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tains, burrowed under the slime of the sea, girdled the earth, and put Puck to shame as a lagging messenger. Even in late years the telephone, the trolley, the dynamo, the electric lamp, and wireless telegraphy have all sprung into being as by magic, and soon all of our rivers will be harnessed and made subservient to the comfort of mankind.
The human hand, that most perfect instrument, has been almost driven out of the industrial market by various machines which do its work so much more cheaply and often so much better. Metallurgical processes have so cheapened the production of iron, copper, aluminum, and other metals that whereas a few years ago their constant use was impossible on account of their cost, they are now common household implements.
When I was in college, the so-called Fraunhofer lines were simply a curious phenomenon in the solar spectrum; yet, a few years later, they furnished us with a chemical analysis not only of the sun, but of far distant comets and nebulæ, and have determined even the velocity of light coming from the furthest confines of the universe. Nay, more, by means of the spectroscope elements unknown on the earth have been discovered in the sun; and now that by its means we have discovered helium and know that uranium becomes changed into radium and radium into helium, one element into another, the asserted philosopher's stone of Paracelsus and the other alchemists, by which they could transform the baser metals into gold, may possibly be found to be of more substantial stuff than dreams are made of.
Meanwhile educational endowments of millions have been made. Philanthropy cares for the children, the prisoner, the degenerate, and the lower animals; slavery has been abolished; the International Tribunal of Arbitration will soon be housed in a palace dedicated to Peace and erected by an American; and religious liberty is enjoyed as never before.
But, with all this wonderful progress, where has medicine.
been? Has it kept step with the other arts and sciences or has it lagged behind? It delights me to say that it has not only kept up with the foremost rank, but has even outstripped not a few. In 1846 and 1847 ether and chloroform were discovered and the operating-table was robbed of well-nigh all its terrors. Thirty years later, thanks to Lister, antisepsis added its benison to the blessing of anæsthesia, and operations have been deprived of nearly all their pain and of their former frightful mortality. These two blessings, the one making operations painless, the other making recovery almost certain, have made possible a new surgery which was not only impossible, but even undreamed of, when I began to study medicine. In this way have been developed the surgery of the kidney, of the liver, of the gall-bladder, of the pancreas, of the stomach, of the intestines, of the appendix, of the prostate, of the brain, of hernia, of the pelvic organs, and even of the heart. By these means the mortality of compound fractures and of ovariotomy, which used to claim two out of every three patients, is now reduced almost to a vanishing point. In fact, were my old teachers of surgery, Gross and Pancoast, to come to life, they could not even understand our modern vocabulary; and if they were to visit a modern surgical clinic, they would think us stark mad.
Moreover, we have blocked many diseases at the fountain-head by discovering their causes and the means by which they become diffused among the well. Thus we have found that the guilty culprit spreading yellow fever and malaria is the mosquito, and that the cause of malaria is a parasite whose life-history is now perfectly known. The efficiency of our means for preventing outbreaks of both of these scourges of the human race will find a splendid illustration within the next few years in the sanitation of the Isthmus of Panama, which will be Chapter II in the splendid volume whose first chapter was written in Cuba by Major Walter Reed of the United States Army. The cause of the
plague and its dissemination by the rat is well known; the cause of typhoid fever and its dissemination by flies and through drinking water, and of cholera and its diffusion through drinking water, are also matters of popular knowledge. We know now the deadly cause of diphtheria, and the use of its antitoxine is making the once loud wail of parents for their lost little ones, as after the death of the firstborn in Egypt, grow fainter and fainter. The prevention of small-pox has been known for a century, and lately its probable cause has been found by an Italian and by an American. The cause of cancer, of scarlet fever, of measles, and of many other of the commoner diseases of childhood, have as yet eluded the scrutiny of the ablest men of the profession. The discovery of these is among the unfulfilled tasks to which I referred a few moments ago, which is committed to your hands.
