o
o
GIFT
OF
UNITED STATES NAVAL MEDICAL SCHOOL
WASHINGTON, D. C
Addresses Delivered at the
Closing Exercises
(FOURTEENTH SESSION: APRIL 12, 1916)
BY
MEDICAL DIRECTOR JAMES D. GATEWOOD, U. S. N.
PRESIDENT OF THE SCHOOL
THE HONORABLE JOSEPHUS DANIELS
SECRETARY OF THE NAVY
SURGEON GENERAL WILLIAM C. BRAISTED
UNITED STATES NAVY
AND
HUBERT A. ROYSTER, M. D.
RALEIGH, N. C.
COMMENCEMENT ADDRESS:
The Humanity of Surgery
ff OF THE
; U N 1 V E K 3 I T Y
WASHINGTON ^r-
GOVERNMENT PRINTING OFFICE ^SstZ- I F ' "> R
1916
UNITED STATES NAVAL MEDICAL SCHOOL
WASHINGTON, D. C.
Addresses Delivered at the
Closing Exercises
(FOURTEENTH SESSION: APRIL 12, 1916 )
BY
MEDICAL DIRECTOR JAMES D. GATEWOOD, U. S. N.
[PRESIDENT OF THE SCHOOL
THE HONORABLE JOSEPHUS DANIELS
SECRETARY OF THE NAVY
SURGEON GENERAL WILLIAM C. BRAISTED
UNITED STATES NAVY
AND
HUBERT A. ROYSTER, M. D.
RALEIGH, N. C.
COMMENCEMENT ADDRESS:
The Humanity of Surgery
WASHINGTON
GOVERNMENT PRINTING OFFICE
1916
366836
PROGRAM.
Invocation, by Chaplain G. L. Bayard, United States Navy.
Address of welcome, by Medical Director J. D. Gatewood, United'States Navy.
Presentation of diplomas, by the Secretary of the Navy.
Address, by the Secretary of the Navy.
Address, by Surg. Gen. W. C. Braisted, United States Navy.
Commencement address, "The Humanity of Surgery," by Hubert A. Royster, M. D.
Benediction, by Chaplain G. L. Bayard, United States Navy.
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GRADUATING CLASS.
Asst. Surg. John Harper, Medical Keserve Corps, United States Navy.
Asst. Surg. Richard H. Miller, Medical Reserve Corps, United States
Navy.
Asst. Surg. Paul Richmond, Jr., Medical Reserve Corps, United States
Navy.
Asst. Surg. Forrest M. Harrison, Medical Reserve Corps, United
States Navy.
Asst. Surg. Lawrence F. Drumm, Medical Reserve Corps, United
States Navy.
Asst. Surg. George W. Taylor, Medical Reserve Corps, United States
Navy.
Asst. Surg. Walter A. Vogelsang, Medical Reserve Corps, United
States Navy.
Asst. Surg. Elphege A. M. Gendreau, Medical Reserve Corps, United
States Navy.
Asst. Surg. Grover C. Wilson, Medical Reserve Corps, United States
Navy.
Asst. Surg. Russell J. Trout, Medical Reserve Corps, United States
Navy.
Asst. Surg. Virgil H. Carson, Medical Reserve Corps, United States
Navy.
(4)
CLOSING EXERCISES.
ADDRESS OF MEDICAL DIRECTOR JAMES D. GATEWOOD, UNITED
STATES NAVY,
President of the School.
LADIES AND GENTLEMEN : It happens to be my privilege, as well as
duty, to say a few words here.
You know this is a situation that recurs. Each year there is an
audience composed of interested, heartening, and welcome witnesses ;
there is a class made up of those who have met the school require-
ments; and there are certain exercises that include the bestowing
upon each class member of a certificate showing his successful work.
But this situation dissolves. It is preliminary to the departure
of each of the central figures, of each member of the class. They all
go out to sea, starting voyages of great length and in many directions.
Now this reminds one, as a mere simile, of a number of vessels
dropping downstream at the same time and going out to sea. You
have stood on the sands and watched them and you have noted that
as each gets into deep water it proceeds on its own predetermined
course, but that, whatever the course, it is always toward the horizon.
To you, standing on the sands, each vessel attains the horizon and
disappears in its mists. But from the point of view of those on the
vessel the horizon is never reached, the great inverted bowl of the
sky ever hanging directly overhead, with rim touching the sea just so
many miles away.
Perhaps in this can be found some reminder of different types of
men of men varying in their attitudes toward life. We live by our
visions, and the ambitious, venturesome, or progressive, using the
light of imagination or guided by reason and judgment, discern dim
objects on the horizon of the sea of life toward which they feel
impelled to move. But lo! when they satisfy those desires, when
they find something greatly coveted, the horizon is still as far away
as ever, and other shapes are looming there calling to restless minds.
But the onlooker, the man of routine, does not seem to struggle,
does not seem to travel, as his horizon is ever the same. His general
view of life does not vary. He sees many pass by, and he also notes
many wrecks in his time. He studies his vicinity, he goes over and
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over the same course day after day. He does things in the same way,
and numerous harbors of refuge are always near at hand. Each
situation has a precedent, and he steers by it. He does not own the
routine; the routine owns him. And he is apt to have a kind of
blindness, a limitation of the field of vision.
Yet I do not wish to be understood as talking against routine and
against system. Each life becomes quite valueless without them.
But they ought to be owned, they ought to be appropriated as a
means. They cause too great limitations, they stifle the imagination,
and they kill originality of thought when they are the owners and not
the slaves of men.
Now, the central idea of all this is travel. We speak of life's voyage,
of the sea of life, of man's walk in life, and of the race of life in which
one man passes another. We think of the faces of those whom we
have loved, admired, and respected but who are no longer with us;
and we feel that they have gone on before. We thus unconsciously
recognize that we are all travelers, all moving toward the bourne
from which no traveler returns.
Thus the question arises as to what traveling is. Certainly it is
not a mere matter of transportation. Under that idea a trunk could
be made to travel with the assistance of a baggage check.
