MEDICINE AS A CAREER. 
To the young man about to choose a professional career, medicine 
at this time offers opportunities for the employment of the highest 
mental faculties, for the increase of knowledge, for usefulness to the 
world, and for the attainment of true happiness, such as no other pro- 
fession presents. It is not meant by this to assert that it will certainly 
secure to its followers all or indeed any of these things, but that, 
given the same degree of intellect with a good preliminary education, 
the probabilities are that out of a thousand men taking up the study 
of medicine more will attain success than will do so among a similar 
number of young men of like character and attainments who devote 
themselves to theology, law, politics, or education. 
What is the meaning of “success” in this connection? I call a 
successful career one in which the man has done good work, the best 
of which he was capable, work in which he was strongly interested 
and which in itself gave him pleasure, work done unselfishly because 
he believed it to be good work which ought to be done and not merely 
performed as a means grudgingly made use of to obtain wealth or 
fame or power as the real objects sought. It is a career which has 
secured a happy home and sufficient means to support it, although it 
may not have led to wealth; it has brought to its pursuer the ap- 
proval and friendship of those best acquainted with his life and work, 
although it may not have made him famous or given him decorations 
or formal honors; it has made his advice valued and sought for by 
those who know him, although it may not have given him an execu- 
tive office or made him a ruler over his fellow-men. Such a career 
does not protect from the afflictions and sorrows common to humanity, 
but it does away in a great measure with boredom and ennui, with 
weary waiting for something to turn up, and the work itself is the 
best resource against inevitable grief. The man who achieves such a 
career has not been dependent on his acquaintances for his happiness, 
he has not fretted and worried because his family or his friends or 
his associates or the state have not recognized his merit according to 
his conception of it, for he has acted on the principle that he exists 
for their benefit and that they are not merely his appendages. 726 
MEDICINE AS A CAREER. 
In speaking of a medical career as a means of obtaining such suc- 
cess, the word medicine is used in its broadest sense to include the 
study of the phenomena of human life—disease and death—the circum- 
stances by which these can be influenced, and the practical application 
of the results to prevention as well as to cure. No other profession 
affords such opportunities for investigation and experiment or a 
greater field of usefulness, and no other profession demands so much 
knowledge of natural science and of the laws of being. Of all men, 
the skilled physician stands nearest to the veil of Isis, which is be- 
coming thinner, though it may never be lifted. To one who has a 
thirst for knowledge for its own sake or as a means for the benefit of 
others, the problems of the medicine of to-day offer peculiar attrac- 
tions, for it is not that which is known, but that which is half known, 
mysterious, tantalizing, and which apparently might be known by 
special study, which attracts such a man. 
In the preface to the “Meddygon Myddfai,” a Welsh medical work 
dating from the thirteenth century, the scribe declares that the reason 
why the authors Rhiwallon and his sons “thus caused a record of 
their skill to be committed to writing was lest no one should be found 
after them so endowed with the requisite knowledge as they were.” 
We may excuse the naive vanity of these physicians in view of their 
desire to make their knowledge available for the general good; but 
there is small danger that any skilled practitioner of to-day will be 
troubled with the fear which beset the physicians of “Myddfai.” The 
more he knows of the huge strides which have been made in recent 
years in our knowledge of the laws of life and of disease, the more he 
sees the extent of the dim, hazy, shifting outlines which yet remain to 
be explored, measured, and mapped out. He must be a student so 
long as he lives; as yet there is no visible end of the things which he 
does not know and ought to know and has reason to think that he 
might know by the expenditure of a little time and effort. Let us 
consider a few of the simplest examples. 
We know that the cholera bacillus is the essential or immediate 
cause of Asiatic cholera; but we do not know why it was that when, 
the other day, von Pettenkoffer and Emmerich swallowed several 
millions of cholera bacilli and proved that these were living in their 
alimentary canals they did not have cholera. Was it due to the fact 
that the bacilli had their nature changed by culture, or was it due to 
the mysterious ux ” which von Pettenkoffer supposed was present in 
Hamburg and not in Munich? We know that malaria is probably MEDICINE AS A CAREER. 
