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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 Caspia 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.*
N 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.
I have had neither the time nor the opportunity to make a similar investigation, but what I shall say is based upon an experience now covering forty years of teaching, during which time I have observed the careers more or less accurately of from 6000 to 7000 students. Their successes and their failures have been probably about in the same proportion as Sir James Paget's. But I have never known a man to fail of achieving an honorable or even enviable success who had four characteristics:
First, a good moral character;
Second, good manners;
Third, perseverance; and,
I need say but a word as to a good moral character, for it is the foundation of success in every department of life. He who lacks moral character lacks everything, and not only as a rule will not succeed, but ought not to succeed.
"Manners make the man," is an old adage, and in no calling in life, perhaps, are they so important as in medicine, for the doctor has to do not only with his fellow-men, but very largely with women and children, in which relations good manners are essential. It has been said of a well-known New York physician, now dead, that he owed much of his success to what was humorously called, among his friends, his "tenthousand-dollar smile," and, while such a statement always carries the inaccuracy which inheres in most aphorisms, yet there was a large basis of truth for it. Neatness always pays. To wear a grease-spotted coat is reckless extravagance. It will cost you far more than a whole, clean, new suit. To display grimy finger-nails is as bad socially as it is surgically.
To illustrate the value of perseverance, my third requisite for success, let me give you an incident which occurred a number of years ago in my own office. Among my students was one who had had unusual advantages. His parents had sufficient means to give him the best education. He gradu
When he took
ated at his university at the head of his class. his degree in medicine, he was an honor man. honorable apprenticeship as a hospital resident. He spent a year or more abroad and acquired an excellent knowledge of French and German as well as added to his knowledge in medicine. Before going abroad he married and, as soon as he returned, settled in practice. One day he came to me greatly discouraged and said: "I think I must give up the practice of medicine. My parents have been very kind to me, but I cannot always be dependent upon them for the support of myself and my family." I said to him: "My dear doctor, exactly how long have you been in practice?" "Seven months." "How much have you actually collected in cash?" "Two dollars and a half." In other words, in 210 days he had made 250 cents, a little over one cent a day. It was enough, I confess, to chill even a stout heart, but I encouraged him and told him what I am telling you, that I had never known a man with these four qualifications to fail; that he had three of our four requisites, a good moral character, good manners, studiousness; and that, if he would but remember the fourth qualification, perseverance, he would be sure of success. To-day he is widely known as a most successful practitioner and has an enviable place not only in the esteem of the profession, but in that of the community.
I might give you beside this a little of my own experience, for I passed through almost the identical stage of discouragement that I have just related to you. Failure I thought again and again stared me in the face. It seemed for a number of very long years as if I should never be able even to earn a decent livelihood. Plenty of people needed surgical advice, but the ninety and nine went decorously on the well-beaten paths leading to other offices. Only the one poor forlorn and wandering sheep, attracted by the luxuriant grass in an unfrequented path, reached my own. But I had good