In fact, man travels by his mind. The shoemaker, as he passes
the thread or hammers in the peg, revisits his home in southern Italy.
The writer or student of history sees the temples of Egypt or walks
the streets of ancient Greece, or, sitting in the Colosseum, hears the
Jidbct of the Roman populace in the days of the Caesars. The poet
wanders through the hearts of men and lifts their faces to the stars.
And the writer of romance accompanies you through the intricacies
of plot, carries you into his world, and introduces you to his people.
A man travels by his mind.
Futhermore, the member of the human race who puts forward
something of continuing importance to mankind lives and travels
forever with those he has benefited. The cablegram you receive
has traveled thousands of miles along the ocean bed and carried to
you something of the mind of Morse. The wireless sending its im-
pulses through the ether also sends through space something of the
mind of Marconi. Each day thousands of miles of telephone wire
carry countless messages that depend for transportation upon some-
thing that has come to us through the mind of Bell and others. And
each night as the great ship pushes its way through the waters
there is something there of the mind of Fulton and a host of others
strangers to us, many of them, but travelers are often strangers in
strange surroundings.
And there is a science and art of traveling as truly worth culti-
vating as the science and art of medicine or the science and art of
surgery. There is a spirit of patient observation to be cultivated,
an understanding of the feelings of others through which one's own
selfishness lessens. Even hi our own homes we are all travelers
the place where it too often happens that we know one another so
well that we do not know one another at all.
And now you, members of this class, central figures on this occa-
sion, are about to begin your travels in the Navy. Are you thinking
of a ship merely as a means of transportation from one port to
another, from one seacoast city to another ? I tell you that a man
travels by his mind and that it is about the ship you must travel.
Your travel on the ship is merely incidental. You must study
your ship from bow to stern, from upper deck to keel. You must
know bilges, holds, and storerooms. And you must consider long
and carefully 'the living quarters. Are they well ventilated under
all conditions, are they clean, are they well lighted, are they suitable
habitations for men? Is anything wrong, and, if so, what can be
done? You must know the water supply, literally know it all the
time. You must even know the character of paint in composition
and color employed within the ship, for there are relations to the
health of crews. There are innumerable things, here, there, and
everywhere within the ship that should make constant appeal to
the trained mind. You must know everything a good traveler
should know, and this includes, in your case, not only the care of
sick and injured, and preparation for battle, but also, and primarily,
the prevention of sickness, the preservation of the health of men.
And shall you not all be travelers together? In the wardroom
you will rub elbows with a number. Will you really know them?
Will you see the strength as well as the weakness ? Will you know
that men can not be judged by their weakesses but rather by their
power to lift their heads above others in time of stress and peril?
I warn you to be good travelers, to study the personnel, to cultivate
the spirit of the Navy, the love of duty that is stronger than the
love of life.
Will you play the game earnestly and as a very part of it ? Will
you cultivate, truly cultivate, the art of traveling the spirit of
patient and unselfish observation ? I ask you because your careers
will be watched with great interest. Word will come back here
where you start. Will it be a good voyage you are about to make ?
A man travels by his mind.
4142916 2
ADDEESS OF THE HONORABLE JOSEPHTTS DANIELS,
Secretary of the Navy.
It gives me great pleasure to welcome you into the Navy. Two
years ago, when I had the privilege of welcoming the graduating class,
I undertook in a brief address to invite the attention of the young
surgeons coming into this high profession to the career of that gre;it
Scotch doctor, William MacLure, and I should be glad if all you
young men would make the spirit of Ian MacLaren's hero your
emulation. Last year I invited your attention to the life story of
Dr. Amboyne, the hero of an older but equally great novel, Charles
Reade's "Put Yourself in His Place," of whom his patients said:
"Talking with you, doctor, is like drinking sunshine." I would like
to-day to call your attention to a distinguished physician, a literary
master, not the product of the brain of a great novelist, but a man
of flesh and blood, who, beginning his profession in London, arose
to the highest eminence and did what so few doctors have done
left behind him a memorial of his life work, "The Diary of a Late
Physician." This great man went to London and for years fought
his way to practice, and after he had been in the profession for years
had the honor of making $200 a year and a small additional amount
by writing. And yet in his philosophy and in his life he held up a
very high ideal before your profession. While his Diary must have
been suggestive and inspirational to the professional men of his day,
its chief value lies in the spirit of sympathy which pervades the
recital of each case described. The introduction contains these words :
The bar, the church, the Army, the Navy, and the stage have all of them spread
the volumes of their secret history before the prying gaze of the public, while that
of the medical profession has remained hitherto, with scarcely an exception, a sealed
book. And yet there are no members of society whose pursuits lead them to listen
more frequently to what has been exquisitely termed, "The still, sad music of
humanity."
No doubt it was the bitterness and hardship of the early struggle
for success which helped to beget in the heart of this physician the
tenderness and kindliness which characterized the practice of his
profession throughout his long and useful life.
In his paper entitled "Cancer," Dr. Warren draws a fine picture
of the strength of weakness as exemplified hi the endurance of a
young mother of about 27 years of age whose husband, a captain
in the incomparable navy of Great Britain, was far away engaged
in his country's service. The description of the operation for cancer,
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located on the face and from which the vi6tim suffered great pain,
is interesting in the light of present-day appliances and efficiency.
As this beautiful woman came into the room in her residence where
the operation was to be performed, this sympathetic doctor de-
clares that his heart ached, and goes on to say: "A decanter of port
wine and some glasses were placed on a small table near the win-
dow." This was the anesthetic. The number of glasses indicated
that the wine was to do double duty to strengthen the patient for
the operation and to nerve the distinguished surgeon, whom Dr.