727 
due to a minute animal organism which has several stages of develop- 
ment, some of which occur while it is in the human body. But we 
have not yet been able to observe the growth and development of this 
organism outside the human body, where it probably has a different 
form. It may be, for instance, in a mosquito, and until we know, we 
have not mastered the chief problem in the important matter of prac- 
tical prevention of malaria. We know that typhoid fever is caused 
by the poisonous products produced by a minute vegetable, the bacillus 
of typhoid; but we do not know whether this bacillus has one or 
many forms, or whether it may not under certain circumstances be 
developed from organisms which every man carries within his ali- 
mentary canal during adult life. Probably also the effects of this 
bacillus or of its products are modified to a considerable extent by 
the antecedent or coincident action of certain other bacteria and their 
products; but experiments on this point have only just been com- 
menced. We know that the products formed by the growth of 
certain disease-producing bacteria, as, for instance, those of anthrax or 
tetanus, have the power of making an animal immune against those 
diseases, or, in other words, that the poison is hostile to the organisms 
which produce it; and this is probably about to become the basis of 
new and successful modes of treatment as well as of prevention of 
such diseases, but the amount of work yet to be done to place this on 
a firm scientific basis is enormous. 
It is now known that the brain is not a single organ, but an aggre- 
gation of many nerve-centres, each having a more or less distinct 
function, although closely connected with others; that the action of 
some of these centres may be specially stimulated or checked either 
by certain products evolved by various organs and parts of the body 
or by certain drugs or by producing certain sensations through the 
channels of vision and of hearing. Thus, through the modern 
methods of investigation of the structure, connections, and functions 
of these nerve-centres, we are beginning to understand better the 
mental phenomena of man and their aberrations as the result of 
disease or of drugs or hypnotism. We have now some means of 
measuring the rapidity of mental action and find that “ as quick as 
thought” is really not very quick, and we can locate certain lesions 
of the brain, from the external symptoms which they produce, with so 
much precision as to justify the surgeon in opening the skull at the 
point indicated and removing the cause of the trouble. Yet psycho- 
physics and the physiology, pathology, and therapeutics of the 728 
MEDICINE AS A CAREER. 
nervous system are branches of medicine which as yet are only in 
their infancy and in which there are many modes of investigation 
yet to be tried. 
In like manner, I might indicate the possibilities, even the prob- 
abilities, that such diseases as diphtheria, hydrophobia, tetanus, 
rheumatism, yellow fever, and cancer will in the near future be de- 
prived of much of their danger by the results of scientific study. I 
might take up each of the systems, organs, and fluids of the living 
body and show how the latest methods and discoveries in bacteriology, 
chemistry, electricity, etc., re main to be applied in research, in 
diagnosis, or in therapeutics with regard to them; but enough has 
probably been said to prove not only the variety and extent of the 
fields to be explored, but that they lie close at hand and are really 
explorable. And every new discovery widens the horizon and opens 
new paths. It would be easy to-day to set before each of a hundred 
skilled investigators a problem in physiology or pathology as yet 
unsolved, but probably solvable by a few years’ patient labor; and 
each one of these students in the course of his work would un- 
doubtedly come across a dozen other problems as side issues which 
would claim attention. |The clergyman subscribes to certain doctrines 
which he is to expound and explain; the lawyer takes a proposition 
and collects evidence in favor of it; but the physician collects evi- 
dence first and then asks, not what it proves, but what it makes 
probable j 
That \Vhich is unknown, but probably knowable, has, as I have 
said, great attractions for certain minds, and to such 1 medicine as a 
career needs no other panegyric than the indication of the possibilities 
which it presents. The tastes of other men incline not so much to 
actual experiment as to the collation and comparison of the results of 
the experiments of others. In this, also, medicine presents at the 
present time peculiar attractions. Its current literature is of vast 
extent, and while much of this literature is worthless, much of it is 
suggestive, and perhaps one per cent of it is of permanent value. 
Now, it is this very fact that it requires search and discrimination to 
find what is useful that is attractive to certain minds. Just as, in the 
early days of California, pocket-hunting had a zest of its own which 
regular quartz-mill work could not give, so the man who commences 
a literary research for what has been reported with regard to some 
peculiar disease or method of treatment may take great pleasure in 
the search itself and be rather disappointed than otherwise if he MEDICINE AS A CAREER. 
729 
comes across an article in which he finds the work ably done for him. 
The great difficulty in this field of investigation is, for most men, the 
want of access to the books required. 
