate  a  French 
or  a  German  work  or  to  annotate  an  English  one.  He  was 
one  of  the  earliest  to  create  an  American  medical  literature 
of  importance,  and  his  works  on  the  "Urinary  Organs,"  on 
"Foreign  Bodies  in  the  Air-passages,"  and  his  text-book  on 
"Surgery"  gave  a  position- to  American  surgery  abroad 
which  we  can  now  hardly  appreciate;  while,  as  already  re- 
lated, his  "Pathological  Anatomy"  was  the  very  first  work 
in  the  English  language  on  that  most  important  branch  of 
medicine. 

His  experiments  and  monograph  on  "Wounds  of  the  In- 
testines" laid  the  foundation  for  the  later  studies  of  Parkes, 
Senn,  and  other  American  surgeons,  and  have  led  to  the 
modern  rational  and  successful  treatment  of  these  then  so 
uniformly  fatal  injuries.  He  first  advocated  abdominal  sec- 
tion in  rupture  of  the  bladder,  the  use  of  adhesive  plaster 
in  fractures  of  the  legs,  amputation  in  senile  gangrene,  and 
the  immediate  uniting  of  tendon  to  tendon  when  they  were 
divided  in  an  incised  wound.  Had  he  lived  but  a  year  or 
two  longer  bacteriology  would  have  shown  him  that  scrofula 
was  of  tuberculous  origin,  and  not,  as  he  so  firmly  believed 
and  vigorously  taught,  a  manifestation  of  hereditary  syphilis. 

That  his  eminence  as  an  author  should  have  met  with 
recognition  from  scientific  organizations  and  institutions  of 
learning  is  no  cause  of  surprise.  It  made  him  the  president 
of  the  International  Medical  Congress  of  1876,  a  member  of 
many  of  the  scientific  societies  of  Europe  as  well  as  of  America, 
and  won  for  him  the  LL.D.  of  the  University  of  Pennsylvania, 
and  I  believe  the  unique  honor  in  America  of  having  had 
conferred  upon  him  the  highest  degree  of  all  three  of  the 
leading  universities  of  Great  Britain — Oxford,  Cambridge,  and 
Edinburgh.  Indeed,  it  is  both  significant  and  pathetic  to 
note  that  he  laid  down  his  pen  just  after  recording  in  his 


THE   S.    D.    GROSS    MEMORIAL    ADDRESS.  239 

autobiography  the  announcement  of  the  honor  which  the 
University  of  Edinburgh  intended  to  bestow  upon  him  at  its 
tercentenary  celebration. 

As  a  teacher,  I  can  speak  both  with  personal  knowledge 
and  enthusiasm.  I  can  see  his  tall,  stately  form,  his  hand- 
some face,  his  glowing  features,  his  impressive  gestures.  He 
was  earnestness  itself.  Filled  to  overflowing  with  his  subject, 
his  one  desire  was  to  impart  to  us  as  much  of  the  knowledge 
he  possessed  as  our  young  heads  could  hold.  Repetition  did 
not  blunt  the  novelty  nor  time  lessen  the  attraction  of  his 
theme.  It  always  seemed  as  if  he  were  telling  us  for  the 
first  time  the  new  story  of  the  beneficent  work  that  surgery 
could  do  for  the  injured  and  the  suffering.  His  whole  heart 
was  in  his  work.  Especially  did  he  inculcate  the  principles 
of  surgery,  for  he  was  convinced,  and  rightly,  that  one  who 
was  thoroughly  imbued  with  these  could  not  go  far  wrong 
in  his  practice. 

His  own  statement  of  one  of  the  qualifications  of  a  teacher 
is  so  true,  yet  so  often  forgotten,  that,  in  spite  of  its  mixed 
metaphor,  I  will  quote  it:  "A  teacher  should  be  bold  and 
decided  in  his  opinions;  not  too  positive,  but  sufficiently  so 
to  be  authoritative.  The  student  cannot  judge  for  himself. 
The  knowledge  that  is  placed  before  him  must  be,  so  to  speak, 
well  digested  for  him."  His  sense  of  the  heavy  responsibility 
of  the  teacher  is  well  shown  by  the  following  from  his  auto- 
biography: "Nothing  was  more  offensive  to  me  than  applause 
as  I  entered  the  amphitheatre,  and  I  never  permitted  it  after 
the  first  lecture.  I  always  said,  'Gentlemen,  such  a  noise 
is  more  befitting  a  theatre  or  a  circus  than  a  temple  dedicated 
not  to  ^Esculapius,  but  to  Almighty  God,  for  the  study  of 
disease  and  accident,  and  your  preparation  for  the  great 
duties  of  your  profession.  There  is  something  awfully  solemn 
in  a  profession  which  deals  with  life  and  death,  and  I  desire, 
at  the  very  threshold  of  this  course  of  lectures,  to  impress 
upon  your  minds  its  sacred  and  responsible  character,  that 


240  ADDRESSES   AND   OTHER   PAPERS. 

you  may  be  induced  to  make  the  best  possible  use  of  your 
time,  and  conduct  yourselves  in  a  manner  worthy  of  the 
dignity  of  Christian  gentlemen.'  ' 

The  value  of  recitations  in  a  medical  course  I  fully  appre- 
ciate and  indorse.  They  will  occupy  in  the  future  a  much 
larger  place  in  our  medical  schools  than  they  now  do.  But 
I  am  equally  convinced  that  such  a  voice,  such  a  presence, 
such  an  impressive,  earnest  lecturer  will  never  lose  their 
powerful  influence  nor  their  place  in  instruction.' 

As  a  man,  he  was  beautiful  in  his  relations  with  his  family, 
who  were  devoted  to  him  with  an  affection  that  was  unusually 
strong;  upright  in  all  his  dealings,  and  despising  cant  and 
pretense  and  anything  unworthy  a  true  gentleman.  Few 
men  were  more  widely  known  in  and  out  of  the  profession, 
and  few  ever  had  the  good  fortune  to  know  intimately  so 
many  distinguished  people  of  both  continents.  Wherever  he 
was  known  he  was  respected,  and  by  those  who  knew  him 
intimately  he  was  beloved. 

Such,  then,  was  the  man  whom  we  are  gathered  to-day  to 
honor.  The  American  Surgical  Association,  the  Alumni  Asso- 
ciation of  the  Jefferson  Medical  College,  and  a  few  friends 
who  have  gladly  united  with  us  in  this  service  of  affectionate 
remembrance,  have  presented  his  statue  to  the  people  of  the 
United  States,  to  stand  forever  hi  our  beautiful  capital  city 
as  a  mute,  yet  eloquent,  evidence  of  our  esteem  for  his  per- 
sonal worth  and  his  professional  attainments. 

It  is  strange  that  the  human  race  has  failed  so  grievously 
to  recognize  publicly  its  great  medical  benefactors.  Mr. 
Lecky,  hi  his  last  remarkable  book,  in  speaking  of  the  rewards 
of  genius  in  Great  Britain,  after  enumerating  the  chief  of  the 
extraordinary  and  beneficent  achievements  of  medical  men 
in  the  present  century,  says,  "England  may  justly  claim  a 
foremost  place  in  this  noble  work,  and  many  of  her  finest 
intellects  have  been  enlisted  in  its  service.  In  no  single 
instance  has  this  kind  of  eminence  been  recognized  by  a 


THE   S.    D.    GROSS   MEMORIAL   ADDRESS.  241 

peerage.  It  is  clearly  understood  that  another  and  a  lower 
dignity  is  the  stamp  of  honor  which  the  State  accords  to  the 
very  highest  eminence  hi  medicine  and  surgery — as  if  to 
show  in  the  clearest  light  how  inferior  in  its  eyes  are  the  pro- 
fessions which  do  most  to  mitigate  the  great  sum  of  human 
agony  to  the  professions  which  talk  and  quarrel  and  kill."* 
And  yet  Jenner  almost  saved  England  from  extinction,  and 
Simpson  and  Lister  have  done  far  more  to  mitigate  the 
terrors  of  surgery  and  the  pangs  of  maternity,  to  save  life, 
and  to  bring  health  and  happiness  to  the  human  race  than 
Marlborough  and  Wellington  and  Nelson  have  done  to  destroy 
life  and  to  bring  sorrow  and  pain,  rapine  and  misery. 

It  is  pleasant  to  record  that  with  the  opening  of  this  year, 
England  has  atoned  for  such  long-continued  neglect.  In 
making  Sir  Joseph  Lister  the  first  medical  peer  she  has  con- 
ferred less  honor  upon  Lord  Lister  than  upon  herself. 

The  statue  of  Marion  Sims,  not  long  since  erected  hi  New 
York,  and  this  of  Samuel  D.  Gross,  let  us  hope,  are  the  be- 
ginning of  a  similar  recognition  of  beneficent  genius  in  our 
own  land.  Go  through  the  broad  streets  of  this  beautiful 
city,  and  in  its  circles  and  parks  and  squares  you  will  find, 
with  singular  exceptions,  only  the  statues  of  statesmen  and 
warriors — men  who  deserve,  we  all  agree,  their  well-won 
honors  and  immortality.  But,  truly,  "  Peace  hath  her  vic- 
tories no  less  renowned  than  those  of  war."  Though  its 
heroes  are  not,  it  may  be,  portrayed  in  marble  or  bronze, 
they  are  enshrined  in  the  grateful  hearts  of  mankind,  im- 
mortal in  literature,  even  the  humblest  of  such  toilers  as  the 
Gideon  Grays  and  the  Weellum  Maclures  that  cheer  and 
brighten  the  world. 

And  were  the  soldiers,  whose  statues  one  may  see  every- 
where around  us,  the  sole  possessors  of  bravery?  In  1832, 
that  most  dreaded  of  all  scourges,  Asiatic  cholera,  for  the 
first  time  broke  out  all  over  this  country  with  the  greatest 

*  Democracy  and  Libert}*,  i,  429. 
16 


242  ADDRESSES   AXD   OTHER   PAPERS. 

virulence.  Easton  was  only  eighty  miles  from  New  York 
and  the  citizens,  in  terror  lest  the  dread  disease  would  reach 
their  own  town,  appointed  a  young,  intrepid  surgeon  to  visit 
New  York  and  learn  what  he  could  for  their  benefit.  When 
others  were  fleeing  in  frightened  thousands  from  the  pesti- 
lence Gross  bravely  went  directly  into  the  very  midst  of  it, 
reaching  New  York  when  the  epidemic  was  at  its  very  height. 
In  that  then  small  and  half-depopulated  town  385  persons 
died  on  the  very  day  of  his  arrival — and  he  stayed  there  a 
week  in  a  hot  July,  visiting  only  its  hospitals  and  its  charnel- 
houses.  What  call  you  that  but  the  highest  type  of  bravery? 
— a  bravery  which  Norfolk  and  Mobile  and  Memphis  have 
since  seen  repeated  by  scores  of  courageous  physicians  ready 
to  sacrifice  their  lives  for  their  fellow-men  with  no  blare  of 
trumpets,  no  roar  of  cannon,  no  cheer  of  troops,  no  plaudits 
of  the  press!  No  battlefield  ever  saw  greater  heroes;  no 
country  braver  men! 

Yonder  statue  of  Joseph  Henry  has  stood  alone  for  too 
many  years.  We  have  to-day  unveiled  its  worthy  compan- 
ion. Both  of  them  are  memorials  of  men  great  hi  science, 
whose  lives  were  devoted  to  the  good  of  their  fellow-creatures, 
to  saving  life,  adding  to  human  comfort,  lessening  pain,  pro- 
moting knowledge,  cheering  the  sick,  and  assuaging  even  the 
very  pangs  of  the  dying.  We  do  well  thus  to  honor  hi  im- 
perishable bronze  the  men  who  have  won  these  victories  of 
peace!  To  no  one  can  the  words  of  the  blessed  Master  apply 
with  greater  force  than  to  the  kind  surgeon  whose  time  and 
thought  and  talents  are  given  to  humanity,  and,  above  all 
to  the  poor,  with  no  payment  but  the  grateful  look  of  return- 
ing health  and  rescued  life  and  that  inward  satisfaction 
which  far  surpasses  all  the  wealth  of  the  Orient.  "  Inasmuch 
as  ye  have  done  it  unto  one  of  the  least  of  these  my  brethren 
ye  have  done  it  unto  Me." 


SEMICENTENNIAL  ADDRESS  IN  SURGERY.* 


MR.  PRESIDENT  AND  GENTLEMEN  OF  THE  AMERICAN  MEDI- 
CAL ASSOCIATION: 

IT  is  always  proper  to  acknowledge  an  honor,  but  when  it 
comes  unsolicited  from  so  large  and  distinguished  a  body 
of  men,  representative  of  the  entire  profession  in  the  United 
States,  and  on  an  exceptional  occasion,  I  feel  it  a  double  honor 
to  have  been  chosen  to  deliver  the  Semicentennial  Address 
in  Surgery.  I  beg  to  return  you  my  very  hearty  thanks  for 
your  extreme  kindness. 

As  we  celebrate  on  this  occasion  the  Semicentennial  of  the 
organization  of  the  American  Medical  Association,  in  this 
city,  in  1847,  it  is  very  natural  and  proper  that  the  Address 
in  Surgery  should  be  a  review  of  the  work  done  in  the  last 
fifty  years,  and,  by  contrasting  the  state  of  surgery  and  of 
surgical  teaching  in  1847  with  that  which  exists  in  1897,  to 
see  what  progress  has  been  made.  To  recount  what  has  been 
achieved  in  these  "fifty  years  of  science"  far  better  than  a 
" cycle  of  Cathay"  is  not  only  a  pleasure,  but  it  is  an  immense 
incentive,  since  by  the  progress  made  in  the  last  fifty  years 
we  can  in  some  measure  anticipate  the  enormous,  and  proba- 
bly even  still  greater  progress,  that  will  be  made  in  the  next 
half -century. 

The  time,  also,  is  opportune.  Last  year  was  celebrated 
the  centennial  of  vaccination  and  the  semicentennial  of  the 
first  public  administration  of  ether.  Sydney  Smith's  bitter 

*  Delivered  at  the  Semicentennial  Meeting  of  the  American  Medical 
Association  at  Philadelphia,  Pa.,  June  3,  1897.  Reprinted  from  the 
Journal  of  the  American  Medical  Association,  June  12,  1897. 

243 


244  ADDRESSES   AND   OTHER   PAPERS. 

query  in  1820,  "In  the  four  quarters  of  the  globe,  who  reads 
an  American  book,  .  .  .  what  does  the  world  yet  owe  to 
American  physicians  or  surgeons?"  was  answered  a  quarter 
of  a  century  later  and  made  all  these  "four  quarters  of  the 
globe"  our  grateful  and  everlasting  debtors  for  the  gift  of 
anaesthesia.  It  was  the  discovery  of  an  American  dentist,  was 
first  used  by  an  American  surgeon,  was  christened  by  an 
American  physician  and  litterateur,  and  the  recent  celebration 
awakened  throughout  the  world  the  interest  not  only  of  the 
profession,  but  also  of  the  entire  public.  The  strains  of  our 
still  living  poet,  novelist,  physiologist,  and,  as  we  all  best  love 
to  remember  him,  neurologist,  Dr.  S.  Weir  Mitchell, — nihil 
tetigit  quodnon  ornavit, — as  he  sung  of  the  "Birth  and  Death 
of  Pain,"  have  scarce  died  away  before  we  begin  anew  our 
round  of  celebrations  in  the  anniversary  of  this  now  almost 
venerable  association. 

A  most  important  factor  in  the  improvement  not  only 
in  surgery,  but  also  in  all  departments  of  medicine,  has  been 
the  immense  advance  made  in  Medical  Teaching.  The  educa- 
tional plane  of  the  profession  has  been  steadily  elevated.  If 
the  teachers  of  fifty  years  ago  were  to  revisit  the  scenes  of 
their  early  labors  they  would  scarcely  recognize  the  medical 
colleges  in  which,  in  their  day  and  generation  and  with  the 
meagre  appliances  then  at  their  command,  they  did  what 
we  must  still  recognize  as  yeoman's  work  in  education.  Ap- . 
parently,  at  that  time,  the  entire  instruction  consisted  in 
lectures,  no  text-books  even  being  advised.  In  reply  to  a 
letter  addressed  to  the  deans  of  the  Jefferson  Medical  College 
and  of  the  Medical  Departments  of  the  University  of  Penn- 
sylvania, Harvard  University,  and  Columbia  University,  I 
am  told  that  no  lists  of  text-books  whatever  appear  on  the 
catalogues  of  fifty  years  ago.  In  the  "catalogue"  of  the 
Jefferson  for  1857 — a  mere  catalogue  of  names  of  the  faculty 
and  students,  instead  of  the  present  elaborate  "Announce- 
ment"— for  the  first  time  appears  a  list  of  "Books  of  Refer- 


SEMICENTENNIAL  ADDRESS   IN   SURGERY.  245 

ence,"  and  the  Dean  of  Harvard  states  that  there  "the  first 
mention  whatever  made  of  text-books  appears  in  the  an- 
nouncement of  the  summer  session,  beginning  March  12, 1866," 
four  years  after  I  graduated!  At  first  the  text-books  gener- 
ally recommended  on  surgery  were  Drewitt  and  Erichsen; 
Malgaigne  and  Pancoast*  on  "Operative  Surgery,"  and,  for 
collateral  reading,  Brodie  and  Holmes. 

The  course  of  didactic  lectures  then  began  on  the  second 
Monday  of  October  and  ended  soon  after  the  middle  of  Feb- 
ruary, and  if  we  take  out  the  holidays,  and  remember  that 
not  a  few  made  up  for  coming  late  by  leaving  early,  it  was 
quite  a  possibility  for  a  man  to  receive  his  authorization  to 
practice,  a  diploma  which  alleged  him  to  be  "Virum  probum 
in  arte  medica,  ceque  ac  chirurgica  .  .  .  dignwn  amplis- 
simis  hononbus  academicis,"  after  practically  only  two  ses- 
sions of  little  more  than  three  months  each!  The  examina- 
tion was  a  farce  and  the  diploma  a  falsehood.  Even  so  late 
as  1860,  when  I  began  the  study  of  medicine,  there  were  no 
laboratories,  except  that  of  anatomy — the  dissecting-room. 
I  doubt  whether  of  the  two  hundred  and  odd  men  who  gradu- 
ated with  me  in  1862,  10  per  cent,  had  ever  looked  through 
a  microscope  or  handled  a  test-tube,  palpated  a  tumor,  or 
auscultated  a  chest.  There  were  no  recitations;  neither 
were  there  ward  classes  nor  other  means  for  actual  contact 
of  the  student  with  disease.  We  can  but  wonder  that  any 
of  us  who  graduated  in  the  first  twenty  years  of  the  half- 
century  we  are  celebrating  ever  learned  enough  to  prevent 
some  from  being  rivals  to  Saul,  who  had  slain  his  thous- 
ands, and  the  more  nimble  from  rivalling  David,  who  slew 
his  ten  thousands.  That  we  have  become  respectable  prac- 
titioners, or  possibly  more  than  respectable,  is  due  not  so 

*  The  names  of  American  surgeons  are  printed  in  italics,  to  point  out 
more  distinctly  some  of  those  Americans  who  have  aided  in  the  develop- 
ment of  surgery.  The  limits  of  the  address  only  allowed  me  to  name  a 
few,  and  I  must  apologize  for  all  the  necessary  omissions. 


246  ADDRESSES   AND    OTHER   PAPERS. 

much  to  our  early  opportunities  as  to  later  incessant  midnight 
labors. 

Now  we  may  congratulate  ourselves  that  the  majority  of 
the  Medical  Schools  of  the  country  have  a  graded  course  of 
four  years,  each  covering  not  less  than  six,  and  often  eight 
months;  not  only  lectures,  but  in  many  instances  constant 
and  searching  recitations;  a  dozen  laboratories  in  which  each 
student  actually  does  the  work  of  observation  and  experiment; 
ward  classes  in  which  every  man  is  obliged  to  train  his  eyes, 
his  ears,  his  fingers,  and  his  judgment  in  the  examination  of 
patients  in  every  department  of  medicine;  to  ferret  out  the 
history  of  the  cases  brought  before  him,  ascertain  symptoms, 
seek  for  physical  signs,  reach  a  diagnosis,  determine  the  treat- 
ment, and  often  actually  to  prescribe  and  to  assist  at  opera- 
tions. 

Not  only,  however,  is  the  advance  marked  in  our  medical 
schools,  whose  diploma  now  really  means  almost  what  it  says, 
but  also  all  over  the  land  since  1847  there  have  been  estab- 
lished, partly  from  philanthropic  motives  and  partly  for  the 
purpose  of  medical  teaching,  an  enormous  number  of  Hos- 
pitals, in  which  a  very  large  proportion  of  the  young  men, 
after  receiving  their  diplomas,  spend  a  year  or  more  in  the 
actual  practice  of  their  profession,  under  the  eyes  of  accom- 
plished teachers.  It  is  impossible  to  describe  the  immense 
benefit  thus  obtained  by  large  numbers  of  nascent  practi- 
tioners, from  such  familiarity  with  all  the  phases  of  disease 
which  they  will  meet  in  their  after-lives.  Not  a  few  of  them 
also,  by  being  brought  in  contact  with  energetic,  enthusiastic, 
and  wise  teachers,  receive  their  first  stimulus,  both  literary 
and  scientific,  a  stimulus  which  will  influence  their  entire 
future  course,  and  is  of  far  more  value  than  any  amount  of 
mere  scientific  knowledge  they  may  acquire. 

What  untold  good  these  hospitals  do,  not  merely  to  the 
patients  who  are  cured  and  the  internes  who  are  taught,  but 
equally  to  the  older  medical  staff  who  are  still  further  trained 


SEMICENTENNIAL  ADDRESS   IN   SURGERY.  247 

and  educated  by  them!  Not  only  in  great  metropolitan 
centres,  but  in  small  towns,  and  sometimes  even  in  rural 
communities,  this  growth  of  hospitals  has  been  within  the 
last  twenty  years  one  of  the  striking  features  of  our  civiliza- 
tion. It  is  not  too  much  to  say  that  every  city  or  town 
establishing  a  hospital  is  repaid  a  hundredfold  by  the  imme- 
diate improvement  of  its  medical  men  from  those  opportuni- 
ties for  experience  and  exact  study.  No  one  can  visit  a 
modern  hospital  without  being  struck  by  the  immense  im- 
provements of  the  last  few  years.  The  noisome  hotbeds  of 
contagion,  of  fever,  of  suppuration,  of  erysipelas,  of  blood- 
poisoning,  and  of  "hospital"  gangrene — could  irony  wield  a 
sharper  weapon  than  such  a  name? — have  given  way  to  neat 
and  trim  wards,  the  home  of  cleanliness  itself,  with  iron  bed- 
steads, glass-topped  tables,  cement  or  marble,  tiled  or  tessel- 
lated floors  and  walls,  with  trained  nurses  whose  jaunty  caps 
and  pretty  uniforms  and  often  winsome  faces  almost  make 
one  half  wish  to  be  sick,  and  when  one  is  sick  half  loth  to 
be  well. 

I  mentioned  a  moment  ago  the  Text-books  in  use  forty 
years  ago.  Except  Pancoasfs  "Operative  Surgery,"  every 
one  of  them,  it  will  be  observed,  was  the  work  of  a  European. 
Gross's  "System  of  Surgery,"  which  has  probably  had  a 
wider  influence  in  educating  the  profession  than  any  other 
general  surgical  text-book  issued  up  to  the  present  time — a 
monument  of  surgical  knowledge  and  indefatigable  labor — 
was  first  published  in  1859.  This  was  far  in  advance  of  most 
of  the  surgical  text-books  then  in  use.  The  literary  labors 
of  American  surgeons  consisted  chiefly  in  translating  foreign 
surgeries  or  in  annotating  American  editions  of  English  text- 
books. 

Within  the  last  two  decades,  and  especially  the  last,  we  all 
know,  without  my  undertaking  the  invidious  task  of  naming 
them,  how  many  distinctly  American  surgeries  have  been 
written,  and  we  may  say,  without  undue  national  vanity, 


248  ADDRESSES   AND   OTHER   PAPERS. 

that  they  are  the  equals  of  any  similar  European  works. 
This  literary  and  scientific  activity,  however,  has  not  been 
limited  to  text-books  or  systems  of  surgery  alone,  but  our 
forward  strides  in  education  have  been  marked  by  the  appear- 
ance of  not  a  few  monographs  of  original  research  which  do 
credit  not  only  to  their  authors,  but  to  all  American  surgeons. 

On  more  than  one  occasion  I  have  had  to  call  attention  to 
the  difference  between  American  surgery  and  that  of  Europe. 
While  in  the  department  of  the  practice  of  surgery,  after  a 
full  acquaintance  and  observation  with  European  men  and 
methods,  I  can  state  my  deliberate  conclusion  that  the  best 
American  surgeons  are  the  peers  of  the  best  European  sur- 
geons; yet  in  the  department  of  original  research  and  espe- 
cially of  laboratory  work,  we  must  confess  our  very  evident 
shortcomings.  I  do  not  say  that  we  should  be  ashamed  of 
them,  for  we  must  remember  that  we  are  but  little  more  than 
a  century  old  as  a  nation ;  that  the  practical  needs  of  everyday 
life  must  first  be  met;  that  opportunities  must  be  created  by 
the  construction  and  endowment  of  laboratories,  and  espe- 
cially by  the  growth  of  that  literary  and  scientific  spirit  which 
only  develops  in  any  community  or  profession  in  the  course 
of  long  years  and  with  accumulated  wealth,  and  which  has 
had  little  opportunity  for  growth  in  this  country  until  within 
the  last  twenty  years.  The  genius  of  our  institutions  is  such 
that  we  can  never  look  for  government  or  State  endowments 
of  such  laboratories,  but  must  depend  on  the  far-sighted  and 
broad-minded  liberality  of  our  wealthy  fellow-citizens  for  the 
establishment  of  such  laboratories  and  the  consequent  oppor- 
tunities for  investigation  and  discovery.  Nor  do  I  believe,  in 
the  long  run,  that  we  shall  suffer  by  reason  of  this  difference. 
As  a  people  we  are  not  apt  to  be  left  behind  in  the  race,  and 
the  stimulus  of  a  somewhat  exceptional  distinction  in  science 
or  literature  will  meet  with  a  responsive  chord  in  the  breast 
of  many  a  young  man  now  beginning  his  studies. 

To  attempt  to  impress  upon  the  members  of  the  American 


SEMICENTENNIAL   ADDRESS   IN   SURGERY.  249 

Medical  Association  the  need  for  such  original  research  in 
this  country  is  a  work  of  supererogation,  but  I  may  with 
propriety  urge  you  with  all  the  ardent  and  intense  conviction 
I  feel,  that  as  we  leave  this  festal  meeting  and  go  to  our 
homes,  everyone  of  us  as  occasion  offers  will  urge  upon  our 
wealthy  liberal-minded  fellow-citizens  the  duty  and  also  the 
privilege  of  founding  in  connection  with  every  medical  school 
laboratories  of  research,  the  good  influence  and  beneficent 
results  of  which  can  never  be  estimated  in  paltry  dollars  and 
cents.  Yet  tried  even  by  this  commercial  standard  science 
pays.  The  early  recognition  of  the  germs  of  cholera  at  the 
port  of  New  York  some  years  ago  by  preventing  the  entrance 
of  such  a  commerce-destroying  epidemic,  leaving  wholly  out 
of  consideration  the  saving  of  human  life,  saved  to  the  citizens 
of  the  metropolis  more  millions  of  dollars  than  are  represented 
many  times  over  by  the  cost  of  all  the  laboratories  now 
existing  in  this  country.  Our  merchants  should  be  made  to 
understand,  therefore,  that  even  from  a  financial  point  of 
view,  to  say  nothing  of  the  humanitarian  standpoint,  the 
cheapest  means  of  preventing  the  enormous  business  losses 
which  occur  from  epidemics  is  by  such  scientific  and  hygienic 
measures  as  the  laboratory  makes  possible. 

Allied  to  medical  teaching  and  the  most  important  adjunct 
to  medical  literature  is  the  establishment  of  extensive  Medical 
Libraries.  In  this,  as  an  American,  I  am  proud  of  my  own 
country.  No  foreign  nation  can  point  with  equal  pride  to 
any  such  medical  libraries  as  the  last  thirty  years  have  devel- 
oped in  this  country.  Foremost,  not  only  among  American 
libraries,  but  in  the  world,  is  that  of  the  Surgeon-General's 
Office  of  the  United  States  Army  in  Washington.  Not  only 
has  it  gathered  thousands  of  medical  books  and  eleven  hun- 
dred medical  journals  (the  estimate  of  Dr.  Fletcher)  from  all 
over  the  world,  but  the  entire  library  is  managed  with  a 
liberality  which  makes  it  the  admiration  and  the  envy  of 
foreigners.  Its  treasures  are  freely  at  the  service  of  the  entire 


250  ADDRESSES  AND  OTHER  PAPERS. 

profession  of  the  country,  and  the  publication  (under  the 
editorship  of  Dr.  John  S.  Billings)  of  its  magnificent  "Index 
Catalogue,"  has  made  the  whole  world  debtors  to  America. 
We  trust  that  a  more  liberal  congress  may  see  that  if  even 
the  small  amounts  thus  far  given  to  it  have  made  it  of  such 
immense  value,  still  larger  and  more  generous  appropriations 
would  keep  it  ever  in  the  van. 

In  addition  to  this,  the  libraries  of  the  College  of  Physicians 
of  Philadelphia,  of  the  New  York  Academy  of  Medicine,  and 
of  the  Boston  Medical  Library  Association  are  only  surpassed 
by  those  of  the  faculties  of  medicine  in  Paris,  of  the  Royal 
College  of  Surgeons  of  London,  and  of  the  Military  Medical 
Institute  of  St.  Petersburg;  while  those  of  the  Newberry 
Library  in  Chicago  (thanks  to  our  honored  and  liberal  presi- 
dent), of  the  New  York  Hospital,  and  of  the  Pennsylvania 
Hospital  rank  well  with  the  best  European  libraries.  With 
such  literary  opportunities,  therefore,  if  we  had  equally  good 
scientific  laboratories  the  possibilities  of  American  medicine 
and  surgery  would  be  almost  unbounded. 

The  scientific  progress  of  this  half-century  of  surgery  has 
separated  as  from  the  past  as  by  a  great  gulf.  Great  theolo- 
gians, such  as  a  Calvin  or  a  Jonathan  Edwards,  were  they  re- 
called to  life,  could  discourse  as  learnedly  as  ever  of  Predesti- 
nation and  Free  Will;  great  preachers,  as  a  Beecher  or  a 
Spurgeon,  could  stir  our  souls  and  warm  our  hearts  as  of  old; 
great  jurists,  as  a  Justinian  or  a  Marshall,  could  expound  the 
same  principles  of  law  which  hold  good  for  all  time;  great 
forensic  orators,  as  a  Burke  or  a  Webster,  could  convince  us 
by  the  same  arguments  and  arouse  us  by  the  same  invectives 
or  the  same  eloquence  that  made  our  fathers  willing  captives 
to  their  silver  tongues.  But  to-day,  so  rapid  has  been  our 
surgical  progress,  a  Velpeau,  a  Sir  William  Ferguson,  or  a 
Pancoast,  all  of  whom  have  died  within  the  last  thirty  years, 
could  not  teach  modern  surgical  principles  nor  perform  a 
modern  surgical  operation.  Even  our  everyday  surgical 


SEMICENTENNIAL  ADDRESS   IN   SURGERY.  251 

vocabulary — staphylococcus,  streptococcus,  infection,  immu- 
nity, antisepsis  and  asepsis,  toxine  and  antitoxine — would  be 
unintelligible  jargon  to  him;  and  our  modern  operations  on 
the  brain,  the  chest,  the  abdomen,  and  the  pelvis  would  make 
him  wonder  whether  we  had  not  lost  our  senses,  until  seeing 
the  almost  uniform  and  almost  painless  recoveries,  he  would 
thank  God  for  the  magnificent  progress  of  the  last  half- 
century,  which  had  vouchsafed  such  magical — nay,  such 
almost  divine — power  to  the  modern  surgeon. 

The  splendid  "Index  Catalogue  of  the  Library  of  the  Sur- 
geon-General's Office"  teaches  another  lesson.  In  law,  the 
jurist  or  attorney  deals  with  statutes  and  precedents,  and  to 
some  extent  with  principles  which  are  for  the  most  part  local. 
An  American  lawyer  could  not  plead  a  case  in  Germany,  nor 
a  German  lawyer  in  Russia,  nor  a  Russian  lawyer  in  Italy. 
Laws  and  customs  differ  from  country  to  country.  An 
American  or  an  English  divine  is  an  alien  in  language  and 
religion  in  Hindustan;  a  Hindu,  equally  an  alien  in  China; 
a  Chinaman,  in  Africa.  But  surgery  is  one  and  the  same 
the  world  over.  Whether  in  the  frozen  north  or  under  the 
equator,  in  civilized  America  or  barbaric  Africa,  be  the  patient 
white  Caucasian,  swarthy  negro,  red  Indian,  or  yellow  Malay, 
the  same  accidents  and  diseases  assail  him,  the  same  remedies 
save  him,  identical  operations  cure  him:  a  new  remedy  dis- 
covered in  Japan  is  equally  efficacious  in  Philadelphia;  a 
new  operation  devised  in  America  is  equally  applicable  in 
Egypt.  The  "Index  Catalogue,"  which  is  a  catalogue  not  for 
one  country,  but  for  all  nations  and  all  tongues,  contains 
them  all.  This,  with  our  noble  stand  as  a  profession  against 
patenting  any  instrument,  any  operation,  or  any  method  of 
treatment,  makes  every  sick  or  injured  man  my  brother, 
and  makes  me  his  keeper,  under  every  sky,  and  clothed  in 
any  skin.  Heaven  bless  such  a  divine  profession,  such  a 
noble  array  of  generous  men  battling  for  the  life  and  health 
of  all  mankind,  the  world  over,  in  one  serried  phalanx  of 
unselfish  heroes! 


252  ADDRESSES   AND   OTHER   PAPERS. 

The  development  of  modern  surgery,  apart  from  surgical 
teaching,  libraries  and  laboratories,  is  dependent  on  several 
noteworthy  factors.  These  have  to  do  partly  with  the  dis- 
covery and  development  of  surgical  principles,  and  partly 
with  the  development  of  surgical  practice.  Now  the  one 
and  now  the  other  is  in  advance.  Each  is  the  handmaid  of 
the  other.  In  Listerism  we  see  surgical  practice  outstripping 
surgical  principles,  for  of  Lister  it  might  truly  be  said,  that 
by  the  "  scientific  use  of  the  imagination  "  he  saw  the  germs, 
"when  as  yet  there  were  none  of  them."  His  surgical  insight 
convinced  him  of  the  existence  of  the  germs  of  suppuration 
years  before  Ogston's  and  Rosenbaum's  discovery  of  the 
pyogenic  organisms.  On  the  other  hand,  the  moment  that 
the  scientist  discovered  these  germs,  the  laboratory  enabled 
him  to  discover  many  others,  and  the  discovery  of  the  bacillus 
of  tetanus,  of  the  tubercle  bacillus,  of  the  streptococcus  of 
erysipelas,  of  the  gonococcus,  of  the  bacillus  of  malignant 
oedema,  the  bacillus  mallei,  etc.,  illustrate  the  converse — 
science  forging  ahead  of  practice,  and  pointing  the  way  to 
new  achievements  in  the  healing  art. 

First. — Foremost  among  the  important  studies  which  the 
past  fifty  years  have  seen  established  on  a  firm  foundation,  is 
that  of  Pathology  and  Pathological  Anatomy.  It  is  not  a  little 
credit  to  America  that  the  first  pathology  written  in  the 
English  language  was  written  by  a  young  American  doctor, 
in  a  then  small  Western  town,  as  early  as  1839.  In  spite  of 
Gross's  book,  however,  pathology  and  pathological  anatomy 
were  almost  unknown  sciences  hi  1847.  The  Pathological 
Society  of  Dublin  was  founded  in  1839,  that  of  New  York 
in  1844,  that  of  London  in  1846,  and  that  of  Philadelphia 
In  1857.  The  microscope,  and  especially  microscopical 
methods  of  staining,  section  cutting,  and  the  like  were  in 
their  infancy,  or  may  indeed  be  said  scarcely  to  have  existed. 
No  accurate  views  of  pathology  could  be  entertained  without 
these  aids.  What  is  now  the  heritage  of  every  first  year 


SEMICENTENNIAL  ADDRESS   IN   SURGERY.  253 

student  was  beyond  the  possibilities  of  the  most  advanced 
teacher  of  fifty  years  ago. 

Second. — Allied  sciences  have  been  put  under  tribute  to 
surgery.  In  physics  the  discovery  of  the  Roentgen  rays  is 
so  recent  as  to  require  only  mention.  This  discovery,  as 
well  as  the  enormous  advances  of  Electricity,  as  seen  in  the 
electric  headlight,  the  cystoscope,  the  gastro-diaphanoscope, 
and  other  means  of  diagnosis,  engenders  the  hope  that  other 
forces  and  other  means  of  investigation  quite  as  surprising 
and  quite  as  marvelous,  are  certainly  to  be  expected  within 
the  next  fifty  years. 

It  is  due,  however,  especially  to  the  development  of  Em- 
Bryology  and  Comparative  Anatomy,  in  combination  with 
pathology,  that  our  views  of  the  nature  of  disease  have 
become  so  much  more  accurate.  Perhaps  the  book  which  then 
influenced  surgical  views  and  surgical  practice  more  than 
any  other  was  Chelius's*  "Surgery,"  of  which  a  translation 
by  South  was  republished  in  Philadelphia  in  1847.  It  had 
passed  through  six  editions,  and  had  appeared  in  eight  lan- 
guages. It  may  be  taken,  therefore,  as  the  type  of  the  most 
advanced  European  surgery  of  that  day.  How  curiously 
vague  his  ideas  of  pathology  were  may  be  seen  in  his  classify- 
ing together  false  joints,  old  rupture  of  the  female  perineum, 
harelip  and  cleft  palate,  as  "old"  in  contradistinction  to 
"recent,"  " solutions  of  continuity  which  do  not  suppurate." 
Though  he  speaks  of  the  last  two  as  "original  vices,"  yet  so 
far  as  concerned  embryology,  which  has  shown  the  cause 
for  harelip  and  cleft  palate,  he  is  absolutely  silent.  Stenosis 
of  the  oesophagus,  of  the  rectum,  of  the  prepuce,  urethra,  and 
vagina,  were  all  classed  together  under  "  diseases  of  unnatural 
adhesions  of  parts."  The  existence  of  neoplasms  as  a  cause 
of  the  stenosis  was  not  clearly  differentiated  from  other 
causes.  All  his  ideas  as  to  tumors  were  vague,  and,  as  we 
now  know,  wholly  unscientific.  There  is  no  chapter  on 

*  Professor  of  Surgery  at  Heidelberg. 


254  ADDRESSES   AND   OTHER   PAPERS. 

tumors  in  the  modern  sense,  though  there  is  one  on  "  diseases 
which  consist  hi  the  degeneration  of  organic  parts,  or  hi  the 
production  of  new  structures";  but  even  in  this,  enlarged 
clitoris,  goitre,  warts,  bunions,  fungus  of  the  dura  mater, 
fatty  swellings,  encysted  swellings,  and  loose  bodies  in  the 
joints  are  grouped  with  polyps,  sarcoma,  cancer,  and  other 
new  growths.  Ranula,  retention  of  urine,  and  retention  of 
the  fetus  are  classed  together  as  "Foreign  bodies  formed  in 
our  organism  by  the  retention  of  natural  products,"  and 
hernia  cerebri  is  treated  in  connection  with  all  other  forms 
of  hernia.  Greater  disregard  of  their  pathology  or  etiology, 
of  their  origin  and  significance,  can  hardly  be  imagined. 

Though  John  Hunter  had  dissected  over  five  hundred 
varieties  of  animals  a  half-century  before  the  American  Medi- 
cal Association  was  organized,  yet  the  solidarity  of  the  animal 
kingdom  from  man  down  to  the  lowest  form  of  life  was  not 
recognized.  Evolution,  and,  therefore,  reversion  to  animal 
types,  was  not  recognized,  and  hence  not  used  to  explain 
many  abnormal  developments.  For  instance,  abnormities 
in  the  arch  of  the  aorta  and  its  branches,  which  we  now 
recognize  as  variations  of  a  general  plan  running  through  the 
entire  animal  kingdom,  were  then  mere  curiosities  of  structure 
without  any  meaning. 

Third. — The  year  before  the  American  Medical  Association 
was  organized  the  world  was  startled  and  surgery  revolution- 
ized by  the  introduction  of  Aruesthesia;  first  of  ether,  in 
America,  in  the  year  1846;  then  of  chloroform,  in  Edinburgh, 
hi  the  following  year.  What  this  has  done  for  the  ameliora- 
tion of  the  horrors  of  pre-ansesthetic  surgery  very  few  now 
living  can  appreciate.  Instead  of  shrieks,  and  cries,  and 
groans,  and  a  needful  celerity  which  sometimes  became 
dangerous  haste,  everything  now  proceeds  with  that  quiet 
and  leisure  which  is  essential  to  the  performance  of  many, 
if  not  most,  of  our  modern,  elaborate,  and  prolonged  surgical 
operations.  Now  "  the  fierce  extremity  of  suffering  has  been 


SEMICENTENNIAL  ADDRESS   IN   SURGERY.  255 

steeped  in  the  waters  of  oblivion,  and  the  deepest  furrow 
in  the  knotted  brow  of  agony  has  been  smoothed  away  for- 
ever" (Holmes).  Who  could  possibly  endure  the  tortures 
of  an  operation  lasting  for  one,  two,  or  it  may  be  even  three 
hours,  when  every  minute  seemed  an  eternity  of  agony?  I 
would  rather  be  the  discoverer  of  anaesthesia  than  have  won 
an  Austerlitz  or  a  Waterloo! 

The  old  motto,  "tuto  cito  et  jucunde,"  is  now  changed  by 
the  omission  of  "cito."  In  fact,  as  has  been  pointed  out  by 
Cheever  and  a  few  others,  the  leisurely  performance  of  opera- 
tions which  is  made  possible  by  ether  is  in  danger  of  leading 
us  to  a  dilatory  method  of  operating  which  has  its  own  dan- 
gers. Some  of  our  most  successful  modern  surgeons  owe  not 
a  little  of  their  lessened  mortality,  I  am  sure,  to  their  swiftness. 

The  ideal  anaesthetic  has  not  yet  been  obtained.  No  one 
who  reads  the  journals  from  week  to  week,  and  sees  the  sad 
headings  "Death  from  Anaesthetics,"  and  especially  "Death 
from  Chloroform,"  can  fail  to  see  that  both  ether  and  chloro- 
form, and  also  a  few  others  which  occasionally  replace  them, 
have  very  real  dangers.  The  ideal  anaesthetic  will  not  be  one 
which  will  abolish  pain  without  abolishing  consciousness. 
To  have  the  patient  aware  of  surgical  emergencies  which  test 
even  a  veteran  operator's  skill  and  resources  to  the  utmost 
would  frequently  invite  death  by  the  terror  which  it  might 
occasion.  The  ideal  anaesthetic  will  abolish  pain  by  the 
abolition  of  consciousness,  but  without  danger  to  life.  That  it 
will  be  found  is  as  certain  as  that  experiment  and  progress 
are  our  watchwords. 

Besides  general  anaesthesia,  several  forms  of  local  anaesthesia 
have  been  devised,  within  the  last  few  years,  by  freezing  with 
salt  and  ice,  rhigolene,  or  chloride  of  ethyl,  by  cocaine,  eucaine, 
Schleich's  infiltration  method,  etc.,  methods  which  have  a 
distinct  sphere  of  usefulness,  especially  in  minor  operations. 

Fourth.  Antiseptic  Surgery. — While  the  exact  date  of  the 
revolution  in  surgery  due  to  anaesthesia  can  be  fixed,  a  later 


256  ADDRESSES   AND   OTHER   PAPERS. 

revolution  in  our  surgical  methods  came  in  so  gradually  that 
one  cannot  name  any  special  day,  or  even  year,  when  it  was 
introduced.  But,  while  the  day  or  year  cannot  be  given, 
the  one  man  to  whom  this  great  revolution  in  modern  surgery 
is  due  is  well  known.  The  name  of  Lister,  primus  inter  pares, 
is  honored  throughout  the  entire  surgical  world,  and  his 
recent  distinction,  as  the  first  medical  peer  of  the  United 
Kingdom,  is  an  honor  conferred  not  upon  Lord  Lister  alone, 
but  upon  the  entire  profession,  and  worthily  marks  a  new 
departure  in  the  recognition  of  medical  science  by  the  Queen. 

So  far  as  this  country  is  concerned,  the  introduction  of 
antiseptic  surgery  may  be  said  to  date  from  the  visit  of  Mr. 
Lister  to  this  same  city  of  Brotherly  Love,  at  the  Centennial 
International  Medical  Congress  of  1876.  Derided  at  first  as 
a  "fad"  or  as  "nothing  more  than  surgical  cleanliness,"  it 
has  now  won  its  way  over  the  whole  world.  A  few  laggards 
in  the  surgical  army  there  are  who  even  yet  do  not  practice 
modern  antiseptic  or  aseptic  surgery,  but  the  overwhelming 
majority  of  the  profession  recognize  that  the  world  owes  a 
debt  to  Lord  Lister  which  no  honors  can  pay.  His  service 
to  humanity  will  never  be  forgotten,  and  probably  never  will 
be  surpassed,  in  its  wide-reaching  beneficent  influence. 
Ansesthesia  abolished  pain;  antisepsis  has  almost  abolished 
suppuration,  erysipelas,  tetanus,  and  the  various  forms  of 
blood-poisoning;  in  other  words,  nine-tenths  of  the  dangers 
of  surgical  operations. 

Malgaigne,  from  1836  to  1840,  lost  126  amputations  of  the 
thigh,  out  of  201,  a  mortality  of  nearly  63  per  cent.*  Erd- 
man\  has  shown  that  in  nine  New  York  hospitals,  from  1882 
to  1894,  the  mortality  in  223  amputations  of  the  thigh  was 
21.5  per  cent.  HeimannJ  reports  in  Germany,  in  1894,  475 
cases  with  a  mortality  of  21.7  per  cent.  Page,§  of  Newcastle- 

*  Mutter's  Listen,  p.  425.  t  Annals  of  Surgery,  xxii,  1895,  p.  358. 

J  Arch.  f.  klin.  Chir.,  1897,  liv,  223.  §  Lancet,  1894,  i,  1439. 


SEMICENTENNIAL  ADDRESS  IN  SURGERY.       257 

.  upon-Tyne,  has  shown  that,  from  1876  to  1893,  of  230  ampu- 
tations of  the  thigh,  the  mortality  was  only  11.3  per  cent.; 
and  Estes*  of  77  such  amputations,  lost  only  8,  a  mortality 
of  but  10.4  per  cent.  Not  a  little  of  this  lessened  mortality 
is  due  to  our  improved  methods  of  haemostasis,  especially  by 
the  use  of  the  haemostatic  forceps,  and  at  the  shoulder-  and 
hip-joints  by  the  use  of  Wyeth's  pins. 

Without  anaesthesia  and  antisepsis  modern  surgery  would 
be  an  impossibility.  It  is  to  me  an  inspiring  and  encouraging 
thought  that  the  world  owes  the  three  greatest  discoveries 
of  modern  medicine — Vaccination,  Anaesthesia,  and  Antisep- 
sis— to  England  and  America.  Long  may  we  be  joined  in 
such  scientific  brotherhood!  Never  may  we  be  sundered  by 
fratricidal  strife ! 

Fifth. — As  an  outgrowth  from  the  practical  development 
of  antiseptic  surgery  has  arisen  a  wholly  new  science  and  a 
wholly  new  method  of  practice  which  bid  fair  to  revolutionize 
our  modern  therapeutics — Bacteriology  and  Orrhotherapy 
(Serum-therapy) .  Like  the  antiseptic  method,  they  have  been 
a  gradual  outgrowth.  Modern  laboratory  research  has  verified 
the  crude  suspicions  and  shrewd  guesses  of  thirty  years  ago,  and 
transformed  them  into  the  certainties  of  modern  science.  The 
discovery  of  the  anthrax  bacillus  by  Pollender,  in  1855;  the 
epoch-making  discovery  of  the  pyogenic  organisms,  in  1881, 
by  Ogston  and  Rosenbaum;  of  the  tubercle  bacillus  by  Koch, 
in  1882;  of  the  tetanus  bacillus  by  Nicolaier,  in  1887,  well 
illustrate  how  recent  is  this  scientific  knowledge.  The  splendid 
results  which  have  been  achieved  in  medicine,  by  the  use  of 
Behring's  and  Roux's  diphtheritic  antitoxine,  seem  to  promise 
that  some  form  of  antistreptococcic  serum  will  do  as  much 
for  surgery,  and  that  your  orator  fifty  years  from  now  will 
be  able  to  trace  the  history  of  the  probably  soon-to-be-realized 
method  of  battling  with  infection,  of  which  at  present  we 
have  only  a  premonition.  Bacteriology  and  orrhotherapy 
*  N.  Y.  Med.  Rec.,  Nov.  3,  1894. 


258  ADDRESSES   AND   OTHER   PAPERS. 

are  so  recent  that  it  is  dangerous  to  prophecy  what  may  occur, 
but  it  is  not  venturing  far  to  predict  that  fifty  years  from 
now  we  shall  be  able  not  only  easily  to  convert  infected  into 
non-infected  wounds,  but  also,  by  some  means  as  yet  undis- 
covered, we  shall  be  able  successfully  to  combat  the  infection, 
and  prevent  the  dire  ravages  of  tuberculosis,  of  syphilis,  of 
cancer,  of  sarcoma,  and  possibly  even  the  occurrence  of  benign 
tumors.  That  will  be,  indeed,  the  surgical  "Golden  Age," 
when  surgery  will  be  robbed  of  nearly  all  its  terrors,  when 
a  peaceful  victory  will  abolish  our  present  instruments  and 
the  majority  of  our  present  operations. 

Sixth. — Animal  experimentation  has  had  also  a  very  large 
share  in  the  development  of  modern  surgery.  The  whole 
question  of  the  introduction  of  animal  ligatures  was  begun  in 
America  by  Physick,  who  used  buckskin ;  his  follower,  Dorsey, 
who  used  kid,  and  cut  both  ends  short;  Hartshorne,  who  used 
parchment,  and  Bellenger  and  Eve,  the  tendon  of  the  deer; 
and  this  has  been  solved  principally  by  experiments  upon 
animals,  in  order  to  determine  accurately  the  behavior  of 
such  ligatures  in  the  tissues.  Only  professional  readers  can 
appreciate  what  a  boon  to  humanity  this  single  achievement 
has  been.  Modern  cerebral  surgery  also  owes  its  exactness 
and  success  almost  wholly  to  cerebral  localization  and  anti- 
sepsis, both  of  which  were  first  studied  by  experiment  upon 
animals,  and  later  by  the  application  to  man  of  the  knowledge 
so  gained.  Bacteriology  would  not  now  exist  as  a  science,  nor 
would  accurate  modern  surgery  and  a  large  part  of  modern 
medicine  be  possible,  had  experiments  upon  animals  been  pro- 
hibited, as  some  zoophilous  men  and  women  who  love  dogs 
better  than  men  and  women  and  even  little  children,  desire. 

Seventh. — The  developments  of  modern  surgery  have  natu- 
rally been  on  two  lines:  1.  That  of  scientific  progress  based 
especially  on  pathology,  bacteriology,  embryology,  and  com- 
parative anatomy.  Our  present  views  of  tumors,  of  mal- 
formations, of  the  theory  of  immunity,  of  septicaemia  and 


SEMICENTENNIAL   ADDRESS   IN    SURGERY.  259 

pyaemia,  of  thrombosis  and  embolism,  have  been  the  result 
of  the  studies  by  physiologists  and  pathologists,  which  have 
most  profoundly  helped  our  practice  and  influenced  our 
results. 

2.  Within  the  last  twenty-five  years,  especially,  there  has 
come  what  might  be  called  pre-eminently  the  era  of  the 
operative  surgeon,  due  more  especially  to  the  introduction  of 
anaesthesia  and  later  of  antisepsis.  By  making  it  possible 
to  perform  an  operation  without  pain,  and  almost  without 
danger,  organ  after  organ  of  the  body  has  been  made  accessible 
to  the  modern  surgeon  with  almost  invariable  success. 
Scarcely  twenty  years  ago  even  Erichsen,  in  a  public  address, 
declared  that  surgery  had  nearly  reached  its  final  limits,  and 
that  the  brain,  the  heart,  and  the  lungs  must  ever  remain 
inaccessible  to  the  surgeon's  knife!  But  now  these  organs 
are  so  constantly  operated  on  and  even  removed  that  I  have 
about  reached  the  conclusion  that,  with  the  exception  perhaps 
of  the  heart,  all  of  our  internal  organs  are  strictly  to  be  classed 
as  luxuries — and  we  even  know  some  heartless  people.  From 
this  safety  and  painlessness  there  has  been  born  an  audacity 
unknown  to  the  men  of  a  former  generation.  Diseases  then 
thought  to  be  incurable  are  now  vanquished  every  day  in  our 
clinics,  and  organs  thought  to  be  inaccessible  are  attacked 
with  an  impunity  which  is  perfectly  marvellous.  Indeed, 
the  danger  is  not  slight,  that  we  may  go  to  the  other  extreme 
and  we  may  well  heed  the  warning  of  Weir  Mitchell,  that, 
perhaps,  "surgery  has  lost  much  of  that  keen  sense  of  re- 
sponsibility which  grew  out  of  the  larger  mortality  of  other 
days." 

Modern  instruments  of  precision,  such  as  the  clinical  ther- 
mometer, the  cystoscope,  the  ophthalmoscope,  the  laryngo- 
scope, the  otoscope,  the  proctoscope,  the  aspirator,  etc., 
without  which  accurate  diagnosis  and  proper  treatment  are 
often  impossible;  instruments  accessory  to  operation,  such 
as  retractors,  haemostatic  forceps,  transfusion  apparatus,  etc., 


260  ADDRESSES   AND    OTHER   PAPERS. 

without  which  the  modern  surgeon  would  be  hampered  and 
hindered  beyond  measure,  were  wholly  unknown  thirty  years 
ago. 

Time  will  not  permit  me  to  trace  chronologically  the  intro- 
duction of  one  operation  after  another.  We  can  best,  per- 
haps, obtain  a  notion  of  the  difference  between  the  surgery 
of  1847  and  that  of  1897  by  noting  what  operations  were 
performed  at  the  former  date  and  contrasting  them  with 
present  possibilities.  Among  the  operations  performed  a 
half-century  ago  may  be  included : 

Amputations; 

The  ligation  of  the  most  important  arteries; 

Occasionally  excision  of  joints; 

The  removal  of  external  tumors; 

Lithotomy; 

Lithotrity; 

Colostomy; 

Herniotomy; 

Tracheotomy; 

Tenotomy  (the  subcutaneous  performance  of  which,  to- 
gether with  the  difference  in  the  danger  of  open  and  closed 
fractures,  should  have  pointed  out  the  road  to  antiseptic  sur- 
gery long  before  the  day  of  Lister) ;  and 

Trephining,  which,  though  formerly  very  frequent,  had 
almost  fallen  into  desuetude.  South  says  in  1847,  "the  less 
done  as  regards  fractures  of  the  skull,  the  better.  They 
should  never  be  interfered  with  except  compression  be  pres- 
ent." The  barbarous  ecraseur  and  the  equally  barbarous 
Jarvis  adjuster,  were  then  in  frequent  use. 

Ovariotomy  was  more  than  looked  at  askance,  though  it  orig- 
inated with  McDowell  in  Kentucky  as  long  ago  as  1809.  In 
1846,  Mutter,  in  commending  Liston*  for  protesting  against 
ovariotomy,  says:  "It  is  certainly  hazarding  but  little  to 
assert  that  in  a  very  few  years  the  measure  will  be  assigned  to 

*  Mutter's  Liston,  p.  442. 


SEMICENTENNIAL  ADDRESS  IN  SURGERY.       261 

the  oblivion  it  so  richly  merits,"  and  so  late  as  1862,  the  year 
that  I  graduated,  I  heard  the  then  Professor  of  Obstetrics 
(Meigs)  hi  the  Jefferson  College,  in  his  last  course  of  lectures, 
declare  with  a  warmth  which  did  more  credit  to  his  humanity 
than  to  his  science,  "  that  the  men  who  go  about  the  country 
ripping  open  women's  bellies  should  be  indicted  for  murder." 
The  first  ovariotomy  in  England  was  performed  in  1836;  the 
first  in  France  in  1844;  but  for  Europe  ovariotomy  "was  not 
fully  established  as  a  surgical  procedure  until  after  1858, 
when  Sir  Spencer  Wells  took  it  up"  *;  and  in  this  country, 
when  the  brothers  Atlee  at  about  the  same  date  suffered,  one 
may  say  even  persecution,  because  of  their  adherence  to 
their  belief  that  ovariotomy  was  a  justifiable  operation. 
Now,  a  number  of  surgeons  each  can  count  more  than  one 
thousand  ovariotomies,  perhaps  some  even  two  thousand, 
with  a  mortality  hi  their  later  results  as  low  as  three  per  cent. 

It  is  impossible,  in  the  time  allotted  me,  to  do  more  than 
make  a  very  brief  survey  of  the  surgery  of  1897,  as  contrasted 
with  that  of  1847,  but  even  a  hasty  glance  will  give  us  some 
idea  of  how  far  we  have  gone  on  the  road  of  progress. 

One  of  the  most  striking  departments  in  which  progress 
has  been  made  is  in  that  of  the  nervous  system.  In  this, 
Mitchell,  though  not  a  surgeon,  has  suggested  many  surgical 
advances.  I  have  already  quoted  South's  dictum  as  to  frac- 
tures of  the  skull — a  dictum  which  is  now  violated  with  the 
happiest  results  by  almost  every  surgeon  in  the  land.  In 
addition  to  this,  a  very  large  number  of  tumors  of  the  brain 
have  been  successfully  removed,  tumors  which  before  1884 
were  considered  as  wholly  outside  the  domain  of  surgery. 
To  our  British  brethren,  Godlee,  Horsley,  and  Macewen, 
above  all  others,  is  due  the  credit  of  establishing  cerebral 
surgery  on  a  firm  basis  of  right  principles  and  successful 
technic. 

In  abscess  of  the  brain  we  have  a  lesion  which  is  still  more 

*  Heath's  Hunterian  Oration,  1897. 


262  ADDRESSES   AND   OTHER   PAPERS. 

amenable  to  treatment,  and  the  number  of  recoveries  now 
mounts  even  into  the  hundreds.  We  have  recognized  that 
these  abscesses  very  frequently  arise  from  chronic  disease  of 
the  middle  ear,  and,  thanks  to  the  otologist,  we  can  now,  by 
proper  treatment,  in  many  cases  do  better  than  operate  on 
these  abscesses — we  can  prevent  them.  The  papers  of 
Arbuthnot  Lane,  Ballance,  and  Macewen  have  taught  us 
that  even  so  formidable  a  disease  as  thrombosis  of  the  sinuses, 
especially  of  the  sigmoid  sinus,  can  be  dealt  with  successfully. 
Even  the  ventricles  of  the  brain  have  been  successfully  in- 
vaded, drained,  packed  with  gauze,  and  washed  out  from 
side  to  side. 

Tumors  of  the  spine,  since  Mr.  Horsley's  brilliant  paper, 
in  1888,  have  been  proved  accessible  to  the  modern  surgeon. 
Though  Abbe's  division  of  the  posterior  nerve  roots,  in  cases 
of  intractable  neuralgia,  has  not  been  followed  by  all  the 
success  we  could  wish,  it  has  proved  that  the  operation  is 
a  practicable  one.  Although,  in  the  words  of  the  hymn,  we 
have  not  yet  "  stretched  every  nerve,"  we  have  almost  realized 
that  pious  exhortation.  Section  of  nerves  by  accident  or 
deliberately,  in  the  removal  of  tumors,  was  formerly  followed 
by  permanent  paralysis,  but  now  nerve  suture  has  rescued 
many  a  poor  sufferer  and  restored  the  function  of  the  divided 
nerve,  even  after  months  of  paralysis.  Facial  neuralgia, 
once  the  bane  of  the  surgeon  and  the  sufferer,  has  now  been 
cured  in  a  number  of  cases,  not  only  by  the  removal  of  the 
rebellious  nerve,  but,  as  was  suggested  by  Hears  in  1884,* 
even  the  Gasserian  ganglion  itself  has  been  removed  in  more 
than  a  hundred  cases.  In  this  department  the  names  of  our 
American  brethren — Carnochan,  Pancoast,  and  Hartley — 
stand  pre-eminent. 

In  diseases  of  the  organs  of  locomotion — the  bones  and  the 
muscles — the  expansion  of  modern  surgical  technic  has  been 
very  marked.  The  plastic  surgery  of  the  bones  seems  scarcely 

*  Trans.  Amer.  Surg.  Assoc.,  1884,  pp.  482,  483. 


