424 BAYARD HOLMES 



Unlike the European practitioner, the American surgeon 

 found himself in a community in which there was practically 

 a single standard of life; all Americans lived well, and social 

 barriers were low, and the bond of sympathy between the 

 doctor and his patient was high ; the responsibihty of the phy- 

 sician was increased by the sympathy of the man and neighbor. 

 Each patient was a member of his family a little way removed, 

 and called upon him for the most exacting, unselfish and re- 

 sourceful assistance. In no other country is the patient's per- 

 sonality so large a factor with the physician as in America. 

 Other countries may have a more learned profession; other 

 countries may have a profession more highly remunerated or 

 more materially recognized by organized society or by the 

 government; but no country has a profession in such sympathy 

 with the people as the great body of American doctors from 

 colonial days to the present. This homogeneousness of Amer- 

 ican practice has been one of the greatest stimuli to surgical 

 adventure and achievement. 



The conditions of medical and surgical practice have been 

 until a recent time almost entirely unrestrained by legal enact- 

 ment or common law restrictions. The confidence of the peo- 

 ple in the medical profession has been so great that the greatest 

 professional liberty has been enjoyed. The courts, feehng this 

 same confidence and sympathy, have always protected the 

 adventures of surgeons, assuming the humane and benignant 

 motives which prompted them. 



The great isolation which surrounded many practitioners, 

 the unusual accidents which befell a pioneer people, and the 

 early experience of all pioneers in meeting unprecedented emer- 

 gencies with unheard-of resources, have contributed their 

 part to the achievements of Americans in this dramatic and 

 tragic art. The life of the pioneer was risky, eventful and un- 

 trammeled, and his surgeon naturally became a pioneer in his 

 art and undertook rational though drastic remedies inconceiv- 

 able to his erudite but somewhat effeminated European teacher. 



The accidental presence of the negro slave and the pecu- 

 liar relation between the planter's surgeon and his bond labor 

 encouraged a peculiar surgical art. 



The art of surgery, however, is but a single and inseparable 



