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We come to you as representatives of four of our great institutions of learning—from Harvard, hoary with the snows of nearly three centuries, to Johns Hopkins, in the lusty youth of less than three decades. As President of the College of Physicians of Philadelphia I represent also the oldest institution in America at all similar to your own, a Corporation which includes surgeons as well as physicians, and which was already in its teens when the Royal College of Surgeons received its present charter.* On behalf of these and of all our medical institutions we bring you our heartiest greetings on this festal occasion, in the name of sound learning and accurate scholarship.

It has been my pleasure in Philadelphia to welcome many of your Fellows, including three of your most distinguished Presidents. Some of you have even swept across the continent in luxurious palace cars in but little over one hundred hours. To show how swift has been our progress and yet how young we are, I need but recall the fact that this College was nearly forty years old before the name of Chicago-now a city of nearly 2,000,000 people-even appeared upon the map, and, when you were founded, beyond the fringe of civilization. on the Atlantic coast practically the only inhabitants of the vast region from the Alleghanies to the Golden Gate were the buffalo, the bear, and the savage Indian.

But though so young we come not empty-handed. Three

*The Royal College of Surgeons of England was founded originally in 1540 in the reign of Henry VIII. By a misfortune they lost their charter in 1796. A new one was granted to them in 1800 by George III. In 1900, to celebrate the centenary of the granting of this new charter, they conferred their Honorary Fellowship upon the Prince of Wales (now King Edward VII), Lord Salisbury, Lord Rosebery (the leaders of the Conservatives and the Liberals), and thirty-two surgeons from various countries in Europe and America. My address was the response on behalf of the American surgeons upon whom the degree was conferred; namely,-J. Collins Warren, of Harvard; Robert F. Weir, of Columbia; William S. Halsted, of Johns Hopkins; and W. W. Keen, of the Jefferson Medical College. [W. W. K., 1905.]

great medical advances mark the past one hundred years— vaccination, anæsthesia, and antisepsis. The first and third of these are yours, but the second-anesthesia-better than Magian gold and frankincense and myrrh, is the gift which to-day America lays on the altar of science.

Before that historic date, October 16, 1846, the poor victims of the knife were bound hand and foot and held in the grasp of sturdy men; but hand and cord could not repress the fearful outcries which filled the air. But at Warren's touch the thongs fell off; he spoke, and the stormy billows of this Gennesaret of pain were stilled; the peaceful, blessed sleep of ether hushed every cry of pain. Then first was modern surgery made possible, and what was made possible by our Warren was made safe and successful by your Lister-no, not your Lister, but our Lister, for his name belongs to no age and no country, but to humanity.

It is, therefore, with a special fitness that to-day you have conferred your Honorary Fellowship upon the distinguished grandson of him who first demonstrated the blessings of ether to a suffering world. At the very time when this College was founded Warren was a student of Guy's Hospital and his certificate of attendance, signed by Mr. Cline and Sir Astley Cooper, is in the possession of his grandson.

Again, Mr. President, I beg you to accept our sincere thanks. for the distinguished honor you have conferred upon us.

THE PROGRESS OF SURGERY IN THE

NINETEENTH CENTURY *

THE

HE end of the eighteenth century was made notable by one of the most remarkable and beneficent discoveries which has ever blessed the human race,—the discovery of the means of preventing small-pox. On May 14, 1796, Dr. Edward Jenner inoculated James Phipps. When we remember that 2,000,000 persons died in a single year in the Russian Empire from small-pox; that in 1707 in Iceland, out of a population of 30,000, sixty per cent., or 18,000, died; that in Jenner's time "an adult person who had not had small-pox was scarcely met with or heard of in the United Kingdom, and that owing to his discovery small-pox is now one of the rarest diseases," the strong words I have used seem fully justified. But the eighteenth century was not to witness the end of progress in medicine. The advances in the nineteenth century have been even more startling and more beneficent. What these advances have been in the department of medicine has been related by Professor Osler. It is my province to speak only of surgery.

I. METHOD OF TEACHING.

The first advance which should be mentioned is a fundamental one,—namely, methods of medical teaching. At the

* Early in 1901 the New York Sun published a series of articles on the advances made during the nineteenth century in various departments of knowledge. The papers were republished by Harper & Brothers in a volume entitled The Progress of the Century. I am permitted to reproduce my own contribution to this series by the kind permission of Paul Dana, Esq., the editor of the Sun, and of Messrs. Harper & Brothers.

beginning of this century there were only three medical schools in the United States: the medical department of the University of Pennsylvania, established in 1765; the medical department of Harvard, established in 1783; and the medical department of Dartmouth, established in 1797. The last report of the Commissioner of Education gives a list of 155 medical schools now in existence in this country, many of them still poorly equipped and struggling for existence, but a large number of them standing in the first rank, with excellent modern equipment, both in teachers, laboratories, hospitals, and other facilities. The medical curriculum then extended over only two years or less and consisted of courses of lectures at the most by seven professors, who, year after year, read the same course of lectures without illustrations and with no practical teaching.

The medical schools, even when connected with universities, were practically private corporations, the members of which took all the fees, spent what money they were compelled to spend in the maintenance of what we now should call the semblance of an education, and divided the profits. Until within about twenty years this method prevailed in all our medical schools. But the last two decades of the century have seen a remarkable awakening of the medical profession to the need of a broader and more liberal education, and that, as a pre-requisite, the medical schools should be on the same basis as the department of arts in every well-regulated college. To accomplish this the boards of trustees have taken possession of the fees of students, have placed the faculties upon salaries, and have used such portion of the incomes of the institutions as was needed for a constant and yet rapid development along the most liberal lines.

II. COLLEGE HOSPITALS.

The first step has been the establishment, in connection with most schools, of general hospitals in which the various teachers

in the college should be the clinical instructors and where the students would have the means not only of hearing theoretically what should be done to the sick, but of actually examining the patients under the supervision of their instructors, studying the cases so as to become skilled in reaching a diagnosis and indicating what in their opinion was necessary in the way either of hygiene, medicine, or surgical operation. More than that, in most of the advanced schools to-day the students assist the clinical faculties of the hospitals in the actual performance of operations, so that when they graduate they are skilled to a degree utterly unknown twenty years ago.

III. ESTABLISHMENT OF LABORATORIES.

Another step which was equally important, and in some respects even more so, has been the establishment of laboratories connected with each branch of instruction. A laboratory of anatomy (the dissecting-room) every medical school has always had, but all the other laboratories are recent additions. Among these may be named a laboratory of clinical medicine, a laboratory of therapeutics, in which the action of drugs is studied; a laboratory of chemistry; a laboratory of microscopy; a laboratory of pathology, for the study of diseased tissues; a laboratory of embryology, for the study of the development of the human body and of animals; a laboratory of hygiene; a laboratory of bacteriology; a laboratory of pharmacy; a surgical laboratory, in which all the operations of surgery are done on the cadaver by each student; a laboratory of physiology, and in many colleges. private rooms in which advanced laboratory work may be done for the discovery of new truths.

In all these laboratories, instead of simply hearing about the experiments and observations, each student is required to handle the drugs, the chemicals, the apparatus, to do all the operations, to look through the microscope, etc.; in other

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