MEDICINE AS A CAREER FOR EDUCATED MEN. 
The Commencement Address, Lafayette College, June 13, 1893, and the 
Phi Beta Kappa Oration, Brown University, June 20, 1893. 
W. W. KEEN, M.D, LL.D, 
PROFESSOR OF THE PRINCIPLES OF SURGERY AND OF CLINICAL SURGERY, JEFFERSON MEDICAL COLLEGE, PHILADELPHIA. 
[.Reprinted from The College and Clinical Record, November, iSqgi] 
Commencement always carries me back to 
the classic shades where I spent the four most 
blissful and fruitful years of my life, to which 
I have ever reverted as the halcyon days of 
youth. As for me thirty-four years ago, so 
now for you, the joys, the trials, the studies, 
the achievements of your college life are 
or soon will be over. The world stands open 
before you. “ What shall I do?” is the ques- 
tion of questions to you. The decision of this 
question may make or mar you. If you de- 
cide rightly, you will achieve success, honor, 
happiness, and the final consolation of a life well 
and nobly spent. If wrongly, your decision 
may wreck, even hopelessly, a young life full 
of brilliant promise. You and your fellows 
in the many colleges of the land who will 
graduate in this leafy June have on your side 
youth with all its potencies. You have a just 
and laudable ambition. You are ready to 
work your finger-nails off. You have trained 
intellects. You are members of the true aris- 
tocracy of learning; men of marshaled forces, 
the hope of the nation, the future natural 
leaders of thought in public and in private 
life. What shall you do ? “ Surely,” says 
Carlyle, in his biography of John Stirling, 
“ the young, heroic soul, entering on life so 
opulent, full of sunny hope, of noble valor, 
and divine intention, is tragical as well as 
beautiful to us.” 
some will devote their lives to the highest 
human function and service to their fellow- 
men—winning them to Christ-like lives and 
heavenly aspirations ; some will seek the 
noble profession of the law, and will become 
leaders of the bar and wear the ermine on the 
bench; not a few, I hope, will devote your- 
selves to a scientific career, with, it is true, its 
ceaseless toil, but also its fascinating investiga- 
tions, its splendid discoveries, its beneficent 
inventions. 
It is my desire to lay before you some of 
the rewards, the possibilities, the attractions 
of such a scientific life, and to win you to its 
pursuit, since it has attractions, wonderful 
attractions, from many sides and for every 
type of man—excepting always the lazy. I 
have selected as my topic, therefore, “ Medi- 
cine as a Career for Educated Men.” 
I am met at the outset by the query, “ Are 
there not already too many doctors?” Yes ; 
far too many poor doctors, but far too few 
good ones. . Webster’s oft-quoted remark, 
that “ there is plenty of room at the top,” is 
as true of medicine as of any other profession. 
In any profession there is always a reserved 
seat in the front row for a Faraday, a Schlie- 
mann, a John Hunter, a Lister, a Virchow, a 
Pasteur, a Gross, a Packard, a March. And 
although no one of you may become the peer 
of those I have named—and yet, why should 
you not ?—still there is always room right next 
to them for the trained intellects who will make 
their profession an integral part of their lives, 
and devote themselves earnestly and truly to 
its pursuit. Never has there been such a de- 
mand in medicine for men of the highest 
type, the deepest insight, the profoundest 
spirit of investigation. Never have there 
It is of equal importance to the community 
as well as to you that you elect wisely what 
path you will follow in this busy world. Some 
of you will enter commercial life, lured, possi- 
bly, by hopes of material reward ; some may 
be devoted to art, with its esthetic enjoyments; 
some will find in literature the contentment 
and fame that come to the successful author; 
1 2 
been so many questions of grave import to 
the human race awaiting solution. The 
mighty problems of life and disease and 
death crowd upon us and await the touch of 
a master hand to make the obscure clear, to 
avert the dire results of accident, to stay the 
hand of the angel of death, and say in mas- 
terful tones, “ Thus far and no farther.” Medi- 
cine is looking to just such well-equipped, 
thoroughly trained men as you for its cham- 
pions in this daily fight with death. And if 
you wish to rise above the dull level of medi- 
ocrity, it will be to you college men that the 
renown which is the proper object of a laud- 
able ambition will surely come. President 
Thwing, in the June Forum, states that “ Ap- 
pleton’s Encyclopaedia of American Biogra- 
phy” contains the names of 912 doctors, of 
whom 473 were college-bred men. The 
Medical Record, commenting upon this fact, 
estimates that 300,000 men have started out 
in medicine in this country during the present 
century, and that, if so, the chance of the 
ordinary doctor becoming famous is about 
one in three hundred ; but if he be a college- 
bred man, it is about one in six. 
