time, to study thoroughly every branch of medicine, and the student comes 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 HE revolving cycle of the passing years makes it to-day my pleasing duty to say a parting word of advice, of caution, 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 discouragement, 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 Hospital, and, if possible, a year or two abroad. In other words, twenty-one years of study are practically what is required 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 advantages 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. 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 time. surely recognize your merit. If you have genius you may gain a fortune; but even mediocrity is sure of a competence 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 performed. 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 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 irksome drudgery; but put your heart into it and the lowest drudgery 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 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 sional wintry winds, and at last when the storm comes 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 faithfully 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 |