SEMICENTENNIAL  ADDRESS   IN   SURGERY.  263 

to  have  any  limit.  Osteotomy  is  so  safe  that  in  1884  Macewen 
reported  1267  operations,  on  704  patients,  with  only  5  deaths, 
and  these  were  chiefly  due  to  causes  other  than  the  operation. 
Tenotomy  and  transplantation  of  tendons  have  assumed  a 
new  field  of  usefulness  undreamed  of  a  few  years  ago.  In 
fractures  and  dislocations  the  progress  has  been  equally 
extraordinary.  Jarvis's  adjuster  has  given  way  to  the  method 
of  manipulation  first  introduced  by  Reid,  and  reduced  to  a 
science  by  Bigelow  and  Allis,  for  the  hip,  and  Kocher,  for 
the  shoulder,  and  in  a  combination  of  fracture  with  disloca- 
tion the  ingenious  hook  of  McBurney  has  enabled  the  surgeon, 
in  many  cases,  to  accomplish  that  which  manipulation  alone 
could  not  have  done.  The  splints  of  Nathan  R.  Smith  and 
Hodgen,  and  the  introduction  of  adhesive  plaster  by  Gross, 
and  the  subsequent  application  by  this  means  of  the  weight 
and  pulley  by  Buck,  have  supplanted  the  clumsy  splint  of 
Desault.  Even  so  simple  a  means  of  treatment  as  that  by 
plaster  of  Paris,  together  with  the  thorough  disinfection  of 
compound  fractures,  has  enabled  us  to  obtain  results,  either 
by  the  recumbent  or  the  ambulatory  treatment,  which,  but 
a  few  years  ago,  were  impossible.  Compound  fractures, -then 
among  the  most  serious  accidents  of  the  human  frame,  with 
a  mortality  of  about  two  out  of  every  three,  have  so  lost 
all  their  dangers  that  the  mortality  is  hardly  more  than  two 
out  of  every  hundred. 

Tumors,  once  too  formidable  either  by  reason  of  their  size, 
their  location,  their  adhesions,  or  the  haemorrhage  which 
attended  their  removal,  have  been  made  wholly  amenable 
to  treatment.  We  have  been  taught  largely  by  the  labors 
of  the  younger  Gross  and  Halsted  that  even  cancer  no  longer 
necessarily  entails  death  by  recurrence,  but  that  if  we  remove 
the  growth  early  and  thoroughly,  we  can  obtain  a  cure,  which 
in  the  hands  of  Mr.  Cheyne*  has  recently  reached  the  extra- 
ordinary result  of  57  per  cent,  of  permanent  cure  in  cancer 
of  the  breast. 

*  Lancet,  1896,  1,  p.  397. 


264  ADDRESSES   AXD   OTHER   PAPERS. 

Not  only  has  the  exterior  of  the  chest  been  invaded,  but 
the  ribs  and  the  sternum  are  now  resected,  and  when  neces- 
sary the  entire  chest  wall,  over  a  large  area,  is  removed  with 
impunity. 

Few  of  us,  excepting  the  older  living  members  of  the  pro- 
fession, can  remember  the  immense  advance  which  paracen- 
tesis  of  the  chest  made,  by  reason  of  the  persistent  and 
fruitful  researches  of  Bowditch  and  Wyman,  about  1850,  out 
of  which  have  grown  Estlander's  and  Schede's  heroic  and 
successful  operations.  Not  only  have  accumulations  within 
the  pleura  been  evacuated,  but  Roberts  was  among  the  pio- 
neers in  the  operation  of  paracentesis  pericardii,  while  the 
surgery  of  the  lung  is  now  taking  its  first  tentative  steps. 
The  pericardium  has  also  been  sutured,  and  even  the  heart 
itself  has  twice  been  sutured,  with  one  complete  recovery.* 

We  were  taught  by  the  younger  Gross  that  the  great  veins 
could  be  successfully  tied,  and  recently  they  have  been  suc- 
cessfully sutured — even  the  lateral  sinus.  The  recent  re- 
searches of  Abbe\  and  Murphyl  may  open  a  new  chapter  in 
the  surgery  of  the  arteries  by  substituting  suture  with 
preservation  of  their  lumen  for  occlusion  by  the  ligature. 

Quite  as  fruitful  has  been  the  surgery  of  the  digestive  tract. 
Foreign  bodies  in  the  oesophagus,  which  were  very  ineffi- 
ciently dealt  with  fifty  years  ago,  thanks  to  the  Roentgen 
rays  and  modern  surgical  methods  are  now,  in  the  large 
majority  of  cases,  successfully  removed.  In  non-malignant 
stricture  of  the  oesophagus  Abbe's  bowstring  method  has  been 
a  credit  to  American  surgery. 

I  can  do  scarcely  more  than  allude  to  the  surgery  of  the 
stomach:  to  the  value  of  gastro-enterostomy;  topylorectomy; 
to  pyloroplasty;  to  dilated  stomach,  in  which  a  tuck  has 
been  taken  both  by  European  and  American  surgeons;  or 

*  Farina,  Rev.  de  Chir.,  1897,  335;   Rehn,  Lancet,  1897,  1,  1306. 
t  N.  Y.  Med.  Rec.,  Jan.  13,  1894,  39. 
J  N.  Y.  Med.  Rec.,  Jan.  16,  1897,  73. 


SEMICENTENNIAL   ADDRESS   IN   SURGERY.  265 

hourglass  contraction  of  the  stomach,  which  Weir  and  Watson 
have  successfully  remedied  by  operative  procedures;  to  gas- 
trostomy  in  stricture  of  the  oesophagus  or  Richardson's  gas- 
trotomy  for  the  extraction  of  foreign  bodies  in  the  oesophagus. 
In  the  surgery  of  the  entire  intestinal  tract,  America,  it  can 
be  safely  said,  has  led  the  world.  To  no  one  laborer  in  this 
field  is  more  credit  due  than  to  the  distinguished  President 
of  the  American  Medical  Association  (Senn),  to  whose  irre- 
pressible labor,  genius,  and  skill  we  owe  most  of  our  means 
and  methods  of  dealing  with  such  diseases.  He  first  showed 
us  the  most  successful  methods  of  making  intestinal  anasto- 
mosis, from  which  have  arisen  all  of  our  modern  methods  of 
treatment  of  cancer  of  the  large  and  small  intestines,  and 
many  allied  conditions.  From  these  fruitful  labors  also  have 
arisen  our  modern  methods  of  the  treatment  of  intestinal 
and  fecal  fistulse,  even  in  some  cases  reaching  so  far  as  the 
total  exclusion  of  a  considerable  portion  of  the  bowel.  The 
modern,  wonderfully  successful  treatment  of  wounds,  whether 
stab  wounds,  gunshot  wounds,  or  others  of  the  stomach, 
intestine,  or  bladder,  owe  their  success  largely  to  the  labors 
of  the  elder  Gross,  Parkes,  Senn,  Bull,  Murphy,  and  other 
Americans. 

Cancer  of  the  rectum,  which,  until  about  ten  years  ago, 
was  almost  inoperable,  has  now  taken  its  place  among  the 
formal  and  justifiable  operations  of  modern  surgery,  so  that 
as  much  as  twelve  inches  of  the  rectum  have  been  resected 
by  Kraske's  method.  The  mortality  has  been  reduced  to  20 
per  cent.,  and  permanent  cure  of  such  a  formerly  fatal  disease 
has  been  attained  in  over  one-third  of  the  cases  which  re- 
covered.* 

The  other  accessory  organs  in  the  abdomen  have  been 
conquered  by  the  modern  surgeon.  Fifty-seven  tumors  of 
the  liver  have  been  removed  with  a  mortality  as  low  as 
thirteen  and  one-half  per  cent.f  The  world  owes  to  America 

*  Therap.  Gaz.,  April  and  May,  1897. 

t  Trans.  Pennsylvania  State  Med.  Soc.,  1897. 


266  ADDRESSES   AND    OTHER   PAPERS. 

the  operation  of  cholecystotomy,  since  it  was  first  done  by 
Bobbs  in  1867,  and  was  popularized  by  the  powerful  influence 
of  Sims  in  1870.  Pancreatic  cysts,  chiefly  through  the  labors 
of  Senn,  are  now  amenable  to  treatment,  while  the  spleen  has 
been  extirpated  many  times. 

The  appendix,  that  meagre,  but  most  troublesome,  ances- 
tral vestige,  which,  with  the  bicycle,  has  been  the  faithful 
friend  of  the  surgeon  through  the  past  few  years  of  com- 
mercial depression,  has  been  recognized  within  the  last  few 
years  as  the  real  origin  of  the  so  frequent  abscesses  in  the  right 
iliac  fossa.  Beginning  with  Willard  Parker's  paper,  in  1867,* 
and  Fitz's  memorable  paper,  in  1886,t  the  treatment  of  ap- 
pendicitis, and  even  its  much  abused  name,  are  distinctly 
of  American  origin,  and  an  immense  credit  to  American 
surgery. 

Until  Simon's  classical  experiments  on  dogs,  in  1870,t  the 
kidney  was  a  practically  inaccessible  organ,  but  now,  when 
it  wanders,  we  secure  it  by  sutures;  when  there  is  a  stone 
in  it,  we  open  it  fearlessly  and  remove  the  stone;  when  it  is 
distended  with  pus  or  urine  we  drain  it,  and  if  it  is  past  hope 
of  recovery  we  extirpate  it,  all  with  most  remarkable  success. 
Even  stones  in  a  ureter  or  a  divided  ureter,  Cabot,  Fenger, 
Kelly,  and  Van  Hook  have  shown  us,  can  be  successfully 
dealt  with. 

The  treatment  of  stone  in  the  bladder  has  undergone  an 
extraordinary  revolution  since  the  introduction  of  Bigelow's 
litholapaxy.  Its  introduction  as  a  surgical  procedure  was 
dependent  on  the  prior  researches  of  Otis  and  other  Americans, 
who  showed  us  that  the  calibre  of  the  urethra  was  much 
greater  than  we  had  supposed,  and  permitted,  therefore, 
the  introduction  of  instruments  of  much  larger  diameter  than 
before  had  been  deemed  allowable.  The  reintroduction  of 
suprapubic  cystotomy,  due  largely  to  Dulles' s  paper  in  1875, § 

*  N.  Y.  Med.  Rec.,  1867,  ii,  25.     f  Trans.  Assoc.  Amer.  Phys.,  1886. 
t  Deutsche  Klinik,  xxii,  137.  §  Am.  Jour.  Med.  Sci.,  Ixx,  39. 


SEMICENTENNIAL   ADDRESS   IN   SURGERY.  267 

has  permitted  us  to  deal  not  only  with  large  stones,  but  also 
with  ulcers  and  tumors  of  the  bladder;  even  large  portions 
of  the  wall  of  the  bladder  have  been  removed  successfully. 
The  enlarged  prostate  is  now,  though  always  a  serious  danger, 
far  less  a  menace  to  comfort  and  life  since  the  introduction 
of  McGuTs  and  other  methods  of  prostatectomy,  and  of 
White's  operation  of  orchidectomy  or  the  resection  of  the 
vas  deferens. 

The  surgery  of  the  pelvic  organs  has,  one  may  say,  been 
created  since  1847,  but  its  triumphs  are  so  many  that  time 
allows  only  a  word.  Sims' s  treatment  of  vesico-vaginal  fistula 
and  his  introduction  of  silver  wire  in  1852  were  distinctly 
American  triumphs,  while  the  labors  of  the  Atlees,  Kimball, 
Peasky,  Goodell,  Thomas,  Emmet,  Battey,  and  Kelly — house- 
hold names  to  all  of  us — have  made  pelvic  surgery  so  suc- 
cessful that  the  danger  is  that  it  may  be  overdone.  Many 
an  ovary  or  womb,  in  the  words  of  the  witty  toast,  "absent 
from  the  body,  but  present  in  the  spirit,"  would  far  better 
have  been  left  in  possession  of  their  owners. 

The  radical  cure  of  hernia  has  been  the  product  of  the  last 
twenty  years,  and  the  operations  of  Halsted,  Bassini,  and 
Macewen,  not  to  mention  the  many  others,  have  taken  a 
permanent  place  in  the  practice  of  the  profession  within  the 
last  ten  years.*  When  we  can  report,  as  Coleyf  has  recently 
done,  360  cases,  with  only  1  death  and  7  recurrences,  or,  as 
De  Garmo  has  reported  at  this  very  meeting,  250  cases  un- 
marred  by  a  single  death,  the  question  of  the  propriety  of 
operating  for  the  radical  cure  of  hernia,  even  in  children,  is 
settled  once  for  all. 

Goitre  fifty  years  ago  was  simply  allowed  to  run  its  course, 
since  haemorrhage  destroyed  nearly  all  those  operated  on; 

*  Marcy  informs  me  that  he  published  his  first  paper  on  the  use  of 
the  buried  suture  in  1870,  and  in  1881  he  insisted  on  restoring  the  obliquity 
of  the  inguinal  canal  and  using  tendon  sutures. 

t  Annals  of  Surg.,  March,  1897,  270. 


•  268  ADDRESSES   AND    OTHER   PAPERS. 

but  two  years  ago  Kocher*  reported  a  series  of  a  thousand 
operations,  with  a  mortality  of  but  one  per  cent.,  in  non- 
malignant  cases. 

Extirpation  of  the  larynx  for  malignant  growths  has  taken 
its  place  among  the  justifiable  and  formal  operative  pro- 
cedures. Acute  intestinal  obstruction,  whether  from  bands, 
volvulus,  intussusception  or  other  conditions,  is  now  dealt 
with  as  it  ought  to  be, — surgically, — and,  if  promptly  done, 
with  the  happiest  results. 

A  hasty  and  very  imperfect  review,  such  as  has  been  above 
given,  of  the  improvements  in  surgery  within  the  last  fifty 
years,  does  much  more  than  show  us  the  adroitness,  audacity, 
and  success  of  the  modern  surgeon.  That  is  the  thing  which 
strikes  us  most  as  surgeons,  but  we  must  regard  all  this  prog- 
ress also  from  the  standpoint  of  the  patient  and  the  com- 
munity, and  see  what  it  means.  It  means  a  prolongation 
of  life  by  operations  which,  while  not  without  pain  and  suf- 
fering during  recovery,  have  been  robbed  of  all  their  primary 
terrors  by  anaesthesia,  and  most  of  their  subsequent  pain  and 
suffering  and  danger  by  antisepsis;  it  means  that  patients 
who  in  1847  were  hopelessly  consigned  to  the  grave  after 
weeks  and  months  of  suffering  are  now,  in  the  vast  majority 
of  cases,  rescued  from  death;  it  means  that  families  formerly 
bereft  of  husband  and  wife,  parent  or  child,  and  left  to  spend 
years  of  sorrow,  of  suffering,  and — in  many  cases — of  poverty, 
because  the  breadwinners  were  taken  away,  have  now  restored 
to  them  their  loved  ones  in  health  and  strength  and  usefulness; 
it  means  that  the  hecatombs  of  a  Caesar,  an  Alexander,  a 
Napoleon,  are  offset  by  the  beneficent  labors  of  a  Morton, 
a  Warren,  a  Lister,  who  are,  and  for  all  time  will  be,  blessed 
by  many  a  poor  patient,  who  never  heard  of  them,  instead 
of  being  cursed  as  the  destroyers  of  nations  and  of  homes 
innumerable;  it  means  that  man's  inhumanity  to  man  shall 
be  replaced  by  a  scientific  and  Christian  altruism,  which  sheds 

*  Beilage  z.  Centralbl.  f.  Chir.,  1895,  66. 


SEMICENTENNIAL   ADDRESS   IN    SURGERY.  269 

blessings  and  benefits  on  the  whole  human  race,  seeing  in  the 
patient,  whether  saint  or  sinner,  only  a  human  being  who  is 
suffering  from  accident  or  disease,  whom  it  is  the  province 
of  the  surgeon,  in  imitation  of  Him  who  went  about  doing 
good,  to  restore  to  health  and  happiness.  Even  where  life 
cannot  be  prolonged,  the  agonies  of  death  itself  can  be  soothed 
by  his  gentle  hand  and  his  fruitful  skill. 

What  the  future  has  in  store  for  us  we  can  only  dream. 
Two  diametrically  opposing  tendencies  are  prominent  in 
modern  surgery:  radical  interference  with  disease  so  that 
there  is  now  scarcely  a  single  organ  or  portion  of  the  body 
not  within  our  reach;  yet,  on  the  other  hand,  a  remarkably 
conservative  tendency  in  cultivating  remedial  rather  than 
radical  surgery.  Joints  so  diseased  as  once  to  require  ampu- 
tation are  now  treated  conservatively  with  the  best  results; 
ovaries,  a  portion  of  which  can  be  preserved,  are  kept  in  the 
abdomen;  kidneys  once  doomed  to  total  extirpation  are  now 
partially  removed,  and  bones  so  destroyed  that  they  formerly 
required  amputation  are  now  excised  and  the  limb  preserved. 
Experiments  upon  animals  have  recently  given  us  wholly 
new  views  of  infection  and  of  the  origin  of  many  diseases, 
and  also  the  little  knowledge  that  we  yet  have  as  to  either 
natural  or  acquired  immunity,  and  to  a  consequent  orrho- 
therapy. 

It  is,  I  believe,  on  these  lines  that  our  more  immediate 
future  triumphs  will  be  achieved.  We  have  discovered  the 
actual  cause  of  tetanus,  tuberculosis,  erysipelas,  suppuration, 
and  a  host  of  other  diseases  and  conditions,  of  the  cause  of 
which  we  were  wholly  ignorant  a  few  years  ago.  The  causes 
of  many  other  disorders,  both  medical  and  surgical,  still 
remain  hidden  from  our  view.  We  know  almost  nothing  of 
the  origin  of  benign  tumors,  and  are  groping  to  discover  the 
origin  of  cancer,  sarcoma,  and  other  malignant  growths. 
When  we  have  discovered  the  cause,  we  are  nearly  half  way, 
or  at  least  a  long  way,  on  the  road  to  the  discovery  of  the 


270  ADDRESSES   AND   OTHER   PAPERS. 

cure,  and  I  think  it  not  unlikely  that  in  1947  your  then 
orator  will  be  able  to  point  to  the  time  when  a  definite  knowl- 
edge of  the  causes  of  these  diseases  was  attained,  and  probably 
to  a  time  when  their  cure  was  first  instituted. 

That  will  be  a  surgical  Paradise,  when  we  can  lay  aside  the 
knife,  and  by  means  of  suitable  toxines  or  antitoxines,  drugs 
or  other  methods  of  treatment,  control  inflammation,  arrest 
suppuration,  stay  the  ravages  of  tuberculosis  and  syphilis, 
abort  or  disperse  tumors,  cure  cancer,  and,  it  may  be,  so 
prolong  human  life  that  all  of  his  then  audience  will  die  either 
of  accident  or  of  old  age.  Would  that  you  and  I  could  be 
alive  in  1947  to  join  in  the  glorious  surgical  Te  Deum! 


THE  DEBT  OF  THE  PUBLIC  TO  THE  MEDI- 
CAL PROFESSION.* 


IT  is  a  graceful  courtesy,  which  I  very  highly  appre- 
ciate, that  you  should  ask  a  stranger,  instead  of  one  of 
your  own  members,  to  address  you  on  this  festal  occasion. 
The  fact  that  you  have  completed  an  existence  of  a  century  as 
a  medical  society  naturally  suggests  that  the  address  should 
be  somewhat  of  a  review  of  the  past. 

I  have,  therefore,  chosen  as  my  subject  "The  Debt  of  the 
Public  to  the  Medical  Profession."  I  shall  endeavor  to  in- 
dicate, hi  a  brief  outline,  how  much  the  profession  has  done  for 
the  community.  The  conclusion,  therefore,  is  inevitable  that 
there  is  an  obligation  on  the  part  of  the  public  to  recognize 
this  debt  by  affording  enlarged  facilities  to  a  profession  which 
has  given  of  its  time  and  labor  so  unselfishly  for  the  good  of 
the  public. 

In  one  respect  the  medical  profession  differs  from  all  others, 
in  that  it  is  the  only  profession  which  is  self-destructive. 
While  we  live  by  ministering  to  the  wants  of  those  who  are 
suffering  by  accident  and  disease,  I  glory  in  the  fact  that  the 
medical  profession  is  foremost  in  the  endeavor  to  abate  disease 
and  to  prevent  accident.  The  profession  could  not  have 
attained  this  end  by  its  own  efforts  alone,  but  it  has  been 
pendent  very  largely  upon  the  general  intelligent  co-opera- 
tion of  the  public,  and  of  sanitary  engineers,  and  also  of  legis- 

*  The  Oration  delivered  before  the  Medical  and  Chirurgical  Faculty  of 
the  State  of  Maryland,  at  the  Celebration  of  the  Centennial  Anniversary 
of  their  Foundation,  April  26, 1899.  Reprinted  from  the  Philadelphia 
Medical  Journal,  April  29.  1899. 

271 


272  ADDRESSES   AND   OTHER   PAPERS. 

lators,  for  the  legal  means  to  make  effective  the  measures 
which  the  profession  has  shown  to  be  needful  for  the  public 
health. 

Public  hygiene  or  sanitation  has  been  a  very  large  element 
in  arresting  the  ravages  of  disease,  which,  in  former  times, 
swept  over  entire  nations,  and  even  continents;  and  it  is 
a  source  of  pride  to  us  that  among  the  foremost  sanitarians  in 
every  community  are  the  doctors.  It  is  a  very  striking  fact 
that  diseases  which  once  assumed  the  form  of  veritable  pes- 
tilences are  now,  at  least  in  civilized  countries,  almost  un- 
heard of,  and  others,  though  they  have  not  yet  disappeared, 
have  had  their  fangs  drawn,  so  that  the  public  suffers  far 
less  than  it  formerly  did.  If  the  voice  of  the  profession  were 
heeded,  even  the  diseases  which  have  been  only  abated  would 
almost,  if  not  entirely,  disappear. 

Let  us  briefly  consider  a  few  of  these  diseases: 
/.  The  Plague. — Among  the  most  fearful  epidemics  which 
have  devastated  the  world,  perhaps  the  worst  has  been  what 
is  known  as  the  plague.  It  is  represented  now  by  the  bubonic 
plague,  of  which  we  have  had  a  memorable  instance  within 
the  last  two  years  in  India,  when  over  250,000  lives  have  been 
lost.  But,  bad  as  it  has  been  there,  its  recent  devastation  is 
as  nothing  compared  with  its  former  ravages.  Those  of  you 
who  have  read  James's  novel,  entitled  "The  Fire  and  the 
Plague,"  will  recall  the  vivid  and  frightful  picture  of  the 
plague  in  1665,  during  which  70,000  persons  perished  in  the 
then  relatively  small  city  of  London  alone.  Still  earlier,  in 
the  fourteenth  century,  the  Black  Death,  as  was  then  its 
horrible  name,  swept  over  Europe,  and  carried  off  25,000,000 
people,  one-fourth  of  the  entire  population  of  that  continent ! 
This  frightful  destruction,  it  will  be  observed,  took  place  in 
the  then  most  civilized  countries  of  the  world.  By  contrast, 
the  bubonic  plague  of  the  nineteenth  century  is  limited 
wholly  to  peoples  who  are  only  semicivilized,  among  whom 
sanitary  laws  are  not  understood,  and  the  grossest  violation 


DEBT  OF  THE   PUBLIC  TO  THE  MEDICAL   PROFESSION.     273 

of  them  is  a  common  everyday  occurrence.  But  this  terrible 
mortality,  it  would  seem,  is  never  to  be  repeated.  As  a  result 
of  laboratory  researches  the  bacillus  of  the  plague  has  been 
discovered,  and  Haffkine  has  recently  introduced  a  preventive 
inoculation  with  sterilized  bouillon-cultures  of  its  bacillus. 
In  India,  which  is  now  the  home  of  the  plague,  Haffkine  has 
shown  extraordinarily  good  results,  both  in  experimental  in- 
oculations of  animals  and  of  man.  For  example,  of  20  rats 
from  a  ship,  newly  arrived  from  Europe,  10  were  inoculated 
with  the  protective  serum  and  10  were  not.  Into  the  cage  in 
which  the  whole  20  were  kept,  a  rat  suffering  from  the  plague 
was  introduced.  Of  the  10  uninoculated  rats,  9  died.  Of 
the  10  rats  rendered  immune  by  inoculation,  only  1  con- 
tracted the  disease.  Following  upon  this  and  many  other 
experiments,  it  was  deemed  right  to  inoculate  human  beings, 
and  there  are  thousands  now  who  owe  their  lives  to  this  pre- 
ventive inoculation. 

To  take  but  a  single  instance,  in  the  town  of  Lower  Dau- 
maun,  2197  persons  were  inoculated,  6033  remaining  un- 
protected. Of  the  latter  1482  died,  almost  twenty-five 
per  cent.,  whereas  only  36  of  those  who  were  inoculated 
succumbed  to  the  disease,  less  than  one  and  two-fifths  per 
cent.* 

Would  it  be  an  impertinent  question  were  I  to  ask  whether 
there  could  be  mentioned  a  single  lawyer  who  has  thus 
cut  off  the  means  of  livelihood  of  his  brothers-in-law,  or 
a  single  merchant  who  would  so  destroy  his  own  business 
and  that  of  his  fellow-merchants  by  pointing  out  a  means 
by  which  the  community  could  dispense  with  his  wares? 

//.  Cholera. — Another  scourge  which  has  been  almost 
throttled  in  civilized  countries  is  cholera.  It  first  appeared 
in  Europe  in  1832,  and  in  France  alone  120,000  people  died. 
In  the  single  city  of  New  York  there  were  3500  deaths. 
Its  ravages  have  been  conspicuous  very  recently  in  the 

*  Osier's  Practice,  3d  edition,  p.  193. 
18 


274  ADDRESSES   AND   OTHER   PAPERS. 

city  of  Hamburg,  when  in  three  months,  in  the  summer 
of  1892,  there  were  18,000  victims,  with  7614  deaths. 
Engineers  and  physicians  can  proudly  point  to  their  achieve- 
ments in  this  epidemic.  The  city  of  Altona,  which  is  physic- 
ally continuous  with  Hamburg,  drank  the  water  of  the 
Elbe,  but,  being  located  nearer  the  mouth,  drank  the  water 
with  all  the  added  contamination  of  Hamburg;  yet  in  Altona 
there  were  only  516  cases  as  against  18,000  in  Hamburg, 
and  many  of  the  516  were  refugees  from  Hamburg  itself. 
The  explanation  is  a  very  simple  one.  Hamburg  drank  the 
unfiltered  water  of  the  Elbe,  whereas  the  inhabitants  of 
Altona  had  a  filtration  plant,  which  was  their  efficient  bul- 
wark against  the  disease. 

This  is  taking  into  account  only  the  question  of  life,  which 
is,  of  course,  by  far  the  most  important.  But  looking  at 
it  also  from  a  commercial  point  of  view,  we  all  remember 
how  the  business  of  Hamburg  was  for  the  time  ruined. 
The  few  millions  which  would  have  properly  filtered  the 
water  of  the  same  river  for  Hamburg  were  lost  five  or  ten 
times  over  by  the  merchants  of  Hamburg  as  a  result  of 
their  fatal  delay.  The  voice  of  the  physicians  and  sani- 
tarians of  Hamburg  was  but  a  voice  crying  in  the  wilder- 
ness until  emphasized  by  the  hoarse  diapason  of  disease. 
This  is  an  object-lesson  which  our  own  country  and  many 
of  our  own  cities  would  do  well  to  heed. 

///.  Yellow  Fever. — Another  scourge,  similar  in  its  extent 
and  its  violence  to  the  plague  and  to  cholera,  and  one 
which  appeals  to  the  people  of  this  country  even  more  than 
those  two,  is  the  yellow  fever.  The  fearful  epidemic  of 
1797  is  well  known  to  every  intelligent  American.  Not 
limited  to  the  southern  portion  of  our  country,  its  path- 
way was  strewn  with  corpses  in  all  the  larger  cities  of  the 
North  as  well  as  of  the  South.  Our  own  immortal  Rush 
has  left  a  monument  to  his  name  in  his  efforts  to  stem  the 
tide  of  the  disease.  By  his  unselfish  bravery  and  his  devo- 


DEBT  OF  THE  PUBLIC  TO  THE  MEDICAL  PROFESSION.  275 

tion  to  duty  in  the  midst  of  pestilence  he  has  set  us  an  ex- 
ample which  the  whole  country  admires,  and  which,  fortu- 
nately, will  never  again  be  needed.  The  later  freedom 
of  this  country  from  similar  widespread  and  fatal  epidemics 
of  yellow  fever  is  due  chiefly  to  intelligent  plans  for  sani- 
tary reform  and  to  our  vigilant  quarantine  regulations, 
which,  as  a  rule,  during  the  present  century  have  kept  it 
at  bay. 

We  are  now  about  to  do  better,  for  having  driven  the 
indolent  and  ignorant  Spaniard  from  Cuba,  we  shall  be  able 
to  attack  the  disease  at  its  fountain  head.  The  efforts  of  our 
officers,  especially  of  General  Wood,  whom  we  gladly  recog- 
nize both  as  doctor,  diplomat,  and  warrior,  will  bear  the 
richest  harvest  of  good  by  exterminating  the  disease  in 
Cuba  itself.  Before  this  we  could  only  erect  a  defensive  wall 
against  the  disease;  now  we  can  prevent  it  in  its  very  home.* 

How  much  such  prevention  of  disease  means  commer- 
cially is  shown  by  a  statement  in  the  newspapers  only  ten 
days  ago,  that  capitalists  had  $40,000,000  ready  to  invest 
in  New  Orleans  if  the  sewage  question  could  be  solved  and 
epidemics  of  small-pox  and  yellow  fever  prevented. 

IV.  Scurvy. — Prior  to  the  present  century,  scurvy  was 
one  of  the  most  dreaded  diseases,  especially  on  shipboard. 
Armies  were  decimated  by  it  and  navies  rendered  useless; 
sometimes  half  a  ship's  crew  would  be  disabled  by  scurvy. 
Until  the  researches  of  physicians  showed  that  it  owed  its 
origin  to  the  lack  of  fresh  vegetables,  its  ravages  were  fre- 

*  Through  the  efforts  of  the  commission  of  which  the  late  lamented 
Major  Walter  Reed  was  a  member,  the  mosquito  has  been  discovered  to 
be  the  only  means  of  propagating  yellow  fever.  By  preventing  the  access 
of  the  mosquito  to  yellow  fever  patients  the  disease  has  been  banished 
from  Cuba  for  the  first  time  in  one  hundred  and  seventy  years !  This 
means  also  that  it  has  been  banished  from  the  United  States  as  well. 
Colonel  William  C.  Gorgas  Chief  Sanitary  Officer  of  the  Panama  Canal 
zone  will  do  for  that  region  the  same  splendid  life-saving  work  he  did  in 
Havana.— (W.  W.  K.,  1905.) 


276  ADDRESSES   AND   OTHER   PAPERS. 

quent  and  widespread.  In  1795  there  were  introduced 
into  the  British  navy  the  admirable  regulations  for  pro- 
visioning ships  of  war,  drawn  up  by  Blane.  Since  then 
scurvy  has  almost  disappeared.  At  the  present  time  it  is 
seen  only  hi  exceptional  circumstances,  such  as  have  recently 
arisen  in  the  Klondike.  Even  in  the  long,  lonely  voyages 
to  the  pole,  our  means  of  furnishing  the  crews  with  vege- 
table food  in  various  forms  has  prevented  any  outbreak 
of  importance. 

V.  Typhus    Fever. — Another    scourge    of    humanity    in 
past  ages  has  been  the  dreaded  typhus  fever.    Its  various 
synonyms — ship-fever,      hospital-fever,      jail-fever,      camp- 
fever — reek  of  filth,  overcrowding,  and  the  want  of  sani- 
tation.    "A  complete  history  of  typhus,"  says  Murchison, 
"  would  be  the  history  of  Europe  for  the  last  three  and  a  half 
centuries."    It  was  as  dreaded  as  the  plague  itself.    How 
rare  it  is  now  is  shown  by  the  fact  that  hi  my  entire  pro- 
fessional life  of  nearly  forty  years    I  have  never  known 
in  Philadelphia  of  more  than  half  a  score  of  cases,  and  have 
never  hi  my  life  personally  seen  a  single  one.     The  modern 
exemption  of  armies,  ships,  jails,  and  hospitals  from  typhus 
is  due  to  our  own  profession  more  than  any  other  agency. 

VI.  Typhoid  Fever. — I  wish  I  could  tell  the  same  story 
of  typhoid  fever.     Unfortunately  the  public  has  not  yet 
listened  to  the  voice  of  .sanitary  physicians.     Every  year 
a  large  harvest  of  deaths  is  furnished  the  grim  reaper  in 
almost  all  of  our  American  cities  by  typhoid  fever.     And 
yet  typhoid  is  as  preventable  a  disease  as  typhus.    The  means 
of  its  diffusion  are  well  known.     Water  contaminated  by 
the   typhoid   bacilli  and  milk   similarly   contaminated   are 
the  two  chief  means  by  which  it  reaches  the  gastro-intestinal 
tract  of  man.     What  damage  can  be  done  by  a  single  case 
was  well  shown  in  the  town  of  Plymouth,  Pennsylvania,  in 
1885.     "A  portion  of  the  water  of  the  town  was  derived  from 
a  reservoir  supplied  by  a  mountain  stream  some  distance 


DEBT   OF  THE    PUBLIC   TO   THE  MEDICAL    PROFESSION'.     277 

above.  A  man  ill  with  enteric  fever  occupied  a  house  near 
the  bank  of  this  stream,  during  January,  February,  and 
March.  Upon  the  ground,  frozen  and  covered  with  snow,  the 
copious  dejections  of  this  patient  were  thrown  without  dis- 
infection. Toward  the  end  of  March  a  thaw,  accompanied  by 
rain,  took  place.  About  the  10th  of  April  an  extraordinary 
epidemic  of  enteric  fever  developed  in  the  town,  chiefly  among 
those  receiving  water  from  the  reservoir.  In  a  population  of 
8000  people,  about  1200  cases  occurred."  The  remedy,  as 
some  of  us  in  Philadelphia  have  tried  to  point  out  as  forcibly 
as  we  could,  is  clear.  Purify  the  water-supply  and  provide 
good  sewerage  and  typhoid  fever  almost  disappears.  In 
Vienna  the  typhoid  rate  of  12.5  deaths  per  10,000  inhabitants 
fell  to  1.1  after  a  pure  water-supply  was  obtained;  in  Dantzig 
it  fell  from  10  per  10,000  to  1.5;  in  Munich,  from  21  per  10,- 
000  to  6.3;  in  Boston  from  17.4  per  10,000  to  5.6.  These 
are  but  cold  figures.  If  we  could  transfigure  them  and  let 
them  represent  broken  hearts  and  desolated  homes,  and  meas- 
ure them  by  anguish  and  sorrow,  they  would  speak  more 
eloquently  than  mere  percentages. 

All  of  the  diseases  thus  far  considered  have  been  those 
wilich  have  disappeared  either  wholly  or  very  largely  (at 
least  in  civilized  countries)  as  a  result  of  improved  sanita- 
tion, and  I  can,  therefore,  well  claim  that  the  public  owes  their 
disappearance  or  limitation  to  the  efforts  of  the  medical  pro- 
fession aided  by  engineers,  by  intelligent  legislators,  by  un- 
proved methods  of  food-supply,  and  by  the  general  intelli- 
gence of  the  entire  community.  But  the  greatest  preacher 
of  righteousness  has  been  the  doctor. 

VII.  Small-pox. — The  next  disease  to  which  I  ask  your 
attention  is  one  which  owes  its  abolition  wholly  to  the  phy- 
sician. In  these  days,  a  century  after  Edward  Jenner's  mem- 
orable inoculation  of  James  Phipps  on  May  14,  1796,  we  can 
hardly  appreciate  what  small-pox  was.  A  few  facts,  however, 
will  show  its  dreadful  ravages.  Dinsdale,  who  went  to  St. 


278  ADDRESSES   AND   OTHER   PAPERS. 

Petersburg  to  inoculate  the  Empress  Catharine,  says  that 
2,000,000  people  died  in  a  single  year  in  the  Russian  Empire 
from  small-pox.  In  1707,  in  Iceland,  out  of  a  population  of 
50,000,  18,000  died, — thirty-six  per  cent.!  In  Mexico  in  the 
sixteenth  century,  3,500,000  people  died,  leaving,  in  some 
places,  scarcely  enough  alive  to  bury  the  dead.  At  the  end  of 
the  eighteenth  century,  Gilbert  Blane  estimated  that  "an  adult 
person  who  had  not  had  small-pox  was  scarcely  met  with  or 
heard  of  in  the  United  Kingdom."  When  servants  were  ad- 
vertised for,  it  was  common  to  specify  "  that  they  must  have 
had  small-pox  in  the  natural  way."  In  1688,  in  an  advertise- 
ment for  a  counterfeiter,  it  was  noted  as  a  means  of  his  identi- 
fication that  he  was  "  without  pock-holes."  At  the  Institu- 
tion for  the  Indigent  Blind,  two-thirds  of  the  applicants  were 
made  blind  by  the  small-pox. 

It  attacked  the  high  as  well  as  the  humble.  In  the  family 
of  William  III  of  England,  his  Queen,  Mary,  his  father,  his 
mother,  his  uncle  and  two  cousins,  children  of  James  I,  all 
died  of  the  small-pox  and  the  king  himself  barely  escaped 
with  his  life.  During  the  eighteenth  century,  one  Emperor 
and  two  Empresses  of  Austria,  six  archdukes  and  archduch- 
esses, an  elector  of  Saxony,  an  elector  of  Bohemia,  a  Dauphin 
and  a  King  of  France,  a  King  of  Sweden,  and  a  Tsar  of  Russia 
were  all  numbered  among  its  victims.  So  fearful  were  its  rav- 
ages that  Bernouilli  estimated  that  60,000,000  persons  died 
from  small-pox  in  the  century  the  close  of  which  saw  the 
foundation  of  your  own  Faculty.  Well  might  Macaulay  say : 
"  The  havoc  of  the  plague  had  been  far  more  rapid,  but  the 
plague  visited  our  shores  only  once  or  twice  within  living 
memory.  But  the  small-pox  was  always  present,  filling  the 
churchyard  with  corpses,  leaving  on  those  whose  lives  it  spares 
the  hideous  traces  of  its  power,  turning  the  babe  into  a 
changling  at  which  the  mother  shuddered,  and  making  the 
eyes  and  cheeks  of  the  betrothed  maiden  objects  of  horror 
to  her  lover."  It  was  "the  most  terrible  of  all  the  ministers 
of  death." 


DEBT   OF  THE   PUBLIC  TO   THE  MEDICAL   PROFESSION.     279 

But  in  1796  arose  the  medical  David  who  was  to  smite  this 
Goliath.  From  that  time  till  the  present  small-pox  has  been 
shorn  of  all  its  terrors.  Very  recently,  hi  Jenner's  own 
country,  attempts  have  been  made  to  show  that  vaccination 
was  useless;  that  it  drove  out  of  the  system  one  vile  disorder 
by  introducing  another,  that  it  disseminated  instead  of  pre- 
venting disease.  Were  we  to  grant  all  that  is  falsely  alleged 
as  to  the  introduction  of  tuberculosis  and  syphilis,  even  then 
the  benefits  it  has  conferred  would  outnumber  the  evils 
ten-thousand-fold.  But,  as  a  matter  of  fact,  the  cases  hi 
which  evil  results  have  followed  are  few  and  far  between,  and 
by  the  use  of  animal  virus  instead  of  the  humanized  and  by 
the  proper  antiseptic  care  hi  vaccination  (which  is  really  a 
minor  surgical  operation)  all  of  these  ill  effects  can  be  avoided. 

A  few  statistics  will  show  the  benefits  vaccination  has  con- 
ferred. In  Sweden,  before  vaccination,  the  deaths  per  million 
were  2045.  Since  compulsory  vaccination  was  introduced 
they  have  fallen  to  155.  In  England  during  the  eighteenth 
century,  the  average  deaths  per  million  were  about  2000. 
Since  the  epidemic  of  1871-72  and  the  enforcement  of  the  law 
for  vaccination,  the  deaths  have  fallen  to  53  per  million,  and 
in  Scotland  they  have  fallen  to  8  per  million.  In  Prussia, 
before  compulsory  vaccination,  there  were  309  deaths  per 
million;  in  the  last  ten  years  only  7.  In  Austria,  without 
compulsory  vaccination,  hi  the  last  ten  years  the  average  has 
been  458  deaths  per  million,  and  in  Belgium  without  compul- 
sory vaccination  from  1875  to  1884,  there  were  441  deaths 
per  million.  In  the  Sheffield  epidemic  of  1887-88  of  the 
un vaccinated  population,  1  in  20  died;  of  those  who  were 
vaccinated,  1  in  1300. 

Another  illustration  of  what  havoc  a  single  mild  case  may 
work  was  seen  by  the  epidemic  in  Montreal  fourteen  years  ago. 
Among  the  French  Canadians,  there  was  the  greatest  preju- 
dice against  vaccination,  so  much  so  that  there  were  even 
vaccination  riots.  As  a  consequence  of  this  prejudice  a  large 


280  ADDRESSES   AND   OTHER   PAPERS. 

unprotected  population  grew  up  and  the  materials  were  ready 
for  an  extensive  epidemic.  The  soil  had  been  prepared  and 
it  only  needed  the  introduction  of  the  seed,  which  in  due 
time  came  in  a  Pullman  car  conductor  from  Chicago,  February 
28,  1885.  Within  the  next  ten  months  thousands  of  persons 
were  stricken  with  the  disease  and  3164  died  in  a  city  of  only 
185,000  inhabitants — i.  e.,  one  person  in  every  58  died,  besides 
all  those  whose  lives  were  blighted  by  its  disgusting  relics. 
Perhaps  no  more  striking  proof  could  be  given  of  the  value 
of  compulsory  vaccination  and  revaccination  than  the  ex- 
perience of  Germany  and  France  in  the  Franco-Prussian  war. 
In  the  German  army  there  were  but  261  cases,  while  in  the 
French  army,  which  was  not  similarly  protected,  there  were 
23,469.  Again,  our  Philadelphia  Welch*  has  shown  that 
among  5000  cases  of  small-pox,  of  1412  cases  with  good  vac- 
cination marks,  the  death  rate  was  8.78  per  cent. ;  whereas 
among  1759  cases  unvaccinated,  the  death-rate  was  58.38 
per  cent. 

And  yet  in  the  face  of  these  well-established  facts  there  are 
people  who  declaim  against  vaccination.  Happily,  in  view 
of  the  well-known  and  almost  universally  recognized  pro- 
tective power  of  vaccination,  the  good  sense  of  the  American 
people  will  never  allow  us  to  go  back  to  the  old  days  of  death 
and  disfigurement.  Well  may  Professor  Whittaker  say  "the 
most  consummate  cynic  must  admit  that,  up  to  the  present 
time,  Edward  Jenner  has  been  the  greatest  benefactor  that 
the  world  has  ever  known."  Even  the  untutored  Indians  de- 
clared "we  shall  not  fail  to  teach  our  children  to  speak  the 
name  of  Jenner  and  to  thank  the  Great  Spirit  for  bestowing 
upon  him  so  much  wisdom  and  benevolence." 

VIII.  Tuberculosis. — The  most  noteworthy  feature  in 
modern  medicine  is  the  introduction  of  laboratory  methods 
in  the  study  of  various  diseases.  We  are  only  really  at 
the  beginning  of  this  method,  but  it  has  yielded  results  of 

*New  York  Med.  Jour.,  March  17,  1894. 


DEBT   OF  THE    PUBLIC   TO   THE    MEDICAL   PROFESSION.    281 

such  inestimable  value  that  its  future  is  certain  to  reward 
the  diligent  searcher  after  truth  with  a  rich  harvest. 

Among  other  diseases  which  have  been  investigated  with 
very  fruitful  results  is  tuberculosis,  a  disease  which  ranks 
with  alcoholism  and  syphilis  as  the  three  most  disastrous  to 
the  human  race,  and,  in  the  case  of  tuberculosis,  to  animals 
as  well  as  man.  To  Robert  Koch,  of  Berlin,  a  physician,  be- 
longs the  credit  of  discovering  and  of  proving  absolutely  its 
cause,  namely,  the  bacillus  tuberculosis.  While  it  is  perfectly 
true  that  this  has  not  yet  led  to  the  hoped-for  results  in  the 
cure  of  the  disease,  yet  all  must  admit  that  the  discovery  of 
the  cause  of  any  disorder  is  the  first  step  toward  its  cure. 
Moreover,  the  results,  even  from  a  diagnostic  and  therapeutic 
standpoint,  have  been  by  no  means  insignificant. 

First  of  all  it  has  enabled  us  to  determine  positively  the 
existence  of  tuberculosis  of  the  lungs  and  the  intestines  with 
absolute  certainty,  and  at  a  much  earlier  stage  than  was  be- 
fore possible.  Hence  even  the  ordinary  treatment  at  our  dis- 
posal, change  of  climate  and  the  administration  pf  remedies, 
is  instituted  at  a  much  earlier  period  than  formerly,  and  so 
leads  to  cure  in  cases  which,  under  the  older,  uncertain  meth- 
ods, would  have  run  on  until  they  had  become  practically  in- 
curable. Secondly,  although  the  tuberculin  treatment  of  Koch 
has  not  realized  all  that  was  hoped  for,  yet  by  better  methods 
and  improved  tuberculin,  a  number  of  cures  have  resulted. 
Even  had  Koch's  researches  proved  of  no  value  to  the  human 
race,  its  value  in  the  early  and  certain  diagnosis  of  the  disease 
in  the  lower  animals  has  been  of  the  greatest  possible  service 
to  our  dairymen  and  butchers  in  the  preservation  of  their 
herds,  and  to  the  community  in  preventing  the  use  of  tuber- 
culous meat  and  milk  as  articles  of  food,  a  use  which  is  fraught 
with  the  greatest  danger  to  human  beings.  The  reaction  which 
follows  the  use  of  tuberculin  in  animals  is  acknowledged  by 
all  veterinary  surgeons  as  practically  of  the  greatest  use  in 
weeding  out  tuberculous  animals  from  herds  of  cattle.  It  is 


282  ADDRESSES   AND    OTHER   PAPERS. 

not  too  much  to  hope  that  further  researches  may  yield  a  heal- 
ing serum  which  will  show  far  better  results  than  anything 
thus  far  produced.  Even  the  present  results  have  justified  all 
the  labor  and  expense  which  have  been  involved  in  the  dis- 
covery of  the  cause  of  tuberculosis. 

IX.  Diphtheria. — The  laboratory  has  given  us  a  proof  of 
its  value,  however,  in  another  direction,  hi  which  we  are 
treading  on  much  firmer  ground.  Diphtheria  is  one  of  those 
diseases  which  does  not  yield  to  improved  sanitation.  Whether 
it  show  itself  in  sporadic  cases,  or  as  an  endemic  or  epidemic, 
its  death-rate  has  been  appalling.  Until  a  few  years  ago  its 
mortality  was  placed  at  about  forty  per  cent,  of  all  the  cases 
attacked.  But  laboratory  researches  and  experiments  upon 
animals  have  robbed  it  of  more  than  half  its  terrors.  Perhaps 
the  three  most  important  papers  thus  far  published  are  those 
of  your  own  Prof.  William  H.  Welch*  and  the  collective  in- 
vestigations of  the  American  Psediatric  Society  of  1896  and 
1897.  Welch  investigated  7166  cases  from  eighty  different 
sources.  Among  this  large  number  of  cases,  1239,  or  only 
17.3  per  cent,  died,  a  diminution  in  the  mortality,  as  a  result 
of  the  use  of  the  antitoxine  of  55.8  per  cent.  It  is  very  strik- 
ing also,  to  observe  the  different  results  of  the  treatment  ac- 
cording to  the  day  on  which  it  was  begun.  The  following 
table  shows  the  regularly  increasing  mortality  according  to 
the  day  on  which  the  treatment  was  begun,  from  the  first  to 
the  eighth  days: 

MORTALITY 
DAT.  PERCENTAGE. 

1 18.3 

2 22.7 

3 38.1 

4 53.6 

5 67.0 

6 67.4 

7 72.5 

8 81.6 

*  Johns  Hopkins  Bulletin  for  1895. 


DEBT   OF  THE   PUBLIC  TO   THE  MEDICAL   PROFESSION.    283 

Could  figures  be  more  eloquent,  or  call  more  loudly  for  the 
earliest  possible  use  of  the  remedy? 

In  the  first  collective  report  of  the  American  Psediatric 
Society  there  were  nearly  6000  cases  in  the  practice  of  615 
physicians.  The  large  number  of  physicians  from  all  over 
this  country  and  Canada  eliminates  accidental  variations 
due  to  climate,  to  the  personal  equation  of  any  one  physician, 
etc.  The  mortality  was  12.3  per  cent,  or,  deducting  the  218 
cases  which  were  moribund  at  the  time  when  the  treatment 
was  begun,  a  mortality  of  only  8.8  per  cent,  instead  of  40 
per  cent. !  In  over  4000  cases,  in  which  the  treatment  was  be- 
gun during  the  first  three  days,  the  mortality  was  only  4.8 
per  cent.  The  results  of  this  treatment  are  still  more  striking 
hi  the  laryngeal  cases,  which  require  intubation  or  trache- 
otomy. In  5546  such  cases  reported  by  242  physicians  before 
the  introduction  of  the  serum,  the  mortality  was  69.5  per 
cent.  In  533  cases  in  which  the  serum  was  used  the  mortality 
was  but  25.9  per  cent.  In  the  report  of  1897  it  is  stated  that 
before  the  introduction  of  the  serum  treatment,  90  per  cent, 
of  the  cases  of  laryngeal  diphtheria  required  operation;  after 
its  introduction,  only  39.2  per  cent.  Before  the  serum  treat- 
ment was  introduced,  recovery  took  place  in  27  per  cent,  and 
death  in  73  per  cent. ;  after  the  serum  treatment  was  intro- 
duced the  figures  were  precisely  reversed;  recovery  took  place 
hi  73  per  cent,  and  death  in  27  per  cent. 

In  the  "  Philadelphia  Medical  Journal  "  for  April  1,  1899, 
p.  631,  is  given  the  still  more  recent  results  in  Chicago. 
In  ten  years  of  the  pre-antitoxine  period  the  annual  average 
of  deaths  was  1417.  In  the  three  years  after  the  antitoxine 
treatment  was  introduced,  though  the  city's  population 
was  larger  both  by  natural  increase  and  by  annexation, 
the  annual  average  was  only  851  deaths,  a  direct  saving 
of  600  lives  a  year,  and  a  forty  per  cent,  reduction  of  the 
previous  mortality.  The  closing  remarks  of  Professor  Welch 
are  eminently  in  point:  "  The  discovery  of  the  healing  serum 


284  ADDRESSES   AND    OTHER    PAPERS. 

is  entirely  the  result  of  laboratory  work.  It  is  an  out- 
come of  the  studies  of  immunity.  In  no  sense  was  the 
discovery  an  accidental  one.  Every  step  leading  to  it  can 
be  traced,  and  every  step  was  taken  with  a  definite  pur- 
pose and  to  solve  a  definite  problem.  These  studies  and 
the  resulting  discoveries  mark  an  epoch  in  the  history  of 
medicine.  It  should  be  forcibly  brought  home  to  those 
whose  philozoic  sentiments  outweigh  sentiments  of  true 
"philanthropy  that  these  discoveries  which  have  led  to 
the  saving  of  untold  thousands  of  human  lives  have  been 
gained  by  the  sacrifice  of  the  lives  of  thousands  of  animals, 
and  by  no  possibility  could  have  been  made  without  experi- 
mentation upon  animals."  Each  year,  for  all  future  time 
will  add  other  thousands  of  human  lives  thus  saved  by 
the  laboratory. 

X.  Hydrophobia. — Another  direct  result  of  laboratory 
research  is  the  splendid  achievement  of  Pasteur  in  the  cure 
of  hydrophobia.  Prior  to  his  researches  about  14  per  cent, 
of  those  bitten  by  animals  believed  to  be  rabid  were  attacked 
by  hydrophobia,  and  of  the  persons  so  attacked  everyone 
died — a  mortality  of  100  per  cent.  There  is  no  authentic 
case  reported  of  recovery  after  the  development  of  hydro- 
phobia. But  in  1893  the  mortality  in  St.  Petersburg,  in 
cases  submitted  to  Pasteur's  treatment,  was  only  0.84  per 
cent. ;  in  Turin  (report  for  1894)  the  mortality  for  the  preced- 
ing ten  years  was  only  0.95  per  cent.;  and  in  Paris,  in  1897, 
in  1060  persons  bitten  by  animals,  proved  experimentally  or 
diagnosticated  by  a  veterinary  surgeon  to  have  been  rabid, 
the  mortality  was  only  0.56  per  cent.  Instead  of  141  deaths 
from  a  horrible  and  formerly  irremediable  disease  there  were 
only  6  deaths! 

Figures  such  as  these  can  leave  no  doubt  in  the  minds 
of  reasonable  persons  that  this  gift  of  the  laboratory  has 
been  of  the  greatest  possible  value. 

XL  Trichinosis. — Another    direct    result    of    laboratory 


DEBT   OF  THE   PUBLIC   TO   THE   MEDICAL   PROFESSION.    285 

research  has  been  the  discovery  of  the  trichina  worm.  When 
studying  in  Berlin  in  the  winter  of  1865-66  I  well  remember 
the  demonstration,  among  the  first  that  had  then  been 
made,  of  the  cause  of  a  dreadful  epidemic  of  trichinosis. 
In  the  little  town  of  Hedersleben,  in  Saxony,  a  butcher 
killed  three  hogs  and  made  them  into  sausages.  They 
were  eaten  by  a  large  number  of  the  inhabitants  of  the 
little  town.  Several  hundred  persons  fell  desperately  ill 
and  I  think  over  one  hundred  died.  Professor  Virchow 
sent  one  of  his  assistants  to  the  town  to  discover  the  cause 
of  the  trouble,  and  all  of  the  students  in  the  Pathological 
Institute  in  Berlin  were  intensely  interested  in  the  discovery 
that  the  epidemic  was  due  to  the  fact  that  one  of  these  hogs 
had  been  infected  with  the  trichina.  A  portion  of  the  in- 
fected pork  was  brought  to  Berlin  and  fed  to  some  of  the 
lower  animals  and  the  life  history  of  the  trichina  was  studied 
with  the  minutest  care.  As  a  result  of  this  and  of  similar 
studies,  the  method  of  preventing  the  disease  was  very 
soon  discovered.  Heat  kills  the  worm  and  so  renders  it 
innocuous.  The  epidemic  in  Hedersleben  was  due  to  the 
fact  that  the  inhabitants  had  eaten  insufficiently  cooked 
sausages  in  which  the  parasites  were  still  alive.  Digestion 
dissolved  the  capsule  in  which  they  lay  and  freed  them  for 
their  future  devastating  work.  Cooking  would  have  en- 
tirely prevented  the  epidemic.  Since  these  studies,  all 
civilized  countries  have  made  obligatory  by  law  the  microscop- 
ical investigation  of  several  portions  of  the  carcasses  of  all 
hogs  which  have  been  killed  for  food,  and  all  of  our  meats 
derived  from  the  hog  now  are  perfectly  innocuous  by  the 
elimination  of  all  the  infected  carcasses. 

XII.  Animal  Diseases. — Had  I  the  time  and  were  I  as 
familiar  with  the  facts  in  veterinary  medicine  as  hi  human 
medicine,  I  should  be  able  to  point  out  to  you  the  laboratory 
studies  which  have  been  undertaken  abroad  and  in  this 
country  by  our  admirable  Bureau  of  Animal  Industry  as  to 


286  ADDRESSES   AND   OTHER   PAPERS. 

anthrax  (wool-sorters'  disease),  the  cattle  plague,  chicken 
cholera,  swine  fever,  hog  cholera,  and  lumpy  jaw  or  actin- 
omycosis,  and  show  you  that  not  only  is  the  human  race  a 
debtor  to  the  laboratory,  but  how  much  animals  themselves 
owe  to  it.  The  commercial  value  of  these  researches  hi  a 
country  like  ours,  which  exports  immense  quantities  of  meat, 
can  hardly  be  overestimated.  It  is  within  the  mark  when  I 
say  that  many  millions  of  dollars  are  saved  annually  in  our 
flocks  and  herds  as  a  direct  result  of  such  laboratory  investi- 
gations. Inasmuch,  also,  as  a  number  of  these  diseases  are 
capable  of  infecting  the  human  subject  (and  the  number  of 
cases  of  anthrax  and  of  actinomycosis  is  large),  they  are  as 
important  to  the  human  race  as  to  animals. 

Let  us  now  leave  medicine  proper  and  turn  to  surgery.  Be- 
fore doing  so  I  must  point  out  the  fact  that  all  the  diseases 
so  far  considered  are  medical,  and  not  surgical.  I  often  hear 
it  said  that,  while  surgery  has  made  such  giant  strides  of  late, 
medicine  has  lagged  behind.  It  is  but  just  to  the  physicians 
to  call  attention  to  the  fact  that  the  statements  already  made 
show  that  medicine  has  made  equal  or  even  greater  progress. 
The  saving  of  life  in  diphtheria  is  less  dramatic,  less  striking 
to  the  average  mind,  but  it  is  none  the  less  real  or  less  benefi- 
cent. 

XIII.  Ancesthesia. — We  come  now  to  two  of  the  epoch- 
making  discoveries  in  the  history  of  medicine,  both  of  which 
have  been  made  in  the  last  half-century — the  discovery  of 
anaesthesia  and  of  antisepsis.  Though  Long,  of  Georgia,  had 
used  ether  prior  to  1846,  practically  the  introduction  of  an- 
aesthesia dates  from  October  16,  1846,  when,  for  the  first  time 
since  Adam  parted  with  his  precious  rib,  Dr.  John  C.  Warren, 
in  the  Massachusetts  General  Hospital,  performed  a  major 
surgical  operation  without  inflicting  the  slightest  pain.  The 
news  went  like  wild-fire,  and  anaesthesia  was  soon  introduced 
into  every  clinic  and  at  almost  every  operation  throughout 
the  civilized  world.  Prior  to  that  time  a  surgical  operation 


DEBT   OF  THE   PUBLIC   TO   THE   MEDICAL    PROFESSION.     287 

was  attended  with  horrors  which  those  who  live  in  these  days 
cannot  appreciate.  He  was  the  best  surgeon  who  could  per- 
form any  operation  in  the  least  possible  time.  The  whole 
object  of  new  methods  of  operating  was  to  shorten  the  period 
of  frightful  agony  which  every  patient  had  to  endure.  Every 
second  of  suffering  saved  was  an  incalculable  boon.  To  sub- 
mit to  any  operation  required  then  a  heroism  and  endurance 
which  are  almost  incomprehensible  to  us  now.  All  of  the 
more  modern,  deliberate,  careful,  painstaking  operations  in- 
volving minute  dissection,  amid  nerves  and  blood-vessels, 
when  life  or  death  depends  on  the  accuracy  of  almost  every 
touch  of  the  knife,  were  absolutely  impossible.  It  was  be- 
yond human  endurance  to  submit  one's  self  for  an  hour,  for 
an  hour  and  a  half,  for  even  two  hours  or  longer,  to  such 
physical  agony  and  in  absolute  physical  repose. 

It  is  a  striking  commentary  on  the  immediate  results  of 
anesthesia  to  learn  that,  in  the  five  years  before  the  introduc- 
tion of  ether,  only  184  persons  were  willing  to  submit  them- 
selves to  such  a  dreadful  ordeal  in  the  Massachusetts  General 
Hospital — an  average  of  37  operations  per  annum,  or  3  per 
month.  In  the  five  years  immediately  succeeding  its  intro- 
duction, although  the  old  horror  could  not  at  once  be  over- 
come, 487  operations,  or  almost  100  annually,  were  performed 
in  the  same  hospital.  During  the  last  year  in  the  same  hospital, 
a  Mecca  for  every  surgeon  the  world  over,  over  3700  opera- 
tions were  performed.  It  is  not  an  uncommon  thing  at  the 
present  day  for  any  one  of  the  more  active  surgeons  of  this 
country  to  do  as  many  as  400  to  500  operations  in  a  year.  I 
have  known  as  many  as  19  operations  to  be  done  in  the  Jef- 
ferson College  Hospital  in  a  single  day — equalling  six  months' 
work  in  the  Boston  hospital  before  the  introduction  of  ether. 

Such  a  boon,  the  direct  gift  of  the  profession  to  a  suffering 
world,  has  placed  the  public  under  a  debt  which  can  never 
be  sufficiently  appreciated,  still  less  be  repaid.  Every  sufferer 
may  well  bless  the  names  of  Morton  and  Warren,  to  which 


288  ADDRESSES   AND   OTHER   PAPERS. 

should  be  added  certainly  the  name  of  that  giant  of  surgery, 
Sir  James  Y.  Simpson,  who  discovered  the  anaesthetic  use  of 
chloroform  in  1847. 