Five years ago nearly all the medical schools 
in this country were two-year schools. Now 
nearly all have three-year courses and a few 
four, and the new Pennsylvania law requires 
four years of study, of which three shall be in a 
medical school. This movement in the direc- 
tion of a more thorough education means that 
the medical schools desire to offer a curriculum 
worthy to attract the best educated men. 
Moreover, the medical schools are endeavor- 
ing to adjust their courses so that they will be 
the natural continuation of the college courses. 
Without sacrificing the symmetry and com- 
pleteness of the college curriculum or abridg- 
ing the studies for the medical degree, their 
aim is so to adjust the two that they shall be 
linked together as one complete whole. Thus 
many of the medical schools are considering 
what means can be adopted to draw into 
affiliation with them the colleges and college 
men in preference to others. The larger 
development of the Jefferson Medical College, 
of the medical department of Harvard Univer- 
sity, of the University of Michigan, of the 
University of Pennsylvania, and of Johns 
Hopkins, are evidences of the same wish to 
win college men to a medical career. The 
union of the College of Physicians and Sur- 
geons with Columbia College as its medical 
department, and the projected absorption of 
one or more of the Chicago medical schools 
by the University of Chicago, show the same 
tendency. Moreover, Brown University, La- 
fayette and other Colleges are looking equally 
toward the medical schools, as I have pointed 
out, by the establishment of courses which 
will naturally lead up to medicine. 
The profession, as I have said, is filled to 
repletion with poor men and untrained men. 
What we want is the men fresh from the 
laboratories of the best colleges—men whose 
minds are trained in logical methods, who are 
versed in the “ humanities,” who possess 
refinement and culture, who, having eyes and 
ears, have learned to use them. In that 
delightful book, “ The Gold-headed Cane,” 
Radclifife (him of the library) visits Mead in 
his library and says ; “ As I have grown older, 
every year of my life has convinced me more 
and more of the value of the education of the 
scholar and the gentleman to the thorough- 
bred physician. Perhaps your friend there 
(pointing to a volume of Celsus) expresses 
my meaning better than I can myself, when 
he says that this discipline of the mind, 
‘ Quamvis non faciat medicum, aptiorem 
tamen raedicinse reddit.’ ” 
If any of you look forward to medicine as a 
career, you should view it from three different 
standpoints. First, on its economic side. 
This is a matter of no little importance, for 
every man in this world must earn his living, 
and also naturally looks forward to the sup- 
port, not only of himself, but of his wife and 
children in the future. No one should expect 
in medicine to make a fortune. A few doctors 
do so, but they are the exception. But every 
man who enters medicine, if he will be faith- 
ful and honest in his work, and a fortiori the 
The signs of the times point to a closer 
affiliation of colleges and medical schools, 
which will be equally advantageous to both. 3 
more intellectual college man, can be sure of 
a competence—nay, more, can be sure that he 
will enjoy not only the reasonable reward of 
toil, but be able to lay up sufficient for his own 
old age and for his family. 
What a fruitful field there is in hygiene both 
for scientific and benevolent teaching, as to 
plumbing, drainage, ventilation, clothing, 
food, drink, city architecture, city streets and 
sewage, city water supply, and the eradica- 
tion of all the evil influences which confront 
us, in country and especially in city life. 
Many diseases are now recognized as prevent- 
able if the community were only alive to the ne- 
cessity and the possibility of their prevention. 
“ For every case of typhoid fever,” it has been 
said, “ somebody ought to be hung ”—a rough 
and epigrammatic way of stating what is un- 
doubtedly true, that in a perfectly regulated 
community there would be no typhoid fever. 
