THE CITIZEN-DOCTOR * 
By Clarence J. Blake, M.D., 
Professor of Otology in Harvard Medical School. 
There is no country, no assemblage of people, and no form of 
government in and under which a man can more fully follow 
the dictates of his own conscience, more adequately pursue an 
honest purpose and more confidently expect the fruition of wor- 
thy hopes, than in these United States of America, and nowhere 
does citizenship mean more, both in its privileges and its obli- 
gations, than under a government of the people, by the people 
and for the people. 
With this solemn thought the man who has maturely come 
to an appreciation of his opportunities finds himself inevitably 
fa'ce to face with the question, what can I do to serve ? and 
since each man’s duty as a citizen lies foremost in the walk of 
life which he has chosen, or which has come to him, I have 
taken the Citizen-Doctor as the subject of our talk to-day. 
“First, man; second, citizen; and then doctor, is the right 
order,” says Edward Emerson, but, with the broadening of our 
medical education, with the increasing demand for that ounce 
of prevention which is worth a pound of cure, a demand born 
of the increase in popular intelligence, the man who is a doc- 
tor finds the bounds within which he may express his citizen- 
ship enlarging, and that there is before him an ever widening 
place in the life and interests of the community; a place which 
it behooves him to be, first, a true man, second, a worthy doctor 
and wholly an earnest and grateful citizen to adequately fill. 
It is safe to say that no man enters upon, or continues in, 
the study of medicine from selfish and mercenary motives 
* Address delivered at Yale University, June 28, 1898. alone; indeed such motives are entirely incompatible with per- 
sistence in the study, or success in the practice of, this profes- 
sion. 
As an incentive to the study of medicine there is more 
required than the thirst for knowledge or the zeal for scientific 
investigation. 
The purpose of a life which leads a man to battle with his 
instinctive dreads, to fight his normal repugnance, and to pros- 
ecute one of the hardest courses of education, lies far deeper 
than any merely intellectual gratification, since it finds its roots 
in the thought of that benefit to humanity which makes the 
crowning impulse to a useful life. 
Nor should it be forgotten that the study of our human kind, 
so necessary as a foundation for the actual practice of medicine, 
contains within it a personal appeal to all that we like to know 
and regard as highest in ourselves; and that this, as an addi- 
tional incentive, looking always to broader and broader possi- 
bilities, is one of the lights which throws all that might be 
otherwise instinctively deterring and abhorent in the study of 
medicine, into the deeper shadow in which it is forgotten. 
There is probably no one of this graduating class who does 
not recall, as the two primal incentives which led him, as a 
a schoolboy, or as an undergraduate, to decide upon this as his 
life career; first, a desire to know more of the life we live, 
second, the appreciation that life itself implies a debt which 
must be paid in usefulness in living—a desire for knowledge, 
the possession of which is honor—a desire for the means of 
using that knowledge beneficially, which is service, honor in 
the one line, and service, the rendering of self to the needs of 
other selves, in the other; honor and service the two parallel 
lines, between which move quietly and steadfastly, if they are 
lived at their best, the purposes of the medical profession. 
The course which you have thus far pursued under wise and 
able teachers, while it has afforded you the means with which 
you are soon to begin, and has laid the foundation for, that 
further acquisition of knowledge with which you are to con- 
tinue your life work, has failed of its fullest purpose unless 
you have individually learned the lesson of its nobility, and 
that you enter upon this career less for what you can get out of 
it for yourselves than for what you can put into it for others. 
The very beginning of our medical studies is an acquaint- 
ance with the structure of the body, that beautiful dwelling of 
which we are tenants at the will of its Creator, a study which 
awakens at first wonder and admiration, and then, almost unconsciously, reverence, and leads inevitably to that appre- 
ciation of the moral value and moral use of the human body, 
which remains, and not only remains but grows in the life of 
every true physician; so that through wonder, admiration and 
reverence, he comes to an understanding of the privileges of 
his knowledge, and to the consciousness of the debt which he 
owes for it, and which it is his further privilege to pay in serv- 
ice to his fellow men. 
If the study of anatomy calls forth our admiration and 
reverence, the study of physiology takes us a step further 
forward in the knowledge of the wonderful adaptation of 
means to ends, of the manner in which the different organs of 
the body do their work and supplement each other, and of that 
beautiful provision for their maintenance and repair which 
bears added evidence of a definite plan in design. 
