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There are certain classes in society, and I am sorry to say the upper and educated classes, who have been born and reared in America, whose ancestors have toiled on American soil, been made rich by America's increase; who know, or ought to know, the early struggles, the possibilities and probabilities of their country, who to-day are ashamed of America, ashamed of her institutions, ashamed of her accent, ashamed of her politics, and ashamed of her prosperity; who are so disgusted with her institutions that they send their offspring to England to be educated, nay even to be married; who have their children born abroad; who buy titles with worthless and notorious men attached to them, at the price of millions, for their daughters; who, with the skill of the parrot, endeavor to introduce a foreign accent in their American speech; who clothe their bodies in foreign garments, adopt foreign customs, often highly inappropriate, put on foreign manners, bow down before foreign friends, and for their pains are treated with ridicule and contempt by those they ape. So it is in medicine. It is the fashion now. to suppose that we must look to the "other side" for the great improvements, the great men, the new instruments, and the new operations. This is a mistake, a great mistake. While every one must acknowledge, not only in a social and educational point of view, the greatness, beauty and grace of the best social customs in the old country (I say best, for there are some very bad ones), and must admire the hospitality and genial kindness, the solidness of education, and the definite and exalted ends that are attained thereby, still you must give to your country its share in the originality and advancement in both the science and the art of surgery and medicine, so tardily acknowledged by most of our foreign brethren.

You must remember that ether anæsthesia belongs to us; that ovariotomy came from Kentucky, excision of the inferior maxillary from Tennessee, skin grafting and litholapaxy from New England; the Sims speculum, which caused such revolutions in gynecology, silver sutures, trachelorraphy, the plaster jacket, the relations of the Y-ligament to dislocations of the hip, and numberless instruments for the perfect surgery of the day, are American; and I am of opinion the balance of surgical skill, certainly in a practical sense, lies on this side of the Atlantic, and that the time is not far distant when to our shores will come the aspirants for surgical knowledge, and that surgical eminence will not be complete without the American stamp.

If the doctrines of natural selection, or the survival of the fittest, be true, American surgery will hold its place when compared with that of any other country in the world. I do not desire to make these remarks either to depreciate the status of

any department of medical science as at present taught and existing in other countries, and still would hold up for admiration and example the truly great minds in all countries who have toiled unceasingly for the well being of the race; but my advice is to study the advances in your own country, embrace the facilities she offers, recognize the ability of her teachers, and then, and only then, will you be able to draw a fair comparison between the national and the foreign. It is always a matter of surprise to me when I hear medical foreigners eternally and disadvantageously comparing (in print and in conversation) our institutions, our surgeons, our methods, our instruments, and our practice with that of the older countries. I always wonder why, America being so inferior, they condescend to stay with us, or why they do not remain amid the perfect glory and undimmed radiance of their own country. Why don't they go home? They are absolutely of no service here. Be American physicians and surgeons, admire what is good and great in every land and every clime, but do not make yourselves ridiculous in the eyes of the really educated portion of the community by becoming either Anglomaniacs, Teutonomaniacs, or Gaulomaniacs, or any other kind of imbecile.

Prof. Harold C. Wood, in a paper entitled "The Medical Profession, the Medical Sects and the Law," read at Yale University, with the intent of demolishing homoeopathy, says that the doctor of to-day is scarcely more like the doctor of a hundred years ago than like our Darwinian forefather, blushing with shame at the sight of his first tailless offspring.

This is true, and I may carry the comparison still further, and say that the medical student of to-day bears as little resemblance to the medical student of fifty years ago as the full-fledged doctor described in the apothegm of Dr. Wood does to his prototype.

In the first place, it must be remembered that half a century ago the branches of learning taught in the medical universities numbered about seven Anatomy, Surgery, Practice of Medicine, Obstetrics, Physiology, and Chemistry, and very often two of these were combined and taught by one chair; thus, Anatomy and Surgery, Obstetrics and Diseases of Women, Institutes and Practice of Medicine, Chemistry and Toxicology, and so on. If we compare this meagre curriculum with that of this, or any other first-class medical college, you will readily see how the tentacles of medicine have spread in all directions, and that as the sciences have multipled and expanded, the student who essays to master them, or that portion of them necessary for the passage of his examinations, must have not only more cultivated mental capacities, but also more teachers and more time. Within the past half century Chemistry has become a new science; in