Secondly, a much more elevating and 
attractive side is the philanthropic or humani- 
tarian. The medicine of the future will be 
chiefly in the direction of that most philan- 
thropic object, the prevention rather than the 
cure of disease. Hygiene, or preventive 
medicine, has only arisen since I left college. 
It has already done much, but it promises 
far more. If it is necessary to show that the 
knowledge of hygiene is still limited, look at 
the recent reports on the sources of the water 
supply of the city of New York. Nay, you 
need only go into the slums of your own city; 
or, if you live in the more God-blessed coun- 
try, you may find a startling ignorance of the 
laws of health in almost every farm-house. 
Nay, more, you need only cross-question a 
half-dozen of your intimate friends as to their 
modes of life to discover that the laws of hy- 
giene are “ more honored in the breach than 
the observance.” 
But besides such public benevolent service, 
there is a personal philanthropic side of medi- 
cal life, to which I gladly advert. Picture to 
yourselves the daily life of the doctor. It has 
undoubtedly its trials, many and great. The 
humdrum recital of ancient aches and pains 
sometimes becomes irksome by repetition. 
The doctor has patients, upon whom he has 
bestowed unremitting care and his very best 
mental and physical powers, who have proved 
ungrateful and have even become his foes. 
He does an immense amount of unrequited 
service. His nights are disturbed, his days 
are not his own, of his family and friends he 
sees but little. But then, what calling does 
not have its trials ? In what life is there not 
friction, which, as in mechanics, should be 
allied for and not permitted to become a 
source of irritation and annoyance ? But in 
spite of all these trials, the doctor’s life is so 
rich in its personal rewards, in its humane 
service, that it ought to be to him a daily joy. 
That there is ample room for missionary 
work in the matter of personal cleanliness 
alone will be evident from two recent incidents 
in my clinics at St. Agnes’ and the Orthopedic 
Hospitals. At the former, as I uncovered the 
feet of a woman to examine them in conse- 
quence of an accident, I was startled at their 
condition, and asked her when she had had a 
bath. “ And phwhat’s that ? ” was the innocent 
reply. A t the latter, last winter, after examining 
the spine of a young lady of 16, the daughter 
of a respectable farmer, I said to the parents 
with a bluntness born of indignant surprise, 
“ It must be a long time since your daughter 
has had a bath ? ” “ Why, yes,” said her fa- 
ther, reflectively, “ I don’t believe she has been 
in a tub for a year.” To which his indignant 
wife replied, “ Why, of course she has, John. 
Don’t you remember that bath she took last 
summerf” They probably agree with a 
witty medical friend who seriously avers 
that “ everybody ought to take a bath once 
a year, whether he needs it or not.” 
There is to him a daily personal growth in 
knowledge. Every sick-room is a school- 
room, and every case a lesson, from which he 
comes a larger man. There is a daily per- 
sonal growth in character, so that he should 
lie down each night a better man. There is 
a daily personal growth in his power to do 
good, which should be at once a reward of 
past work and a stimulus to better. There 
is a daily personal growth in the friendships 
and esteems of life, which constitute one of 
the most delightful rewards of the doctor. 4 
What greater joy can there be in life than 
to go about among his fellow men, carrying 
with him, as the doctor does, an atmosphere 
of comfort, of hope, of courage, of health? 
surpassed even this result, that every 1000 
similar operations to-day add not less than 
30,000 years to human life. Think what one 
such life means, as the pale cheek regains its 
color, the feeble pulse its force, strength suc- 
ceeds to weakness, each day records a gain, 
and finally health is re-established. The ten- 
der father returns to his usual pursuits; the 
adored mother once more becomes the cen- 
tre of loving care of her family; the beloved 
child is restored to the family circle with 
ruddy health, rescued from the valley of the 
shadow of death itself. The hushed voices, 
the soft tread of the sick-room, have given 
place to the laughter of health, the mists of 
sorrow are driven away, the anxious alarms 
of disease have vanished. What, think you, 
can equal the joy of the physician as he 
views this happy transformation ? Who is 
a dearer, more cherished, more welcome 
friend than he? Who finds a warmer place 
by the fireside and in the very hearts of his 
patients? No one can adequately appreciate 
his profound joy, his daily delight, his deep 
gratitude to the “ Giver of every good and 
perfect gift.” Omy friends ! it is a blessed 
profession, a divine calling, with a heavenly 
recompense on earth. 
