May 22, 1903.] 



SCIENCE. 



807 



pass not unheeded by the recording angel. 



But, as I have pointed out elsewhere, 

 instead of receiving any pay, they give to 

 hospitals. The mere money value of this 

 daily gift of the profession to the poor 

 amounts to an enormous sum. The value 

 of the professional services of the staff of 

 the Jefferson Medical College Hospital, a 

 single hospital in a single city, on a mod- 

 erate basis of fees, I found was more than 

 half a million dollars annually. The mil- 

 lions upon millions of money given in that 

 most self-sacrificing form^personal service 

 — by the entire profession all over the 

 United States, and I might add with still 

 further pride, all over the world, is simply 

 incalculable. The Gideon Grays and Weel- 

 lum MacLures are not found only in Scot- 

 land or at the countryside. They are even 

 more plentiful in the slums of our great 

 cities, giving of their time, their skill, and 

 what is more, their hearts, their lives, 

 themselves to the service of humanity. 



Trustees sometimes seem to take it for 

 granted that their duties are ended when 

 they have done two things : begged or given 

 and safely invested the necessary funds, 

 and then elected the staff. To my mind, 

 their duties do not by any means end at 

 this point. They should see to it that the 

 resources of the hospital are utilized to the 

 utmost in doing the largest good. 



Let us see now how the objects of a 

 hospital, as I have stated them, can be 

 realized. The first object is the care and 

 cure of the patients. But the cure of any 

 individual patient is not the 'be all and 

 the end all' of a hospital. His cure must 

 be a means of larger vision to the doctor, 

 who will thus be better fitted to care for 

 future similar cases. Even his death, if 

 he can not be cured, should minister to 

 the increasing knowledge and skill of the 

 doctor, so that he may be able to snatch 

 future victory from the present defeat. 



The second— the training of doctors and 

 students— is frequently carried out, but 

 sometimes even objected to. There are 

 three classes of doctors who are trained 

 by a hospital: first, the staff of the hos- 

 pital itself. ■ I have lived through the 

 period of the establishment of hospitals in 

 many of the smaller cities and towns, and 

 in some cases even villages in this country, 

 for it was a rare thing in my early pro- 

 fessional life for any except the larger 

 cities to have hospitals. The moment that 

 a hospital is established with its medical 

 and surgical staff, that moment a new era 

 has dawned on the community in which the 

 hospital is established. More careful meth- 

 ods are introduced, greater cleanliness is 

 observed, hygienic conditions are bettered, 

 laboratory methods are inevitably intro- 

 duced in time. Even if the old-timers who 

 graduated years before our modern labo- 

 ratory methods were adopted do not care 

 for them or can not use them, the young 

 fellows who come fresh from our medical 

 schools and serve as residents, and even 

 the nurses graduated from our training 

 schools, finally shame the older ones into 

 better ways and greater exactness, not only 

 in the hospital, but in their private work 

 as well. 



As a consequence of the establishment 

 of these hospitals and the added skill and 

 training of the local physicians and sur- 

 geons, the character of the consultations of 

 the physicians and surgeons of our great 

 medical centers has been greatly modified. 

 The really simple cases, such as hydrocele 

 and small tumors (and even large ones), 

 clubfoot, harelip, etc., which used to be sent 

 to city consultants, are now successfully 

 operated on by the local surgeons, and only 

 the more difficult, serious or complicated 

 cases are sent to the cities. This is a great 

 advantage to the patient, whose good is the 

 first consideration, and to the local medical 



