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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.

[.Reprintedfrom The College and ClinicalRecord, November, iSqgi]

Commencement always carries me back tothe classic shades where I spent the four mostblissful and fruitful years of my life, to whichI have ever reverted as the halcyon days ofyouth. As for me thirty-four years ago, sonow for you, the joys, the trials, the studies,the achievements of your college life areor soon will be over. The world stands openbefore you. “ What shall I do?” is the ques-tion of questions to you. The decision of thisquestion may make or mar you. If you de-cide rightly, you will achieve success, honor,happiness, and the final consolation ofa life welland nobly spent. If wrongly, your decisionmay wreck, even hopelessly, a young life fullof brilliant promise. You and your fellowsin the many colleges of the land who willgraduate in this leafy June have on your sideyouth with all its potencies. You have a justand laudable ambition. You are ready towork your finger-nails off. You have trainedintellects. You are members of the true aris-tocracy of learning; men of marshaled forces,the hope of the nation, the future naturalleaders of thought in public and in privatelife. What shall you do ? “ Surely,” saysCarlyle, in his biography of John Stirling,“ the young, heroic soul, entering on life soopulent, full of sunny hope, of noble valor,and divine intention, is tragical as well asbeautiful to us.”

It is of equal importance to the communityas well as to you that you elect wisely whatpath you will follow in this busy world. Someof you will enter commercial life, lured, possi-bly, by hopes of material reward ; some maybe devoted to art, with its esthetic enjoyments;some will find in literature the contentmentand fame that come to the successful author;

some will devote their lives to the highesthuman function and service to their fellow-men—winning them to Christ-like lives andheavenly aspirations ; some will seek thenoble profession of the law, and will becomeleaders of the bar and wear the ermine on thebench; not a few, I hope, will devote your-selves to a scientific career, with, it is true, itsceaseless toil, but also its fascinating investiga-tions, its splendid discoveries, its beneficentinventions.

It is my desire to lay before you some ofthe rewards, the possibilities, the attractionsof such a scientific life, and to win you to itspursuit, since it has attractions, wonderfulattractions, from many sides and for everytype of man—excepting always the lazy. Ihave selected as my topic, therefore, “ Medi-cine as a Career for Educated Men.”

I am met at the outset by the query, “Arethere not already too many doctors?” Yes ;

far too many poor doctors, but far too fewgood ones. . Webster’s oft-quoted remark,that “ there is plenty of room at the top,” isas true ofmedicine as of any other profession.In any profession there is always a reservedseat in the front row for a Faraday, a Schlie-mann, a John Hunter, a Lister, a Virchow, aPasteur, a Gross, a Packard, a March. Andalthough no one of you may become the peerof those I have named—and yet, why shouldyou not ?—still there is always room right next

to them for the trained intellects who will maketheir profession an integral part of their lives,and devote themselves earnestly and truly toits pursuit. Never has there been such a de-mand in medicine for men of the highesttype, the deepest insight, the profoundestspirit of investigation. Never have there

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been so many questions of grave import tothe human race awaiting solution. Themighty problems of life and disease anddeath crowd upon us and await the touch ofa master hand to make the obscure clear, toavert the dire results of accident, to stay thehand 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 ifyou wish to rise above the dull level of medi-ocrity, it will be to you college men that therenown which is the proper object of a laud-able ambition will surely come. PresidentThwing, in the June Forum, states that “ Ap-pleton’s Encyclopaedia of American Biogra-phy” contains the names of 912 doctors, ofwhom 473 were college-bred men. TheMedical Record, commenting upon this fact,estimates that 300,000 men have started outin medicine in this country during thepresentcentury, and that, if so, the chance of theordinary doctor becoming famous is aboutone in three hundred ; but if he be a college-bred man, it is about one in six.

