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partments who by good hard work makes for himself a name is fairly sure, before long, of being called to some important post as a professor, director of a laboratory, or some similar position. But the facilities for work in clinical medicine and clinical surgery are far more restricted, since opportunities for both the exercise of their clinical skill are less frequently open to them and the possibility of combined physiological, pathological, bacteriological, and anatomical research along with their clinical work are but scantily provided for. This plea is reinforced by a recent paper of Sir Michael Foster.* These special graduates, bright young men, determined to devote themselves to one or another department of medicine or surgery, are the men who bring honor to the school at which they obtain their training, and are invaluable to the community. They are future Jenners, Pasteurs, Virchows, Listers, Da Costas, and Grosses, and our hospitals should provide exceptional facilities for these exceptional men.

The third object of a hospital is the promotion of knowledge, and so, fourthly, the good of humanity. Physicians and surgeons engaged only in private practice do not generally keep notes of their cases, and rarely publish important contributions to knowledge. I find in 100 books taken consecutively in my library that 85 were written by hospital men and only 15 by authors not connected with any hospital so far as was indicated on the title page.

In order that proper investigations may go on, trustees should enforce a permanent record of all the cases treated in the hospital, properly indexed, from which the staff may derive their data for papers and books. Each large hospital should have its pathological resident as well as the clinical residents in the various wards, so that post-mortem records shall be well kept, pathological, bacteriological, and chemical investigations of various secretions or blood-counts, etc., *Nineteenth Century, January, 1901, p. 57.

shall be properly made and permanently recorded in such a manner best by a modern card-catalogue-as to be accessible.

It is too often the case that trustees, as I have said, regard their duties and responsibilities at an end when they have taken care of the funds and elected the staff. They may say that, after all, this is their real duty, and that all I have advocated is medical and surgical, and that the responsibility for it should devolve on the staff, and not on the trustees. I do not take so narrow a view of the duties of trustees. When they have elected a physician or surgeon, if he neglects his duty, it is their business to displace him and fill his place with another man who will attend to his duty, and the duties that I have indicated pertaining to the increase of knowledge as well as of its diffusion are quite as much within their province as it is to see that the funds are invested to the best advantage. The intellectual funds as well as the invested funds must bring in good dividends.

If trustees and staff work together for such a purpose and in such a manner, they will create an ideal hospital which will do more good to the patients than any other type of hospital. It will attract the best physicians and surgeons in every community, will acquire the best reputation, not only local, but it well may be national, and do the most for the good of science and the benefit of humanity.

It may be said that this is an unduly strenuous view of the duties of trustees, that in our father's day and in our own earlier lives no such conditions existed or were contemplated. "I need hardly ask a body like this," said President Roosevelt in addressing the Methodists assembled in council, "to remember that the greatness of the fathers becomes to the children a shameful thing if they use it only as an excuse for inaction instead of as a spur to effort for noble aims. The instruments with which, and the surroundings in which we work have changed immeasurably from what they were in

the days when the rough backwoods preachers ministered to the moral and spiritual needs of the rough backwoods congregations. But, if we are to succeed, the spirit in which we do our work must be the same as the spirit in which they did theirs."

Moreover, we must remember that "the world field into which all nations are coming in free competition by the historical movement to which all narrower policies must sooner or later yield, will be commanded by those races which, in addition to native energy and sagacity, bring the resources of scientific investigation and of thorough education." The international race for the leadership of the world is just as strenuous and intense in medicine as it is in commerce. If we are going to join the race and win the prize, there must be the highest development of American education at the top. The best men must be pushed to the front, and ample opportunities for growth, for investigation, and for original research must be provided. Never has there been so large an opportunity for the man of large ideas, complete education, and indomitable energy and purpose as there is to-day. The world is waiting, looking, longing for him and will cry "Make room" for him when he is found.

In the hands of the trustees of our colleges and hospitals are the money and the opportunity for developing such men. If the right spirit pervades both trustees and medical faculties and hospital staffs, then it will be but a short time before America will lead the world in medicine as well as she now does in commerce.

Will the profession rise to the level of their great opportunity? Yea, verily they will! Never yet have they been wanting when the emergency arose; not only the emergency of labor, but also the emergency of danger.

In Russia the common soldier counts for little. Yet in Vladikavkaz (where the Dariel Pass the old Porta Caspiæ of Herodotus-leading from the Caucasus joins the railroad

from Baku on the Caspian to Moscow) is a monument to a common soldier. At the last battle in which the Russians won the victory over Schamyl which gave them undisputed sway over the Caucasus, this soldier blew up a mine and won the day at the cost of his own life. It was ordered that his name should never be erased from the list of his company. At every roll-call when his name is reached, the solemn answer is given, "Died in the service of his country."

In our hospitals lurk the deadly breath of diphtheria, the fatal virus of bubonic plague, of cholera, of yellow fever, of typhoid fever, and the ever-present danger of blood-poisoning. I have known of brother-physicians who have died victims to each one of these scourges. Yet who has ever known one of our guild to shrink when danger smote him on the right hand and the left and death barred the way? As brave as the Russian soldier, ready to risk life, and, if need be, to lose it, these martyrs to duty shall never have their names stricken off the honor list, and at the last roll-call the solemn reply shall be, "Died in the service of humanity."

THE QUALITIES ESSENTIAL TO SUCCESS IN

MEDICINE.*

IN

the "Selected Essays and Addresses" of that most distinguished English surgeon, the late Sir James Paget, one of the most interesting is entitled "What Becomes of Medical Students." It opens thus: "It is said that, on entering the anatomical theatre for one of his Introductory Lectures, Mr. Abernethy looked around at the crowd of pupils and exclaimed, as if with painful doubt, 'God help you all! What will become of you?" Sir James then proceeds to analyze the results of an inquiry into the later history of 1000 of his former students. The result may be stated in round numbers as follows: Sixty per cent. achieved success varying from "distinguished" and "considerable" to "fair," 18 per cent. a "very limited success" or entire failure, and 22 per cent. either died or left the profession. His paper concludes as follows: "Nothing appears more certain than that the personal character, the very nature, the will, of each student had far greater force in determining his career than any helps or hindrances whatever. All my recollections would lead me to tell that every student may draw from his daily life a very likely forecast of his life in practice, for it will depend upon himself a hundredfold more than on circumstances. The time and the place, the work to be done and its responsibilities will change; but the man will be the same, except in so far as he may change himself."

*The Commencement Address before the Medical Department of Columbian University, Washington, D. C., June 1, 1903. Reprinted from the Philadelphia Medical Journal, June 6, 1903.

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