are no less brave women, are endeavoring to bring the blessings 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 in 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 suffering 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 fellowcreatures 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 Hospital 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

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 laboratories for larger and more fruitful work; not for our own homes, but for our colleges to furnish us the means for better teaching; in 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 Cæsar. He is flanked by Napoleon and Alexander the Great and followed by Attila, Semiramis, and a lengthening 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 in 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 in 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 Paré, Virchow, John Hunter, and many a modest, but unknown hero who has yielded up his spirit in the performance of his

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

WO 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, secondly 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 importance 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 bequests 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

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 cottonmill 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 appreciate 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 education," says President Eliot, of Harvard, "which more needs endowment. Medical education is very expensive, because it has become, in the main, individual instruction. Large lectures and crowded clinics are seen to be of really very limited