The profession, as I have said, is filled torepletion with poor men and untrained men.What we want is the men fresh from thelaboratories of the best colleges—men whoseminds are trained in logical methods, who areversed in the “ humanities,” who possessrefinement and culture, who, having eyes andears, have learned to use them. In thatdelightful book, “ The Gold-headed Cane,”Radclifife (him of the library) visits Mead inhis library and says ;

“As I have grown older,every year of my life has convinced me moreand more of the value of the education of thescholar and the gentleman to the thorough-bred physician. Perhaps your friend there(pointing to a volume of Celsus) expressesmy meaning better than I can myself, whenhe says that this discipline of the mind,‘ Quamvis non faciat medicum, aptioremtamen raedicinse reddit.’ ”

The signs of the times point to a closeraffiliation of colleges and medical schools,which will be equally advantageous to both.

Five years ago nearly all the medical schoolsin this country were two-year schools. Nownearly all have three-year courses and a fewfour, and the new Pennsylvania law requiresfour years of study, of which three shall be in amedical school. This movement in the direc-tion of a more thorough education means thatthe medical schools desire to offer a curriculumworthy to attract the best educated men.Moreover, the medical schools are endeavor-ing to adjust their courses so that they will bethe 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, theiraim is so to adjust the two that they shall belinked together as one complete whole. Thusmany of the medical schools are consideringwhat means can be adopted to draw intoaffiliation with them the colleges and collegemen in preference to others. The largerdevelopment of the Jefferson Medical College,of the medical department of Harvard Univer-sity, of the University of Michigan, of theUniversity of Pennsylvania, and of JohnsHopkins, are evidences of the same wish towin college men to a medical career. Theunion of the College of Physicians and Sur-geons with Columbia College as its medicaldepartment, and the projected absorption ofone or more of the Chicago medical schoolsby the University of Chicago, show the sametendency. Moreover, Brown University, La-fayette and other Colleges are looking equallytoward the medical schools, as I have pointedout, by the establishment of courses whichwill naturally lead up to medicine.

If any of you look forward to medicine as acareer, you should view it from three differentstandpoints. First, on its economic side.This is a matter of no little importance, forevery 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 andchildren in the future. No one should expectin medicine to make a fortune. A few doctorsdo so, but they are the exception. But everyman who enters medicine, if he will be faith-ful and honest in his work, and a fortiori the

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more intellectual college man, can be sure ofa competence—nay, more, can be sure that hewill enjoy not only the reasonable reward oftoil, but be able to lay up sufficient for his ownold age and for his family.

Secondly, a much more elevating andattractive side is the philanthropic or humani-tarian. The medicine of the future will bechiefly in the direction of that most philan-thropic object, the prevention rather than thecure of disease. Hygiene, or preventivemedicine, has only arisen since I left college.It has already done much, but it promisesfar more. If it is necessary to show that theknowledge of hygiene is still limited, look atthe recent reports on the sources of the watersupply of the city of New York. Nay, youneed 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 thelaws of health in almost every farm-house.Nay, more, you need only cross-question ahalf-dozen of your intimate friends as to theirmodes of life to discover that the laws of hy-giene are “ more honored in the breach thanthe observance.”

That there is ample room for missionarywork in the matter of personal cleanlinessalone will be evident from two recent incidentsin my clinics at St. Agnes’ and the OrthopedicHospitals. At the former, as I uncovered thefeet of a woman to examine them in conse-quence of an accident, I was startled at theircondition, and asked her when she had had abath. “ And phwhat’s that ? ” was the innocentreply. A t the latter, lastwinter, afterexaminingthe spine of a young lady of 16, the daughterof a respectable farmer, I said to the parentswith a bluntness born of indignant surprise,“ It must be a long time since your daughterhas had a bath ? ” “ Why, yes,” said her fa-ther, reflectively, “ I don’tbelieve she has beenin a tub for a year.” To which his indignantwife replied, “ Why, of course she has, John.Don’t you remember that bath she took lastsummer f” They probably agree with awitty medical friend who seriously aversthat “ everybody ought to take a bath oncea year, whether he needs it or not.”

What a fruitful field there is in hygiene bothfor scientific and benevolent teaching, as toplumbing, drainage, ventilation, clothing,food, drink, city architecture, city streets andsewage, city water supply, and the eradica-tion of all the evil influences which confrontus, 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 beensaid, “ somebody ought to be hung ”—a roughand epigrammatic way of stating what is un-doubtedly true, that in a perfectly regulatedcommunity there would be no typhoid fever.