Microscopical analysis and the chemistry of the secretions have been wholly rewritten within the past quarter of a century, while the examination of the blood as a means of diagnosis and the serum treatment of disease have made splendid beginnings. Percussion and auscultation have opened a new world to us in the diagnosis of diseases of the chest and abdomen.
Meantime numerous instruments have been added to our armamentarium, without which the modern physician and surgeon would be almost helpless. The thermometer, which has only been our hand-maid for about thirty years, has substituted exactness for surmise; the hypodermatic syringe disclosed a new method of medication about the same time; the aspirator was not known till after I graduated in medicine; the ophthalmoscope has revealed an unknown world in the interior of the eye, and with many other instruments of precision, has made ophthalmology one of the most exact of the medical sciences and a model of accurate measurement and statement for all its sister sciences. The otoscope, rhino
scope, cystoscope, esophagoscope, and other similar instruments have revealed to us the interior of other organs of the body in a way formerly wholly unknown, while the simple hæmostatic forceps and retractors have made many modern operations physically possible.
The growth of medical laboratories within the last twentyfive years has been phenomenal. The laboratory has done much more than merely afford the opportunity for investigations which have yielded such an abundant fruit. It has cultivated laboratory methods-that is to say, methods of exactness, and the use of instruments of precision. The experimental method in medicine has done more than any other one thing to widen the boundaries of our knowledge. Besides this, it has cultivated precision in thinking, which is more important than any instrument or method. The vague theories and subtle reasoning of our forefathers are now replaced by exact methods of investigation. The difference is well set forth by Mumford when writing of Rush and the yellow fever. "Like the rest of the profession," says he, "Rush was at his wits' end, and it is interesting to note how different from modern methods were the means adopted by such men for solving the problem of treatment. In these days the natural history of a disease is worked up, its pathological anatomy investigated, and clinical and laboratory researches elaborately and carefully made in order to learn the exact nature of the phenomena under discussion and so, perchance, to find an appropriate and rational remedy. Those ancient men, on the contrary, had their preconceived notions as to the nature of the disease, and limited themselves mainly to searching the literature of the subject and to experimenting with drugs." Reasoning about the yellow fever and its effects, Rush "thought he saw that the debility indicated by the low pulse was due to the 'oppressed state of the system' [whatever that may mean], which must be relieved by purging, supplemented by bleeding."
Imagine, if you can, the forlorn condition of the doctor sixty years ago without our present means for physical diagnosis, without the thermometer, the hypodermatic syringe, the various specula and other instruments I have named, without the aid of hæmatology, of anæsthetics, of antisepsis, of the modern microscope, without our laboratories, and our experiments, our chemistry, our bacteriology, and our antitoxines-without everything except his eyes, his ears, and is fingers: then you can appreciate the triumphal march of medicine during a single lifetime.
In this brief review I have given you, very hastily and imperfectly, something of what has been done in medicine during my own lifetime. What, now, has the future in store for you?
You entered the medical school in vastly different conditions from those which obtained when I began the often weary study of Gray, Gross, Watson, and Ramsbotham. I am often reminded of the time when the Chief Captain rescued St. Paul from the mob, and asked him whether he were a Roman citizen. When the Apostle declared that he was, "With a great sum obtained I this freedom," said the Chief Captain; to which his Hebrew captive proudly answered, "But I was born free." You, too, are "born free"; born to an inheritance of anæsthesia, of antisepsis, of laboratories, of improved methods of teaching, of many heretofore unknown drugs. "With a great sum" of toil, and work, and worry the men of my generation have obtained the freedom which you have inherited.
What use will you make of this freedom? First, you will improve, I trust, on our present laboratory methods and our present methods of teaching. Pathology, a feeble aid to medicine and surgery when I began my medical studies in 1860, and bacteriology, a word found in no lexicon of that date, have become veritable foundations of the medical curriculum even since I began to teach. You, in your turn