The study of the body in disease still further convinces us 
of the power which underlies these processes of repair, and of 
the fact that the dominating principle in the creation of the 
human machine looks to its persistence to useful ends. The 
part which becomes dead through disuse or abuse becomes a 
slough, is separated, thrown off, and replaced by newer tissues. 
The body which is not duly exercised, the mind which is not 
continually trained, soon lose their power, and their effective 
day is done; the moral purpose which is not kept taut in the 
straight line of its greatest effectiveness and greatest activity, 
comes to be a devious entanglement which bars the way to 
further progress. 
The training as undergraduates in medicine teaches us that 
lesson of activity, which is a necessity to success in the acqui- 
sition of further information, and, in its practical application, 
the value of that wholesomeness in ourselves which is abso- 
lutely necessary, since it must represent the standard for 
measurement, to a just estimate of unwholesome conditions in 
others; it teaches us the importance of self abnegation, because 
in all research called scientific, since science is the search 
after truth, the personal equation is always the questionable, 
and often the disturbing factor. 
Many years ago in experimenting on molecular movement 
in solids my father subjected a slab of feldspar to a contin- 
ued heat of 2400° F. for many days. When put into the crucible, 
the feldspar was opaque and grayish in color, because of the 
admixture of minute particles of metallic iron. At the end of 
the appointed heating time the furnace was allowed to cool, and 
the feldspar was found to be clear, glistening and transparent, 4 
with the metallic iron in a compact vein upon one of its smaller 
surfaces. The lesson is not far to seek. 
There is probably no line of study, other than the one you 
have chosen and pursued, which makes such absolute demand 
upon a man for the rendition of himself. The eyes which look 
into those of the physician, be the patient man, woman or 
little child, challenge him always with the question, what 
manner of man is this who has come to me in my need ? 
The sick person is always, in some measure, helpless and in 
need of help; to him the physician must be able to bring, first 
of all, the truth, that which he knows, or else the statement 
that he does not know; and, as he goes on in his practice he 
will find himself able more clearly to define his knowledge, and 
more willing to confess his ignorance; it is only the little man 
whose horizon stretches no further than the tips of his own 
fingers who is afraid to make this admission. 
And furthermore, the man in whom the weak trust, to whom 
the sinking look for help, and the sorrowful for such mede of 
consolation as the truth can bring, must, in the continued fire 
of an earnest and reverent purpose, burn out of himself and set 
aside the dross and learn to keep himself clear for the pass- 
age of that light which it is his great privilege to transmit. 
For in no work in life is the relation with the individual 
and the community so close; to no one is given so fully as to 
the physician the opportunity to study human motives and 
human needs, to guide the one, and to minister to the other; 
cognosce occasionem might well be one of the mottoes of the med- 
ical profession, and to know his opportunities, to minister to 
the body, and to the life within it, the physician needs to look 
first of all well to himself, to be sure not only of his knowledge, 
but of the purpose to which he is to use it, and of that his con- 
viction must be honest, steadfast and sincere. 
In the old days of coming of age the young Lord of the 
Manor was presented to his people amidst joyous festivities, a 
part of which included an enumeration of his various newly 
acquired titles, holdings and estates. Upon this threshold of 
your home,you stand to-day and look forth upon that of which 
you have come into possession. It is a noble heritage. No line 
of human work has been more directly inspired, none has 
found its votaries more eager, more willing to sacrifice them- 
selves, counting their individual life of little value, so that it 
helped others to live more abundantly; recking very little of 
credit, so that the work were done well. How this is being done is shown by the steady advance in our 
knowledge of the nature and of the remedy for disease, and 
still more important, our knowledge of that branch of our pro- 
fession to which we give the name Preventive Medicine, and 
which finds its foundation in the knowledge of healthy living; 
an advance, it may seem startling, but is nevertheless safe to 
say, which is paralleled within a given period of later years, 
by no other line of scientific investigation. 