But besides such public benevolent service,there is a personal philanthropic side of medi-cal life, to which I gladly advert. Picture toyourselves the daily life of the doctor. It hasundoubtedly its trials, many and great. Thehumdrum recital of ancient aches and painssometimes becomes irksome by repetition.The doctor has patients, upon whom he hasbestowed unremitting care and his very bestmental and physical powers, who have provedungrateful and have even become his foes.He does an immense amount of unrequitedservice. His nights are disturbed, his daysare not his own, of his family and friends hesees but little. But then, what calling doesnot have its trials ? In what life is there notfriction, which, as in mechanics, should beallied for and not permitted to become asource of irritation and annoyance ? But inspite of all these trials, the doctor’s life is sorich in its personal rewards, in its humaneservice, that it ought to be to him a daily joy.

There is to him a daily personal growth inknowledge. Every sick-room is a school-room, and every case a lesson, from which hecomes a larger man. There is a daily per-sonal growth in character, so that he shouldlie down each night a better man. There isa daily personal growth in his power to dogood, which should be at once a reward ofpast work and a stimulus to better. Thereis a daily personal growth in the friendshipsand esteems of life, which constitute one ofthe most delightful rewards of the doctor.

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What greater joy can there be in life thanto go about among his fellow men, carryingwith him, as the doctor does, an atmosphereof comfort, of hope, of courage, of health?

There come to him constantly cases inwhich disease challenges him to a contest.It says to him, as it were, “Catch me if youcan, in all my devious wanderings and un-expected disguises and there is a mentalexhilaration in following every turn in thetrail and running to earth the fleeing goblinwhich is captivating to every inquiring mind.

Look for a moment at the methods of thecareful, intelligent doctor, as he investigatessuch a case. First, he inquires into thefamily history for lurking influences of evilheredity. Next, into the personal history, notonly the physical history of the patient frombirth, but the influences of his environment,his habits, his hours of rest, his methods oflabor, his physical and mental virtues andvices. Then follows a history of his presentillness, including all his symptoms, the exanvination of his secretions and excretions, theshrewd judgment which eliminates unessen-tial and often the inaccurate or imaginativestatements from those which are real andessential. Then, too, he must not forget theinfluence of mental states; of worry, of familytrouble, of personal trials. Next he passes tothe physical examination of his patient, whenhis eye must be as keen as that of an eagle,his touch deft and delicate in estimating fize,consistency, elasticity, and other physicalconditions. He must then co-ordinate all ofthe disjointed facts with a mental acumenand logical method, which, at first laborious,becomes afterward comparatively easy if hehas been faithful and thorough in his earlierinvestigations. By these means he reaches a

diagnosis and settles definitely upon themedical or surgical treatment. Each case,then, is a study in physics, anatomy, physi-ology, pathology, psychology, chemistry,therapeutics. In the vast majority of caseshe is rewarded by seeing returning health.Sir Spencer Wells as the net result of hisfirst 1000 ovariotomies added 20,000 yearsto human life, and so far has modern surgery

surpassed even this result, that every 1000similar operations to-day add not less than30,000 years to human life. Think what onesuch life means, as the pale cheek regains itscolor, 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; theadored mother once more becomes the cen-tre of loving care of her family; the belovedchild is restored to the family circle withruddy health, rescued from the valley of theshadow of death itself. The hushed voices,the soft tread of the sick-room, have givenplace to the laughter of health, the mists ofsorrow are driven away, the anxious alarmsof disease have vanished. What, think you,can equal the joy of the physician as heviews this happy transformation ? Who isa dearer, more cherished, more welcomefriend than he? Who finds a warmer placeby the fireside and in the very hearts of hispatients? No one can adequately appreciatehis profound joy, his daily delight, his deepgratitude to the “ Giver of every good andperfect gift.” Omy friends ! it is a blessedprofession, a divine calling, with a heavenlyrecompense on earth.

But sometimes death must come. Evenhere, however, the kind and sympatheticphysician 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 inthe hour of their bitter extremity as thestrong yet tender Christian physician ? Ofteneven death makes for us our dearest, mostloving friends, who would pass through fireand water for us.

