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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

preventable, could be reduced to a minimum by proper sanitation. Our ears have been deaf, our eyes closed, and our minds dulled to this horrible state of affairs, because forsooth we are used to it. How often in my clinic at the Jefferson Hospital, as my house surgeon reads to the class the history of patient after patient, I hear this startling statement: "A. B., aged 25 years, had the usual diseases of childhood"as if disease ought to be "usual." Moreover, those of whom this is said have recovered from the "usual diseases of childhood," but those who have fallen in the holocaust from measles, mumps, chicken-pox, whooping cough, scarlet fever, and diphtheria have passed beyond any clinic or any history. This field alone is a splendid opportunity for fruitful work in this fair twentieth century just opening, and if you do your duty, and the rest of our profession do theirs, long before its end, such a history will state that "A. B., aged 25 years, had the usual health of childhood," for the now usual diseases will be banished. Happy childhood will be free from their assaults, and health instead of sickness will be the standard. It is a mark of a low grade of civilization that any disease should be "usual." It reminds us of the days before Jenner, when almost everybody had small-pox, and its victims were numbered by the hundreds of thousands. Soon may the happy day come when the only two causes of death will be accident and old age; when the surgeons will only be called upon to remedy the injuries inflicted by the first, and the physicians' only service will be to assist at our entrance into the world and to sign the death-certificates of centenarians!


OST people, even most Christian people, shrink from Death. In sermons and hymns, and in literature, it is generally represented as repulsive. It is spoken of as



Death's Cold Stream," "The Last Enemy," and the "Dark Valley of the Shadow of Death," and the "terrors of death" are pictured in vivid terms. For the Christian at least this is all wrong. Death should be in reality his best friend; welcomed rather than feared.

So far as the physical aspect of death is concerned, the universal teaching of physicians is that the process of dying is rarely painful or even unwelcome to the patient, though full of sorrow to his family. A happy unconsciousness in nearly all cases shields the dying man from pain. The weakness, the fever, the parched lips, the labored breathing, are all unfelt. Most people die quietly and often almost imperceptibly.

"We thought her dying when she slept,
And sleeping when she died"

is often true. Even when convulsive moments occur, they are entirely independent of consciousness; merely physical in origin and character, and absolutely unattended by any suffering.

If, then, death is not an unpleasant process physically, why should it be feared from the spiritual side? See what it does for the Christian.

* Reprinted from the Outlook of October 24, 1903.

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