Both  anaesthetics  have  their  dangers,  and  the  profession 
will  never  be  satisfied  so  long  as  there  is  the  slightest  danger 
in  the  use  of  any  such  drug.  Our  researches  are  still  directed 
toward  the  discovery  of  the  ideal  anaesthetic.  This  will  not 
be,  in  my  opinion,  an  anaesthetic  like  cocaine,  which  abolishes 
pain  without  abolishing  consciousness,  but,  rather,  one  which, 
without  danger  to  life,  will  produce  unconsciousness  to  every- 
thing, including  pain,  for  this  reason :  Very  frequently  during 
an  operation  emergencies  occur  (especially  haemorrhage) 
which,  although  the  surgeon  is  perfectly  capable  of  coping 
with  them,  would  greatly  alarm  the  patient  and  might  de- 
feat the  object  of  the  surgeon,  were  they  known  to  the  patient 
at  the  time.  That  such  an  ideal  anaesthetic  will  be  discovered 
is  as  certain  as  that  the  twentieth  century  will  soon  dawn 
upon  us.  Happy  will  be  the  surgeons  who  can  operate  with- 
out the  least  fear  of  their  anaesthetic,  and  yet  be  certain 
that  the  patient  is  relieved  from  all  suffering  and  free  from 
all  danger  of  shock  or  other  after-consequences. 

XIV.  Antisepsis. — Even  the  introduction  of  anaesthesia, 
however,  did  not  rid  surgery  of  all  its  terrors.  The  acute  pain 
of  the  operation  was  abolished,  but  the  after-suffering,  as  I 
knew  only  too  well  in  my  early  surgical  days,  was  something 
dreadful  to  see.  The  parched  lips  of  the  poor  sufferer,  tossing 
uneasily  during  sleepless  nights,  wounds  reeking  with  pus, 
and  patients  dying  by  scores  from  blood-poisoning,  from 
erysipelas,  from  tetanus,  from  gangrene,  were  only  too  fa- 
miliar sights  in  the  pre-antiseptic  days.  Then,  again,  there 
arose  one  of  these  deliverers  of  the  human  race  whose  name 
can  never  be  forgotten  and  whose  fame  will  last  so  long  as  time 
shall  endure.  Jenner,  Warren,  and  Lister  are  a  triumvirate 
of  names  of  which  any  profession  may  well  be  proud.  Thank 
God,  they  all  sprang  from  virile  Anglo-Saxon  loins!  No 


DEBT  OF  THE   PUBLIC  TO  THE  MEDICAL  PROFESSION.    289 

praise,  no  reward,  no  fame  is  too  great  for  them.  That  Lord 
Lister  still  lives  to  see  the  triumph  of  his  marvellous  services 
to  humanity  is  a  joy  to  all  of  us.  And  when  the  profession 
arose  en  masse,  within  the  last  few  years,  at  the  International 
Congress  of  Berlin  and  at  the  meeting  of  the  British  Medical 
Association  in  Montreal,  and  welcomed  him  with  cheer  after 
cheer,  it  was  but  a  feeble  expression  of  gratitude  for  benefits 
which  no  words  can  express. 

Before  Lister's  day,  erysipelas,  tetanus,  gangrene,  and 
blood-poisoning  hi  its  various  phases  were  the  constant  at- 
tendant of  every  surgeon.  They  were  dreaded  guests  at 
almost  any  operation;  and  when  in  rare  cases  we  obtained 
primary  union  without  a  drop  of  pus,  without  fever,  and  with 
but  little  suffering,  it  was  a  marvellous  achievement.  Now  it 
is  precisely  reversed.  The  surgeon  who  does  not  get  primary 
union  without  a  drop  of  pus,  with  no  fever,  and  with  little 
suffering,  asks  himself — What  was  the  fault  in  my  technic? 
To  open  the  head,  the  abdomen,  or  the  chest  thirty  years 
ago  was  almost  equivalent  to  signing  the  death-warrant  of 
a  patient.  The  early  mortality  of  ovariotomy  was  about  60 
per  cent. ;  2  out  of  3  died.  Now  many  a  surgeon  can  point  to 
a  series  of  100  abdominal  operations  with  a  fatality  of  only 
2  per  cent,  or  3  per  cent. 

This,  too,  is  a  direct  result  of  laborious  laboratory  researches 
beginning  with  the  investigations  of  Liebig  and  Pasteur  on 
fermentation.  Lister  went  still  further.  Even  before  the 
discovery  of  the  bacteria  of  suppuration,  of  tetanus,  and  of 
erysipelas,  he  showed  us  experimentally  how,  by  surgical 
cleanliness,  we  could  avoid  all  infection  and  so  banish  these 
pests  from  our  hospitals  and  bring  life  and  health  to  many 
who  otherwise  would  have  perished  from  operations  which 
are  now  perfectly  safe. 

The  mortality  of  compound  fractures  in  the  pre-antiseptic 
days  was  about  60  per  cent.  It  was  one  of  the  most  dreaded 
of  all  accidents.  Its  mortality  now  is  perhaps  not  over  3  per 

19 


290  ADDRESSES    AND    OTHER   PAPERS. 

cent.,  and  the  mortality  from  sepsis  after  such  a  fracture,  in 
the  hands  of  well-instructed  surgeons,  is  almost  nil.  Prior 
to  Lister's  day,  the  mortality  of  major  amputations  varied 
from  50  to  63  per  cent.  Now,  it  is  from  10  to  20  per  cent. 
And  so  I  might  go  on  with  operation  after  operation  and  show 
how  they  have  become  so  safe  that  one  need  not  dread  any, 
saving  exceptional,  cases. 

These  two  modern  discoveries,  anaesthesia  and  antisepsis, 
have  utterly  revolutionized  modern  surgery.  They  have  made 
possible  operations  which,  by  reason  of  their  length  and  pain 
and  danger,  were  utterly  unjustifiable  in  former  days,  but 
are  now  the  daily  occupation  of  a  busy  surgeon.  And,  far 
better  than  this,  they  have  enabled  us  to  bring  to  homes  and 
hearts,  which  otherwise  would  have  been  broken  up  and 
wrung  with  sorrow,  the  comfort  of  life  restored  to  dear  ones 
upon  whom  depended  the  happiness  and  support  of  the 
families.  Translate  figures  into  happy  hearts  and  prosperous 
homes  if  you  can,  and  then  you  can  tell  me  what  Warren  and 
Lister  have  done  for  humanity! 

XV.  Bravery  of  the  Profession. — But  it  is  not  only  by  its 
achievement  in  specific  diseases  that  the  profession  has 
brought  the  community  into  its  debt.  Quite  as  much  by  his 
character  has  the  physician  pointed  the  way  to  the  noblest 
development  that  human  nature  can  attain.  Not  only  has 
he  diminished  the  horrors  of  war,  but  he  has  shared  in  its 
perils  and  has  shown  a  disregard  of  danger  and  a  fearlessness 
in  the  performance  of  his  duty  which  is  worthy  of  all  praise. 
During  the  Civil  War  40  Northern  medical  officers  lost  their 
lives  in  battle  and  73  were  wounded,  a  number  "propor- 
tionately larger  than  that  of  any  other  staff  corps."  The 
heroism  of  Gibbs,  who  perished  in  Cuba,  is  known  to  you  all. 
In  the  navy,  Dr.  John  F.  Bransford  had  resigned  his  com- 
mission as  surgeon  in  1890,  but  immediately  volunteered  for 
service  in  the  war  with  Spain.  During  the  battle  of  July  3, 
off  Santiago,  he  dropped  his  scalpel  and  bravely  took  charge 


DEBT   OF  THE  PUBLIC  TO   THE   MEDICAL   PROFESSION.    291 

of  a  gun,  fighting  gallantly  throughout  the  engagement,  his 
services  as  surgeon  not  being  called  upon  until  the  wounded 
prisoners  were  brought  on  board.  Like  the  mother  of  the 
Gracchi,  we  may  proudly  point  to  such  and  say,  "  these  are 
our  jewels." 

But  while  gallantry  in  action  justly  merits  our  highest 
admiration,  there  is  a  quiet,  unostentatious  bravery  in  the 
midst  of  pestilence  which  is  no  less  heroic,  though  less  dra- 
matic. 

"In  1832,  that  most  dreaded  of  all  scourges,  Asiatic  cholera,  for  the 
first  time  broke  out  all  over  this  country  with  the  greatest  virulence. 
Easton  was  only  eighty  miles  from  New  York,  and  the  citizens,  in  terror 
lest  the  dread  disease  would  reach  their  own  town,  appointed  a  young, 
intrepid  surgeon  to  visit  New  York  and  learn  what  he  could  for  their  bene- 
fit. Wlien  others  were  fleeing  in  frightened  thousands  from  the  pesti- 
lence, Gross  bravely  went  directly  into  the  very  midst  of  it,  reaching 
New  York  when  the  epidemic  was  at  its  very  height.  In  that  then  small 
and  half-depopulated  town  385  persons  died  on  the  very  day  of  his  arrival 
— and  he  stayed  there  a  week  in  a  hot  July,  visiting  only  its  hospitals  and 
its  charnel-houses.  What  call  you  that  but  the  highest  type  of  bravery? 
— a  bravery  which  Norfolk  and  Mobile  and  Memphis  have  since  seen  re- 
peated by  scores  of  courageous  physicians  ready  to  sacrifice  their  lives 
for  their  fellow-men,  with  no  blare  of  trumpets,  no  roar  of  cannon,  no 
cheer  of  troops,  no  plaudits  of  the  press !  No  battlefield  ever  saw  greater 
heroes;  no  country  braver  men!"  (Page  241.) 

And  Gross  was  not  alone  in  this  bravery.  Amid  Arctic 
snows  and  surrounded  with  desolation,  Kane  and  Hayes  have 
shown  what  steady  courage  could  do  in  Arctic  exploration; 
while  the  revered  Livingstone,  in  the  midst  of  the  wilds  of 
Africa,  surrounded  by  savage  beasts  and  still  more  savage 
men,  exposed  to  the  dangers  of  fever  and  miasm  on  every 
hand,  showed  what  the  doctor  could  do  amid  torrid  heats  in 
the  performance  of  his  duty  in  exploring  an  unknown  conti- 
nent and  hi  exterminating  the  traffic  in  human  life.  At  this 
moment  in  India,  Burma,  China,  Africa,  two  hundred  and 
sixty-eight  brave  medical  missionaries,  of  whom  sixty-four 


292  ADDRESSES   AND   OTHER   PAPERS. 

are  no  less  brave  women,  are  endeavoring  to  bring  the  bless- 
ings of  modern  medicine  and  of  Christianity  to  the  natives 
benighted  lands.  "  We  can  imagine,"  says  the  "  Lancet,"  "  no 
career  more  lofty  or  honorable  than  that  of  a  well-informed, 
capable,  and  courageous  medical  missionary."  Their  efforts 
especially  hi  bringing  health  to  the  down-trodden  women 
of  heathen  lands,  in  their  efforts  to  abolish  child-marriage 
with  all  of  its  attendant  horrors,  and  in  their  ministrations  to 
the  sick  of  body  and  of  soul  have  been  fruitful  of  the  highest 
good  to  millions  of  the  human  race. 

XVI.  Generosity  of  the  Profession. — Moreover,  there  is  no 
profession  which  gives  so  freely  for  the  good  of  the  human 
race.  Where  is  the  doctor  whose  ear  is  deaf  to  the  cry  of  suf- 
fering humanity  in  cases  of  accident,  or  during  the  pangs  of 
maternity,  who  will  not  deprive  himself  of  well-earned  sleep 
and  needed  recreation,  to  minister  to  his  suffering  fellow- 
creatures  without  ever  a  thought  of  any  pecuniary  benefit 
to  himself? 

I  am  sure  that  the  public  does  not  appreciate  the  amount 
of  time  and  the  value  of  the  services  given  to  the  poor  by  the 
rank  and  file  of  the  profession.  Take  a  single  example  with 
which  I  am  familiar.  In  the  Jefferson  Medical  College  Hos- 
pital the  last  report  shows  129  medical  men  on  the  staff  of 
the  hospital.  As  nearly  as  I  can  estimate,  they  give  every 
year  about  60,000  hours  of  their  time  to  the  poor,  which, 
at  8  hours  per  diem,  amounts  to  20  years  of  labor  of  one  man 
year  after  year;  and  their  services,  were  they  paid  for  at  a 
very  moderate  rate,  make  an  annual  gift  to  the  poor  of  over 
$500,000.  This,  mark  you,  is  from  a  single  hospital  in  a  single 
city.  Were  we  to  take  account  of  all  the  hospitals  in  every 
city  and  town  in  this  country,  you  can  easily  see  how  many 
millions  of  dollars'  worth  of  gratuitous  services  and  how 
many  decades  of  time  are  given  to  humanity  every  year  by 
the  medical  profession.  It  is  only  by  such  vast  aggregates 


DEBT  OF  THE  PUBLIC  TO  THE  MEDICAL  PROFESSION.    293 

that  we  can  appreciate  how  much  there  is  of  generous  giving 
on  the  part  of  the  profession  which  we  do  well  to  love  and 
honor. 

How  shall  the  public  pay  this  great  debt?  "  Freely  ye  have 
received,  freely  give. "  We  do  not  ask  dollar  for  dollar,  but 
may  we  not  expect  a  Scriptural  tenth?  Not  for  our  own 
pockets,  but  for  our  hospitals;  not  to  minister  to  our  own 
ease  and  enjoyment,  but  to  equip  our  libraries  and  labora- 
tories for  larger  and  more  fruitful  work;  not  for  our  own 
homes,  but  for  our  colleges  to  furnish  us  the  means  for  better 
teaching;  hi  a  word,  not  for  ourselves,  but  for  humanity, 
to  whose  service  our  lives  are  dedicated. 

In  Mr.  John  Wanamaker  's  gallery  is  one  of  the  most  striking 
pictures  I  have  ever  seen.  On  a  large  canvas  by  Fritel,  in  the 
center  of  the  picture,  advancing  directly  toward  the  spectator, 
is  a  large  cavalcade  of  warriors  arrayed  in  corselet  and  casque. 
Their  stately  march  at  once  arrests  the  eye.  The  leader  is 
Julius  Caesar.  He  is  flanked  by  Napoleon  and  Alexander 
the  Great  and  followed  by  Attila,  Semiramis,  and  a  lengthen- 
ing host  of  those  whom  the  world  counts  among  its  greatest 
"Conquerors."  They  advance  between  two  long  rows  of 
rigid,  ghastly  corpses  all  stretched  at  right  angles  to  their 
line  of  march.  Spectral  mountains  in  the  distance  hedge  hi 
a  desolate  plain  given  over  to  the  vulture,  the  bat,  and  silence. 

I  would  that  some  artist  might  paint  a  companion  picture 
of  the  "conquerors  in  medicine,"  instead  of  the  "conquerors 
hi  war."  Instead  of  spectral  hills  and  a  barren  waste,  the 
scene  should  be  laid  in  a  happy,  smiling  valley,  bounded  by 
the  Delectable  Mountains  and  kissed  by  a  fertile  sun.  The 
stately  procession  should  be  led  by  Edward  Jenner.  He 
should  be  flanked  by  Joseph  Lister  and  John  C.  Warren,  and 
followed  by  Simpson,  Billroth,  Livingstone,  Ambroise  Pare", 
Virchow,  John  Hunter,  and  many  a  modest,  but  unknown 
hero  who  has  yielded  up  his  spirit  hi  the  performance  of  his 


294  ADDRESSES   AND   OTHER   PAPERS. 

duty.  Instead  of  treading  their  way  between  lines  of  corpses, 
they  should  march  between  lines  of  grateful  men  and  women 
and  a  host  of  God's  little  children  who,  on  bended  knee 
and  with  clasped  hands,  would  reverently  invoke  Heaven's 
richest  benediction  upon  their  deliverers. 

Thus  should  humanity  recognize  its  debt  to  the  medical 
profession. 


THE  ENDOWMENT  OF  MEDICAL  COLLEGES.* 


TWO  duties  seem  to  me  to  devolve  on  the  President  of 
the  American  Medical  Association  in  his  annual  address. 
First,  to  consider  the  condition  of  the  Association  with  any 
suggestions  that  may  be  made  for  improvement,  and,  sec- 
ondly to  take  up  some  subject  of  professional  interest  which 
may  be  properly  considered  before  the  chief  representative 
medical  body  of  the  United  States. 

[I  omit  those  paragraphs  dealing  with  the  affairs  of  the 
Association.] 

Turning,  now,  from  the  affairs  of  the  Association,  I  wish 
to  say  a  few  words  in  reference  to  a  subject  of  paramount  im- 
portance which  I  am  sure  will  appeal  to  the  sympathies  of  all 
present,  namely, — the  need  for  endowments  for  medical 
schools. 

The  tide  of  charity  in  the  United  States  has  reached  a 
remarkable  height.  The  Chicago  "Tribune"  publishes  an 
annual  list  showing  that  in  1894  the  charitable  gifts  and  be- 
quests in  the  United  States  amounted  in  round  numbers  to 
$20,000,000;  in  1895,  to  $29,000,000;  in  1896,  to  $34,000,000; 
in  1897,  to  $34,000,000;  in  1898,  to  $24,000,000;  and  in 
1899,  to  the  enormous  sum  of  nearly  $80,000,000. 

But  a  small  portion  of  this  charity,  however,  has  been 
bestowed  upon  medical  schools.  It  is  mostly  to  colleges, 
theological  schools,  hospitals,  museums,  and  libraries  that  the 
principal  amounts  have  been  given.  The  cause  for  this,  I 

*  Presidential  Address,  Fifty-first  Annual  Meeting,  American  Medical 
Association,  Atlantic  City,  June  5-8,  1900.  Reprinted  from  the  Journal 
of  the  American  Medical  Association  June  9,  1900 

295 


296  ADDRESSES   AND    OTHER   PAPERS. 

think,  has  been  chiefly  the  vicious  method  in  which  all  our 
practically  joint-stock  companies  organized  Medical  Schools 
for  the  benefit  of  the  faculties.  As  Professor  Bowditch  has 
said,  one  might  as  well  expect  the  public  to  endow  a  cotton- 
mill  as  to  endow  such  a  school.  The  day  of  these  private 
enterprises  is  now,  happily,  nearly  past.  The  respectable 
schools  of  medicine  are  now  conducted  by  trustees,  a  body 
of  men  wholly  apart  from  the  faculties,  who  manage  the 
affairs  of  the  medical  school  just  as  they  would  those  of  a 
university,  taking  control  of  the  income  and  expenditures  of 
the  school,  placing  the  professors  and  other  teachers  upon 
salaries  and  conducting  the  affairs  of  the  institution  on  broad 
lines  of  educational  progress.  Partly  as  a  result  of  this  change, 
chiefly  through  the  medical  faculties,  and  largely,  I  am  glad 
to  say,  as  a  result  of  the  influence  of  the  profession  exerted 
through  this  Association,  the  courses  of  study  at  the  medical 
schools  of  to-day,  and,  therefore,  the  necessities  of  the  student, 
are  so  wholly  different  from  those  of  twenty-five  years  ago 
that  it  may  be  well  termed  a  new  era  in  medical  education. 
As  a  consequence  of  the  broadening  and  lengthening  of  the 
medical  course  of  study,  the  cost  of  medical  education  has 
enormously  increased.  The  public  at  large  do  not  at  all  ap- 
preciate this  changed  condition,  and  even  you,  members  of 
the  profession  itself  who  may  have  graduated  many  years 
since,  scarcely  appreciate  to  its  full  value  the  difference.  As 
a  consequence,  the  fees  of  the  students,  which  can  scarcely  be 
raised  beyond  the  present  amount,  are  wholly  inadequate  for 
providing  a  proper  medical  education,  and  the  medical  school 
appeals,  as  does  the  college,  the  theological  school,  and  the 
technical  school,  for  wise  and  liberal  endowments  in  order  to 
provide  this  suitable  education.  "  There  is  no  branch  of  edu- 
cation," says  President  Eliot,  of  Harvard,  "which  more  needs 
endowment.  Medical  education  is  very  expensive,  because  it 
has  become,  in  the  main,  individual  instruction.  Large  lec- 
tures and  crowded  clinics  are  seen  to  be  of  really  very  limited 


THE    ENDOWMENT   OF   MEDICAL   COLLEGES.  297 

application,  so  that  year  by  year  the  medical  teaching  be- 
comes more  and  more  costly." 

What  were  the  necessities  of  a  medical  school  twenty-five 
years  ago?  Two  lecture-rooms,  in  which  seven  professors 
talked,  a  dissecting-room,  and,  if  possible,  a  clinic,  which  was 
occasionally,  but  rarely,  in  a  college  hospital.  Practically  the 
instruction  which  the  student  obtained,  with  the  exception 
of  dissecting,  was  limited  to  "book-knowledge"  and  "ear- 
knowledge."  The  student  was  not  brought  into  actual 
personal  contact  with  any  patients  or  any  concrete  facts, 
observations,  or  experiments.  He  only  listened  to  what  his 
teachers  said  about  Athena.  Millions  were  given  to  hospitals 
in  which  the  sick  were  treated,  but  only  sixpences  to  medical 
schools  in  which  the  men  who  are  to  care  for  their  future 
patients  were  trained.  "Spain,"  says  Lyman  Abbott,  "in 
the  late  war  had  nineteenth-century  guns  and  sixteenth- 
century  men  behind  them.  We  know  what  came."  Our 
splendidly  equipped  hospitals  are  the  nineteenth  century 
guns.  Insufficiently  trained  doctors  are  the  sixteenth- 
century  men.  The  time  has  eminently  come  when  the  "  men 
behind  the  guns"  must  equal  in  efficiency  the  weapons  with 
which  they  do  the  fighting. 

To  perform  a  tracheotomy  and  rescue  a  child  suffering  from 
diphtheria  is  a  dramatic  occurrence  which  appeals  to  every 
one.  To  conduct  a  long  series  of  experiments  in  the  labora- 
tory by  means  of  which  the  cause  of  diphtheria  shall  be  found 
and  the  necessity  for  a  tracheotomy  avoided,  appeals  only  to 
the  educated  few;  yet  the  service  done  by  the  operation  is  a 
service  only  to  the  one  patient  who  may  be  rescued  by  the 
knife,  while  the  other  is  a  service  to  hundreds  and  thousands 
of  patients  for  all  time  who  will  escape  both  the  knife  and  the 
disease.  Yet,  such  a  series  of  experiments  in  preventive 
medicine  brings  no  reward  in  money,  a  limited  reward  in 
fame,  and  only  its  largest  reward  in  the  consciousness  of  giving 
a  great  boon  to  humanity,  for  which  it  never  can  pay. 


298  ADDRESSES   AND    OTHER    PAPERS. 

The  era  of  the  man  who  simply  listened  to  what  his  teachers 
had  to  tell  him  and  then  went  on  his  way,  as  a  "  rule  of  thumb  " 
man  is,  happily,  past.  This  is  the  era  of  the  trained  man  and 
the  trained  woman,  and  training  means  opportunity  provided 
by  the  community  and  time,  labor,  and  money  given  by  the 
man  and  the  woman. 

Let  us  look  for  a  moment  at  what  a  medical  school  now 
needs.  It  stands  for  two  things:  First,  "thing-knowledge," 
instead  of  "book-knowledge"  and  "ear-knowledge,"  teach- 
ing the  facts  of  modern  science,  by  scientific  methods;  that 
is  to  say,  methods  of  precision.  But,  secondly,  no  medical 
school  should  be  content  simply  with  imparting  the  knowledge 
that  exists.  It  should  push  back  the  boundaries  of  ignorance 
and  by  research  add  to  existing  knowledge. 

In  the  accomplishment  of  the  first  duty  of  the  medical  school 
there  are  required,  first,  didactic  lectures.  I  am  not  one  of 
those  who  believe  that  the  day  of  the  didactic  lecture  is  past. 
"Never,"  said  President  Faunce,  of  Brown  University,  in  his 
notable  inaugural,  "never  shall  we  be  able  to  do  without  the 
personality  of  the  teacher  flaming  with  enthusiasm  for 
knowledge,  pressing  up  the  heights  himself  and  helping  the 
student  on." 

In  the  156  medical  schools  in  this  country  there  are,  per- 
haps, over  1500  members  in  their  Faculties.  In  all  of  them 
are  inspiring  teachers  flaming  with  enthusiasm,  for  a  not  in- 
considerable proportion  may  properly  be  so  described,  and 
the  influence  of  such  enthusiastic  teachers  is  felt  by  the  entire 
class.  One  or  two  such  men  in  every  school  make  a  good 
Faculty.  Besides  the  didactic  lectures,  a  good  working  library 
and  a  reading  or  study  room  is  a  requisite.  And  it  is  a  matter 
of  no  little  encouragement  that  in  the  reports  of  the  Commis- 
sioner of  Education  for  1898,  72  medical  schools  reported  151,- 
433  volumes  in  their  libraries. 

Secondly, — The  great  difference  between  the  modern 
method  of  teaching  medicine  and  the  older  method  consists  in 


THE   ENDOWMENT   OF   MEDICAL   COLLEGES.  299 

laboratory  instruction  and  clinical  instruction,  both  of  which 
must  be  individual.  Laboratories  are  very  costly.  They 
require  buildings,  equipment,  and  assistants.  The  number  of 
laboratories  required  in  the  present  day  in  a  fully  equipped 
medical  school  is  astonishing.  First,  the  dissecting-room— 
the  anatomical  laboratory,  and  along  with  this  a  laboratory 
of  histology,  and  another  which  may  be  combined  with  it, 
a  laboratory  of  embryology.  Next,  a  physiological  labora- 
tory, in  which  each  student  will  not  become  an  accomplished 
physiologist,  but  will  become  familiar  with  physiological 
methods  and  be  trained  in  exact  and  careful  observation;  a 
laboratory  of  chemistry  and,  combined  with  it,  especially, 
a  laboratory  of  physiological  chemistry;  in  the  department  of 
materia  medica,  a  laboratory  of  pharmacy,  in  which  the 
student  will  not  become  a  good  pharmacist,  but  will  learn  the 
essentials  of  pharmacy  so  that  he  will  not  make,  at  least,  gross 
mistakes,  which  otherwise  would  constantly  occur.  Still 
more  important  is  a  laboratory  of  pharmacology,  in  which 
he  will  learn  the  action  of  drugs  and  be  prepared  rightly  to  use 
them.  In  obstetrics,  a  laboratory  of  practical  obstetrics  and 
obstetrical  operations  is  essential.  In  surgery,  he  needs  a 
laboratory  in  which  he  shall  be  taught  all  the  ordinary  surgical 
operations.  In  pathology,  he  needs  a  laboratory  of  morbid 
anatomy,  a  laboratory  of  bacteriology,  and  a  laboratory  of 
hygiene.  The  mere  statement  of  this  catalogue  of  thirteen 
laboratories  will  enforce  the  fact  that  an  enormous  expense  not 
only  for  the  installation,  but  also  for  the  running  expenses, 
will  be  required.  To  show  what  one  university  abroad  does, 
Professor  Welch  has  stated*  that  the  Prussian  Government 
expends  outside  of  the  salaries  of  professors  in  the  University 
of  Berlin  alone  over  $50,000  annually!  What  American 
medical  school  can  show  anything  approaching  an  endowment 
which  will  provide  such  a  sum? 

*  Higher  Medical  Education  and  the  Need  for  its  Endowment,  Medical 
News,  July  21,  1894. 


300  ADDRESSES    AND   OTHER    PAPERS. 

And  what  has  not  the  laboratory  done  for  us  within  the 
last  few  years?  It  has  discovered  the  cause  of  tuberculosis, 
tetanus,  suppuration,  cholera,  diphtheria,  bubonic  plague, 
typhoid  fever,  erysipelas,  pneumonia,  glanders,  and  a  host  of 
other  diseases;  it  has  shown  us  how  to  avoid  all  danger  from 
trichina  so  that  our  entire  commerce  in  hog-products  is  con- 
ditioned upon  the  laboratory;  it  has  shown  us  how  to  banish 
suppuration,  erysipelas,  tetanus,  and  pyaBmia  from  our 
hospitals  and  reduce  our  death-rates  after  operations  from 
50  per  cent,  or  33  per  cent,  to  10,  5,  1,  and  often  even  frac- 
tions of  1  per  cent.;  it  has  given  us  a  really  scientific  hy- 
giene in  which  we  no  longer  guess,  but  know;  it  has  shown 
us  the  role  of  the  mosquito  in  malaria,  of  the  rat  in  bubonic 
plague,  of  the  fly  in  typhoid  fever;  it  has  given  us  the  power 
to  say  to  diphtheria  "thus  far  shalt  thou  go  and  no  farther"; 
it  will  give  us  the  power  to  utter  a  paean  of  victory  over 
typhoid,  cholera,  bubonic  plague,  tuberculosis,  yellow  fever, 
cancer,  and  other  such  implacable  enemies  of  the  human  race — 
and  yet  there  are  those  who  would  stay  this  God-given  hand 
of  help! 

And  the  laboratory  has  had  not  only  its  devotees,  but  its 
heroes.  Listen  to  the  story  of  but  one.  Dr.  Franz  Muller, 
of  Vienna,  was  one  of  those  who  in  his  investigations  of  the 
bubonic  plague  in  1897  contracted  the  dreaded  disease  from 
the  bacilli  in  his  culture-tubes.  When  he  became  certain  that 
he  was  infected  he  immediately  locked  himself  in  an  isolated 
room  and  posted  a  message  on  the  inside  of  the  window  pane, 
reading  thus : 

"I  am  suffering  from  plague.  Please  do  not  send  a  doctor 
to  me,  as,  in  any  event,  my  end  will  come  in  four  or  five  days." 

A  number  of  his  associates  were  anxious  to  attend  him,  but 
he  refused  to  admit  them  and  died  alone,  within  the  time  he 
predicted.  He  wrote  a  farewell  letter  to  his  parents,  placed 
it  against  the  window,  so  it  could  be  copied  from  the  outside, 
and  then  burned  the  original  with  his  own  hands,  fearful  lest 


THE   ENDOWMENT  OF  MEDICAL   COLLEGES.  301 

it  might  be  preserved  and  carry  the  mysterious  germ.  Can 
you  find  me  a  finer  example  of  self-sacrificing  altruism? 
Was  ever  a  Victoria  Cross  more  bravely  won? 

But  the  establishment  of  laboratories  with  their  attendant 
expenses  is  not  the  only  improvement  in  our  medical  curricu- 
lum. Every  well-conducted  medical  school  requires  a  large 
hospital  in  connection  with  it.  Here  must  be  installed  again 
a  fourteenth  laboratory  of  clinical  medicine  in  which  all  the 
excretions  of  the  body  will  be  examined,  tumors  studied, 
cultures  and  blood-counts  made,  or  else  the  patients  in  the 
hospital,  from  the  modern  point  of  view,  are  neglected.  It 
is  not  too  much  to  say  that  a  patient  requiring  such  examina- 
tions, be  he  the  poorest  of  the  poor,  has  his  case  more  scien- 
tifically studied,  more  exactly  measured,  more  precisely 
treated  than  most  rich  patients  in  sumptuous  homes. 

Again,  the  individual  instruction  to  which  President  Eliot 
referred  is  now  carried  out  in  all  of  our  best  medical  school 
hospitals  by  the  establishment  of  small  ward-classes,  by  whom 
or  before  whom  the  patients  are  examined",  prescribed  for, 
and  operated  upon  by  the  professor  or  instructor,  each  student 
bearing  a  part;  and  so,  by  having  his  investigations  directed, 
his  powers  of  observation  cultivated,  his  mistakes  pointed 
out,  his  merits  applauded,  the  student  graduates  from  the 
medical  school  equipped  as  none  of  us  older  graduates,  alas! 
ever  had  the  opportunity  for.  All  of  these  laboratory  and 
ward-classes  imply  an  enormous  increase  in  the  number  of 
assistants,  young  men  striving  not  only  to  perfect  themselves, 
but,  by  teaching,  to  forge  to  the  front  so  that  the  best  men  will 
win  in  the  struggle  for  preferment. 

Again,  the  course  of  study  has  been  prolonged  from  two 
years,  as  it  was  until  twenty  or  twenty-five  years  ago,  to 
four  years,  and  in  addition  the  terms  have  also  been  length- 
ened. When  I  was  a  student  the  course  of  study  consisted  of 
two  sessions  of  about  19  weeks  each,  or  38  weeks  in  all.  Now 
the  course  consists,  as  a  rule,  of  four  sessions  of  32  weeks  each, 


302  ADDRESSES   AND   OTHER   PAPERS. 

or  a  total  of  128  weeks,  an  increase  of  90  weeks, — nearly  three 
and  one-half  times  as  much  as  twenty-five  years  ago.  In 
1885,  103  schools  had  courses  of  two  years,  and  5  schools 
courses  of  three  years.  In  1899,  2  schools  had  courses  of 
two  years,  10  of  three  years,  and  141  of  four  years.* 

It  can  be  easily  seen  that  from  this  additional  time  required 
another  source  of  expense  has  arisen  in  addition  to  the  in- 
creased number  of  assistants.  The  time  given  to  teaching 
by  members  of  the  faculty,  as  a  rule,  has  been  more  than 
tripled,  as  compared  with  twenty-five  years  ago.  In  addition 
to  this,  professors  in  charge  of  laboratories  must  practically 
give  their  whole  time  to  the  work  and  are  precluded,  there- 
fore, from  any  income  from  practice.  These  men  must  receive 
salaries  sufficient  for  them  to  live  upon. 

Surely  this  statement  of  the  difference  between  the  educa- 
tion given  twenty-five  years  ago,  which  required  but  little 
expenditure  of  money  and  resulted  in  considerable  incomes, 
and  the  modern  methods  of  education  hi  the  laboratory  and 
the  hospital,  as  well  as  the  lecture-room,  which  require 
enormous  expenses,  is  an  ample  reason  for  large  endowments. 

But  the  function  of  the  medical  school,  as  I  have  said,  should 
not  be  limited  merely  to  the  imparting  of  existing  knowledge. 
No  school  is  worthy  of  the  name  that  does  not  provide  for 
greater  or  less  research  work  by  which  substantial  additions 
to  our  knowledge  may  be  made  and  the  facilities  and  the 
results  of  the  healing  art  made  more  efficient  for  the  welfare  of 
mankind.  Twenty-five  years  ago  there  were  practically  few 
young  men  who  were  fitted  for  research  work,  especially 
laboratory  work.  Now  every  well-equipped  school  has  at- 
tached to  it  hi  one  way  or  another  a  score  or  more  of  young 
men  who  are  eager  for  work,  longing  for  the  opportunity  for 
usefulness  and  distinction  if  they  can  only  obtain  a  bare  living. 

*  Monographs  on  Education  in  the  United  States,  No.  10,  Professional 
Education,  James  Russell  Parsons,  Jr.,  Department  of  Education  for  the 
United  States  Commission  to  the  Paris  Exposition  of  1900,  p.  11. 


THE   ENDOWMENT   OF  MEDICAL   COLLEGES.  303 

When  in  my  own  school  I  look  around  me  and  see  these  young 
men  thirsting  for  opportunities  for  usefulness  and  distinction, 
I  am  often  heartsick  at  our  want  of  facilities  for  this  purpose, 
and  I  long  with  an  intense  longing  for  some  wise  and  munifi- 
cent friend  of  humanity  who  will  endow  postgraduate  scholar- 
ships, and  laboratories  for  just  such  an  end.  Our  hospitals 
do  a  magnificent  work  in  charity,  helping  the  sick  and  the 
forlorn,  the  weak  and  the  suffering  in  a  way  which  appeals  to 
the  charitable  instincts  of  our  fellow-countrymen,  and  to  this 
appeal  they  have  responded  most  generously.  But  I  venture 
to  say  that  the  medical  school  which  trained  a  Lister,  a  Pasteur, 
a  Koch,  has  done  more  for  humanity  than  all  the  hospitals  of 
this  country  combined.  The  modest  laboratory  at  Wiirzburg 
consisted  chiefly  of  a  Ruhmkorff  coil  and  a  Crookes'  tube — 
and  Roentgen.  Other  Roentgens  and  Listers  we  have  among 
us  if  we  but  knew  it.  These  are  the  men  who  are  the  world's 
real  illustrious  heroes. 

It  is  especially  in  these  clays  that  in  America  we  need  such 
researches,  for  our  tropical  possessions  have  brought  us  face 
to  face  with  new  problems  which  we  can  only  justly  meet  by 
the  most  careful  investigations.  It  is  to  our  credit  that 
several  of  our  medical  colleges  have  already  established  schools 
of  tropical  medicine,  which  show  that  the  profession,  as  well 
as  the  public,  are  rising  to  the  level  of  our  responsibilities  and 
duties. 

It  is  also  a  cheerful  sign  of  the  times  that  at  Harvard  a 
School  of  Comparative  Medicine  has  been  established,  which 
will  lead  to  other  similar  schools  in  connection  with  our 
medical  colleges  for  the  broad  study  of  disease  both  in  man 
and  in  the  lower  animals.  All  such  knowledge  should.be  corre- 
lated, and  we  may  well  learn  from  the  diseases  of  animals  how 
to  care  for  man,  as  thus  far  we  have  learned  chiefly  from  the 
diseases  of  man  how  to  care  for  animals.  The  endowment  of 
this  school  with  the  modest  sum  of  $100,000  is  an  omen  of 
future  good.  So,  too,  the  somewhat  similar  school  at  Buffalo 


ADDRESSES   AND   OTHER   PAPERS. 

bids  fair  to  add  immensely  to  our  knowledge  and  therefore  to 
our  ability  to  heal. 

What  now  has  the  American  public  done  for  the  medical 
school?  Let  us  contrast  it  with  the  endowments  in  theology. 
Our  academic  institutions  have  such  an  enormous  sum-total 
of  endowments  that  I  do  not  even  consider  these.  Let  us, 
however,  compare  theology  and  medicine,  remembering  that 
theology  is  almost  wholly  a  literary  study,  dealing  not  with 
the  facts  of  nature,  requiring  no  laboratories  and  no  large 
corps  of  assistants  and  therefore  conducted  at  a  minimum  of 
cost.  In  1898  (United  States  Education  Report)  84  theolog- 
ical schools  reported  endowments  of  $18,000,000;  71  schools 
do  not  report  this  item :  19  out  of  151  medical  schools  report 
endowments  of  $1,906,072.  Five  theological  schools  have 
endowments  of  from  $850,000  to  $1,369,000  each.  Yet  in 
1899  there  were  only  8000  students  of  theology  for  whom  this 
enormous  endowment  was  provided  as  against  24,000  students 
of  medicine.  Each  theological  student  had  the  income  of  an 
endowment  of  $2250  provided  for  his  aid ;  each  medical  student 
the  income  from  $83.  As  against  171  endowed  chairs  of 
theology  there  were  only  5  in  medicine. 

I  do  not  grudge  a  dollar  to  the  theologian,  but  I  plead 
for  his  medical  brother  that,  with  a  vastly  more  expensive 
education,  he  shall  have  a  reasonable  provision  made  for  his 
training. 

I  have  already  indicated  to  some  extent  the  direction  which 
these  endowments  of  medical  schools  should  take.  They  may 
be  classed  in  three  categories : 

First,  the  endowment  of  professorships.  By  doing  this 
the  present  salary  of  the  professor  would  be  made  available 
for  the  other  wants  of  the  school.  The  endowment  may  well 
take  the  form  of  a  memorial,  either  of  the  generous  donor,  or, 
still  better,  of  some  distinguished  former  occupant  of  such  a 
chair  whose  name  would  always  add  luster  to  it. 

Secondly.    The  endo\vment  of  the  laboratories  which,  as  I 


THE   ENDOWMENT  OF  MEDICAL   COLLEGES.  305 

have  indicated,  are  so  costly,  both  in  their  installation  and  in 
their  yearly  expenses. 

Thirdly.  The  endowment  of  post-graduate  scholarships  and 
research  fellowships,  these  being  intended  especially  for  those 
who  will  devote  their  time  to  original  research.  Students 
cannot  take  much  time  for  original  research;  their  regular 
studies  absorb  all  their  energies.  Research  must  be  done 
chiefly  by  young  graduates  under  the  direction  of  stimulating 
and  energetic  members  of  the  faculty. 

It  is  not,  I  trust,  too  much  to  hope,  if  not  now,  that  in  the 
near  future  the  American  Medical  Association  will  set  a 
fruitful  example  by  giving  each  year  "Scientific  Grants  in 
Aid  of  Research."  The  first  object  of  the  Association  must 
be,  necessarily,  to  place  itself  on  a  strong  financial  basis.  It 
should  own  its  own  building,  its  printing  and  publishing  plant, 
and,  as  soon  as  possible,  should  have  a  reserve  fund  of  con- 
siderable proportions.  Nothing  conduces  to  the  stability 
and  conservativeness  of  any  institution  like  a  good  bank 
balance.  The  British  Medical  Association  has  to-day  an 
excess  of  assets  over  liabilities  of  nearly  $380,000,  chiefly 
invested  in  its  building  at  429  Strand,  London.  The  Ameri- 
can Medical  Association  has  made  a  fair  start  with  a  surplus  of 
over  $27,000  last  January,  and,  with  its  large  and,  let  us  hope, 
rapidly  increasing  membership,  it  will  before  long  assume  a 
rank  second  only  to  the  British  Medical  Association.  Last 
year*  the  Scientific  Grants  Committee  allotted  £741,  or 
somewhat  more  than  $3500,  for  research  work,  distributed  to 
three  research  scholarships,  the  holders  of  which  were  paid 
$750  each  a  year,  and  33  grants  in  aid  of  research  work, 
varying  in  amounts  from  $25  to  $100.  Among  those  to  whom 
grants  were  made  occur  the  well-known  names  of  Beevor, 
Vaughan  Harley,  Kanthack,  Leuff,  Manson,  Noel  Payton,  and 
Risien  Russell.  I  should  hope  that  the  American  Medical 
Association  might  even  now  begin  by  a  modest  appropriation, 

*  British  Medical  Journal,  1899,  ii,  p.  219. 
20 


306  ADDRESSES    AXD    OTHER   PAPERS. 

say  of  $500  a  year,  which  should  be  allotted  by  the  trustees, 
or  by  a  special  Committee  on  Scientific  Grants,  after  a  careful 
investigation  of  the  merits  and  the  character  of  the  person  to 
whom  such  grants  were  made.  No  grant  should  exceed  $100, 
or  possibly  even,  at  first,  $50  in  amount.  The  results  of  such 
grants  would  be  not  only  absolute  additions  to  our  knowledge, 
but  the  cultivation  of  a  scientific  spirit  which  would  permeate 
the  whole  profession  and  elevate  its  objects  and  aims.* 

In  pleading  for  these  endowments  of  medical  schools,  it  is 
but  a  plea  for  a  return  to  the  profession  of  a  tithe  of  what  they 
have  given.  Two  years  ago  I  carefully  investigated  the  value 
of  the  services  rendered  to  the  poor  in  the  city  of  Philadelphia 
by  the  medical  staff  of  the  Jefferson  Medical  College  Hospital 
alone,  and  I  found  that  129  medical  men  were  then  attached 
to  the  hospital  and  their  services,  calculated  on  a  very  moder- 
ate basis  of  the  ordinary  fees,  I  valued  at  over  $500,000.  To 
a  profession  which  gives  so  freely  of  that  which  is  most 
difficult  to  give,  its  own  life-blood,  surely  the  public  for  its 
own  protection  may  give  reasonable  endowments  to  the 
medical  schools.  It  will  be  returned  to  the  community 
tenfold  in  better  educated,  better  trained,  and  more  successful 
doctors.  More  devoted,  self-sacrificing  men  and  women  they 
never  can  have. 

*  I  am  glad  to  say  that  the  Association  has  made  such  Annual  Grants 
ever  since  this  address,  and  they  are  already  bearing  good  fruit. — (W.  W. 
K.,  1905.) 


THE  IDEAL  PHYSICIAN.* 


WHEN  casting  about  for  a  suitable  topic  on  which  to 
address  you,  I  was  much  perplexed  at  first,  but 
finally  bethought  me  that  perhaps  I  could  not  do  you  a  better 
sevice  than  to  sketch  in  very  brief  outlines  the  characteristics 
of  the  ideal  physician.  Let  me  address  you,  therefore,  as 
aspirants  for  the  realization  of  this  ideal. 

Few  of  us,  perhaps,  at  the  close  of  life,  can  say  that  we  have 
realized  our  ideals.  But  unless  we  have  a  high  ideal,  the 
trajectory  of  our  life  will  never  have  risen  to  any  noble  height. 
"Hitch  your  wagon  to  a  star,"  said  Ralph  Waldo  Emerson. 
Even  though  you  fail  you  will  more  nearly  reach  the  firmament 
than  if  you  had  never  made  the  attempt. 

The  physician  may  be  regarded  from  three  points  of  view: 
(1)  His  personal  life;  (2)  his  professional  life;  and  (3)  his  public 
life. 

Personal  Life. — The  ultimate  basis  of  esteem  is  personal 
character.  Wealth  for  a  time  may  lend  its  glamour;  in- 
tellectual attainments  for  a  time  may  dazzle  the  judgment; 
power  for  a  time  may  achieve  apparent  success,  but  when  the 
testing  time  comes,  as  come  it  must  to  every  man  when  some 
great  temptation  to  do  wrong  confronts  him,  wealth  and  in- 
tellectual power  are  as  if  they  were  not;  character  is  the  one 
thing  that  tells  in  this  Me  and  death  struggle.  Having  that, 
you  will  win  the  fight  and  be  crowned  with  the  laurel  of 

*  The  Commencement  Address  delivered  to  the  students  of  Rush 
Medical  College  in  Affiliation  with  the  University  of  Chicago,  June  21, 
1900.  Reprinted  from  the  Journal  of  the  American  Medical  Associa- 
tion, June  23,  1900. 

307 


308  ADDRESSES   AND   OTHER   PAPERS. 

victory.  Wanting  that,  you  will  succumb,  defeated  and  dis- 
honored. The  struggle  may  be  a  public  temptation  known  of 
all  men,  and  if  you  fall  your  fall  will  be  like  that  of  Lucifer; 
or  it  may  be  hidden  in  your  own  breast,  known  only  to  God 
and  yourself;  but  if  you  win,  the  victory,  measured  by  the  eyes 
of  Omnipotence,  is  just  as  great,  for  a  character  has  been 
saved  and  strengthened,  a  true  man  has  attained  his  growth. 

It  is  due,  I  am  glad  to  say,  to  this  prevalence  of  high 
character  that  our  profession  has  won  such  a  lofty  place  in  the 
esteem  of  the  community.  Its  purity  is  almost  never  im- 
peached. Remember  that  every  time  you  are  alone  with  a 
woman-patient  in  your  consulting  room,  with  every  eye 
barred  out,  she  gives  her  honor  into  your  hands  and  hi  turn 
you  place  your  reputation  unreservedly  in  hers.  A  whisper 
will  destroy  either  or  both  of  you.  In  my  opinion,  it  is  the 
highest  tribute  that  can  be  paid  to  the  character  of  our  pro- 
fession and  equally  to  the  credit  of  our  patients  that  this 
mutual  confidence  is  so  seldom  abused  and  the  tongue  of 
scandal  is  so  seldom  busied  with  noxious  tales.  When  you 
remember  that  there  are  over  one  hundred  thousand  physi- 
cians in  this  country,  with  daily  possibilities  of  wrong-doing, 
is  it  not  marvellous  that  this  sacred  trust  is  so  jealously  con- 
served? 

Greatness  of  character  finds  its  best  expression  in  kindness. 
To  no  one  are  so  many  opportunities  for  this  fine  trait  given 
as  to  the  physician.  In  the  heyday  of  health  and  happiness 
he  is  not  needed,  but  when  sickness  and  weariness  and  woe 
come,  when  the  bread-winner  may  be  taken,  or  the  loved 
mother's  gentle  life  may  be  in  peril,  or  a  sweet  little  child  hi 
whom  is  centered  all  the  tenderness  of  unbounded  love  is  lying 
ill,  and  death  seems  to  dog  the  doctor's  footsteps,  then  the 
trusted  physician,  wise  of  head  and  kind  of  heart,  is  indeed 
a  welcome  visitor.  Then  can  his  gentle  touch  give  assurance ; 
then  can  his  sympathetic  voice  bring  hope ;  then  can  the  thou- 
sand and  one  acts  of  thoughtful  kindness  bind  to  him  for  life 


THE    IDEAL   PHYSICIAN.  309 

the  anxious  hearts  looking  to  him  as  the  messenger  of  life. 
Even  in  the  daily  routine  of  a  hospital  clinic,  a  kind  word  is 
often  better  than  any  medicine. 

Manners  make  the  man.  The  boor  has  no  place  among  us. 
The  physician  should  never  be  the  fop,  but  always  the  gentle- 
man; never  unclean  of  clothes  or  speech,  but  always  neatly 
dressed  and  so  careful  of  his  words  that  he  need  not  ask,  as  did 
one  of  General  Grant's  aids,  when  about  to  tell  a  questionable 
story:  "There  are  no  ladies  present,  are  there?"  "No,"  was 
Grant's  stinging  reply,  "but  there  are  several  gentlemen." 
Soiled  linen  and  unclean  finger-nails  are  as  much  condemned 
by  antisepsis  as  they  are  by  decency.  The  flavor  of  stale 
tobacco  smoke  about  his  beard  and  clothes  will  never  char- 
acterize the  ideal  physician,  nor  will  indulgence  in  alcohol  ever 
cloud  his  judgment  or  disgust  his  patients. 

Make  it  a  point  not  to  let  your  intellectual  life  atrophy 
through  non-use.  Be  familiar  with  the  classics  of  English 
literature  in  prose  and  verse;  read  the  lives  of  the  great 
men  of  the  past,  and  keep  pace  with  modern  thought  in 
books  of  travel,  history,  fiction,  science.  A  varied  intellectual 
life  will  give  zest  to  your  medical  studies  and  enable  you  to 
enter  not  unequipped  into  such  social  intercourse  as  will  beget 
you  friends  and  will  relieve  the  monotony  of  a  purely  medical 
diet.  Let  music  and  art  shed  their  radiance  upon  your  too 
often  weary  life  and  find  in  the  sweet  cadences  of  sound  or  the 
rich  emotions  from  form  and  color  a  refinement  which  adds 
polish  to  the  scientific  man. 

I  suspect  the  next  characteristic  of  the  ideal  physician  will 
meet  with  a  ready  assent, — marry  as  soon  as  you  can  support 
a  wife  and  the  hostages  to  fortune  who  will  make  your  home 
life  happy  beyond  compare.  But  choose  wisely  and  not  too 
hastily.  A  bachelor  doctor  is  an  anomaly.  He  cannot  fully 
comprehend  the  hopes  and  fears  and  desires  of  parents.  He 
knows  not  the  lions  in  the  path  of  childhood.  Imagine,  if  you 
can,  some  sweet  lassie  confiding  to  him  the  symptoms  of  a 


310  ADDRESSES   AND  OTHER  PAPERS. 

heart  disease  which  digitalis  cannot  cure.  The  ideal  physician 
is  a  good  husband  and  a  good  father,  and  so  will  he  enter  into 
the  lives  and  hearts  of  parents  and  children,  not  as  a  stranger, 
but  as  one  who  can  partake  of  all  their  emotions,  because  he 
has  felt  the  same  joys,  partaken  of  the  same  sorrows,  loved  as 
they  have  loved,  and,  it  may  be,  drunk  to  the  dregs  the  same 
cup  of  loss. 

But  the  ideal  doctor  lives  also  a  spiritual  life.  You  gentle- 
men will  have  to  deal  with  the  entrance  and  the  exit  of  life. 
You  must  often  ask  yourself  what  and  whence  is  this  new  ego 
that  is  born  into  the  world;  whither  goes  the  spirit  when  it 
quits  this  tabernacle  of  flesh  which  is  left  to  moulder  and  decay. 
The  tremendous  problems  of  life  and  death  are  daily  put  be- 
fore you  for  solution.  You  cannot  avoid  them  if  you  would; 
they  are  forced  upon  you  by  your  daily  occupation. 

As  man  to  man,  may  I  not  ask  you  to  give  them  that  con- 
sideration which  befits  the  highest  problem  that  can  be  pre- 
sented to  any  human  being.  That  this  life,  with  its  hopes  and 
its  joys,  its  diseases  and  its  disasters  is  all,  is  denied  alike  by 
common  sense,  by  reason,  and  by  revelation.  He  is  the  best 
physician  who  takes  account  of  the  life  hereafter  as  well  as 
the  life  that  now  is,  and  who  not  only  heals  the  body,  but  helps 
the  soul.  Let  your  lives,  therefore,  be  thoroughly  religious, 
religious  in  your  inmost  soul,  though  often  you  may  be  denied 
its  customary  outward  observances.  Then  shall  character, 
which  was  my  first  postulate  for  our  ideal  physician,  find  ex- 
pression in  an  ideal  altruistic  life. 

Professional  Life. — The  ideal  physician  is  a  member  of  a 
learned  guild.  He  should  be  above  the  tricks  and  petty 
jealousies  of  trade.  True,  he  lives  by  his  profession,  but  he  who 
practices  for  gain  is  only  a  hireling  and  not  a  true  shepherd 
of  the  sheep.  If  you  would  attain,  therefore,  to  this  profes- 
sional ideal,  you  must  be  a  constant  student,  keeping  abreast 
of  that  scientific  progress  of  which  hi  your  community  you 
must  be  the  exponent.  You  must  not  be  satisfied  with  the 


THE   IDEAL  PHYSICIAN.  311 

knowledge  which  you  now  possess;  you  must  read,  especially 
the  medical  journals,  or  you  will  be  left  behind  in  this  day  of 
rapid  progress.  You  must  know  not  only  your  own  language, 
but  must  be  familiar,  at  least  by  a  reading  knowledge,  with 
French  and  German,  and  if  possible  with  other  tongues.  He 
who  knows  two  languages  is  twice  the  man  he  was  when  he 
knew  but  one. 

You  must  not  only  be  skillful,  but  careful.  I  have  made 
not  a  few  mistakes  in  my  own  professional  life,  and  in  re- 
viewing them  I  can  see  that  for  every  one  made  by  reason 
of  lack  of  knowledge  and  skill,  two  at  least  have  been  com- 
mitted by  haste  or  want  of  care.  With  all  our  varied  in- 
struments of  precision,  useful  as  they  are,  nothing  can  replace 
the  watchful  eye,  the  alert  ear,  the  tactful  finger,  and  the 
logical  mind  which  correlates  the  facts  obtained  through  all 
these  avenues  of  information  and  so  reaches  an  exact  diag- 
nosis, institutes  a  correct  treatment,  and  is  rewarded  by  a 
happy  result. 

Be  careful  in  your  relations  to  your  patients  to  deal  with 
them  conscientiously.  In  no  other  calling  is  the  amount  of 
service  to  be  paid  for  committed  absolutely  to  the  judgment 
and  conscience  of  the  person  who  is  to  be  paid  for  his  services. 
Whether  you  shall  make  few  or  many  visits  is  left  to  your 
discretion  and  honest  judgment.  Sordid  motives  may  oc- 
casionally lead  to  the  giving  of  unnecessary  attention.  But 
again  it  is  a  glory  of  our  guild  that  very  few  physicians  be- 
tray this  trust,  and  those  who  do  quickly  lose  their  professional 
standing.  Watch  yourselves  jealously  in  this  respect,  and 
never  let  the  greed  of  gain  dull  the  fine  edge  of  professional 
honesty. 

You  will  be  the  father  confessor  to  many  a  penitent. 
Family  skeletons  will  be  unveiled  to  you  alone.  The  con- 
scientious duty  of  professional  secrecy  is  given,  I  am  proud  to 
say,  into  not  unworthy  hands.  True,  physicians  are  some- 
times too  lax  in  the  repetition  of  petty  gossip,  but  the  pro- 


312  ADDRESSES   AXD   OTHER   PAPERS. 

fession  as  a  whole  is  worthy  of  the  confidences  so  freely  given. 
Be  careful,  even  to  reticence,  of  any  betrayal  of  this  trust. 
Better  suffer  misconception  and  unmerited  blame  yourselves 
than  betray  your  patients. 

Be  brave  men.  Your  fathers  were  brave  men.  When 
pestilence  stalks  in  the  streets  and  contagion  lurks  in  every 
chamber  of  illness,  where  have  the  doctors  been  found? 
Fleeing  from  danger  with  the  frighted  multitude?  Nay,  verily. 
If  you  wish  to  find  them  you  must  seek  in  the  crowded  tene- 
ments, in  the  hospitals,  and  in  the  charnel-houses.  There  you 
will  find  them  cheerfully  tending  the  sick,  facing  disease  in  the 
midst  of  its  victims,  and  seeking,  even  in  the  bodies  of  the  dead, 
the  knowledge  that  will  make  them  masters  of  the  plague. 
Witness  Rush  in  the  yellow  fever  of  1797,  Gross  in  the 
cholera  of  1832,  and  Haffkine  in  the  bubonic  plague  of  the 
present  time.  War  has  given  us  many  fine  examples  of  per- 
sonal bravery,  but  pestilence  has  bred  its  quiet  heroes  who 
have  gone  about  their  daily  duty,  simply,  fearlessly,  de- 
votedly. No  granite  shaft,  no  enduring  brass  may  mark  their 
last  resting-place,  but  the  Recording  Angel  has  dropped  a  tear, 
blotting  out  their  faults,  and  writ  their  names  high  in  the  roll 
of  fame. 

In  your  professional  relations,  never  forget  to  be  charitable. 
The  best  patients  you  will  ever  have  will  be  the  thankful  poor, 
and  your  hearts  will  often  find  a  sincere  and  grateful  glance 
better  payment  than  any  gold.  In  your  relations  with  other 
physicians,  you  will  find  many  opportunities  for  that  same 
brotherly  kindness  which  is  so  beautiful  a  characteristic  of  our 
guild.  Always  extend  to  other  physicians  and  their  im- 
mediate families  the  courtesy  of  faithful  attendance  without 
pecuniary  return.  Avoid  the  petty  jealousies,  which,  I  am 
sorry  to  say,  not  seldom  estrange  physicians  from  each  other. 
Always  believe  the  best  motive  unless  you  know  the  worst  is 
present.  Never  say  an  unkind  word  of  a  brother-doctor 


THE   IDEAL   PHYSICIAN.  313 

when  you  can  utter  a  kindly  one.  Try  to  be  just,  even  to  those 
who  are  unjust  to  you. 

Public  Life. — In  most  communities,  especially  in  minor 
towns  and  villages,  the  doctor  is  one  of  a  small  circle  of 
educated  men.  His  scientific  studies  make  him  familiar  with 
many  public  problems,  especially  those  concerning  sanitation, 
the  water-supply,  the  prevention-  of  epidemics,  the  preserva- 
tion of  the  public  health,  the  problems  of  school  life,  the  foster- 
ing of  a  proper  athletic  indulgence,  the  management  of  prisons, 
the  care  of  the  feeble-minded,  the  insane,  the  poor.  On  all  of 
these  questions  you  must  make  your  voices  heard  in  the  com- 
munities in  which  you  live  or  else  you  give  them  over  to  others 
less  qualified  and  only  mischief  can  follow. 

No  one,  perhaps,  is  more  of  a  leader  than  the  physician  in  the 
various  philanthropic  enterprises  of  the  day.  These  are  closely 
allied  in  many  respects  to  the  topics  just  mentioned,  and  you 
will  be  on  boards  of  directors  and  managers  and  trustees  where 
you  must  bring  your  influence  to  bear  for  a  wise  outlay  of 
charitable  gifts  and  civic  appropriations  and  for  harmonizing 
the  antagonistic  elements  which  too  often  produce  discord 
and  confusion.  If  you  combine  the  qualities  which  I  have 
sketched  for  the  ideal  doctor,  you  will  find  that  men  will  easily 
recognize  you  as  wise  leaders  whom  they  will  be  glad  to  follow. 

My  best  wish  for  you  is  that  you  may  realize  in  your  own 
lives  these  characteristics  of  the  ideal  physician.  It  will 
matter  little  then  whether  your  life  be  long  or  short,  for  the 
proper  measure  of  a  life  is  not  how  long,  but  how  it  has  been 
lived,  and  if  you  attain  to  old  age,  when  the  hairs  whiten  and 
the  crow's  feet  begin  to  show,  when  your  natural  forces  are 
abated,  you  will  then  not  be  alone  in  the  world,  but  will  have 
honor,  love,  obedience,  troops  of  friends,  and  one  Friend  above 
all  others,  the  Great  Physician.  And  when  you  pass  from  this 
life  into  the  next,  then  shall  you  be  greeted  not  only  by  this 
one  great  Friend,  but  by  many  from  whose  pathway  you  have 
plucked  the  thorns  and  briars  of  this  earthly  life;  many 


314  ADDRESSES   AND  OTHER  PAPERS. 

whom,  through  the  devious  paths  of  convalescence,  you  have 
led  back  to  perfect  health,  to  home,  husband,  father,  mother, 
children;  and  even  if  you  have  not  been  able  to  stay  the 
hands  of  the  grim  reaper,  those  too  will  greet  you  whose  last 
hours  you  have  soothed  amid  the  pangs  of  death  and  have 
helped  through  the  new  birth  into  the  heavenly  Jerusalem. 