Even the dangers of medicine and surgeryare an attraction akin to those which drawthe hardy mountaineer toward the dizzyheights of the Matterhorn. And when tothese 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 whorode into the Valley ofDeath were no braver than the unsung heroes

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of Norfolk or of Hamburg. I glory in myprofession, that in such hours of peril it hasknown no cowards; the meanest soldier inits ranks has been a brave, unselfish, devotedhero, and oftentimes a faithful, gentle martyr,dying at his post of duty.

But besides the economic and the philan-thropic side, medicine has its splendidscientific aspect, which fuses with both of theothers and yet may be regarded separatelyfrom them. Let me point out some of thebest achievements and present problems ofmedicine. The present century has seenvast strides in every department of medi-cine. I will not weary you by mention-ing the immense improvements made in manyminor details, which would be more suited toa technical audience; but it is proper that Ishould allude to three brilliant discoverieswhich stand out prominently as of the firstmagnitude.

First, the discovery of anaesthetics. Thebeneficent results from this discovery are sowell known that I need only call attention tothem, and also note in passing that the threeprincipal anaesthetics, ether, chloroform, andnitrous oxide, are American either by discov-ery or by introduction into general use.

The second great achievement is the anti-septic method, by one of our cousins acrossthe sea, the justly immortal Sir Joseph Lister.While anaesthetics have been an immenseboon, especially in the domain of surgery,antiseptics have saved countless lives and un-told suffering. The method is so recent thatI have seen both its birth and its develop-ment. In our late war and for ten years afterits close every wound and every operation wasfollowed, as a matter of course, by fever andmore or less suppuration, or the formation of“matter,”which in a multitude ofcases resultedin blood-poisoning, erysipelas, hospital gan-grene, lockjaw, and a hundred other kindredevils from this Pandora’s box. Now, how-ever, we are enabled to perform any one ofthe ordinary operations, such as amputations,ligations of the great blood-vessels, the ex-tirpation of tumors, and the like, with almostabsolute safety, and this surgical security has

emboldened us to perform many operationsundreamed of even by an Astley Cooper, aNelaton, or a Pancoast.

The third great discovery of the century isthe new science of bacteriology, a child as yetin its teens. It arose when many of myyounger auditors were discarding their knick-erbockers for trousers. That minute organ-isms or germs were the cause of very manydiseases had long been suspected, but untiltwelve years ago we were not at all certainthat 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 thecause of all inflammation, but scientific in-vestigation has shown us that all suppuration,pneumonia, lockjaw, diphtheria, erysipelas,leprosy, tuberculosis, and a host of otherdiseases are due to these minute vegetablegerms. You can easily understand that onlythe first elementary facts have been ascer-tained, and by no means all of these. Hereis a whole new science awaiting patient in-vestigation and brilliant discovery. Whothat has ambition and enthusiasm is notaroused by such a prospect ?

How is it that these minute germs producetheir malign influences ? We know that theysecrete or in some way prodqce certain dele-terious poisons in the human body, but howthese 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 themeans of counteracting their harmful influ-ences. The problem how to destroy thebacteria without destroying the patient isone which we have not yet solved. Weknow that they produce infection. Weknow fairly well how to prevent their en-trance into the body in surgical cases, by thecareful antiseptic cleansing of the person ofthe patient, of the instruments, sponges,dressings, hands—everything which comes incontact with the wound. But in many in-stances cases are brought to us already in-fected. A man who has met with anyaccident has an infected wound, and if anytime has elapsed his system has become in-

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fected. We are as yet groping for methodsby which we can surely overcome such a pre-viously established infection. Here, you see,is another field for scientific activity and themost beneficent results.

We are learning how to prevent typhoidfever, tuberculosis, and other medical dis-eases, but have not even yet begun to learnhow to prevent the entrance into the systemof the bacilli of pneumonia, influenza, andother similar diseases.

