810 



SCIENCE. 



[N. S. Vol. XVII. No. 438. 



sphygmomanometer, the various specula. 

 Here he learns when to make blood counts, 

 how to take histories, arrives at the actual 

 facts by skilful cross-questioning, notes the 

 varying symptoms and physical signs of a 

 case, determines the need for laboratory 

 investigations, all under the guidance of 

 skilled observers, who will point out his 

 errors, encourage his queries and stimulate 

 his thought. 



Moreover, trustees may overlook one im- 

 portant advantage of a teaching hospital. 

 Who will be least slovenly and careless 

 in his duties, he who prescribes in the 

 solitude of the sick chamber, and operates 

 with two or three assistants only, or he 

 whose every movement is eagerly watched 

 by hundreds of eyes, alert to detect every 

 false step, the omission of an important 

 clinical laboratory investigation, the neg- 

 lect of the careful examination of the back 

 as well as of the front of the chest, the 

 failure to detect any important physical 

 sign or symptom? Who will be most cer- 

 tain to keep up with the progress of med- 

 ical science, he who works alone with no 

 one to discover his ignorance; or he who 

 is surrounded by a lot of bright young 

 fellows who have read the last Lancet, or 

 the newest Amials of Surgery, and can 

 trip him up if he is not abreast of the 

 times ? I always feel at the Jefferson Hos- 

 pital as if I were on the run with a pack 

 of lively dogs at my heels. I can not 

 afford to have the youngsters familiar 

 with operations, means of investigation or 

 newer methods of treatment of which I am 

 ignorant. I must perforce study, read, 

 catalogue and remember; or give place to 

 others who will. Students are the best 

 whip and spur I know. 



Of the value of training graduates in 

 postgraduate work I need scarcely speak, 

 to this audience at least. The doctor who 

 graduated five, ten or fifteen years ago 



comes to our great centers of medical edu- 

 cation and renews his youth at the foun- 

 tain of knowledge. He learns the use of 

 all the new instruments, sees new methods 

 of operation, new methods of treatment, 

 new means of diagnosis, and goes home an 

 enormously better equipped man. 



The trustees should see that the staff 

 does not become fossilized by following the 

 same ancient local methods from year to 

 year, but should encourage them to visit 

 other hospitals, see other men operate, hear 

 other men discourse on the latest methods 

 of investigation, and then import into their 

 own hospitals all the good found elsewhere. 

 I learn a deal by such frequent visits to 

 the clinics of my brother surgeons, and if 

 one who has grown gray in the service can 

 thus learn, surely the younger men can do 

 so. When we are too old to learn we are 

 too old to remain on a hospital staff. 



I do not know anything which has more 

 impressed upon me the enormously rapid 

 progress which surgery is making than a 

 recent experience. I was absent from this 

 country for almost a year and a half. In 

 that time circumstances were such that I 

 saw almost no medical journals and but 

 few doctors. I have been home now eight 

 months and even with incessant work I 

 have not yet caught up, so rapid has been 

 the progress of surgery in this short time. 

 Had I been absent for five years, verily I 

 should have been a 'back number.,' and 

 never could have caught up at all. 



In his very excellent presidential address 

 before the Association of American Physi- 

 cians in 1901, Professor Welch made a plea 

 for hospitals to afford ' the requisite oppor- 

 tunities to young men who aim at the higher 

 careers in clinical medicine and surgery.' 

 He called attention to the fact that in our 

 bacteriological, pathological and anatomical 

 laboratories the opportunities, though still 

 too few, were reasonably good, and in a 