ADDRESS  AT  THE 

ROYAL  COLLEGE  OF  SURGEONS  OF  ENGLAND 
AT  THE    CONFERRING  OF   HONORARY  DE- 
GREES AT  THE  CENTENARY  CELEBRATION 
OF  THE  GRANTING  OF  ITS  PRESENT 
CHARTER.* 


ON  behalf  of  my  American  colleagues  and  myself  it  gives 
me  great  pleasure  to  return  our  very  hearty  thanks  for 
the  honor  just  conferred  upon  us.    We  regard  it  as  the  highest 
surgical  honor  we  could  receive,  for  "  Praise  from  Sir  Hubert  is 
praise  indeed." 

Though  the  Royal  College  of  Surgeons  of  England  has  at- 
tained a  venerable  age,  it  is  far  from  decrepitude.  No  better 
evidence  of  this  can  be  found  than  the  many  Members  and 
Fellows  who  at  the  call  of  duty  so  cheerfully  went  to  the  front 
in  South  Africa.  Foremost  among  them  was  your  distin- 
guished President,  who,  though  he  has  reached  an  age  when 
most  men  seek  repose  and  slippered  ease,  responded  to  his 
country's  call  with  his  customary  energy  and  alacrity. 
Happily  the  war  is  now  nearing  its  end.  Apart  from  any 
political  results  in  South  Africa,  it  has  had  two  results  in  which 
we  may  well  rejoice.  It  has  bound  together  Great  Britain 
and  her  colonies  in  one  solid  empire;  and  through  the  wise 
statesmanship  of  the  Most  Noble  the  Marquis  of  Salisbury  and 
His  Excellency  the  American  Ambassador  has  joined  Great 
Britain  and  America  in  a  firm  moral  union  in  which  Her 
Majesty,  if  not  monarch  of  our  persons,  is  surely  Queen  of  our 
Hearts. 

*  Reprinted  from  the  British  Medical  Journal,  August  4,  1900. 

315 


316  ADDRESSES   AND   OTHER   PAPERS. 

We  come  to  you  as  representatives  of  four  of  our  great  in- 
stitutions of  learning — from  Harvard,  hoary  with  the  snows 
of  nearly  three  centuries,  to  Johns  Hopkins,  in  the  lusty  youth 
of  less  than  three  decades.  As  President  of  the  College  of 
Physicians  of  Philadelphia  I  represent  also  the  oldest  institu- 
tion in  America  at  all  similar  to  your  own,  a  Corporation  which 
includes  surgeons  as  well  as  physicians,  and  which  was  already 
in  its  teens  when  the  Royal  College  of  Surgeons  received  its 
present  charter.*  On  behalf  of  these  and  of  all  our  medical 
institutions  we  bring  you  our  heartiest  greetings  on  this  festal 
occasion,  in  the  name  of  sound  learning  and  accurate  scholar- 
ship. 

It  has  been  my  pleasure  in  Philadelphia  to  welcome  many 
of  your  Fellows,  including  three  of  your  most  distinguished 
Presidents.  Some  of  you  have  even  swept  across  the  con- 
tinent in  luxurious  palace  cars  in  but  little  over  one  hundred 
hours.  To  show  how  swift  has  been  our  progress  and  jret  how 
young  we  are,  I  need  but  recall  the  fact  that  this  College  was 
nearly  forty  years  old  before  the  name  of  Chicago — now  a  city 
of  nearly  2,000,000  people — even  appeared  upon  the  map, 
and,  when  you  were  founded,  beyond  the  fringe  of  civilization 
on  the  Atlantic  coast  practically  the  only  inhabitants  of  the 
vast  region  from  the  Alleghanies  to  the  Golden  Gate  were 
the  buffalo,  the  bear,  and  the  savage  Indian. 

But  though  so  young  we  come  not  empty-handed.    Three 

*  The  Royal  College  of  Surgeons  of  England  was  founded  originally  in 
1540  La  the  reign  of  Henry  VIII.  By  a  misfortune  they  lost  their  charter 
in  1796.  A  new  one  was  granted  to  them  in  1800  by  George  III.  In  1900, 
to  celebrate  the  centenary  of  the  granting  of  this  new  charter,  they  conferred 
their  Honorary  Fellowship  upon  the  Prince  of  Wales  (now  King  Edward 
VII),  Lord  Salisbury,  Lord  Rosebery  (the  leaders  of  the  Conservatives 
and  the  Liberals),  and  thirty-two  surgeons  from  various  countries  in 
Europe  and  America.  My  address  was  the  response  on  behalf  of  the 
American  surgeons  upon  whom  the  degree  was  conferred;  namely, — J. 
Collins  Warren,  of  Harvard;  Robert  F.  Weir,  of  Columbia;  William  S. 
Halsted,  of  Johns  Hopkins;  and  W.  W.  Keen,  of  the  Jefferson  Medical 
College.  [W.  W.  K,  1905.] 


ADDRESS  AT  THE  ROYAL  COLLEGE  OF  SURGEONS.       317 

great  medical  advances  mark  the  past  one  hundred  years — 
vaccination,  anaesthesia,  and  antisepsis.  The  first  and  third 
of  these  are  yours,  but  the  second — anesthesia — better  than 
Magian  gold  and  frankincense  and  myrrh,  is  the  gift  which 
to-day  America  lays  on  the  altar  of  science. 

Before  that  historic  date,  October  16, 1846,  the  poor  victims 
of  the  knife  were  bound  hand  and  foot  and  held  in  the  grasp 
of  sturdy  men;  but  hand  and  cord  could  not  repress  the  fear- 
ful outcries  which  filled  the  air.  But  at  Warren's  touch  the 
thongs  fell  off;  he  spoke,  and  the  stormy  billows  of  this 
Gennesaret  of  pain  were  stilled ;  the  peaceful,  blessed  sleep  of 
ether  hushed  every  cry  of  pain.  Then  first  was  modern 
surgery  made  possible,  and  what  was  made  possible  by  our 
Warren  was  made  safe  and  successful  by  your  Lister — no, 
not  your  Lister,  but  our  Lister,  for  his  name  belongs  to  no  age 
and  no  country,  but  to  humanity. 

It  is,  therefore,  with  a  special  fitness  that  to-day  you  have 
conferred  your  Honorary  Fellowship  upon  the  distinguished 
grandson  of  him  who  first  demonstrated  the  blessings  of  ether 
to  a  suffering  world.  At  the  very  time  when  this  College  was 
founded  Warren  was  a  student  of  Guy's  Hospital  and  his 
certificate  of  attendance,  signed  by  Mr.  Cline  and  Sir  Astley 
Cooper,  is  in  the  possession  of  his  grandson. 

Again,  Mr.  President,  I  beg  you  to  accept  our  sincere  thanks 
for  the  distinguished  honor  you  have  conferred  upon  us. 


THE   PROGRESS   OF  SURGERY   IN  THE 
NINETEENTH  CENTURY  * 


THE  end  of  the  eighteenth  century  was  made  notable  by 
one  of  the  most  remarkable  and  beneficent  discoveries 
which  has  ever  blessed  the  human  race, — the  discovery  of  the 
means  of  preventing  small-pox.  On  May  14, 1796,  Dr.  Edward 
Jenner  inoculated  James  Phipps.  When  we  remember  that 
2,000,000  persons  died  in  a  single  year  in  the  Russian  Empire 
from  small-pox;  that  in  1707  in  Iceland,  out  of  a  population 
of  30,000,  sixty  per  cent.,  or  18,000,  died;  that  in  Jenner's 
time  "  an  adult  person  who  had  not  had  small-pox  was  scarcely 
met  with  or  heard  of  in  the  United  Kingdom,  and  that  owing 
to  his  discovery  small-pox  is  now  one  of  the  rarest  diseases," 
the  strong  words  I  have  used  seem  fully  justified.  But  the 
eighteenth  century  was  not  to  witness  the  end  of  progress  in 
medicine.  The  advances  in  the  nineteenth  century  have  been 
even  more  startling  and  more  beneficent.  What  these  ad- 
vances have  been  in  the  department  of  medicine  has  been 
related  by  Professor  Osier.  It  is  my  province  to  speak  only 
of  surgery. 

I.  METHOD  OF  TEACHING. 

The  first  advance  which  should  be  mentioned  is  a  funda- 
mental one, — namely,  methods  of  medical  teaching.  At  the 

*  Early  in  1901  the  New  York  Sun  published  a  series  of  articles  on 
the  advances  made  during  the  nineteenth  century  in  various  departments 
of  knowledge.  The  papers  were  republished  by  Harper  &  Brothers  in 
a  volume  entitled  The  Progress  of  the  Century.  I  am  permitted  to  repro- 
duce my  own  contribution  to  this  series  by  the  kind  permission  of  Paul 
Dana,  Esq.,  the  editor  of  the  Sun,  and  of  Messrs.  Harper  &  Brothers. 

318 


PROGRESS   OF  SURGERY  IN   NINETEENTH   CENTURY.      319 

beginning  of  this  century  there  were  only  three  medical  schools 
in  the  United  States:  the  medical  department  of  the  University 
of  Pennsylvania,  established  in  1765;  the  medical  department 
of  Harvard,  established  in  1783;  and  the  medical  department 
of  Dartmouth,  established  in  1797.  The  last  report  of  the 
Commissioner  of  Education  gives  a  list  of  155  medical  schools 
now  in  existence  in  this  country,  many  of  them  still  poorly 
equipped  and  struggling  for  existence,  but  a  large  number  of 
them  standing  in  the  first  rank,  with  excellent  modern  equip- 
ment, both  in  teachers,  laboratories,  hospitals,  and  other 
facilities.  The  medical  curriculum  then  extended  over  only 
two  years  or  less  and  consisted  of  courses  of  lectures  at  the 
most  by  seven  professors,  who,  year  after  year,  read  the  same 
course  of  lectures  without  illustrations  and  with  no  practical 
teaching. 

The  medical  schools,  even  when  connected  with  univer- 
sities, were  practically  private  corporations,  the  members 
of  which  took  all  the  fees,  spent  what  money  they  were  com- 
pelled to  spend  in  the  maintenance  of  what  we  now  should  call 
the  semblance  of  an  education,  and  divided  the  profits.  Until 
within  about  twenty  years  this  method  prevailed  in  all  our 
medical  schools.  But  the  last  two  decades  of  the  century 
have  seen  a  remarkable  awakening  of  the  medical  profession  to 
the  need  of  a  broader  and  more  liberal  education,  and  that,  as 
a  pre-requisite,  the  medical  schools  should  be  on  the  same  basis 
as  the  department  of  arts  in  every  well-regulated  college.  To 
accomplish  this  the  boards  of  trustees  have  taken  possession 
of  the  fees  of  students,  have  placed  the  faculties  upon  salaries, 
and  have  used  such  portion  of  the  incomes  of  the  institutions 
as  was  needed  for  a  constant  and  yet  rapid  development  along 
the  most  liberal  lines. 

II.  COLLEGE  HOSPITALS. 

The  first  step  has  been  the  establishment,  in  connection  with 
most  schools,  of  general  hospitals  in  which  the  various  teachers 


320  ADDRESSES   AND   OTHER  PAPERS. 

in  the  college  should  be  the  clinical  instructors  and  where  the 
students  would  have  the  means  not  only  of  hearing  theoreti- 
cally what  should  be  done  to  the  sick,  but  of  actually  examin- 
ing the  patients  under  the  supervision  of  their  instructors, 
studying  the  cases  so  as  to  become  skilled  in  reaching  a 
diagnosis  and  indicating  what  in  their  opinion  was  necessary 
in  the  way  either  of  hygiene,  medicine,  or  surgical  operation. 
More  than  that,  in  most  of  the  advanced  schools  to-day  the 
students  assist  the  clinical  faculties  of  the  hospitals  in  the 
actual  performance  of  operations,  so  that  when  they  graduate 
they  are  skilled  to  a  degree  utterly  unknown  twenty  years  ago. 


III.  ESTABLISHMENT  OF  LABORATORIES. 

Another  step  which  was  equally  important,  and  in  some 
respects  even  more  so,  has  been  the  establishment  of  labora- 
tories connected  with  each  branch  of  instruction.  A  labor- 
atory of  anatomy  (the  dissecting-room)  every  medical  school 
has  always  had,  but  all  the  other  laboratories  are  recent  ad- 
ditions. Among  these  may  be  named  a  laboratory  of  clinical 
medicine,  a  laboratory  of  therapeutics,  in  which  the  action  of 
drugs  is  studied;  a  laboratory  of  chemistry;  a  laboratory  of 
microscopy;  a  laboratory  of  pathology,  for  the  study  of 
diseased  tissues;  a  laboratory  of  embryology,  for  the  study 
of  the  development  of  the  human  body  and  of  animals;  a 
laboratory  of  hygiene;  a  laboratory  of  bacteriology;  a 
laboratory  of  pharmacy;  a  surgical  laboratory,  in  which  all 
the  operations  of  surgery  are  done  on  the  cadaver  by  each 
student;  a  laboratory  of  physiology,  and  in  many  colleges 
private  rooms  in  which  advanced  laboratory  work  may  be 
done  for  the  discovery  of  new  truths. 

In  all  these  laboratories,  instead  of  simply  hearing  about  the 
experiments  and  observations,  each  student  is  required  to 
handle  the  drugs,  the  chemicals,  the  apparatus,  to  do  all  the 
operations,  to  look  through  the  microscope,  etc.;  in  other 


PROGRESS  OF  SURGERY  IN  NINETEENTH  CENTURY.   321 

words,  to  do  all  that  which  is  necessary  for  the  proper  under- 
standing of  the  case  in  hand.  In  fact,  it  may  be  said  that,  in 
view  of  the  opportunities  and  the  requirements  of  modern 
hospitals,  it  is  undoubtedly  true  that  a  hospital  patient,  the 
poorest  of  the  poor,  often  has  his  case  more  thoroughly  studied 
and  more  carefully  treated  than  the  wealthy  patient  who  is 
attended  at  his  home.  On  the  other  hand,  however,  so  many 
laboratories  with  their  expensive  apparatus  and  a  large  staff 
of  assistants  mean  an  enormous  increase  in  the  expense  of  a 
medical  education,  for  which  the  student  does  not  pay  anything 
like  an  equivalent.  Hence  the  need  in  all  of  our  best  modern 
medical  schools  for  endowments,  in  order  that  such  work  may 
be  carried  on  properly  and  yet  the  student  not  be  charged  such 
fees  as  to  be  practically  prohibitory,  excepting  for  the  rich  or, 
at  the  least,  the  well-to-do.  I  do  not  hesitate  to  say  that  by 
reason  of  these  facilities  at  the  end  of  the  second  year  many 
a  diligent  student  of  to-day  is  better  fitted  to  practise  than 
was  the  graduate  of  half  a  century  ago. 


IV.  ANATOMICAL  MATERIAL. 

One  of  the  most  important  means  of  the  study  of  medicine, 
and  especially  of  surgery,  is  a  thorough  acquaintance  with  the 
anatomy  of  the  human  body.  No  one  would  think  of  placing 
a  complicated  piece  of  machinery  in  charge  of  an  engineer  who 
had  never  become  intimately  acquainted  with  all  the  parts  of 
such  a  machine  and  could  take  it  to  pieces  and  put  it  together 
again  with  ease  and  intelligence.  Yet,  until  comparatively 
recently,  this  knowledge  of  anatomy  was  both  required,  and 
yet  at  the  same  time  the  means  of  obtaining  it  were  forbidden, 
the  medical  student.  If  he  performed  an  operation  and  was 
guilty  of  negligence  or  error,  due  to  his  want  of  anatomical 
knowledge,  he  was  liable  to  a  suit  for  malpractice.  Yet  his 
only  means  of  becoming  acquainted  with  the  anatomy  of  the 
human  body  was  by  stealing  the  bodies  of  the  dead.  In 
21 


322  ADDRESSES   AND   OTHER   PAPERS. 

England,  up  to  1832,  this  was  equally  true.  A  regular  traffic 
in  human  bodies  existed  there  as  well  as  here,  and  by  reason  of 
its  perils  the  cost  of  bodies  for  dissection  was  very  great;  but 
it  was  only  a  question  of  money.  In  his  testimony  before  the 
Parliamentary  Committee,  Sir  Astley  Cooper  made  a  shiver 
run  down  the  backs  of  the  noble  Lords  who  listened  to  him 
when  he  said  that  in  order  to  dissect  the  body  of  any  of  them 
it  was  only  necessary  for  him  to  pay  enough.  The  large 
pecuniary  profits  of  such  business,  when  the  supply  was  very 
small,  led  to  the  horrible  atrocities  of  Burke  and  Hare  in 
Edinburgh  in  1832.  They  deliberately  murdered  a  consider- 
able number  of  persons,  and  sold  the  bodies  to  the  dissecting- 
rooms  in  that  city. 

The  discovery  of  their  crimes  finally  led  to  the  passage  of 
the  Anatomy  act,  which  has  been  in  force  in  Great  Britain 
ever  since.  Similar  violations  of  graveyards  in  this  coun- 
try have  led  to  the  passage  in  various  States  of  somewhat 
similar  laws,  usually  giving  for  dissection  the  bodies  of  those 
who  were  so  poor  in  friendship  that  no  one  would  spend 
the  money  necessary  for  their  burial.  But  even  to-day, 
in  a  large  number  of  our  States,  the  former  anomalous  con- 
dition of  affairs  still  exists.  The  increase  of  anatomical 
material  which  has  resulted  from  the  enactment  of  wise  and 
salutary  laws  for  this  purpose  has  given  a  great  impetus  to  the 
study  of  anatomy,  and  has  produced  a  far  better  educated 
class  of  physicians  in  most  parts  of  the  United  States  within 
the  last  few  years.  The  enlightened  sense  of  the  community 
has  perceived  that  to  deny  the  medical  schools  the  means  of 
properly  teaching  anatomy  was  a  fatal  mistake  and  resulted 
in  an  ignorance  of  which  the  community  were  the  victims. 
As  a  result  it  is  possible  now,  by  law,  in  most  States  to  obtain 
a  reasonable  number  of  cadavers,  not  only  for  the  study  of 
anatomy,  but  for  the  performance  of  all  the  usual  operations.* 

*  For  the  atrocities  of  Burke  and  Hare  see  pp.  20-22.  For  the  Penn- 
sylvania Act  the  best  of  all  the  Anatomy  Acts  see  p.  14,  footnote. 


PROGRESS  OF  SURGERY  IN  NINETEENTH  CENTURY.   323 

V.  MEDICAL  LIBRARIES. 

Along  with  this  there  has  been  throughout  this  country  a 
marked  movement  hi  favor  of  medical  libraries.  It  is  to  the 
credit  of  the  Government  of  the  United  States  that  the  whole 
world  is  debtor  to  us,  not  only  for  the  foremost  medical  li- 
brary in  the  world,  that  of  the  Surgeon-General  of  the  Army  in 
Washington,  but  also  for  the  magnificent  Index-Catalogue  not 
only  of  the  books,  but  of  all  the  journal  articles  in  every  lan- 
guage in  the  world.  No  better  investment  of  money  was  ever 
made  than  the  establishment  of  this  library,  and  its  allied 
museum,  and  the  publication  of  the  Index-Catalogue. 


VI.  EMBRYOLOGY. 

As  a  result  of  all  these  means  and  methods  of  study,  and  as 
a  part  of  the  great  educational  and  scientific  movement  of  the 
century,  medical  men  now  take  a  wholly  different  view  of  the 
normal  and  abnormal  structures  of  the  human  body.  The 
study  of  embryology  has  shown  us  that  many  of  the  deviations 
from  the  normal  development  of  the  human  body  are  easily  ex- 
plained by  embryology.  One  of  the  most  important  changes 
in  our  idea,  for  example,  of  tumors  is  due  to  the  fact  that  the 
study  of  embryology,  and  of  the  tissues  of  the  embryo,  has 
shown  that  diseased  structures  which  entirely  lack  explanation 
when  compared  with  the  adult  human  tissues  readily  find  their 
explanation,  and  fall  into  an  unexpected  order,  when  com- 
pared with  the  tissues  of  the  embryo.  Not  only,  however, 
has  the  study  of  embryological  tissues  thrown  a  flood  of  light 
on  diseased  structures,  but  we  have  obtained  new  views  of 
the  relation  of  man  to  all  creatures  lower  in  the  scale  of  life. 
Largely  owing  to  the  doctrine  of  evolution,  we  now  recognize 
the  fact  that,  so  far  as  his  body  is  concerned,  man  is  kindred  to 
the  brutes;  that  his  diseases,  within  certain  limitations,  are 
identical  with  similar  diseases  of  the  lower  animals;  that  his 


324  ADDRESSES   AND    OTHER   PAPERS. 

anatomy  and  physiology  are,  in  essence,  the  same  as  the  anat- 
omy and  physiology  of  the  lower  animals, — even  the  very 
lowest, — and  that  many  of  his  diseases  can  be  best  studied  in 
the  lower  animals,  because  upon  them  we  can  make  exact 
experiments  which  would  be  impossible  in  man.  While  it  is 
true  that  each  animal  has  disorders  which  are  peculiar  to 
itself,  and  that  it  is  not  subject  to  some  of  the  disorders  to 
which  man  is  a  victim,  and,  per  contra,  that  man  is  a  victim 
to  some  disorders  which  animals  do  not  suffer  from,  yet,  taking 
them  as  a  whole,  the  diseases  of  man  and  of  animals,  and  the 
action  of  remedies  on  both  are  practically  identical.  To 
this  I  shall  have  occasion  to  refer  again. 


VII.  PATHOLOGY. 

Among  the  laboratories  which  I  mentioned,  one  of  the  most 
important  is  that  of  pathology  and  morbid  anatomy,  or  the 
study  of  diseased  tissues  and  organs.  The  first  work  on 
pathology  in  this  country  was  written  by  one  of  our  best- 
known  surgeons,  the  late  Samuel  D.  Gross,  and  one  of  his  most 
important  contributions  to  surgical  progress  consisted  in  his 
persistent  advocacy  of  the  need  for  the  study  of  pathology 
as  a  basis  for  all  our  means  of  cure.  This  is  evident,  if  we  con- 
sider the  illustration  I  used  a  moment  ago  of  a  steam  engine. 
Unless  one  knows  precisely  the  defects  of  such  a  machine,  the 
influence  of  fresh  or  salt  water  on  a  boiler,  the  influence  of  rust, 
the  effect  of  oils,  entirely  apart  from  the  mere  mechanism  of 
the  engine,  an  engineer  might  make  the  most  serious  mistake 
resulting  in  fatal  damage,  both  to  the  machine  and  probably 
to  life.  So  surgical  pathology  is  the  study  of  the  processes  of 
disease,  the  alterations  in  the  minute  structure  of  tissues  and 
organs,  without  which  no  surgeon  can  be  fitted  for  his  task, 
much  less  can  he  be  called  an  accomplished  surgeon.  All  of 
these  laboratories  mark  the  difference  between  the  scientific 
and  the  empirical  method.  The  old  student  of  medicine  went 


PROGRESS  OF  SURGERY  IN  NINETEENTH  CENTURY.   325 

from  case  to  case,  heard  many  a  good  maxim  and  learned 
many  a  useful  trick,  but,  after  all,  it  was  only  an  empirical 
knowledge  which  he  obtained.  It  did  not  go  to  the  founda- 
tion of  things.  It  was  not  scientific,  as  is  the  collegiate  in- 
struction of  to-day. 

Having  thus  glanced  rapidly  at  the  improvement  in  medical 
instruction,  let  me  turn  now  to  a  few  of  the  principal  dis- 
coveries which  have  made  the  surgery  of  to-day  so  much 
superior  to  the  surgery  of  a  hundred  years  ago. 


VIII.  ANESTHESIA. 

After  vaccination,  the  next  most  important  surgical  event 
of  the  century  was  the  discovery  of  anaesthesia.  While  there 
were  some  prior  attempts  at  anaesthesia,  practically  it  dates 
from  October  16, 1846,  when  Dr.  John  C.  Warren,  in  the  Massa- 
chusetts General  Hospital,  first  performed  a  major  surgical 
operation  without  inflicting  the  slightest  pain.  I  cannot  enter 
into  the  merits  of  the  various  claimants  for  the  credit  of  first 
using  an  anaesthetic,  but  ether  was  then  for  the  first  time  pub- 
licly administered  by  Morton,  and  the  very  sponge  which  was 
then  used  is  now  a  precious  trophy  of  the  Massachusetts  Gen- 
eral Hospital.  I  may  perhaps  quote  from  an  address  which  I 
delivered  before  the  Medical  and  Chirurgical  Faculty  of  the 
State  of  Maryland  at  their  centennial  anniversary  in  April, 
1899  (p.  271)  the  following  in  relation  to  anaesthesia: 

The  news  went  like  wildfire,  and  anaesthesia  was  soon  introduced  into 
every  clinic  and  at  almost  every  operation  throughout  the  civilized  world. 
Prior  to  that  time  a  surgical  operation  was  attended  with  horrors  which 
those  who  live  in  these  days  cannot  appreciate.  He  was  the  best  surgeon 
who  could  perform  any  operation  in  the  least  possible  time.  The  whole 
object  of  new  methods  of  operating  was  to  shorten  the  period  of  frightful 
agony  which  every  patient  had  to  endure.  Every  second  of  suffering 
saved  was  an  incalculable  boon.  To  submit  to  any  operation  required 
then  a  heroism  and  an  endurance  which  are  almost  incomprehensible  to 
us  now.  All  of  the  more  modern,  deliberate,  careful,  painstaking  opera- 
tions involving  minute  dissection,  amid  nerves  and  blood-vessels,  when 


326  ADDRESSES   AND   OTHER   PAPERS. 

life  or  death  depends  on  the  accuracy  of  almost  every  touch  of  the  knife, 
were  absolutely  impossible.     It  was  beyond  human  endurance  quietly  to 
submit  one's  self  for  an  hour,  for  an  hour  and  a  half,  for  two  hours  or 
even  longer,  to  such  physical  agony. 

It  is  a  striking  commentary  on  the  immediate  results  of  the  intro- 
duction of  anaesthesia  to  learn  that,  in  the  five  years  before  the  intro- 
duction of  ether,  only  184  persons  were  willing  to  submit  themselves  to 
such  a  dreadful  ordeal  in  the  Massachusetts  General  Hospital,  an  average 
of  37  operations  per  annum,  or  3  per  month.  In  the  five  years  imme- 
diately succeeding  its  introduction,  although  the  old  horror  could  not 
at  once  be  overcome,  487  operations,  or  almost  100  annually,  were  per- 
formed in  the  same  hospital.  During  the  last  year  in  the  same  hospital, — 
a  Mecca  for  every  surgeon  the  world  over, — over  3700  operations  were 
performed.  It  is  not  an  uncommon  thing  at  the  present  day  for  any 
one  of  the  more  active  surgeons  of  this  country  to  do  as  many  as  400 
to  500  operations  in  a  year.  I  have  known  as  many  as  19  operations 
to  be  done  in  the  Jefferson  Medical  College  Hospital  hi  a  single  day — 
equalling  six  months'  work  in  Boston  before  the  introduction  of  ether. 

The  next  year,  1847,  witnessed  the  introduction  of  chloro- 
form by  Sir  James  Y.  Simpson,  of  Edinburgh.  Until  I  be- 
came acquainted  with  the  striking  figures  just  quoted  I  had 
often  wondered  at  the  hospital  scene  hi  that  most  touching 
story,  "Rab  and  His  Friends,"  by  the  late  gifted  and  well- 
beloved  physician,  Dr.  John  Brown,  of  Edinburgh.  Nowa- 
days students  do  not  rush  into  the  surgical  amphitheatre 
when  they  learn  that  an  operation  is  to  be  done,  but  it  is 
taken  as  a  matter  of  course,  for  practically  every  day  many 
operations  are  done  in  most  of  our  large  hospitals.  But,  at 
the  time  when  Rab's  mistress  was  operated  upon,  an  opera- 
tion, as  has  been  stated,  was  a  very  rare  event.  Few  had 
the  fortitude  to  endure  its  dreadful  pangs.  Now,  thanks  to 
the  blessed  sleep  of  anaesthesia,  sufferers  from  even  the  most 
dreadful  disorders  can  have  long  and  difficult  operations  done, 
accurate  and  tedious  dissections  made,  and  yet  feel  not  a 
twinge  of  pain. 

Besides  general  anaesthesia  by  ether,  chloroform,  and  a  few 
other  agents,  there  have  been  introduced  several  means  for 
producing  "local  anaesthesia,"  i.  e.,  agents  which  destroy  the 


PROGRESS  OF  SURGERY  IN  NINETEENTH  CENTURY.   327 

sensibility  of  the  part  of  the  body  to  be  operated  upon  while 
not  producing  unconsciousness.  Freezing  the  part  by  ice 
and  salt  and  by  a  quickly  evaporating  spray  of  rhigolene  or 
chloride  of  ethyl  are  sometimes  used.  But  cocaine  and  a 
somewhat  similar  substance,  eucai'ne,  have  of  late  been  more 
extensively  used  on  man,  after  their  harmlessness  had  been 
first  shown  by  experiments  on  animals.  In  1885  Corning, 
of  New  York,  injected  a  solution  of  cocaine  as  near  to  the 
spinal  cord  as  was  possible  and  produced  insensibility  of  all  the 
body  below  the  point  of  injection  by  the  effect  of  the  cocaine 
upon  the  spinal  cord.  A  few  years  ago  Quincke,  of  Kiel,  in 
Germany,  devised  a  means  of  puncturing  the  spinal  canal 
itself  in  the  lumbar  region  (the  lowest  part  of  the  small  of  the 
back)  for  the  purpose  of  drawing  off  some  of  the  fluid  for  ex- 
amination. 

This  suggested  to  Bier,  then  of  Kiel,  who  was  appar- 
ently ignorant  of  Coming's  work,  that  cocaine  could  be  in- 
jected through  a  hollow  needle  inserted  into  the  spinal  canal 
by  "lumbar  puncture"  and  so  produce  anaesthesia  of  all  the 
body  below  this  point.  This  method  was  published  by  him  in 
1899  and  was  soon  repeated  in  America.  In  France,  how- 
ever, it  has  been  practised  more  than  elsewhere,  Tuffier,  of 
Paris,  having  successfully  done  over  two  hundred  operations 
by  "  spinal  anesthesia."  All  of  the  body  below  the  diaphragm 
can  thus  be  deprived  of  sensibility.  The  method  will  probably 
never  replace  ether  and  chloroform,  but  in  many  cases  is  a 
valuable  aid  to  the  surgeon.  But  it  has  its  dangers  and  its 
inconveniences.  The  ideal  anesthetic  is  not  that  which 
destroys  sensibility  and  yet  leaves  the  patient  perfectly 
conscious,  as  spinal  anaesthesia  does.  A  patient  to  whom  I 
recently  proposed  it  for  certain  special  reasons  rejected  it, 
saying,  with  probable  truth,  that  she  could  never  bear  the 
strain  of  lying  on  the  table  perfectly  conscious  of  all  that  was 
being  done  and  frightened  by  any  surgical  emergency  which 
might  easily  arise  in  such  a  long,  difficult,  and  dangerous 


328  ADDRESSES   AND   OTHER    PAPERS. 

operation.  The  ideal  anaesthetic  is  that  which  will  abolish 
pain  and  consciousness  without  danger  to  life.  The  twentieth 
century  will  undoubtedly  see  the  discovery  of  this  safe  and 
efficient  ansesthetic. 

IX.  ANTISEPSIS. 

But  we  have  not  yet  reached  the  limits  of  surgical  progress. 
Let  me  quote  again  from  the  address  before  alluded  to : 

Even  the  introduction  of  anaesthesia,  however,  did  not  rid  surgery 
of  all  its  terrors.  The  acute  pain  of  the  operation  was  abolished,  but 
the  after-suffering,  as  I  know  only  too  well,  in  my  early  surgical  days 
was  something  dreadful  to  see.  The  parched  lips  of  the  poor  sufferer, 
tossing  uneasily  during  sleepless  nights;  wounds  reeking  with  pus,  and 
patients  dying  by  scores  from  blood-poisoning,  from  erysipelas,  from 
tetanus,  from  gangrene,  were  only  too  familiar  sights  in  the  pre-anti- 
septic  days.  Then,  again,  there  arose  one  of  these  deliverers  of  the 
human  race  whose  name  can  never  be  forgotten  and  whose  fame  will 
last  so  long  as  time  shall  endure.  Jenner,  Warren,  and  Lister  are  a 
triumvirate  of  names  of  which  any  profession  may  well  be  proud.  Thank 
God,  they  all  sprang  from  virile  Anglo-Saxon  loins!  No  praise,  no  re- 
ward, no  fame,  is  too  great  for  them.  That  Lord  Lister  lives  to  see  the 
triumph  of  his  marvellous  services  to  humanity  is  a  joy  to  all  of  us.  And 
when  the  profession  arose  en  masse,  within  the  last  few  years  at  the  In- 
ternational Congress  of  Berlin  and  at  the  meeting  of  the  British  Medical 
Association  in  Montreal  and  welcomed  him  with  cheer  after  cheer,  it 
was  but  a  feeble  expression  of  gratitude  for  benefits  which  no  words 
can  express. 

Before  Lister's  day  erysipelas,  tetanus,  gangrene,  and  blood-poison- 
ing in  its  various  phases  were  the  constant  attendant  of  every  surgeon. 
They  were  dreaded  guests  at  almost  any  operation;  and  when  in  rare 
cases  we  obtained  primary  union  without  a  drop  of  pus,  without  fever, 
and  with  but  little  suffering,  it  was  a  marvellous  achievement.  Now  it 
is  precisely  reversed.  The  surgeon  who  does  not  get  primary  union 
without  a  drop  of  pus,  with  no  fever,  and  with  little  suffering,  asks  him- 
self: What  was  the  fault  in  my  technic?  To  open  the  head,  the  abdo- 
men, or  the  chest  thirty  years  ago  was  almost  equivalent  to  signing  the 
death  warrant  of  a  patient.  The  early  mortality  of  ovariotomy  was  about 
60  per  cent.;  2  out  of  3  died.  Now  many  a  surgeon  can  point  to  a  series 
of  100  abdominal  operations  with  a  fatality  of  only  2  or  3  per  cent. 

This,  too,  is  a  direct  result  of  laborious  laboratory  researches,  begin- 
ning with  the  investigations  of  Liebig  and  Pasteur  on  fermentation. 
Lister  went  still  further.  Even  before  the  discovery  of  the  bacteria  of 


PROGRESS  OF  SURGERY  IN  NINETEENTH  CENTURY.   329 

suppuration,  of  tetanus,  and  of  erysipelas,  he  showed  us  experimentally 
how,  by  surgical  cleanliness,  we  could  avoid  all  infection  and  so  banish 
these  pests  from  our  hospitals  and  bring  life  and  health  to  many  who 
otherwise  would  have  perished  from  operations  which  are  now  perfectly 
safe. 

The  mortality  of  compound  fractures  in  the  pre-antiseptic  days  was 
about  60  per  cent.  It  was  one  of  the  most  dreaded  of  all  accidents.  Its 
mortality  now  is  perhaps  not  over  3  per  cent,  and  the  mortality  from 
sepsis  after  such  a  fracture  in  the  hands  of  well-instructed  surgeons  is 
almost  nil.  Prior  to  Lister's  day,  the  mortality  of  major  amputations 
varied  from  50  to  63  per  cent.  Now  it*is  from  10  to  20  per  cent.  And 
so  I  might  go  on  with  operation  after  operation  and  show  how  they  have 
become  so  safe  that  one  need  not  dread  any,  saving  exceptional,  .cases. 

These  two  modern  discoveries,  anaesthesia  and  antisepsis,  have 
utterly  revolutionized  modern  surgery.  They  have  made  possible  opera- 
tions which,  by  reason  of  their  duration,  pain,  and  danger,  were  utterly 
unjustifiable  in  former  days,  but  are  now  the  daily  occupation  of  a  busy 
surgeon.  And,  far  better  than  this,  they  have  enabled  us  to  bring  to 
homes  and  hearts,  which  otherwise  would  have  been  broken  up  and 
wrung  with  sorrow,  the  comfort  of  life  restored  to  dear  ones  upon  whom 
depended  the  happiness  and  support  of  the  families.  Translate  figures 
into  happy  hearts  and  prosperous  homes  if  you  can,  and  then  you  can 
tell  me  what  Warren  and  Lister  have  done  for  humanity. 

The  result  of  these  two  wonderful  discoveries  has  been 
to  separate  us  from  the  surgical  past,  as  by  a  great  gulf. 

Great  theologians,  such  as  a  Calvin  or  a  Jonathan  Edwards,  were 
they  recalled  to  life,  could  discourse  as  learnedly  as  ever  of  Predestina- 
tion and  Free  Will;  great  preachers,  as  a  Beecher  or  a  Spurgeon,  could 
stir  our  souls  and  warm  our  hearts  as  of  old;  great  jurists,  as  a  Justinian 
or  a  Marshall,  could  expound  the  same  principles  of  law  which  hold  good 
for  all  time ;  great  forensic  orators,  as  a  Burke  or  a  Webster,  would  con- 
vince us  by  the  same  arguments  and  arouse  us  by  the  same  invectives 
and  the  same  eloquence  that  made  our  fathers  willing  captives  to  their 
silver  tongues.  But  to-day,  so  rapid  has  been  our  surgical  progress,  a 
Velpeau,  a  Sir  William  Ferguson,  or  a  Pancoast,  all  of  whom -have  died 
within  the  last  thirty  years,  could  not  teach  modern  surgical  principles 
or  perform  a  modern  surgical  operation.  Even  our  everyday  surgical 
vocabulary — staphylococcus,  streptococcus,  infection,  immunity,  antisep- 
sis and  asepsis,  toxine  and  antitoxine — would  be  unintelligible  jargon  to 
him;  and  our  modern  operations  on  the  brain,  the  chest,  the  abdomen, 
and  the  pelvis  would  make  him  wonder  whether  we  had  not  lost  our 
senses,  until,  seeing  the  almost  uniform  and  almost  painless  recoveries, 


330  ADDRESSES  AND   OTHER   PAPERS. 

lie  would  thank  God  for  the  magnificent  progress  of  the  last  half-century, 
which  had  vouchsafed  such  magical — nay,  such  almost  divine — power  to 
the  modern  surgeon.* 


X.  THE  SURGERY  OF  WAR. 

One  of  the  immediate  consequences  of  the  introduction 
of  the  antiseptic  method  has  been  a  remarkable  mitigation 
of  the  horrors  of  war.  Our  recent  war  with  Spain  has  proved, 
and  the  present  military  operations  in  the  Philippines  and 
of  the  British  in  South  Africa  will  still  further  prove,  its  ad- 
vantages. Witness  a  little  book  written  by  Prof,  von  Es- 
march,  of  Kiel,  Germany,  with  the  apt  title  "The  Fight  of 
Humanity  Against  the  Horrors  of  War,"  with  an  appendix 
entitled  "The  Samaritan  on  the  Battlefield."  One  of  the 
most  valuable  means  for  the  preservation  of  human  We  is 
carried  by  every  soldier  in  a  modern  civilized  army  as  a  part 
of  his  regulation  outfit,  a  "  First  Aid  Package  "  for  the  treat- 
ment of  any  wound  or  injury,  and  one  of  the  most  valuable 
and  interesting  papers  read  before  the  American  Surgical 
Association  at  its  meeting  in  Chicago  in  1899  was  by  Professor 
Senn  on  the  "First  Aid  Package."  This  first  aid  package 
contains  an  antiseptic  dressing,  which  can  be  applied  to  all 
but  the  gravest  wounds  for  the  purpose  of  preventing  infec- 
tion, which  is  the  principal  danger  to  life  after  accident  or 
injury.  The  universal  testimony  of  our  surgeons  in  Cuba 
was  that  by  its  use  most  wounds  were  prevented  from  be- 
coming infected  and,  therefore,  inflamed,  and  that  the  num- 
ber of  operations  was  greatly  diminished  by  reason  of  its  use. 

XI.  BACTERIOLOGY. 

In  experimental  science  two  methods  of  progress  are  ob- 
served: first,  in  actual  practice  certain  methods  are  adopted 

*  From  my  Address  in  Surgery  at  the  Semicentennial  Meeting  of  the 
American  Medical  Association,  1897  (vide  ante  page  243). 


PROGRESS  OF  SURGERY  IN  NINETEENTH  CENTURY.   331 

because  they  are  found  to  be  the  most  advantageous  and 
useful,  though  we  cannot  explain  why  it  is  so, — i.  e.,  practice 
outstrips  theory.  Again,  as  a  result  of  experimental  inves- 
tigation, certain  facts  are  discovered  which  explain  why  the 
practical  methods  just  alluded  to  are  the  best,  and  this  in 
turn  suggests  further  improvements  in  our  practice, — i.  e., 
theory  outstrips  practice  and  enlarges  its  domain.  Thus  out- 
stripping theory,  the  practical  advance  made  by  Lister  was 
an  example  of  the  first.  His  striking  results  in  turn  stimu- 
lated scientific  observers  to  make  new  discoveries  of  the 
greatest  importance,  and  thus  science  immensely  improved 
and  widened  our  practical  methods. 

No  definite  year  or  day  can  be  assigned  as  the  birth  date  of 
Lord  Lister's  antiseptic  methods,  as  we  can,  for  instance,  for 
vaccination  or  for  anesthesia.  We  may  assume,  at  least  for 
this  country,  the  summer  of  1876  as  the  starting  point. 
During  that  year  Lord  Lister  attended  the  International 
Medical  Congress  held  in  Philadelphia  and  demonstrated  his 
then  methods  and  convinced  a  few  surgeons  of  their  immense 
advantages.  Even  before  that  date  there  had  been  very 
many  experiments  and  observations,  especially  on  the  blood. 
In  1863  Davaine  in  France  had  discovered  little  rod-like  bodies 
in  the  blood  in  wool-sorters'  disease  or  anthrax,  which  he 
named  from  their  shape  "bacteria,"  or  "little  rods."  This 
name  has  been  adopted  for  all  forms  of  germs,  though  many 
of  them  are  not  rod-like  in  their  shape.  Not  until  1881  was 
the  cause  of  inflammation  and  suppuration  (the  formation  of 
pus  or  "  matter")  discovered.  In  that  year  Ogston,  of  Aber- 
deen, published  experiments  which  he  believed  demonstrated 
the  fact  that  certain  bacteria  were  the  cause  of  suppuration. 
Since  then  this  has  been  amply  confirmed  not  only  by  ex- 
periments upon  animals,  but  by  observation  in  man.  In  1882 
Robert  Koch,  of  Berlin,  discovered  the  cause  of  tuberculosis, 
a  little,  rod-like  body  which  is  named  the  "bacillus"  of  tu- 
berculosis. In  1883  Fehleisen  discovered  the  cause  of  ery- 


332  ADDRESSES   AND   OTHER   PAPERS. 

sipelas,  and  in  1887  Nicolaier  and  Rosenbaum  discovered  the 
bacillus  of  tetanus  or  lockjaw.  So  recent  have  been  the 
discoveries  in  bacteriology  which  have  led  to  vast  improve- 
ments in  our  methods  of  treatment  of  wounds  and  the  per- 
formance of  operations. 

While  the  principles  established  by  Lord  Lister  have 
remained  unchanged,  the  details  in  the  treatment  have  been 
greatly  simplified  and  made  more  efficient.  For  the  infor- 
mation of  the  general  reader  let  me  state  a  few  facts.  Bacteria 
are  divided  into  two  principal  classes,  in  accordance  with  their 
form.  One  class,  known  as  "cocci,"  from  the  Greek  word 
coccus, — "berry," — may  be  likened  to  billiard-balls.  Some 
of  these  occur  in  bunches,  which  have  been  likened  to  bunches 
of  grapes,  and  hence  are  called,  again  from  a  Greek  term, 
"staphylococci."  Others  are  arranged  in  chains,  like  beads, 
and  are  called  "streptococci."  These  last  are  very  much 
more  virulent  and  dangerous  than  the  staphylococci.  Both 
of  these  produce  pus  or  matter,  and  they  are  the  most  widely 
diffused  and  most  common  forms  found  in  infected  or  sup- 
purating wounds.  One  form  is  the  cause  of  erysipelas.  A 
second  class,  known  as  "bacilli,"  may  be  likened  to  a  lead- 
pencil.  Among  the  various  bacilli  that  have  been  dis- 
covered are  those  of  tuberculosis,  glanders,  tetanus  or  lock- 
jaw, etc.  I  omit  many  others  found  hi  medical  disorders,  as 
they  do  not  concern  this  paper.  How  important  these  dis- 
coveries are  may  be  seen  by  the  following  facts :  Tuberculosis, 
next  to  suppuration,  is,  perhaps,  the  most  widely  extended 
infection  to  which  man,  as  well  as  animals,  is  liable.  We  are 
all  familiar  with  it  in  the  form  of  "consumption,"  but  the 
non-medical  reader  is,  perhaps,  not  aware  of  the  fact  that  it 
affects  not  only  the  lungs,  but  also  the  bowels  in  consumption 
of  the  bowels;  the  bones,  as  is  seen  by  every  surgeon  almost 
daily,  and  especially  as  the  cause  of  the  crooked  backs  seen  in 
spine  diseases;  in  the  joints,  as  is  seen  in  hip-joint  disease, 
white  swelling  of  the  knee,  ankle-joint  disease,  and  similar 


PROGRESS    OF   SURGERY    IN   NINETEENTH    CENTURY.      333 

disease  of  all  the  other  large  joints  of  the  body;  in  the  brain,  in 
tuberculous  meningitis;  in  the  abdominal  cavity,  in  tubercu- 
lous peritonitis;  in  the  skin,  in  certain  forms  of  ulceration, 
commonly  called  lupus;  in  the  glands,  as  in  the  swollen 
glands,  or  "  bunches  "  in  the  neck,  and  endless  other  varieties 
which  I  need  not  name. 

The  bacillus  of  lockjaw  is  found  in  great  abundance  around 
stables,  and  this  explains  the  fact  that  hostlers,  drivers,  cavalry- 
men, all  of  whom  have  to  do  with  horses,  are  especially  liable 
to  attacks  of  lockjaw.  The  fact  was  long  known;  the  reason 
was  wholly  unknown  until  1887.  Moreover,  certain  bac- 
teria thrive  best  when  exposed  to  the  open  air.  Other  bac- 
teria, and  among  them  the  bacilli  of  lockjaw,  thrive  best 
when  the  air  is  excluded,  and  this  explains  the  danger  of 
treading  on  a  rusty  nail,  which  is  popularly  and  rightly 
known  as  peculiarly  liable  to  produce  lockjaw.  The  reason 
is  not  because  it  is  a  nail,  nor  because  it  is  old,  nor  because 
it  is  rusty,  but  because  from  the  earth  in  which  it  lies  it  is 
most  apt  to  be  the  means  of  introducing  into  a  punc- 
tured wound  the  bacilli  of  lockjaw.  Such  a  wound  bleeds 
very  little,  the  blood  soon  crusts  and  excludes  the  air,  and 
if  any  of  the  bacilli  of  lockjaw  have  been  carried  into  the 
body,  they  find  in  such  a  closed  wound,  from  which  the  air 
is  excluded,  the  most  favorable  conditions  for  growth  and 
infection  of  the  whole  body.  Knowing  these  facts  from 
experiment,  the  treatment  is  clear.  Lay  open  such  a  wound 
as  soon  as  it  is  received  and  disinfect  it,  and  lockjaw  will  not 
occur. 

These  two  forms,  the  "cocci,"  or  berry-like  bacteria,  and 
the  "bacilli,"  or  rod-like  bacteria,  comprise  the  great  majority 
of  dangerous  bacteria. 

It  must  be  remembered  that  there  is  an  enormous  number 
of  bacteria  which  are  not  dangerous;  some  of  them  are  en- 
tirely harmless  even  if  introduced  into  the  human  body. 
Others  are  the  bacteria  of  decomposition,  or  putrefaction, 


334  ADDRESSES   AND   OTHER   PAPERS. 

which  are  known  as  "  saprophytic "  bacteria.  All  of  the 
harmless  ones  are  known  as  "non-pathogenic," — that  is, 
non-producers  of  disease.  Those  which  produce  disease  are 
known  as  "  pathogenic  " ;  and  those  which  produce  suppura- 
tion as  "pyogenic"  or  pus-producing  bacteria. 

All  of  these  bacteria  are  plants,  and  not,  as  is  very  fre- 
quently supposed,  animals  of  a  low  form.  The  danger  from 
their  introduction  into  the  body  can  be  best  appreciated, 
perhaps,  by  the  statement  of  Belfield,  who  estimated  that 
a  single  bacterium  which  weighs,  approximately,  only  the 
40^0^000  part  of  a  grain,  if  given  plenty  of  food  and 
plenty  of  "elbow  room,"  would  so  rapidly  develop  that  hi 
three  days  it  would  form  a  mass  weighing  800  tons!  It  is 
the  old  story  of  the  blacksmith  who  was  to  get  a  penny  for 
the  first  nail,  two  for  the  second,  four  for  the  third,  and  so 
on  till  a  set  of  shoes  would  cost  more  than  Croesus  could 
pay  for. 

The  effect  of  the  bacteria  has  been  determined  by  experi- 
ment to  be  proportionate  to  the  dose.  A  cubic  centimetre 
is  a  cube  two-fifths  of  an  inch  on  each  side.  One-tenth  of 
such  a  cube  of  pure  culture  of  one  bacterium  (proteus  vul- 
garis)  contains  225,000,000  bacteria,  and  if  injected  under 
the  skin  of  a  rabbit  will  produce  death.  Less  than  18,000,000 
will  produce  no  effect  whatever.  Of  one  kind  of  staphylo- 
coccus,  if  250,000,000  are  introduced  under  the  skin  of  a 
rabbit  there  will  be  produced  a  small  abscess,  but  it  requires 
1,000,000,000  to  produce  speedy  death.  On  the  other  hand, 
of  the  bacillus  of  lockjaw  it  requires  only  1000  to  produce 
death,  so  virulent  is  this  germ. 

Moreover,  their  effect  on  tissues  and  persons  in  different 
conditions  varies  very  much.  Thus,  it  is  found  that  when  a 
certain  number  of  bacteria  are  injected  into  the  cavity  of 
the  abdomen  of  an  animal,  if  the  animal  is  healthy  and  the 
peritoneum  (the  thin  lining  membrane  of  the  abdomen)  is 
healthy,  the  animal  will  recover  perfectly  well;  but  if  the 


PROGRESS  OF  SURGERY  IN  NINETEENTH  CENTURY.   335 

peritoneum  be  scraped  and  torn  (and  it  must  be  remembered 
that  the  healthy  peritoneum  is  devoid  of  sensation),  that 
the  same  dose  which  before  was  harmless  will  now  produce 
a  violent  peritonitis  and  very  likely  death.  The  practical 
lesson  from  this  experiment  upon  animals  is  very  evident. 
Every  surgeon  who  opens  the  abdomen  is  most  careful,  if 
possible,  not  to  injure  the  peritoneum,  but  to  manipulate  with 
the  greatest  gentleness  lest  fatal  results  follow  any  serious 
injury  to  that  membrane.  So,  too,  it  is  found  that  an  injec- 
tion of  bacteria  from  which  a  healthy  animal  would  recover 
will  be  followed  by  fatal  consequences  if  the  general  health 
is  below  par.  Again,  if  an  animal  has  a  simple  fracture  of 
his  thigh-bone,  and  that  is  the  only  injury  that  he  receives, 
no  infection  from  the  exterior  having  occurred,  he  will  make 
a  good  recovery;  but  if  at  the  same  time  he  receives  a  lacer- 
ated wound,  it  may  be  even  in  another  part  of  the  body, 
and  his  wound,  not  being  cared  for  most  scrupulously,  be- 
comes infected,  the  infection  will  fasten  on  the  distant  spot 
of  least  resistance,  the  broken  thigh-bone,  and  will  produce 
a  most  dangerous  and  very  frequently  fatal  form  of  inflam- 
mation. 

I  need  scarcely  point  out  in  this  connection,  as,  in  fact, 
throughout  this  entire  consideration  of  bacteriology,  how 
important  a  part  in  its  development  has  been  played  by 
experiment  upon  animals.  The  experimental  facts  just 
stated  are  of  vital  importance  in  the  treatment  of  surgical 
diseases,  and  evidently  could  not  have  been  determined 
upon  mankind.  It  is  not  too  much  to  say  that  had  vivi- 
section been  restricted  or  prohibited  the  surgery  of  to-day 
would  be  the  barbarous  surgery  of  thirty  years  ago. 

Even  granting  that  an  enormous  number  of  the  bacteria 
are  harmless,  the  wonder  is  that  with  so  many  foes  on  every 
hand  we  live  an  ordinary  lifetime.  Fortunately,  however, 
in  the  human  body  there  is  not  only  a  lack  of  sufficient  food 
and  enough  "  elbow  room  "  for  them  to  work  their  dire  effects, 


336  ADDRESSES   AND    OTHER    PAPERS. 

but  there  is  that  which  "makes  for  righteousness"  in  our 
physical  organization  as  well  as  in  our  souls. 

The  moment  that  bacteria  are  introduced  into  the  human 
body  a  certain  number  of  cells  hasten  to  destroy  them. 
These  are  called  "phagocytes"  or  devouring  cells,  because 
they  eat  up  the  bacteria.  Whether  the  patient  survives 
or  dies  depends  on  whether  the  bacteria  get  the  upper  hand 
of  the  phagocytes  or  the  phagocytes  the  upper  hand  of  the 
bacteria. 

These  statements  are  very  easy  to  make,  but  the  results 
have  only  been  obtained  by  prolonged  and  laborious  inves- 
tigations hi  the  laboratory  and  by  experiments  upon  animals 
which  have  demonstrated  these  facts. 

The  bacteria  are  recognized  by  various  methods:  First, 
by  form.  Many  which  are  identical  in  appearance,  how- 
ever, differ  greatly  in  effects.  A  handful  of  turnip-seed 
and  a  handful  of  rape-seed  look  very  much  alike,  but  if  they 
are  planted  the  plants  differ  so  greatly  that  we  can  recognize 
the  difference  in  the  seed  by  the  difference  in  the  crop ;  hence 
the  second  method  of  recognizing  differences  in  bacteria  is 
by  planting  them.  Different  methods  have  been  practised. 
Some  are  sown  on  the  raw  surface  of  a  potato;  others  on 
bread  paste;  others  in  certain  jelly-like  materials,  such  as 
gelatin  or  agar-agar.  It  was  soon  found  as  a  result  of  these 
experiments  that  the  bacteria  flourished  best,  some  in  one 
soil,  some  in  another.  Again,  the  crops  of  mould  which  come 
from  them  differ  greatly  in  color,  some  being  black,  some  red, 
some  white,  some  yellow,  etc.  A  third  method  also  is  by 
staining  them  with  various  dyes,  when  it  is  found  that  some 
bacteria  will  take  one  stain  best,  others  will  take  another, 
and  so  on  through  the  whole  list. 

At  first  it  was  thought  that  these  bacteria  existed  chiefly 
in  the  air,  and  hence  in  Lister's  early  methods  powerful 
spray-producing  apparatuses  were  used;  but,  while  it  is  true 
that  they  do  exist  in  the  air,  it  is  found  that  this  is  not  the 


PROGRESS  OF  SURGERY  IN  NINETEENTH  CENTURY.   337 

principal  source  of  infection.  There  is  no  substance  (which 
has  not  been  disinfected)  that  is  not  covered  with  the  germs 
of  these  little  plants.  They  exist  in  our  food  and  drink;  but 
the  intestine  is,  one  may  say,  a  natural  home  in  which  many 
exist  without  harm  to  the  body. 

From  a  surgical  point  of  view  their  existence  is  most 
important,  first  in  the  earth,  where,  as  I  have  already 
shown,  the  bacillus  of  lockjaw  is  most  frequently  found. 
So,  too,  the  bacillus  of  wool-sorters'  disease  (anthrax) 
exists  in  the  earth.  If  an  animal  dying  of  anthrax  is  buried, 
worms  coming  from  the  carcass  up  through  the  ground  carry 
the  infection  so  that  other  animals  grazing  over  this  surface 
will  readily  become  infected.  The  means  by  which  we  can 
avoid  infection  from  the  earth  is  very  evident, — viz.,  that 
every  person  who  has  been  run  over  by  the  cars  or  who  has 
fallen  on  the  ground  and  broken  his  leg,  etc.,  must  have  the 
wound  most  carefully  cleansed  from  all  dirt.  If  this  is 
scrupulously  done  the  danger  of  tetanus  or  other  similar  earth- 
born  bacterial  disease  is  almost  nothing. 

A  still  greater  danger  to  every  patient,  however,  is  found  in 
the  clothing,  in  the  skin,  and  all  dressings  which  are  applied  to 
wounds.  The  skin  is  full  of  bacteria  of  the  most  dangerous 
kind ;  even  the  spotless  hands  of  the  bride  are,  in  the  eyes  of 
the  surgeon,  dirty.  No  one  can  touch  a  wound  with  ordinarily 
clean  hands  without  infecting  it.  All  clothing,  dressings, 
— e.  g.,  lint  and  soft  linen  rags, — and  such  like  are  full  of 
bacteria  of  the  most  dangerous  kind.  Perhaps  the  most 
dangerous  place  is  the  space  under  the  nails  of  the  surgeon's 
hand,  for  the  mere  mechanical  removal  of  any  dirt  under  the 
nails  by  cleansing  them  does  not  make  them  clean  surgically. 
The  nails  must  be  cut  short  and  prepared  in  a  way  I  shall 
mention  directly  or  they  are  full  of  peril  to  any  patient  into 
whose  wound  a  non-disinfected  finger  is  introduced.  Again, 
another  source  of  infection  which  thirty  years  ago  we  never 

thought   of   is   our   instruments.     Then,    instruments   were 
22 


338  ADDRESSES   AND    OTHER   PAPERS. 

washed  with  soap  and  water  and  were  made  clean  to  the  eye; 
but  they  were  covered  with  death-dealing  bacteria  which 
especially  hid  in  the  joints  and  irregularities  of  the  surface  of 
all  instruments. 

All  of  these  somewhat  detailed  statements  lead  up  to  a  con- 
sideration of  the  difference  between  the  old  surgery  and  the 
new.  Thirty  years  ago  when  an  operation  was  to  be  per- 
formed or  an  accident  cared  for  we  laid  out  our  instruments, 
which  were  visibly  clean,  used  them  with  hands  which  were  as 
clean  as  those  of  any  gentleman,  and  applied  soft  linen  rags, 
lint,  and  other  dressings.  To-day  we  know  that  these 
apparently  clean  instruments,  hands,  and  dressings  are 
covered  with  bacteria  which  produce  infection  and,  therefore, 
suppuration,  and  frequently  run  riot  in  blood-poisoning, 
erysipelas,  lockjaw,  and  death. 

How  does  a  modern  surgeon  perform  an  operation?  All 
bacteria  can  be  killed  by  heat.  Cold  has  no  effect  upon  them, 
but  the  temperature  of  boiling  water  (212°  F.)  is  sufficient  to 
destroy  them  all,  usually  within  fifteen  or  twenty  minutes; 
hence,  first,  instruments  are  all  boiled,  and,  secondly,  dress- 
ings are  either  steeped  in  such  solutions  as  have  been  found 
to  destroy  the  bacteria,  such  as  carbolic  acid  or  corrosive  sub- 
limate, or  other  preparations,  or,  still  better,  are  placed  in 
sterilizers,  that  is  to  say,  metal  cylinders,  which  are  then  filled 
with  steam,  usually  under  pressure,  so  as  to  obtain  a  tempera- 
ture of  240°  F.,  and  thus  make  sure  of  the  death  of  the 
bacteria.  Unfortunately  our  hands  cannot  be  boiled  or 
steamed,  but  the  modern  surgeon  first  uses  soap  and  water 
most  vigorously  over  his  hands  and  arms  beyond  the  elbows. 
The  nails  are  cut  short  and  the  scrubbing  brush  is  especially 
applied  to  the  nails  so  as  to  clean  the  fingers  at  their  ends. 
Then  by  various  means,  such  as  pure  alcohol,  which  is  one  of 
our  best  disinfectants,  or  solutions  of  corrosive  sublimate,  and 
other  means  too  technical  to  mention,  the  hands  are  sterilized. 
Rubber  gloves  are  frequently  used,  so  as  to  preclude  infection, 


PROGRESS  OF  SURGERY  IN  NINETEENTH  CENTURY.   339 

as  they  can  be  steamed  to  240°  F.  Removing  at  least  his 
outer  clothing,  the  surgeon  puts  on  a  cotton  gown  which  has 
been  steamed  and  so  made  free  from  bacteria.  Not  a  few 
surgeons  also  wear  sterilized  caps,  so  that  any  bacteria  in  the 
hair  will  not  be  sifted  into  a  wound,  and  some  wear  respirators 
of  sterile  gauze  over  the  mouth  and  beard  for  a  similar  reason. 
All  the  dressings  have  been  sterilized  by  superheated  steam. 
All  the  threads  by  which  blood-vessels  are  tied  have  been 
either  boiled  or  otherwise  sterilized.  All  the  material  for 
sewing  up  the  wounds  and  the  needles  with  which  they  are 
sewn  up  have  been  similarly  disinfected.  The  skin  of  the 
patient  is  also  sterilized,  usually  the  day  beforehand,  in  the 
same  manner  in  which  the  surgeon's  hands  have  been  disin- 
fected and  are  disinfected  a  second  time  just  at  the  moment 
of  the  operation.  If  the  case  is  one  of  accident,  such  as  a 
crushed  leg  from  a  trolley  car,  all  of  the  dirt  is  most  carefully 
washed  away  with  soap  and  water  and  the  parts  are  disin- 
fected, not  only  on  the  exterior,  but  also  by  prolonged  wash- 
ing with  some  cleansing  agent  in  the  interior  of  the  wound,  the 
patient  being  under  the  influence  of  ether,  of  course. 