Warren had called in to use the knife, for his difficult task. The
subject of the operation barely touched the glass with her lips, and
then implored the physician to hold before her eyes the envelope
of a letter which she had just received from her absent husband
and which she declared was all that would be necessary to nerve
her for the ordeal, and this Dr. Warren did while the surgeon used
the knife. Then the Diary continues:
"'I am prepared/ said she, and sat down in the chair that was
placed for her. One of the attendants removed the shawl from her
shoulders * * *. She then suffered Sir to place her on
the corner side of the chair, with her left arm thrown over the back
of it, and her face looking over her left shoulder. She gave me her
right hand ; and, with my left, I endeavored to hold Capt. S 's
letter, as she had desired. She smiled sweetly, as if to assure me
of her fortitude; and there was something so indescribably affecting
in the expression of her full blue eyes, that it almost broke my
heart * * *. Sir - , now, with a calm eye and a steady
hand, commenced the operation. At the instant of the first incision,
her whole frame quivered with a convulsive shudder, and her cheeks
became ashy pale. I prayed inwardly that she might faint, so that
the earlier stage of the operation might be got over while she was
in a state of insensibiliy. It was not the case, however her eyes
continued riveted on the beloved handwriting of her husband;
and she moved not a limb, nor uttered more than an occasional
sigh, during the whole of the protracted and painful operation.
When the last bandage had been applied, she whispered almost
inarticulately, 'Is it all over, doctor ? ' '
The patient was then lifted by the physician and the surgeon, and
carried, sitting in the chair, up to her bed, whereupon she instantly
swooned, "and continued so long insensible that Sir - held
a looking glass over her mouth and nostrils, apprehensive that the
vital energies had at last sunk under the terrible struggle. She
recovered, however, and under the influence of an opiate draught,
slept for several hours. The operation resulted in permanent cure
and the account of this operation, of about just 100 years ago, and
which, by way of contrast with what you young gentlemen are
10
accustomed to in the way of surgical facilities, must be interesting
to you, ends with a statement which the patient made to Dr. Warren
just before he discharged her from his care. As a faint crimson
mantled her cheek, she expressed regret over the personal disfigure-
ment she had suffered, but added falteringly after a pause, "I think
Capt. S - (meaning her husband) will love me yet."
This single illustration from the diary serves to show that there
was carried about by this man something of light and cheer and help,
because he recognized what the world needed more than anything
else was human sympathy. Sympathy is needed on shipboard, where
men are away from the restraints of home influence. You come into
a profession of noble traditions. You come into a service where you
are not compelled to wait for patients. Samuel Warren waited a
fourth of his life for an opportunity to secure them. This month
there will graduate in America hundreds of young men who will go
into the practice of medicine, and the first thing they will ask them-
selves when they get their diplomas is, " Where will I practice and
where will I find patients?" and many of them, skilled and learned as
they are, must perforce undergo a long waiting period before the
opportunity to distinguish themselves will come. You are entering
a department of service where there is no waiting period. Your
diploma to-day gives you a title, an office, a clientele, patients
selected out of the best in all America, for the Navy is the process of
elimination as in no other service in the world. It is a selected serv-
ice. Among every six men who apply to come into the enlisted
ranks we accepted only one, the other five having failed. The Naval
Academy would be fortunate if 70 per cent of the young men who got
appointments were able to enter, and the process goes on year by
year throughout the whole life of the men in the Navy. I heard a
captain say not long ago that he was being "pawed over all his life,
examined, tested, and thumped, to find out whether he was mentally,
morally, and physically fit." It is for you to say, therefore, whether
the Navy shall be fit and strong, because no man can enter unless you
pronounce him qualified. It is your duty to stand at the door of the
Navy and say only the fittest survive, and bring into the service
young men of character and physical excellence, and when they come
in it is your business to keep them well and strong. In the olden
days of the practice of medicine, we employed a physician if we were
sick to make us well; that was an ancient theory. In the Navy now
we employ physicians to keep the Navy well. We are learning the
importance and power of prevention.
When you go on the ship, you will be the physician, the friend, the
associate, of these selected men, and while the captain of that ship
will say the last word, you will have the supreme influence in the
11
lives of the young men if, along with your skill, you have human
sympathy and the touch of kindness for the homesick lad.
You are coming into the Navy at the tune of its greatest expansion
and on the threshold of an efficiency never before known. Sixty
thousand men look to you to keep them ready, and you have learned
enough to know that men can not be made ready instantly. Michael
Dorizas, the Greek athlete and undefeated wrestler of the University
of Pennsylvania, asked when he made his special preparation for his
bouts, replied : " I never prepare ; I am always ready. " The man who
has to get ready is the man who is never ready. Those were inspiring
words of Admiral Badger when the Navy was ordered to Vera Cruz.
Within 48 hours that majestic fleet, fully equipped, was on its way,
with our present Surgeon General as fleet surgeon. He had no orders
except to go to Vera Cruz. When asked what he was going to do, he
said: "I do not know what we may be called upon to do, but we are
ready."
In most professions there is a glamor and a glory to men who win
its highest rewards. You are coming into a profession in which you
will not stand in the forum when you fight your great battles. Sen-
ators and advocates and admirals and generals have an inspiration
from the applause of the men about them. You will win your con-
flicts in the still watches of the night, ministering to the humble
sailor, whose mother, far off, loves him as your mother loves you;
and you will come through conflicts and victories that will give you
a sweetness and a strength that never came to those who had the ear
of listening senates. I was glad to read some tune ago that the State
of Georgia had determined to put in Statuary Hall, in the Nation's
Capitol, where every State may place the figure of two of its greatest
men, the statue of Dr. Long, the first surgeon to use an anesthetic.
I hope we will see the day when other States will recognize that it is
the physician as well as the general, that it is the surgeon in the sick
bay as well as the admiral on the bridge, who deserves the highest
recognition and rewards from a grateful Republic. But you will get
these rewards only if you touch the hearts of your fellows.
I am not going to speak to you about progress in your profession.
Dr. Gatewood, who is the head of this institution, who inspired you
in the days of your preparation here and whose ideals are that we
shall take into the Navy no man who has not shown himself qualified
in character and capacity, has done this. The average layman thinks
medicine is a dry subject. President Wilson once told a doubting
pupil at Princeton that there was no such thing as a dry subject;
that the only thing that was dry was the mind it came in contact
with, and if that mind perceived the significance of the subject, it
yielded all the sap that was necessary for the most intense interest.