In 1876, those of us who saw the International Exhibition in 
Philadelphia, said, to ourselves, the discoveries in science and 
in the adaptation of scientific knowledge to human uses has 
been such during the last twenty-five years, as illustrated here, 
as to make it impossible, apparently, that the next quarter cen- 
tury should show a similar advance; and at that very‘time there 
was, in an out of the way part of the electrical exhibit, a little 
instrument, which came very near being passed over as a toy, 
but which held in it the germ out of which should grow enor- 
mous activities in a new field of investigation. In 1878, in an 
address before the British Society of Telegraph Engineers in 
London, I ventured the prediction that the gain to science dur- 
ing the next twenty-five years from the invention of the so- 
called toy, the telephone, would far outweigh in value the com- 
mercial advantages to be derived from the use of that instru- 
ment ; and now, notwithstanding all time saving, all the contri- 
butions to our comfort and convenience, and with the long 
distance telephone service bringing more than 32,000,000 of 
people on this continent within speaking distance of each 
other, I believe the prophecy to have been fulfilled. 
Go back with me for a moment, over a period of a little more 
than thirty years in medicine, and make your own contrasts 
between the then and the now. The eye with which we see the 
infinitely little was just coming into practical use in medicine, 
and I very well remember the pride of Dr. Holmes in his first 
microscope, which he had arranged upon a wooden base with a 
handle to it, so that it could easily be put into, and taken out of 
its box, without touching the instrument, an ingenious arrange- 
ment which gave some of the colleagues of the Professor of 
Anatomy an opportunity to deride it as Dr. Holmes’ flatiron, 
with which he proposed to smooth the way in the more intimate 
study of his beloved subject. 
At that time also the opportunities accorded the student for 
the practice of midwifery and the study of diseases of women 
were so meagre in most schools in this country that it was neces- 
sary to seek the clinics of London, Edinburgh, Paris and 6 
Vienna to secure an adequate equipment in this important 
branch. 
The surgery, too, was very much the surgery of old; pus 
dressings were not uncommon, healing by first intention was 
sqmething to be unusually grateful for, and suppurative 
wounds the rule ; dropsy was frequently enumerated as a dis- 
ease, and the surgical invasion of the abdominal and cranial 
cavities was, except under certain limited conditions, regarded 
as unadvisable, if not unjustifiable. 
The one definite specialty in medical practice was ophtha- 
mology; comparatively little was known of diseases of the 
ear, and autopsies showed many cases of abscess of the brain, 
with which the suppurative disease of the ear was supposed 
to be merely coincident, or was not regarded at all. Our 
hospitals were equipped according to the fashion of a day in 
which asepsis was unknown, and in the operating room the 
knives were taken from a plush-lined case when required, and 
often the surgeon tested the edge of a catlin on his thumb. 
The nursing of the patients was entrusted to men and women 
who were supposed to have a natural aptitude for this service; 
they were expected to learn from their own observation, and 
I have vivid recollections of the experiences as a house officer 
in the first year of the Boston City Hospital in 1864, when 
such conditions as those to which I have alluded pertained. 
The patients got well, most of them; the progress toward 
health in the surgical, as well as in the medical wards, being 
often slow and tedious; and the five house officers who had that 
year of duty came out of it with an abounding admiration for 
the vis viedicatrix natures, as the three of them who are still living 
persistently attest. 
It would be very difficult for you, unless you could complete 
this mental picture, to appreciate what this thirty years of 
heritage has given you. The elaborate preparation which has 
been accorded you, puts you at graduation on a par with, and 
in some respects, in advance of, the best living practitioner of 
to-day in all but one thing, his practical experience, that super- 
imposed series of observations of individual cases which gives 
him a composite as his standard for comparison and enables 
him to draw with speed conclusions which you can at present 
accomplish only at leisure. 
In passing from the medical department of Yale University, 
you are only entering another school, one in which the studies 
do not slacken, in which the effort must be in no whit dimin- 
ished, and in which the examinations come every day in the year. They are examinations which you yourselves must proc- 
tor and adjudge, and which make, therefore, upon you the 
demand for that character, the sustaining of which is an abso- 
lute necessity to your progress in your profession. 
The school which you enter is that of the applied art, and 
there are certain rules which you can with advantage adopt in 
this your new curriculum. One is, to so regulate your thought- 
life as to keep yourselves steady to the end you have in view, 
that best end of usefulness. You cannot help others to find 
the truth unless you seek it within yourselves. You cannot 
transmit that light which falls upon you, because of your edu- 
cation, in such abundance, if you let any film of self-consider- 
ation obstruct its rays. To this end also you must be firm and 
rigorous with yourselves, though your knowledge of those physi- 
cal causes which sometimes underlie moral delinquencies may 
make you lenient to others. 