Passing now from the pleasures of study for its own sake, which 
in the eyes of a few surpass all others, let us briefly consider the in- 
ducements which medicine offers as a career to the man who desires 
knowledge mainly as a means to an end, that end being practical 
utility to his fellow-men. 
A professional man is defined as one who professes or announces 
that he is in possession of special knowledge such as the great majority 
of men do not have, and that he is willing to furnish the benefit of 
his knowledge to his fellow-men in the shape of advice or super- 
vision of certain of their affairs. The three learned professions offer 
such advice and supervision with reference to men’s souls, property, 
and bodies; but, as Mr. Evarts has remarked, the field of usefulness is 
more universal for medicine than it is for law or theology, since there 
are many who have no property to be cared for and there are some 
with regard to whose possession of souls there may be a question; 
but everybody has a body, which at times is liable to require skilled 
management to avoid suffering and death and to enable it to do its 
work, although some bodies, it must be confessed, are hardly worth 
preserving. Almost every one sooner or later desires the aid of the 
physician’s special skill for himself or for his family; wealth, genius, 
fame, power do not specially diminish this need, nor do poverty and 
ignorance exempt from it. It is true that there are things more im- 
portant than bodily health, that there are times and occasions when it 
is one’s duty to undertake or persist in a mode of life which will 
almost certainly produce premature disability or death, and, as Dr. 
Allbutt says, “ there is something not heroic in the mere health- 
hunter, the man who wanders from doctor to doctor and from land to 
land, not that he may do his duty the better, but that he may have an 
ache the less.” This, however, does not make it the less necessary 
for physicians to supply the wants of all, trivial though they may 
seem to him, for each must be allowed to judge for himself as to 
where and how much the shoe pinches. 
Consider the practical usefulness of medicine. It is not merely 
physical pain in individuals that is to be lessened or averted. Its re- 
sults extend far beyond the man whose disability is removed, whose 
pain is diminished, whose death is delayed, and who is thus enabled 
to go on with his share of the world’s work; they affect the welfare and 730 
MEDICINE AS A CAREER. 
happiness of his family, of his associates, and, it may be, the interests 
of a nation, or of the world of science, of literature, or of art. It deals 
also with the health of cities and of nations, with great commercial 
interests, threatened on the one hand by epidemics and on the other 
by unwise and unnecessary restrictions imposed under the dictates of 
panic, the offspring of ignorance and cowardice, and its power and 
possibilities are inextricably involved in many social problems of the 
gravest importance to modern civilization. 
The relative influences of heredity and of environment in the pro- 
duction of the defective, dependent, and dangerous classes of society, 
of the feeble-minded, the insane, the deaf-mutes, the vagrants, and the 
criminals, the means of preventing such production or of dealing with 
them after they have been produced, are all medical quite as much as 
they are sociological questions. It is to specialty skilled physicians 
that the jurist looks for advice in dealing with persons whose respon- 
sibility for their actions is doubtful; the wise theologian will seek 
their counsel in cases of morbid conscientiousness and self-reproach, 
of epidemic emotional manifestations under religious influence, of 
alleged miracles. The professional educator, from the teacher in a 
common school to the head of a great university, has need of the 
information which the medical sciences are collecting with regard to 
the development of the organs of sensation, of memory, of comparison, 
and of judgment, which he is training for the coming generation, the 
men and women of the twentieth century; and with regard to the 
effects of variations in light, food, exercise, succession or order of 
studies, and many other things connected with school or college life 
upon the little masses of gray nerve substance which form the phy- 
sical substratum of intellect, of emotions, and of morals. Whether 
one supposes that soul, intellect, and vital force are each distinct 
entities, having an existence independent of these nerve-centres, or 
that one or more of them are the result of the organization and func- 
tion of such centres, all must admit the fact that injury to these 
centres modifies or prevents their manifestations. With a little 
change in certain cells of the cortical gray, a change which requires 
the use of the microscope to determine, the orator becomes speech- 
less, the judge becomes a criminal, and the prudent man of busi- 
ness, the affectionate husband and father, the model citizen and 
pillar of the church becomes extravagant, unchaste, deceitful, and 
thus enters upon the first stage of a degeneration which, if unchecked, 
will make him a hopeless paralytic and a drivelling idiot. MEDICINE AS A CAREER. 