The fearful ravages of cancer are familiar toall. Its cause is unknown, its cure is achievedonly by its early extirpation, and even then, Imust regretfully confess, is but rare. But with-in the last year research has seemed to showthat we are on the verge of the discovery of itscause, and if so time will give us its cure. Whoof you would not rather make such a discoverythan be the father of the Atlantic cable or thesuccessful general of a great war ? Whowould be so blessed by future millions of man-kind as the discoverer of such a boon to thewhole race ?

Again, there are certain half-discoveredfacts which already give us glimpses of un-suspected triumphs. Within the last fewyears it has been found by experiments onanimals that the germs of certain diseases,when inoculated, for instance, in a rabbit, fromthat to a second, a third, and so on, becomeintensified in their action ; whereas, if simi-larly inoculated in one monkey after anotherthey become diluted and weakened in theiraction. How or why does the virus or germbecome stronger by transmission through aseries of rabbits and weaker in its transmis-sion through monkeys ? How can we utilizethis for the benefit of humanity? Here isanother problem awaiting its Newton or itsMorse.

Again, we know that there are animals inwhich we cannot produce certain diseases.For instance, the attempt has been madescores of times to inoculate cancer into thelower animals without success. They do notsuffer from measles or scarlet fever, whoop-ing-cough or mumps. There are also dis-eases peculiar to certain animals which man

does not take. We know very well, too, thatthere are some human diseases from which cer-tain persons are exempt. For instance, somepeople have grown up from childhood, beenexposed to scarlet fever, or measles, or small-pox, and yet have not taken it. These ani-mals or people have what we call a “ naturalimmunity ”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 personcan be exposed repeatedly, even in epidemicsof smallpox, without contracting the disease.With such a striking example before us forover a century, how strange it is that it didnot suggest experiments in the same directionin other diseases.

But at last this hint has been taken, and itpromises much in the future. For instance,it has been discovered that if we inoculate ananimal with the germ of lockjaw, the mostvirulent of all bacteria, and then take thewatery part of the animal’s blood —the blood-serum —and inoculate another animal with it,the second animal may then be inoculatedwith the germ of lockjaw without becomingthe victim of the disease ; in other words, inthe second animal there has been producedan acquired immunity against the disease.Even if the lockjaw had already attacked thesecond animal, this blood-serum, it was found,would vanquish the disease. Here we cometo one of the most striking recent results ofscientific investigation. Once that it hadbeen tried sufficiently often to determine thatthis mode of conferring immunity or of arrest-ing the disease was not deleterious to theanimal, it was deemed right that the same at-tempt should be made in man to cure thisdreadful malady; and within the last three orfour years there have been recorded nearly ascore of cases iri which patients suffering fromviolent attacks of lockjaw have been curedby inoculation with the blood-serum fromsuch an animal. This immunity or cure issupposed to come from some antidote, or, asit is called, antitoxin, produced in the first

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inoculated animal and introduced into thebody of the second animal or of man withthe blood-serum. Think you that it will beno great service to humanity, no great scien-tific feat, which will fill one’s mind with a won-dering, never-ending satisfaction, and crownhis life with fame, when this problem is fullysolved ? What extraordinary results it maylead to we can as yet only guess at, but itspossibilities seem magnificent. At this verymoment Dr. Hafifkine is in India inoculatingpeople with the antitoxin of cholera, and bidsfair to succeed in his efforts to limit or pre-vent this fearful plague.

You have all heard, of course, of Koch’stuberculin. This consists of a modificationof the ptomaines or poisons produced by dielittle bacillus or germ which causes tuberculo-sis, or consumption. You know how thediscovery was prematurely announced andheralded by the newspapers, and then fell intodisuse, and has been the object both of ob-loquy and ridicule. As a matter of fact, it isstill being used in other modified forms byphysicians and surgeons, and it is not toomuch to say that we have gone a long waytoward finding the means by which withinthe next few years we shall probably cure con-sumption and all the dire effects which followfrom tuberculosis. And when I tell you thatthere is not an organ in the body which isnot affected by tuberculosis, and that it is thecause of far more suffering and more deathsthan any other disease, you will appreciatethe immense boon its cure will be.

And please note that these instances whichI have given, of lockjaw, and cholera, andconsumption, are but types of a series ofinvestigations in the antitoxins, or naturalantidotes. This opens the door to a whollynew class of remedies, furnished by our veryfoes, on which a large number of experimentsare being constantly made.