You must work strenuously and incessantly. The very 
catalogue alone of what has been accomplished in medicine in 
the last thirty years, shows you upon what sort of a race you 
have entered. 
You cannot prosper unless you transmit. You must give 
as well as receive, in order to keep your own mental currents 
healthy. 
You have no right to this heritage of the past unless you 
contribute something to it for the future, and while the physi- 
cian’s absolute first duty is to his individual patient, he must be 
a student who teaches as well as a practitioner. 
“Then is it not also true,” said Plato, “that no physician 
considers or enjoins what is for the physician’s interest, but 
that all seek the good of their patients, for we have agreed that 
a physician, so called, is a ruler of bodies and not a maker of 
money,” or, as Dr. Holmes has pithily put it in one of the watch- 
words which he has given to the profession, “ the principal 
object of the practice of medicine is the benefit of the patient.” 
Truly this, and to fulfil it we must in no way stagnate ourselves, 
we must keep pace with the advances of our times, and must 
add our contributions to the mass of information as well as our 
stimulus, through example, to other workers. 
The man who, when he graduates, says, “ I have worked 
hard for four years or more, now I will settle down and wait 
for practice,” waits. 
The waiting is apt to be the creation of that abhorrent thing, 
a vacuum. Do not wait—work. Above all things, if you can, 
get into, or into connection with, a hospital. When asked what desirable thing the Faculty of the Har- 
vard Medical School could accord the students, one of them 
replied, “ What we want more than anything else is to touch a 
patient.” 
How much of thought lies behind that earnestly expressed 
desire. How much we need to stand face to face with our 
medical problems, and how little, comparatively, the books and 
the lectures alone can teach us, is shown by the change which 
has come over medical instruction in the last few years. The 
didactic instruction has steadily diminished, and the laboratory 
and clinical instruction have steadily grown. 
In the older time, when the medical school instruction con- 
sisted of two or more courses of lectures, extending over a few 
months in the year, it was understood that the remainder of 
the time should be spent in the office of, or riding about with, 
an active general practitioner. The clinical instruction was 
thus provided. 
With the growth of scientific investigation, the incoming of 
laboratory instruction, and the consequent enlargement of the 
medical school work, this form of clinical teaching fell into the 
background, and it became necessary to substitute the material 
of the hospital, and, while this is an efficient and more abundant 
substitute, it still leaves to be desired that experience with the 
individual patient in his own surroundings, which can be 
acquired only in active practice. 
The hospital, as at present constituted, with its well organ- 
ized medical staff and its trained nurses, affords not only an 
admirable field for the consecutive study of disease, but it 
inculcates habits of order, of precision, of accuracy in observa- 
tion and of record, which are exceedingly important to the 
young man going out to make his own place in the community, 
and I would suggest, therefore, to each one of you, as a part of 
your graduate schooling, some share in hospital or district 
work, the advantage of the latter especially being that you 
come to a knowledge of ways of living in the midst of the ma- 
terial realities of life, which will tend to enlarge your horizon, 
as well as your understanding, as no other experience can. 
Remember also that it is our part to meet moral as well as 
material problems. The graduate of the Divinity School goes 
out to his life duty, wearing a cloth which marks him as one set 
apart to the good work of the world. His garment is to him a 
protection, since he stands thus avowed; he is one of a regu- 
lar caste, but this very robe is sometimes a barrier between him 
and the people he would reach. 9 
The doctor bears no such mark, his vow is a Hippocratic 
oath; his brotherhood with his fellows, none the less real, is not 
so evident. His protection lies in his unproclaimed fight for 
his own integrity, and as an individual among men, he often 
gets nearer to the inner man of his neighbor than does the cler- 
gyman. 
It behooves him, therefore, so far as in him lies, to find the 
truth and speak it. His intimate knowledge of human weak- 
ness and human motive, as well as of the basal rules of health, 
his knowledge of the thus far and no further as set forth in 
Nature’s laws, in the light of his daily experience, make it incum- 
bent upon him to live himself as an example, in order that he 
may speak and not be ashamed; and in order that this influence 
of his profession should be conserved and made to grow, he 
must live for that standard, die for it if need be, in order that 
his brethren, too, may be held worthy of their ministry. 