There come to him constantly cases in 
which disease challenges him to a contest. 
It says to him, as it were, “Catch me if you 
can, in all my devious wanderings and un- 
expected disguises and there is a mental 
exhilaration in following every turn in the 
trail and running to earth the fleeing goblin 
which is captivating to every inquiring mind. 
Look for a moment at the methods of the 
careful, intelligent doctor, as he investigates 
such a case. First, he inquires into the 
family history for lurking influences of evil 
heredity. Next, into the personal history, not 
only the physical history of the patient from 
birth, but the influences of his environment, 
his habits, his hours of rest, his methods of 
labor, his physical and mental virtues and 
vices. Then follows a history of his present 
illness, including all his symptoms, the exanv 
ination of his secretions and excretions, the 
shrewd judgment which eliminates unessen- 
tial and often the inaccurate or imaginative 
statements from those which are real and 
essential. Then, too, he must not forget the 
influence of mental states; of worry, of family 
trouble, of personal trials. Next he passes to 
the physical examination of his patient, when 
his eye must be as keen as that of an eagle, 
his touch deft and delicate in estimating fize, 
consistency, elasticity, and other physical 
conditions. He must then co-ordinate all of 
the disjointed facts with a mental acumen 
and logical method, which, at first laborious, 
becomes afterward comparatively easy if he 
has been faithful and thorough in his earlier 
investigations. By these means he reaches a 
diagnosis and settles definitely upon the 
medical or surgical treatment. Each case, 
then, is a study in physics, anatomy, physi- 
ology, pathology, psychology, chemistry, 
therapeutics. In the vast majority of cases 
he is rewarded by seeing returning health. 
Sir Spencer Wells as the net result of his 
first 1000 ovariotomies added 20,000 years 
to human life, and so far has modern surgery 
But sometimes death must come. Even 
here, however, the kind and sympathetic 
physician finds his place. Who can so ten- 
derly guide the poor sufferer to his long rest, 
so gently assuage the pain of the dying ? 
Who so endears himself to broken hearts in 
the hour of their bitter extremity as the 
strong yet tender Christian physician ? Often 
even death makes for us our dearest, most 
loving friends, who would pass through fire 
and water for us. 
Even the dangers of medicine and surgery 
are an attraction akin to those which draw 
the hardy mountaineer toward the dizzy 
heights of the Matterhorn. And when to 
these dangers is added, in times of pestilence, 
the clarion call of duty to his fellow man, 
where has there been a recreant doctor ? 
Point out the renegade if you can. The gal- 
lant Six Hundred who rode into the Valley of 
Death were no braver than the unsung heroes 5 
of Norfolk or of Hamburg. I glory in my 
profession, that in such hours of peril it has 
known no cowards; the meanest soldier in 
its ranks has been a brave, unselfish, devoted 
hero, and oftentimes a faithful, gentle martyr, 
dying at his post of duty. 
emboldened us to perform many operations 
undreamed of even by an Astley Cooper, a 
Nelaton, or a Pancoast. 
The third great discovery of the century is 
the new science of bacteriology, a child as yet 
in its teens. It arose when many of my 
younger auditors were discarding their knick- 
erbockers for trousers. That minute organ- 
isms or germs were the cause of very many 
diseases had long been suspected, but until 
twelve years ago we were not at all certain 
that the process of inflammation and the for- 
mation of matter or pus, or that many well- 
known diseases, were the result Of such germs. 
Now we know not only that they are the 
cause of all inflammation, but scientific in- 
vestigation has shown us that all suppuration, 
pneumonia, lockjaw, diphtheria, erysipelas, 
leprosy, tuberculosis, and a host of other 
diseases are due to these minute vegetable 
germs. You can easily understand that only 
the first elementary facts have been ascer- 
tained, and by no means all of these. Here 
is a whole new science awaiting patient in- 
vestigation and brilliant discovery. Who 
that has ambition and enthusiasm is not 
aroused by such a prospect ? 