It  is  easily  seen  from  such  a  description  of  a  modern  opera- 
tion that  no  case  can  receive  due  care  in  one  of  our  modern 
homes,  even  the  best.  The  facilities  do  not  exist,  and  hence 
surgeons  are  more  and  more  declining  to  do  operations, 
whether  for  accident  or  disease,  in  private  houses,  except  hi 
cases  of  absolute  necessity,  and  a  happy  custom  is  growing 
more  and  more  in  favor  with  the  community  of  having  all 
operations  done  and  all  accidents  cared  for  in  a  well-equipped 
modern  hospital. 

XII.  RESULTS  OF  MODERN  SURGERY. 
As  the  result  of  our  ability  to  perform  operations  without 
pain,  thanks  to  anaesthesia,  and  our  ability  to  perform  opera- 
tions without  infection,  and,  therefore,  almost  without  dan- 


340  ADDRESSES   AND   OTHER   PAPERS. 

ger,  thanks  to  antisepsis,  the  range  of  modern  surgery  has 
been  enormously  increased.  Unless  one  has  lived  through 
the  old  surgery  and  into  the  new  he  scarcely  can  appreciate 
this  widening  of  the  field  of  operative  surgery.  Thirty  years 
ago,  in  consequence  of  the  great  danger  of  opening  the  head, 
the  chest,  or  the  abdomen,  or,  in  fact,  of  making  an  incision 
anywhere  about  the  body,  the  surgeon  never  dared  to  inter- 
fere until  he  was  obliged  to  do  so.  Hence,  not  only  were 
many  modern  operations  not  even  thought  of,  but  in  obscure 
cases  we  had  to  wait  until  time  and  disease  developed  symp- 
toms and  physical  signs  such  that  we  were  sure  of  our  diag- 
nosis and  then,  knowing  that  death  would  follow  if  we  did 
not  interfere,  we  ventured  to  operate.  Now  we  anticipate 
such  a  fatal  termination,  and  in  most  cases  can  avert  it. 

In  perhaps  no  class  of  cases  has  the  benefit  of  this  immunity 
from  infection  and  danger  been  shown  than  in  the  obscure 
diseases  of  the  brain  and  the  abdomen.  To-day  if  we  are 
uncertain  as  to  whether  there  is  serious  danger  going  on 
which  if  unchecked  will  result  in  death,  we  deliberately 
open  the  one  cavity  or  the  other  in  order  to  find  out  the  exact 
state  of  affairs.  Supposing  that  the  mischief  is  trifling  or 
even  that  there  is  no  mischief,  we  then  know  how  to  deal 
with  the  symptoms  which  have  been  puzzling  us.  So  far 
as  the  exploratory  operation  is  concerned,  the  patient  re- 
covers from  it  in  a  short  time,  and,  meantime,  perhaps,  has 
also  been  cured  of  the  symptoms  which  were  before  so  ill 
understood.  If  any  serious  disease  is  found,  hi  the  majority 
of  cases  we  can  cope  with  it  successfully.  Before  the  days 
of  antisepsis  and  anaesthesia  the  field  of  operation  was  greatly 
restricted,  and  practically  the  removal  of  tumors,  amputa- 
tions, and  a  few  other  operations  were  all  that  were  done. 
Now  all  the  then  inaccessible  organs  are  attacked  with  an 
intrepidity  born  of  an  assurance  of  safety.  Recovery  usually 
sets  the  seal  of  approval  on  the  judgment  of  the  surgeon. 
Thirty  years  ago,  taking  all  operations  together,  fully  one- 


PROGRESS  OF  SURGERY  IN  NINETEENTH  CENTURY.   341 

third  of  our  patients  died,  many  of  them  often  from  slight 
operations  which  were  followed  by  infection.  To-day,  in- 
cluding even  the  far  more  grave  operations  which  are  now 
done,  the  general  mortality  will  scarcely  exceed  five  per 
cent.,  and  many  surgeons  are  able  in  a  series  of  several  hun- 
derd  operations  to  save  ninety-seven  out  of  every  hundred 
patients. 

XIII.  SERUM  TREATMENT. 

Another  remarkable  recent  discovery,  the  result  of  numer- 
ous and  careful  investigations  in  the  laboratory,  is  a  wholly 
new  means  of  treatment, — viz.,  that  method  which  is  known 
as  orrhotherapy  or  serum-therapy,  or  the  treatment  by  in- 
jecting certain  antitoxines  under  the  skin  by  a  hypodermatic 
syringe.  It  would  lead  me  too  far  to  enter  into  the  theory 
upon  which  these  were  first  used.  Suffice  it  to  say  that  in 
the  blood  of  an  animal  that  has  passed  through  a  certain 
disorder  the  liquid  part  contains  an  antidote  or  antitoxine. 
If  a  certain  amount  of  this  is  injected  under  the  skin  of  an 
animal  or  man  suffering  from  the  same  disorder  in  its  in- 
cipient stages  the  antitoxine  prevents  the  development  of  the 
disease.  The  use  of  this  method  has  thus  far  been  much 
more  medical  than  surgical  and  its  results  in  diphtheria  and 
other  medical  disorders  have  been  perfectly  marvellous.  In 
surgery,  however,  less  favorable  results  have  been  obtained, 
but  in  all  probability  in  the  future  we  shall  be  able  to  do 
for  some  of  our  surgical  disorders  what  the  physician  can 
do  to-day  for  diphtheria.* 

There  has  been  also  discovered  another  means  which  in 
surgery  has  rendered  some  valuable  service.  From  certain 
organs,  as,  for  instance,  the  thyroid  gland  (the  gland  whose 
enlargement  produces  goitre),  we  can  obtain  a  very  potent 
extract  of  great  value.  In  cases  of  goitre  very  noteworthy 

*  For  the  remarkable  results  in  diphtheria  I  must  refer  the  reader  to 
Professor  Osier's  paper  in  this  same  series  of  papers. 


342  ADDRESSES   AND   OTHER   PAPERS. 

results  have  already  been  obtained  by  the  administration 
of  this  thyroid  extract.  A  number  of  other  organs  in  the 
body  of  animals  have  been  used  to  combat  certain  disorders 
in  the  human  body  with  advantage.  The  chief  develop- 
ment of  both  of  these  new  forms  of  medication,  however, 
will  take  place  in  the  twentieth  century. 


XIV.  INSTRUMENTS  OF  PRECISION. 

Another  direction  in  which  the  century  has  seen  enor- 
mous progress  is  in  the  introduction  of  instruments  of  pre- 
cision. When  I  was  a  student  in  the  early  sixties  instruction 
in  microscopy  was  conspicuous  only  by  its  absence  from 
our  medical  curriculum.  Now,  every  student  who  graduates 
is  more  or  less  of  an  accomplished  microscopist  and  carries 
into  his  practice  the  methods  and  observations  which  the 
microscope  furnishes  him.  At  the  same  period  I  remember 
being  greatly  interested  in  a  discussion  which  two  of  my 
teachers  had  as  to  whether  it  was  possible  to  make  an  appli- 
cation accurately  to  the  vocal  chords  in  the  larynx.  Now 
every  tyro  hi  medicine  makes  such  applications  to  the  larynx 
as  a  routine  procedure  in  cases  requiring  it,  and  similar 
methods  have  been  applied  by  the  ophthalmoscope  to  examine 
the  interior  of  the  eye;  the  rhinoscope,  to  examine  the  in- 
terior of  the  nose;  the  otoscope,  for  examination  of  the  ear, 
and  other  similar  instruments  for  examining  all  the  other 
hollow  organs  in  the  body.  If  I  add  to  these  the  hypodermatic 
syringe,  the  aspirator,  which  may  be  described  as  a  large 
hypodermatic  syringe  for  suction  instead  of  injection;  the 
clinical  thermometer,  which  was  introduced  in  the  late  six- 
ties; the  haemostatic  forceps,  for  controlling  haemorrhage 
by  seizing  the  blood-vessels  and  clamping  them  till  we  have 
time  to  tie  them,  and  other  instruments  intended  to  facilitate 
our  operative  methods,  it  will  be  seen  at  once  that  the  arma- 
mentarium of  the  modern  surgeon  is  very  different  from  that 


PROGRESS  OF  SURGERY  IN  NINETEENTH  CENTURY.   343 

of  his  predecessor  at  the  beginning,  or  even  at  the  middle, 
of  the  century. 


XV.    THE  ROENTGEN  RAY. 

One  of  those  extraordinary  discoveries  which  startle  the 
whole  world  was  made  nearly  at  the  end  of  the  present  century, 
in  the  winter  of  1895-96.  At  that  time  a  modest  professor 
in  the  University  of  Wiirzburg,  announced  that  he  could 
readily  see  the  skeleton  inside  the  body  through  the  flesh. 
Naturally,  the  first  announcement  was  received  with  almost 
absolute  incredulity,  but  very  soon  his  discovery  was  confirmed 
from  all  sides  and  it  has  now  taken  its  place  among  the  recog- 
nized facts  of  science.  By  means  of  certain  rays,  which, 
being  of  unknown  nature,  were  called  "X"  rays,  after  the 
well-known  mathematical  x,  or  unknown  quantity,  Professor 
Roentgen  has  shown  us  that  not  only  can  the  bones  be  seen, 
but  that  almost  all  the  organs  in  the  body  can  be  seen  and 
their  form  and  structure  reproduced  in  pictures.  The  reason 
they  can  be  seen  is  because  they  are  all  obstacles  to  the  pass- 
age of  these  x-rays  and  so  produce  shadows  on  a  sensitized 
photographic  plate. 

If  the  exposure  is  sufficiently  prolonged  the  rays  pene- 
trate even  through  the  bones  and  act  upon  the  photographic 
plate,  so  that  no  shadow  remains.  If  the  rays  are  allowed 
to  penetrate  for  a  shorter  time  the  bones  show  dense  shadows 
and  one  can  get  a  light  shadow  of  the  soft  parts.  If  the 
exposure  is  still  shorter,  then  we  can  recognize  the  dense 
shadow  of  the  bone,  the  much  less  dense  shadows  of  the  mus- 
cles, and  the  still  lighter  shadows  of  the  layer  of  fat  immedi- 
ately under  the  skin.  The  heart  can  be  seen  beating  and  its 
shadow  is  now  a  well-recognized  feature  in  skiagraphs  of  the 
chest.  At  first  it  was  thought  impossible  to  discover  anything 
inside  of  the  bony  skull,  but  there  are  now  on  record  nearly  a 
score  of  instances  in  which  bullets  have  been  detected  within 


344  ADDRESSES   AND   OTHER   PAPERS. 

the  skull,  and  after  trephining  have  been  found  and  removed 
exactly  at  the  location  indicated.  It  is  a  very  common  thing 
now  to  locate  a  piece  of  steel  or  other  similar  foreign  bodies 
within  the  eyeball  by  the  method  of  Dr.  Sweet,  or  some  simi- 
lar method  within  one  or  two  millimetres  (a  millimetre  is  one 
twenty-fifth  of  an  inch).  It  is  now  well  recognized  that  even 
stones  in  the  kidney  will  throw  shadows  sufficiently  strong 
for  them  to  be  recognized,  and,  by  noting  their  level  in  rela- 
tion to  the  vertebrae,  we  can  tell  precisely  in  what  part  of  the 
kidney  to  make  the  incision  in  order  to  find  and  remove 
them.  It  has  happened  to  myself  and  many  other  surgeons 
to  cut  down  upon  a  kidney,  believing  that  there  was  a  stone 
in  the  kidney,  only  to  find  that  we  had  been  misled  by  the 
apparently  clear  symptoms  of  such  a  foreign  body.  In  fu- 
ture no  such  mistakes  should  be  made  by  any  surgeon  within 
reach  of  a  skillful  skiagrapher.  Unfortunately,  gall-stones* 
and  numerous  other  foreign  bodies,  vegetable  substances, 
such  as  beans,  corn,  wood,  etc.,  being  as  transparent  to  the 
x-rays  as  are  the  soft  parts,  are  not  revealed  by  means  of  this 
new  method  of  investigation;  but  cavities  in  the  lung,  ab- 
scesses in  bone,  and  similar  diseases  which  produce  thinning 
of  the  lung,  bone,  and  other  such  organs,  and  so  lighten  instead 
of  deepen  the  shadows,  can  now  be  recognized  by  means  of 
light  spots  in  the  pictures  as  well  as  others  by  means  of  a 
shadow. 

I  spoke  a  moment  ago  of  the  need  of  a  skillful  skiagrapher, 
for  it  must  be  remembered  that  there  may  be  the  same  dif- 
ference in  the  personal  skill  and,  therefore,  in  the  reliability 
of  the  results,  in  skiagraphy  as  there  is  in  photography.  A 
poor  photographer  will  get  results  very  different  from  a  skill- 
ful one,  even  if  he  uses  precisely  the  same  quality  of  plates 
and  precisely  the  same  camera.  Personal  skill  and  experience 
in  the  skiagrapher  is,  therefore,  one  of  the  most  important 
elements  in  success.  It  must  be  remembered,  also,  that  the 

*  Of  course,  happily,  this  is  no  longer  true. — (W.  W.  K.,  1905.) 


PROGRESS  OF  SURGERY  IN  NINETEENTH  CENTURY.   345 

rr-rays  in  not  a  few  cases  may  mislead  us.  I  have  personally 
fractured  a  bone  on  account  of  deformity,  and  taken  the 
z-ray  picture  immediately  after  the  operation,  and  yet  the 
picture  showed  not  the  slightest  evidence  of  a  fracture  which 
I  absolutely  knew  existed.  Moreover,  foreign  bodies  found 
on  the  outside  of  the  person  may  mislead  us,  as,  for  example, 
the  metal  part  of  suspenders,  a  coin  in  one's  pocket,  and 
such  like.  They  look  in  the  picture  as  if  they  were  inside 
rather  than  outside  the  body,  and  any  article  the  shape  or 
size  of  which  would  not  reveal  its  nature  might  easily  be  mis- 
taken for  a  foreign  body  within  the  patient.  Therefore,  in 
many  cases  only  an  expert  can  determine  precisely  what  the 
skiagraph  means.  I  especially  mention  this,  because  there  is 
a  tendency  at  present  to  utilize  skiagraphs  in  court  in  order  to 
convince  the  jury  that  such  a  picture  is  an  evidence  of  mal- 
practice. Such  pictures  always  need  an  interpreter  in  order 
to  judge  correctly  of  their  meaning.  It  is  precisely  as  if  the 
jury  were  asked  to  look  through  a  microscope.  I  have  been 
myself  accustomed  to  use  the  microscope  for  thirty  years, 
but  there  are  many  instances  even  yet  in  which  I  am  obliged 
to  ask  a  pathologist  or  bacteriologist  what  I  really  am  look- 
ing at  in  the  microscope.  While  one  may  make  a  mistake  of 
small  moment  in  some  cases,  yet  if  a  man's  life  or  liberty  or 
purse  is  at  the  mercy  of  a  jury  which  does  not  know  how  to 
interpret  a  skiagraph  and  may,  therefore,  give  a  verdict 
which  is  "precisely  wrong,"  as  Professor  Lincoln,  my  old 
teacher  of  Latin,  used  to  call  many  of  our  translations,  it  will 
be  a  very  serious  matter  and  lead  to  gross  injustice. 


XVI.  CITY  AND  VILLAGE  HOSPITALS. 

Another  great  improvement  in  our  means  of  caring  for  our 

surgical  patients  is  the  establishment  of  hospitals  all  over  the 

land.     These,  happily,  are  not  limited  to  our  great  cities,  but 

in  every  country  town  and  not  a  few  large  villages,  small,  but 


346  ADDRESSES  AND   OTHER   PAPERS. 

well-equipped  and  well-managed,  hospitals  have  been  estab- 
lished and  have  done  incalculable  good.  It  is  not  too  much 
to  say  that  every  city  or  town  establishing  such  a  hospital  is 
repaid  a  hundredfold. 


XVII.  TRAINED  NURSES. 

The  trained  nurse  has,  fortunately,  come  to  stay.  In  fact, 
our  antiseptic  methods  as  above  described  have  made  the 
trained  nurse  indispensable.  The  old  nurse  who  by  many 
clumsy  experiments  on  her  patients  had  obtained  a  certain 
rule-of-thumb  knowledge  of  the  care  of  the  sick  can  no  longer 
assist  in  a  surgical  operation  or  properly  care  for  any  surgical 
patient.  The  modern  nurse  must  of  necessity  be  a  well- 
educated,  well-trained  woman  knowing  thoroughly  modern 
antiseptic  methods  and  on  the  alert  to  observe  every  symptom 
of  improvement  and  every  signal  of  danger. 

Without  a  well-trained  nurse  it  is  impossible  at  the  present 
day  properly  to  care  for  any  serious  surgical  case,  and  I 
gladly  bear  witness  to  the  intelligence,  fidelity,  and  skill  of 
scores  of  nurses  who  have  assisted  me,  without  whom  I  should 
have  felt  as  one  blade  of  a  scissors  without  its  fellow. 


XVIII.  SPECIAL  OPERATIONS. 

(a)  Amputations  and  Compound  Fractures. — Having  now 
traced  the  different  modes  of  thought  which  have  aided  surgi- 
cal progress  in  the  present  century  and  the  different  means  of 
investigation,  let  us  turn  finally  to  the  progress  in  individual 
operations.  As  to  amputations  and  compound  fractures,  I 
have  already  indicated  the  immense  improvements  which 
have  followed  the  introduction  of  anaesthesia  and  especially 
of  antisepsis,  which  have  brought  the  mortality  of  amputa- 
tions down  from  50  or  60  per  cent,  to  10  or  15  per  cent.,  and 
in  compound  fractures,  once  so  dreaded,  since  the  mortality 


PROGRESS  OF  SURGERY  IN  NINETEENTH  CENTURY.   347 

was  not  infrequently  as  high  as  2  out  of  3  to  a  relatively 
insignificant  danger. 

(b)  Tumors. — In  no  department,  perhaps,  has  the  intro- 
duction of  antisepsis  and  the  use  of  catgut  and  silk  ligatures 
after  the  antiseptic  method  brought  about  a  greater  improve- 
ment than  in  operations  for  tumors.    The  startling  reluctance 
of  Sir  Astley  Cooper  to  operate  on  King  George  IV,  for  so  sim- 
ple and  small  a  tumor  as  a  wen,  lest  erysipelas  might  follow 
and  even   destroy  his    life — a  very  common    danger   100 
years  ago — is  in  marked  contrast  with  the  success  and, 
therefore   the  boldness,   of  modern  surgeons.      Tumors   in 
all  parts  of  the  body,  whether  they  be  external  or  internal, 
whether  they  involve  the  wall  of  the  chest  or  are  inside 
the  abdomen,  are  now  dealt  with  with  almost  perfect  safety. 
Anaesthesia  has  made  it  possible  to  dissect  out  tumors  in  so 
dangerous  a  region  as  the  neck,  where  the  surgeon  is  con- 
fronted with  adhesions  to  the  jugular  vein,  the  carotid  artery, 
and  the  nerves  of  the  neck  and  of  the  arm,  with  the  greatest 
impunity.     Such  an  operation  not  uncommonly  lasts  from 
three-fourths  of  an  hour  to  an  hour  and  a  half,  and  involves 
often  the  removal  of  two  or  three  inches  of  the  jugular  vein 
and  many  of  the  large  nerves,  the  removal  of  which  a  few 
years  ago  would  have  been  deemed  an  impossibility. 

(c)  Goitre. — One  of  the  most  striking  instances  of  progress 
is  operations  on  goitre.    Writing  in   1876,   the  late  Prof. 
Samuel  D.  Gross  noted  it  as  something  remarkable  that  Dr. 
Green,   of   Portland,    Me.,  had  removed  7  goitres  with  2 
deaths,  and  the  late  Dr.  Maury,  of  Philadelphia,  had  extir- 
pated 2  goitres  with  1  death.     In  marked  contrast  to  this 
Professor  Kocher,  of  Berne,  in  1895  reported  1000  cases,  of 
which  870  were  non-cancerous,  and  he  lost  of  these  last  but 
11  cases,  or  a  little  over  1  per  cent.    In  1898  he  reported 
600  additional  cases,  with  only  1    death   in  the  556   non- 
cancerous  cases,  or  a  mortality  of  only  0.1  per  cent.     It  will 
be  seen,  therefore,  that  an  operation  which  a  few  years  ago 


348  ADDRESSES   AND    OTHER    PAPERS. 

was  excessively  fatal  has  become,  one  might  say,  almost  per- 
fectly safe. 

(d)  Surgery  of  the  Bones. — Operations  on  bones  apart  from 
amputations  show  also  a  similar  improvement.  In  cases  of 
deformity  following  fracture  we  now  do  not  hesitate  to  cut 
down  upon  the  bone  and  refracture  it  or  remove  the  deformed 
portion,  join  the  ends  together,  dress  the  part  in  plaster  of 
Paris  to  secure  fixation,  and  have  the  patient  recover  with 
little  or  no  fever  and  no  suppuration.  Above  the  elbow  a 
large  nerve  runs  in  a  furrow  in  the  arm  bone,  and  in  case 
of  fracture  this  is  liable  to  be  torn  and  a  portion  of  it 
destroyed.  The  result  of  it  is  paralysis  of  all  the  muscles 
on  the  back  of  the  forearm  from  the  elbow  down,  and  conse- 
quent inability  to  extend  either  wrist  or  fingers,  mak- 
ing the  hand  almost  useless.  In  a  number  of  cases  the 
nerve  has  been  sought  for  and  found,  but  the  ends  have 
been  too  far  apart  to  sew  them  together.  In  such  cases  we 
do  not  hesitate  now,  in  order  to  bring  the  two  ends  of  the 
nerve  together,  to  remove  one  or  two  inches  of  the  arm  bone, 
wire  together  the  two  ends  of  the  shortened  bone,  sew  the 
now  approximated  ends  of  the  nerve  together,  put  the  arm  in 
plaster,  and  as  soon  as  the  wound  is  healed,  with  appropriate 
later  treatment  to  the  muscles,  we  can  obtain  in  a  reasonable 
number  of  cases  a  perfect,  or  almost  perfect,  union  of  the 
nerves  and  a  re-establishment  of  the  usefulness  of  the  hand. 

In  very  many  cases  the  bones  are  deformed  as  a  result  of 
rickets  and  in  some  cases  in  consequence  of  hip-joint  disease. 
In  such  cases  the  leg  is  crooked  or  flexed  and  cannot  be  used 
for  walking.  Such  cases  of  stiff  joints  and  crooked  legs  are 
now  operated  on,  one  might  say,  wholesale.  At  the  Inter- 
national Medical  Congress,  held  in  Copenhagen  in  1884, 
Professor  Macewen,  of  Glasgow,  reported  1800  operations  on 
1267  limbs  in  704  patients  in  which  he  had  sawn  or  chiselled 
through  the  bones  so  as  to  fracture  them,  placed  them  in  a 
straight  position,  and  after  a  few  weeks  the  bone  has  become 


PROGRESS  OF  SURGERY  IN  NINETEENTH  CENTURY.   349 

consolidated  and  the  leg  or  arm  made  straight.  The  whole 
number  of  operations  was  successful  excepting  five  cases,  and 
even  these  deaths  were  not  due  to  the  operation,  but  to  some 
other  disorder,  such  as  an  unexpected  attack  of  pneumonia, 
diphtheria,  or  scarlet  fever. 

(e)  Surgery  of  the  Head  and  Brain. — In  the  surgery  of  the 
head  we  find  one  of  the  most  remarkable  illustrations  of  the 
modern  progress  of  surgery.  Fractures  of  the  skull  have  been 
the  most  dangerous  and  fatal  of  accidents  until  within  a  short 
time.  Of  course,  many  of  them  even  now  must  necessarily 
be  fatal  from  the  widespread  injury  to  the  bones  and  the  brain. 
But  our  modern  methods  by  which  we  can  disinfect  the  cavi- 
ties of  the  ear,  the  nose,  and  the  mouth,  with  which  these 
fractures  often  communicate  and  through  these  avenues  be- 
come infected,  are  so  successful  that  such  cases,  instead  of 
being  looked  upon  as  hopeless,  are  in  a  majority  of  instances 
followed  by  recovery.  Even  gunshot  wounds  in  which  the 
ball  may  remain  inside  the  cavity  of  the  head  are  successfully 
dealt  with,  unless  the  injury  produced  by  the  ball  has  been 
necessarily  fatal  from  the  start.  Fluhrer,  of  New  York,  has 
reported  a  very  remarkable  case  of  gunshot  wound  in 
which  the  ball  entered  at  the  forehead,  traversed  the  entire 
brain,  was  deflected  at  the  back  of  the  skull,  and  then 
pursued  its  course  further  downward  in  the  brain.  By 
trephining  the  skull  at  the  back  of  the  head  he  found  the 
ball,  passed  a  rubber  drainage  tube  through  the  entire  brain 
from  front  to  back  and  had  the  satisfaction  of  seeing  the 
patient  recover. 

Until  1884  it  was  excessively  difficult  to  locate  with  any 
degree  of  accuracy  a  tumor  within  the  brain,  but  in  that  year 
Dr.  Bennett,  of  London,  for  the  first  time  accurately  located 
a  tumor  within  the  skull  without  there  being  the  slightest 
evidence  on  the  exterior  of  its  existence,  much  less  of  its  loca- 
tion. Mr.  Godlee  (surgeons  in  England  are  not  called  "  Dr.," 
but  "Mr.")  trephined  the  skull  at  the  point  indicated,  found 


350  ADDRESSES   AND    OTHER   PAPERS. 

the  tumor,  and  removed  it.  True,  this  patient  died,  but  the 
possibility  of  accurately  locating  a  tumor  of  the  brain,  reach- 
ing it,  and  removing  it  was  now  demonstrated,  which  is  far 
more  important  to  humanity  at  large  than  whether  this  in- 
dividual patient  survived  or  not.  Since  then  there  has  been 
a  very  large  number  of  tumors  successfully  removed.  The 
latest  statistics  are  those  of  von  Bergmann,  of  Berlin,  hi  1898. 
He  collected  273  operations  for  brain  tumors,  of  which  169 
(61.9  per  cent.)  recovered  and  134  (38.1  per  cent.)  died. 
This  is  by  far  the  best  percentage  of  results  so  far  reported, 
but  there  is  reason  to  believe  that  with  the  constant  improve- 
ment in  our  ability  to  locate  such  tumors  and  in  our  methods 
of  removing  them  the  mortality  rate  will  be  still  further 
lessened. 

Even  more  successful  than  the  surgery  of  brain  tumors  has 
been  that  of  abscesses  of  the  brain.  I  have  no  available 
statistics  of  the  exact  numbers,  but  it  is  certain  that  several 
hundred  have  been  operated  on  and  with  even  better  success 
than  in  the  case  of  brain  tumors.  The  most  frequent  cause  for 
such  abscesses  is  old  and  neglected  disease  of  the  ear.  No 
child  suffering  from  a  "running  from  the  ear,"  which  is  es- 
pecially apt  to  follow  scarlet  fever  and  other  similar  disorders, 
should  be  allowed  to  pass  from  under  the  most  skilled  treat- 
ment until  a  cure  is  effected.  This  is  the  commonest  cause  of 
abscess  of  the  brain.  The  inflammation  in  the  ear  which  be- 
gins in  the  soft  lining  of  the  cavities  of  the  ear  finally  extends 
to  the  bone,  and  after  years  of  intermittent  discharge  will 
suddenly  develop  an  abscess  of  the  brain,  which,  if  not  re- 
lieved, will  certainly  be  fatal.  Prompt  surgical  interference 
alone  can  save  life,  and,  happily,  though  we  cannot  promise 
recovery  in  all,  a  very  large  percentage  of  success  is  assured. 

In  epilepsy  as  a  result  of  injuries  of  the  head,  in  a  moderate 
number  of  cases  we  can  obtain  a  cure  of  the  disease  by  opera- 
tion, but  in  the  great  majority  of  cases,  and,  one  may  say, 
practically  in  all  of  the  cases  in  which  the  epilepsy  originates 


PROGRESS  OF  SURGERY  IN  NINETEENTH  CENTURY.   351 

"of  itself," — that  is  to  say,  without  any  known  cause, — 
it  is  useless  to  operate,  certainly  at  least  after  the  epileptic 
habit  has  been  formed.  Possibly  were  operation  done  at  the 
very  beginning  we  might  obtain  better  results  than  experience 
thus  far  has  shown  us  is  possible. 

Very  many  cases  of  idiocy  are  constantly  brought  to  sur- 
geons in  the  hope  that  something  can  be  done  for  these  lam- 
entable children.  Unfortunately,  at  present  surgery  holds 
out  but  little  hope  in  such  cases.  In  a  few  exceptional 
instances  it  may  be  best  to  operate,  but  a  prudent  surgeon  will 
decline  to  do  any  operation  in  the  vast  majority  of  cases. 

(f)  Surgery  of  the  Chest  and  Heart. — The  chest  is  the  region 
of  the  body  which  has  shown  the  least  progress  of  all,  and  yet 
even  here  the  progress  is  very  marked.     When,  as  a  result 
of  pleurisy,  fluid  accumulates  on  one  side  of  the  chest,  even 
displacing  the  heart,  we  now  do  not  hesitate  to  remove  an 
inch  or  two  of  one  or  more  ribs  and  thoroughly  drain  the  cavity 
with  not  only  a  reasonable,  but  in  a  majority  of  cases,  one 
may  almost  say,  a  certain  prospect  of  cure.     We  have  also 
entered  upon  the  road  which  will  lead  us  in  time  to  a  secure 
surgery  of  the  lung  itself.     A  few  cases  of  abscess,  of  serious 
gunshot  wound  attended  by  otherwise  fatal  haemorrhage,  and 
even  of  tuberculous  cavities  in  the  lungs  have  been  successfully 
dealt  with,  but  the  next  century  will  see,  I  have  no  doubt, 
brilliant  results  in  thoracic  surgery. 

One  of  the  most  striking  injuries  of  the  chest  has  recently 
assumed  a  new  importance, — viz.,  wounds  of  the  heart  itself. 
In  several  instances  an  opening  has  been  made  in  the  bony  and 
muscular  walls  of  the  chest  and  a  wound  of  the  heart  itself  has 
been  sewed  up.  The  number  is  as  yet  small,  but  there  have 
been  several  recoveries,  which  lead  us  to  believe  that  here,  too, 
the  limits  of  surgery  have  by  no  means  been  reached.* 

(g)  Surgery  of  the  Abdomen. — Of  the  abdomen  and  the  pelvis 

*  Stewart  (Amer.  Jour.  Med.  Sci.,  Sept.,  1904,  p.  431)  has  collected  60 
cases  with  23  recoveries.— (W.  W.  K.,  1905.) 


352  ADDRESSES   AND   OTHER   PAPERS. 

a  very  different  story  can  be  told.  These  cavities  might 
almost  be  called  the  playground  of  the  surgeon,  and  'the 
remarkable  results  which  have  been  obtained  warrant  us  in 
believing  that  even  greater  results  are  hi  store  for  us  in  the 
future. 

In  the  earlier  part  of  this  article  I  spoke  of  the  advantages 
of  the  study  of  the  pathological  anatomy  of  the  diseased  con- 
dition of  individual  organs.  Perhaps  no  better  illustration  of 
the  value  of  this  can  be  given  than  in  the  study  of  appendicitis. 
This  operation  has  been  one  of  the  contributions  to  the 
surgery  of  the  world  in  which  America  has  been  foremost. 
While  there  were  one  or  two  earlier  papers,  Willard  Parker,  of 
New  York,  in  1867  first  made  the  profession  listen  to  him 
when  he  urged  that  abscesses  appearing  above  the  right  groin 
should  be  operated  on  and  the  patient's  life  saved.  But  it 
was  not  until  Fitz,  of  Boston,  in  1886,  published  his  paper,  hi 
which  he  pointed  out,  as  a  result  of  a  study  of  a  series  of 
postmortem  examinations  of  persons  dying  from  such  an 
abscess  above  the  right  groin,  that  the  appendix  was  the  seat 
of  the  trouble  that  this  so  frequent  disease  was  rightly  under- 
stood and  rightly  treated.  As  a  result  of  the  facts  gathered  in 
his  paper,  the  treatment  was  perfectly  clear,  not  only  that  we 
ought  to  operate  in  cases  of  abscess,  but  that,  in  the  case  of 
patients  suffering  from  two  or  more  attacks  and  often  from 
even  one  attack  of  appendicitis,  the  appendix  should  be  re- 
moved to  prevent  such  abscess. 

The  mortality  in  cases  in  which  such  an  abscess  has  formed 
is,  perhaps,  quite  20  or  25  per  cent.,  whereas,  if  patients  are 
operated  on  "in  the  interval," — that  is  to  say,  when  the 
abdominal  cavity  is  free  from  pus, — the  mortality  is  scarcely 
more  than  2  or  3  per  cent.,  and  may  be  even  less. 

Surgeons  are  often  asked  whether  appendicitis  is  not  a 
fad  and  whether  our  grandfathers  ever  had  appendicitis, 
etc.  As  a  matter  of  fact,  in  my  early  professional  days 
appendicitis  was  well  known.  It  was  called  "localized  peri- 


PROGRESS  OF  SURGERY  IN  NINETEENTH  CENTURY.   353 

tonitis,"  or  " localized  abscess,"  but  while  the  disease  was 
very  frequent,  its  relation  to  the  appendix  was  not  recognized 
until,  from  his  study  of  its  pathology,  an  American  (Fitz) 
pointed  it  out.  Even  now  European  surgeons,  with  a  few 
exceptions,  are  not  alive  to  the  need  for  operation  in  such 
cases. 

There  is  little  doubt  that  the  great  prevalence  of  grippe 
during  the  last  few  years  has  increased  the  number  of  cases  of 
appendicitis,  both  of  them  being  catarrhal  conditions  of  the 
lining  membrane  of  the  same  continuous  tract  of  the  lungs, 
the  mouth,  the  stomach,  and  the  intestines. 

One  of  the  most  fatal  accidents  that  can  befall  a  patient  is 
to  have  an  ulcer  of  the  stomach  perforate  so  that  the  contents 
of  the  stomach  escape  into  the  general  abdominal  cavity. 
Until  1885  no  one  ventured  to  operate  in  such  a  case.  In  an 
inaugural  dissertation  by  Tinker,  of  Philadelphia,  232  cases  of 
such  perforating  ulcers  of  the  stomach  have  been  collected,  of 
which  123  recovered,  a  mortality  of  48.81  per  cent.  In  not  a 
few  of  them,  if  prompt  instead  of  late  surgical  help  had  been 
invoked,  even  a  still  better  result  would  have  been  reported. 
If  no  operation  had  been  done  the  mortality  would  have  been 
100  per  cent. 

In  cancer  of  the  stomach  itself  we  are  able,  as  a  rule,  to  make 
a  positive  diagnosis  only  when  a  perceptible  tumor  is  found. 
By  that  time  so  many  adhesions  have  formed  and  the  infection 
has  involved  the  neighboring  glands  to  such  an  extent  that 
it  is  impossible  to  remove  the  tumor,  but  the  statistics  even 
here  are  not  without  encouragement,  at  least  for  comfort  if  not 
for  life.  In  many  cases  the  tumor  has  been  removed  and  the 
stomach  and  intestine  joined  together  by  various  devices,  and 
the  mortality,  which  at  first  was  necessarily  great,  has  been 
reduced  by  Czerny  to  12  per  cent,  and  by  Carle  to  7  per  cent. 
Even  the  entire  stomach  has  been  removed  in  several  cases 
and  recovery  has  followed  in  about  one  half.  Most  of  these 
patients,  however,  have  died  from  a  return  of  the  disease. 

23 


354  ADDRESSES   AND    OTHER   PAPERS. 

When,  as  a  result  of  swallowing  caustic  lye  or  other  similar 
substances,  the  gullet  (the  oesophagus)  becomes  contracted 
to  such  an  extent  that  no  food  can  be  swallowed,  we  now 
establish  an  opening  into  the  stomach  through  which  a  tube 
is  inserted  at  mealtime  and  the  patient  has  his  breakfast, 
dinner,  and  supper  poured  into  his  stomach  through  the  tube. 
If  the  stricture  of  the  oesophagus  is  from  malignant  disease, 
of  course  this  only  prolongs  life  by  preventing  a  horrible  death 
by  starvation,  but  in  cases  in  which  it  is  non-malignant  life 
is  indefinitely  prolonged.  The  mortality  of  such  an  operation 
is  very  small. 

By  a  freak  of  nature  or  disease  the  stomach  sometimes  is 
narrowed  in  the  middle,  forming  what  is  called  an  "hour-glass 
stomach."  In  such  a  case  we  open  the  abdomen,  make  an 
opening  into  the  two  parts  of  the  stomach,  and  unite  the  edges 
of  the  two  openings  so  that  we  re-establish  the  single  cavity  of 
the  stomach.  The  mortality  of  the  operation  is  very  slight, — 
8  per  cent.  Again,  sometimes  the  stomach  becomes  unduly 
dilated,  thus  interfering  seriously  with  its  function.  A  num- 
ber of  surgeons  in  such  cases  have  simply  folded  over  the  wall 
of  the  stomach  upon  itself  and  have  sewed  it  together,  taking  a 
plait  or  "tuck"  in  the  stomach  wall,  and  have  restored  it  to 
its  normal  capacity  and  function. 

One  of  the  most  important  advances  has  been  made  in  the 
treatment  of  gall-stones.  The  bile  in  the  gall-bladder  is  in  a 
state  of  quiescence  which  is  favorable  to  a  deposit  of  crystals 
from  the  bile.*  These  crystals  become  agglutinated  together 
into  larger  or  smaller  solid  masses  called  gall-stones.  Some- 
times the  number  of  these  is  very  small,  from  one  to  four  or 
five;  sometimes  they  accumulate  in  enormous  numbers, 
several  hundred  having  been  reported  in  a  number  of  instances. 
Where  they  are  small  they  can  escape  through  the  duct  of 

*  Since  this  paper  was  written  we  have  learned  that  the  chief  cause  of 
gall-stones  is  infection  from  bacteria  which  act  as  nuclei  around  which  the 
gall-stones  form.— (W.  W.  K,  1905.) 


PROGRESS  OF  SURGERY  IX  NINETEENTH  CENTURY.   355 

the  gall-bladder  into  the  bowel  and  create  no  disturbance, 
but  where  they  are  large,  so  that  they  cannot  make  their  es- 
cape, they  not  uncommonly  are  causes  not  only  of  serious 
discomfort  and  prolonged  ill  health,  but  often  of  death. 
Nowadays  one  of  the  safest  operations  of  surgery  is  to  open 
the  abdomen  and  the  gall-bladder  and  remove  this  menace 
to  life,  and  the  great  majority  of  such  patients  recover  with- 
out any  untoward  symptoms.  Even  large  abscesses  of  the 
liver  and,  what  is  still  more  extraordinary,  large  tumors  of  the 
liver,  are  now  removed  successfully.  A  year  ago  all  of  the 
reported  cases  were  collected  which  had  been  operated  from 
1888  to  1898,  76  in  number.  The  termination  in  2  cases 
were  unknown,  but  of  the  other  74,  63  recovered  and  11  died, 
a  mortality  of  only  14.9  per  cent. 

The  surgery  of  the  intestines  by  itself  is  a  subject  which 
could  well  occupy  the  entire  space  allowed  to  this  article.  I 
can  only  in  a  very  superficial  way  outline  what  has  been 
done.  Hernia,  or  rupture,  is  a  condition  in  which  through 
an  opening  in  the  abdominal  wall  a  loop  of  the  bowel  escapes. 
If  it  could  be  replaced  and  kept  within  the  abdomen  by  a 
suitable  truss,  this  was  the  best  that  we  could  do  till  within 
the  last  ten  or  fifteen  years.  The  safety  and  the  painlessness 
of  modern  surgery  which  have  resulted  from  the  introduction 
of  anaesthesia  and  antisepsis  are  such  that  now  no  person  suf- 
fering from  such  a  hernia,  unless  for  some  special  personal 
reason,  should  be  allowed  to  rely  upon  a  truss,  which  is  always 
a  more  or  less  treacherous  means  of  retaining  the  hernia. 
We  operate  on  all  such  cases  now  with  impunity.  Coley  has 
recently  reported  a  series  of  639  cases,  all  of  which  recovered 
with  the  exception  of  1  patient.  Even  in  children,  if  a 
truss  worn  for  a  reasonable  time,  a  year  or  so,  does  not  cure 
the  rupture,  operation  affords  an  admirable  prospect  of  cure. 

Every  now  and  then  a  band  forms  inside  the  abdomen, 
stretching  like  a  string  from  one  place  to  another.  If  a  loop 
of  bowel  slips  under  such  a  band,  it  can  be  easily  understood 


356  ADDRESSES   AXD   OTHER   PAPERS. 

that  total  arrest  of  the  intestinal  contents  ensues,  a  condition 
incompatible  with  life.  There  are  other  causes  for  such  "  in- 
testinal obstruction,"  which  are  too  technical  to  be  described 
hi  detail,  but  this  may  be  taken  as  a  type  of  all.  It  is  impossi- 
ble, of  course,  to  tell  before  opening  the  abdomen  precisely 
the  cause  of  the  obstruction,  but  the  fact  is  readily  determined 
in  most  cases.  If  we  open  the  abdomen  promptly  we  can  cut 
such  a  band  or  remove  the  other  causes  of  obstruction  in  the 
majority  of  cases,  and  if  the  operation  has  not  been  too  long 
delayed  the  prospect  of  entire  recovery  is  good.  The  mortality 
which  has  followed  such  operations  has  been  considerable, 
and  by  that  I  mean,  say,  over  20  per  cent.;  but  a  very 
large  number  of  the  fatal  cases  have  been  lost  because  the 
operation  has  been  delayed.  In  fact,  it  may  be  stated  very 
positively  that  the  mere  opening  of  the  abdomen  to  find  out 
precisely  the  nature  of  any  disease  or  injury  is  attended  with 
but  little  danger.  If  further  surgical  interference  is  required 
the  danger  will  be  increased  proportionately  to  the  extent 
and  gravity  of  such  interference.  But  "  exploratory  opera- 
tions," as  we  call  them,  are  now  undertaken  constantly  with 
almost  uniform  success. 

Even  in  cancer  of  the  bowel  we  can  prolong  life  if  we  cannot 
save  it.  Cancer  of  the  bowel  sooner  or  later  produces  "ob- 
struction" and  so  destroys  life;  but  in  such  cases  we  can 
either  make  a  permanent  opening  in  the  bowel  above  the 
cancer  and  so  relieve  the  constant  pain  and  distress  which 
are  caused  by  the  obstruction,  or  in  a  great  many  cases  we 
make  two  openings  in  the  bowel  one  above  the  cancer  and 
another  below  it  and  by  uniting  the  two  openings,  if  I  may 
so  express  it,  "side-track"  the  contents  of  the  bowel.  If  the 
cancer  has  no  adhesions  and  the  patient's  condition  allows 
of  it  we  can  cut  out  the  entire  portion  of  the  bowel  contain- 
ing the  cancer,  unite  the  two  ends,  and  thus  re-establish  the 
continuity  of  the  intestinal  canal.  As  much  as  eight  feet, 
nearly  one-third  of  the  entire  length  of  the  bowel,  have  been 


PROGRESS  OF  SURGERY  IN  NINETEENTH  CENTURY.   357 

removed  by  Shepherd,  of  Montreal,  and  yet  the  patient  re- 
covered and  lived  a  healthy  life. 

Similarly  in  gunshot  wounds,  stab  wounds,  etc.,  involving 
the  intestine  the  modern  surgeon  does  not  simply  stand  by 
with  folded  hands  and  give  opium  or  morphine  to  make  the 
patient's  last  few  hours  or  days  relatively  comfortable,  but  he 
opens  the  abdomen,  finds  the  various  perforations,  closes 
them,  and  recovery  has  followed  even  hi  cases  in  which  as 
many  as  seventeen  wounds  of  the  intestine  have  been  pro- 
duced by  a  gunshot  wound. 

The  kidney,  until  thirty  years  ago,  was  deemed  almost  be- 
yond our  reach,  but  now  entire  volumes  have  been  written 
on  the  surgery  of  the  kidney  and  it  is,  one  might  say,  a  fre- 
quent occurrence  to  see  the  kidney  exposed,  sewed  fast  if  it 
is  loose,  opened  to  remove  a  stone  in  its  interior,  drained  if 
there  be  an  abscess,  or  if  it  be  hopelessly  diseased  it  is  removed 
in  its  entirety.  The  other  kidney,  if  not  diseased,  becomes 
equal  to  the  work  of  both. 

Of  the  pelvic  organs,  it  would  not  be  becoming  to  speak  in 
detail,  but  one  operation  I  can  scarcely  omit ;  namely,  ovari- 
otomy. One  of  my  old  teachers  was  Washington  L.  Atlee, 
who,  with  his  brother,  was  among  the  first  ovariotomists  in 
this  country  who  placed  the  operation  on  a  firm  foundation. 
I  heard  a  very  distinguished  physician  in  1862,  in  a  lecture  to 
his  medical  class,  denounce  such  men  as  "murderers";  but 
to-day  how  differently  does  the  entire  profession  look  upon 
the  operation!  Instead  of  condemning  the  surgeon  because 
he  did  remove  such  a  tumor,  the  profession  would  condemn 
him  because  he  did  not  remove  it.  The  operation  had  its  rise 
in  America.  Ephraim  McDowell,  of  Kentucky,  in  1809  first 
did  the  operation  which  now  reflects  so  much  credit  upon 
modern  surgery.  The  mortality  of  the  Atlees  was  about  1 
in  3.  Now,  owing  to  the  immense  improvement  introduced 
by  the  antiseptic  methods,  the  deaths  in  competent  hands 
are  not  over  5  per  cent,  or  even  3  per  cent. 


358  ADDRESSES  AND   OTHER   PAPERS. 

The  limits  of  this  article  compel  me  to  stop  with  the  story 
very  imperfectly  told,  but  yet,  perhaps,  it  has  been  sufficient 
in  detail  to  show  somewhat  of  the  astonishing  progress  of 
surgery  within  the  century,  but  especially  within  the  last 
quarter  of  the  century. 

About  two  decades  ago  one  of  the  foremost  surgeons  of 
London,  Mr.  Erichsen,  said  hi  a  public  address  that  "  surgery 
had  reached  its  limits. "  How  short  was  his  vision  is  shown 
by  the  fact  that  surgery  at  that  very  time  was  just  at  the 
beginning  of  its  most  brilliant  modern  chapter. 

We  have  reached  in  many  respects,  apparently,  the  limits 
of  our  success,  but  just  as  anaesthesia  and  antisepsis  and  the 
Roentgen  rays  have  opened  new  fields  to  us  wholly  unsus- 
pected until  they  were  proclaimed,  so  I  have  no  doubt  that  the 
twentieth  century  will  see  means  and  methods  devised  which 
will  put  to  shame  the  surgery  of  to-day  as  much  as  the  surgery 
of  to-day  puts  to  shame  that  of  thirty  years  ago,  and  still 
more  of  a  century  ago.  The  methods  by  which  this  will  be 
attained  will  be  by  the  more  thorough  and  systematic  study 
of  disease  and  injury,  so  as  to  better  our  means  of  diagnosis, 
and  so  prepare  us  for  immediate  surgical  interference,  instead 
of  delaying  it,  as  we  now  do  in  many  cases  for  want  of  certain 
knowledge;  by  the  use  of  new  chemical  and  pharmaceutical 
means  to  perfect  our  antisepsis  and  possibly  to  introduce 
other  methods  of  treatment;  but  above  all,  we  shall  obtain 
progress  by  the  exact  experimental  methods  of  the  labora- 
tory. We  can  never  make  progress  except  by  trying  new 
methods.  New  methods  must  be  tried  either  on  man  or  on 
animals,  and  as  the  former  is  not  allowable,  the  only  way  re- 
maining to  us  is  to  test  all  new  methods,  drugs,  and  appli- 
cations first  upon  animals.  He  who  restricts  and,  still  more, 
he  who  would  abolish  our  present  experiments  upon  animals 
is,  in  my  opinion,  the  worst  foe  to  the  human  race,  and  to 
animals  as  well,  for  they,  as  well  as  human  beings,  obtain  the 
benefit  derived  from  the  methods.  He  may  prate  of  his  hu- 
manity, but  he  is  the  most  cruel  man  alive. 


THE  MISSION  OF  A  MEDICAL  COLLEGE.* 


TWELVE  years  ago  I  had  the  honor  of  delivering  the  in- 
troductory address  at  the  opening  of  the  session  of  the 
Jefferson  Medical  College.  I  took  as  my  topic  "  The  New  Era 
in  Medicine,  and  its  Demands  upon  the  Profession  and  the  Col- 
lege." In  it  I  pointed  out  the  demands  which  this  new  era 
in  medicine  made  on  our  medical  colleges.  To-day  I  purpose 
supplementing  that  address  by  considering  an  allied  topic, 
"  The  Mission  of  a  Medical  College." 

A  mission  is  defined  as  "that  with  which  a  messenger  or 
agent  is  charged,"  and  I  find  in  Webster  an  apt  illustrative 
quotation  from  Milton : 

"  How  to  begin,  how  to  accomplish  best, 
His  end  of  being  on  earth  and  mission  high." 

There  are  missions  for  individuals,  as  for  Columbus,  Wash- 
ington, and  Lincoln,  and  in  medicine  for  a  Vesalius,  a  Jenner, 
and  a  Lister.  There  are  missions  for  nations,  as  for  the 
Hebrews  in  religion,  the  Greeks  in  art,  the  Romans  in  law, 
England  and  America  in  civil  and  religious  liberty.  But 
there  are  also  missions  for  institutions,  especially  for  in- 
stitutions of  learning,  such  as  the  Universities  of  Bologna, 
Oxford,  Edinburgh,  Harvard,  etc.  Has  not  the  Medical 
College  a  mission?  If  so,  what  is  its  nature  and  how  is  it 
being  accomplished  ?  The  mission  of  institutions  of  learn- 
ing, among  which  may  be  classed  the  medical  school,  is 

*  Address  delivered  at  the  Seventy-sixth  Commencement  of  the  Jeffer- 
son Medical  College  of  Philadelphia,  May  15.  1901.  Reprinted  from 
American  Medicine,  May  25,  1901. 

359 


360  ADDRESSES   AND   OTHER   PAPERS. 

threefold:  First  and  foremost  the  development  of  the  char- 
acter of  its  students;  secondly,  the  education  of  its  students; 
and,  thirdly,  the  encouragement  of  original  research. 

First,  the  development  of  character;  that  is  ''the  sum  of 
the  moral  and  mental  qualities  which  distinguish  an  individual 
viewed  as  a  homogeneous  whole."  The  school  which  in- 
structs the  intellect,  but  does  not  develop  the  moral  character 
of  its  students,  fails  in  its  most  important  duty.  "Intellect 
alone  is  cold,  heartless,  and  selfish;  it  must  be  lighted  up  by 
moral  and  spiritual  principles  to  reveal  its  beauty  or  fulfill 
its  high  mission." 

Character  is  partly  the  result  of  heredity  and  of  environ- 
ment. Those  who  are  so  fortunate  as  to  possess  parents  to 
whom  they  can  look  up  with  reverence,  even  after  they  have 
passed  away,  are  most  happy.  They  have  had  a  training 
which  nothing  else  can  replace.  The  environment  which 
they  have  had  at  home  and  the  subtle  influences  of  the  family 
life  will  influence  their  whole  subsequent  career.  The  pre- 
liminary education  which  they  have  had,  the  physical  health 
with  which  they  have  been  endowed,  the  mental  stimulus  that 
they  have  received  from  their  parents,  all  these  count  for 
much.  Then  there  are  undoubtedly  individual  differences; 
for  example,  the  slothful,  the  vicious,  the  brave,  intelligent, 
hard-working,  and  virtuous.  It  would  be  a  trite  saying  to 
assert  that  the  last  are  those  who  will  win  the  prizes  in  the 
struggle  of  life. 

But  when  a  young  man  has  left  his  home  and  enters  the 
medical  school,  he  comes  under  a  different  set  of  influences, 
partly  from  his  fellow-students,  but  chiefly  from  his  teachers. 
He  is  moved  by  their  example,  observes  their  industry, 
acknowledges  their  ability,  and  recognizes  their  success  in  life 
as  due  to  a  sturdy  character  which  hi  turn  develops  the  char- 
acter of  the  student.  The  College  is  a  center  for  those  pro- 
jectile moral  forces  which,  once  set  hi  action,  prolong  their 
effects  for  many  years  afterward  in  well-nigh  every  student. 


THE    MISSION   OF   A   MEDICAL   COLLEGE.  361 

We  can  point  for  example  in  this  school  to  the  splendid  and 
forceful  lives  of  a  McClellan,  a  Dunglison,  a  Gross,  a  Pancoast, 
and  a  Da  Costa,  whose  influence  on  the  character  of  hundreds 
and  even  thousands  of  men  all  over  the  world  tells  for  the  best 
and  the  highest  ideals  in  medicine. 

Not  the  information  which  one  acquires  in  a  medical  school 
or  in  any  other  educational  institution  is  of  the  most  value.  The 
methods  he  learns  rather  than  the  facts  which  he  acquires;  the 
high  ideals  which  are  instilled  into  him  rather  than  the  low  cra- 
vings for  a  mere  sordid  success — these  are  the  things  which  are 
of  value  and  develop  most  the  character.  To  do  one's  level  best 
every  day  with  every  patient  and  in  many  cases  without  hope 
of  fee  or  reward  save  the  sense  of  duty  done,  the  inspiring 
influence  of  success  in  the  constant  and  irrepressible  conflict 
between  good  and  evil,  life  and  death, — this  is  what  is  of  more 
value  to  the  student  of  this  and  every  other  college  than  the 
mere  information  which  he  has  acquired.  It  is  not  given  to 
everyone  to  occupy  a  conspicuous  place,  but  every  one  of 
you  in  your  sphere,  humble  though  it  may  be,  can  do  your 
daily  duty  faithfully  and  truly,  and  if  you  do  this,  if  you  de- 
velop a  high  and  noble  character,  even  though  your  sphere 
be  humble,  when  you  lay  down  life's  burdens  the  Great  Master 
may  well  say  to  you,  "  Well  done,  good  and  faithful  servant." 
Character  depends  not  on  the  sphere,  but  on  the  person,  not  on 
the  greatness  of  the  opportunity,  but  on  how  the  opportunity 
is  met.  Let  me  quote  a  portion  of  the  justly-celebrated  oath 
of  Hippocrates  to  show  you,  away  back  in  the  fifth  century 
before  the  Christian  era,  how  well  the  Father  of  Medicine  met 
his  opportunity  and  set  us  an  example  we  well  may  follow: 

I  will  "  reckon  him  who  taught  me  this  Art  equally  .dear  to 
me  as  my  parents,  to  share  my  substance  with  him,  and  re- 
lieve his  necessities  if  required ;  to  look  upon  his  offspring  on 
the  same  footing  as  my  own  brothers,  and  to  teach  them  this 
art,  if  they  shall  wish  to  learn  it,  without  fee  or  stipulation; 
and  that  by  precept,  lecture,  and  every  other  mode  of  in- 


362  ADDRESSES   AND   OTHER   PAPERS. 

struction,  I  will  impart  a  knowledge  of  the  Art  to  my  own 
sons,  and  those  of  my  teachers,  and  to  disciples  bound  by  a 
stipulation  and  oath  according  to  the  law  of  medicine,  but  to 
none  others.  I  will  follow  that  system  of  regimen  which, 
according  to  my  ability  and  judgment,  I  consider  for  the 
benefit  of  my  patients,  and  abstain  from  whatever  is  deleteri- 
ous and  mischievous.  I  will  give  no  deadly  medicine  to  any- 
one if  asked,  nor  suggest  any  such  counsel.  .  .  .  With 
purity  and  with  holiness  I  will  pass  my  life  and  practise  my 
Art.  .  .  .  Into  whatever  house  I  enter,  I  will  go  into 
them  for  the  benefit  of  the  sick,  and  will  abstain  from  every 
voluntary  act  of  mischief  and  corruption.  .  .  .  What- 
ever, in  connection  with  my  professional  practice,  or  not  in 
connection  with  it,  I  see  or  hear,  in  the  life  of  men,  which 
ought  not  to  be  spoken  of  abroad,  I  will  not  divulge,  as  reckon- 
ing that  all  such  should  be  kept  secret.  While  I  continue  to 
keep  this  oath  un violated,  may  it  be  granted  to  me  to  enjoy 
life  and  the  practice  of  the  Art,  respected  by  all  men  in  all 
times!  But  should  I  trespass  and  violate  this  oath,  may  the 
reverse  be  my  lot!" 

The  second  mission  of  a  medical  school  is  education.  In 
the  address  already  alluded  to,  I  pointed  out  in  considerable 
detail  the  enormous  and  rapid  strides  which  had  been  made 
in  medical  education  hi  the  last  thirty  years.  It  is  especially 
gratifying  that  the  progress  made  has  not  been  only  hi  medi- 
cine proper,  but  largely  in  the  preliminary  education  which  is 
required  of  medical  students  of  to-day.  The  better  educated 
men  you  are  at  starting,  the  better  educated  men  you  will 
be  at  the  finish,  and,  as  a  rule,  the  greater  your  success.  But 
along  with  this  better  preliminary  education  in  order  to  meet 
the  enormously  increased  demands  of  a  modern  medical 
education,  a  college  must  furnish  facilities  which  were  not  in 
existence  thirty  years  ago,  but  are  absolutely  indispensable 
now.  Let  us  see  how  the  demand  has  been  met : 

The  former  methods  were  limited  to  lectures  and  text-books. 


THE   MISSION   OF   A   MEDICAL   COLLEGE.  363 

The  spoken  word,  in  my  opinion,  is  of  the  greatest  importance. 
Fresh  from  his  everyday  contact  with  disease  and  death,  an 
impressive,  ardent  lecturer  exerts  a  powerful  influence  which 
nothing  else  equals.  His  flaming  words  awaken  enthusiasm 
and  stamp  his  ideas  on  his  students.  But  this  alone  is  quite 
insufficient  for  your  purpose.  It  must  be  supplemented  by 
your  text-books.  In  them  is  garnered  the  knowledge  of  the 
past  and  the  present.  This  is  indispensable  as  a  starting 
point.  As  there  were  brave  men  before  Agamemnon,  so  there 
were  great  surgeons  before  Gross.  They  were  men  with  few 
of  our  artificial  helps,  but  they  had  eyes  and  ears  and  fingers 
to  observe  with  and  common  sense  and  sharp  intellects  to 
utilize  their  stores  of  accumulated  facts. 

But  the  knowledge  of  other  men  which  one  reads  about  is 
with  difficulty  made  part  and  parcel  of  our  own  intellectual 
bone  and  muscle.  We  must  do  more  than  this.  We  must 
develop  individual  observation  and  individual,  personal 
knowledge.  This  is  done  in  the  modern  medical  school  in 
two  ways  relatively  new. 

The  most  striking  change  in  modern  medical  education  is 
the  introduction  of  the  laboratory.  There  the  medical 
student  has  his  powers  of  observation  developed  by  his 
teachers  in  approved  directions  and  trained  and  filed  to  a 
fineness  by  careful  personal  investigations.  There  he  learns 
not  what  others  have  done,  but  what  he  himself  can  do  and 
sees  the  results  that  he  himself  has  accomplished.  Yet,  when 
I  began  the  study  of  medicine  hi  1860,  there  was  absolutely  no 
laboratory  connected  with  the  Jefferson,  or  any  other  medical 
college,  with  the  exception  of  the  dissecting-room;  that  is,  the 
laboratory  of  anatomy.  Now  we  have  eleven  laboratories, 
through  each  of  which  every  student  passes,  and  there  learns 
to  observe  for  himself  and  think  for  himself.  That  was  a  very 
brief,  but  pregnant,  reply  of  Huxley  to  a  querulous  correspon- 
dent, a  reply  which  epitomizes  the  value  of  knowledge  ac- 


364  ADDRESSES   AND    OTHER   PAPERS. 

quired  for  one's  self  by  actual  personal  investigation.  "  Take 
a  cockroach  and  dissect  it." 