English is a beautifully fine and honest mother tongue, too 
honest, with its short, crisp, forcible syllables, to be lightly 
used, and the doctor who has to study the inherited and 
acquired weaknesses of mankind, to search their follies to the 
dregs, who knows too much to despise, and who must learn, 
therefore, both to pity and to teach, has need to speak firmly 
and plainly; but to earn the right to this, he must first himself 
be strong. 
Take, therefore, as greeting for your future, this four-square 
rule in your life of service—i, clean living; 2, just thinking; 3, 
hard work; and lastly, carefully weighed, straightly dealt, when 
there is need of it, as need must sometimes be, both within the 
profession and without it—English from the shoulder. 
The festivities of the coming of age are over, and the young 
Lord of the Manor, entering upon his possessions, if he be 
wise and not wasteful, if he regard his life for what he can put 
into it, and not for what he can get out of it, turns himself to 
the question of the responsibilities of his inheritance. 
You have each one of you to decide upon the course you are 
to pursue, guided thereto by natural aptitudes and inclinations, 
or by fixed and determined purpose. One man goes back into 
the country to help an older practitioner, whose still undimmed 
enthusiasm is weighted down by age; another proposes settling 
in general practice in the city; still another has it in mind to 
study the diseases of some special organ, and to devote himself 
to the limited field of practice which therewith accords; still 
another, whose substitute for the wholesome necessities of 
bread winning is an ardent studiousness, will devote himself 10 
to laboratory research, and through his investigations make the 
practical work of his colleagues easier and more fruitful. To 
each one of you there is given, out of a life experience in the 
medical profession, this advice; make that which you have 
chosen your first consideration, your sole line of expenditure 
of effort, except in so far as you bring other things to bear 
upon and to contribute to it. Be the doctor first and foremost 
or be the doctor not at all. 
You will have many temptations into other paths of useful- 
ness; the luxury of intellectual exercise in other lines will 
tempt you, but aside from such occupation as is necessary for 
relaxation, put aside diverting things. Privilege and responsi- 
bility go together. 
It is so great a privilege to be a doctor, that the man who 
holds that title truly, owes every thing that he can give to it, 
and he may be called upon to give much. 
To the man who is to settle in the country, let me say, first, 
if you can, get a hospital appointment, if you have not already 
had one, and learn at first hand not only the meeting of those 
emergencies with which you must single-handed deal, but that 
other lesson, the study of the patient as well as of the disease, 
and when you go to your country practice, keep in touch with 
your profession through your local or state societies, and read 
as broadly as you can. 
To the man who is to settle in the city, likewise, get, if pos- 
sible, a hospital appointment, attend the medical meetings, in 
which you will often get much more from the discussion than 
from the papers read, learn to measure thereby your own habit 
of thought with that of your professional brethren; do not wait, 
but work; depend, so far as you can, in justice to your patient, 
upon your own skill and judgment, as you would be obliged to 
do if you were a practitioner in a more sparsely settled dis- 
trict, rather than yield to the easy temptation of placing the 
responsibility upon your neighbor next door. 
To the specialist, I would say, remember always that, as a 
rule, the man who succeeds best as a specialist, is the man who 
would have succeeded as a general practitioner. You have 
had the privilege of special opportunities for study; you must 
show yourself worthy of them, not only by applying them, but 
by taking every opportunity which comes to you of distribut- 
ing your added knowledge among the members of the general 
profession. 
To the man in the laboratory, I would say, do not let your 
devotion to your particular subject lead you to forget that you are a member of that broad profession which brings all its 
power to center upon one object—the individual man, and upon 
one purpose—his betterment. 
And to all I would say, as you go on in your study and 
practice, one sense will grow upon you, or you yourselves will 
cease to grow, and that is, a sense of your obligation, and with 
it will grow the question as to how this obligation can be 
discharged. 
Your further contact with, and intimate study of the indi- 
vidual, leads you to a better appreciation of the needs of the 
mass, and you will find yourselves facing certain of the prob- 
lems of social and community life, with an earnest desire to 
take a hand in the furtherance of their reform or enlargement, 
which will not be satisfied until, so far as in you lies, you have 
paid this debt. 