deed its field is so vast that it can scarcely be acquired by a single mind in a lifetime. The microscope was known as little better than a toy fifty years ago. In those halcyon times the leucocytes were swimming unrecognized in the blood serum, and, octopus-like and unmolested, were sticking "like limpets to a rock" on the overhanging edges of each solution of continuity; silent and unknown micro-organisms were sailing in reckless security in the atmosphere, dividing themselves into amoeboid forms or leptothrix filaments, innocent of the culture tube, or incubator; bacilli were sapping continually the foundations of our constitutions, and we knew it not. The theories of inflammation and the doctrines of pathology as now taught were scarcely hinted at; the remnants of the old humoral pathology still tinged therapeutics; the revelations obtained by reflected light within the cavities of the body were just beginning to be appreciated, and of course the laryngoscope, the ophthalmoscope, the endoscope and the otoscope had not come into use. Specialism, as it exists in its exclusiveness to-day, was unknown — the general practitioner, it is true, cultivated that branch of medicine which suited his peculiar taste, whether ophthalmology, obstetrics, or surgery, but was the general practitioner still. The trained nurse had yet to be evolved (from the good, old-fashioned, aged, fat and sherry-loving woman of old). The clinical thermometer had not sprung into existence; hypodermic medication was unknown, and respect and awe for traditions in medicine (always a stolid antagonism to rapid advancement) still narrowed the mental horizon of the best men in the profession. With the absence of these now important, nay necessary adjuvants of medical instruction, it will readily be seen that seven practical branches of medical study, seven, indeed, sometimes six, professors to teach them, and two courses of lectures - each course covering the same ground, and continuing about four months— might be a sufficient curriculum for those times; and let me tell you, gentlemen, that some of the greatest men that ever lived started with just such advantages, and no more. To make the comparison complete I may also say that the final examinations. were conducted in a much more formal manner than at present. The green-room was an awe-inspiring word to the candidate for graduation. The student, often trembling inside, but with a bold exterior, was introduced into a room around which, in a circle, in self-satisfied dignity, and with the weight of a thousand years of tradition expressed on every feature of every face, sat the entire Faculty. This august presence alone was sufficient to overwhelm with confusion the wretched man before them. Then came the questions, and then the vote; and I must say, as a rule, in spite of the decorum and dignity of the Faculty, gener

ally every man got through. In this college you have thirty-six professors instead of seven, as of old; you have four years of study, and three compulsory courses of lectures, against two courses and eight months' study; each of the present terms of lectures continues for six months, against four in the years that have gone. In addition you have to undergo an examination by a Board of Censors, not in any way connected with the Faculty, before you can receive your diplomas; and add to these a State examination by the Board of Regents of the University of the State of New York, upon entering the college, to ascertain if you have sufficient education to begin your course of medical study, and a final one after you have passed your college examination, to discover if you be fit to take the lives of patients into your hands. These are the differences between the "then and now" of the student's life.

But, gentlemen, surrounded as you are by all the paraphernalia of learning, overshadowed by lectures and examinations, you must be made aware of one fact, and that is, that the mere material presence of subjects cannot compel your minds to absorb them, and that

"If not to some peculiar end assigned,

Study's the specious trifling of the mind."

The presence of your environment will not necessarily fix your mental faculties upon them, or upon the subjects which it symbolizes; indeed, mental idiosyncrasies are both peculiar and inexplicable. The man of God in the Temple, surrounded by and honestly acknowledging all the solemnities of the day, the hour, the sanctuary, and the occasion, may, in a second, have his mind transfer itself from the devotional to the ludicrous, or even to devilisha constant familiarity with your surroundings may breed an actual carelessness and neglect of them, in the same manner as the dwellers amid the most magnificent scenery regard it not, and as the inhabitants of a great city are taught its wonders by the stranger. Surroundings necessarily have their influence upon all of us. To the emotional they appeal with greater force than to the stolid and phlegmatic; but there must exist deep down at the bottom of it all, if you wish your student days and your professional lives to be successful, that absolute devotion to your profession which is derived from a love of humanity. This, after a time, no doubt, will pour gold at your feet; will place your name in honorable mention in the Esculapian Temple, and give you social status, all of which cannot, nor ought not, to be disregarded in the contemplation of one's future career, but which cannot be considered in comparison with the actual good that it will reflect upon the people with

whom you are brought in daily contact, with whom you rub in the daily friction of a busy world.

An important subject for consideration now arises. With all these improvements in medicine and the collateral sciences, has mankind been benefitted in proportion? Do all these branches of medical education, now considered necessary for the study of the student and the understanding of the medical practitioner, prevent disease, ameliorate suffering, and save life? Or did the old-fashined systems and the lack of facilities for obtaining information, which of late years have become so numerous, produce as beneficial results upon humanity as our more advanced methods? Here are some figures which can answer the question definitely, and which are well worthy of serious consideration, as well as gratifying to those who are foremost in adopting all the newer and well-proved methods of preventing and curing disease.

In 1889 the death rate of England was 17.9 per 1,000. From 1881 to 1889, a period of nine years, the mortality was less than at any previous period. From the year 1871 to 1880 the death rate was 21.4 per 1,000. Taking the last nine years and comparing the death rate with the previous decade the statistics show that there has been a saving of 2.5 in every 1,000, or, according to the English registrar-general, there are now 600,000 more people alive in England and Wales than would have been if the previous mortality had continued the same during the past nine years. Medical News, July 5th, 1891.

I have not been able, although I have made some research, to find accurately the mortality of this country; although from what I have gleaned I should suppose a similar diminution of mortality to result.

But, gentlemen, don't misunderstand me; don't think because I have covered the hill-top of life and am going downward to the inevitable beyond that you can make me suppose that your latter end of the nineteenth century medical student, as evolved from the student of the olden time, is by any means a perfect young man; or, on the other hand, that I have forgotten that most of you are in the hey-day of your youth, or that youth is the time. for looking through the rose-colored glass of the present, regardless of what is to come. What I want understood is this are you, with the surrounding advantages of place, position, study and social surroundings, as good as you ought to be, or as good, cæteris paribus, as students of fifty years ago?

There always are, and always will be, wild young men, wayward young men, bad young men, and good young men, in every class of medical students; and I must say, in justice to even the bad fellows, that sometimes in the end they make the best dctoors.

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