The  other  relatively  new  method  is  the  clinical;  that  is  to 
say,  each  individual  student  is  not  taught,  as  formerly,  only 
didactically  the  symptoms  of  disease  which  he  must  memorize, 
and  the  treatment  which,  very  likely,  he  will  forget,  but  in 
small  ward  classes  he  is  made  to  examine  as  many  patients  as 
possible  for  himself,  elicit  the  family  and  the  personal  history, 
institute  a  physical  examination,  percuss,  auscultate,  palpate, 
and  by  the  most  approved  clinical  methods  discover  the  nature 
of  the  existing  ailment,  understand  its  pathology,  comprehend 
its  symptoms,  and  suggest  the  proper  treatment,  all  by  the 
exercise  of  his  own  brains.  Contrasting  the  exclusively  di- 
dactic methods  when  I  was  a  student  with  those  of  to-dajr, 
which  are  so  personal  and  individual,  the  difference  is  almost 
that  of  darkness  and  of  light.  Surely,  the  Jefferson  Medical 
College,  which  has  tripled  the  length  of  its  course  of  instruc- 
tion and  quadrupled  the  means  and  the  thoroughness  of  in- 
struction, is  fulfilling  its  mission. 

Yet,  any  medical  school  which  is  content  with  its  present 
methods  of  fulfilling  its  mission  has  at  once  fallen  from  its  high 
estate.  If  it  does  not  advance  to  newer  methods,  to  better 
methods,  to  more  exact  methods,  it  is  left  behind  in  the  march 
of  progress.  The  whole  history  of  the  well-nigh  fourscore 
years  that  the  Jefferson  Medical  College  has  existed  shows 
that  it  has  constantly  made  progress  to  these  better  and  bet- 
ter methods.  That  the  next  half-century  will  witness  a  still 
greater  progress  who  can  doubt? 

The  third  mission  of  a  medical  college  is  to  encourage 
original  research.  Teaching  existing  knowledge  is  very  well 
and  for  the  student  is  the  chief  end  or  final  cause  for  which 
a  medical  college  exists.  But  the  medical  school  owes  a  duty 
to  the  profession,  to  the  public,  and  to  the  cause  of  science. 
This  duty  is  constantly  to  add  to  our  present  knowledge,  to 
solve  the  riddles  of  disease,  to  answer  the  questions  which  are 


THE   MISSION   OF   A  MEDICAL   COLLEGE.  365 

ever  arising  in  the  human  mind  as  to  our  animal  existence, 
with  all  its  disorders  and  accidents  and  our  mental  capacity 
and  its  disturbances,  and  persistently  and  intelligently  to 
improve  our  means  and  methods  of  treating  these  deviations 
from  the  normal.  We  must  restlessly  and  continually  enlarge 
the  boundaries  of  knowledge  if  we  desire  to  make  progress— 
and  where  in  the  quest  for  additional  knowledge  should  in- 
vestigation and  original  research  be  so  likely  to  find  a  con- 
genial home  as  in  the  very  institutions  where  the  present  state 
of  knowledge  is  exhibited  from  day  to  day,  where  teacher  and 
pupil,  conscious  alike  of  the  limitations  of  their  knowledge, 
long  for  a  better  and  a  wider  view? 

The  characteristic  of  the  past  century,  which  Wallace  has  so 
well  described  as  the  "Wonderful  Century,"  is  that  of  original 
research  and  the  consequent  growth  of  every  department  of 
human  knowledge.  Witness  the  enormous  progress  in  our 
means  of  transportation  on  land  and  water  for  social  and  com- 
mercial purposes;  witness  the  wonderful  development  of  our 
manufactures  from  the  invention  of  the  steam  engine,  the 
sewing  machine,  the  cotton-gin;  the  various  electrical  devices, 
such  as  the  telegraph,  the  telephone,  the  trolley  car,  and  the 
dynamo;  the  fast  printing  press;  the  improved  processes  for 
making  iron  and  steel;  and  a  hundred  other  instances  which 
occur  to  you  hi  a  moment. 

All  these,  mark  you  well,  are  the  result  of  the  searching, 
persistent  careful  work  of  the  scientific  student  in  the  labora- 
tory. They  are  not  accidents,  they  have  followed  in  the  wake 
of  the  discovery  of  the  laws  of  dynamics,  of  electricity,  of 
chemistry.  First  came  that  which  was  pure  theory,  then  the 
practical  application  for  the  welfare  of  the  world. 

Nor  has  medicine  lacked  during  this  wonderful  century. 
We  have  seen  the  introduction  of  vaccination,  of  anaesthetics, 
of  antisepsis,  which  three,  as  with  a  besom,  have  swept  into 
oblivion  a  large  part  of  the  disfigurements,  pain,  and  death 
which  ravaged  the  race  in  former  centuries;  of  the  serum 


366  ADDRESSES   AND   OTHER   PAPERS. 

treatment  of  disease,  which  has  gone  far  to  put  an  end  to  the 
hecatombs  of  victims  of  diphtheria  and  its  congeners.  Phar- 
macology has  given  us  so  many  new  drugs  that  our  prescrip- 
tions differ  as  the  antipodes  from  those  of  one  hundred  years 
ago.  Bacteriology  has  revealed  the  actual  causes  of  many 
diseases  and,  still  better,  has  shown  us  how  to  protect  mankind 
from  their  invasion.  Chemistry  has  given  us  new  and  efficient 
methods  of  sanitation,  which  have  wonderfully  prolonged 
human  life.  The  microscope  has  laid  bare  to  us  the  processes 
of  disease;  the  blood  has  yielded  up  at  least  some  of  its  secrets; 
the  examination  of  the  secretions  now  warns  of  unsuspected 
dangers.  We  can  see  the  spectral  forms  of  the  bones  and  even 
the  beating  of  the  heart  by  the  x-rays,  and  instruments  of 
precision  have  enabled  us  accurately  to  weigh  and  to  measure, 
where  before  we  only  vaguely  guessed. 

In  view  of  this  enormous  progress,  it  may  be  asked  whether 
there  is  anything  left  to  be  discovered.  To  this  it  may  be 
replied  that,  if,  starting  with  their  poor  equipment,  our  sturdy 
fathers  made  such  immense  forward  strides,  shame  upon  us, 
their  degenerate  sons,  if,  with  our  rich  inheritance,  we  cannot 
outdo  them  and  solve  many  of  the  enticing  problems  by  which 
disease  beckons  us  onward  into  the  realms  of  the  unknown; 
if  there  are  not  among  us  other  Jenners,  and  other  Listers,  and 
other  Roentgens,  to  make  the  twentieth  the  most  illustrious 
of  the  centuries! 

What  a  boon  will  he  confer  upon  humanity  who  discovers 
the  cause  and  the  means  of  cure  of  those  curses  of  the  race — 
cancer,  sarcoma,  and  other  tumors;  of  syphilis,  typhus  fever, 
rheumatism  and  gout,  scarlet  fever,  measles,  and  even  who 
can  tell? — a  panacea  for  old  age  and  all  its  evils! 

Other  triumphs,  too,  in  wholly  unknown  and  unsuspected 
realms  await  the  patient,  persistent  investigator.  These  tri- 
umphs will  be  won  by  close  observation  at  the  bedside  and 
by  indefatigable  investigations  in  the  laboratory.  To  me  the 
most  encouraging  sign  of  the  times  in  medicine  is  the  enthusi- 


THE   MISSION   OF   A  MEDICAL   COLLEGE.  367 

asm  with  which  the  laboratory  has  been  welcomed,  not  to 
replace,  but  to  be  the  handmaid  of,  the  clinician. 

In  this  country  our  medical  schools  have  not  been  wanting 
in  their  duty.  I  need  but  to  point  to  the  many  laboratories 
now  hi  actual  daily  use,  not  only  facilitating  the  instruction  of 
the  student,  but  training  up  skilled  assistants  who,  within  the 
next  few  years,  will  be  in  the  van  in  making  new  discoveries 
of  the  utmost  importance  to  the  well-being  of  mankind. 

But  all  this  means  more  buildings,  enlarged  equipment, 
more  men,  more  money.  Whence  are  all  these  to  come? 
The  student  cannot  pay  increased  fees  at  all  commensurate 
with  the  increased  expense  of  his  education.  The  older 
methods,  where  one  man  lectured  to  200,  400,  or  500  men  at 
once  have  been  replaced  by  a  method  of  instruction  which 
requires  the  training  of  small  classes  of  20, 15, 10,  or  even  one 
or  2  men  by  a  single  teacher.  In  other  words,  our  modern 
methods  have  wholly  changed  from  general  instruction 
given  to  large  classes,  to  individual  instruction  of  smaller 
classes  and  often  even  of  single  students.  As  Harvard,  Yale, 
Princeton,  Brown,  and  all  other  universities  are  clamoring  for 
increased  endowments  for  just  such  enlarged  work  and  are 
getting  them,  just  so  the  medical  school  must  have  increased 
funds  for  providing  facilities  for  instruction  and  research,  and 
especially  must  have  endowments  by  which  these  hitherto 
unknown  expenses  can  be  met. 

I  have  indicated  the  mission  of  the  medical  school  and  have 
shown  that  it  is  being  splendidly  fulfilled.  Is  there  no  cor- 
responding duty  also  for  the  community?  Shall  it  be,  can 
it  be,  that  these  ardent  teachers  and  these  faithful  students 
shall  valiantly  struggle  on  in  the  endeavor  to  solve  the  problem 
how  to  transmute  sickness  into  health,  how  to  avert  the  dire 
effects  of  accident,  how  to  say  to  death,  "thus  far  and  no 
farther,"  and  the  community  stand  aloof,  apathetic  and  in- 
different, absorbed  in  business,  forgetful  that  sickness  and 
sorrow  must  some  time  inevitably  come  to  them?  Remember 


368  ADDRESSES   AND   OTHER    PAPERS. 

that  sickness  and  sorrow  can  only  be  averted  by  the  highest 
skill,  the  greatest  learning,  the  wisest  judgment,  all  founded 
upon  knowledge  gained  in  these  expensive  laboratories  and  in 
these  great  hospitals  which  train  the  men  who  are  to  minister 
to  you  in  the  time  of  peril. 

Citizens  of  Philadelphia,  to  you  we  must  appeal.  Yonder 
College  and  Hospital,  as  I  have  told  you,  are  fulfilling  their 
"mission  high,"  but  are  sorely  hampered  for  want  of  larger 
means.  Every  week  we  have  to  refuse  worthy  sufferers  for 
want  of  a  larger  number  of  beds  in  a  constantly  crowded 
hospital.  You  can  give  them  to  us.  We  need  endowments 
for  Professorships,  for  Fellowships,  and  for  Scholarships. 
You  can  give  them  to  us.  By  your  gifts  and  your  bequests 
you  may  make  possible  the  fine  ideals  which  we  hope  to  realize. 
We  have  the  men,  men  of  brains,  of  education,  of  industry, 
who  are  longing  only  for  the  opportunity.  If  you  but  knew 
as  I  know  how  earnest,  how  intense,  how  consuming  is  the 
longing  in  these  very  young  men  before  you  to  do  their 
level  best,  if  you  only  give  them  the  chance!  Must  we  Amer- 
icans, we  Philadelphians,  say  them  nay  for  want  of  such  en- 
couragement and  of  such  gifts?  I  do  not  believe  it.  As  in 
your  hours  of  sickness  you  trust  implicitly  to  us,  so  in  your 
hours  of  health  and  wealth  we  trust  implicitly  to  you,  and  I 
know  we  shall  not  trust  in  vain. 


THE  DUTIES  AND  RESPONSIBILITIES  OF 

TRUSTEES  OF  PUBLIC  MEDICAL 

INSTITUTIONS.* 


r  1 1HE  value  of  occasional  and  stated  gatherings  of  the  prin- 
JL  cipal  leaders  of  medical  thought  in  the  various  special 
departments  is  acknowledged  by  all.  Certainly  those  who 
have  attended  this  Congress,  now  held  for  the  sixth  time,  have 
felt  its  broadening  influence.  We  are  apt  to  become  narrow 
when  we  are  devoted  heart  and  soul  to  one  specialty,  be  it 
medicine,  surgery,  physiology,  ophthalmology,  or  any  other. 
When  we  meet  nearly  all  of  the  more  prominent  men  in  cog- 
nate interrelated  branches  of  medicine  in  Washington  every 
third  year,  we  are  sure  to  find  that  there  are  as  interesting 
and  as  important  questions  in  other  specialties  as  there  are 
hi  our  own;  and,  moreover,  we  are  sure  to  find  that  there 
are  men  of  as  acute  intelligence,  wide  reading,  and  original 
thought  in  other  than  our  own  departments  whom  it  is  our 
pleasure  to  meet,  and  whose  acquaintance  becomes  not  only 
valuable  for  what  we  find  them  to  be,  but  because  of  the 
stimulus  that  they  give  to  our  own  thoughts. 

Ordinarily  the  presidential  address  has  been  devoted  to 
some  special  professional  topic.  My  first  idea  was  to  select 
such  a  subject  for  to-night,  but  as  I  was  absent  from  the 
country  when  I  received  the  very  highly  appreciated  notice 
of  my  selection,  I  asked  the  members  of  the  executive  com- 

*  The  Presidential  Address  at  the  Sixth  Congress  of  American  Physi- 
cians and  Surgeons,  Washington,  May  12,  1903.  Reprinted  from  the 
Sixth  Volume,  Transactions  of  the  Congress  of  American  Physicians  and 
Surgeons,  1903. 

24  369 


370  ADDRESSES   AND    OTHER   PAPERS. 

mittee  for  suggestions,  being  sure  that  their  united  judgment 
would  be  better  than  my  own.  I  was  very  glad  when  they 
proposed  the  topic  upon  which  I  shall  address  you,  partly 
because  it  is  different  from  the  usual  type  of  such  addresses, 
and  partly  because  it  seems  to  me  appropriate  to  the  present 
time.  I  shall,  therefore,  give  the  time  at  my  disposal  to  pre- 
senting to  you  some  thoughts  on  "The  Duties  and  Responsi- 
bilities of  Trustees  of  Public  Medical  Institutions." 

Before  entering  upon  my  topic  I  beg  to  state  explicitly 
that  what  I  will  say  is  offered  in  no  spirit  of  unfriendly  criti- 
cism, but  only  by  way  of  friendly  suggestion.  I  have  been 
too  long  and  too  intimately  associated  with  scores  of  such 
trustees  not  to  know  that  they  are  almost  without  exception 
generous,  self-sacrificing,  giving  of  their  time  and  money  and 
thoughtful  care  without  stint,  and  often  sacrificing  personal 
convenience  and  comfort  for  the  good  of  the  college  or  hos- 
pital which  they  so  faithfully  serve.  Anxious  to  discharge 
their  trust  to  the  best  of  their  ability,  I  am  sure  they  will  ac- 
cept these  suggestions,  the  fruit  of  forty  years  of  personal 
service  as  a  teacher  and  a  hospital  surgeon,  in  the  same 
friendly  spirit  in  which  they  are  offered. 

There  are  two  such  classes  of  institutions  to  be  considered : 
(1)  Medical  Colleges  and  (2)  Hospitals,  whether  they  be 
connected  with  medical  schools  or  not. 

There  is,  it  is  true,  a  third  class  of  trustees  for  a  wholly  new 
kind  of  medical  institution  which  has  arisen  as  a  modern 
Minerva  Medica,  born  full-armed  for  the  fray.  Of  this  class 
we  have  as  yet  but  a  single  example — the  Rockefeller  Institute 
for  Medical  Research.  Akin  to  it  are  laboratories  for  special 
investigations,  such  as  the  two  Cancer  Laboratories  in  Buffalo 
and  Boston.  But  the  Rockefeller  Institute  is  so  recent,  and 
its  scope  at  present  necessarily  so  undetermined,  that  I  would 
not  venture  to  consider  the  duties  or  these  trustees,  and  I  am 
sure  their  responsibilities  are  adequately  felt  by  them.  More- 
over, their  admirable  selection  of  a  director  for  the  institution 


DUTIES    AND   RESPONSIBILITIES   OF  TRUSTEES.  371 

is  the  best  pledge  of  a  future  wise  administration.  I  heartily 
congratulate  the  profession  and  America  upon  the  establish- 
ment of  so  peculiarly  useful  an  institute.  Its  founder  has 
wisely  left  its  work  unhampered  saving  as  to  its  general  pur- 
pose, and  the  whole  world,  and  especially  the  United  States, 
will  soon  be  his  debtor  for  researches  and  discoveries  that  will 
abridge  or  even  abolish  some  diseases,  shorten  sickness,  pro- 
long life,  and  add  enormously  to  the  sum  of  human  happiness. 
Could  any  man  of  wealth  by  any  possible  gift  win  for  himself 
a  higher  reward  or  a  happier  recollection  when  he  faces  the 
future  world? 

Though  not  a  medical  institution,  I  cannot  refrain  also  at 
this  point  from  expressing  not  only  for  myself,  but  for  you,  our 
hearty  appreciation  of  what  the  Carnegie  Institution  has  done 
for  medicine  in  the  re-establishment  of  the  "Index  Medicus." 
This  publication  is  essentially  and  peculiarly  American  in 
origin,  but  its  usefulness  is  world-wide.  It  aids  alike  an  author 
in  Japan,  or  in  India,  in  Europe  or  America.  It  is  one  of  the 
best  and  wisest  undertakings  of  this  lusty  educational  giant. 
But  to  ensure  the  permanent  publication  of  the  "Index  Med- 
icus" the  profession  must  show  that  it  really  values  this 
generous  gift.  Unless  the  "Index"  finds  a  hearty  support 
in  the  profession  abroad  and  especially  at  home,  we  can  hardly 
expect  the  continuance  of  this  unique  and  invaluable  pub- 
lication. May  I  earnestly  ask,  therefore,  of  this  audience  of 
the  chief  medical  authors  of  the  United  States  that  each  one 
will  demonstrate  his  appreciation  by  an  immediate  sub- 
scription to  the  "Index  Medicus." 

There  are  some  matters  common  both  to  the  medical  col- 
lege and  the  hospital  which  may  be  considered  together.  The 
most  important  of  all  these  is  the  cordial  and  hearty  co-opera- 
tion of  the  medical  men  connected  with  the  college  or  hospital 
and  the  boards  of  trustees.  In  order  to  ensure  this  the  mem- 
bers of  each  body  must  be  acquainted  with  each  other.  I 
have  known  of  instances  in  which,  if  a  professor  in  the  medical 


372  ADDRESSES   AND   OTHER   PAPERS. 

school  ventured  to  suggest  any  changes  as  to  its  management, 
or  even  to  state  his  opinion  as  to  the  qualifications  of  a  can- 
didate for  a  vacant  professorship,  his  suggestions  were  re- 
sented as  an  interference,  instead  of  being  welcomed  as  a 
means  of  valuable  information.  I  take  it  for  granted  that 
we  should  not  offer  such  suggestions  after  the  fashion  of  a 
partisan  either  of  a  man  or  a  measure,  for  the  advancement 
of  a  friend  or  to  the  disadvantage  of  an  enemy,  but  solely 
for  the  good  of  the  institution  with  which  we  are  connected. 
He  who  would  endeavor  to  foist  a  friend  upon  an  institution 
because  he  is  his  friend,  and  in  spite  of  the  fact  that  a  rival 
is  the  abler  man,  and  better  fitted  for  the  position,  is  just 
as  false  to  his  duty,  to  his  college,  or  to  his  hospital  as  the 
trustee  who  would  vote  for  the  less  desirable  man  on  the 
ground  of  personal  friendship  or  of  association  in  some  so- 
ciety, church,  or  other  similarjbody.  Of  all  these  influences, 
that  arising  from  membership  in  the  same  religious  body 
is,  I  fear,  the  most  frequent  and  yet  most  absolutely  inde- 
fensible. What  one's  theological  opinions  are  has  no  more 
to  do  with  his  qualifications  for  a  professional  or  hospital 
appointment  than  his  opinions  on  protection  as  against  free 
trade,  or  whether  Bacon  or  Shakespeare  wrote  Hamlet. 

I  have  always  honored  one  of  a  board  of  trustees,  who 
was  an  old  personal  friend  of  my  father's  and  who  had 
known  me  from  boyhood,  yet  who  in  my  early  professional 
career,  when  I  asked  for  his  vote  for  an  important  hospital 
appointment,  had  the  manly  courage  to  tell  me  that  he 
thought  a  rival,  who  was  older  and  more  experienced,  was 
the  better  man  for  the  place  and  that  he  should,  accordingly, 
vote  for  him,  and  not  for  me.  I  confess  it  was  at  the  time 
a  bitter  disappointment  to  me,  but  I  never  had  so  high  an 
opinion  of  my  father's  friend  as  after  he  denied  me  his  vote. 

There  should  be,  in  my  opinion,  but  two  questions  asked 
in  considering  the  election  of  either  a  professor  or  a  hospital 
physician  or  surgeon.  First,  which  one  of  the  candidates  for 


DUTIES   AND   RESPONSIBILITIES  OF  TRUSTEES.  373 

the  place  has  the  best  qualifications  from  the  medical  point 
of  view?  This  should  include  not  only  his  scientific  knowl- 
edge, but  his  ability  practically  to  impart  or  to  apply  that 
knowledge.  Secondly,  are  his  personal  qualifications  and 
character  such  as  to  make  him  a  desirable  incumbent  of  the 
position?  It  must  be  remembered  that  a  man  may  be  scien- 
tifically and  practically  an  extremely  able  man,  but  of  such  a 
quarrelsome  disposition,  or  the  unfortunate  possessor  of  some 
other  similar  personal  disqualification,  as  to  make  him  a  most 
undesirable  member  of  a  staff.  The  personal  equation  may  be 
quite  as  important  as  the  scientific  qualification.  Of  course, 
his  personal  moral  character  should  be  above  reproach.  To 
place  a  drunkard  or  a  libertine  in  a  position  of  so  much 
responsibility  and  influence  is  to  abuse  a  trust.  No  patient 
should  be  confined  to  the  care  of  such  a  man,  and  still  more  no 
such  man  should  be  made  an  instructor  of  young  men,  upon 
whom  his  influence  would  be  most  disastrous. 

It  is  often  extremely  difficult  for  a  layman  to  reach  a  correct 
conclusion  as  to  the  qualifications  of  medical  men  for  college  or 
hospital  appointments,  because  of  the  confident,  yet  conflict- 
ing, statements  of  their  friends.  But  there  is  apt  to  be  a 
certain  clear  partisanship  in  such  statements  which  betrays 
the  purpose  of  the  speaker.  Especially  will  this  be  so  if  he 
advocates  the  election  of  A  or  B  on  the  lower  grounds  of  friend- 
ship, social  position,  or  for  other  similar  motives.  The  man 
who  is  advocating  the  best  man  because  he  is  the  best  man  has 
the  stamp  of  sincerity  upon  every  word. 

Perhaps  the  most  striking  example  I  can  adduce  of  such  an 
unfortunate  misjudgment  is  Dr.  S.  Weir  Mitchell,  who  was 
denied  a  professorship  in  both  the  medical  institutions  of  his 
native  city,  thus  depriving  them  of  the  most  brilliant  medical 
genius  that  America  has  produced  within  my  personal  rec- 
ollection. For  him  it  is  now  a  matter  of  indifference,  and  for 
American  literature  it  has  been  a  gain.  But  for  medicine, 
and  especially  for  physiology,  it  was  an  immense  loss.  Both 


374  ADDRESSES   AND   OTHER   PAPERS. 

of  his  rivals  were  estimable,  worthy  gentlemen  who  held  an 
honorable  position  in  the  profession,  it  is  true,  but  Mitchell  is 
a  genius.  "Eclipse  was  first;  the  rest  were  nowhere." 

One  of  the  best  methods  of  bringing  the  medical  board  and 
the  board  of  trustees  into  more  intimate  contact  would  be  to 
have  the  dean  or  a  committee  of  the  faculty,  or,  in  a  hospital, 
if  the  staff  is  not  too  large,  the  whole  staff  invited  to  the  meet- 
ings of  the  board.  Here  I  can  speak  from  personal  experience. 
At  the  Orthopaedic  Hospital  and  Infirmary  for  Nervous 
Diseases  in  Philadelphia  there  are  three  surgeons  and  three 
physicians.  These  members  of  the  medical  staff  are  invited 
to  meet  with  the  board  of  managers  at  each  monthly  meeting, 
excepting  the  annual  meeting,  when  the  medical  staff  is 
elected.  They  are  free  to  express  their  opinions  on  any  topic 
relating  to  the  management  of  the  hospital  to  which  their 
judgment  may  contribute  something  of  value,  but  when  a 
decision  is  taken  they  have  no  vote.  It  is  purely  in  an 
advisory  capacity  and  for  the  purpose  of  giving  and  receiving 
information  that  they  are  present.  The  plan  works  exceed- 
ingly well.  When  economy  is  necessary  in  the  hospital,  the 
staff  is  fully  acquainted  with  the  fact  and  can  co-operate  with 
the  trustees;  when  expenses  have  run  up  from  carelessness 
in  the  wasteful  use  of  dressings  or  appliances,  a  halt  is  called ; 
when,  alas,  very  rarely,  the  treasurer  is  all  smiles,  and  plans  for 
the  extension  of  the  hospital,  or  the  installation  of  some  new 
addition  to  the  plant  is  contemplated,  their  knowledge  as  to 
the  necessity,  for  instance,  of  a  hydrotherapeutic  or  an  x-ray 
plant,  or  a  new  operating-room,  is  of  the  greatest  possible 
value.  Nothing  but  good,  in  my  opinion,  can  come  from  such 
personal  co-operation. 

One  of  the  difficult  questions  which  boards  of  trustees  have 
to  face  is  whether  there  shall  be  a  fixed  age  at  which  a  college 
professor  or  a  hospital  physician  or  surgeon  shall  retire  from 
the  active  duties  of  his  post.  I  firmly  believe  that  they  should 
fix  such  a  retiring  age  in  the  interest  of  the  students  and  the 


DUTIES  AND   RESPONSIBILITIES   OF   TRUSTEES.  375 

patients.  As  age  advances,  a  man's  opinions  and  his  practice 
become  "as  petrified  as  his  arteries."  He  is  incapable  of 
constant  study,  of  adding  to  his  knowledge  or  of  keeping  up 
with  the  feverish  strides  of  medicine.  He  ought  then  to  be 
relieved  of  his  cares  and  his  duties.  If  no  rule  exists,  he  is 
allowed  to  continue  his  inefficient  or  even  disastrous  work,  or 
by  some  harsh  suggestion  is  compelled  to  give  place  to  another 
more  competent  man.  A  rule  is  a  condition  accepted  when 
he  is  appointed.  In  the  army  and  navy,  when  an  officer 
reaches  64  or  62  years  of  age  he  is  retired  on  reduced  pay, 
and  because  it  is  a  rule  he  does  not  feel  hurt  or  humiliated. 
So  in  a  college  or  a  hospital,  when  time  and  the  rule  bring  us  to 
the  period  when  we  must  gracefully  retire,  no  one's  reputation 
is  injured  or  his  feelings  lacerated. 

I  have  ascertained  that  the  following  rules  are  in  force  hi 
some  of  the  larger  institutions : 

At  Harvard,  the  age  when  a  professor  may  request  to  be  re- 
tired is  60,  provided  he  has  been  in  the  service  of  the  university 
for  20  years,  with  a  reduced  pay  ranging  from  one-third  to 
two-thirds  of  his  salary.  At  66  he  may  be  retired  by  the 
President  and  Fellows  partly  or  wholly.  The  details  of  the 
plan  are  admirably  arranged. 

At  Chicago,  while  no  plan  is  yet  in  force,  largely,  I  presume, 
because  of  its  recent  establishment  on  the  present  basis,  such 
a  plan  will  soon  be  made  operative. 

At  Columbia  the  retiring  age,  after  15  years  of  service,  is  65, 
either  at  the  request  of  the  professor  or  upon  motion  of  the 
trustees,  and  on  half-pay. 

At  Yale  the  retiring  age  is  65,  after  25  years  of  service,  and 
on  half-pay,  but  the  retirement  is  not  compulsory.  It  will 
probably  be  made  compulsory  before  long. 

At  Cornell  the  retiring  age  is  70,  but  the  Pension  Fund  will 
not  be  available  until  1914.  The  retiring  pension  will  then  be 
$1500. 


376  ADDRESSES   AND   OTHER   PAPERS. 

At  the  University  of  Pennsylvania  and  at  Johns  Hopkins  no 
retiring  age  is  fixed. 

The  only  hospitals  I  know  of  in  which  a  retiring  age  is  fixed 
are  the  Massachusetts  General  Hospital  and  the  Boston  City 
Hospital.  At  the  former  the  compulsory  retiring  age  of  the 
surgeons  is  63,  and  of  the  physicians,  65.  At  the  Boston 
City  Hospital  the  visiting  surgeons  are  retired  at  65,  but  the 
physicians,  gynaecologists,  and  all  the  other  medical  officers 
continue  in  service  indefinitely — a  very  curious  anomaly. 

These  varying,  but  in  the  main  identical,  provisions,  when 
any  exist,  show  the  trend  of  thought  and  practice.  They 
generally  apply  to  the  medical  department,  except  that,  in 
case  a  professor  is  engaged  in  the  practice  of  his  profession  and 
so  has  a  private  income,  the  provision  for  continuing  a  por- 
tion of  his  salary  does  not  apply.  This  is  right  and  fair.  Of 
course,  in  all  hospitals  in  which  there  are  no  salaries,  no  pro- 
vision as  to  reduced  salary  would  obtain. 

The  point  I  wish  to  emphasize  is,  however,  that  the  age 
limit  (which  in  my  opinion  should  be  65)  should  be  compulsory 
and  so  not  be  invidious  in  any  given  case.  It  will  be  objected 
that  not  a  few  men  are  in  full  intellectual  and  physical  vigor 
at  65,  and  it  will  be  a  detriment  to  the  institution  to  lose  their 
services  when  their  ripe  experience  and  admirable  teaching  are 
most  desirable.  I  admit  it.  But  for  every  one  such  case  of 
harm  done  by  compelling  a  competent  man  to  stop,  there  are  a 
score  of  instances  of  men  who  are  doing  vast  injury  by  their 
inefficiency.  Moreover,  in  the  very  few  cases  in  which  it 
might  be  allowable,  as  boards  of  trustees  make  rules  they  can 
unmake  them,  and  in  special  cases  they  could  pay  a  graceful 
compliment  and  preserve  to  the  institution  their  exceptional 
men  by  extending  the  limit  to  70.  In  no  case  should  I  think 
it  wise  to  go  beyond  this  limit. 

In  some  of  the  universities  I  have  quoted  a  sabbatical  year 
of  rest  or  study  is  allowed  a  professor.  He  is  put  upon  half- 
pay,  and  his  place  is  filled  by  a  temporary  substitute,  who 


DUTIES    AND   RESPONSIBILITIES   OF   TRUSTEES.  377 

receives  the  other  half  of  his  salary.  I  believe  that  in  present 
conditions  this  should  not  be  applied  to  medical  faculties,  for 
nearly  all  of  the  professors  are  in  active  practice  and  take 
sufficiently  long  summer  holidays.  These  latter  are  often 
spent  in  observation  and  study  abroad — a  most  useful  and 
remunerative  employment  of  a  holiday — and  serve  the  pur- 
pose of  the  sabbatical  year  for  men  whose  entire  time  is 
given  to  their  teaching.  In  hospitals  it  certainly  should  not 
apply. 

One  of  the  recurring  questions  in  hospital  and  college 
management  is  whether  there  should  be  a  certain  number  of 
doctors  on  the  board.  I  know  that  there  is  a  wide  diversity  of 
opinion  upon  this  point.  My  own  belief  is  that  a  small  pro- 
portion of  well-chosen  medical  men  is  a  distinct  advantage  in 
such  boards  of  trustees.  I  have  said  a  "small  proportion," 
for  it  should  not  be,  I  think,  larger  than  probably  20  per  cent. ; 
and  I  also  said  "  well  chosen  " ;  that  is,  they  should  be  men  of 
large  mental  caliber  and  executive  ability.  It  should  be 
distinctly  understood,  if  not  indeed  absolutely  expressed,  in 
institutions  in  large  cities  at  least,  that  any  physician  or  sur- 
geon placed  upon  such  a  board  should  never  be  eligible,  even 
by  resignation  from  the  board,  for  a  position  on  the  faculty 
or  the  medical  staff.  In  small  towns  the  lack  of  suitable  per- 
sons for  hospital  trustees  and  members  of  the  hospital  staff 
might  make  it  desirable  not  to  institute  such  a  rule. 

Moreover,  such  medical  men  should  be  selected  for  trustees 
as  by  their  mental  training,  social  relations,  and  personal 
character  would  be,  so  far  as  it  is  possible  for  human  nature  to 
realize  such  a  position,  absolutely  free  from  influences  arising 
from  personal  jealousy  or  professional  bias.  If  it  were  a  social 
club,  it  would  be  perfectly  proper  to  vote  against  a  man 
because  he  is  personally  distasteful,  but  where  it  is  a  scien- 
tific body  responsible  for  the  education  of  large  numbers  of 
young  men  and  for  the  care  of  still  larger  numbers  of  hospital 
patients  among  the  poor,  even  if  a  candidate  were  personally 


378  ADDRESSES   AND    OTHER   PAPERS. 

unfriendly  I  should  vote  for  his  election  if  he  were  the  man 
best  fitted  for  the  place. 

Turning  now  to  the  duties  and  responsibilities  peculiar  to 
trustees  of  hospitals,  let  me  point  out  the  objects  of  a  hospital : 
First,  the  care  and  cure  of  the  sick  and  injured;  secondly,  the 
education  of  medical  men  and  medical  students;  and,  thirdly, 
the  promotion  of  knowledge,  which,  in  turn,  will  inure  all 
over  the  world  to  the  more  speedy  and  certain  cure  of  the  sick 
and  injured,  and  so  be  of  the  greatest  benefit  to  humanity. 

In  order  to  accomplish  these  three  purposes,  it  is  necessary 
that  the  hospital  shall  have  sufficient  funds  to  purchase 
ground,  erect  buildings  and  provide  a  thorough  material 
equipment.  It  is  a  great  pleasure  to  me,  as  to  you  also,  to 
note  that  throughout  the  length  and  breadth  of  the  land  the 
medical  and  surgical  staff  never  tax  the  always  inadequate 
resources  of  hospitals  for  any  remuneration.  They  serve 
without  pay,  they  give  their  time  and  skill  ungrudgingly  and 
freely,  day  and  night,  to  the  poor,  often  for  many  years,  with- 
out ever  a  thought  of  any  money  reward.  Their  reward  comes 
from  increased  knowledge  and  skill,  and  the  daily  blessing  in- 
voked of  heaven,  often  lisped  in  children's  prayers  or  breathed 
in  mothers'  benisons  which  pass  not  unheeded  by  the  Record- 
ing Angel. 

But,  as  I  have  pointed  out  elsewhere,  instead  of  receiving 
any  pay,  they  give  to  hospitals.  The  mere  money  value  of 
this  daily  gift  of  the  profession  to  the  poor  amounts  to  an 
enormous  sum.  The  value  of  the  professional  services  of  the 
staff  of  the  Jefferson  Medical  College  Hospital,  a  single  hospital 
in  a  single  city,  on  a  moderate  basis  of  fees,  I  found  was  more 
than  half  a  million  dollars  annually.  The  millions  upon 
millions  of  money  given  in  that  most  self-sacrificing  form — 
personal  service — by  the  entire  profession  all  over  the  United 
States,  and  I  might  add  with  still  further  pride,  all  over  the 
world,  is  simply  incalculable.  The  Gideon  Grays  and  Weel- 
lum  MacLures  are  not  found  only  in  Scotland  or  at  the 


DUTIES   AND   RESPONSIBILITIES   OF   TRUSTEES.  379 

countryside.  They  are  even  more  plentiful  in  the  slums  of 
our  great  cities,  giving  of  their  time,  their  skill,  and — what  is 
more — their  hearts,  their  lives,  themselves,  to  the  service  of 
humanity. 

Trustees  sometimes  seem  to  take  it  for  granted  that  their 
duties  are  ended  when  they  have  done  two  things :  begged  or 
given  and  safely  invested  the  necessary  funds,  and  then 
elected  the  staff.  To  my  mind,  their  duties  do  not  by  any 
means  end  at  this  point.  They  should  see  to  it  that  the 
resources  of  the  hospital  are  utilized  to  the  utmost  in  doing 
the  largest  good. 

Let  us  see  now  how  the  objects  of  a  hospital,  as  I  have 
stated  them,  can  be  realized.  The  first  object  is  the  care  and 
cure  of  the  patients.  But  the  cure  of  any  individual  patient 
is  not  the  "be  all  and  the  end  all"  of  a  hospital.  His  cure 
must  be  a  means  of  larger  vision  to  the  doctor,  who  will  thus 
be  better  fitted  to  care  for  future  similar  cases.  Even  his 
death,  if  he  cannot  be  cured,  should  minister  to  the  increasing 
knowledge  and  skill  of  the  doctor  so  that  he  may  be  able  to 
snatch  future  victory  from  present  defeat. 

The  second — the  training  of  doctors  and  students — is 
frequently  carried  out,  but  sometimes  even  objected  to. 
There  are  three  classes  of  doctors  who  are  trained  by  a 
hospital:  First,  the  staff  of  the  hospital  itself.  I  have  lived 
through  the  period  of  the  establishment  of  hospitals  in  many 
of  the  smaller  cities  and  towns,  and  in  some  cases  even  villages 
in  this  country,  for  it  was  a  rare  thing  in  my  early  professional 
life  for  any  except  the  larger  cities  to  have  hospitals.  The 
moment  that  a  hospital  is  established  with  its  medical  and 
surgical  staff,  that  moment  a  new  era  has  dawned  on  the 
community  in  which  the  hospital  is  established.  More  careful 
methods  are  introduced,  greater  cleanliness  is  observed, 
hygienic  conditions  are  bettered,  laboratory  methods  are 
inevitably  introduced  in  time.  Even  if  the  old-timers,  who 
graduated  years  before  our  modern  laboratory  methods  were 


380  ADDRESSES   AND   OTHER   PAPERS. 

adopted,  do  not  care  for  them  or  cannot  use  them,  the  young 
fellows  who  come  fresh  from  our  medical  schools  and  serve  as 
residents,  and  even  the  nurses  graduated  from  our  training 
schools,  finally  shame  the  older  ones  into  better  ways  and 
greater  exactness,  not  only  in  the  hospital,  but  in  their  private 
work  as  well. 

As  a  consequence  of  the  establishment  of  these  hospitals 
and  the  added  skill  and  training  of  the  local  physicians  and 
surgeons,  the  character  of  the  consultations  of  the  physicians 
and  surgeons  of  our  great  medical  centers  has  been  greatly 
modified.  The  really  simple  cases,  such  as  hydrocele  and 
small  tumors  (and  even  large  ones),  clubfoot,  harelip,  etc., 
which  used  to  be  sent  to  city  consultants,  are  now  successfully 
operated  on  by  the  local  surgeons,  and  only  the  more  difficult, 
serious,  or  complicated  cases  are  sent  to  the  cities.  This  is  a 
great  advantage  to  the  patient,  whose  good  is  the  first  con- 
sideration, and  to  the  local  medical  men;  and,  though  seem- 
ingly a  serious  loss  to  the  city  consultant,  it  is  in  the  end  an 
advantage,  as  he  must  prove  his  better  mettle  in  the  higher 
scientific  fields  and  be,  as  well  as  seem  to  be,  a  better  man. 

Moreover,  the  trustees  of  every  hospital  should  see  to  it  that 
a  good  library  and  laboratory  are  provided.  Insensibly  the 
staff  will  read  more  and  more.  A  single  restless  progressive 
spirit,  even  though  it  be  a  young  interne,  calling  attention  to 
this  case  and  to  that,  in  one  journal  or  another,  will  compel 
the  rest  of  the  staff  to  read  in  spite  of  themselves.  It  is  ab- 
solutely clear  that  a  laboratory  with  modern  equipment  for 
bacteriological,  pathological,  and  chemical  research  in  its 
examination  of  tumors,  the  urine,  the  sputum,  the  faeces,  the 
blood,  the  pus,  and  other  fluids  from  wounds,  etc.,  is  a  neces- 
sity in  every  hospital.  Even  many  of  our  smaller  hospitals 
are  equipped  with  microscope  and  reagents,  if  not  with  a 
complete  bacteriological  outfit,  which  nowadays  is  inexpen- 
sive and  imperative.  All  of  this  raises  the  intellectual  and 
professional  standard  of  the  staff.  I  venture  to  say  that  no 


DUTIES    AND  RESPONSIBILITIES   OF    TRUSTEES.  381 

town  of  20,000  people  can  afford  to  be  without  its  hospital  for 
the  sake  of  its  own  citizens,  utterly  irrespective  of  the  good  ife 
does  to  the  poor  who  are  treated  in  its  wards.  It  must  be 
established  in  the  interest  of  the  well-to-do  citizens  and  their 
families,  so  that  they  may  secure  better  equipped  doctors  for 
themselves  as  well  as  for  the  patients  in  their  hospital.  Self- 
interest,  therefore,  should  compel  every  community  to  es- 
tablish its  hospital,  even  if  charitable  motives  had  no  in- 
fluence. 

Again,  the  trustees  of  all  hospitals  of  any  size  should  es- 
tablish a  training-school  for  nurses.  Only  those  who,  like 
myself,  have  lived  in  the  period  before  such  training  schools 
were  established  can  appreciate  the  vast  improvement 
effected  hi  a  hospital  by  this  change.  To  replace  the  former 
ignorant,  untrained  attendants  by  "trained  nurses  whose 
jaunty  caps  and  pretty  uniforms  and  often  winsome  faces 
almost  make  one  half  wish  to  be  sick,  and  when  one  is  sick, 
half  loath  to  be  well,"  is  not  only  a  boon  to  the  patients, 
but  to  the  doctors  as  well.  The  intelligent,  well-trained 
nurse,  who  is  on  the  alert  to  observe  every  important  change 
of  symptoms  and  who  will  keep  accurate  bedside  notes,  is 
the  doctor 's  right  hand.  Not  a  few  patients  who  would  other- 
wise lose  heart  and  hope  are,  one  may  say,  lured  back  to 
health  and  happiness  by  the  tactful  attentions  and  restful, 
but  efficient,  care  of  such  a  nurse.  The  community  of  the  well- 
to-do  also  are  benefited,  because  the  hospital  provides  them 
with  skilled  nurses  in  their  homes  when  they  are  so  unfortu- 
nate as  to  be  compelled  to  remain  there  instead  of  going  to 
the  hospital. 

The  old  repugnance  to  entering  a  hospital  when  sick  or 
when  an  operation  is  demanded  is  rapidly  fading  away.  The 
immense  advantages  of  a  good  hospital  over  the  most  luxuri- 
ous home  are  now  acknowledged  on  all  hands.  The  poorest 
patient  in  a  hospital  is  better  cared  for,  his  case  more  care- 
fully investigated  by  bacteriological,  chemical,  and  clinical 


382  ADDRESSES   AND    OTHER   PAPERS. 

methods  in  a  hospital,  than  are  the  well-to-do  in  their  own 
homes.  Indeed,  wise  surgeons,  except  in  cases  of  emergency, 
now  very  properly  refuse  to  do  operations  hi  homes  instead  of 
in  hospitals.  In  many  instances  lives  that  would  be  lost  hi 
homes  are  saved  hi  hospitals,  where  the  many  and  complex 
modern  appliances  for  every  surgical  emergency  are  provided. 

The  hospital  in  direct  or  indirect  connection  with  medical 
schools,  however,  do  a  far  larger  work  than  merely  the  train- 
ing of  its  own  staff  of  doctors.  They  train  three  other  classes 
of  doctors:  First,  the  undergraduates  who  are  aspiring  to 
the  degree;  secondly,  graduate  physicians  who  spend  a 
certain  amount  of  time  hi  the  hospitals  either  as  internes 
or  as  temporary  students  refurbishing  their  professional 
knowledge;  and  thirdly,  experts  in  certain  branches  of 
medicine  and  surgery. 

The  undergraduates  are  taught  first  in  the  general  clinics, 
where  to  some  extent  they  learn  both  by  didactic  instruction 
and  by  seeing  the  patients,  hearing  their  histories,  and  wit- 
nessing the  institution  of  proper  treatment  by  prescription, 
by  regimen,  or,  if  necessary,  by  surgical  operation.  This  is 
of  great  value,  particularly  in  the  more  important  cases, 
and  especially,  for  I  speak  now  as  a  surgeon,  in  important 
operations.  It  is  often  objected  that  students  see  nothing 
in  large  clinics.  To  some  extent  this  holds  good;  but  no 
student  can  look  on  at  an  operation  when  the  jugular  vein 
or  the  lateral  sinus  is  torn,  the  pleural  cavity  opened,  the 
bowel  lacerated,  or  other  of  the  great  emergencies  of  surgery 
occur,  and  fail  to  be  impressed  by  the  coolness  of  the  operator, 
the  carefully  explained  methods  adopted  for  remedying  the 
mischief,  and  the  various  devices  used  to  save  life,  all  of 
which  hereafter  will  be  used  by  him  when  similar  emergen- 
cies may  occur. 

Yet  far  more  important  than  the  public  clinics  are  the 
smaller  clinics  held  with  classes  of  ten  to  twenty  men  each, 
when  under  an  experienced  teacher  the  absolute  work  of  the 


DUTIES    AND   RESPONSIBILITIES  OF  TRUSTEES.  383 

clinic  is  divided  among  the  various  students  in  turn,  watching 
the  pulse  and  the  respiration,  giving  an  anaesthetic,  assist- 
ing actively  at  operations,  percussing  the  chest,  palpating 
the  abdomen,  determining  inequalities  of  the  surface  or  the 
varying  density  of  underlying  organs.  Here  is  the  real  forum 
in  which  our  modern  medical  student  acquires  his  skill.  In 
many  cases  visits  in  the  ward  itself  are  made,  and  to  a  small 
group  around  the  bedside  the  physician  or  surgeon  will  point 
out  the  phenomena  to  be  recorded,  the  need  for  the  examina- 
tion of  the  blood,  the  results  of  bacteriological  cultures,  the 
facts  discovered  by  the  microscope,  or  the  chemical  reagent. 
'By  the  Socratic  method,  also,  he  will  reveal  to  the  student 
the  imperfection  of  his  knowledge,  call  out — e-ducate — his 
powers  of  observation,  of  reasoning;  stimulate  his  thought, 
and  give  him  an  impetus  which  will  last  throughout  life. 
Who  that  has  "walked  the  hospitals"  with  a  Skoda,  a 
Trousseau,  a  NeUaton,  a  Da  Costa,  or  a  Mitchell  can  ever 
forget  their  teaching? 

It  is  sometimes  objected  by  those  who  are  not  familiar 
with  the  actual  facts,  and  especially  by  trustees,  that  this 
method  of  actual  bedside  instruction  does  harm  to  the  sick. 
I  speak  after  an  experience  of  nearly  forty  years  as  a  surgeon 
to  a  half  dozen  hospitals  and  can  confidently  say  that  I  have 
never  known  a  single  patient  injured  or  his  chances  of  recovery 
lessened  by  such  teaching.  Of  course,  the  surgeon  or  physi- 
cian uses  common  sense.  He  would  not  allow  a  number  of 
men  to  palpate  the  abdomen  of  a  patient  with  peritonitis, 
or  move  an  acutely  inflamed  joint,  nor  would  the  physician 
allow  a  patient  with  pneumonia  to  have  the  chest  unduly 
exposed,  or  a  typhoid  fever  patient  disturbed  if  his  con- 
dition were  such  that  it  would  be  inadvisable.  But  such 
cases  are  the  exception.  In  fact,  many  of  you  are  familiar 
with  patients  who  have  responded  to  repeated  percussion 
by  members  of  such  a  class  by  prompt  recovery,  attributed 
by  the  patient  to  the  supposed  medication  of  percussion. 


384  ADDRESSES   AND   OTHER   PAPERS. 

Moreover,  it  is  by  this  actual  practice  only  that  the  student 
acquires  the  necessary  skill  in  the  use  of  modern  instruments 
of  precision,  such  as  the  stethoscope,  the  laryngoscope,  the 
sesthesiometer,  the  sphygmomanometer,  the  various  specula. 
Here  he  learns  when  to  make  blood-counts,  how  to  take  his- 
tories, arrive  at  the  actual  facts  by  skillful  cross-questioning, 
note  the  varying  symptoms  and  physical  signs  of  a  case, 
determine  the  need  for  laboratory  investigations,  all  under 
the  guidance  of  skilled  observers,  who  will  point  out  his 
errors,  encourage  his  queries,  and  stimulate  his  thought. 

Moreover,  trustees  may  overlook  one  important  advantage 
of  a  teaching  hospital.  Who  will  be  least  slovenly  and  care- 
less in  his  duties:  he  who  prescribes  in  the  solitude  of  the 
sick  chamber,  and  operates  with  two  or  three  assistants  only, 
or  he  whose  every  movement  is  eagerly  watched  by  hun- 
dreds of  eyes,  alert  to  detect  every  false  step,  the  omission  of 
an  important  clinical  laboratory  investigation,  the  neglect 
of  the  careful  examination  of  the  back  as  well  as  the  front 
of  the  chest,  the  failure  to  detect  any  important  physical 
sign  or  symptom?  Who  will  be  most  certain  to  keep  up 
with  the  progress  of  medical  science:  he  who  works  alone 
with  no  one  to  discover  his  ignorance,  or  he  who  is  surrounded 
by  a  lot  of  bright  young  fellows  who  have  read  the  last  "Lan- 
cet" or  the  newest  "Annals  of  Surgery"  andean  trip  him 
up  if  he  is  not  abreast  of  the  times?  I  always  feel  at  the  Jef- 
ferson Hospital  as  if  I  were  on  the  run  with  a  pack  of  lively 
dogs  at  my  heels.  I  cannot  afford  to  have  the  youngsters 
familiar  with  operations,  means  of  investigations,  or  newer 
methods  of  treatment  of  which  I  am  ignorant.  I  must  per- 
force study,  read,  catalogue,  and  remember,  or  give  place 
to  others  who  will.  Students  are  the  best  whip  and  spur 
I  know. 

Of  the  value  of  training  graduates  in  post-graduate  work 
I  need  scarcely  speak, — to  this  audience  at  least.  The  doctor 
who  graduated  five,  ten,  or  fifteen  years  ago  comes  to  our 


DUTIES  AND    RESPONSIBILITIES   OF  TRUSTEES.  385 

great  centers  of  medical  education  and  renews  his  youth  at 
the  fountain  of  knowledge.  He  learns  the  use  of  all  the  new 
instruments,  sees  new  methods  of  operation,  new  methods  of 
treatment,  new  means  of  diagnosis,  and  goes  home  an 
enormously  better  equipped  man. 

The  trustees  should  see  that  the  staff  does  not  become 
fossilized  by  following  the  same  ancient  local  methods  from 
year  to  year,  but  should  encourage  them  to  visit  other  hos- 
pitals, see  other  men  operate,  hear  other  men  discourse  on 
the  latest  methods  of  investigation,  and  then  import  into 
their  own  hospitals  all  the  good  found  elsewhere.  I  learn  a 
deal  by  such  frequent  visits  to  the  clinics  of  my  brother-sur- 
geons, and  if  one  who  has  grown  gray  in  the  service  can  thus 
learn,  surely  the  younger  men  can  do  so.  When  we  are  too 
old  to  learn,  we  are  too  old  to  remain  on  a  hospital  staff. 

I  do  not  know  anything  which  has  more  impressed  upon 
me  the  enormously  rapid  progress  which  surgery  is  making 
than  a  recent  experience.  I  was  absent  from  this  country 
for  almost  a  year  and  a  half.  In  that  time  circumstances 
were  such  that  I  saw  almost  no  medical  journals  and  but 
few  doctors.  I  have  been  home  now  eight  months  and  even 
with  incessant  work  I  have  not  yet  caught  up,  so  rapid  has 
been  the  progress  of  surgery  in  this  short  time.  Had  I  been 
absent  for  five  years,  verily  I  should  have  been  a  "back 
number,"  and  never  could  have  caught  up  at  all. 

In  his  very  excellent  presidential  address  before  the  As- 
sociation of  American  Physicians  in  1901,  Professor  Welch 
made  a  plea  for  hospitals  to  afford  "the  requisite  opportu- 
nities to  young  men  who  aim  at  the  higher  careers  in  clinical 
medicine  and  surgery."  He  called  attention  to  the  fact  that 
in  our  bacteriological,  pathological,  and  anatomical  labora- 
tories the  opportunities,  though  still  too  few,  were  reason- 
ably good,  and  in  a  few  places  exceptionally  good,  for  the 
training  of  young  men  for  positions  as  teachers  of  anatomy, 
pathology  and  bacteriology.  Any  young  man  in  these  de- 

25 


386  ADDRESSES   AND   OTHER   PAPERS. 

partments  who  by  good  hard  work  makes  for  himself  a  name 
is  fairly  sure,  before  long,  of  being  called  to  some  important 
post  as  a  professor,  director  of  a  laboratory,  or  some  similar 
position.  But  the  facilities  for  work  in  clinical  medicine 
and  clinical  surgery  are  far  more  restricted,  since  oppor- 
tunities for  both  the  exercise  of  their  clinical  skill  are 
less  frequently  open  to  them  and  the  possibility  of  com- 
bined physiological,  pathological,  bacteriological,  and  an- 
atomical research  along  with  their  clinical  work  are  but 
scantily  provided  for.  This  plea  is  reinforced  by  a  recent 
paper  of  Sir  Michael  Foster.*  These  special  graduates,  bright 
young  men,  determined  to  devote  themselves  to  one  or  an- 
other department  of  medicine  or  surgery,  are  the  men  who 
bring  honor  to  the  school  at  which  they  obtain  their  training, 
and  are  invaluable  to  the  community.  They  are  future 
Jenners,  Pasteurs,  Virchows,  Listers,  Da  Costas,  and  Grosses, 
and  our  hospitals  should  provide  exceptional  facilities  for 
these  exceptional  men. 

The  third  object  of  a  hospital  is  the  promotion  of  knowl- 
edge, and  so,  fourthly,  the  good  of  humanity.  Physicians 
and  surgeons  engaged  only  in  private  practice  do  not  gen- 
erally keep  notes  of  their  cases,  and  rarely  publish  important 
contributions  to  knowledge.  I  find  in  100  books  taken  con- 
secutively hi  my  library  that  85  were  written  by  hospital  men 
and  only  15  by  authors  not  connected  with  any  hospital  so 
far  as  was  indicated  on  the  title  page. 

In  order  that  proper  investigations  may  go  on,  trustees 
should  enforce  a  permanent  record  of  all  the  cases  treated 
in  the  hospital,  properly  indexed,  from  which  the  staff  may 
derive  their  data  for  papers  and  books.  Each  large  hospital 
should  have  its  pathological  resident  as  well  as  the  clinical 
residents  in  the  various  wards,  so  that  post-mortem  records 
shall  be  well  kept,  pathological,  bacteriological,  and  chemical 
investigations  of  various  secretions  or  blood-counts,  etc., 

*  Nineteenth  Century,  January,  1901,  p.  57. 


DUTIES    AND    RESPONSIBILITIES  OF  TRUSTEES.  387 

shall  be  properly  made  and  permanently  recorded  in  such 
a  manner — best  by  a  modern  card-catalogue — as  to  be  ac- 
cessible. 

It  is  too  often  the  case  that  trustees,  as  I  have  said,  regard 
their  duties  and  responsibilities  at  an  end  when  they  have 
taken  care  of  the  funds  and  elected  the  staff.  They  may  say 
that,  after  all,  this  is  their  real  duty,  and  that  all  I  have  advo- 
cated is  medical  and  surgical,  and  that  the  responsibility  for 
it  should  devolve  on  the  staff,  and  not  on  the  trustees.  I  do 
not  take  so  narrow  a  view  of  the  duties  of  trustees.  When 
they  have  elected  a  physician  or  surgeon,  if  he  neglects  his 
duty,  it  is  their  business  to  displace  him  and  fill  his  place  with 
another  man  who  will  attend  to  his  duty,  and  the  duties  that  I 
have  indicated  pertaining  to  the  increase  of  knowledge  as  well 
as  of  its  diffusion  are  quite  as  much  within  their  province  as  it 
is  to  see  that  the  funds  are  invested  to  the  best  advantage. 
The  intellectual  funds  as  well  as  the  invested  funds  must  bring 
in  good  dividends. 

If  trustees  and  staff  work  together  for  such  a  purpose  and  in 
such  a  manner,  they  will  create  an  ideal  hospital  which  will 
do  more  good  to  the  patients  than  any  other  type  of  hospital. 
It  will  attract  the  best  physicians  and  surgeons  in  every  com- 
munity, will  acquire  the  best  reputation,  not  only  local,  but 
it  well  may  be  national,  and  do  the  most  for  the  good  of  science 
and  the  benefit  of  humanity. 

It  may  be  said  that  this  is  an  unduly  strenuous  view  of  the 
duties  of  trustees,  that  in  our  father's  day  and  in  our  own 
earlier  lives  no  such  conditions  existed  or  were  contemplated. 
"I  need  hardly  ask  a  body  like  this,"  said  President  Roose- 
velt in  addressing  the  Methodists  assembled  in  council,  "to 
remember  that  the  greatness  of  the  fathers  becomes  to  the 
children  a  shameful  thing  if  they  use  it  only  as  an  excuse  for 
inaction  instead  of  as  a  spur  to  effort  for  noble  aims.  .  .  . 
The  instruments  with  which,  and  the  surroundings  in  which 
we  work  have  changed  immeasurably  from  what  they  were  in 


388  ADDRESSES   AND    OTHER   PAPERS. 

the  days  when  the  rough  backwoods  preachers  ministered  to 
the  moral  and  spiritual  needs  of  the  rough  backwoods  con- 
gregations. But,  if  we  are  to  succeed,  the  spirit  in  which  we 
do  our  work  must  be  the  same  as  the  spirit  in  which  they  did 
theirs." 

Moreover,  we  must  remember  that  "  the  world  field  into 
which  all  nations  are  coming  in  free  competition  by  the 
historical  movement  to  which  all  narrower  policies  must 
sooner  or  later  yield,  will  be  commanded  by  those  races  which, 
hi  addition  to  native  energy  and  sagacity,  bring  the  resources 
of  scientific  investigation  and  of  thorough  education."  The 
international  race  for  the  leadership  of  the  world  is  just  as 
strenuous  and  intense  in  medicine  as  it  is  in  commerce.  If 
we  are  going  to  join  the  race  and  win  the  prize,  there  must  be 
the  highest  development  of  American  education  at  the  top. 
The  best  men  must  be  pushed  to  the  front,  and  ample  op- 
portunities for  growth,  for  investigation,  and  for  original 
research  must  be  provided.  Never  has  there  been  so  large  an 
opportunity  for  the  man  of  large  ideas,  complete  education, 
and  indomitable  energy  and  purpose  as  there  is  to-day.  The 
world  is  waiting,  looking,  longing  for  him  and  will  cry  "Make 
room"  for  him  when  he  is  found. 

In  the  hands  of  the  trustees  of  our  colleges  and  hospitals 
are  the  money  and  the  opportunity  for  developing  such  men. 
If  the  right  spirit  pervades  both  trustees  and  medical  faculties 
and  hospital  staffs,  then  it  will  be  but  a  short  time  before 
America  will  lead  the  world  in  medicine  as  well  as  she  now 
does  in  commerce. 

Will  the  profession  rise  to  the  level  of  their  great  oppor- 
tunity? Yea,  verily  they  will!  Never  yet  have  they  been 
wanting  when  the  emergency  arose;  not  only  the  emergency 
of  labor,  but  also  the  emergency  of  danger. 

In  Russia  the  common  soldier  counts  for  little.  Yet  hi 
Vladikavkaz  (where  the  Dariel  Pass — the  old  Portse  Caspiae 
of  Herodotus — leading  from  the  Caucasus  joins  the  railroad 


DUTIES   AND   RESPONSIBILITIES   OF  TRUSTEES.  389 

from  Baku  on  the  Caspian  to  Moscow)  is  a  monument  to  a 
common  soldier.  At  the  last  battle  in  which  the  Russians 
won  the  victory  over  Schamyl  which  gave  them  undisputed 
sway  over  the  Caucasus,  this  soldier  blew  up  a  mine  and  won 
the  day  at  the  cost  of  his  own  life.  It  was  ordered  that  his 
name  should  never  be  erased  from  the  list  of  his  company. 
At  every  roll-call  when  his  name  is  reached,  the  solemn  answer 
is  given,  "  Died  in  the  service  of  his  country." 

In  our  hospitals  lurk  the  deadly  breath  of  diphtheria,  the 
fatal  virus  of  bubonic  plague,  of  cholera,  of  yellow  fever,  of 
typhoid  fever,  and  the  ever-present  danger  of  blood-poisoning. 
I  have  known  of  brother-physicians  who  have  died  victims  to 
each  one  of  these  scourges.  Yet  who  has  ever  known  one  of 
our  guild  to  shrink  when  danger  smote  him  on  the  right  hand 
and  the  left  and  death  barred  the  way?  As  brave  as  the  Rus- 
sian soldier,  ready  to  risk  life,  and,  if  need  be,  to  lose  it,  these 
martyrs  to  duty  shall  never  have  their  names  stricken  off 
the  honor  list,  and  at  the  last  roll-call  the  solemn  reply  shall 
be,  "  Died  in  the  service  of  humanity." 