With your devotion to your profession, the questions con- 
cerning its intellectual and moral advancement are those 
which first occur to you. Having had the best attainable 
education of your time, it is your just desire to see that the 
man who comes after you gets a better. 
The advances which are being made in medical instruction 
in this country are entirely in accord with this wish. 
Within a very few years the course of study in many of our 
medical schools has been increased to four years, simply as a 
matter of necessity, because the shorter time has been found 
insufficient to include all the studies which the present and 
growing standard of the profession demands. 
In all educational institutions fostering the growth of the 
tree of knowledge, the spreading and uplifting of its branches, 
demand more nutriment at its roots, and medical schools are 
already beginning to require a college degree as one condition 
of admission within their walls. 
The formation of alumni associations gives you the oppor- 
tunity of keeping in touch with the advancement of your own 
particular school, in order that you may promote its interests 
by the influence which as a graduate you can exert; the duty of 
the graduate in this respect is plain, and still further, by a per- 
fectly natural process, we may come to a representative associ- 
ation of the alumni of all higher grade medical schools, with 
a view to the upholding of a superior standard, and the conse- 
quent encouragement of the more highly educated practitioner. 
With the growth of clinical teaching, the hospital has be- 
come so necessary a part of the medical school, that its double 
function as an institution for the care of the patient and for the education of the practitioner, has come to be very generally 
recognized, and your interest in its welfare, in its support, its 
government and its protection to these purposes, in addition to 
the part which you may individually take in its medical and 
surgical service, is inevitable to you as a citizen. 
The hospital of to-day represents in a high degree the or- 
ganization of effective work for beneficent purposes; it deals 
with the individual, and has to consider the mass; it stimulates 
public generosity on the one hand and administers to public 
needs on the other; it is one of the links between the many who 
have and the one who has not, and who is the objective point of 
its whole existence; the directly operative instrument of all this 
concentration is the member of the medical staff of the hospi- 
tal, and behind him is the machinery which makes his helpful 
existence possible. 
With this view of the scheme of hospital existence the in- 
terdependence of the governing and operating parts is plainly 
visible, and one of the expedient duties of the medical man 
who has the privilege of a hospital appointment, is to do what 
he can to bring them into close and cordial relationship. 
As ordinarily constituted the hospital organization includes 
a board of managers and a medical staff. The board of mana- 
gers is made up, as a rule, of men in other than medical walks 
of life, business men trained to consideration of problems of in- 
vestment, of income and outgo, glad to contribute their part of 
the indebtedness of life through a channel of helpfulness to 
which they themselves have not been trained. 
Their duties require of them the acceptance of financial 
obligations which they are sometimes called upon to meet 
themselves, questions of building, equipment and administra- 
tion which they have to study to understand, and which some- 
times make heavy demands on the time of otherwise busy'men; 
their general inclination is to help the doctor to what he needs, 
to sustain and protect him in his purpose, and to make the 
practical exhibition of that purpose most readily possible. 
The member of a hospital staff finds himself in possession 
of an opportunity to indulge his helpful instincts, to satisfy his 
zeal for scientific investigation, and to learn from practical 
experience more in a year, often, than he could learn in a life- 
time of merely private practice. 
He relieves, it is true, many suffering people who could not 
pay him a fee, but in doing this he does that only which is 
obligatory upon him as a member of the medical profession, 
and, through the hospital organization, he does this duty and 13 
pays this debt with an ease which would be impossible were he 
to depend upon his own resources. 
Much has been said to the effect that the hospital with its 
board of business managers exists for the doctor, because with- 
out it the doctor could have no existence. This is only a partial 
truth; the hospital organization which has grown to its present 
elaboration from the time of the Knights Hospitalliers exists 
for the benefit of humanity at large both within and without 
its walls, and in it the managers and the medical staff have 
equal though different responsibilities and can with mutual 
advantage stand nearer together than they often do. 
One means by which this may be brought about is the estab- 
lishment in any hospital of an executive committee with mem- 
bers from both the managing and medical staffs, a committee 
meeting periodically as well as in emergencies, to consider the 
effective working of the hospital plant for its double purposes 
of medical treatment and medical education, and having, as its 
name implies, within certain variously defined limits, an exec- 
utive power. 
A committee of this kind, the channel through which the 
interchange of ideas, from different points of view, may flow, 
is capable of doing much to prevent misunderstandings which 
sometimes arise, and to economize the hospital expenditure 
both in money and in effort. 