You must bring that enthusiasm aboard ship. The chaplain here
12
and men of his calling who are devoting their lives to preaching the
gospel can not do all that you can do because there is something
about young men which yields to the advice of a physician when
they close their hearts even to ministers. It is because they recog-
nize your work is based not only upon spiritual welfare but physical.
Three of the greatest contributions that have been made in recent
years to the literature of your profession were made by naval officers.
During the Russo-Japanese War your distinguished surgeon general,
Dr. Braisted, was sent to study conditions in the Japanese fleet and
Dr. Spear in that of the Russians. They wrote reports which you
should read and which have helped doctors in all the countries en-
gaged in the European struggles, and only this year Dr. Fauntleroy
made a study of conditions in Europe that is illuminating and
invaluable.
I trust that as you enter upon your careers you will catch the
spirit of Samuel Warren who wrote about his profession and made
the world see its nobility and that you will write like Braisted, Spear,
and Fauntleroy.
I am glad to see Dr. Rixey here, under whose administration the
Medical Corps of the Navy made giant strides.
When the Saviour was upon the earth, men called Him by many
titles King, Master, Teacher, Lord, and Brother but we love best
of all to call Him the Great Physician; and I think it is His highest
title and that which brings us nearer to Him. In His day people
were healed by the touch of His hand and even by touching the
hem of His garment. He has gone from the earth and we do not
have His divine-human touch to-day, but there is something akin
to it in the love of fellow man which you will exhibit and in your
helpfulness of men to clean living and clean thinking. The faith they
have in you will win half the battle, for they will have the faith that
you can heal them by even the touch upon the friendly hem of your
skill and experience. It is this ideal I would present to you young
gentlemen who have come into this profession, and if you will live up
to it, as I am sure you will, and follow in the steps of other strong
men of the Navy who give their lives to healing, when you come to
the time of retirement you may look bagk on your lives with satis-
faction, and when you come to that final hour may say truly, as
Jeanie Deans said: "When the hour of death comes, that comes to
hi^h and low, then it isna vrhat we hae dune for oursells but what we
o *
hae dune for ithers that we think on maist pleasantly."
ADDRESS OF STTSG. GEN. W. C. BBAISTED, UNITED STATES NAVY.
Gentlemen, it is always with a feeling of the deepest obligation,
and, if I may say it without misinterpretation, noblesse oblige, that
I have risen to address this class and its predecessors on the occasion
of the graduation from the Naval Medical School. I have been
through what you are going through, I have trod the many steps
that lie ahead of you, and if my experience in the service, my pleas-
ures and my sorrows, my hopes and ambitions, my regrets and dis-
appointments if these, I say, can in any way be offered to you as
a guide and mentor in your coming life work, I want to offer them
freely. We all know as we grow older that youth profits but little
from the advice of age ; it is a sign of the latter when the realization
is borne in upon us that millions and millions have passed along the
same road over which we have been deviously toiling, and it is only
given to the young to idealize the future. We all have at some time
sought the rainbow and the pot of gold, as have those of countless
ages before us. Despite the proverbial impossibility, let us hope
that many have reached their rainbow, and in poverty or in wealth,
in restless energy or placid seclusion, attained their share of happi-
ness and contributed their mite to the fund of human good and
advancement.
You are this day, gentlemen, upon the threshold of a career in
life. Your life work and your rewards are mapped out for you with
a degree of accuracy and certainty that is generally impossible on
graduation from the usual professional course. It is therefore easier
to provide helping tenets or guide posts for that path that lies before
you.
First of all, I regard as essential your own appreciation of your
future its permanency, its possibilities, what you owe to it, and
what opportunities are afforded you to prove your right to exist
therein and to discharge that obligation to the world at large that
is the duty and inheritance of every living being. Crystallize fixed
ideas of ambition; you will find that perseverance, pertinacity, appli-
cation, pursuance of laudable ideals, will attain their object with a
facility attributable both to the excellence of the individual and the
aid afforded by conditions where all are more or less working for a
common good.
We are in a way a small community living within walled bounda-
ries, an advanced fortress protecting the public weal. We have our
(13)
14
own courts, our own system of supply and subsistence, our own
rules and regulations, and of this community of some 68,000, you
and I and our colleagues in the corps are the sole guardians of the
public and individual health. You are one among 347. It should
be your aim to make those other 346, and the rest of that 68,000,
realize that you mean business. You already have a name in the
corps. By your personality, by your activities, your fellow officers
will soon be classing you as a drifter or as a worker. Service repu-
tations once established are, justly or not, often the permanent
indices of a man's ability or desirability. And you will find that a
good name is easily acquired, a poor one difficult of erasure. Com-
mand the respect of your fellow officer? and of your future patients.
Establish the foundations of a good name early, and the later main-
tenance of it is easy. Competition for preeminence offers far greater
rewards for success than the same energy expended in private prac-
tice, where you are one struggling among 150,000 others. Merit is
more easily recognized, and recognition of this by your fellow officers
gives in the end reward ample in itself, in the lasting consciousness
of their admiration, respect, and esteem. Material rewards to excel-
lence and mediocrity may seem at times to be the same, but this is
not so, as shown in the passage of years hi the value of the posi-
tions assigned, and the opportunities afforded the worker for ex-
ploitation of his talents. Be altruistic with your time and labors.
Subserve self to loyalty to service and to country. The common
good is your aim. Your increased efforts are not rewarded finan-
cially more than those of your slothful shipmate. You are not
battling for pelf let us hope the ethics and higher ideals of the
medical profession make this a rarity your living is not haunted
by the specter of the wolf that may be behind the door hi days of
sickness and reverse. Therefore, all the more is your time available
for thoughts and actions for the bettering of the conditions of the
personnel under your charge, or for scientific research or study.
And in the formative state you are now in, your earliest steps should
take you into the path that tends ever upward in ideals and profi-
ciency. Realize constantly that it is to-day that counts. Idleness
and lethargy, industry and initiative, the spirit of "just enough,"
the spirit of "never enough" choose between them.
