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,

Fourth, studiousness.

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

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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

friends who encouraged me, and I remembered the story of the knight whose crest was a man at the foot of a great mountain which he was attacking with a pick axe, and whose motto was "petit à petit,”—“little by little." More than one disappointment in preferment came to me, but I simply buckled down to my work with more tenacity of purpose than ever before, resolved to do each day the work of that day as well as I knew how to do it. Finally the clouds broke away, and the bright blue sky and the beaming sun were revealed. So it will be with you if you will heed the lesson that I am giving you. Remember Emerson's saying, "Make yourself necessary to the world, and mankind will give you bread."

Studiousness is the fourth essential condition of medical success. Medicine is a science, and one which has progressed with extraordinarily rapid strides, especially within the last few decades. The rate of progress in the next fifty years, during your active lifetime, will probably be even more rapid than it has been. Unless you devote yourself, therefore, to your patients, your books, and your medical journals, you must expect, and you ought to expect, to be left behind, stranded on the shore of idleness, while others sail on to fortune and to fame.

When you begin, for a number of years your cases will be sufficiently infrequent for you to be able to study each case as if your own as well as your patient's life depended upon your knowing all about that case. One case thoroughly studied, so that you know not only all about that individual case, but all about that individual disease or accident, is worth a dozen treated in a slipshod routine manner. If with each differing case you master the disease as well as treat the case, it will not be long before you will have run the gamut of most of the ordinary diseases and have become master of them all. Make each patient understand, while you are investigating his case, that he is the only patient in the world for you at that time. If you practise in the country, do not waste your time

in gossip at the corner store. Remember that medicine is a jealous mistress and will allow no rival. She must have your whole heart or she will have none of you.

Moreover, remember that there are broader and larger questions to be studied than this or that disorder, however important it may be. Let me name a few which have arisen in my day. I have seen the birth and development of antisepsis, of asepsis, of all our knowledge of immunity, of the serum treatment of disease, of the x-rays, of practically the entire departments of neurology and gynæcology; the whole of pathology and of surgery have been rewritten from the time of Virchow's "Cellular Pathology," published just as I was entering upon the study of medicine, and since Lister's epoch-making work in the sixties and the seventies. These subjects touch all diseases rather than any one disease or any one particular case. In the future there will be new discoveries quite as important, and, it may be, even more so, and you must be on the alert to absorb all the new knowledge that comes from investigations, many of which doubtless you yourselves will be among the foremost to undertake.

In addition to this, you must not neglect that culture which so broadens a man's view, adds to his influence and importance in the community, and is in itself a source of so much delight. Not many of you, perhaps, will be able to imitate. the Scotch country doctor whose story is told by John Brown in his charming "Spare Hours." When paying him an early visit, he found the old Aberdonian at breakfast ready for his morning ride, but meantime "amusing himself" (mark you, not working at it, but "amusing" himself) "with penciling down a translation of an ode of Horace into Greek verse." But you can all make yourselves familiar, certainly, with the masterpieces of English prose and verse. And let me add that none of you will be as good a doctor as you ought to be unless you know at least French and German and draw not only on the medical stores of knowledge to be found

in these languages, but also on the splendid literature which awaits you when you once possess the ability to read and, I hope, to speak these tongues.

When you have gathered sufficient experience and attained sufficient knowledge, write; but not till you have something worth saying. In order to have something worth saying you must have an accumulated lot of case-notes; hence from the very day of your graduation let every case be recorded and indexed. Even the commonest disorders, when you have gathered the notes of a large number of cases, will afford you material for excellent papers which those who are less industrious and less painstaking will read with pleasure and profit.

You are about to join a great and noble profession whose value to the community is beyond estimate. The lives and happiness of the community you serve will be in your hands. Dare you be recreant to your trust, indifferent as to whether you add to your knowledge as the science progresses, or remain a fossil of the year 1903, indifferent to the death of defenseless youth and hoary age, of the bread-winning father, of the tender, care-taking mother, of the loving and beloved child whose untimely death leaves a scar on the heart, which all the waters of Lethe cannot efface?

The whole world has been moved within the last few weeks by an atrocious massacre in Kischineff, and the press and the platform have been right in their denunciation of such a crime. The slain and the injured, it is said, number nearly 1000. But where has a voice been raised in indignant protest against the massacre of 50,000 persons in the year 1902, in the United States alone, by typhoid fever?—a preventable disease which ought to be stamped out, and practically could be stamped out, were a proper water-supply and proper sanitary precautions taken. Have you heard any national denunciation of the massacre last year of 150,000 persons in the United States by tuberculosis?-another disease which, if not absolutely