There is one member of the medical profession who has 
come into it within the last thirty years, to whom you are 
already, or are sure to be in time, under great obligations, and 
for whom you are, in the line of inheritance, in a measure, 
responsible. 
You will find her in the hospital undergoing an arduous 
training and rendering efficient service in the dispensary dis- 
tricts and among your private patients, supplementing your 
efforts and substituting intelligent observation and trained 
manipulation for reports of condition, honeycombed with con- 
jectures, and the ministrations of unskilled hands trembling 
with a personal emotion. 
The business of caring for the sick is so serious a business, 
the margin between success and failure is often so narrow, and 
the commodity dealt with is so precious, that the best intelli- 
gence to be brought to bear upon the transaction is none too 
good, and personal feeling and personal sentiment can in no 
wise take its place. 
In those perilous waters where life is the open sea and death 
the lee shore, when the wind fails and the currents suck in 14 
toward the land, there can be but one captain to the ship, but 
he needs a good crew. 
To meet the necessity for more continued observation and 
treatment of the patient than could be given by the practi- 
tioner in his daily rounds, or than could be expected of persons 
self trained, or trained not at all, the doctor, through the 
medium of the hospital as a school, called the trained nurse 
into being as a recognized factor in our community life, and he 
is therefore responsible that she shall have her fair chance for 
an adequate education and shall be encouraged and protected 
as becomes a member of an honorable profession. 
As is the case with the medical schools in this country, the 
hospital training schools are many of them small and afford too 
little opportunity for clinical teaching, and the effort which is 
constantly needed to advance medical education is equally 
required in the nursing profession. 
The graduating doctor has the advantage over the gradu- 
ating nurse in that he is immediately brought into contact with 
his fellows through his medical societies, maintaining mean- 
while his freedom of action, while the nurse has, until very 
recently, had no such provision made for her affiliation and 
finds her only relation to the medical profession through the 
individual doctor with whom she is in service at the time. 
The recent establishment of Alumme Associations has done 
much to correct this condition of affairs for the graduate nurse, 
and to relieve her of that solitary life, which, while it fosters 
self dependence and strength of character, is not conducive to 
growth; but the Alumnae Associations afford only a partial 
remedy; like all limited bodies which furnish merely a repeti- 
tion of the same instruction, they lead to an inbreeding of 
ideas. 
The formation in sufficient centres of population of Gradu- 
ate Nurses’ Associatons, including graduates of all hospitals, 
for self educational and social purposes, with admission of its 
members to the clinics of the different hospitals, and with lim- 
ited courses of lectures on sociological and economic as well 
as on medical subjects, is one of the means by which the doctor 
can pay his debt for the splendid devotion of many of the 
women who have put their lives into this profession. 
In the preface to his “Social Evolution” Benjamin Kidd 
speaks a gladdening word which you young men will do well to 
lay to heart. 
“Nothing,” he says, “is more remarkable in this period of 
reconstruction than the change which is almost imperceptibly 15 
taking place in the minds of the rising generation respecting 
the great social and religious problem of our time. 
We have lived through a period when the very founda- 
tions of human thought have been rebuilt. To many, who in 
the first stage saw only the confusion occasioned by the moving 
of old landmarks, the time has been one of perplexity and 
changing hope. But those whose lot it has been to come later 
have already an inspiring and uplifting conception of the char- 
acter of the work which the larger knowledge is destined event- 
ually to accomplish. That the moral law is the unchanging 
law of progress in human society is the lesson which appears 
to be written over all things. No school of theology has ever 
sought to enforce this teaching with the directness and 
emphasis which it appears that evolutionary science will in the 
future be justified in doing. In the silent and strenuous rivalry 
in which every section of the race is of necessity continually 
engaged, permanent success appears to be invariably associated 
with the ethical and moral conditions favorable to the mainten- 
ance of a high standard of social efficiency, and with those con- 
ditions only.” 
Whether your opportunities be many or few, your power, 
little or great, here is a clarion call that bids each man do his 
best, for apace with the social changes, and a very part of them, 
has been the influence which the medical profession has exerted, 
oftener from individual to individual than through any public 
form of expression. 