Within the last two years also another classof remedies has been introduced, especiallyin connection with a disease with which youare probably not familiar, known as myxoe-dema. You all, doubtless, are aware of whatgoitre is. Until lately it was scarcely deemed

amenable to operation, but modern surgicalmethods have so improved that severalhundreds of cases have been reported inwhich the goitre has been removed, and thepatients have nearly all recovered. But afterthese operations a curious and unexpectedresult was found. Goitre consists in the en-largement of a certain gland in the neck,called the thyroid gland. If the whole ofthis gland, either in health or disease, was re-moved, a considerable proportion of suchpatients underwent a sort of elephantinegrowth all over the body. The featuresbecame thick and clumsy, the fingers andtoes swelled to twice or thrice their or-dinary size. The mental condition, also, de-generated into a form of cretinism. Thismisfortune attending the complete removal ofthe gland led, first to a modification of theoperation, viz.: the partial instead of the totalremoval of the gland; even a little of thegland, if left, it was found wouldprevent sucha bad result. But it has done more than this.Victor Horsley, in England, suggested that incases in which, as sometimes occurs, this dis-ease, myxoedema, arose spontaneously, thethyroid gland itself might be used as its bestremedy. Accordingly, first it was used surgi-cally, The thyroid gland was removed froma sheep and transplanted under the skin orinto the abdominal cavity of the patient. Itgrew there, and so long as it remained thepatient was bettered; but experience showedthat the gland soon disappeared, and the bet-terment vanished with it. Then an extractwas prepared from the gland and used hypo-dermatically. This gave still better results;but it was suggested again that if the patientwere simply fed on the gland itself (it is oneof the sweetbreads of the body), cure mightfollow ; and within thepast year a large num-ber of cases have been reported which havebeen cured by this wholly new method oftreatment. See, then, here another fruitfulfield of research in the administration ofvarious remedies derived from particularglands or other structures in the animal body.Already such an extract from the brain hasbeen used in epilepsy, but it is too early as

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yet to say whether the result will prove to begood or not. Within a month, Vaughan, ofAnn Arbor, has also called attention to thefact that the extract of the thyroid and otherglands is fatal to bacteria. This new discov-ery may lead to the most beneficial results.

But what we do not know in bacteriologyis far, far greater than what we doknow. Thebacteria of scarlet fever, of measles, ofsmall-pox, of whooping-cough, of typhus fever,rabies, and many other diseases are as yetwholly unknown and awaiting your touch,your investigation. If you miss the chance,others will seize it.

If I were to ask any one of you whetherAnatomy, Physiology, and Chemistry arecomparatively complete sciences, I supposeyou would answer, unhesitatingly, yes. Onthe contrary, they are most incomplete. Weknow to a fair extent the gross anatomy ofthe human body, although even here there isan immense deal to be learned ; but the mi-nute anatomy is not well known, and there isscarcely an organ in the body whose physiol-ogy has been half studied. Even so commona substance as the white of an egg has thusfar defied the chemists, and the analysis of95 per cent, of the solids of the animal bodyis imperfect. Yet this is fundamental physio-logical chemistry.

When I first taught Anatomy the greatdivisions of the brain into two hemispheres,the cerebrum, the cerebellum, etc., were, ofcourse, known, but the various convolutionsof the brain surface were deemedto be simplyfortuitous 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 havedefinitely mapped out the brain, showing thatthe convolutions and fissures are not arrangedhap-hazard, but on a definite plan. A portionof the brain at the back of the head and alittle at the side of the head are fairly well-known —well enough, indeed, for the success-ful performance of extraordinary operationsin diseases and injuries of the brain. But allthe rest of the brain is as yet almost a terra in-cognita—an Africa standing expectant for its

Stanley. Here, again, is another problemseeking solution—a problem which is enoughto arouse the scientific ambition of any enthu-siastic mind.

Again, it is only within the last five yearsthat an accurate knowledge of the relation ofdiseases of the ear to diseases of the brainhas been recognized and their scientific sur-gical treatment begun. The splendid resultsalready achieved give promise that within afew years we shall know not only how to curebrain disease, the result of ear disease, but,what is far better, how to prevent it.