THE  QUALITIES  ESSENTIAL  TO  SUCCESS  IN 
MEDICINE.* 


IN  the  "Selected  Essays  and  Addresses"  of  that  most 
distinguished  English  surgeon,  the  late  Sir  James  Paget, 
one  of  the  most  interesting  is  entitled  "What  Becomes  of 
Medical  Students."  It  opens  thus:  "It  is  said  that,  on 
entering  the  anatomical  theatre  for  one  of  his  Introductory 
Lectures,  Mr.  Abernethy  looked  around  at  the  crowd  of  pupils 
and  exclaimed,  as  if  with  painful  doubt,  'God  help  you  all! 
What  will  become  of  you?'"  Sir  James  then  proceeds  to 
analyze  the  results  of  an  inquiry  into  the  later  history  of 
1000  of  his  former  students.  The  result  may  be  stated  in 
round  numbers  as  follows:  Sixty  per  cent,  achieved  success 
varying  from  "distinguished"  and  "considerable"  to  "fair," 
18  per  cent,  a  "very  limited  success"  or  entire  failure,  and  22 
per  cent,  either  died  or  left  the  profession.  His  paper  con- 
cludes as  follows:  "Nothing  appears  more  certain  than  that 
the  personal  character,  the  very  nature,  the  will,  of  each 
student  had  far  greater  force  in  determining  his  career  than 
any  helps  or  hindrances  whatever.  All  my  recollections 
would  lead  me  to  tell  that  every  student  may  draw  from  his 
daily  life  a  very  likely  forecast  of  his  life  in  practice,  for  it  will 
depend  upon  himself  a  hundredfold  more  than  on  circum- 
stances. The  time  and  the  place,  the  work  to  be  done  and 
its  responsibilities  will  change ;  but  the  man  will  be  the  same, 
except  in  so  far  as  he  may  change  himself." 

*  The  Commencement  Address  before  the  Medical  Department  of 
Columbian  University,  Washington,  D.  C.,  June  1,  1903.  Reprinted 
from  the  Philadelphia  Medical  Journal,  June  6,  1903. 

390 


QUALITIES   ESSENTIAL  TO   SUCCESS   IN   MEDICINE.        391 

I  have  had  neither  the  time  nor  the  opportunity  to  make  a 
similar  investigation,  but  what  I  shall  say  is  based  upon  an 
experience  now  covering  forty  years  of  teaching,  during 
which  time  I  have  observed  the  careers  more  or  less  accurately 
of  from  6000  to  7000  students.  Their  successes  and  their 
failures  have  been  probably  about  in  the  same  proportion  as 
Sir  James  Paget's.  But  I  have  never  known  a  man  to  fail 
of  achieving  an  honorable  or  even  enviable  success  who  had 
four  characteristics : 

First,  a  good  moral  character; 

Second,  good  manners; 

Third,  perseverance;  and, 

Fourth,  studiousness. 

I  need  say  but  a  word  as  to  a  good  moral  character,  for  it  is 
the  foundation  of  success  in  every  department  of  life.  He 
who  lacks  moral  character  lacks  everything,  and  not  only  as  a 
rule  will  not  succeed,  but  ought  not  to  succeed. 

"  Manners  make  the  man,"  is  an  old  adage,  and  in  no  calling 
hi  life,  perhaps,  are  they  so  important  as  in  medicine,  for:  the 
doctor  has  to  do  not  only  with  his  fellow-men,  but  very  largely 
with  women  and  children,  hi  which  relations  good  manners  are 
essential.  It  has  been  said  of  a  well-known  New  York 
physician,  now  dead,  that  he  owed  much  of  his  success  to 
what  was  humorously  called,  among  his  friends,  his  "ten- 
thousand-dollar  smile,"  and,  while  such  a  statement  always 
carries  the  inaccuracy  which  inheres  hi  most  aphorisms,  yet 
there  was  a  large  basis  of  truth  for  it.  Neatness  always  pays. 
To  wear  a  grease-spotted  coat  is  reckless  extravagance.  It 
will  cost  you  far  more  than  a  whole,  clean,  new  suit.  To 
display  grimy  finger-nails  is  as  bad  socially  as  it  is  surgically. 

To  illustrate  the  value  of  perseverance,  my  third  requisite 
for  success,  let  me  give  you  an  incident  which  occurred  a 
number  of  years  ago  in  my  own  office.  Among  my  students 
was  one  who  had  had  unusual  advantages.  His  parents  had 
sufficient  means  to  give  him  the  best  education.  He  gradu- 


392  ADDRESSES   AND    OTHER   PAPERS. 

ated  at  his  university  at  the  head  of  his  class.  When  he  took 
his  degree  in  medicine,  he  was  an  honor  man.  He  served  an 
honorable  apprenticeship  as  a  hospital  resident.  He  spent  a 
year  or  more  abroad  and  acquired  an  excellent  knowledge  of 
French  and  German  as  well  as  added  to  his  knowledge  in 
medicine.  Before  going  abroad  he  married  and,  as  soon  as  he 
returned,  settled  in  practice.  One  day  he  came  to  me  greatly 
discouraged  and  said :  "  I  think  I  must  give  up  the  practice  of 
medicine.  My  parents  have  been  very  kind  to  me,  but  I 
cannot  always  be  dependent  upon  them  for  the  support  of 
myself  and  my  family."  I  said  to  him:  "My  dear  doctor, 
exactly  how  long  have  you  been  in  practice?"  "Seven 
months."  "  How  much  have  you  actually  collected  in  cash? " 
"Two  dollars  and  a  half."  In  other  words,  in  210  days  he 
had  made  250  cents,  a  little  over  one  cent  a  day.  It  was 
enough,  I  confess,  to  chill  even  a  stout  heart,  but  I  en- 
couraged him  and  told  him  what  I  am  telling  you,  that  I 
had  never  known  a  man  with  these  four  qualifications  to 
fail;  that  he  had  three  of  our  four  requisites,  a  good  moral 
character,  good  manners,  studiousness ;  and  that,  if  he 
would  but  remember  the  fourth  qualification,  perseverance, 
he  would  be  sure  of  success.  To-day  he  is  widely  known 
as  a  most  successful  practitioner  and  has  an  enviable  place 
not  only  in  the  esteem  of  the  profession,  but  in  that  of  the 
community. 

I  might  give  you  beside  this  a  little  of  my  own  experience, 
for  I  passed  through  almost  the  identical  stage  of  discourage- 
ment that  I  have  just  related  to  you.  Failure  I  thought 
again  and  again  stared  me  in  the  face.  It  seemed  for  a  num- 
ber of  very  long  years  as  if  I  should  never  be  able  even  to 
earn  a  decent  livelihood.  Plenty  of  people  needed  surgical 
advice,  but  the  ninety  and  nine  went  decorously  on  the 
well-beaten  paths  leading  to  other  offices.  Only  the  one  poor 
forlorn  and  wandering  sheep,  attracted  by  the  luxuriant  grass 
in  an  unfrequented  path,  reached  my  own.  But  I  had  good 


QUALITIES  ESSENTIAL  TO   SUCCESS   IN   MEDICINE.       393 

friends  who  encouraged  me,  and  I  remembered  the  story  of 
the  knight  whose  crest  was  a  man  at  the  foot  of  a  great 
mountain  which  he  was  attacking  with  a  pick  axe,  and  whose 
motto  was  "petit  h  petit," — "little  by  little."  More  than  one 
disappointment  in  preferment  came  to  me,  but  I  simply 
buckled  down  to  my  work  with  more  tenacity  of  purpose  than 
ever  before,  resolved  to  do  each  day  the  work  of  that  day  as 
well  as  I  knew  how  to  do  it.  Finally  the  clouds  broke  away, 
and  the  bright  blue  sky  and  the  beaming  sun  were  revealed. 
So  it  will  be  with  you  if  you  will  heed  the  lesson  that  I  am 
giving  you.  Remember  Emerson's  saying,  "Make  yourself 
necessary  to  the  world,  and  mankind  will  give  you  bread." 

Studiousness  is  the  fourth  essential  condition  of  medical 
success.  Medicine  is  a  science,  and  one  which  has  progressed 
with  extraordinarily  rapid  strides,  especially  within  the  last 
few  decades.  The  rate  of  progress  in  the  next  fifty  years, 
during  your  active  lifetime,  will  probably  be  even  more  rapid 
than  it  has  been.  Unless  you  devote  yourself,  therefore,  to 
your  patients,  your  books,  and  your  medical  journals,  you 
must  expect,  and  you  ought  to  expect,  to  be  left  behind, 
stranded  on  the  shore  of  idleness,  while  others  sail  on  to 
fortune  and  to  fame. 

When  you  begin,  for  a  number  of  years  your  cases  will  be 
sufficiently  infrequent  for  you  to  be  able  to  study  each  case  as 
if  your  own  as  well  as  your  patient's  life  depended  upon  your 
knowing  all  about  that  case.  One  case  thoroughly  studied, 
so  that  you  know  not  only  all  about  that  individual  case,  but 
all  about  that  individual  disease  or  accident,  is  worth  a  dozen 
treated  in  a  slipshod  routine  manner.  If  with  each  differing 
case  you  master  the  disease  as  well  as  treat  the  .case,  it  will  not 
be  long  before  you  will  have  run  the  gamut  of  most  of  the 
ordinary  diseases  and  have  become  master  of  them  all. 
Make  each  patient  understand,  while  you  are  investigating 
his  case,  that  he  is  the  only  patient  hi  the  world  for  you  at  that 
time.  If  you  practise  in  the  country,  do  not  waste  your  time 


394  ADDRESSES  AND    OTHER   PAPERS. 

in  gossip  at  the  corner  store.  Remember  that  medicine  is  a 
jealous  mistress  and  will  allow  no  rival.  She  must  have 
your  whole  heart  or  she  will  have  none  of  you. 

Moreover,  remember  that  there  are  broader  and  larger 
questions  to  be  studied  than  this  or  that  disorder,  however 
important  it  may  be.  Let  me  name  a  few  which  have  arisen 
in  my  day.  I  have  seen  the  birth  and  development  of  an- 
tisepsis, of  asepsis,  of  all  our  knowledge  of  immunity,  of  the 
serum  treatment  of  disease,  of  the  x-rays,  of  practically  the 
entire  departments  of  neurology  and  gynaecology;  the  whole 
of  pathology  and  of  surgery  have  been  rewritten  from  the 
time  of  Virchow's  "Cellular  Pathology,"  published  just  as  I 
was  entering  upon  the  study  of  medicine,  and  since  Lister's 
epoch-making  work  in  the  sixties  and  the  seventies.  These 
subjects  touch  all  diseases  rather  than  any  one  disease  or  any 
one  particular  case.  In  the  future  there  will  be  new  dis- 
coveries quite  as  important,  and,  it  may  be,  even  more  so,  and 
you  must  be  on  the  alert  to  absorb  all  the  new  knowledge  that 
comes  from  investigations,  many  of  wrhich  doubtless  you 
yourselves  will  be  among  the  foremost  to  undertake. 

In  addition  to  this,  you  must  not  neglect  that  culture  which 
so  broadens  a  man's  view,  adds  to  his  influence  and  impor- 
tance in  the  community,  and  is  in  itself  a  source  of  so  much 
delight.  Not  many  of  you,  perhaps,  will  be  able  to  imitate 
the  Scotch  country  doctor  whose  story  is  told  by  John 
Brown  in  his  charming  "Spare  Hours."  When  paying  him 
an  early  visit,  he  found  the  old  Aberdonian  at  breakfast  ready 
for  his  morning  ride,  but  meantime  "amusing  himself" 
(mark  you,  not  working  at  it,  but  "amusing"  himself)  "with 
penciling  down  a  translation  of  an  ode  of  Horace  into  Greek 
verse."  But  you  can  all  make  yourselves  familiar,  certainly, 
with  the  masterpieces  of  English  prose  and  verse.  And  let 
me  add  that  none  of  you  will  be  as  good  a  doctor  as  you 
ought  to  be  unless  you  know  at  least  French  and  German  and 
draw  not  only  on  the  medical  stores  of  knowledge  to  be  found 


QUALITIES   ESSENTIAL  TO  SUCCESS  IN   MEDICINE.       395 

in  these  languages,  but  also  on  the  splendid  literature  which 
awaits  you  when  you  once  possess  the  ability  to  read  and,  I 
hope,  to  speak  these  tongues. 

When  you  have  gathered  sufficient  experience  and  attained 
sufficient  knowledge,  write;  but  not  till  you  have  something 
worth  saying.  In  order  to  have  something  worth  saying  you 
must  have  an  accumulated  lot  of  case-notes;  hence  from  the 
very  day  of  your  graduation  let  every  case  be  recorded  and 
indexed.  Even  the  commonest  disorders,  when  you  have 
gathered  the  notes  of  a  large  number  of  cases,  will  afford  you 
material  for  excellent  papers  which  those  who  are  less  in- 
dustrious and  less  painstaking  will  read  with  pleasure  and 
profit. 

You  are  about  to  join  a  great  and  noble  profession  whose 
value  to  the  community  is  beyond  estimate.  The  lives  and 
happiness  of  the  community  you  serve  will  be  in  your  hands. 
Dare  you  be  recreant  to  your  trust,  indifferent  as  to  whether 
you  add  to  your  knowledge  as  the  science  progresses,  or 
remain  a  fossil  of  the  year  1903,  indifferent  to  the  death  of 
defenseless  youth  and  hoary  age,  of  the  bread-winning  father, 
of  the  tender,  care-taking  mother,  of  the  loving  and  beloved 
child  whose  untimely  death  leaves  a  scar  on  the  heart,  which 
all  the  waters  of  Lethe  cannot  efface? 

The  whole  world  has  been  moved  within  the  last  few  weeks 
by  an  atrocious  massacre  in  Kischineff,  and  the  press  and  the 
platform  have  been  right  in  their  denunciation  of  such  a  crime. 
The  slain  and  the  injured,  it  is  said,  number  nearly  1000.  But 
where  has  a  voice  been  raised  hi  indignant  protest  against  the 
massacre  of  50,000  persons  in  the  year  1902,  in  the  United 
States  alone,  by  typhoid  fever? — a  preventable  disease  which 
ought  to  be  stamped  out,  and  practically  could  be  stamped  out, 
were  a  proper  water-supply  and  proper  sanitary  precautions 
taken.  Have  you  heard  any  national  denunciation  of  the 
massacre  last  year  of  150,000  persons  in  the  United  States 
by  tuberculosis? — another  disease  which,  if  not  absolutely 


396  ADDRESSES   AND   OTHER   PAPERS. 

preventable,  could  be  reduced  to  a  minimum  by  proper  sani- 
tation. Our  ears  have  been  deaf,  our  eyes  closed,  and  our 
minds  dulled  to  this  horrible  state  of  affairs,  because  forsooth 
we  are  used  to  it.  How  often  in  my  clinic  at  the  Jefferson 
Hospital,  as  my  house  surgeon  reads  to  the  class  the  history 
of  patient  after  patient,  I  hear  this  startling  statement: 
"A.  B.,  aged  25  years,  had  the  usual  diseases  of  childhood" — 
as  if  disease  ought  to  be  "  usual."  Moreover,  those  of 
whom  this  is  said  have  recovered  from  the  "  usual  diseases  of 
childhood,"  but  those  who  have  fallen  in  the  holocaust  from 
measles,  mumps,  chicken-pox,  whooping  cough,  scarlet  fever, 
and  diphtheria  have  passed  beyond  any  clinic  or  any  history. 
This  field  alone  is  a  splendid  opportunity  for  fruitful  work  in 
this  fair  twentieth  century  just  opening,  and  if  you  do  your 
duty,  and  the  rest  of  our  profession  do  theirs,  long  before  its 
end,  such  a  history  will  state  that  "A.  B.,  aged  25  years,  had 
the  usual  health  of  childhood,"  for  the  now  usual  diseases  will 
be  banished.  Happy  childhood  will  be  free  from  their  as- 
saults, and  health  instead  of  sickness  will  be  the  standard. 
It  is  a  mark  of  a  low  grade  of  civilization  that  any  disease 
should  be  "  usual."  It  reminds  us  of  the  days  before  Jenner, 
when  almost  everybody  had  small-pox,  and  its  victims  were 
numbered  by  the  hundreds  of  thousands.  Soon  may  the 
happy  day  come  when  the  only  two  causes  of  death  will  be 
accident  and  old  age;  when  the  surgeons  will  only  be  called 
upon  to  remedy  the  injuries  inflicted  by  the  first,  and  the 
physicians'  only  service  will  be  to  assist  at  our  entrance  into 
the  world  and  to  sign  the  death-certificates  of  centenarians! 


THE   NEED   FOR    INCREASED  ENDOWMENTS 
FOR  MEDICAL  INSTRUCTION.* 


TO  URGE  "The  Need  for  Increased  Endowments  for 
Medical  Instruction"  is  entirely  superfluous  before  this 
audience.  It  consists  of  a  large  number  of  doctors  who  know 
only  too  well  the  need  for  endowment  for  their  own  and  for 
every  other  medical  school  in  this  country.  I  can  only  repeat, 
therefore,  hi  part  what  I  have  said  elsewhere,!  adding  some- 
what to  it,  perhaps,  in  the  hope  that  you  will  repeat  it  to 
others,  your  patients  and  friends,  whom  you  may  persuade  to 
give  liberally.  It  is  for  the  purpose,  therefore,  of  concentra- 
ting your  thoughts  for  a  few  moments  upon  the  question  of  the 
urgent  need  of  such  endowments  that  I  ask  you  to  listen  to  me. 

I  base  the  need  of  endowment  of  medical  schools  by  the 
general  public  upon  three  grounds : 

First.  The  costliness  of  modern  medical  instruction. — If  you 
look  at  any  large  medical  school  of  the  present  day  you  will 
find  a  very  different  state  of  affairs  from  what  we  had  when 
I  began  the  study  of  medicine.  Then  we  had  two  lecture- 
rooms  between  which  we  swung  like  a  pendulum,  seven  men 
who  talked  to  us  in  one  great  mass  for  an  hour  at  a  time  for 
two  years  on  precisely  the  same  subjects — and  that  was  all. 
To-day  you  need  a  large  medical  building,  you  need  a  large 
hospital,  you  need  a  dozen  laboratories  each  with  a  costly 
equipment  and  with  a  large  number  of  assistants.  You  need, 
as  President  Eliot  has  so  well  pointed  out,  individual  in- 

*  An  address  at  the  complimentary  dinner  tendered  to  Dr.  D.  kB.  St. 
John  Roosa,  in  New  York,  March  1,  1904. 

t  Presidential  Address  before  the  American  Medical  Association,  p.  295. 

399 


400  ADDRESSES   AND    OTHER   PAPERS. 

struction;  not  simply  lectures  to  a  large  class  without  il- 
lustrations and  without  laboratory  work;  but  small  classes  of 
ten,  fifteen,  or,  at  the  most,  of  twenty,  and  individual  in- 
struction in  the  laboratory  for  every  man.  When  I  began  the 
study  of  medicine  in  1860  at  the  Jefferson  Medical  College 
there  was  no  hospital,  and  from  the  faculty  down  to  the 
janitor  the  number  of  those  who  took  part  in  instruction 
numbered  less  than  a  score.  To-day  in  the  Jefferson  College 
and  Hospital,  and  its  dozen  laboratories,  we  have  over  eleven 
score  of  instructors,  an  increase  of  over  eleven  hundred  per 
cent.,  observe!  And  these  men  must  be  paid,  and  the  men  in 
the  theoretical  branches,  who  have  not  the  means  of  making 
additional  income  by  practice,  must  be  paid  large  salaries  so 
that  they  will  be  able  to  give  their  whole  time  to  the  medical 
school.  Yet  the  fees  paid  by  the  students  have  been  less  than 
doubled, — that  is,  increased  less  than  one  hundred  per  cent, 
against  an  increase  of  eleven  hundred  per  cent,  in  the  teaching 
force  ! 

The  medical  fees  are  practically  as  large  as  we  can  make 
them.  The  expense,  therefore,  of  modern  medical  education 
must  be  borne  largely  by  endowment.  Just  exactly  as  in  the 
academic  department  of  our  universities  we  need  great  en- 
dowments to  eke  out  the  insufficient  incomes  derived  from  the 
fees  of  students,  so  in  our  medical  schools  we  need  large  en- 
dowments for  the  same  purpose.  Compare,  for  instance,  the 
theological  schools  of  this  country  with  about  8000  students, 
in  which  the  average  endowment  for  each  student  is  $2250, 
with  the  medical  schools  attended  by  24,000  medical  students 
with  costly  laboratories,  hospitals,  and  appliances  that 
theology  does  not  require,  and  a  paltry  endowment  of  $83 
per  student! 

The  second  reason  for  generous  medical  endowments  from 
the  public  is  the  commercial  value  of  the  medical  profession  to 
the  public.  I  am  not  speaking  now  of  the  value  of  health  to 
everybody,  or  of  our  cherished  desire  for  the  health  of  those 


INCREASED  ENDOWMENTS  FOR  MEDICAL  INSTRUCTION.  401 

who  are  dear  to  us  at  home.  I  am  not  speaking  of  the  kind 
father  that  may  be  lost  to  a  young  dependent  family,  of  the 
loving  mother  that  cares  for  them,  of  the  dear  child  whose 
place  can  never  be  filled  in  our  hearts  or  homes — I  am  speak- 
ing, mind  you,  of  the  mere  sordid  commercial  value  of  the 
profession  to  the  community,  that  is,  its  value  to  the  com- 
munity in  hard  cash — dollars  and  cents.  Let  me  refer  to 
this  somewhat  in  detail. 

It  is  only  a  few  years  since  quarantine  was  one  of  the  most 
horrible  things  we  could  imagine.  To-day,  practically, 
quarantine  has  been  almost  abolished  by  reason  of  the  re- 
searches and  work  of  the  medical  profession.  We  no  longer 
fear  cholera,  the  plague,  or  yellow  fever,  or  even  typhoid  fever, 
as  we  once  did,  because  we  have  exterminated  the  rat,  we  can 
quarantine  or  kill  the  mosquito,  we  have  corralled  the  fly, 
and  we  are  filtering  and  boiling  our  drinking  water.  By  the 
most  patient  scientific  laboratory  work  all  these  things  have 
been  shown  to  be  needful  and  efficient  as  the  chief  means 
for  the  prevention  of  disease. 

But  a  few  years  ago  a  single  case  of  cholera  or  yellow  fever 
down  yonder  Bay  would  have  meant  the  loss  of  millions  of 
dollars  to  your  merchants;  but  to-day,  as  has  been  shown  in 
your  hospitals,  cages  of  cholera,  or  yellow  fever,  or  even  of 
plague,  that  might  and  do  occur,  scarcely  create  a  ripple  of 
excitement  because  the  community  knows  that  your  able 
medical  men  have  these  diseases  by  the  throat.  Dr.  Reed  and 
his  fellow-workers  in  Cuba  have  accomplished  an  epoch- 
making  work.  For  the  first  time  in  one  hundred  and  seventy 
years  Cuba  has  been  made  free  and  kept  free  from  yellow  fever, 
and  the  merchants  of  New  Orleans,  of  Mobile,  of  Norfolk,  and 
of  New  York  are  reaping  the  benefit  of  this  unselfish  labor 
in  hard  dollars  on  the  credit  side  of  their  accounts. 

The  horrible  character  of  the  plague  we  scarcely  appreciate. 
In  the  fourteenth  century  twenty-five  millions  of  human 

beings  lost  their  lives  in  Europe   alone,   and   even   to-day 
26 


402  ADDRESSES   AND    OTHER    PAPERS. 

among  the  ignorant  people  of  India  over  two  hundred  thou- 
sand human  beings  a  year  are  offered  upon  the  altar  of  the 
plague.  But  we  are  beginning  to  see  a  brighter  time.  Haff- 
kine's  inoculations  have  diminished  the  susceptibility  of  the 
people  by  seventy-five  per  cent,  and  have  diminished  the 
mortality  in  equal  proportions;  and  I  believe  that  the  time  is 
coming  when  the  plague,  like  yellow  fever  and  small-pox,  will 
be  practically  wiped  out. 

Again,  we  do  not  appreciate  what  small-pox  was  in  the  past. 
In  the  eighteenth  century  sixty  millions  of  people  died  from 
small-pox  in  Europe  alone,  and  in  addition  to  that  almost  all 
the  living  were  left  with  the  ravages  of  the  disease  marked 
upon  their  persons.  Before  that  memorable  day  when  Jen- 
ner  inoculated  young  Phipps,  it  was  as  uncommon  in  the 
streets  of  London  to  see  a  person  not  pock-marked,  as  it  is 
to-day  to  walk  down  Broadway  and  see  one  who  is  pock- 
marked. In  Russia  alone,  in  the  year  of  Jenner's  splendid 
accomplishment  (1796),  two  millions  of  people  died  from 
small-pox. 

I  said  a  moment  ago  that  I  would  consider  only  the  sordid 
commercial  value  of  the  labors  of  the  profession  to  the  pub- 
lic. Consider,  therefore,  what  all  these  millions  of  saved 
lives  mean  in  revenue  to  the  State,  in  revenue  to  the  family, 
in  the  prevention  of  pauperism,  in  the  comfort  of  human  be- 
ings: then  we  begin  to  appreciate  in  some  degree  the  value 
of  the  services  practically  of  one  man,  the  most  magnifi- 
cent benefactor  of  the  human  race  that  ever  lived,  Edward 
Jenner. 

In  1890  there  were  156,638  unnecessary  deaths  in  our  large 
cities  because  of  defective  sanitation.  For  the  ten  years 
from  1886  to  1895  the  average  death-rate  in  New  York  was 
25.18.  The  sanitary  reform  which  followed  that  year  saved 
in  1895,  3758  lives;  in  1896,  7736;  and  in  1897,  9920— a 
total  of  21,414  in  three  years.  As  there  are  an  average 
of  twenty-eight  cases  of  sickness  for  every  death,  sanitary 


INCREASED  ENDOWMENTS  FOR  MEDICAL  INSTRUCTION.    403 

reform  in  these  three  years  prevented  about  600,000  cases 
of  sickness.  And  who  were  the  chief  of  the  reformers?  You 
physicians.  The  millions,  nay  hundreds  of  millions,  thus 
saved  in  the  last  fifty  years  in  this  city  alone  would  enrich 
even  the  most  avaricious  of  nations. 

I  need  not  tell  an  audience  of  doctors  what  has  been  done 
in  diphtheria,  but  I  may  well  refer  to  its  results  so  that  you 
may  in  turn  remind  others.  It  has  been  done  in  our  day; 
and  it  has  been  done  not  as  a  result  simply  of  constant  and 
fruitless  trials  of  various  supposed  means  of  cure;  it  is  not 
simply  the  work  of  a  shrewd  doctor  carefully  observing  symp- 
toms and  noting  the  effect  of  remedies :  but  it  has  been  done 
by  exact  laboratory  work  by  quiet  men  who  have  been  work- 
ing far  away  from  the  sick-room  with  not  a  single  human  pa- 
tient under  their  care,  men  who  are  not  practitioners  of  medi- 
cine, but  pathologists  and  bacteriologists,  experimenting  on 
rabbits,  guinea-pigs,  and  mice  instead  of  on  men  and 
women,  and  especially  dear  little  children;  and  thus  working 
unobserved,  unheralded,  unseen,  they  have  given  to  the  hu- 
man race  a  boon  second  almost  to  that  of  Jenner. 

As  was  shown  by  the  report  of  the  Psediatric  Society  not 
long  ago,  the  mortality  of  diphtheria  has  fallen  from  40 
to  8.8  per  cent.  In  the  laryngeal  cases,  before  the  introduc- 
tion of  the  serum  treatment,  the  mortality  was  73  per  cent, 
and  the  recoveries  27  per  cent.  Since  that  time  precisely 
the  reverse  has  been  the  case;  the  mortality  is  now  27  per 
cent,  and  the  recovery  rate  73  per  cent.! 

And  yet  there  are  actually  people  who  reject  vaccination 
and  try  to  prove  that  the  serum  treatment  .of  diphtheria  is 
of  no  use ! 

In  the  little  town  of  Plymouth,  Pennsylvania,  a  town  of 
8000  people,  a  few  years  ago  on  its  outskirts  occurred  one 
case  of  typhoid  fever,  in  winter,  with  snow  on  the  ground. 
All  the  dejecta  of  that  patient  were  thrown  out  upon  the  snow. 
When  the  warm  springtime  came  and  the  rain  fell,  it  washed 


404  ADDRESSES   AND   OTHER   PAPERS. 

the  poison  from  this  patient  into  the  reservoir  which  supplied 
the  town  of  Plymouth  with  water.  As  a  result,  1200  cases 
of  typhoid  developed — nearly  one-sixth  of  the  entire  popu- 
lation— and  the  town  was  almost  desolated.  We  have  had 
a  somewhat  similar  experience  in  another  Pennsylvania  town, 
at  Butler,  when  the  water-supply  was  contaminated;  and 
you  have  seen  in  this  State  some  of  the  flower  of  your  young 
men  cut  off  at  Ithaca  for  the  same  reason.  And  all  of  this 
was  preventable! 

When  the  medical  profession  has  shown  you  what  can  be 
done  in  the  way  of  preventing  typhoid  fever,  I  ask  you  whether 
it  is  not  of  enormous  commercial  value  to  the  public,  to  say 
not  one  word  of  its  philanthropic  value,  in  the  saving  of  so 
many  valuable  lives? 

In  1892,  an  epidemic  of  cholera  broke  out  in  the  town  of 
Hamburg ;  18,000  people  were  smitten  down  with  the  disease 
and  7614  died.  Lower  down  on  the  river  Elbe,  where  the  sew- 
age of  Hamburg  was  added  to  the  other  impurities  of  the  river, 
in  Altona,  a  town  continuous  with  Hamburg,  there  were  but 
516  cases.  Why?  Because  Altona  had  a  thoroughly  efficient 
filtration  plant  and  Hamburg  had  not;  yet  the  researches  of 
the  medical  profession  had  shown  that  proper  filtration  of 
the  water-supply  filtered  out  all  the  germs  of  cholera.  Which 
would  have  been  the  cheapest  plan — to  spend  a  few  millions 
of  dollars  on  a  good  filtration  plant,  or  to  smite  its  commerce 
with  a  blight  for  months,  at  a  cost  many  fold  that  of  the  fil- 
tration plant?  You  note  that  I  say  nothing  of  human  lives 
and  human  woes.  The  grim  satire  is  completed  when  I  add 
in  addition  to  the  immense  cost  to  its  commerce  Hamburg 
had  to  build  the  filtration  plant  after  all.  I  need  not  refer 
to  any  other  than  this  one  instance  of  a  single  disease  to  es- 
tablish the  value  of  the  work  done  chiefly  by  the  researches 
of  the  medical  profession.  The  engineer,  the  architect,  other 
professions,  the  public-spirited  citizens  who  are  hi  control 
of  municipal  affairs,  deserve  large  credit,  all  of  them;  but, 


INCREASED  ENDOWMENTS  FOR  MEDICAL  INSTRUCTION.    405 

after  all,  you  gentlemen  and  your  confreres  in  the  medical 
profession  are  the  backbone  of  this  humanitarian  progress. 

Malaria  was  formerly  thought  to  be  the  result  of  the  de- 
composition of  vegetable  matter,  and  that  it  originated  in 
low-lying  swampy  land.  In  Italy  alone  to-day  more  than 
half  a  million  acres  of  land  are  entirely  waste  and  desolate 
because  of  this  dread,  disabling  disease.  On  the  Adriatic 
Railway  it  cost  the  company  one  million  francs  per  annum 
to  take  care  of  their  sick,  due  to  malaria;  but  now,  thanks 
to  the  investigations  of  medical  men,  we  know  perfectly  well 
that  if  you  shut  out  the  mosquito  you  shut  out  malaria  as 
well  as  yellow  fever.  The  warning  will  be  heeded  by  this 
country  when  we  dig  the  Panama  Canal.  Then.  I  have  no 
doubt',  you  will  see  a  splendid  object  lesson  in  sanitation, 
which  will  carry  conviction  to  us  all  of  the  money  value 
of  medical  research  in  the  saving  to  the  country,  to  you  and 
to  me,  of  millions  of  dollars  and  of  thousands  of  lives. 

Of  tuberculosis  I  need  scarcely  speak,  for  we  all,  alas,  know 
its  ravages  in  our  homes  and  hearts.  We  are  on  the  verge 
of  an  equally  beneficent  improvement  in  its  treatment.  In 
Germany  the  cure  of  even  ten  per  cent,  of  its  victims,  it  is  es- 
timated, on  a  moderate  money  value  of  the  daily  labor  of 
those  who  recover,  will  add  two  millions  of  dollars  annually 
to  the  resources  of  the  State.  Are  not  such  money  results 
a  generous  percentage  of  income  from  a  moderate  endowment? 
And  human  lives  and  human  happiness  cannot  be  reckoned 
in  dollars  and  cents. 

In  military  hygiene  and  sanitation  the  money  return  is 
equally  promising.  In  the  British  fleet  in  the  West  Indies 
in  1726 — I  am  stealing  from  a  recent  address  of  one  of  your 
New  York  doctors,  you  see — out  of  a  force  of  4750,  4000 
died  as  a  result  of  bad  sanitation.  On  the  West  African 
cost  the  mortality  was  69  per  cent.  During  our  own 
Civil  War  20  per  cent,  of  the  armies  were  sick.  But 
in  spite  of  all  the  outcry  that  there  was, — partly  just  and 


406  ADDRESSES  AND    OTHER   PAPERS. 

partly  unjust, — during  the  Spanish-American  War,  the  sick 
percentage  was  3^  instead  of  20  per  cent,  and  the  mortality 
was  2£  per  cent.  Even  in  distant — and  as  I  suppose  some 
would  call  it — barbarous  Manila  the  mortality  was  but  ^ 
of  1  per  cent.  But  you  may  say  these  were  soldiers  and 
sailors  wasting  the  country's  substance  and  not  adding  to 
it;  to  which  I  reply  that  for  every  soldier  or  sailor  who 
died  an  artisan  or  a  farmer  had  to  be  taken  from  productive 
labor  to  fill  his  place;  every  soldier  or  sailor  saved  meant 
that  another  productive  unit  was  saved  to  his  family  and 
to  the  State,  and  a  family  which  threatened  to  become  a 
charge  upon  the  community  was  saved  from  expensive 
pauperism. 

In  fact,  at  the  present  day  we  have  changed  the  aspect 
with  which  we  look  at  medicine.  Doctors  thus  far  have 
been,  and  always  will  be  to  some  extent,  for  the  care  of  the 
sick;  but  to-day  the  medical  profession  is  for  the  care  of  the 
well — to  prevent  sickness  instead  of  curing  it.  I  glory  in  it 
that  ours  is  the  only  profession  on  the  face  of  God's  earth, 
I  believe,  that  is  trying  to  destroy  itself. 

As  I  am  a  surgeon,  I  have  purposely  preferred  to  take  my 
examples  from  medicine,  hygiene,  and  sanitation,  rather 
than  from  surgery.  But  I  cannot  refrain  in  passing  from 
calling  to  your  minds  also  a  few  of  the  triumphs  of  surgery. 
The  dreamless  sleep  of  ether  cannot  be  estimated  in  current 
coin  of  the  realm,  but  what  would  you  offer  for  its  blessed 
relief  were  it  just  beyond  your  reach?  But  antiseptic  sur- 
gery has  a  definite  money  value,  when  the  mortality  of  com- 
pound fractures — one  of  the  most  frequent  accidents,  es- 
pecially among  our  laboring  population — which  formerly 
swept  into  the  grave  sixty  out  of  every  one  hundred  of  its 
victims  and  so  often  left  their  families  destitute,  is  now  shown 
to  be  less  than  five  per  cent. ;  when  legs  and  arms  formerly 
cut  off  to  save  life  are  now  saved  and  their  owners  restored  to 
the  ranks  of  the  breadwinners;  when  rupture  which  killed  so 


INCREASED  ENDOWMENTS  FOR  MEDICAL  INSTRUCTION.    407 

many  and  disabled  so  many  more  is  now  cured  with  almost 
no  mortality;  when  diseased  conditions  wholly  beyond  the 
skill  of  our  fathers  are  now  remedied  and  their  victims  re- 
turned to  active  life.  Translate  these  facts  into  figures  and 
tell  me  then  the  money  value  of  surgery  alone  to  the  American 
people!  One  Jenner,  one  Koch,  one  Lister,  is  worth  a  fabu- 
lous sum  to  the  world.* 

I  should  also  refer  to  the  commercial  value  of  all  the  med- 
ical work  done  in  animal  diseases,  such  as  trichina,  which 
touches  man  as  well  as  animals,  hog  cholera,  chicken  cholera, 
rinderpest,  and  all  the  other  local  diseases  that  affect  our 
cattle.  Our  failure  to  control  and  eradicate  hoof  and  mouth 
disease  in  cattle  cost  a  single  steamship  line  lately,  in  its 
trade  to  Great  Britain  alone,  $5000  a  day  profit — and  they 
say  "  money  talks."  The  researches  and  improvements  in- 
troduced by  our  profession  have  reduced  the  losses  to  the 
community  by  millions  of  dollars  every  year,  because  of  the 
prevention  of  those  diseases.  But  when  a  man  does  not 
lose  his  cattle,  when  the  loss  is  only  prevented,  he  is  apt 
scarcely  to  appreciate  what  has  been  done  for  him  negatively. 

I  think  one  of  the  most  remarkable  things  we  have  observed 
in  our  day  has  been  that  experimental  railway  near  Berlin, 
where  on  an  electrical  trolley  line  they  have  driven  the  cars 
up  to  a  speed  of  130  miles  an  hour.  Dr.  Pritchett  has  given 
a  most  interesting  account  of  it  in  a  recent  article  in  "  Mc- 
Clure's  Magazine."  It  seems  that  the  idea  began  in  a  Stu- 

*  As  though  to  reinforce  what  I  have  here  stated,  the  newspapers  on 
April  llth  called  attention  to  the  fact  that  Dr.  Daniel  Lewis,  the  Health 
Commissioner  of  the  State  of  New  York,  in  his  Annual  Report  to  the 
Governor  said: 

"  If  the  monetary  value  of  a  human  life  is  assumed  to  be  $5000,  the 
deaths  from  only  five  of  the  preventable  diseases  during  1903  in  this  State 
represents  a  loss  of  $94,960,000.  These  figures  seem  appalling  and  yet 
millions  upon  millions  can  properly  be  added  to  this  sum,  in  loss  of  wages, 
expense  of  the  care  of  the  sick,  and  many  other  expenses  incidental  to  the 
management  of  these  epidemic  and  infectious  diseases." 


408  ADDRESSES  AND   OTHER   PAPERS. 

clenten-Gesellschaft,  a  company  of  students  who  proposed 
to  study  minutely  and  exactly  all  the  obstacles  in  the  way 
of  rapid  transit  and  the  means  by  which  each  in  turn  could 
be  overcome.  That  they  have  solved  the  problem  where 
all  the  rest  of  the  world  have  failed  we  know  to-day,  and 
Dr.  Pritchett  well  says  in  that  article:  "  The  research  habit 
once  considered  so  far  removed  from  utilitarian  ends,  is  to-day 
the  greatest  financial  asset  of  Germany." 

Go  around  the  world  and  you  meet  in  Japan,  in  China,  in 
India,  in  Egypt,  everywhere,  the  familiar  label,  "Made  in 
Germany."  Why  should  it  not  hereafter  be  "Made  in 
America?"  When  we  have  acquired  the  "research  habit" 
and  make  it  our  best  and  most  valuable  "asset,"  I  believe 
that  this  label  will  surely  supplant  the  other.  This  "re- 
search habit"  in  medicine  is  of  as  distinct  value  as  a  finan- 
cial "asset,"  as  it  is  in  engineering  or  in  commerce. 

The  third  reason  that  I  suggest  for  increased  endowment 
in  medical  schools  is  the  genuine  and  lasting  pleasure  that  it 
gives  to  the  donors.  I  alluded  but  a  moment  ago  to  the  enor- 
mous number  of  human  lives  saved  to  the  community  by 
surgery.  Let  me  ask,  can  there  be  a  greater  pleasure  to  any 
of  your  rich  patients  than  to  know  that  he  has  had  the  com- 
fort and  the  pleasure  of  taking  a  large  part  in  such  a  wonder- 
ful achievement,  a  large  part  in  such  a  superb  gift  to  human- 
ity, a  gift  far  better  than  any  warrior  ever  gave?  .  Could  there 
be  a  greater  comfort  while  a  man  lives,  or  when  he  enters 
the  valley  of  the  shadow  of  death,  than  to  know  that  his  gift 
to  a  medical  school  has  done  and  will  always  do  such  untold 
good? 

Most  of  us  work  both  in  hospitals  and  in  colleges.  As  I 
look  over  my  own  work  in  the  Jefferson  Hospital  and  the 
Jefferson  Medical  College,  I  see  in  the  hospital  scores  of 
patients,  even  hundreds  of  them  every  year,  who  go  out 
happy  and  in  comfort,  contented  and  restored  to  their  fami- 
lies and  to  wage-earning  power,  and  it  is  no  end  of  pleasure 


INCREASED  ENDOWMENTS  FOR  MEDICAL  INSTRUCTION.   409 

to  me,  as  it  is  to  you,  my  colleagues,  to  remember  such  cases. 
But  when  I  look  over  the  faces  of  the  hundreds  of  young 
men  that  I  have  the  pleasure  of  teaching,  when  I  remember 
that  I  can  instill  into  them  high  ideals,  when  I  can  bring  to 
the  birth  in  their  lives  this  "research  habit"  and  the  desire 
to  learn,  and  think  that  they  will  go  all  over  the  world  and 
cure  hundreds  more  than  I  can — thousands  more  than  I  can 
—which  work  is  the  greater?  The  curing  of  my  scores 
of  patients,  or  the  teaching  of  hundreds  of  young  men  to  go 
out  to  cure  their  scores  of  thousands  and  to  bring  the  bless- 
ings of  many  an  exultant  wife  and  many  a  poor  widow  upon 
their  heads  for  the  work  that  they  have  learned  to  do  through 
you  and  through  me? 

The  joy  of  the  teacher,  gentlemen,  as  you  know  so  well, 
is  a  joy  that  is  never  ending.  It  is  one  of  those  delights  that 
come  to  us  new  every  morning  and  fresh  every  evening,  and 
yields  a  sense  of  satisfaction  beyond  anything  else  in  this 
world.  And  if  the  rich  men  of  this  country  will  only  endow 
our  medical  schools  and  so  teach  through  us  all  of  these  hun- 
dreds of  young  men  that  go  the  world  over  as  heralds  of 
cheer  and  apostles  of  health,  surely  they  will  enjoy  the  great- 
est satisfaction  that  can  be  given  to  any  man. 

And  when  we  lay  us  down  for  the  last  time  upon  our  pillow, 
we  can  all  thank  God  that  we  have  been  able  to  contribute, 
some  by  our  work,  others  by  their  means,  to  this  magnificent 
gift  to  humanity. 


AGE  AND  YOUTH  IN  MEDICINE.* 


I  KNOW  nothing  more  inspiring  than  a  scene  like  the 
present.  Before  me  is  a  company  of  young  women 
and  young  men,  recruits  in  the  medical  army,  anxious  to  press 
forward  to  all  the  dangers,  trials,  failures,  and  successes  of  a 
medical  life  to  final  victory.  My  career  will  soon  end  while 
yours  is  just  beginning.  I  look  toward  the  western  setting 
sun,  you  greet  the  eastern  rising  sun.  Mine  is  the  past  with 
its  splendid  accomplishments,  its  dismal  failures,  its  dis- 
heartening, unaccomplished  tasks.  Yours  is  the  golden 
future,  yours  to  renew  the  attack  where  we  have  failed  and  to 
win  the  battles  that  we  have  lost,  yours  to  fulfill  our  unac- 
complished tasks.  Naturally,  therefore,  the  occasion  sug- 
gests a  contrast  between  myself  and  yourselves.  Accordingly, 
I  have  taken  as  my  topic  "Age  and  Youth  in  Medicine." 

Let  me  recount  briefly  some  of  the  wonderful  things  that  I 
have  seen  accomplished  in  the  more  than  three-score  years 
covered  by  my  own  life  and  then  glance  at  what  may  be  in 
store  for  you. 

First,  the  geographical  and  political  changes  I  have  seen 
have  been  almost  kaleidoscopic  in  their  variety  and  extent. 

The  map  of  Europe  has  been  re-made.  Since  1859,  the 
year  that  I  graduated  from  the  University,  Italy  has  been  re- 
created as  a  united  kingdom.  This  new  political  life  has  been 
followed  by  a  wonderful  intellectual  revival,  so  that  Italian 
medical  science  and  letters  to-day  have  won  an  enviable  place. 

*  Address  at  the  Commencement  of  the  Medical  Department  of  Cor- 
nell University,  June  8,  1904.  Reprinted  from  the  Medical  Record,  July 
30,  1904. 

410 


AGE    AND   YOUTH   IN    MEDICINE.  411 

Austria  has  lost  her  Italian  possessions  and  has  been  deposed 
from  her  Teutonic  hegemony.  Germany  has  been  created 
by  the  welding  of  two-score  states  into  one  imposing  Imperial 
power.  Spain,  one  of  Lord  Salisbury's  "  dying  nations,"  has 
lost  her  colonies  and  her  prestige.  France  has  been  shorn  of 
Alsace  and  Lorraine.  The  Danubian  Principalities  have 
taken  the  first  steps  toward  freedom  from  the  rule  of  the 
"  unspeakable  Turk,"  the  one  foul  blot  still  existing  on  the  map 
of  Europe. 

The  map  of  Africa  has  been  drawn  anew  since  my  boyhood. 
The  "terra  incognita"  which  well  described  central  Africa 
when  I  first  studied  geography,  has  been  explored,  and  Stanley, 
its  foremost  explorer,  lies  in  a  new-made  grave.  The  sources 
of  the  Nile  have  been  found ;  the  Mountains  of  the  Moon  have 
disappeared.  Egypt  has  been  renovated  by  Anglo-Saxon 
genius.  The  boundless  resources  of  tropical  Africa  have 
aroused  the  earth-hunger  of  European  nations  until  nearly  the 
whole  of  it  has  been  parcelled  out  among  them.  A  railroad 
will  shortly  connect  Cairo  and  the  Cape,  and  modern  steamers 
will  soon  ply  upon  every  great  river  of  the  Dark  Continent. 

The  old  map  of  Asia  has  been  torn  in  pieces  by  Russia. 
Step  by  step,  stealthily,  yet  steadily,  she  has  encroached  upon 
the  various  predatory  nations  of  Asia  and  has  made  herself 
master  of  one  after  another  until  it  seemed  as  though  every- 
thing north  of  the  Himalayas  would  fall  into  her  capacious 
maw.  But  the  new  map  of  Asia  is  now  in  the  making,  and  in 
its  reconstruction,  Japan,  thank  God,  will  have  much  to  say; 
Japan,  that  wonderful  country,  which  only  emerged  from 
feudal  seclusion  as  I  was  just  approaching  middle  life  and 
then  entered  upon  the  most  remarkable  career  of  national 
development  ever  witnessed  in  historic  time. 

And  what  shall  I  say  of  America?  True,  its  boundaries  had 
been  enlarged  a  century  ago,  but  it  was  still  only  a  vast  virgin 
wilderness,  over  which  roamed  the  bison,  the  bear,  the  Indian, 
and  a  few  adventurous  trappers.  In  my  young  manhood 


412  ADDRESSES   AND   OTHER   PAPERS. 

Indian  wars  were  of  more  than  annual  occurrence,  and  prac- 
tically the  whole  of  our  little  army  occupied  frontier  forts, 
which  now  are  centers  of  a  busy  civilization.  The  "prairie 
schooner,"  slowly  creeping  across  the  plains,  faintly  presaged 
the  Pacific  railroads;  Chicago  was  Fort  Dearborn  when  I  was 
born;  St.  Paul  was  a  village  and  Minneapolis  was  a  name  yet 
uncoined  even  when  I  graduated  from  Brown  University; 
Texas,  California,  and  Alaska  were  all  added  in  my  early 
years,  and  even  you  have  seen  Hawaii,  Porto  Rico,  and  the 
Philippines  become  possessions  of  the  Great  American  Re- 
public. 

In  the  arts  and  sciences  that  minister  to  the  progress  and 
comfort  of  man,  the  changes  have  been  equally  rapid  and 
widespread.  The  railroad  and  the  steamboat  were  just  at  the 
beginning  of  their  marvellous  development  when  I  was  born. 
No  human  face  had  yet  been  fixed  by  the  complaisant  sun  on 
the  plate  of  the  daguerreotype,  the  ambrotype,  or  the  pho- 
tograph. The  scythe  has  been  replaced  by  mowing  and 
reaping  machines;  typesetting  and  printing  were  done  by 
hand  instead  of  typesetting  machines  and  the  swift  Hoe 
printing  press.  In  my  childhood  days  the  ragpicker  was  a 
familiar  figure  on  the  streets,  hooking  over  the  piles  of  waste 
to  find  the  linen  rags  from  which  paper  was  made,  and  paper, 
therefore,  was  very  costly.  Now,  our  forests  are  ground  into 
paper  and  the  modern  penny  newspaper  has  been  born.  I 
shall  never  forget  my  father's  incredulity  when  he  first  read 
of  a  machine  which  would  do  the  work  of.  a  woman's  deft 
fingers,  but  the  American  sewing  machine  has  conquered  the 
world. 

In  my  boyhood  electricity  was  scarcely  known  outside  of 
the  laboratory.  Its  marvellous  multitudinous  uses,  to-day 
barely  at  the  beginning  of  their  development,  were  utterly 
unknown.  The  first  commercial  telegraphic  message  was 
sent  in  the  very  year  of  my  birth — now  it  is  one  of  the  daily 
needs  of  millions.  Its  omnipresent  wires  have  scaled  moun- 


AGE   AND   YOUTH   IN    MEDICINE.  413 

tains,  burrowed  under  the  slime  of  the  sea,  girdled  the  earth, 
and  put  Puck  to  shame  as  a  lagging  messenger.  Even  in  late 
years  the  telephone,  the  trolley,  the  dynamo,  the  electric 
lamp,  and  wireless  telegraphy  have  all  sprung  into  being  as 
by  magic,  and  soon  all  of  our  rivers  will  be  harnessed  and  made 
subservient  to  the  comfort  of  mankind. 

The  human  hand,  that  most  perfect  instrument,  has  been 
almost  driven  out  of  the  industrial  market  by  various 
machines  which  do  its  work  so  much  more  cheaply  and  often 
so  much  better.  Metallurgical  processes  have  so  cheapened 
the  production  of  iron,  copper,  aluminum,  and  other  metals 
that  whereas  a  few  years  ago  their  constant  use  was  impossi- 
ble on  account  of  their  cost,  they  are  now  common  household 
implements. 

When  I  was  in  college,  the  so-called  Fraunhofer  lines  were 
simply  a  curious  phenomenon  in  the  solar  spectrum;  yet,  a 
few  years  later,  they  furnished  us  with  a  chemical  analysis 
not  only  of  the  sun,  but  of  far  distant  comets  and  nebulae, 
and  have  determined  even  the  velocity  of  light  coming  from 
the  furthest  confines  of  the  universe.  Nay,  more,  by  means  of 
the  spectroscope  elements  unknown  on  the  earth  have  been 
discovered  in  the  sun ;  and  now  that  by  its  means  we  have  dis- 
covered helium  and  know  that  uranium  becomes  changed  into 
radium  and  radium  into  helium,  one  element  into  another, 
the  asserted  philosopher's  stone  of  Paracelsus  and  the  other 
alchemists,  by  which  they  could  transform  the  baser  metals 
into  gold,  may  possibly  be  found  to  be  of  more  substantial 
stuff  than  dreams  are  made  of. 

Meanwhile  educational  endowments  of  millions  have  been 
made.  Philanthropy  cares  for  the  children,  the  prisoner,  the 
degenerate,  and  the  lower  animals;  slavery  has  been  abol- 
ished; the  International  Tribunal  of  Arbitration  will  soon  be 
housed  in  a  palace  dedicated  to  Peace  and  erected  by  an 
American;  and  religious  liberty  is  enjoyed  as  never  before. 

But,  with  all  this  wonderful  progress,  where  has  medicine 


414  ADDRESSES   AND   OTHER   PAPERS. 

been?  Has  it  kept  step  with  the  other  arts  and  sciences  or  has 
it  lagged  behind?  It  delights  me  to  say  that  it  has  not  only 
kept  up  with  the  foremost  rank,  but  has  even  outstripped  not 
a  few.  In  1846  and  1847  ether  and  chloroform  were  dis- 
covered and  the  operating-table  was  robbed  of  well-nigh  all  its 
terrors.  Thirty  years  later,  thanks  to  Lister,  antisepsis  added 
its  benison  to  the  blessing  of  anaesthesia,  and  operations  have 
been  deprived  of  nearly  all  their  pain  and  of  their  former 
frightful  mortality.  These  two  blessings,  the  one  making 
operations  painless,  the  other  making  recovery  almost  certain, 
have  made  possible  a  new  surgery  which  was  not  only  im- 
possible, but  even  undreamed  of,  when  I  began  to  study 
medicine.  In  this  way  have  been  developed  the  surgery  of  the 
kidney,  of  the  liver,  of  the  gall-bladder,  of  the  pancreas,  of  the 
stomach,  of  the  intestines,  of  the  appendix,  of  the  prostate,  of 
the  brain,  of  hernia,  of  the  pelvic  organs,  and  even  of  the  heart. 
By  these  means  the  mortality  of  compound  fractures  and  of 
ovariotomy,  which  used  to  claim  two  out  of  every  three  pa- 
tients, is  now  reduced  almost  to  a  vanishing  point.  In  fact, 
were  my  old  teachers  of  surgery,  Gross  and  Pancoast,  to  come 
to  We,  they  could  not  even  understand  our  modern  vocabu- 
lary; and  if  they  were  to  visit  a  modern  surgical  clinic,  they 
would  think  us  stark  mad. 

Moreover,  we  have  blocked  many  diseases  at  the  foun- 
tain-head by  discovering  their  causes  and  the  means  by 
which  they  become  diffused  among  the  well.  Thus  we  have 
found  that  the  guilty  culprit  spreading  yellow  fever  and 
malaria  is  the  mosquito,  and  that  the  cause  of  malaria  is  a 
parasite  whose  life-history  is  now  perfectly  known.  The 
efficiency  of  our  means  for  preventing  outbreaks  of  both  of 
these  scourges  of  the  human  race  will  find  a  splendid  illustra- 
tion within  the  next  few  years  in  the  sanitation  of  the  Isth- 
mus of  Panama,  which  will  be  Chapter  II  in  the  splendid 
volume  whose  first  chapter  was  written  in  Cuba  by  Major 
Walter  Reed  of  the  United  States  Army.  The  cause  of  the 


AGE   AND   YOUTH   IN   MEDICINE.  415 

plague  and  its  dissemination  by  the  rat  is  well  known;  the 
cause  of  typhoid  fever  and  its  dissemination  by  flies  and 
through  drinking  water,  and  of  cholera  and  its  diffusion 
through  drinking  water,  are  also  matters  of  popular  knowl- 
edge. We  know  now  the  deadly  cause  of  diphtheria,  and 
the  use  of  its  antitoxine  is  making  the  once  loud  wail  of  par- 
ents for  their  lost  little  ones,  as  after  the  death  of  the  first- 
born in  Egypt,  grow  fainter  and  fainter.  The  prevention 
of  small-pox  has  been  known  for  a  century,  and  lately  its  prob- 
able cause  has  been  found  by  an  Italian  and  by  an  American. 
The  cause  of  cancer,  of  scarlet  fever,  of  measles,  and  of  many 
other  of  the  commoner  diseases  of  childhood,  have  as  yet 
eluded  the  scrutiny  of  the  ablest  men  of  the  profession.  The 
discovery  of  these  is  among  the  unfulfilled  tasks  to  which 
I  referred  a  few  moments  ago,  which  is  committed  to  your 
hands. 

Microscopical  analysis  and  the  chemistry  of  the  secretions 
have  been  wholly  rewritten  within  the  past  quarter  of  a 
century,  while  the  examination  of  the  blood  as  a  means  of 
diagnosis  and  the  serum  treatment  of  disease  have  made 
splendid  beginnings.  Percussion  and  auscultation  have 
opened  a  new  world  to  us  in  the  diagnosis  of  diseases  of  the 
chest  and  abdomen. 

Meantime  numerous  instruments  have  been  added  to  our 
armamentarium,  without  which  the  modern  physician  and 
surgeon  would  be  almost  helpless.  The  thermometer,  which 
has  only  been  our  hand-maid  for  about  thirty  years,  has  sub- 
stituted exactness  for  surmise;  the  hypodermatic  syringe  dis- 
closed a  new  method  of  medication  about  the  same  time;  the 
aspirator  was  not  known  till  after  I  graduated  in  medicine; 
the  ophthalmoscope  has  revealed  an  unknown  world  in  the 
interior  of  the  eye,  and  with  many  other  instruments  of  pre- 
cision, has  made  ophthalmology  one  of  the  most  exact  of  the 
medical  sciences  and  a  model  of  accurate  measurement  and 
statement  for  all  its  sister  sciences.  The  otoscope,  rhino- 


416  ADDRESSES   AND   OTHER   PAPERS. 

scope,  cystoscope,  cesophagoscope,  and  other  similar  instru- 
ments have  revealed  to  us  the  interior  of  other  organs  of  the 
body  in  a  way  formerly  wholly  unknown,  while  the  simple 
ha3mostatic  forceps  and  retractors  have  made  many  modern 
operations  physically  possible. 

The  growth  of  medical  laboratories  within  the  last  twenty- 
five  years  has  been  phenomenal.  The  laboratory  has  done 
much  more  than  merely  afford  the  opportunity  for  investi- 
gations which  have  yielded  such  an  abundant  fruit.  It  has 
cultivated  laboratory  methods — that  is  to  say,  methods  of 
exactness,  and  the  use  of  instruments  of  precision.  The  ex- 
perimental method  in  medicine  has  done  more  than  any 
other  one  thing  to  widen  the  boundaries  of  our  knowledge. 
Besides  this,  it  has  cultivated  precision  in  thinking,  which 
is  more  important  than  any  instrument  or  method.  The 
vague  theories  and  subtle  reasoning  of  our  forefathers  are 
now  replaced  by  exact  methods  of  investigation.  The  dif- 
ference is  well  set  forth  by  Mumford  when  writing  of  Rush 
and  the  yellow  fever.  "Like  the  rest  of  the  profession," 
says  he,  "Rush  was  at  his  wits'  end,  and  it  is  interesting  to 
note  how  different  from  modern  methods  were  the  means 
adopted  by  such  men  for  solving  the  problem  of  treatment. 
In  these  days  the  natural  history  of  a  disease  is  worked  up,  its 
pathological  anatomy  investigated,  and  clinical  and  labora- 
tory researches  elaborately  and  carefully  made  in  order  to 
learn  the  exact  nature  of  the  phenomena  under  discussion 
and  so,  perchance,  to  find  an  appropriate  and  rational  remedy. 
Those  ancient  men,  on  the  contrary,  had  their  preconceived 
notions  as  to  the  nature  of  the  disease,  and  limited  them- 
selves mainly  to  searching  the  literature  of  the  subject  and 
to  experimenting  with  drugs."  Reasoning  about  the  yellow 
fever  and  its  effects,  Rush  "thought  he  saw  that  the  debility 
indicated  by  the  low  pulse  was  due  to  the  'oppressed  state 
of  the  system'  [whatever  that  may  mean],  which  must  be 
relieved  by  purging,  supplemented  by  bleeding." 


AGE   AND   YOUTH   IN    MEDICINE.  417 

Imagine,  if  you  can,  the  forlorn  condition  of  the  doctor 
sixty  years  ago  without  our  present  means  for  physical  diag- 
nosis, without  the  thermometer,  the  hypodermatic  syringe, 
the  various  specula  and  other  instruments  I  have  named, 
without  the  aid  of  hsematology,  of  anaesthetics,  of  antisepsis, 
of  the  modern  microscope,  without  our  laboratories,  and  our 
experiments,  our  chemistry,  our  bacteriology,  and  our  anti- 
toxines — without  everything  except  his  eyes,  his  ears,  and 
his  fingers:  then  you  can  appreciate  the  triumphal  march 
of  medicine  during  a  single  lifetime. 

In  this  brief  review  I  have  given  you,  very  hastily  and 
imperfectly,  something  of  what  has  been  done  in  medicine 
during  my  own  lifetime.  What,  now,  has  the  future  in 
store  for  you? 