The lesson of “ thou shall not,” which is the first course laid 
in the foundation of permissive law, the lesson of that self 
denial which is conservative of life, the lesson of that cleanli- 
ness which is absolutely necessary to all healthy living. 
To live in a community and know only the needs which 
knock upon the door, to pass festering lanes whose heavy air 
means more than bodily deterioration, to know the shame that 
walks the streets, the crime and the misfortune that fills the 
almshouse and the refuge, to look upon the last resource the 
coward knows, and then sit at ease and wait—it is impossible. 
Inasmuch as it has been given you to know these things, 
these other things you must do, “comfort and help the weak- 
hearted and raise up them that fall.” 
No walk in life affords greater opportunities for the fulfil- 
ment of this injunction than that which you have chosen, and, 
in addition to the immediate practice of your profession, you 
cannot fail to find some outlet for the desired expression of 
your citizenship in ways to which you have been trained. Every- 16 
thing which affects the health of the community, much that 
has to do with its morals, is by your right as a physician, by 
your duty as a citizen, more or less your concern. 
One of the growing reforms, through which you can work as 
a means to many good ends, and which appeals to you particu- 
larly as a physician, is that of physical education. 
The play and game instinct which Froebel so deeply studied 
and which finds its expression in the organized athletics, not 
only of our colleges, but in numberless educational institu- 
tions, clubs and societies all over the country, is one of Nature’s 
leading strings which it is wise to wisely follow, and the very 
existence of the instinct, giving a common meeting ground to 
all sorts and conditions of men, makes it a valuable field for 
the cultivation of other than merely athletic aspirations, while 
the organized physical training, as applicable in educational 
and reformatory institutions, is an important adjunct to other 
teaching, in strengthening something more than the muscles, 
and developing something more than the intellect. 
Physical training, on the gymnasium basis, which had its 
first impulse in this country from German sources in 1825, has 
so far developed within the past thirty years as to justly claim 
a place in any educational scheme looking to the production of 
the best intellectual machine. That this impulse has not been 
confined to any limited portion of the community, is shown by 
the fact that there are in the United States over one thousand 
gymnasiums for physical training and six gymnastic normal 
schools training teachers only. 
The place and duty of the doctor in relation to this branch 
of education are evident; it has been his business to learn the 
capabilities of the human body, and he, better than any other 
citizen, can guard against the abuses, and estimate the value of 
physical training in the direction of increasing the capacity for 
intellectual work and inculcating the moral principles of self 
control and of the expenditure of effort to the best results, 
which tend to make the useful man. 
In the presence of this view it is sincerely to be hoped that 
there will be in time in each of our colleges a Department of 
Civics, which shall have for its purpose the training of stu- 
dents in a knowledge of the needs of citizenship, and in which 
department physical education, either as an obligatory or elec- 
tive course, shall have a preliminary part, so that, beginning 
with the lesson that his body is worth respecting for what it is, 
and worth caring for for what he can do with it, the student 
will come to learn what, as a citizen, it is worth while to care 
to do. As the citizen-doctor you have had your preliminary educa- 
tion and your work is ready at your hand; you will find it 
incumbent upon you to stand among other things for the integ- 
rity of your own calling and to wage that steady and ceaseless 
warfare in behalf of the weak and the ignorant, against the 
charlatan and extortioner, and more strenuous and persistent 
still, against the recognized member of the medical profession 
who basely sells, either at private hand, or in the witness box, 
the honor he is not fit to bear. 
You will be called to serve your country in the field, and will 
go not only willingly but gladly; or none the less gladly, your 
service at home in the fight against demoralization and disease, 
will find its expression in Board of Health work, the medical 
inspection of schools, questions of special provision for compen- 
satory education for cripples, of the provision for the care of 
waste humanity, that fringe and tatter cf city life filling our 
public institutions, questions of food supply, water supply and 
drainage, and of the just and discriminative distribution of 
medical charity, all these, and more, are yours to consider, and 
are among your possible lines of usefulness as citizens. 
And now, gentlemen of the graduating class in medicine, 
“crescit laete,” that which you have had within your college 
walls, and which is so dear to you, you will always have, unless 
you lose it through disuse. 
You have a great service before you; you are going out, as 
each one of you realizes, to a ministry,—a ministry to which 
you cannot be equal, of which you cannot be worthy, unless 
you hold it to be, each to yourself, in your own estimation of 
it,—a priesthood.