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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.*
WO duties seem to me to devolve on the President of
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
application, so that year by year the medical teaching becomes more and more costly."
What were the necessities of a medical school twenty-five years ago? Two lecture-rooms, in which seven professors talked, a dissecting-room, and, if possible, a clinic, which was occasionally, but rarely, in a college hospital. Practically the instruction which the student obtained, with the exception of dissecting, was limited to "book-knowledge" and "earknowledge." The student was not brought into actual personal contact with any patients or any concrete facts, observations, or experiments. He only listened to what his teachers said about them. Millions were given to hospitals in which the sick were treated, but only sixpences to medical schools in which the men who are to care for their future patients were trained. "Spain," says Lyman Abbott, "in the late war had nineteenth-century guns and sixteenthcentury men behind them. We know what came." Our splendidly equipped hospitals are the nineteenth century guns. Insufficiently trained doctors are the sixteenthcentury men. The time has eminently come when the "men behind the guns" must equal in efficiency the weapons with which they do the fighting.
To perform a tracheotomy and rescue a child suffering from diphtheria is a dramatic occurrence which appeals to every one. To conduct a long series of experiments in the laboratory by means of which the cause of diphtheria shall be found and the necessity for a tracheotomy avoided, appeals only to the educated few; yet the service done by the operation is a service only to the one patient who may be rescued by the knife, while the other is a service to hundreds and thousands of patients for all time who will escape both the knife and the disease. Yet, such a series of experiments in preventive medicine brings no reward in money, a limited reward in fame, and only its largest reward in the consciousness of giving a great boon to humanity, for which it never can pay.