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 in 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 The older methods, where one man lectured to 200, 400, or 500 men at once have been replaced by a method of instruction which requires the training of small classes of 20, 15, 10, or even one or 2 men by a single teacher.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 corresponding 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 indifferent, absorbed in business, forgetful that sickness and sorrow must some time inevitably come to them? Remember

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 Americans, we Philadelphians, say them nay for want of such encouragement 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.*

HE value of occasional and stated gatherings of the principal 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 cognate 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 in 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 Physicians and Surgeons, Washington, May 12, 1903. Reprinted from the Sixth Volume, Transactions of the Congress of American Physicians and Surgeons, 1903.

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 presenting to you some thoughts on "The Duties and Responsibilities 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 criticism, 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 hospital which they so faithfully serve. Anxious to discharge their trust to the best of their ability, I am sure they will accept 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. Moreover, their admirable selection of a director for the institution

is the best pledge of a future wise administration. I heartily congratulate the profession and America upon the establishment of so peculiarly useful an institute. Its founder has wisely left its work unhampered saving as to its general purpose, 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, prolong 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 Medicus" 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 publication. 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 subscription to the "Index Medicus."

There are some matters common both to the medical college and the hospital which may be considered together. The most important of all these is the cordial and hearty co-operation of the medical men connected with the college or hospital and the boards of trustees. In order to ensure this the members of each body must be acquainted with each other. I have known of instances in which, if a professor in the medical