The anatomy of the nerves has been knownfor many years in its gross outlines, but theproblems which present themselves here are

many and varied. Cut a certain nerve, theulnar, which supplies the inner part of thehand, and the results are not the same in allpatients. You may abolish touch, and yet painwill remain. You may even, as I have seenwithin the last few weeks in several cases, cutout one to three inches of the sensitive nerveof the face, and it will be reproduced, andwith 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 maybe removed, and you want the nerve to bereproduced and so re-establish sensation inthe skin supplied by it and motion in the mus-cles to which it goes, and the nerve steadilyrefuses to reproduce itself. Why in the onecase it will and why in the other case it willnot reproduce itself we do not know. In fact,what we do 7ioi know about nerves alonewould make a good-sized book.

Thirty years ago, when we looked at an eyeall we knew was what we could see on theoutside. The trouble was that nothing couldbe seen inside the eye, although there wassuch an inviting window in front of it bywhich we could look in, because the interiorwas totally dark. But it occurred to Helm-holz that if by a little bit of looking glass hereflected light into the eye, and then scratcheda little hole in the quicksilver, he could lookthrough the hole into the illuminated interiorof the eye and see all there was inside of it.

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From this simple idea has arisen the ophthal-moscope, by which the whole medicine andsurgery of the eye have been revolutionized,and great light has also been thrown on dis-eases of the brain.

Again, when the mouth was opened, wecould see certain parts, but the whole interiorof the larynx and windpipe was beyond oursight, and, therefore, beyond our knowledge.But soon after the ophthalmoscope was dis-covered, Czermak and Turck found that if alittle mirror were held in the back of thethroat at an angle of about 450 and a ray oflight were thrown upon it from a small per-forated bit of looking glass, the interior of thethroat, like the interior of the eye, would beilluminated, and we could look through thelittle hole in the looking-glass and see the re-flected image of the vocal chords and thewhole of the larynx in the mirror.

Similar inventions await the ingenious in-vestigator of the future for the examinationof other cavities and organs of the body, andthe day is not far distant when we shall beable, I hope, to see, and thereforeto know, theinterior of the stomach as well as we do theexterior of the body. That this will illumi-nate our own minds, as well as the stomachsof our patients, is certain.

And so I might go on in one department ofmedicine after another, presenting to yousimilar problems, some of them so technicalthat they would not be suited to a non-pro-fessional audience, and in each show you thevast need there is for bright minds. Has thelast word been said in surgery, in medicine,in the diseases of any of the special organs ofthe body ? Nay, verily, we are but at thealphabet of investigation and of cure. Greatas has been • the progress in the last fifty

years, greater, I venture to say, than in allprevious time, I believe that the next fiftyyears will far eclipse the discoveries of thepast fifty. Who could have predicted therise of bacteriology a score of years ago ?

And who will venture to say that in the nexttwenty years another science, equally far-reaching, equally beneficent, equally brilliantin its achievements, may not arise? Eventhe present is a splendid time. ’Tis

“ An age on ages telling,To be living is sublime.”

But the twentieth century, in which you willlive, will be the most glorious time of all theages.

And you may take part in this grand marchof progress, not only in the rank and file, butas a leader if you will but write; or it maybe if you have the gift of imparting know-ledge you may be one of the teachers ofmedical science—an enviable post of laborand responsibility, but also of unequaledhonor and enjoyment.

Have I not put before you enough to arousethe ambition, the energy, the benevolence, theenthusiasm of any young man about to choosehis career ? Can therebe in any other depart-ment of human knowledge so fine a field forresearch, for discovery, for fame, and, what isfar better, for serving the human race ? If inconsequence of what I have said to you someof you will select medicine as your chosenpursuit, rest assured that if you will faithfullyperform your duty, at the close of life youwill have the pleasure of surveying a careerwhich has been advantageous to yourselves,has been a means of doing good to yourfellow men, and, I verily believe, has approxi-mated as near as possible to theDivine life asis given to any man to do.