But besides the economic and the philan- 
thropic side, medicine has its splendid 
scientific aspect, which fuses with both of the 
others and yet may be regarded separately 
from them. Let me point out some of the 
best achievements and present problems of 
medicine. The present century has seen 
vast strides in every department of medi- 
cine. I will not weary you by mention- 
ing the immense improvements made in many 
minor details, which would be more suited to 
a technical audience; but it is proper that I 
should allude to three brilliant discoveries 
which stand out prominently as of the first 
magnitude. 
First, the discovery of anaesthetics. The 
beneficent results from this discovery are so 
well known that I need only call attention to 
them, and also note in passing that the three 
principal anaesthetics, ether, chloroform, and 
nitrous oxide, are American either by discov- 
ery or by introduction into general use. 
How is it that these minute germs produce 
their malign influences ? We know that they 
secrete or in some way prodqce certain dele- 
terious poisons in the human body, but how 
these or the bacteria act we do not know. 
When we learn just how they act, in all prob- 
ability we shall be able soon to discover the 
means of counteracting their harmful influ- 
ences. The problem how to destroy the 
bacteria without destroying the patient is 
one which we have not yet solved. We 
know that they produce infection. We 
know fairly well how to prevent their en- 
trance into the body in surgical cases, by the 
careful antiseptic cleansing of the person of 
the patient, of the instruments, sponges, 
dressings, hands—everything which comes in 
contact with the wound. But in many in- 
stances cases are brought to us already in- 
fected. A man who has met with any 
accident has an infected wound, and if any 
time has elapsed his system has become in- 
The second great achievement is the anti- 
septic method, by one of our cousins across 
the sea, the justly immortal Sir Joseph Lister. 
While anaesthetics have been an immense 
boon, especially in the domain of surgery, 
antiseptics have saved countless lives and un- 
told suffering. The method is so recent that 
I have seen both its birth and its develop- 
ment. In our late war and for ten years after 
its close every wound and every operation was 
followed, as a matter of course, by fever and 
more or less suppuration, or the formation of 
“matter,” which in a multitude of cases resulted 
in blood-poisoning, erysipelas, hospital gan- 
grene, lockjaw, and a hundred other kindred 
evils from this Pandora’s box. Now, how- 
ever, we are enabled to perform any one of 
the ordinary operations, such as amputations, 
ligations of the great blood-vessels, the ex- 
tirpation of tumors, and the like, with almost 
absolute safety, and this surgical security has 6 
fected. We are as yet groping for methods 
by which we can surely overcome such a pre- 
viously established infection. Here, you see, 
is another field for scientific activity and the 
most beneficent results. 
does not take. We know very well, too, that 
there are some human diseases from which cer- 
tain persons are exempt. For instance, some 
people have grown up from childhood, been 
exposed to scarlet fever, or measles, or small- 
pox, and yet have not taken it. These ani- 
mals or people have what we call a “ natural 
immunity ”to these diseases. Thus far, pre- 
ventive medicine has only attacked one dis- 
ease in the way of producing an artificial or 
“ acquired immunity.” This is vaccination* 
by which immunity against smallpox is pro- 
duced, or, in other words, a vaccinated person 
can be exposed repeatedly, even in epidemics 
of smallpox, without contracting the disease. 
With such a striking example before us for 
over a century, how strange it is that it did 
not suggest experiments in the same direction 
in other diseases. 
We are learning how to prevent typhoid 
fever, tuberculosis, and other medical dis- 
eases, but have not even yet begun to learn 
how to prevent the entrance into the system 
of the bacilli of pneumonia, influenza, and 
other similar diseases. 
The fearful ravages of cancer are familiar to 
all. Its cause is unknown, its cure is achieved 
only by its early extirpation, and even then, I 
must regretfully confess, is but rare. But with- 
in the last year research has seemed to show 
that we are on the verge of the discovery of its 
cause, and if so time will give us its cure. Who 
of you would not rather make such a discovery 
than be the father of the Atlantic cable or the 
successful general of a great war ? Who 
would be so blessed by future millions of man- 
kind as the discoverer of such a boon to the 
whole race ? 