The process of selection and elimination has long ago started with
each one of you, and you represent the survival of the fittest. Of
those that matriculated with you at your university or medical
school, many have fallen by the wayside. Your emergence from
that ordeal alone, with the coveted diploma, is in itself a creditable
achievement. In preparation for the formation of this class, 57 appli-
cants received permission to appear for examination. You eleven
represent a 20 per cent survival of that 57. You have found during
15
your six months here that selection is still potent, and the price of
application, of early training or aptitude, of hereditary or acquired
ability, is paid more promptly than you will often find, in the deter-
mination of your service rank by your school standing.
For you, gentlemen, the future holds all variety in service duties
and opportunities. You will see the four corners of the earth; you
will be operating surgeons, executives, and commanding officers of
magnificent hospitals and hospital ships ; you will be the only attend-
ant by some poor aborigine in childbed I do not dare to say of any
question that may by the wildest flight of imagination impinge upon
the boundaries of your profession, that you may not be called upon
some day momentously to decide it. You must be adept in all
things, alert in all ways in the practice of your profession, in adding
to your knowledge of it, and in keeping pace with current advance
therein. The independence of isolated stations makes it necessary
that the naval medical officer be a specialist in all things relating to
medicine in the widest application of the word.
To the average young man surgery seems to offer the most
attractive field in planning his life work. It is in many ways the
most spectacular and to the imagination the most romantic. You
will find that the gratification of this ambition will occur in your naval
duties with a much greater certainty than in private practice, where
it is achieved only after years of struggle for the opportunity to
demonstrate your ability, or by the most exceptional occurrence of
an early assignment as member of some hospital visiting staff. Your
entrance examinations into this service and our knowledge of you
since have demonstrated to us that you are each of you qualified to
shoulder such responsibilities to the credit of yourselves and the
corps. In the capacity of junior you will find that your seniors will
be most liberal in affording you material and opportunities. The
specialty of surgery is, however, the most crowded for those very
reasons, and there are many other valuable directions that may
better call for specialized exercise of your activities. For although
I am insisting always that you can not remain a specialist within the
usually accepted meaning of that term, that is, to the extent of
losing intimate touch with other branches of your profession to the
benefit of your particular work, this by no means precludes the fol-
lowing of a particular line of endeavor, provided your state of general
preparedness does not suffer thereby. The Navy constantly has need
of specialized activities, and the man with special knowledge, the man
who has by inheritance or by application something that his neigh-
bors have not, will inevitably be turned to in time of need. Pre-
paredness or unpreparedness, familiar terms to-day, mean as much
to you and your future as they do to the life of our Nation. For the
distinction of special effort or special place your preparedness must
16
make itself known; do not hide your light under a bushel. Let us
all know to whom we can turn for an investigation on this subject, a
report on that, who is a particularly good laboratory man, clinician,
hygienist, alienist, aurist, oculist, roentgenologist, etc.
The current number of our Naval Medical Bulletin, April, 1916,
affords an interesting elucidation of this theme. Seven of the nine
special articles, all emanating from the pens of members of your
own corps, relate to subjects and activities concerning which your
training up to the present time has told you little or nothing.
"The occupational distribution of physical disability" represents the
viewpoint of and lessons learned by the industrial student and
economist; "The exclusion of the mentally unfit from the military
services," points out your duties from the alienist's standpoint in
conserving the health and morale of our personnel; "A greater field
of activity for medical officers of navy yards" is a resumS of unusual
ideals and activities not only projected but achieved; "The hospital
steward" and "The new hospital corps forms" pertain to your share
in supervision of the Hospital Corps; "Studies pertaining to light on
shipboard" is a representation of the most advanced work and
thought on illumination under working conditions aboard our modern
battleships; and "Fumigation of the U. S. S. Tennessee by the cyanid
method" tells its own story.
It is as a result of their own industry, application, research, that these
officers can contribute to the general good these data on economics,
recruiting, navy-yard duty, executive details, lighting problems, etc.,
and by their efforts have accentuated their own value to the corps
and the corps value to the service at large.
I have but touched on the possibilities. Our special hospital for
the tubercular; the tropical medicine opened up by our Philippine
possessions; the many naval hygienic problems as regards food,
light, air, clothing, water supply, submarine life, diving, quarantine,
etc.; specialized work at the Naval Academy hi athletics; our pa-
ternalism at Guam and Samoa, with responsibilities innumerable
these all represent activities and possibilities that depend but upon
your own initiative to achieve distinction and place in universal
admiration and regard.
In so far as is consonant with routine service needs and possibili-
ties I am always glad and willing to assist in the gratification of such
ideals. You will always find that the bureau has only the public
good in mind and that the only favorite that is played is ability.
An equalization of duties, undue favors to none, broadening oppor-
tunities to all, these are, of course, what we constantly strive for as
helping the individual in preparation for the many-sided service life
and as supplying to the needs of that service prepared and resource-
ful officers.
17
And now what is your personal standard of life and morals in the
new relations into which you are now entering? There is an old
conjunction of the words "an officer and a gentleman," which, I
hope, will always be to you more than a mere cant phrase, or care-
lessly accepted fact. To be a gentleman, kind, manly, courteous,
upright, is what we all owe to our position in this great crowded com-
munity, the world, where we are constantly elbowing our way up
or down the surging path of life. And in this new life and among
these new surroundings and responsibilities, where your life and
actions are more arbitrarily fixed than in that larger community,
still more so will you find it necessary to observe these tenets. Make
your lives sober and dignified. Make it a subconscious spur with you
constantly that you acquire and keep the respect of your fellow offi-
cers and of the enlisted men. It is well to be liked by your ship-
mates, but to be respected personally and professionally is what is
more difficult of achievement, but more lasting in effects.
The "hail-fellow-well-met," the ever-welcome "rounder," the
"good fellow," is generally likeable or even lovable, and his name or
his stories or his exploits may be hailed with glee and his assignment
to a mess welcomed with joy, but in time of illness or of stress
it is probable that this type will not be as freely granted the confi-
dence that the more serious-minded student would receive. Your
lives will have little hidden from the close association of wardroom
contact, and at one time or another you will be called upon to attend
these intimates in times to them of greatest stress or danger, either
to themselves, or their wives, their mothers, or their chidren, and in
the trust and faith these show in your personal and professional
integrity will be your greatest reward.