731 
In the first part of this paper has been briefly indicated the vast 
field of unknown and imperfectly-explored regions which belong to 
medicine, and from this point of view it may be supposed by some 
that our present knowledge is of little value. This is by no means 
the case. Modern medicine possesses great knowledge and power, 
much more in some cases than it is allowed to use, because popular 
opinion has not yet been educated to the point of appreciating its 
value. It is in the curious position of continually offering advice 
which, if accepted, would greatly lessen the need of the public for its 
services. When people are ready to obey the physician it is in many 
cases too late for them to have the benefit of his most valuable knowl- 
edge and skill: the tissues are already degenerated, the arteries are 
prematurely old, the epidemic is already raging among the people. 
The medicine of the future is preventive medicine, that which will 
foresee the evil while it is as yet afar off and take measures to avert it. 
I have said that a successful career brings to its pursuer the ap- 
proval and friendship of those who best know his work, and this is 
preeminently true of practical medicine. In some matters the wife 
trusts the medical man more than she does her husband, the youth 
comes to him in trouble concealed from his parents, and the man of 
business confides in him as he does not in his partner. The skilled 
physician becomes not only the trusted adviser in disease, but the per- 
sonal friend, the one who is appealed to for sympathy in joy as well 
as in trouble, whose company is sought upon all occasions, whose 
mere personal presence brings with it assurance and comfort. Almost 
every reader of this paper knows some such man, in whose honesty of 
purpose, fidelity in keeping confidences, and readiness to undergo toil 
and trouble for the sake of his patients, all who know him have per- 
fect confidence; he lives, as Mr. Bayard has said, “surrounded by 
an atmosphere of love and trust, holding as it were the heart-strings 
of a family in his hands.” Sweet as are such trust and affection on 
the part of his patients, at least equally sweet are the confidence and 
friendship which come to him from those best qualified to judge of 
that part of his work which has been done rather for the benefit of 
the community, of science, and of the world than for individuals. 
These are, for the most part, the members of his own profession whom 
he has helped. Some of them may have been his immediate pupils; 
others, whom he may never see, have read his writings or have in 
other ways obtained help from his labors and express their apprecia- 
tion of it in many ways. Through the respect and confidence thus MEDICINE AS A CAREER. 
developed lie becomes a well-known consultant, the man whose 
advice is sought by his brother-physicians in doubtful and difficult 
cases. This increases his experience and his influence and calls his 
attention to the many points in which medical science is still defec- 
tive; for too often when he sees the case he can but recognize its 
incurability and offer only transient relief from suffering. 
The phrase “ brother-physicians ” is one that applies especially in 
medicine, because for more than two thousand years in all civilized 
countries educated physicians have recognized each other as belong- 
ing to a brotherhood. It comes from the time when the study of 
medicine was hereditary in certain families and when the candidate 
swore by Apollo and all the gods “ to reckon him who taught me this 
art equally dear to me as my parents, to share my substance with 
him and relieve his necessities if required, to look upon his offspring as 
my own brothers,” etc. Thus medical men everywhere recognize the 
claim of a physician to advice and care in case of sickness or injury 
and accept no fee for it. As Weir Mitchell says, “the physicians’ 
guild is a world-wide guild, the only one.” 
It is necessary, in speaking of medicine as a career, to consider its 
demands as well as its inducements, and these demands, for those who 
wrish to secure such success as I have referred to, are for good mental 
capacity, for a long period of study, for much patience, for powers of 
physical endurance, for quick and keen sympathies, for honesty and 
for purity of thought, word, and deed. In the hands of the physician 
are placed at times not only the issues of life and death, but of 
things more valuable than these. Not more than one man in a thou- 
sand can properly comply with all these demands. The young man 
whom I would advise to take medicine as a career should have had a 
broad preliminary education, he should know his “humanities,” and 
it is highly desirable that he should have taken his B.A. degree at a 
large university, not merely as a guarantee that he has had proper 
training, but because of the associations which he will have formed 
there, the ideas which are in the air, the intelligent sympathy with 
literature, science, and art which will there be developed and which is 
essential to his future usefulness and happiness. He is then to take a 
four years’ course of instruction in a medical school having ample facil- 
ities in the way of laboratories and hospitals. Following this should 
come a service of a year and a half as resident in a large hospital. 
