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Full text of "Addresses and other papers"

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 an d 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 hah 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:( t iT'f \ r in itn tcn'.v 




Portrait of Frederic Ruvwcli. 



\ ?fs SONIO~\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 
w T holly 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 ADDRESSES g 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 Molire 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 part i a l paralysis of the 
area shows the location of the i, -i f .-, f j i, 

abscess producing pressure n S ht 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 ih 1 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 : 

/^ 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 j r et 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-daj r , 
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 w r hich 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. k B. 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. 



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