It may not be amiss at this point, the closing of the year's work in
the Medical Department, to review for your information the progress
we have made in the past two years hi our work. Last year and the
year before, in retrospect, I paid due tribute to the efforts of Surg.
Gen. Kixey and others in the work or reorganization and rehabilita-
tion of the Medical Department of the Navy, stating that no one
man ever had accomplished more or probably would accomplish more
hi this respect than Admiral Rixey. During the past two years, the
present Secretary of the Navy, in many instances on his own sugges-
tion and hi others by his support of the Bureau of Medicine and Sur-
gery, has advanced our service in the following items:
1. He has recommended to Congress the increase of the Medical
Corps from 347 to nearly 500, the first increase in 20 years, and most
urgently needed.
2. He has provided in his personnel bill a substantial increase in
the upper grades of the Medical Corps. No increase in these grades
18
has been made since 1870, notwithstanding the tremendous growth
of the service as a whole.
3. He has established two of the finest Hospital Corps Training
Schools in the world for the training of male nurses, and made pro-
vision for the increase in this corps by nearly 1,000 men, an increase
urgently demanded by the increase hi the Navy, and has also pro-
vided a possible chance for members of this corps to reach commis-
sioned rank, thereby raising the efficiency and esprit of nearly 2,000
enlisted men in the Hospital Corps of the Navy.
4. He has made provision for a new hospital ship for the Navy,
which will enable us to build the first ship of this kind, designed
especially for this purpose, and which will be a model for our country
and the world. This one effort will, if granted by Congress, be of
inestimable value to the Navy and to all other countries. It will
provide our fleet and our service with a floating hospital for the care
of the sick and injured of the Navy that will rival any metropolitan
hospital in existence.
5. He has established schools for the training of the native women
of Samoa and Guam in nursing, that already are giving most excellent
results and are a most important humanitarian educational effort for
these helpless people, promising, when completed, to be one of the
noblest efforts made for the uplifting of any similar class of people.
6. He has increased our appropriations to meet our necessities and
to enable us to carry on our great work that extends not alone to the
Navy proper, but to thousands of human beings attached to the ser-
vice in various ways and extending to all parts of the world.
7. He has permitted us to take an active part in the regeneration
of Haiti by furnishing medical officers and nurses to care for the sani-
tary needs of the great work that is now in progress in Haiti and
which ranks with one of our greatest humanitarian efforts.
8. He has supplied already, and gradually will furnish our defici-
encies in the many large hospital and medical organizations on shore,
such as contagious units at Mare Island, Puget Sound, New York,
and Newport, and has furnished adequate and commodious homes
for our nurses at Mare Island and Boston, thus adding to the content
and efficiency of the women nurses. South of Norfolk and San Fran-
cisco our coast line is practically unprovided with hospitals for
peace and war, but with a policy defining permanent naval stations
his attention has already been turned to the needs of the medical
department. That we may not be unprovided in this respect hi emer-
gency; he has authorized our efforts with the Red Cross and we are
now beginning the organization of five Red Cross hospital units
(mobile hospitals of 250 beds each, with personnel and equipment
complete) that can be called at notice to any point of this coast line
where needed.
19
9. He has authorized a Medical Reserve Corps of the best medical
talent that our country can furnish, to be ready to come to our
assistance in tune of need, and to prepare this group of the Medical
Corps he is initiating a correspondence school that shall give these
officers a training and working knowledge of their work when called
upon. Realizing the great lesson to be learned from the present
European war, he has detailed a number of our best officers for
duty in Europe as observers, and the excellent results already show
in the report of Surg. Fauntleroy, whose work has added greatly
to the professional knowledge of all who are interested in medico-
military matters and is a credit to our service.
10. The above are only a few examples showing the interest and
activity of our secretary in this branch of the service. Did tune per-
mit I should like to continue in detail to show you his interest and
help as shown in innumerable questions of sanitation and organiza-
tion which makes the work of the Medical Department of the Navy
one of the most important branches of the service. Our work is
most highly specialized, dealing as it does with so many questions,
not alone with the healing of disease but with all that pertains to
the orderly and successful running of this great department of the
Government. The work of the Bureau of Medicine and Surgery
touches ultimately that of every other bureau in the department
and makes us one of the busiest and most active corps.
I have frequently asked myself how is it that the head of the Navy
is so sanely interested in our work, and seems to comprehend our
needs often before they are presented to him, and I think the solution
lies in the fact of his education along medical lines. This comes, I
feel sure, from the association with medical men of great worth and
ability. Where has he had this association that has taught him the
importance of medical work in the welfare of the nation '? From all
I can learn, it has come from the intimate friendship and association
of his family medical advisers, one of whom has honored us by his
presence here to-day, and to them I feel we owe and the nation owes
a deep debt of gratitude for the impress they have made on this one
man. How nobly and how splendidly have these medical men of
Raleigh stood sponsor for their profession. They have built better
than they knew and in this light I want to thank Dr. Royster and
his associates in Raleigh for the great benefits that have come in this
way to the Navy through them. Theirs is the credit, and I trust our
grateful appreciation is their reward.
In conclusion, gentlemen of the graduating class, I wish you every
success in your new life and trust, as the years go by, we shall have
only congratulations to give you for work well done.
ADDBESS OF HTTBEBT A. BOYSTEB, M. D.,
Raleigh, N. C.
"THE HUMANITY OF STJBGEBY."
At the first blush it would seem to be asking too much of a civil
surgeon to instruct, advise, or entertain the naval surgeon. Their
purposes, environment, and training lie in very different directions.
Yet they have, of course, a common interest. That interest is the
service of humanity. Upon that basis we can unite hi an attempt to
redress certain popular misconceptions of surgery, in a consideration
of some of those vital things which control us all hi the practice of
our art, and in an application of these, if possible, to the particular
affairs which constitute your own sphere of work.