You  entered  the  medical  school  in  vastly  different  con- 
ditions from  those  which  obtained  when  I  began  the  often 
weary  study  of  Gray,  Gross,  Watson,  and  Ramsbotham.  I 
am  often  reminded  of  the  time  when  the  Chief  Captain  res- 
cued St.  Paul  from  the  mob,  and  asked  him  whether  he  were 
a  Roman  citizen.  When  the  Apostle  declared  that  he  was, 
"With  a  great  sum  obtained  I  this  freedom,"  said  the  Chief 
Captain;  to  which  his  Hebrew  captive  proudly  answered, 
"But  I  was  born  free."  You,  too,  are  "born  free";  born 
to  an  inheritance  of  anesthesia,  of  antisepsis,  of  laboratories, 
of  improved  methods  of  teaching,  of  many  heretofore  un- 
known drugs.  "With  a  great  sum"  of  toil,  and  work,  and 
worry  the  men  of  my  generation  have  obtained  the  freedom 
which  you  have  inherited. 

What  use  will  you  make  of  this  freedom?  First,  you  will 
improve,  I  trust,  on  our  present  laboratory  methods  and  our 
present  methods  of  teaching.  Pathology,  a  feeble  aid  to 
medicine  and  surgery  when  I  began  my  medical  studies  in 
1860,  and  bacteriology,  a  word  found  in  no  lexicon  of  that 
date,  have  become  veritable  foundations  of  the  medical  cur- 
riculum even  since  I  began  to  teach.  You,  in  your  turn 

27 


418  ADDRESSES   AND   OTHER   PAPERS. 

must  develop  other  and  at  present  equally  unsuspected 
sources  of  knowledge.  You  will  introduce  new  instruments 
of  precision,  new  means  of  investigation,  and  will  thus  be 
able  to  defeat  and,  still  better,  to  prevent  disease.  The 
men  who  will  make  the  most  progress  in  the  next  generation 
will  be  the  physiological  physicians  and  surgeons,  those 
who  are  best  acquainted  with  chemistry  and  physics,  and 
who  will  investigate  the  blood,  the  secretions,  and  the  tis- 
sues in  present  ways  more  perfectly  developed,  and  in  new 
ways  of  which  now  we  cannot  even  guess  the  method  or  the 
object.  Leukocytosis,  iodophilia,  cytodiagnosis,  cryoscopy, 
blood-pressure — all  these  you  will  use  and  improve  upon 
far  more  than  I  dare  picture.  Comparative  pathology  will 
enrich  and  broaden  your  views.  Possibly  the  original  sug- 
gestion of  Sir  Christopher  Wren,  of  intravenous  medication, 
which  we  practice  to  but  a  small  degree  to-day  by  infusions 
of  salt  solution  and  of  adrenalin,  may  become  one  of  the 
recognized  avenues  for  the  administration  of  remedies.  The 
ultramicroscopical  vision  which  has  just  been  conferred  upon 
us,  by  which  minute  particles  far  beyond  observation  with 
our  ordinary  microscopes  have  been  made  visible,  has  opened 
up  a  new  world  for  investigation  which  may  develop  truths 
as  yet  unsuspected. 

Ten  years  ago  who  would  have  believed  that  it  would  be 
possible  to  look  through  skin  and  flesh,  bandages  and  splints 
as  though  they  were  not,  and  to  see  our  bones  and  determine 
their  state  of  health  or  disease,  of  fracture,  or  integrity;  and 
yet  to-day  this  is  known  to  every  layman.  Radio-activity, 
and  possibly  new  means  for  the  employment  of  light,  may 
open  new  avenues  for  treatment.  Certain  it  is  that  your 
studies  in  immunity,  in  toxines,  and  antitoxines  will  give  you 
new  weapons  by  which  to  prevent  or  vanquish  disease  and 
confer  health.  We  need  a  new  and  safe  anaesthetic.  We 
need  new  drugs,  new  instruments  of  precision,  by  which  new 
properties  of  matter,  and  novel  methods  of  physical  diag- 


AGE    AND    YOUTH   IN    MEDICINE.  419 

nosis  shall  be  discovered,  and  the  beneficence  of  medicine 
illustrated  by  unexpected  and,  to-day,  impossible  methods 
of  cure.  In  these  researches,  alas,  I  shall  take  no  part,  but 
I  can  at  least  goad  you  on  to  their  accomplishment. 

But  I  must  not  forget  that  I  am  speaking  to  American 
graduates  in  medicine.  When  I  was  a  young  man,  every 
young  graduate  who  could  afford  the  time  and  expense  went 
to  Europe  to  put  the  finishing  touches  to  his  medical  educa- 
tion. But  the  current  is  turning  westward,  and  will  enable 
us  ere  long  to  repay  the  great  debt  we  owe  to  our  European 
brethren  by  freely  sharing  with  them  our  future  wealth 
of  scientific  and  practical  knowledge  and  experience.  We 
have  awakened  to  a  new  life  of  research  in  the  laboratories 
founded  by  liberal  citizens, — and  no  institution  has  more  rea- 
son to  be  proud  of  a  generous  patron  than  has  Cornell, — we 
have  felt  a  new  intellectual  impulse  in  our  colleges — our  physi- 
cians and  surgeons  are  alert  and  progressive  as  never  before. 

Coincident  with  a  great  political  expansion  that  has  car- 
ried us  half-way  around  the  globe,  with  a  commercial  ex- 
pansion which  has  made  the  world  stand  amazed  at  what 
we  have  accomplished — if  the  experience  of  England  under 
Elizabeth,  of  Italy  under  Victor  Emmanuel,  of  Germany 
under  two  Kaisers  is  any  guide — there  will  surely  be  in  Amer- 
ica an  equal  intellectual  and  scientific  expansion.  The 
future  belongs  to  America — it  belongs  to  you — if  you  but 
show  yourselves  worthy  of  the  great  inheritance  to  which 
you  are  heirs,  and  of  the  splendid  possibilities  which  medi- 
cine offers  you  with  lavish  hand.  You  will  be  unworthy 
children  of  worthy  sires  if  you  do  not  rise  to  the  level  of 
these  opportunities.  Shall  it  be  said  that  our  statesmen, 
our  merchants,  and  our  manufacturers  are  abler,  more  en- 
terprising, more  conquering  than  our  scientists,  our  surgeons, 
and  our  physicians?  Nay,  verily.  You,  new  members  of 
our  own  profession,  will  assuredly  prove  yourselves  equal  to 
the  mighty  task  set  before  you,  and  conquer  the  world  by 
being  its  noblest,  wisest,  and  most  unselfish  benefactors. 


SURGICAL  REMINISCENCES  OF  THE 
CIVIL  WAR.* 


I  HAD  the  honor  of  being  sworn  into  the  service  of  the 
United  States  as  an  Assistant  Surgeon  in  the  shadow 
of  the  Capitol  on  July  4,  1861,  though  I  had  only  begun  the 
study  of  medicine  in  September,  1860,  and  did  not  graduate 
until  March,  1862.  It  came  about  in  this  wise.  My  pre- 
ceptor, Dr.  John  H.  Brinton,  had  received  a  telegram  from  a 
former  student  (let  us  call  him  Smith),  who  had  graduated 
in  March,  1861,  and  was  Assistant  Surgeon  of  the  Fifth 
Massachusetts,  saying  that  he  was  going  to  leave  the  regiment 
and  asking  that  Dr.  Brinton  should  immediately  send  some 
one  in  his  place  if  possible.  Dr.  Brinton  very  kindly  offered 
the  place  to  me.  I  said  to  him  with  very  becoming  modesty 
that  I  hardly  felt  I  knew  enough,  to  which  he  replied  with 
combined  frankness  and  flattery  by  saying:  "It  is  perfectly 
true  that  you  know  very  little,  but,  on  the  other  hand,  you 
know  a  good  deal  more  than  Smith."  Accordingly  I  entered 
the  army  and  immediately  went  into  camp  in  Alexandria. 

From  the  4th  until  the  Battle  of  Bull  Run,  Sunday,  July 
21,  1861,  fortunately,  I  had  very  little  to  do.  The  surgeon 
of  the  regiment  attended  to  sick  call,  while  I  tried  to  make 
myself  somewhat  familiar  with  military  surgery.  I  remem- 
ber only  too  well,  however,  the  trepidation  with  which  I 
went  to  attend  one  member  of  my  regiment  who  accident- 
ally had  shot  himself  through  the  chest.  If  the  soldier  had 
known  how  slender  was  my  own  fund  of  information,  his 
breast  would  have  harbored  not  only  a  serious  gunshot 

*  Read  before  the  College  of  Physicians  of  Philadelphia,  April  5,  1905. 
Dr.  S.  Weir  Mitchell  and  Dr.  John  S.  Billings  contributed  papers  on  their 
reminiscences  at  the  same  time. 

420 


SURGICAL  REMINISCENCES   OF  THE   CIVIL  WAR.          421 

wound,  but  many  disturbing  doubts  as  to  the  probability 
of  his  recovery  in  the  hands  of  Assistant  Surgeon  Verdant 
Green. 

My  first  initiation  into  real  warfare  was  at  the  First  Bull 
Run.  We  had  marched  the  day  before  until  after  midnight 
and  were  awakened  after  a  brief  sleep  to  the  activities  of 
a  memorable  day  in  the  history  of  the  war.  It  was  an  ex- 
ceedingly hot  day,  and  we  marched  and  halted  and  marched 
and  halted  in  the  thick  dust  under  a  broiling  sun  until  about 
noon,  when  my  regiment  became  engaged.  Up  to  that  time, 
and,  in  fact,  during  the  entire  engagement,  I  never  received 
a  single  order  from  either  Colonel  or  other  officer,  Medical 
Inspector,  the  surgeon  of  my  regiment,  or  any  one  else.  It 
was  like  the  days  when  there  was  no  King  in  Israel,  and 
every  man  did  that  which  was  right  in  his  own  eyes.  I  did 
not  see  the  surgeon  from  the  middle  of  the  forenoon. 

As  we  approached  the  battlefield,  I  saw  beside  a  little 
stream  a  few  surgeons,  among  whom  I  knew  one,  and  I 
asked  him  what  I  ought  to  do,  for  I  was  as  green  as  the 
grass  around  me  as  to  my  duties  on  the  field.*  My  friend 
Carr,  of  Rhode  Island,  suggested  that  I  should  turn  in  there 
and  help,  advice  which  I  followed  all  the  more  readily 
because  just  at  that  time  some  of  the  advance  of  my  own 
regiment  appeared  among  the  wounded.  After  a  time,  I  saw 
everybody  around  me  packing  up  and  leaving,  and  upon 
asking  what  was  the  reason,  was  told  that  we  were  ordered 
back  to  Sedley  Springs  Church,  a  mile  or  more  hi  the  rear. 
Accordingly  I  went  with  them,  and  there  in  a  grove  along- 
side of  the  road,  with  no  fence  to  enclose  it,  stood  the  little 
church  perhaps  one  hundred  feet  distant  from  the  road. 

*  Surgeon  W.  S.  King,  of  the  regulars  ("  Medical  and  Surgical  History 
of  the  Rebellion,"  Part  I,  Medical  Volume,  Appendix,  p.  2),  calls  atten- 
tion to  the  fact  that  he  and  Assistant  Surgeon  Magruder  were,  with  few 
exceptions,  the  only  medical  officers  at  the  first  battle  of  Bull  Run  who 
had  ever  served  with  troops  in  the  field. 


422  ADDRESSES    AND   OTHER   PAPERS. 

Both  inside  and  outside  the  church  much  was  going  on. 
An  operating  table  was  improvised  from  two  boards  laid 
on  two  'boxes  in  front  of  the  pulpit;  the  slightly  injured 
looked  down  from  the  gallery  upon  the  industrious  surgeons, 
and  a  number  of  kind  women  from  the  neighborhood  helped 
to  soothe  the  wounded. 

I  always  have  remembered  one  little  illustration  of  the 
ignorance  even  of  brigade  surgeons  who  had  been  hastily 
appointed  at  the  outbreak  of  the  war.  One  of  the  wounded 
required  an  amputation  at  the  shoulder-joint,  and  the  oper- 
ator asked  the  brigade  surgeon  to  compress  the  subclavian 
artery.  This  he  proceeded  to  do  by  vigorous  pressure  ap- 
plied below  the  clavicle.  With  a  good  deal  of  hesitation, 
I  at  last  timidly  suggested  to  him  that  possibly  compression 
above  the  clavicle  would  be  more  efficacious,  when,  with 
withering  scorn,  he  informed  me  that  he  was  pressing  in 
the  right  place  as  was  proved  by  the  name  of  the  artery, 
which  was  sw&clavian.  I  do  not  remember  whether  the 
operator  took  a  hand  in  this  little  linguistic  discussion  or 
even  overheard  it.  I  had  my  rather  grim  revenge,  happily, 
not  to  the  serious  disadvantage  of  the  patient.  When  the 
operator  made  the  internal  flap  the  axillary  artery  gave 
one  enormous  jet  of  blood,  for  the  subclavian  persisted  hi 
running  where  it  could  be  compressed  above  the  clavicle,  in 
spite  of  its  name.  I  caught  the  artery  in  the  flap,  as  I  had 
been  taught  to  do  by  Dr.  Brinton,  and  instantly  controlled 
the  haemorrhage. 

Later,  I  was  outside  the  church  dressing  a  man  who  had 
a  fracture  of  the  humerus  from  a  Minie"  ball.  I  was  apply- 
ing a  splint  and  an  eight-yard  bandage.  We  were  in  the 
wood  surrounding  the  church,  perhaps  twenty  feet  back 
from  the  road,  when  suddenly  one  hundred  or  more  of  the 
soldiers  rushed  pell-mell  down  the  road  from  the  battlefield 
crying  "the  rebs  are  after  us!"  It  did  not  take  more  than 
one  positive  assertion  of  this  kind  to  convince  the  man 


SURGICAL  REMINISCENCES    OF  THE   CIVIL  WAR.          423 

whose  arm  I  was  bandaging  that  it  was  time  for  him  to 
leave,  and  he  broke  away  from  me,  rushing  for  the  more 
distant  woods.  As  he  ran,  four  or  five  yards  of  the  bandage 
unwound,  and  I  last  saw  him  disappearing  in  the  distance 
with  this  fluttering  bobtail  bandage  flying  all  abroad. 

My  experience  in  this  battle  is  a  good  illustration  of  the 
utter  disorganization,  or  rather  want  of  organization,  of  our 
entire  army  at  the  beginning  of  the  war.  It  was  wittily 
expressed  in  a  statement  which  appeared  in  "Vanity  Fair," 
the  "Puck"  or  "Life"  of  1861.  The  editor  announced  that 
he  had  received  from  their  correspondent  on  the  field  a 
dispatch  which  far  surpassed  that  of  Caesar:  it  stated  the 
location  of  the  battle,  described  the  varying  fortunes  of  the 
day,  and  announced  the  final  result.  Their  correspondent's 
laconic  telegram  also  "ran:"  "Bull  Run,  They  Run,  We 
Run." 

Later  in  the  day  the  Quartermaster  of  my  regiment  brought 
the  Colonel,  who  had  been  badly  injured  by  a  falling  limb 
of  a  tree  cut  off  by  a  solid  shot.  He  told  me  that  orders 
had  been  issued  for  the  army  to  retreat  to  Washington, 
and  I  joined  them,  caring  on  the  way  for  the  Colonel.  Soon 
after  the  battle  the  time  of  my  regiment  expired  and  we 
were  mustered  out  of  the  service.* 

I  resumed  my  studies  in  September,  1861,  graduated  in 
March,  1862,  and  two  months  later  entered  the  army  by 
examination.  Under  a  medical  officer  of  the  army  whom 
I  scarcely  saw  I  was  put  in  charge  of  the  Eckington  General 
Hospital  on  the  outskirts  of  Washington.  Not  long  after 
taking  charge,  one  Saturday  afternoon  about  4  o'clock,  I 
received  an  order  to  report  at  the  office  of  Dr.  Letterman, 
the  Medical  Director  of  the  Army  of  the  Potomac,  in  Wash- 
ington. I  had  had  so  little  experience  in  army  orders  that 
I  almost  trembled  at  the  formal  and  peremptory  character 

*  For  my  report  of  the  battle  see  "  Medical  and  Surgical  History  of 
the  War  of  the  Rebellion,"  Part  I,  Medical  Volume,  Appendix,  p.  9. 


424  ADDRESSES   AND   OTHER   PAPERS. 

of  the  order.  I  feared  that  without  knowing  it  I  had  done 
something  to  displease  Mr.  Stanton,  the  Secretary  of  War, 
who  was  a  good  deal  of  a  bogy  to  most  people  at  that  time, 
for  he  had  a  way  of  putting  them  sometimes  into  Fort  Dela- 
ware or  other  similar  close  quarters,  without  giving  any 
reasons,  too,  which  was  very  disagreeable. 

When  I  reported  to  Dr.  Letterman,  however,  I  found  that 
very  stirring  events  were  about  to  occur.  He  directed  me 
to  go  to  the  Ascension  Episcopal  Church  and  the  Eighth 
Street  Methodist  Church,  which  were  just  around  the  corner 
from  each  other,  and  prepare  them  for  general  hospitals; 
that  I  should  find  the  Quartermaster  already  there  making 
the  needful  alterations,  and  that  I  was  to  have  them  ready 
for  occupation  within  five  days.  It  was  then  about  5  o'clock 
on  Saturday  afternoon.  I  went  to  my  field  of  duty  and 
worked  nearly  all  night,  resuming  my  work  very  early  in 
the  morning.  A  gang  of  carpenters  worked  all  night.  At 
about  10  o'clock  on  Sunday  morning  the  minister  of  the 
Ascension  Church,  who  was  well-known  for  his  secession 
views,  entered  the  main  door,  his  eyes  wide  open  with  aston- 
ishment at  what  was  going  on  both  outside  and  inside  of 
the  church.  Finally  his  inquiring  gaze  fell  upon  me,  and, 
as  I  was  hi  uniform,  he  judged  that  I  could  tell  him  the 
reason  why  the  last  pews  were  just  disappearing  under  a 
new  board  floor.  I  answered  his  question  by  saying  that 
the  Secretary  of  War  had  taken  possession  of  the  churches 
of  Washington  and  was  converting  them  into  hospitals,  at 
which  he  uttered  a  "humph,"  turned  on  his  heel,  and  I 
saw  him  no  more.  In  sharp  contrast  was  the  action  of  the 
minister  of  the  Methodist  Church,  who,  with  every  member 
of  his  family,  spent  a  large  part  of  every  day,  and  often 
the  entire  day,  in  the  hospital  ministering  to  the  soldiers. 

My  assignment  to  this  duty  gave  me  another  opportunity 
of  learning  how  utterly  deficient  I  was  in  training  for  my 
position.  People  sometimes  imagine  that  a  practising  physi- 


SURGICAL  REMINISCENCES    OF  THE   CIVIL  WAR.          425 

cian  can  be  transformed  into  an  army  surgeon  merely  by 
putting  a  uniform  on  him.  I  was  not  lacking  in  ordinary 
intelligence  and  was  willing  to  work,  but  I  was  utterly  with- 
out training.  To  get  those  two  churches  ready  as  hospitals 
I  had  to  have  beds,  mattresses,  sheets,  pillow-cases,  chairs, 
tables,  kitchen  utensils,  knives,  forks,  spoons,  peppers  and 
salts,  all  sorts  of  crockery  and  the  other  necessities  for  a 
diningroom,  all  the  drugs,  appliances,  and  instruments 
needed  for  a  drug  store  for  two  hundred  sick  and  wounded 
men;  I  needed  orderlies,  cooks,  and  the  endless  odds  and 
ends  of  things  which  go  to  make  up  a  well-organized  hospital. 
I  did  not  know  how  to  get  a  single  one  of  these  requisites. 
As  to  drugs,  I  did  not  know  whether  to  order  six  ounces  or  a 
gallon  of  laudanum,  an  ounce  or  two  or  a  pound  or  two  of 
opium,  and  I  was  in  utter  darkness  as  to  the  mode  of  getting 
any  of  the  other  things  from  a  teaspoon  to  a  cook.  However, 
I  inquired  and  as  soon  as  I  learned  how,  I  set  myself  to 
work.  For  two  nights  I  slept  only  about  three  hours  each, 
and  I  had  the  satisfaction  of  reporting  to  Dr.  Letterman  at 
the  end  of  three  days,  instead  of  five,  that  I  was  ready.  On 
the  fourth  day  I  had  one  hundred  wounded  men  in  each 
hospital. 

Happily  all  this  is  now  remedied  by  the  Army  Medical 
School  in  Washington,  which  has  been  so  wisely  provided 
for  training  medical  officers  not  only  hi  post-graduate  work 
in  surgery,  bacteriology,  etc.,  but  in  the  making  out  of 
requisitions,  quartermasters'  returns,  the  descriptive  list  of 
every  patient,  and  all  the  endless,  but  much  needed,  book- 
keeping of  a  great  army.  For  want  of  such  proper  docu- 
mentary evidence  not  a  few  deserving  soldiers  lack  a  pen- 
sion, and  for  want  of  it  many  a  scamp  has  obtained  a  pen- 
sion who  would  never  have  received  it  had  his  record  been 
accurately  known.  A  similar  medical  school  does  the  same 
good  work  for  the  Navy. 

In  August,  1862,  was  fought  the  Second  Bull  Run.  v  The 


426  ADDRESSES   AND   OTHER   PAPERS. 

campaign  was  ushered  in  by  Pope's  famous  order  dated 
"Headquarters  in  the  saddle,"  which  was  wittily  criticized 
as  placing  his  headquarters  where  his  hindquarters  ought 
to  be. 

I  was  sent  out  from  Washington  to  Pope's  army  with  a 
large  supply-train.  On  the  way,  near  Fairfax  Courthouse, 
we  met  General  Phil.  Kearney  with  a  squadron  of  cavalry. 
He  fell  in  with  the  enemy  within  ten  minutes  after  he  passed 
us  at  a  gallop  and  received  a  mortal  wound.  My  supply- 
train  was  shelled  for  a  short  time  from  a  parallel  road  at 
some  distance  to  the  north  of  us  by  a  Confederate  battery, 
which  seemed  to  me  odd  in  view  of  Pope's  proclaimed  vic- 
tory. However,  I  finally  reached  Centreville  and  soon  after- 
wards began  to  distribute  the  instruments,  blankets,  medi- 
cines, stimulants,  etc.,  I  had  brought.  I  had  400  dozen 
bottles  of  whiskey,  brandy,  sherry,  etc. ;  2600  blankets ;  600 
cases  of  soups  hi  cans  (one  of  the  few  things  that  were  then 
put  up  in  cans) ;  800  complete  suits  of  underclothes;  a  dozen 
operating  cases,  etc.  Before  I  left  Washington  I  had  been 
directed  to  be  rather  sparing  in  distributing  these,  and  I 
obeyed  orders:  but  afterward  I  had  good  reason  to  regret 
my  want  of  liberality,  for  on  the  third  day  Colonel  Faunt- 
leroy,  of  the  Sixth  Virginia  Confederate  Cavalry,  marched 
hi  and  took  a  hand  in  the  game.  He  was  accompanied  by 
one  of  the  surgeons  of  Lee's  army,  whose  name,  unfortu- 
nately, I  do  not  remember :  but  I  have  a  very  vivid  recol- 
lection when  I  gave  them  the  key  of  the  little  smoke-house 
hi  which  I  had  stored  the  medicines,  stimulants,  operating 
cases,  and  smaller  and  more  valuable  things  that  I  had 
brought  along — how  their  eyes  widened  and  their  faces  were 
wreathed  in  smiles  as  the  doctor,  after  a  rapid  survey  of 
the  boxes  on  the  walls,  turned  to  the  Colonel  and  said  with 
an  expletive,  "There  is  more  good  whiskey  in  this  little  smoke- 
house than  there  is  in  the  whole  city  of  Richmond." 

The  army  left,  and  left  me  practically  stranded.     I  was 


SURGICAL  REMINISCENCES    OF   THE    CIVIL  WAR.          427 

not  attached,  of  course,  to  any  regiment,  brigade,  or  head- 
quarters. Again,  nobody  gave  me  orders,  but,  as  I  found 
in  the  little  church  in  Centreville  one  hundred  wounded 
men  who  needed  attention,  I  saw  my  duty  well  marked 
out.  All  of  these  men  were  severely  wounded,  for  the 
slightly  wounded  marched  away  with  the  army.  Upon  a 
few  mattresses  and  with  almost  no  other  conveniences  or 
comforts,  the  men  were  laid  hi  rows  on  the  floor.  Most  of 
them  had,  hi  fact,  not  even  a  mattress,  but  only  a  little 
straw  under  them,  and  this  hi  a  very  little  tune,  when 
"laudable  pus"  began  to  flow,  became  soiled  and  had  to 
be  diminished  daily.  The  bedsores  which  followed  were 
something  frightful,  often  larger  than  an  entire  hand,  and, 
when  we  add  to  all  this  the  secondary  haemorrhages  which 
often  soaked  the  floor  before  they  could  be  arrested,  one 
can  have  an  idea  of  the  sufferings  of  these  poor  fellows, 
and  of  the  task  of  those  who  were  caring  for  them. 

Moreover,  the  food  problem  soon  became  a  serious  one. 
We  had  only  a  very  moderate  supply  of  canned  soups  that 
the  Confederates  had  very  generously  given  us  when  their 
own  commissariat  was  sadly  deficient,  and  we  had  nobody 
to  forage  for  us,  for  all  of  the  able-bodied  soldiers  had  gone 
away  lest  they  should  be  taken  prisoners.  Fortunately  two 
or  three  of  the  Christian  Commission  and  the  Sanitary  Com- 
mission were  on  hand  and  helped. 

The  third  day  after  the  battle  I  passed  such  a  night  as 
I  had  never  before  experienced  in  my  life.  Long  trains  of 
ambulances  arrived  carrying  our  wounded  from  the  field  of 
battle  back  to  Washington,  and  there  were  but  four  surgeons 
to  look  after  them  and  their  many  imperious  needs.  Fifty 
poor,  thirsty  fellows  were  crying  for  water;  fifty  more  were 
crying  with  the  pain  from  a  jolting  ride  of  nine  miles  over  a 
corduroy  road.  Most  of  them  had  had  nothing  to  eat  for 
one,  two,  or  three  days,  save  what  they  had  obtained  from 
the  haversacks  of  poor  fellows  who  were  dead  in  their  neigh- 


428  ADDRESSES   AND    OTHER    PAPERS. 

borhood.  Some  had  such  horrible  wounds  that  they  could 
absolutely  go  no  further  and  must  be  got  out  on  stretchers 
and  taken  into  the  hospital. 

One  of  us  immediately  started  with  a  pail  of  water  and 
a  tin  dipper  to  supply  the  first  want  of  all;  another,  as 
quickly  as  we  could  heat  some  soup,  started  on  a  similar 
errand  to  supply  then-  hunger,  while  I  took  a  bottle  of  mor- 
phine and  my  pocket  penknife  and  did  not  worry  over  any 
superfluous  exactitude  in  doling  out  the  blessed  relief  which 
morphine  brings  to  men  hi  pain.  All  of  this  was  done  hi 
total  darkness,  with  two  or  three  dim  lanterns,  in  a  drizzling 
rain,  and  in  six  inches  of  Virginia  mud. 

Fortunately,  just  as  our  food  was  giving  out,  an  ambu- 
lance tram  was  sent  from  Washington  and  took  our  patients 
and  ourselves  back  to  civilized  conditions  and  surgical  op- 
portunities. 

In  September,  1862,  I  was  sent  to  Frederick,  Md.,  im- 
mediately after  the  battle  of  Antietam  and  assigned  to 
Hospital  No.  1,  in  charge  of  my  since  then  lifelong  friend, 
Dr.  Robert  F.  Weir.  One  little  incident  that  occurred  just 
after  I  got  there  was  of  a  good  deal  of  personal  interest 
to  me.  After  the  battle,  when  the  present  Mr.  Justice 
Holmes,  of  the  Supreme  Court  of  the  United  States,  then 
a  Captain  hi  the  army,  was  wounded,  his  father,  Dr.  Oliver 
Wendell  Holmes,  immediately  left  Boston  to  find  him.  The 
journey  is  embalmed  hi  a  delightful  account,  published  soon 
afterward  in  the  "Atlantic  Monthly"  under  the  title  "My 
Hunt  After  the  Captain,"*  though  he  did  not  include  hi 
his  story  the  following  little  incident.  In  1862  Holmes,  of 
course,  was  really  at  the  height  of  his  fame.  The  "Atlantic 
Monthly"  had  only  been  started  a  few  years  before,  when  I 
was  a  student  hi  Brown  University.  In  its  very  first  number 
the  publication  of  the  "Autocrat"  began,  and  through  this  the 
entire  country  knew  him  well.  One  day  at  noon,  having  just 

*  "Atlantic  Monthly,"  Dec.,  1862,  p.  738. 


SURGICAL  REMINISCENCES    OF  THE   CIVIL   WAR.          429 

finished  the  round  of  my  ward,  I  was  sitting  in  the  office  in 
undress  uniform.  The  only  other  person  present  was  the  offi- 
cer of  the  day,  who,  of  course,  was  in  full  uniform.  He  was 
a  gentleman  whose  knowledge  of  English  literature  was  quite 
limited,  and  I  fear  the  same  criticism  could  be  made  upon 
his  knowledge  of  surgery.  The  door  opened,  and  with  a 
quick  step  a  dapper  little  man  whom  I  instantly  recognized 
by  his  portrait,  though  I  had  never  seen  him  before,  stepped 
in,  glanced  from  one  to  the  other,  and  quickly  walked  up 
to  the  officer  of  the  day.  He  introduced  himself  by  saying, 
"My  name  is  Holmes,  Dr.  Oliver  Wendell  Holmes,  of  Bos- 
ton. I  have  come  in  search  of  my  son  who  is  wounded." 
My  colleague  looked  at  him  for  a  moment,  scratched  his 
head  to  gather  his  fugitive  ideas  together,  and  repeated 
in  a  half -absent  tone,  "Holmes,  Holmes,  seems  to  me  I 
have  heard  your  name  before,  sir,"  at  which,  in  spite  of 
paternal  anxiety,  the  Autocrat's  eyes  twinkled  with  amuse- 
ment. 

The  surgery  of  that  time  was  very  simple. — cold  water 
dressings  or  simple  cerate  spread  on  lint  made  by  patriotic 
women  by  scraping  one  side  of  old  linen  sheets  or  table- 
cloths, or,  to  encourage  suppuration  (for  pus  at  that  time 
could  be  "laudable"),  the  ordinary  flaxseed  poultice.  An 
amputation  stump  was  always  dressed  with  a  Maltese  cross 
of  lint  spread  with  cerate.  Hanging  out  of  the  two  ends 
of  the  wound  were  from  five  to  twenty  or  thirty  silk  liga- 
tures, one,  two,  or  three  of  them  with  one  or  more  knots 
tied  in  them  in  order  to  identify  those  ligatures  which  be- 
longed to  the  larger  vessels.  From  about  the  fourth  or 
fifth  day  traction  was  made  upon  each  string  to  see  whether 
the  tissues  had  rotted  away  sufficiently  to  allow  it  to  become 
detached.  The  knotted  ligatures  on  the  large  vessels  were 
not  touched  for  a  week  or  ten  days,  and  not  uncommonly 
when  they  came  away,  either  spontaneously  or  from  traction, 
a  gush  of  blood  would  announce  a  secondary  haemorrhage, 


430  ADDRESSES  AND   OTHER   PAPERS. 

requiring  reopening  of  the  wound  or,  in  some  cases  of  re- 
peated haemorrhage,  a  ligation  of  the  vessel  higher  up  in 
the  limb,  or  an  amputation.  Sometimes,  as  in  Lord  Nelson's 
case,  these  ligatures  on  large  vessels  did  not  come  away 
for  many  years. 

What  we  did  not  have  hi  those  days  was  almost  more 
noticeable  than  what  we  did  have.  Among  our  blessings, 
however,  were  ether  and  chloroform.  Ether,  it  will  be 
remembered,  was  first  used  publicly  in  the  Massachusetts 
General  Hospital  on  October  16,  1846;  chloroform  was 
discovered  by  Sir  James  Simpson  hi  the  following  year, 
1847.  Yet  you  will  be  surprised  when  I  tell  you  that  Lord 
Roberts  records,  in  his  "Forty-one  Years  hi  India,"  that 
hi  the  Sepoy  Rebellion  of  1857,  ten  and  eleven  years  after 
the  discovery  of  chloroform  and  ether,  there  were  no  anses- 
thetics  to  alleviate  the  sufferings  of  those  heroes  who  were 
wounded  during  the  terrible  siege  of  Delhi.*  We  had,  how- 
ever, no  antiseptics,  for  antisepsis  was  as  yet  even  undreamed 
of;  hence  erysipelas,  pyaemia,  and  hospital  gangrene  were 
rife.  Many  a  time  have  I  had  the  following  experience — 
indeed,  it  was  fully  expected  and  looked  upon  as  unavoid- 
able: A  poor  fellow  whose  leg  or  arm  I  had  amputated  a 
few  days  before  would  be  getting  on  as  well  as  we  then 
expected ;  that  is  to  say,  he  had  pain,  high  fever,  was  thirsty 
and  restless,  but  was  gradually  improving,  for  he  had  what  we 
looked  on  as  a  favorable  symptom, — an  abundant  discharge 
of  pus  from  his  wound.  Suddenly,  overnight,  I  would  find 
that  his  fever  had  become  markedly  greater,  his  tongue  dry, 
his  pain  and  restlessness  increased,  sleep  had  deserted  his 
eyelids,  his  cheeks  were  flushed,  and  on  removing  the  dress- 
ings I  would  find  the  secretions  from  the  wound  almost 
dried  up  and  what  there  were  were  watery,  thin,  and  foul- 

*  "  Anaesthetics  and  antiseptics  were  then  unknown  [ !] ;  consequently 
few  of  the  severely  wounded  recovered  and  scarcely  a  single  amputation 
case  recovered"  (Lord  Roberts,  vol.  i,  p.  195). 


SURGICAL  REMINISCENCES    OF  THE   CIVIL  WAR.          431 

smelling,  and  what  union  of  the  flaps  had  taken  place  had 
melted  away.  Pyaemia  was  the  verdict  and  death  the  usual 
result  within  a  few  days.  The  total  number  of  cases  of 
pyaemia  reported  during  the  war  was  2818,  of  whom  2747 
died,  a  mortality  of  97.4  per  cent. ! 

Erysipelas,  too,  was  rampant  and  it  was  a  common  obser- 
vation that  it  followed  the  direction  of  the  wind  both  hi  the 
same  ward  and  in  its  direction  from  one  ward  to  another.  We 
had  already  learned  the  hard  lesson,  however,  that  our  erysipe- 
las cases  must  be  isolated  and  dressed  last  or  an  epidemic 
would  occur — why,  the  best  of  us  could  not  tell.  Hospital 
gangrene — a  disease  now  banished,  I  hope,  forever — whose 
very  name  is  a  bit  of  sarcasm,  was  very  common.  In  the 
hospitals  of  Louisville  alone  and  for  only  a  portion  of  1862 
and  1863,  Middleton  Goldsmith  tabulated  343  cases,  with  a 
mortality,  happily,  of  only  21  or  6.2  per  cent.  The  total  num- 
ber of  cases  of  gangrene  of  all  kinds  was  2642.  In  2503 
cases  in  which  the  result  is  known  1361  recovered  and  1142 
died,  a  mortality  of  45.6  per  cent.*  It  was  a  phagedaenic 
ulceration  which,  if  we  should  see  it  now,  we  would  probably 
find  was  due  to  a  streptococcus  infection.t  Often  did  I 
see  a  simple  gunshot  wound,  scarcely  larger  than  the  bullet 
which  made  it,  become  larger  and  larger  until  a  hand  would 
scarce  cover  it,  and  extend  from  the  skin  downward  into 
the  tissues  until  one  could  put  half  his  fist  into  the  sloughing 
wound.  In  my  report  upon  Hospital  Gangrene,:}:  as  it 
occurred  in  Frederick,  Md.,  and  in  the  West  Philadelphia 
Hospital,  I  pointed  out  that  repeatedly  a  few  days  of  cold 
rainy  weather  requiring  windows  and  doors  to  be  closed, 
thus  preventing  a  change  hi  the  atmosphere  of  suppuration, 

*  "  Medical  and  Surg.  History,  etc.,"  Part  III,  Surgical  Volume,  p.  824. 

t  For  good  illustrations  of  this  practically  vanished  disease  see  the 
colored  plates  in  the  Med.  and  Surg.  History  of  the  War,  Part  II,  Surg. 
Vol.,  pp.  739  and  928,  and  Part  III,  Surg.  Vol.,  p.  53. 

t  Med.  and  Surg.  History,  etc.,  Part  III,  Surg.  Vol.,  p.  826. 


432  ADDRESSES   AND   OTHER   PAPERS. 

which  then  was  normal,  would  be  followed  by  an  outbreak 
of  hospital  gangrene,  and  a  few  days  of  warm  sunshine 
would  promptly  check  its  ravages.  One  case  in  particular, 
after  Antietam,  I  remember:  A  wound  on  the  inside  of  the 
upper  thigh  which  enlarged  and  deepened,  first  exposing  the 
femoral  artery,  then  eating  its  way  deeper  and  deeper  under 
the  artery  until  the  pulsating  vessel  stretched  like  a  red 
rope  across  the  chasm.  Beside  his  bed,  day  and  night,  sat 
an  orderly  with  instructions,  in  case  secondary  haemorrhage 
occurred,  instantly  to  screw  down  the  pad  of  a  Petit  tourni- 
quet placed  in  situ.  It  was  one  of  the  most  instructive 
illustrations  I  have  ever  had  of  the  resistance  of  the  fibrous 
and  muscular  wall  of  an  artery.  After  a  tune  the  gangrene 
was  arrested,  the  artery  became  covered  with  granulations, 
the  chasm  below  the  artery  slowly  filled  until  the  granula- 
tions reached  up  to  the  artery,  then  gradually  rose  on  each 
side  of  it,  and  finally  covered  it  completely,  and  the  wound 
cicatrized  without  the  loss  of  a  drop  of  blood. 

Our  method  of  treating  hospital  gangrene,  which  was 
empirical,  we  now  know  to  have  been  based  on  sound  patho- 
logical grounds.  Isolation  and  fresh  air,  and  locally,  pure 
nitric  acid,  the  acid  nitrate  of  mercury,  the  actual  cautery, 
or  bromine,  as  was  introduced  into  practice  by  Middleton 
Goldsmith,  were  our  only,  but  efficient,  weapons. 

Tetanus  also  claimed  its  frequent  victims:  Of  505  cases 
451  were  fatal,  a  mortality  of  89.3  per  cent. 

While  I  was  in  Frederick,  Dr.  John  H.  Brinton  began 
what  is  now  the  most  splendid  Military  Museum  hi  the 
world,  that  of  the  Surgeon-General  of  the  Army  in  Wash- 
ington. He  appointed  me  his  representative  hi  and  about 
Frederick  and  later  in  Philadelphia.  It  was  my  duty  to 
gather  and  forward  all  the  specimens  that  I  could  lay  hands 
upon. 

Among  them  I  remember  were  more  than  a  score  of 
knee-joints,  every  one  of  which  with  our  then  surgical  re- 


SURGICAL  REMINISCENCES    OF  THE   CIVIL  WAR.          433 

sources  should  have  been  amputated.  Conservative  treat- 
ment of  joints  was  an  impossibility  until  antisepsis  and 
asepsis  made  it  not  only  a  possibility,  but  a  duty.  The 
popular  opinion  that  the  surgeons  did  a  large  amount  of 
unnecessary  amputating  may  have  been  justified  in  a  few 
cases,  but,  taking  the  army  as  a  whole,  I  have  no  hesitation 
hi  saying  that  far  more  lives  were  lost  from  refusal  to  am- 
putate than  by  amputation.* 

Wounds  of  the  abdomen  involving  the  viscera  were  almost 
uniformly  fatal.  If  we  were  absolutely  certain  that  the 
bowel  was  penetrated  by  rinding  fecal  matter  exuding  through 
the  wound,  of  course  we  would  then  open  the  abdomen, 
but  he  was  a  bold  surgeon  hi  those  days  who  would  do  an 
abdominal  section  without  such  positive  knowledge.  Opium 
was  practically  our  only  remedy  and  death  the  usual  result. 
Not  more  than  one  incontestable  example  of  recovery  from 
a  gunshot  wound  of  the  stomach  and  not  a  single  incon- 
testable case  of  wound  of  the  small  intestines  are  recorded 
during  the  entire  war  among  the  almost  250,000  wounded. 
Of  recovery  after  wounds  of  the  large  intestine  there  were 
59  cases.  When  we  remember  that  to-day  recovery  has 
followed  as  many  as  19  perforations  of  the  bowel  and  mesen- 
tery, it  gives  those  of  us  who  went  through  the  Civil  War 
many  a  pang  of  conscience.  Only  too  sharply  do  we  remem- 
ber the  dreadful  things  that  we  did  do  and  the  good  things 
that  we  did  not  dare  to  do. 

Of  852  amputations  at  the  should er-joint,  236  died,  a 
mortality  of  28.5  per  cent.  Of  66  cases  of  amputation  of 
the  hip-joint  55,  or  83.3  per  cent.,  died.  Of  155  cases  of 
trephining,  60  recovered  and  95  died,  a  mortality  of  over 
61  per  cent.  Of  374  ligations  of  the  femoral  artery,  93 
recovered  and  281  died,  a  mortality  of  over  75  per  cent. 

*  "  Conservative  surgery  was  practised  too  much  and  the  knife  not 
used  enough "  (Letterman's  Med.  Recollec.  of  the  Army  of  the  Potomac, 
p.  49). 

28 


434  ADDRESSES   AND   OTHER   PAPERS. 

These  figures  afford  a  striking  evidence  of  the  dreadful 
mortality  of  military  surgery  in  the  days  before  antisepsis 
and  first-aid  packages.  Happily  such  death-rates  can  never 
.  again  be  seen,  at  least  in  civilized  warfare. 

Among  other  specimens,  one  of  the  most  curious  which 
I  sent  to  the  Army  Medical  Museum  is  a  bullet  which  I 
found  at  a  post-mortem  in  a  very  unique  position.  It  was 
caught  hi  the  omentum,  so  that  when  the  omentum  was 
held  up  the  ball  was  suspended  hi  a  net  ("Med.  and  Surg. 
History,"  etc.,  Part  II,  Surg.  Vol.,  p.  174). 

The  mischief  one  ball  may  cause  is  well  shown  in  a  later 
student  and  friend.  It  entered  just  below  the  left  eye  and 
emerged  just  behind  the  lobe  of  the  left  ear.  (1)  A  long- 
standing caries  of  the  bones  followed;  (2)  the  left  ear  was 
deaf;  (3)  the  left  eye  was  blind;  (4)  the  left  facial  nerve 
was  destroyed,  causing  paralysis  of  the  left  side  of  the  face; 
(5)  the  ball  passed  through  the  left  temporo-maxillary 
articulation,  and  ankylosis  of  the  jaw  followed;  (6)  a  surgeon 
who  attempted  to  remedy  this  ankylosis  broke  a  number 
of  his  good  teeth  and  also  by  a  later  operation  caused  (7)  a 
salivary  fistula,  requiring  (8)  another  operation  for  its  cure. 
(9)  Repair  of  his  teeth  was  impossible  on  account  of  the 
ankylosis,  and  (10)  he  was  compelled  to  live  all  his  life  after 
his  wound  on  soft  diet,  being  able  only  to  separate  his  teeth 
to  a  very  slight  extent  and  not  being  able  to  masticate  other 
food.  In  spite  of  all  of  these  accumulated  troubles  he  was 
a  most  cheerful,  useful,  and  devoted  surgeon  in  the  Marine 
Hospital  Service  and  a  well-known  expert  on  yellow  fever — 
the  late  surgeon  Murray. 

During  the  winter  after  Antietam  I  was  ordered  to  the 
(West  Philadelphia)  Satterlee  Hospital.  One  of  the  curious 
memories  of  a  colleague  in  that  hospital  was  when  I  quickly 
arrested  his  hand  just  as  he  was  about  to  fashion  the  flaps 
the  wrong  way,  so  that  the  stump  would  have  been  whittled 
down  like  a  lead-pencil,  and  the  flaps  have  been  left  on 
the  amputated  portion. 


SURGICAL  REMINISCENCES    OF  THE   CIVIL  WAR.          435 

Another  vivid  memory  was  my  experience  with  secondary 
haemorrhage  after  the  battle  of  Gettysburg.  Cases  of  second- 
ary haemorrhage  began  to  appear  even  before  the  end  of 
the  first  week,  but  during  the  second  week  they  occurred 
with  dreadful  frequency.  When  I  was  on  duty  for  twenty- 
four  hours  an  officer  of  the  day  and  it  was  my  duty  to  attend 
to  all  emergency  night  calls  I  had  five  cases  of  secondary 
haemorrhage  in  a  single  night  about  two  weeks  after  the 
battle.  In  the  last  20  years  I  do  not  remember  five  other 
cases — thanks  to  antiseptic  surgery.  One  of  them  I  particu- 
larly remember,  a  gunshot  wound  just  above  the  inner  end  of 
the  right  clavicle.  The  bullet  had  not  emerged ;  its  direction 
was  unknown;  the  haemorrhage  was  profuse, — whether  from 
one  of  the  smaller  transverse  vessels  of  the  neck,  or  from  the 
carotid,  jugular,  subclavian,  or  even  the  innominate,  was 
wholly  unknown.  I  etherized  the  man  and  proceeded  to 
search  for  the  wounded  vessel.  My  only  light  was  a  square 
block  of  wood  with  five  auger  holes,  in  each  one  of  which  was 
placed  a  candle.  It  was  before  even  the  days  of  petroleum, 
which  had  then  just  been  discovered  in  Pennsylvania.  As  the 
wound  was  so  near  the  mouth,  of  course  the  light  had  to  be 
near  the  ether  cone.  I  have  often  wondered  why  I  did  not 
have  the  sense  to  use  chloroform.  Suddenly  the  ether  took  fire 
and  the  etherizer  flung  away  both  cone  and  bottle.  Luckily 
the  bottle  did  not  break,  or  we  might  have  had  an  ugly 
fire  in  a  hospital  constructed  wholly  of  wood.  I  was  for- 
tunate enough  finally  to  secure  the  vessel  after  much  search- 
ing and  a  large  loss  of  blood,  and  was  gratified  to  discover 
that  it  was  one  of  the  transverse  arteries  of  the  neck.  The 
patient  recovered. 

This  case  illustrates  well  the  disadvantages  under  which 
we  then  labored.  There  were  no  haemostatic  forceps.  In 
the  depths  of  such  a  wound  the  tissues  could  not  be  seized 
and  drawn  up  to  the  light  and  the  bleeding  vessel  quickly 
clamped.  Our  only  resource  was  to  try  to  pass  a  tenaculum 


436  ADDRESSES   AND   OTHER   PAPERS. 

through  the  vessel  and  tie  it  with  silk.  Usually  we  were  only 
successful  after  several  attempts.  Meanwhile  that  vessel  and 
others  were  all  bleeding;  the  others  had  to  wait  their  turn. 
Moreover,  we  had  no  retractors  by  which  we  could  get  a 
good  view  of  the  depth  of  such  a  wound.  We  had  no  hypo- 
dermatic syringes  at  the  beginning  of  the  war,  and  they 
were  not  in  common  use  till  some  years  after  its  conclusion. 
The  mouth  and  the  bowel  were  the  only  avenues  for  the 
administration  of  remedies.  We  had  no  aspirators  and, 
what  will  astonish  many  of  my  younger  hearers,  we  had  no 
clinical  thermometers;  our  only  means  of  estimating  fever 
was  by  touch.  It  was  not  until  several  years  after  the  war — 
say  the  early  seventies — that  the  thermometer  became  a 
common  instrument.  It  was  then  about  from  ten  to  twelve 
inches  long,  was  never  used  excepting  in  the  axilla,  from 
which  it  stuck  up  like  a  mast,  and  was  often  broken  by 
movements  of  the  patient  or  pressure  of  the  bedclothes. 
The  first  short  clinical  thermometer,  such  as  we  now  have, 
which  I  ever  saw  was  a  gift  from  my  friend  Dr.  S.  Weir 
Mitchell,  brought  from  London  hi  1876.  Many  of  my  other 
thermometers  have  met  with  casualties  and  finished  then* 
career  by  sudden  catastrophies,  but  this  one,  strange  to  say, 
has  had  a  charmed  life,  doubtless  due  to  the  distinguished 
giver,  and  I  still  use  it  with  great  satisfaction. 

In  1863,  at  the  request  of  Drs.  Mitchell  and  Morehouse, 
I  was  ordered  to  the  Christian  Street  Hospital,  hi  the  old 
police  station  which  still  stands  on  Christian  Street  below 
Tenth  Street,  and  later  in  the  Turner's  Lane  Hospital,  which 
then  stood  in  the  midst  of  a  large  farm  near  Twenty-second 
Street  and  Columbia  Avenue.  These  two  hospitals  were 
successively  devoted  to  the  diseases  and  injuries  of  the 
nervous  system. 

The  first  nervous  case  that  I  remember  was  a  very  re- 
markable one  and  the  first  of  its  kind  ever  recorded.  It 
occurred  while  I  was  Executive  Officer  at  the  Satterlee 


SURGICAL  REMINISCENCES    OF  THE   CIVIL  WAR.          437 

Hospital,  West  Philadelphia,  a  very  short  time  before  I  was 
ordered  to  the  Christian  Street  Hospital.  As  Executive 
Officer  it  was  my  duty  to  assign  new  patients  to  the  wards 
and  also  to  transfer  the  cases  in  the  specialties,  such  as  the 
eye,  nervous  diseases,  and  injuries,  etc.,  to  the  special  hos- 
pitals. One  morning  as  I  sat  at  my  desk  a  soldier  applied 
for  assignment.  On  looking  up  at  him  I  said  to  myself: 
"You  are  Dalton's  cat."  Those  of  you  who  are  familiar 
with  Dalton's  good  old  text-book  of  physiology  will  remem- 
ber a  picture  of  a  cat  whose  right  cervical  sympathetic 
nerve  had  been  severed.  The  left  pupil  is  very  large,  .the 
right  one  very  small,  and  the  moment  I  looked  at  this  man 
I  was  struck  with  the  similar  condition  of  his  pupils.  I 
quickly  asked  him:  "Where  were  you  wounded?"  and  when 
he  pointed  to  his  neck  I  said  to  myself  again:  "That  ball 
destroyed  the  sympathetic  nerve."  I  immediately  trans- 
ferred him  to  the  Christian  Street  Hospital,  and  a  few  days 
later  followed  him.  His  case  is  reported  in  full  hi  our  little 
book  on  "Gunshot  Wounds  and  Other  Injuries  of  Nerves," 
p.  39.  In  the  autumn  of  1864  I  took  a  copy  of  this  book 
to  Claude  Bernard  in  Paris,  the  discoverer  of  the  function  of 
the  cervical  sympathetic  and  the  effect  of  its  division  upon 
the  pupil  and  the  blood-vessels.  He  exhibited  true  Gallic 
enthusiasm  when  I  showed  him  the  first  recorded  case  in 
the  human  subject,  which  confirmed  his  brilliant  researches, 
which  were  the  beginning  of  our  knowledge  of  nature's  beau- 
tiful automatic  regulation  of  the  blood-supply.* 

The  results  of  injuries  of  nerves  have  been  dwelt  upon 
fully  by  Dr.  Mitchell,  and  I  need  say  little  about  them. 
All  of  our  patients,  of  course,  were  convalescents.  The 
phenomena  of  fatal  cases  we  had  no  opportunity  of  observing, 
but  I  can  never  forget  the  extraordinary  contractures, 

*  This  was  the  real  starting  point  of  our  knowledge  of  the  functions 
of  the  sympathetic  nerve,  although  Pourfour  du  Petit,  in  1727,  had  noticed 
the  effect  of  its  division  on  the  pupil,  (de  Schweinitz.) 


438  ADDRESSES   AND    OTHER    PAPERS. 

paralyses,  and  other  results  of  the  extensive  wounds  of 
nerves  such  as  we  studied  there  for  the  first  time.  One 
poor  fellow  (since  then  I  have  seen  one  similar  case)  was 
shot  directly  through  the  posterior  portion  of  both  eyeballs ; 
another  had  necrosis  of  a  large  part  of  the  body  of  the  third 
cervical  vertebra.  The  sequestrum  discharged  through  the 
mouth,  showing  the  anterior  portion  of  the  foramen  for  the 
transmission  of  the  vertebral  artery,  which,  fortunately, 
did  not  suffer  either  by  the  original  wound  or  the  secondary 
necrosis  and  suppuration. 

Very  naturally  among  so  many  soldiers  of  diverse  char- 
acter, and  especially  of  men  with  wounds  and  injuries  of 
the  nervous  system,  we  had  perhaps  more  than  our  usual 
proportion  of  malingerers.  In  the  "  American  Journal  of  the 
Medical  Sciences"  for  October,  1864,  p.  367,  in  a  paper  on 
"Malingering,"  especially  hi  regard  to  simulation  of  dis- 
eases of  the  nervous  system,  a  number  of  our  conclusions 
were  stated.  From  the  necessity  of  the  case,  we  devised 
some  new  means  for  discovering  such  malingerers.  We  first 
suggested  the  use  of  ether  (alone  or  in  combination  with 
other  means)  as  a  test  in  a  number  of  alleged  diseases  and 
conditions  in  which  it  had  never  before  been  used.  It  proved 
a  most  efficient  method  of  detection.  For  instance,  in 
asserted  blindness,  we  suggested  that  the  man  should  be 
etherized,  the  sound  eye  then  covered  with  adhesive  plaster, 
and  when  recovering  from  the  anaesthetic,  before  he  was 
able  to  reason  and  guard  himself  against  making  mistakes, 
that  his  sight  should  be  tested  by  very  simple  means,  such 
as  holding  out  to  him  in  the  hand  some  water  or  some  whiskey, 
or  any  other  act  which  would  reveal  the  presence  or  absence 
of  sight  in  the  supposed  blind  eye.  So  in  deafness  we  dis- 
covered some  malingerers  by  the  old  trick  of  gradually 
lowering  the  voice ;  but  hearing,  like  sight,  can  best  be  tested 
during  the  recovery  stage  of  ether  when  the  patient  is  taken 
unawares,  as  Parr,  in  his  "Medical  Dictionary,"  speaks  of 


SURGICAL  REMINISCENCES    OF  THE   CIVIL   WAR.          439 

a  man  who  pretended  to  be  dumb,  of  whom  a  sympathetic 
passer-by,  with  most  insidious  humanity,  inquired:  "How 
long  have  you  been  dumb,  my  good  friend?"  "Three  weeks, 
sir, "  replied  the  uncautious  deceiver. 

We  also  recorded  what  Da  Costa  first  called  our  attention 
to:  that  in  feigned  lameness  the  cane  is  apt  to  be  put  down 
after  the  leg  instead  of  before,  whereas  a  really  lame  man, 
needing  the  support  of  a  cane,  always  will  put  the  cane 
down  first.  In  some  instances  the  substitution  of  the  urine 
of  a  soldier  known  to  have  renal  disease  by  a  malingerer 
for  his  own  of  course  was  readily  detected  by  having  him 
pass  his  water  in  the  presence  of  the  ward-master  or  of  the 
surgeon. 

In  both  paralysis  and  ankylosis  we  again  resorted  to  the 
use  of  anaesthesia,  a  means  which  now,  of  course,  every  one 
is  familiar  with,  but  which  at  that  time  was  a  novelty. 
Sometimes  it  was  not  needed,  as  accident  would  disclose 
the  fraud.  Thus,  one  of  the  most  persistent  and  successful 
malingerers  at  last  unmasked  himself.  His  right  arm  had 
long  hung  useless  by  his  side.  One  day  as  he  was  going 
out  on  leave  a  high  wind  suddenly  blew  the  cape  of  his 
overcoat  over  his  head,  and  in  an  unguarded  moment  both 
arms  were  raised  to  throw  back  the  cape  so  that  he  could 
see.  The  Army  of  the  Potomac  speedily  received  a  rein- 
forcement of  one.  A  necessary  precaution  is  to  be  noted, — 
namely,  that  sometimes  malingerers  who  had  been  in  the 
ward  a  considerable  time  and  had  seen  other  patients  ether- 
ized, not  only  feigned  disease,  but  feigned  complete  anaes- 
thesia long  before  it  actually  existed,  and  thus  very  nearly 
deceived  us.  A  little  extra  dose,  so  that  one  is  absolutely 
sure  that  the  etherization  is  real  and  not  imitated,  of  course, 
will  avoid  this  danger.  In  this  manner  we  detected  one 
man  whose  arm  had  been  "paralyzed"  for  a  long  while, 
and  left  him  yawning  and  stretching  himself  with  both  arms 
far  above  his  head  and  every  effort  to  move  them  down 


440  ADDRESSES   AND    OTHER   PAPERS. 

resisted  by  his  deltoid,  which,  previous  to  this  test,  had 
been  entirely  useless.  The  same  test  served  us  well  in  some 
cases  of  alleged  aphonia.  The  old  adage  "In  vino  veritas" 
might  well  be  applied  to  anaesthesia.  The  supposed  blind 
will  see,  the  dumb  will  speak,  the  lame  will  freely  move 
paralyzed  limbs,  deaf  ears  will  be  unstopped,  and  all  in  spite 
of  the  malingerers'  best  efforts. 

In  one  of  our  cases  of  aphonia,  detected  without  the 
slightest  difficulty,  the  patient,  however,  quickly  recovered 
himself  and  fell  at  the  surgeon's  feet  with  clasped  hands, 
exclaiming  with  a  voice  and  attitude  worthy  of  a  Garrick: 
"Thank  God,  Doctor,  you  have  restored  my  voice!" 

Our  means  of  detecting  fraudulent  epileptics  are  fully 
described  in  the  paper  above  mentioned.  For  want  of  time 
I  cannot  do  more  than  refer  those  interested  in  the  subject 
to  it  for  details. 

Three  things  are  impressed  upon  my  mind  as  a  result  of 
this  review  of  the  Surgery  of  the  Civil  War.  The  first  is 
the  utter  inadequacy  of  our  present  system  of  enlargement 
of  the  medical  corps  of  the  army  when  war  or  a  great  battle 
suddenly  precipitates  this  necessity  upon  us.  The  parsimony 
of  Congress  has  cut  down  the  numbers  of  the  medical  military 
establishment  below  what  is  necessary  for  a  proper  perform- 
ance of  its  duties  even  on  a  peace  basis.  The  Surgeon- 
General  always  is  forced  to  employ  a  large  number  of  acting 
assistant  surgeons,  who,  faithful  as  they  may  be,  can  ill 
supply  the  place  of  men  trained  in  the  regular  medical  corps. 
When  war  suddenly  comes,  an  enormous  number  of  barely 
competent  or  often  incompetent  men  must  be  put  in  charge 
of  the  lives  and  health  of  the  soldier,  men  who  are  as  utterly 
untrained  as  I  have  shown  I  was  when  I  entered  the  army. 
The  Medical  Corps  of  the  army  should  be  enlarged,  as  was 
urged  upon  the  last  Congress  by  the  President,  the  Secretary 
of  War,  and  the  Surgeon-General;  all  vacancies  should  be 
filled,  and  measures  taken  either  under  existing  or  future 


SURGICAL   REMINISCENCES   OF  THE   CIVIL  WAR.  441 

laws  to  have  a  supplementary  Medical  Corps  ready  for 
instant  service. 

A  second  reflection  is  that,  subject  of  course  to  impera- 
tive military  requirements,  medical  officers  should  have  sub- 
stantial control  over  sanitary  matters,  such  as  camping  places, 
latrines,  water  supply,  &c.  These  are  often  vital  to  the  effi- 
ciency of  an  army.  Our  later  experience  in  the  Spanish- 
American  War  and  by  contrast  the  extraordinary  results 
which  have  been  obtained  by  the  Japanese  methods  reinforce 
this  suggestion  in  a  most  striking  way. 

The  last  reflection  is  that  those  who  made  such  a  fearful 
outcry  as  to  the  sufferings  of  our  soldiers  in  the  Spanish- 
American  War,  though  justified  to  some  extent,  did  not 
know  what  suffering  was  as  experienced  during  the  Civil 
War. 

When  a  battle  occurs,  the  survivors  of  the  regiment  must 
march  away  with  the  army  and  some  of  their  surgeons  must 
go  with  them.  When,  therefore,  tens  of  thousands  of  men 
are  wounded  in  a  day  or  two  the  number  of  surgeons  avail- 
able is  totally  inadequate  for  the  sudden  emergency.  It  is 
absolutely  unavoidable,  no  matter  what  progress  is  made 
in  the  scientific  treatment  of  wounds  by  first-aid  packages 
and  other  devices,  or  in  methods  of  transportation,  that 
men,  especially  those  of  the  defeated  army,  must  often  lie 
on  the  battlefield  one,  two,  three,  or  more  days  before  they 
can  possibly  be  attended  to.  The  horrible  suffering  this 
entails  is  part  of  the  grim  penalty  of  war..  Those  of  us  who 
went  through  the  Civil  War  are  the  most  anxious  to  avoid 
another  war.  Only  a  righteous  and  noble  cause  can  justify 
such  sacrifices  and  suffering.* 

*See  an  excellent  paper  by  McCaw,  Jl.  Assoc.  Military  Surgeons, 
May,  1905,  p.  334. 


29 


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