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than mental development. To erect suitable buildings for an important medical school, and to equip and endow its laboratories and museum, is as much a work of philanthropy, and brings back ultimately to the community as large a return as similar gifts to academic institutions or to hospitals. We have already hospitals and dispensaries, and asylums and homes in excess of the needs of the community. What is needed now is the strengthening and development of the medical schools which educate the men who make the hospitals useful; the endowment of laboratories in which original research will continue for all time; researches which will repay for their outlay a thousandfold; and the establishment of scholarships and fellowships, to enable young men whose devotion to a scientific career is hindered and often blighted for want of reasonable pecuniary help. For these innovations and encouragements we now ask money, and the indications are that the community is alive to the need for them. The recent endowment of the Chair of Surgery in the University of Pennsylvania, the erection of the new buildings at Harvard, the establishment of the Carnegie, the Loomis, and the Hoagland laboratories, and especially the magnificent gifts of the Vanderbilt family in New York, and of Johns Hopkins at Baltimore-all these are encouraging signs.
The Jefferson now boldly proclaims its work, and asks for similar help. The new era in medicine compels us to enlarge our facilities, and this wider and better instruction will benefit the public at large. To them we appeal confidently, knowing that they will not disregard an appeal founded alike in justice, mercy, and charity.
And the reasons urging on this college to these large and wise advances apply equally to the other medical schools, and to the profession at large. The demands of the new era in medicine will only be complied with when the medical colleges give all the necessary facilities in equipment and in
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:
HE revolving cycle of the passing years makes it to-d 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
Makes that and the action fine."
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