In the early days surgeons were looked upon as mere mechanics.
In fact the derivation of the term surgery, or chirurgery, from two
Greek words, meaning "handwork," signifies its original application.
The surgeon was the barber and was regarded as of a lower order than
the physician, under whose guidance he acted. We have not yet
entirely outlived this impression, for even at the present day it is held
by some that it requires a higher degree of intellectual capacity and
a sounder judgment to be an eminent medical consultant than it does
to be a great surgeon. Moreover, the surgeon has been called a
"butcher"; it is said that he "loves to cut"; he is commonly spoken
of as one who "thinks no more of operating on human flesh than of
sawing on so much wood." Perhaps these criticisms are natural.
But let us ask ourselves if they are just. Have we endeavored to
counteract such impressions, or have we deserved the criticism ?
Who does not now know that the surgeon, besides bearing all the
burdens connected with operative technic, shares equally with the
physician the responsibilities of diagnosis and af tertreatment ? The
modern surgeon who is not skilled in clinical diagnosis fails to measure
up to the standard set by his advancing science. Further, the
surgeon who is lacking in general knowledge of disease and in the
use of remedies will never ripen into true greatness. This has been
well expressed by Ashhurst in these words: "The importance and
even necessity of a thorough knowledge of practical anatomy can,
indeed, scarcely be overrated; yet it is more essential for the surgeon
to be well versed in pathology and therapeutics (or hi other words,
to be an accomplished physician) than it is for him to know the
attachments of every muscle in the body, or all the possible variations
of arterial distribution."
(20)
21
Let no one suppose this is a plea for loose methods at the expense
of scientific surgery. It simply means the blending of mind and
hand, the joint partnership of judgment and action, with proper faith
in each. We can not leave out the human equation if we are to round
out a life of usefulness. We must be men before we are surgeons.
Character must be the foundation for skill; for what you are will
show in what you do. Is it true that in our rush of work we are
losing somewhat the human touch, the personal interest? No
matter how we shall answer this question, we can truthfully confess,
believe me, that the eminent surgeons of the generation just pre-
ceding us were men of great individual power, and that they deserved
more credit for the results they achieved than we do for the success
we have attained. They helped us to grow out of the mechanic
into the modern operator, to advance from the bonesetter to the
diagnostician. And they have left us much to emulate.
" We think our fathers fools, so wise we grow;
Our wiser sons, perhaps, will think us so."
One of the common misconceptions in regard to surgery is that
the knife is considered its symbol. That most dreaded of all instru-
ments is chosen to typify the whole surgical art, and such expressions
as "going under the knife," "nothing but the knife will do," or the
"horror of the knife," are frequently heard both from the laity and
from medical men. The truth is that the knife, while of course one
of the most important instruments, is really used less than are many
other instruments. A being of stern visage brandishing the scalpel
would not be a true picture of the surgeon; rather should he be
represented as one of calm countenance with a handful of hemostats
or a needle and thread instruments far less gruesome, but more
widely employed and requiring greater ingenuity in then- use. Besides,
there are many operations done wholly without the knife. The
singling out of this alarming implement as the popular embodiment
of surgery is but a sign of the fascination for most minds of the
terrifying and the dramatic. It smacks of the old days of the barber
surgeon.
The most satisfying thought to one in the practice of surgery is
the consciousness of having directly rescued or prolonged the lives
of one's fellow creatures. In no branch of the profession is the
relation of cause and effect so manifest or the personal responsi-
bility so obvious as in surgery. A patient under medical treatment
may be managed with consummate skill, may be carried over diffi-
culties and snatched from dangers, and yet so many factors enter
in as to preclude us from saying that any one dose turned the tide
or any one act alone produced the result. Not so with the surgical
case. In every operation a life is immediately at stake and the
operator himself is the accountable agent. The very risk is alluring
22
and, therefore, the gratification the greater. To remove a tumor,
which is slowly but surely killing the sufferer; to evacuate a pus
collection, breeding poison and death; to correct a deformity and
see the joy over the outcome; to ligate a bleeding vessel and thus
actually keep life's blood in the body no human feeling compares
with these sources of profound mental satisfaction, which are the
surgeon's daily heritage.
Those who practice surgery are either ennobled or degraded by it.
Their characters are developed and sweetened or else made coarse.
There is no halfway ground. Looked upon as so much slashing,
surgical operations do but brutalize those that perform them; viewed
hi the light of God-given occasions for exercising skill and healing
humanity, they are the means of uplifting and purifying. The
heroism often exhibited by patients can not but have its effect upon
the surgeon's character. Who can behold uninfluenced a calm
mental and moral attitude toward physical suffering? Who of us
has not seen the sufferer himself do his part as well as we did ours and
at times surpass us in courage? To have ministered to even one of
these is worth a lifetime of worry.
In the case of a well-poised surgeon this reflection upon the hu-
manity of his patient will detract in no wise from his own boldness
or self control. It should rather give him more sensible conscious-
ness of the right and a larger conception of his duty to do it. After
all, "nerve" may be defined as knowing what you are doing. An
operator who possesses that confidence born of upright judgment
and intimate knowledge feels at home under all conditions in which
he places himself. Mere assumption of bravery is a counterfeit;
recklessness is not "nerve." The renowned Valentine Mott in his
later days stepped into the amphitheater where one of his younger
colleagues was doing a herniotomy and saw the operator at one stroke
cut through the tissues down upon the sac. With a shudder the old
surgeon exclaimed, "Lord, save the man!" and walked away from
the table. Glancing back again after a few minutes, he remarked,
"He did."
Surgeons everywhere have been called upon to perform services of
the most heroic kind; and, be it said to their credit, they have been
found for the most part sufficient for their tasks. Even in civil life
examples are not lacking. My own state presents an instance of the
highest type in the person of Edmund Stmdwick, who by one deed
would have the title of hero. Not in all the annals of history have
I read of nor is it in my mind to conceive of firmer devotion to duty
or of more daring fortitude than he exhibited. When near sixty
years of age he was called to a distant county to perform an opera-
tion. Leaving on a 9 o'clock evening train, he arrived at his station
about midnight and was met by the physician who summoned him.
