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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!
THE CHEERFULNESS OF DEATH.*
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,
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.
It frees him from accident, sickness, and suffering, to which his body has been liable all his life, and from which he has often suffered, sometimes intensely and for long periods of time.
It frees him from all sorrow. No one who has reached even adolescence escapes sorrow. To many, sorrows are multiplied manifold and bear down even the stoutest heart. The "weary" and the "heavy laden" make up the mass of mankind.
It opens the gates of heaven to him. While we know nothing accurately of the details of the heavenly life, we do know that there we shall live in eternal bliss; there we shall be in the presence of God himself; there we shall see and know intimately our Lord Jesus Christ; there we shall feel the influence of the Holy Spirit; there we shall meet the saints of all ages; there we shall be reunited to the dear ones who have happily preceded us; there shall come in due time the dear ones we have left on earth; there our minds. will expand beyond our present comprehension; there all the unsolved problems of earth will be as clear as day; there we shall learn why perplexity, disappointment, and trouble were our lot on earth and were needful for the orderly and sufficient development of our own character, and of God's large plans not only for us, but for the race; there, in a world, all that is evil shall vanish away and all that is good shall be ours forever.
If death, then, is not a painful, unpleasant process, and if it does for us so much, it should be, not the last enemy, but our best friend; not dreaded as the messenger of evil, but welcomed as a companion who will lead us into paths of pleasantness and reveal to us the joys for which we have. been longing all our lives. We shall not speak of the terrors of death, but should feel in our very hearts the cheerfulness of death.
THE NEED FOR INCREASED ENDOWMENTS
FOR MEDICAL INSTRUCTION.*
10 URGE "The Need for Increased Endowments for
T Instruction is entirely before
audience. It consists of a large number of doctors who know only too well the need for endowment for their own and for every other medical school in this country. I can only repeat, therefore, in part what I have said elsewhere,† adding somewhat to it, perhaps, in the hope that you will repeat it to others, your patients and friends, whom you may persuade to give liberally. It is for the purpose, therefore, of concentrating your thoughts for a few moments upon the question of the urgent need of such endowments that I ask you to listen to me. I base the need of endowment of medical schools by the general public upon three grounds:
First. The costliness of modern medical instruction.-If you look at any large medical school of the present day you will find a very different state of affairs from what we had when I began the study of medicine. Then we had two lecturerooms between which we swung like a pendulum, seven men who talked to us in one great mass for an hour at a time for two years on precisely the same subjects-and that was all. To-day you need a large medical building, you need a large hospital, you need a dozen laboratories each with a costly equipment and with a large number of assistants. You need, as President Eliot has so well pointed out, individual in
* An address at the complimentary dinner tendered to Dr. D. B. St. John Roosa, in New York, March 1, 1904.
† Presidential Address before the American Medical Association, p. 295.
struction; not simply lectures to a large class without illustrations and without laboratory work; but small classes of ten, fifteen, or, at the most, of twenty, and individual instruction in the laboratory for every man. When I began the study of medicine in 1860 at the Jefferson Medical College there was no hospital, and from the faculty down to the janitor the number of those who took part in instruction numbered less than a score. To-day in the Jefferson College and Hospital, and its dozen laboratories, we have over eleven score of instructors, an increase of over eleven hundred per cent., observe! And these men must be paid, and the men in the theoretical branches, who have not the means of making additional income by practice, must be paid large salaries so that they will be able to give their whole time to the medical school. Yet the fees paid by the students have been less than doubled, that is, increased less than one hundred per cent. against an increase of eleven hundred per cent. in the teaching force!
The medical fees are practically as large as we can make them. The expense, therefore, of modern medical education must be borne largely by endowment. Just exactly as in the academic department of our universities we need great endowments to eke out the insufficient incomes derived from the fees of students, so in our medical schools we need large endowments for the same purpose. Compare, for instance, the theological schools of this country with about 8000 students, in which the average endowment for each student is $2250, with the medical schools attended by 24,000 medical students with costly laboratories, hospitals, and appliances that theology does not require, and a paltry endowment of $83 per student!
The second reason for generous medical endowments from the public is the commercial value of the medical profession to the public. I am not speaking now of the value of health to everybody, or of our cherished desire for the health of those