But at last this hint has been taken, and it 
promises much in the future. For instance, 
it has been discovered that if we inoculate an 
animal with the germ of lockjaw, the most 
virulent of all bacteria, and then take the 
watery part of the animal’s blood—the blood- 
serum—and inoculate another animal with it, 
the second animal may then be inoculated 
with the germ of lockjaw without becoming 
the victim of the disease ; in other words, in 
the second animal there has been produced 
an acquired immunity against the disease. 
Even if the lockjaw had already attacked the 
second animal, this blood-serum, it was found, 
would vanquish the disease. Here we come 
to one of the most striking recent results of 
scientific investigation. Once that it had 
been tried sufficiently often to determine that 
this mode of conferring immunity or of arrest- 
ing the disease was not deleterious to the 
animal, it was deemed right that the same at- 
tempt should be made in man to cure this 
dreadful malady; and within the last three or 
four years there have been recorded nearly a 
score of cases iri which patients suffering from 
violent attacks of lockjaw have been cured 
by inoculation with the blood-serum from 
such an animal. This immunity or cure is 
supposed to come from some antidote, or, as 
it is called, antitoxin, produced in the first 
Again, there are certain half-discovered 
facts which already give us glimpses of un- 
suspected triumphs. Within the last few 
years it has been found by experiments on 
animals that the germs of certain diseases, 
when inoculated, for instance, in a rabbit, from 
that to a second, a third, and so on, become 
intensified in their action ; whereas, if simi- 
larly inoculated in one monkey after another 
they become diluted and weakened in their 
action. How or why does the virus or germ 
become stronger by transmission through a 
series of rabbits and weaker in its transmis- 
sion through monkeys ? How can we utilize 
this for the benefit of humanity? Here is 
another problem awaiting its Newton or its 
Morse. 
Again, we know that there are animals in 
which we cannot produce certain diseases. 
For instance, the attempt has been made 
scores of times to inoculate cancer into the 
lower animals without success. They do not 
suffer from measles or scarlet fever, whoop- 
ing-cough or mumps. There are also dis- 
eases peculiar to certain animals which man 7 
inoculated animal and introduced into the 
body of the second animal or of man with 
the blood-serum. Think you that it will be 
no great service to humanity, no great scien- 
tific feat, which will fill one’s mind with a won- 
dering, never-ending satisfaction, and crown 
his life with fame, when this problem is fully 
solved ? What extraordinary results it may 
lead to we can as yet only guess at, but its 
possibilities seem magnificent. At this very 
moment Dr. Hafifkine is in India inoculating 
people with the antitoxin of cholera, and bids 
fair to succeed in his efforts to limit or pre- 
vent this fearful plague. 
amenable to operation, but modern surgical 
methods have so improved that several 
hundreds of cases have been reported in 
which the goitre has been removed, and the 
patients have nearly all recovered. But after 
these operations a curious and unexpected 
result was found. Goitre consists in the en- 
largement of a certain gland in the neck, 
called the thyroid gland. If the whole of 
this gland, either in health or disease, was re- 
moved, a considerable proportion of such 
patients underwent a sort of elephantine 
growth all over the body. The features 
became thick and clumsy, the fingers and 
toes swelled to twice or thrice their or- 
dinary size. The mental condition, also, de- 
generated into a form of cretinism. This 
misfortune attending the complete removal of 
the gland led, first to a modification of the 
operation, viz.: the partial instead of the total 
removal of the gland; even a little of the 
gland, if left, it was found would prevent such 
a bad result. But it has done more than this. 
Victor Horsley, in England, suggested that in 
cases in which, as sometimes occurs, this dis- 
ease, myxoedema, arose spontaneously, the 
thyroid gland itself might be used as its best 
remedy. Accordingly, first it was used surgi- 
cally, The thyroid gland was removed from 
a sheep and transplanted under the skin or 
into the abdominal cavity of the patient. It 
grew there, and so long as it remained the 
patient was bettered; but experience showed 
that the gland soon disappeared, and the bet- 
terment vanished with it. Then an extract 
was prepared from the gland and used hypo- 
dermatically. This gave still better results; 
but it was suggested again that if the patient 
were simply fed on the gland itself (it is one 
of the sweetbreads of the body), cure might 
follow ; and within the past year a large num- 
ber of cases have been reported which have 
been cured by this wholly new method of 
treatment. See, then, here another fruitful 
field of research in the administration of 
various remedies derived from particular 
glands or other structures in the animal body. 