23
Together they got into a carriage and set out for the patient's home
six miles in the country. The night was dark and cold; the road,
was rough; the horse became frightened at some object, ran wild,
upset the carriage and threw the occupants out, stunning the country
doctor (who it was afterward learned was addicted to the opium
habit) and breaking Dr. Strudwick's leg just above the ankle. As
soon as he had sufficiently recovered, Dr. Strudwick called aloud,
but no one answered; and he then crawled to the side of the road
and sat with his back against a tree. In the meantime the other
physician, who had somehow managed to get into the carriage again,
drove to the patient's house, where for a time he could give no
account of himself or of his companion; but, coming out of his
stupor, he faintly remembered the occurrence and at once dis-
patched a messenger to the scene of the accident. Dr. Strudwick
was still leaning against the tree, calling now and then in the hope of
making some one hear, when the carriage came up about sunrise.
He got in, drove to the house, without allowing his own leg to be
dressed, and, sitting on the bed, operated upon the patient for
strangulated hernia with a successful result. "Greater love hath no
man than this."
The records of military surgery are so full of valorous deeds and
gallant sacrifices that it would be superfluous to point them out.
They are the rule rather than the exception. Your training here, I
am sure, has brought you to value the opportunities which may
come to you for proving your courage as well as your skill and your
humanity. Honored names are those which stand out on the list of
American naval surgeons, honored for their worth, their work, and
their wisdom. Examples are not wanting over the whole world to
demonstrate the important parts played by surgeons of various
navies in the history of their profession and of their country.
I can not refrain from mentioning Richard Wiseman, who exercised
so wide an influence over British military surgery in the seven-
teenth century. We are told 1 that, having finished his apprentice-
ship at the Barber Surgeons' Hall, he entered the Dutch naval
service, in which he soon saw active duty, for Holland was then at
war with Spain. His extensive experience prompted him to teach
that bullets should be extracted at once and that primary amputa-
tion was the best course to pursue in many cases, but by no means
in all. This is the good doctrine that he preached: "Consider well
the member and, if you have no probable hope of sanation, cut it
off quickly while the soldier is heated and in mettle. But if there
be hopes of cure, proceed rationally to a right and methodical healing
of such wounds; it being more to your credit to save one member
than to cut off many." And again, "Amongst the cruisers in private
1 British Journal of Surgery, January, 1916.
24
frigates from Dunkirk it was complained that their chirurgeons were
too active in amputating those fractured members. As in truth
there are such silly brothers, who will brag of the many they have
dismembered, and think that way to lie themselves into credit.
But they that truly understand amputation and their trade well
know how villainous a thing it is to glory in such work." What an
admirable tribute to the humanity of surgery! How nearly he
expresses what we feel to-day; that it is more blessed to save than
to destroy! From his own words we know that Wiseman did not
lay claim to great physical bravery, for he confesses that on one
occasion a "sudden cry that our ship was on fire put me in such dis-
order that I rather thought of saving myself than dressing my
patients." And later, while serving with the English army, he spoke
of making excuses to a wounded man so successfully that he "was
at liberty to fly from the enemy who was entered into the town."
We may not judge him too harshly until we disprove the relation of
discretion and valor or the connection between running away and
another day. On the deck and in the field, as in the operating room,
it sometimes required more courage to get out than it does to stay in.
No more appealing reflection can come to you than that of the
university of science. She speaks in every language, she dwells in
every land, she waits on every age. It has been written: "All that
is best in the great poets of all countries is not what is national
in them but what is universal." May we not make equal claim for
our own science and say the same for the great surgeons of the
world ? In the work which you have chosen you can not, you will
not, know friend or foe; with disease, destruction, and death all
around you, your concern will be for help and hope to all those under
your care. Patriots? Yes; but, above all, seekers for truth and
servants of humanity.
Even from its most unsatisfactory side, surgery must be looked
upon as a humane art, for its aid is usually invoked as a last
resort. When all other means have failed, it has been customary to
advise surgical interference, and relief must come, if it does come,
under most adverse and unpromising conditions. How much better
if surgery were made an early resort, if not a first resort, in cases
where it is surely demanded. Too late! the saddest expression in
our language. In surgery these words mean hopelessness and de-
spair. Operations done too soon are curiosities ; so rare in fact as to
be inconsiderable. Operations done too late are the popular reproach
of our art. All the merciful instincts of our nature demand that a
disease inevitably dependent upon surgical treatment be submitted
to such procedure at a time when the outlook will admit of a success-
ful issue and not temporized with until the last chance is passing
away. The disease must not be allowed to kill the patient before
25
the operation can save him. Keep it ever in mind that surgical
mortality is due chiefly to havoc wrought by the pathological changes
already present and only in comparatively rare instances to the opera-
tion itself. It is humane surgery, therefore, to act when a life can
be preserved and not to delay until it is placed in jeopardy. There
is such a thing as preventive surgery the high-water mark of all
our future efforts.
Let us feel, then, that in the practice of surgery there are situa-
tions calling for the exercise of a larger and deeper portion of humanity
than the surface markings seem to indicate. The keynote of sur-
gery is hopefulness, or, as expressed by another, " magnificent
optimism," and its devotees constantly exhale this spirit. It is
unjust to think of the surgeon as one who " loves to cut" at all
hazards and who cares not for consequences. The very essence of
our calling impels us to strive for permanence and perfection.
Humanity teaches us that it is an exalted privilege to relieve suf-
fering; it also bids us know that it is much nobler and more com-
passionate to cure the complaint. Surgery's mission is to heal, to
restore, to remove forever the offending lesion. It is with this spirit
that I beg you to become imbued as you depart on your missions of
service. Whether you go to the east or to the west, whether you be
on land or on sea, whether your lot be cast in war or in peace, I
welcome you into the splendid company of those whose days are
spent in
"Battling with custom, prejudice, disease,
"As once the son of Zeus with Death and Hell."
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