By the end of this period, and not much before the end of 
it, he will be qualified to form a fairly wise judgment as to his own MEDICINE AS A CAREER. 
733 
capacity and tastes and as to the particular branch or branches of 
medicine which are best suited to his wishes. He must beware of 
beginning to specialize too soon; the foundations must be broad. 
Now he can decide whether his next two or three years of study shall 
be spent chiefly in laboratories or in clinics, or how they shall be 
divided between the two. As an undergraduate in medicine, his work 
in laboratories must be confined to the learning of a few methods of 
techniqiLe and something of the spirit which animates research. When 
he comes to making original research for himself, he will find that its 
demands for unremittent persistent attention and thought are such 
that for the time being he can do little else. The clinic instruction 
which he needs after his residence in the hospital is not to be had in 
one place or from one man: he needs to compare the manners, the 
methods, and the results of different men, each the leader in his own 
place, and for this purpose he must travel and visit the great clinics 
in different cities. This done he will be ready to go to work, he will 
have some idea, though probably not an adequate one, of the things 
he does not know, and his advice and opinions will begin to be 
valuable. There is little cause to fear lest he do not find employ- 
ment ; there is always a place for a competent and trustworthy man- 
for one who can be depended on to work without supervision and 
to do more than the letter of his engagement calls for; and in labora, 
tories, in hospitals, in medical schools, and in the broad field of prac- 
tice there are such places waiting to-day for the men who have not yet 
been found for them. 
But it will be said by some, “You demand too much time and 
money for education and training; the man ought to begin to support 
himself long before your scheme would permit him to do so.” My 
answer is that the man who has the means which will enable him to 
spend the time above indicated as required to fit him to take charge 
of the health and lives of his fellow-men had better so invest them, 
while he who has not such means should carefully consider as to 
whether he had better not abandon all thought of studying medicine 
and try some of the numerous other occupations which offer a better 
investment for his time and money and in which he may be a less 
dangerous and more useful member of society. This country is in no 
need of men possessing the diploma of Doctor of Medicine; it already 
has at least twenty thousand more of them than it requires or can 
properly support; but it does need several hundred, say a thousand, 
more of such properly-trained physicians as I have indicated, and I 734 
MEDICINE AS A CAREER. 
am quite sure that the people will be able to recognize them when 
they appear and will take proper care of their material interests. 
My young friend whose attention I wish to direct to medicine as 
a career will have spent five years at a good intermediate school as a 
preliminary to entering the university, which he does when he is 
about seventeen years old. He spends three or four years at the uni- 
versity, four years at the medical school, one and one-half years in the 
hospital, and two years in travel and special studies. When, therefore, 
he is ready to begin work he will be about twenty-eight years old, and 
his education, living, books, etc., will have cost about eight thousand 
dollars from the time he entered the university. It can be done for 
less, but this is a fair average estimate. 
I am not considering medicine as a trade or looking at it from the 
commercial point of view. I have not presented among its attractions 
the probabilities of being able to have a villa at Newport or to keep a 
yacht or fast horses, but have only claimed that it will provide means 
to secure a comfortable and happy home and to aid in some degree 
those who are less fortunate. The physician whom I have in mind can- 
not afford to waste his time in making more money than is required 
for his own immediate needs and for those of his family; as one who 
has had special advantages in culture and in the acquisition of knowl- 
edge, he is subject to special claims on the part of his fellow-men who 
have not been granted such opportunity. The torch of science is 
placed in his hands, not merely to illuminate his own path, but to 
enable him to guide and help others in their passage over Mirza’s 
bridge, out of the darkness into the darkness; and, moreover, it is his 
duty to hand it on to his successors with added fuel, that it may be 
more bright for them than it has been for himself. His duties as a 
citizen are higher than those of non-professional men, for increase of 
knowledge brings with it not only power, but responsibility as well. 
This, no doubt, brings upon him at times special cares and anxieties: 
he will see signs of coming trouble in what to most men may appear 
to add to beauty or to be evidences of robust health and prosperity; 
he may have to take the unpleasant part of Cassandra in giving un- 
heeded warnings of evils to come. But these are but incidental and 
occasional troubles, far more than counterbalanced by the satisfaction 
derived from the interesting, continuous, useful employment and de- 
velopment of every human faculty which even now belongs to, and 
which in the near future will still more characterize, medicine as a 
career. John S. Billings.