Already such an extract from the brain has 
been used in epilepsy, but it is too early as 
You have all heard, of course, of Koch’s 
tuberculin. This consists of a modification 
of the ptomaines or poisons produced by die 
little bacillus or germ which causes tuberculo- 
sis, or consumption. You know how the 
discovery was prematurely announced and 
heralded by the newspapers, and then fell into 
disuse, and has been the object both of ob- 
loquy and ridicule. As a matter of fact, it is 
still being used in other modified forms by 
physicians and surgeons, and it is not too 
much to say that we have gone a long way 
toward finding the means by which within 
the next few years we shall probably cure con- 
sumption and all the dire effects which follow 
from tuberculosis. And when I tell you that 
there is not an organ in the body which is 
not affected by tuberculosis, and that it is the 
cause of far more suffering and more deaths 
than any other disease, you will appreciate 
the immense boon its cure will be. 
And please note that these instances which 
I have given, of lockjaw, and cholera, and 
consumption, are but types of a series of 
investigations in the antitoxins, or natural 
antidotes. This opens the door to a wholly 
new class of remedies, furnished by our very 
foes, on which a large number of experiments 
are being constantly made. 
Within the last two years also another class 
of remedies has been introduced, especially 
in connection with a disease with which you 
are probably not familiar, known as myxoe- 
dema. You all, doubtless, are aware of what 
goitre is. Until lately it was scarcely deemed 8 
yet to say whether the result will prove to be 
good or not. Within a month, Vaughan, of 
Ann Arbor, has also called attention to the 
fact that the extract of the thyroid and other 
glands is fatal to bacteria. This new discov- 
ery may lead to the most beneficial results. 
Stanley. Here, again, is another problem 
seeking solution—a problem which is enough 
to arouse the scientific ambition of any enthu- 
siastic mind. 
Again, it is only within the last five years 
that an accurate knowledge of the relation of 
diseases of the ear to diseases of the brain 
has been recognized and their scientific sur- 
gical treatment begun. The splendid results 
already achieved give promise that within a 
few years we shall know not only how to cure 
brain disease, the result of ear disease, but, 
what is far better, how to prevent it. 
But what we do not know in bacteriology 
is far, far greater than what we do know. The 
bacteria of scarlet fever, of measles, of small- 
pox, of whooping-cough, of typhus fever, 
rabies, and many other diseases are as yet 
wholly unknown and awaiting your touch, 
your investigation. If you miss the chance, 
others will seize it. 
The anatomy of the nerves has been known 
for many years in its gross outlines, but the 
problems which present themselves here are 
many and varied. Cut a certain nerve, the 
ulnar, which supplies the inner part of the 
hand, and the results are not the same in all 
patients. You may abolish touch, and yet pain 
will remain. You may even, as I have seen 
within the last few weeks in several cases, cut 
out one to three inches of the sensitive nerve 
of the face, and it will be reproduced, and 
with it the frightful pain of tic douloureux, 
for which the nerve was removed, will return. 
On the other hand, by a wound or an opera- 
tion, from one to three inches of a nerve may 
be removed, and you want the nerve to be 
reproduced and so re-establish sensation in 
the skin supplied by it and motion in the mus- 
cles to which it goes, and the nerve steadily 
refuses to reproduce itself. Why in the one 
case it will and why in the other case it will 
not reproduce itself we do not know. In fact, 
what we do 7ioi know about nerves alone 
would make a good-sized book. 
If I were to ask any one of you whether 
Anatomy, Physiology, and Chemistry are 
comparatively complete sciences, I suppose 
you would answer, unhesitatingly, yes. On 
the contrary, they are most incomplete. We 
know to a fair extent the gross anatomy of 
the human body, although even here there is 
an immense deal to be learned ; but the mi- 
nute anatomy is not well known, and there is 
scarcely an organ in the body whose physiol- 
ogy has been half studied. Even so common 
a substance as the white of an egg has thus 
far defied the chemists, and the analysis of 
95 per cent, of the solids of the animal body 
is imperfect. Yet this is fundamental physio- 
logical chemistry. 
When I first taught Anatomy the great 
divisions of the brain into two hemispheres, 
the cerebrum, the cerebellum, etc., were, of 
course, known, but the various convolutions 
of the brain surface were deemed to be simply 
fortuitous by the anatomist, the physiologist, 
the physician, or the surgeon, and one convo- 
lution had no more value than another. In- 
vestigations in the last twenty years have 
definitely mapped out the brain, showing that 
the convolutions and fissures are not arranged 
hap-hazard, but on a definite plan. A portion 
of the brain at the back of the head and a 
little at the side of the head are fairly well- 
known—well enough, indeed, for the success- 
ful performance of extraordinary operations 
in diseases and injuries of the brain. But all 
the rest of the brain is as yet almost a terra in- 
cognita—an Africa standing expectant for its 
Thirty years ago, when we looked at an eye 
all we knew was what we could see on the 
outside. The trouble was that nothing could 
be seen inside the eye, although there was 
such an inviting window in front of it by 
which we could look in, because the interior 
was totally dark. But it occurred to Helm- 
holz that if by a little bit of looking glass he 
reflected light into the eye, and then scratched 
a little hole in the quicksilver, he could look 
through the hole into the illuminated interior 
of the eye and see all there was inside of it. 9 
From this simple idea has arisen the ophthal- 
moscope, by which the whole medicine and 
surgery of the eye have been revolutionized, 
and great light has also been thrown on dis- 
eases of the brain. 
years, greater, I venture to say, than in all 
previous time, I believe that the next fifty 
years will far eclipse the discoveries of the 
past fifty. Who could have predicted the 
rise of bacteriology a score of years ago ? 
And who will venture to say that in the next 
twenty years another science, equally far- 
reaching, equally beneficent, equally brilliant 
in its achievements, may not arise? Even 
the present is a splendid time. ’Tis 
Again, when the mouth was opened, we 
could see certain parts, but the whole interior 
of the larynx and windpipe was beyond our 
sight, and, therefore, beyond our knowledge. 
But soon after the ophthalmoscope was dis- 
covered, Czermak and Turck found that if a 
little mirror were held in the back of the 
throat at an angle of about 450 and a ray of 
light were thrown upon it from a small per- 
forated bit of looking glass, the interior of the 
throat, like the interior of the eye, would be 
illuminated, and we could look through the 
little hole in the looking-glass and see the re- 
flected image of the vocal chords and the 
whole of the larynx in the mirror. 
“ An age on ages telling, 
To be living is sublime.” 
But the twentieth century, in which you will 
live, will be the most glorious time of all the 
ages. 
And you may take part in this grand march 
of progress, not only in the rank and file, but 
as a leader if you will but write; or it may 
be if you have the gift of imparting know- 
ledge you may be one of the teachers of 
medical science—an enviable post of labor 
and responsibility, but also of unequaled 
honor and enjoyment. 
Similar inventions await the ingenious in- 
vestigator of the future for the examination 
of other cavities and organs of the body, and 
the day is not far distant when we shall be 
able, I hope, to see, and therefore to know, the 
interior of the stomach as well as we do the 
exterior of the body. That this will illumi- 
nate our own minds, as well as the stomachs 
of our patients, is certain. 
Have I not put before you enough to arouse 
the ambition, the energy, the benevolence, the 
enthusiasm of any young man about to choose 
his career ? Can there be in any other depart- 
ment of human knowledge so fine a field for 
research, for discovery, for fame, and, what is 
far better, for serving the human race ? If in 
consequence of what I have said to you some 
of you will select medicine as your chosen 
pursuit, rest assured that if you will faithfully 
perform your duty, at the close of life you 
will have the pleasure of surveying a career 
which has been advantageous to yourselves, 
has been a means of doing good to your 
fellow men, and, I verily believe, has approxi- 
mated as near as possible to the Divine life as 
is given to any man to do. 
And so I might go on in one department of 
medicine after another, presenting to you 
similar problems, some of them so technical 
that they would not be suited to a non-pro- 
fessional audience, and in each show you the 
vast need there is for bright minds. Has the 
last word been said in surgery, in medicine, 
in the diseases of any of the special organs of 
the body ? Nay, verily, we are but at the 
alphabet of investigation and of cure. Great 
as has been • the progress in the last fifty